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.     

Médecine nucléaire et imagerie multimodalités des tumeurs endocrines

Endocrine digestive tumors have various clinical presentations (familial history, hindgut, midgut or foregut origin, histological type, functionality, and evolution). Depending on their radio-isotopic and uptake characteristics, various SPECT and PET radiopharmaceuticals, especially with CT-hybrid acquisition, are accurate to precise localisation and extension. They may also help to define new prognostic factors, to complement the WHO, Grade and TNM ENETS classifications. Their place in the follow-up have yet to be evaluated.     

Structuration des liens entre médecine nucléaire et radiopharmacie

Radiopharmaceuticals are nowadays under the responsibility of the radiopharmacist because of their medicinal product status. Radiopharmacy belongs to the hospital pharmacy department, nevertheless, interactions with nuclear medicine department are important: rooms are included or located near nuclear medicine departments in order to respect radiation protection rules, more over staff, a part of the material and some activities are shared between the two departments. Consequently, it seems essential to formalize links between the radiopharmacy and the nuclear medicine department, setting the goals to avoid conflicts and to ensure patients’ security. Modalities chosen for this formalization will depend on the establishment's organization.     

Le point sur les niveaux de référence diagnostiques en médecine nucléaire en 2011

Seven years after the publication of the first diagnostic reference levels (DRL) order, the analysis of the data allows the French Institute for radiation protection and nuclear safety (IRSN) to assess and evaluate the increase of the nuclear medicine departments involvement and of the level administered activities to the patients during the most common examinations performed in France. IRSN analyses show a good agreement between the distribution of transmitted examinations and the frequency of examinations performed in France, taking into account 95% of the number of examinations and 95% of the dose delivered to patients by nuclear medicine. These analyses highlight the necessary consistency between DRL regulation, the French society of nuclear medicine (SFMN) recommendations and national practice. The IRSN recommendations established from data analyses have leaded the authorities to publish a new DRL order in January 2012. This first update of the regulation takes into account actual clinical practice in nuclear medicine and introduces fundamental points as pediatric DRL. In the future, periodical updates will be implemented in order to take into account procedures and devices evolutions.     

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.     

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.     

Apport de la médecine nucléaire dans le cancer du sein : à propos de 3 cas cliniques

Presentation of three clinical cases that illustrate the current multidisciplinary management in breast cancer, and the role of nuclear medicine in diagnostic strategies.     

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.     

Pénurie de technétium99m : des pistes pratiques pour gérer les périodes de crise dans les services de médecine nucléaire

Technetium^99m (^99mTc) shortage crisis regularly affect nuclear medicine activity and oblige the community to find solutions in order to perform most of the prescribed exams and avoid systematic substitutions by other non-nuclear medicine techniques. Firstly, some practical solutions can be set up in radiopharmacy departments such as using more than two generators together, realizing fractionated elutions, preparing radiopharmaceuticals with elutions providing from different generators… Then, it could be interesting to have a reflexion in nuclear medicine departments to convene patients the days when ^99mTc supply is sufficient, to pool some exams or to make substitutions with more available isotopes.     

Partie 3. Aspects structurels spécifiques du service de médecine nucléaire

A nuclear medicine department is made up of several sectors whose layout, governed by the level of exposure to radiation (“cold” or “hot” sectors), must necessarily take into account the constraints of preparation and distribution of radiopharmaceuticals, storage/management of contaminated waste and effluent, and the patient pathway (reception, MRP injection, image acquisition. ASN Guide No. 32 specifically specifies the rules for the design and operation of nuclear medicine departments. Without forgetting that the ASN is not the only body with requirements concerning the structuring of a service, it is sometimes complex to modulate the premises in an optimal way with all the difficulties and architectural specificities that this can cause. anticipated RIV, through its impact on the layout of the service, is a structural issue in the short/medium term.