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  1. Yeong CH, Abdullah BJ, Ng KH, Chung LY, Goh KL, Perkins AC
    Nucl Med Commun, 2013 Jul;34(7):645-51.
    PMID: 23612704 DOI: 10.1097/MNM.0b013e32836141e4
    This paper describes the use of gamma scintigraphic and magnetic resonance (MR) fusion images for improving the anatomical delineation of orally administered radiotracers used in gastrointestinal (GI) transit investigations.
  2. Yeong CH, Abdullah BJ, Ng KH, Chung LY, Goh KL, Sarji SA, et al.
    Nucl Med Commun, 2011 Dec;32(12):1256-60.
    PMID: 21934547 DOI: 10.1097/MNM.0b013e32834b3ac8
    Nuclear medicine techniques are well established for the investigation of gastrointestinal (GI) motility and transit. Ion-exchange resins radiolabelled with ⁹⁹mTc and ¹¹¹In are widely used as nonabsorbable radiopharmaceutical markers, with ¹¹¹In being preferred for whole-gut transit studies. This radionuclide, however, is not produced in many countries and may be expensive when obtained through international shipment. This study describes the use of neutron-activated ¹⁵³Sm-resin as an alternative tracer for use in GI scintigraphic investigation. A measure of 50 mg of stable samarium-152 chloride (¹⁵²SmCl₃) was incorporated into 100 mg of cation-exchange resin and irradiated in a neutron flux of 1 × 10¹³ cm⁻² s⁻¹ for 100 s to achieve an activity of 5 MBq after 66 h. Aliquots of ¹¹¹In-radiolabelled resin (5 MBq) were prepared for comparison of labelling and stability. Radiolabelling efficiencies were obtained by washing resin with distilled water, and the activity lost was measured. The radiolabelled resins were immersed in simulated gastric and intestinal fluid environments, and the retention of ¹⁵³Sm³⁺ and ¹¹¹In³⁺ was measured over a 24 h period. At 66 h after production, 91.15 ± 12.42% of ¹⁵³Sm was bound to the resin after washing in distilled water, whereas radiolabelling with ¹¹¹In achieved 99.96 ± 0.02% efficiency. Both radiolabelled resins demonstrated almost 100% stability in simulated intestinal fluid and >90% stability in artificial gastric juice over 24 h. The performance of neutron-activated ¹⁵³Sm-resin is similar to that of ¹¹¹In-resin and can be used as an alternative tracer for GI transit studies when In is not available.
  3. Ng AH, Clay D, Blackshaw PE, Bugby SL, Morgan PS, Lees JE, et al.
    Nucl Med Commun, 2015 Nov;36(11):1134-42.
    PMID: 26352214 DOI: 10.1097/MNM.0000000000000377
    To develop a method for the assessment of small field of view (SFOV) gamma cameras using a novel phantom designed to simulate the localization of sentinel nodes in the presence of a high-activity injection site.
  4. Ganatra R, Gembicki M, Nofal M
    Nucl Med Commun, 1988 Feb;9(2):131-9.
    PMID: 3386976
    The third and final meeting of a coordinated research programme on the diagnosis and management of thyroid disorders was held in Vienna from 15 to 17 December 1986. The participants were from Czechoslovakia, Egypt, Israel, Malaysia and Thailand. Each participant had studied between 500 and 1000 patients for thyroid function evaluation by performing T3, T4 and TSH radioimmunoassays. Each had also used the newly available supersensitive immunoradiometric (IRMA) assay in a group of patients to compare the efficiency of the new assay with that of the conventional assay. A microcomputer was provided to each participant for data analysis. Internal quality control was studied by establishing precision profiles and external quality control was on the basis of pooled standard sera in different ranges. Recommendation for the strategy suggested T4 RIA as the test of first choice in each category of thyroid function. IRMA TSH was suggested as a second test in borderline cases.
  5. Ng AH, Blackshaw PE, Alqahtani MS, Jambi LK, Bugby SL, Lees JE, et al.
    Nucl Med Commun, 2017 Sep;38(9):729-736.
    PMID: 28704342 DOI: 10.1097/MNM.0000000000000715
    INTRODUCTION: Hybrid imaging has proven to be a major innovation in nuclear medicine, allowing the fusion of functional information with anatomical detail. In the past, the use of hybrid imaging such as PET-CT, PET-MRI and SPECT-CT has been of great clinical benefit; however, these scanners are relatively large and bulky. We have developed and investigated the clinical application of a compact small field of view hybrid gamma camera (HGC) that is suitable for small-organ imaging at the patient bedside.

