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Concept: Nuclear medicine


6-Fluoro-((18)F)-L-3,4-dihydroxyphenylalanine (FDOPA) is an amino acid analogue for positron emission tomography (PET) imaging which has been registered since 2006 in several European Union (EU) countries and by several pharmaceutical firms. Neuroendocrine tumour (NET) imaging is part of its registered indications. NET functional imaging is a very competitive niche, competitors of FDOPA being two well-established radiopharmaceuticals for scintigraphy, (123)I-metaiodobenzylguanidine (MIBG) and (111)In-pentetreotide, and even more radiopharmaceuticals for PET, including fluorodeoxyglucose (FDG) and somatostatin analogues. Nevertheless, there is no universal single photon emission computed tomography (SPECT) or PET tracer for NET imaging, at least for the moment. FDOPA, as the other PET tracers, is superior in diagnostic performance in a limited number of precise NET types which are currently medullary thyroid cancer, catecholamine-producing tumours with a low aggressiveness and well-differentiated carcinoid tumours of the midgut, and in cases of congenital hyperinsulinism. This article reports on diagnostic performance and impact on management of FDOPA according to the NET type, emphasising the results of comparative studies with other radiopharmaceuticals. By pooling the results of the published studies with a defined standard of truth, patient-based sensitivity to detect recurrent medullary thyroid cancer was 70 % [95 % confidence interval (CI) 62.1-77.6] for FDOPA vs 44 % (95 % CI 35-53.4) for FDG; patient-based sensitivity to detect phaeochromocytoma/paraganglioma was 94 % (95 % CI 91.4-97.1) for FDOPA vs 69 % (95 % CI 60.2-77.1) for (123)I-MIBG; and patient-based sensitivity to detect midgut NET was 89 % (95 % CI 80.3-95.3) for FDOPA vs 80 % (95 % CI 69.2-88.4) for somatostatin receptor scintigraphy with a larger gap in lesion-based sensitivity (97 vs 49 %). Previously unpublished FDOPA results from our team are reported in some rare NET, such as small cell prostate cancer, or in emerging indications, such as metastatic NET of unknown primary (CUP-NET) or adrenocorticotropic hormone (ACTH) ectopic production. An evidence-based strategy in NET functional imaging is as yet affected by a low number of comparative studies. Then the suggested diagnostic trees, being a consequence of the analysis of present data, could be modified, for some indications, by a wider experience mainly involving face-to-face studies comparing FDOPA and (68)Ga-labelled peptides.

Concepts: Cancer, Oncology, Nuclear medicine, Medical imaging, Positron emission tomography, Neuroimaging, Carcinoid, Single photon emission computed tomography


This study is dedicated to the environmental monitoring of radionuclides released in the course of the Fukushima nuclear accident. The activity concentrations of β(-) -emitting (90)Sr and β(-)/γ-emitting (134)Cs and (137)Cs from several hot spots in Japan were determined in soil and vegetation samples. The (90)Sr contamination levels of the samples were relatively low and did not exceed the Bq⋅g(-1) range. They were up four orders of magnitude lower than the respective (137)Cs levels. This study, therefore, experimentally confirms previous predictions indicating a low release of (90)Sr from the Fukushima reactors, due to its low volatility. The radiocesium contamination could be clearly attributed to the Fukushima nuclear accident via its activity ratio fingerprint ((134)Cs/(137)Cs). Although the correlation between (90)Sr and (137)Cs is relatively weak, the data set suggests an intrinsic coexistence of both radionuclides in the contaminations caused by the Fukushima nuclear accident. This observation is of great importance not only for remediation campaigns but also for the current food monitoring campaigns, which currently rely on the assumption that the activity concentrations of β(-)-emitting (90)Sr (which is relatively laborious to determine) is not higher than 10% of the level of γ-emitting (137)Cs (which can be measured quickly). This assumption could be confirmed for the samples investigated herein.

