Seminars in nuclear medicine
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Review
Somatostatin receptor-targeted radionuclide therapy of tumors: preclinical and clinical findings.
In preclinical studies in rats we evaluated biodistribution and therapeutic effects of different somatostatin analogs, [(111)In-DTPA]octreotide, [(90)Y-DOTA,Tyr(3)]octreotide and [(177)Lu-DOTA,Tyr(3)]octreotate, currently also being applied in clinical radionuclide therapy studies. [Tyr(3)]octreotide and [Tyr(3)]octreotate, chelated with DTPA or DOTA, both showed high affinity binding to somatostatin receptor subtype 2 (sst(2)) in vitro. The radiolabelled compounds all showed high tumor uptake in sst(2)-positive tumors in vivo in rats, the highest uptake being reached with [(177)Lu-DOTA,Tyr(3)]octreotate. In preclinical therapy studies in vivo in rats, excellent, dose dependent, tumor size responses were found, responses appeared to be dependent on tumor size at therapy start. ⋯ Minor CT-assessed tumor shrinkage (25% - 50% reduction) was noticed in 6% of 18 patients and partial remission (50% - 100% reduction, SWOG criteria) in 39%. Eleven percent of patients had tumor progression and in 44% no changes were seen. These data show that radionuclide therapy with radiolabelled somatostatin analogs, like [DOTA, Tyr(3)]octreotide and [DOTA, Tyr(3)octreotate is a most promising new treatment modality for patients who have sst(2)-positive tumors.
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Telemedicine is defined as the "delivery of health care and sharing of medical knowledge over a distance using telecommunication systems." The concept of telemedicine is not new. Beyond the use of the telephone, there were numerous attempts to develop telemedicine programs in the 1960s mostly based on interactive television. The early experience was conceptionally encouraging but suffered inadequate technology. ⋯ Telemedicine, including teleradiology, is here to stay and is changing the practice of medicine dramatically. National and international communications networks are being created that enable the sharing of information and knowledge at a distance. Technological barriers are being overcome leaving organizational, legal, financial, and special interest issues as the major impediments to the further development of telemedicine and realization of its benefits.
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Biography Historical Article
The formation and evolution of the Society of Nuclear Medicine.
The Society of Nuclear Medicine was created and constructed by persons from many branches of medicine and the physical sciences, but it originated mostly in the mind of a chemist-physicist-engineer named Norman "Jeff" Holter. Because most medical organizations seemed to care little about the use of radioactive materials for medical purposes, Holter believed a new organization was necessary for their promotion. From its origin in 1954 as the Pacific Northwest Society of Nuclear Medicine, The Society of Nuclear Medicine became a national, multidisciplinary organization in 1956. ⋯ By nurturing and embracing the Technologist Section, the Society became a robust and representative organization for all who serve nuclear medicine. From these beginnings came the vigorous Society of Nuclear Medicine of today. Jeff Holter (1914-1983) would be justifiably proud.
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The American Board of Nuclear Medicine gave its first certifying examination in 1972 to 1,096 candidates. It was established with the support of the Society of Nuclear Medicine amid considerable conflict involving the American Board of Radiology, the American Board of Internal Medicine, and the American Board of Pathology. As a result of the numerous parties involved, the initial formation of the Board was as a conjoint Board that required the approval of one of its sponsoring Boards for the acceptance of candidates for certification. ⋯ In 1985, the American Board of Nuclear Medicine was finally relieved of the burden of conjoint Board status and became one of the primary Boards of the American Board of Medical Specialties. There are presently 12 active members of the American Board of Nuclear Medicine, 40 living life members who serve the Board, and 3 deceased life members. As of this date, the Board has certified 4,236 specialists in nuclear medicine and continues to grow and thrive.
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Sedation of the pediatric patient for nuclear medicine imaging procedures requires careful planning, patient preparation, and monitoring to ensure patient safety. The American Academy of Pediatrics guidelines for the safe use of sedation recommend a systematic plan for the use of sedative agents. Elements of the plan include informed consent, a patient pre-sedation health evaluation, monitoring by a cardiopulmonary resuscitation-trained health-care practitioner, and recovery of the patient to the pre-sedation state before discharge. ⋯ Chloral hydrate used at a maximum dosage level of 100 mg/kg is a preferred sedative agent because it provides the widest margin of safety. Implementation of the guidelines provides a coordinated approach to the use of sedation for multiple procedures performed on the same day that require sedation, thus enhancing patient safety and successful completion of all procedures. Adequate resources, including personnel and equipment, are necessary for successful implementation of an adequate sedation program.