    PATIENTS AND METHODS: The HGC - consisting of a CsI(Tl) scintillation crystal coupled to an electron-multiplying charge-coupled device and an optical camera - was used in this study. Eligible patients attending the nuclear medicine clinic at Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK, were invited to take part in this study. Following the standard injection of either a Tc-labelled or I-labelled radiopharmaceutical, images of the patient were acquired using the HGC and presented in a fused optical-gamma display.

    RESULTS: There were 24 patients enrolled in the study (age range between 30 and 83 years, mean: 58.6 years), images of 18 of whom were successfully acquired. These included patients who were undergoing bone, thyroid, lacrimal drainage, DaTscan and lymphatic imaging. In general, the small field of view system was well suited to small-organ imaging. The uptake could be clearly seen in relation to the patient surface anatomy and showed particular promise for lymphatic, thyroid and lacrimal drainage studies.

    CONCLUSION: This pilot study has demonstrated the first clinical results of hybrid optical-gamma imaging in patients. The use of this system has raised new possibilities for small-organ imaging, in which the localization of radiopharmaceutical uptake can be presented in an anatomical context using optical imaging. The compact nature of the hybrid system offers the potential for bedside investigations and intraoperative use.

  6. Tan HY, Wong YH, Kasbollah A, Md Shah MN, Perkins AC, Yeong CH
    Nucl Med Commun, 2023 Apr 01;44(4):227-243.
    PMID: 36808108 DOI: 10.1097/MNM.0000000000001665
    Personalised cancer treatment is of growing importance and can be achieved via targeted radionuclide therapy. Radionuclides with theranostic properties are proving to be clinically effective and are widely used because diagnostic imaging and therapy can be accomplished using a single formulation that avoids additional procedures and unnecessary radiation burden to the patient. For diagnostic imaging, single photon emission computed tomography (SPECT) or positron emission tomography (PET) is used to obtain functional information noninvasively by detecting the gamma (γ) rays emitted from the radionuclide. For therapeutics, high linear energy transfer (LET) radiations such as alpha (α), beta (β - ) or Auger electrons are used to kill cancerous cells in close proximity, whereas sparing the normal tissues surrounding the malignant tumour cells. One of the most important factors that lead to the sustainable development of nuclear medicine is the availability of functional radiopharmaceuticals. Nuclear research reactors play a vital role in the production of medical radionuclides for incorporation into clinical radiopharmaceuticals. The disruption of medical radionuclide supplies in recent years has highlighted the importance of ongoing research reactor operation. This article reviews the current status of operational nuclear research reactors in the Asia-Pacific region that have the potential for medical radionuclide production. It also discusses the different types of nuclear research reactors, their operating power, and the effects of thermal neutron flux in producing desirable radionuclides with high specific activity for clinical applications.
  7. Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, et al.
    Nucl Med Commun, 2023 Nov 01;44(11):937-943.
    PMID: 37615527 DOI: 10.1097/MNM.0000000000001748
    PET-computed tomography (PET/CT) is a hybrid imaging technique that combines anatomical and functional information; to investigate primary cancers, stage tumours, and track treatment response in paediatric oncology patients. However, there is debate in the literature about whether PET/CT could increase the risk of cancer in children, as the machine is utilizing two types of radiation, and paediatric patients have faster cell division and longer life expectancy. Therefore, it is essential to minimize radiation exposure by justifying and optimizing PET/CT examinations and ensure an acceptable image quality. Establishing diagnostic reference levels (DRLs) is a crucial quantitative indicator and effective tool to optimize paediatric imaging procedures. This review aimed to distinguish and acknowledge variations among published DRLs for paediatric patients in PET/CT procedures. A search of relevant articles was conducted using databases, that is, Embase, Scopus, Web of Science, and Medline, using the keywords: PET-computed tomography, computed tomography, PET, radiopharmaceutical, DRL, and their synonyms. Only English and full-text articles were included, with no limitations on the publication year. After the screening, four articles were selected, and the review reveals different DRL approaches for paediatric patients undergoing PET/CT, with primary variations observed in patient selection criteria, reporting of radiation dose values, and PET/CT equipment. The study suggests that future DRL methods for paediatric patients should prioritize data collection in accordance with international guidelines to better understand PET/CT dose discrepancies while also striving to optimize radiation doses without compromising the quality of PET/CT images.
  8. Mohd Rohani MF, Zanial AZ, Suppiah S, Phay Phay K, Mohamed Aslum Khan F, Mohamad Najib FH, et al.
    Nucl Med Commun, 2021 Jan;42(1):9-20.
    PMID: 33165258 DOI: 10.1097/MNM.0000000000001306
    Skeletal whole-body scintigraphy (WBS), although widely used as a sensitive tool for detecting metastatic bone disease in oncology cases, has relatively low specificity. Indeterminate bone lesions (IBLs) detected by WBS cause a diagnostic dilemma, which hampers further management plans. In the advent of hybrid imaging, single-photon emission computed tomography/computed tomography (SPECT/CT) has been gaining popularity as a tool to improve the characterisation of IBLs detected by WBS. As yet, there has not been a systematic review to objectively evaluate the diagnostic capabilities of SPECT/CT in this area. We conducted a systematic review of relevant electronic databases up to 30 August 2020. The outcomes of interest were the reporting of SPECT/CT to identify benign and malignant IBLs and the calculation of the sensitivity and specificity of the index test, based on histopathological examination or clinical and imaging follow-up as the reference standard. After the risk of bias and eligibility assessment, 12 articles were identified and synthesised in the meta-analysis. The pooled sensitivity and specificity of SPECT/CT for diagnosing IBLs are 93.0% [95% confidence interval (CI) 0.91-0.95] and 96.0% (95% CI 0.94-0.97), respectively. There was heterogeneity of the articles due to variable imaging protocols, duration of follow-up and scoring methods for interpreting the SPECT/CT results. The heterogeneity poses a challenge for accurate interpretation of the true diagnostic capability of SPECT/CT. In conclusion, targeted SPECT/CT improves the specificity of diagnosing bone metastases, but efforts need to be made to standardise the thresholds for SPECT/CT, methodology, as well as harmonising the reporting and interpretation criteria. We also make some recommendations for future works.
  9. Vinjamuri S, Pant V, Bomanji JB, Marengo M, Zanial A, Dondi M, et al.
    Nucl Med Commun, 2024 Apr 01;45(4):263-267.
    PMID: 38247573 DOI: 10.1097/MNM.0000000000001815
    Quality Management Audits in Nuclear Medicine (QUANUM) is an initiative conceived by the International Atomic Energy Agency to enhance global standards in Nuclear Medicine practices. Acknowledging the intricate regulatory frameworks and the necessity for multidisciplinary collaboration, QUANUM has gained global acceptance, demonstrating widespread implementation and positive impacts on patient care. This manuscript critically evaluates the QUANUM program through the lens of quality improvement (QI), by employing established and validated QI tools. Our analysis identifies areas of conformance, underscores key strengths inherent to QUANUM, and pinpoints further learning opportunities for continuous enhancement. Additionally, we assert that the insights derived from scrutinizing this global project within Nuclear Medicine, have valuable implications for departments aspiring for establishing good quality management systems, thereby contributing to the improvement of patient care.
  10. Tan HY, Wong YH, Kasbollah A, Md Shah MN, Abdullah BJJ, Perkins AC, et al.
    Nucl Med Commun, 2022 Apr 01;43(4):410-422.
    PMID: 35045548 DOI: 10.1097/MNM.0000000000001529
    PURPOSE: Hepatic radioembolization is an effective minimally invasive treatment for primary and metastatic liver cancers. Yttrium-90 [90Y]-labelled resin or glass beads are typically used as the radioembolic agent for this treatment; however, these are not readily available in many countries. In this study, novel samarium-153 oxide-loaded polystyrene ([153Sm]Sm2O3-PS) microspheres were developed as a potential alternative to 90Y microspheres for hepatic radioembolization.