Concepts: Chernobyl disaster, Nuclear medicine, Concentration, Chemical equilibrium, HotSpot, Radioactive contamination, Lists of nuclear disasters and radioactive incidents, Assumption of Mary


A primary health concern among residents and evacuees in affected areas immediately after a nuclear accident is the internal exposure of the thyroid to radioiodine, particularly I-131, and subsequent thyroid cancer risk. In Japan, the natural disasters of the earthquake and tsunami in March 2011 destroyed an important function of the Fukushima Daiichi Nuclear Power Plant (F1-NPP) and a large amount of radioactive material was released to the environment. Here we report for the first time extensive measurements of the exposure to I-131 revealing I-131 activity in the thyroid of 46 out of the 62 residents and evacuees measured. The median thyroid equivalent dose was estimated to be 4.2 mSv and 3.5 mSv for children and adults, respectively, much smaller than the mean thyroid dose in the Chernobyl accident (490 mSv in evacuees). Maximum thyroid doses for children and adults were 23 mSv and 33 mSv, respectively.

Concepts: Chernobyl disaster, Nuclear medicine, Nuclear power, Radioactive contamination, Lists of nuclear disasters and radioactive incidents, Nuclear safety, Three Mile Island accident, Hanford Site


Food contamination caused by radioisotopes released from the Fukushima Dai-ichi nuclear power plant is of great public concern. The contamination risk for food items should be estimated depending on the characteristics and geographic environments of each item. However, evaluating current and future risk for food items is generally difficult because of small sample sizes, high detection limits, and insufficient survey periods. We evaluated the risk for aquatic food items exceeding a threshold of the radioactive cesium in each species and location using a statistical model. Here we show that the overall contamination risk for aquatic food items is very low. Some freshwater biota, however, are still highly contaminated, particularly in Fukushima. Highly contaminated fish generally tend to have large body size and high trophic levels.

Concepts: Sample size, Chernobyl disaster, Nuclear medicine, Nuclear fission, Isotope, Coal, Nuclear power, Radioactive contamination


In an unprecedented food monitoring campaign for radionuclides, the Japanese government took action to secure food safety after the Fukushima nuclear accident (11 March 2011). In this paper we analyze a part of the immense data set, in particular radiocesium contaminations in food from the first year after the accident. Activity concentrations in vegetables peaked immediately after the campaign had commenced, but they decreased quickly, so that by early summer 2011 only few samples exceeded the regulatory limits. Later, accumulating mushrooms and dried produce led to several exceedances of the limits again. Monitoring of meat started with significant delay, especially outside Fukushima prefecture. After a buildup period, contamination levels of meat peaked by July 2011 (beef). Levels then decreased quickly, but peaked again in September 2011, which was primarily due to boar meat (a known accumulator of radiocesium). Pre-Fukushima 137Cs and 90Sr levels (resulting from atmospheric nuclear explosions) in food were typically lower than 0.5 Bq/kg, whereby meat was typically higher in 137Cs, and vegetarian produce was usually higher in 90Sr. The correlation of background radiostrontium and radiocesium indicated that the regulatory assumption after the Fukushima accident of a maximum activity of 90Sr being 10% of the respective 137Cs concentrations may soon be at risk, as the 90Sr/137Cs ratio increases with time. This should be taken into account for the current Japanese food policy as the current regulation will soon underestimate the 90Sr content of Japanese foods.

Concepts: Nuclear medicine, Food, Japan, Radioactive contamination, Prefectures of Japan, Government of Japan, Honshū, Cabinet of Japan


Radioactive iodine is a crucial tool for treatment of differentiated thyroid cancer (DTC). In 5% of cases, DTCs lose I-131 avidity and assume an aggressive behaviour. Treatment options for iodine-refractory DTC are limited. We report the experience of off-label use of the tyrosine kinase inhibitor sorafenib for treatment of advanced iodine-refractory DTC.

Concepts: Chernobyl disaster, Nuclear medicine, Isotopes of iodine, Radiation therapy, Protein kinase, Thyroid, Thyroglobulin, Iodine-129


Positron emission tomography (PET) of brain amyloid β is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. To provide guidance to dementia care practitioners, patients, and caregivers, the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be used appropriately. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. Although empirical evidence of impact on clinical outcomes is not yet available, a set of specific appropriate use criteria (AUC) were agreed on that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient-centered outcomes.

