Historique de l’imagerie en médecine nucléaire

Nuclear medicine is one among the older medical imaging current modalities. Its story is closely tied to those of radioactivity (natural then artificial) and of related instrumentation. It took indeed many advantages from all progresses gained in domains as different as nuclear physics and nuclear chemistry, physics of radiation detectors, and electronics. Its recent and current developments continue to give it an important place in medical diagnosis.     

Les essais cliniques en médecine nucléaire

The EU clinical trials directive (2001/20/EC) was published on the 4th April 2001 and was transposed into French law in 2004. This new clinical trial regulation has modified considerably the research area including clinical trials conducted with radiopharmaceutical medicinal products. This new regulation aims at ensuring the protection of the health and safety of clinical trial participants, the ethical soundness and the reliability and robustness of data generated in clinical trials. In practice, the sponsor has to submit a clinical trial application to the Afssaps for authorization and to the concerned Ethics Committee for a positive opinion. The content of the clinical trial application regarding the investigational medicinal product is very detailed and a heavy technical dossier could be required in order to justify the quality of the medicinal product used in the clinical trial. Furthermore, pharmacy and radiopharmacy required specific authorizations for preparing these medicinal products. This new regulation could refrain nuclear medicine from conducting clinical trials.     

La simulation Monte Carlo en médecine nucléaire

The Monte Carlo method allows for simulating random processes by using series of pseudo-random numbers. It became an important tool in nuclear medicine to assist in the design of new medical imaging devices, optimise their use and analyse their data. Presently, the sophistication of the simulation tools allows the introduction of Monte Carlo predictions in data correction and image reconstruction processes. The availability to simulate time dependent processes opens up new horizons for Monte Carlo simulation in nuclear medicine. In a near future, these developments will allow to tackle simultaneously imaging and dosimetry issues and soon, case system Monte Carlo simulations may become part of the nuclear medicine diagnostic process. This paper describes some Monte Carlo method basics and the sampling methods that were developed for it. It gives a referenced list of different simulation software used in nuclear medicine and enumerates some of their present and prospective applications.     

Imagerie de la néoangiogenèse en médecine nucléaire

The formation of new vessels, a process referred to as neoangiogenesis, is one of the key pathophysiological mechanisms in the development and progression of cancer. It contributes to tumour growth and dissemination of neoplastic cells and can determine response or resistance to anticancer therapies. It involves different signaling pathways including the vascular endothelial growth factor (VEGF) pathway and integrins, which are also preferred targets for the development of antiangiogenic therapies. Changes in the microvasculature induced by antiangiogenic treatments occur before morphological changes can be detected with conventional imaging approaches. The development of molecular tools enabling an assessment of these targets before initiating therapy, or early detection of response or recurrence during or following treatment is essential for the close monitoring of antiangiogenic treatments. These outstanding needs call for the development of specific probes enabling the characterization of the molecules and pathways involved. This review summarizes the major signaling pathway involved in promoting tumor neoangiogenes is, the different radiotracers recently developed in preclinical and clinical settings, as well as their potential use in humans in order to improve the management of patients treated with antiangiogenic treatments.     

Psammocarcinome ovarien et médecine nucléaire

We report three cases of ovarian psammocarcinoma, which is a serous adenocarcinoma having psammoma calcifications. The FDG uptake in the psammomatous lesions is due to the tissular part of the lesion and the technetium-99m labelled agents uptake to its calcified part. Calcifications are detected on CT scans. Therefore, they are relatively simple to diagnose by nuclear medicine which is useful given relatively the better prognosis of the psammomatous ovarian serous carcinoma when compared to the serous one.     

Mise en œuvre du contrôle de qualité en médecine nucléaire

Like in many nuclear medicine centers, the AFSSAPS decision of November 25, 2008, has slightly changed our habits. The centers with medical physicist already made most of these controls, and this concept was not new for them. But what about the other centers? Sometimes, measures were made as expected, other times the manufacturers were expected to do them during the maintenance time, often nothing was formalized, and even in some cases nothing was done. Our experience in quality control in nuclear medicine is relatively recent, but we find interesting to raise some issues, including the duration for all these controls, the possible delegations, the means necessary to build them and difficulties in applying these controls.