    METHODS: The [152Sm]Sm2O3-PS microspheres were synthesized using solid-in-oil-in-water solvent evaporation. The microspheres underwent neutron activation using a 1 MW open-pool research reactor to produce radioactive [153Sm]Sm2O3-PS microspheres via 152Sm(n,γ)153Sm reaction. Physicochemical characterization, gamma spectroscopy and in-vitro radionuclide retention efficiency were carried out to evaluate the properties and stability of the microspheres before and after neutron activation.

    RESULTS: The [153Sm]Sm2O3-PS microspheres achieved specific activity of 5.04 ± 0.52 GBq·g-1 after a 6 h neutron activation. Scanning electron microscopy and particle size analysis showed that the microspheres remained spherical with an average diameter of ~33 μm before and after neutron activation. No long half-life radionuclide and elemental impurities were found in the samples. The radionuclide retention efficiencies of the [153Sm]Sm2O3-PS microspheres at 550 h were 99.64 ± 0.07 and 98.76 ± 1.10% when tested in saline solution and human blood plasma, respectively.

    CONCLUSIONS: A neutron-activated [153Sm]Sm2O3-PS microsphere formulation was successfully developed for potential application as a theranostic agent for liver radioembolization. The microspheres achieved suitable physical properties for radioembolization and demonstrated high radionuclide retention efficiency in saline solution and human blood plasma.

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