Concepts: Alzheimer's disease, Medicine, Nuclear medicine, Medical imaging, Positron emission tomography, Positron, Ethics, Morality


The availability of (99m)Tc for single-photon imaging in diagnostic nuclear medicine is crucial, and current availability is based on the (99)Mo/(99m)Tc generator fabricated from fission-based molybdenum (F (99)Mo) produced using high enriched uranium (HEU) targets. Because of risks related to nuclear material proliferation, the use of HEU targets is being phased out and alternative strategies for production of both (99)Mo and (99m)Tc are being evaluated intensely. There are evidently no plans for replacement of the limited number of reactors that have primarily provided most of the (99)Mo. The uninterrupted, dependable availability of (99m)Tc is a crucial issue. For these reasons, new options being pursued include both reactor- and accelerator-based strategies to sustain the continued availability of (99m)Tc without the use of HEU. In this paper, the scientific and economic issues for transitioning from HEU to non-HEU are also discussed. In addition, the comparative advantages, disadvantages, technical challenges, present status, future prospects, security concerns, economic viability, and regulatory obstacles are reviewed. The international actions in progress toward evolving possible alternative strategies to produce (99)Mo or (99m)Tc are analyzed as well. The breadth of technologies and new strategies under development to provide (99)Mo and (99m)Tc reflects both the broad interest in and the importance of the pivotal role of (99m)Tc in diagnostic nuclear medicine.

Concepts: Nuclear medicine, Uranium, Nuclear weapon, Nuclear power, Nuclear proliferation, Depleted uranium, Enriched uranium, Light water reactor


The objective of this study is to quantify the relative amounts of exchangeable organically bound tritium (OBT) and non-exchangeable OBT in various vegetables. A garden plot at Perch Lake, where tritium levels are slightly elevated due to releases of tritium from a nearby nuclear waste management area and Chalk River Laboratories (CRL) operations, was used to cultivate a variety of vegetables. Five different kinds of vegetables (lettuce, cabbage, tomato, radish and beet) were studied. Exchangeable OBT behaves like tritium in tissue free water in living organisms and, based on past measurements, accounts for about 20% of the total tritium in dehydrated organic materials. In this study, the percentage of the exchangeable OBT was determined to range from 20% to 57% and was found to depend on the type of vegetables as well as the sequence of the plants exposure to HTO.

Concepts: Organism, Plant, Nuclear medicine, Annual plant, Fruit, Waste, Tritium, Root vegetable


Background: There is a concern regarding the use of iodinated contrast agents (ICA) for chest and neck computed tomography (CT) to localize metastatases in patients with differentiated thyroid cancer (DTC). This is because the iodine in ICA can compete with (131)I and interfere with subsequent whole scans or radioactive iodine treatment. The required period for patients to eliminate the excess iodine is not clear. Therefore, knowing the period for iodine levels to return to baseline after the injection of ICA would permit a more reliable indication of CT for DTC patients. The most widely used marker to assess the plasmatic iodine pool is the urinary iodine (UI) concentration, which can be collected over a period of 24 hours (24U) or as a single-spot urinary sample (sU). As 24U collections are more difficult to perform, sU samples are preferable. It has not been established, however, if the measurement of iodine in sU is accurate for situations of excess iodine. Methods: We evaluated 25 patients with DTC who received ICA to perform chest or neck CT. They collected 24U and sU urinary samples before the CT scan and 1 week and 1, 2, and 3 months after the test. UI was quantified by a semiautomated colorimetric method. Results: Baseline median UI levels were 21.8 μg/dL for 24U and 26 μg/dL for sU. One week after ICA, UI median levels were very high for all patients, 800 μg/dL. One month after ICA, however, UI median levels returned to baseline in all patients, 19.0 μg/dL for 24U and 20 μg/dL for sU. Although the values of median UI obtained from sU and 24U samples were signicantly different, we observed a significant correlation between samples collected in 24U and sU in all evaluated periods. Conclusion: One month is required for UI to return to its baseline value after the use of ICA and for patients (after total thyroidectomy and radioiodine therapy) to eliminate the excess of iodine. In addition, sU samples, although not statistically similar to 24U values, can be used as a good marker to evaluate patients suspected of contamination with iodine.

Concepts: Chernobyl disaster, Nuclear medicine, Isotopes of iodine, Medical imaging, Radiography, Iodine, Iodine-131, Iodine-129