Journal of nuclear medicine technology最新文献

Relating planar lung scintigraphic image features to bronchopulmonary anatomy is a mental task requiring specialized medical experience. This study aimed to accurately normalize spatial data to overlay patient images onto a bronchopulmonary segment atlas (BSA), enhancing image interpretation for nonexperts and enabling quantification. Methods: This study evaluates the efficacy of 3 spatial normalization techniques: naïve registration, cost function masking, and perfusion defect removal with convolutional autoencoders. Autoencoders were trained for each of 6 projection angles using a large cohort of healthy patients (n = 660). Perfusion planar population templates for each projection, with its corresponding BSA, were constructed using a random subset sample of these patients (n = 149). Synthetic perfusion defects were applied on 60 projections from 10 patients with normal perfusion, allowing a comprehensive assessment of each spatial normalization technique's performance and effect on defect size in the template space. Results: The results reveal that autoencoder preprocessing significantly outperforms the naïve method and exhibits comparable or superior performance to cost function masking, particularly in preserving defect size and minimizing registration error to the population template within the defect. Visual comparisons further support the efficacy of autoencoder preprocessing in preserving anatomic features. Conclusion: Autoencoder preprocessing is a fully automatic and reliable method for reducing distortions during spatial normalization in perfusion scintigraphy, highlighting its potential for enhancing registration accuracy in clinical practice for BSA overlay and defect quantification.

Isolated skeletal lymphoma is a rare subtype of lymphoma, and isolated mandibular involvement is extremely uncommon. We describe a case of isolated mandibular lymphoma detected on ¹⁸F-FDG PET/CT, presenting as an ¹⁸F-FDG-avid lytic expansile lesion in the left hemimandible, with no other pathologic findings in the body.

Global expansion of radiopharmaceutical therapy (RPT) and the rising need for patient-centered approaches present opportunities for innovation in the United States and New Zealand. The first part of this paper outlines in detail the Society of Nuclear Medicine and Molecular Imaging's Radiopharmaceutical Therapy Center of Excellence designation, including its tiers, criteria, and practical blueprint for establishing RPT centers. The New Zealand center is presented as a practical framework for building a center that adheres to the country's rules and regulations. In the United States, the Society of Nuclear Medicine and Molecular Imaging established a Center of Excellence designation that is awarded to centers performing RPT with the highest standards of care. The Center of Excellence program sets the framework for successfully establishing RPT centers, aiding expansion nationwide. Expansion is especially necessary in underserved and rural communities that lack access to nuclear medicine services and RPT. Although many common challenges exist that make it more difficult to expand RPT services, potential solutions can be used to overcome these challenges and successfully establish well-rounded RPT programs. Establishing RPT centers that are engrained with the Center of Excellence values is highly beneficial to patients, referring providers, and payers. With highly skilled Centers of Excellence, RPT is no longer the future of medicine; it is the present of precision health care. In New Zealand, Hawke's Bay on the North Island's east coast lacked PET/CT and radiopharmaceutical services. In 2022, the decision was made to design and construct a molecular imaging and therapy center. Embedded in this design was emphasis on patient journey, radiation safety, cultural sensitivity, future readiness, sustainability, and ensuring continuous service delivery. Like the United States, New Zealand faced a shortage of nuclear medicine technologists. Compounding this challenge was that New Zealand had only 1 radiopharmacist at the time. As a result, nuclear medicine technologists had to upskill rapidly, especially in radiopharmaceutical synthesis, to meet the demands of the service. After extensive collaboration among the physicist, planning team, and nuclear medicine staff, a consensus was reached on a design that successfully integrated all key expectations. Despite challenges, there are centers in the United States and New Zealand that have succeeded in performing RPT with the highest level of expertise in training, personnel, equipment, radiation safety, and patient management and are at the forefront of innovation with regard to RPT.

Major pharmaceutical companies are investing heavily in nuclear medicine theranostics, including mass-market television and print campaigns that highlight the precision tools we provide to physicians. The number of clinical trials has reached unprecedented levels, and the current demands and expected growth are straining the system. The complexity of what is needed is increasing, including the expertise and resources required. Companies and outside organizations see huge potential in theranostics but also note challenges to reaching its full potential. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has been at the forefront of advancing the field of theranostics through initiatives and programs that have accelerated both clinical practice and research including the creation of Centers of Excellence, establishment of a dedicated Therapy Clinical Trials Network, development of accreditation in partnership with the Intersocietal Accreditation Commission, and the planning and hosting of the annual Therapeutics Conference, recently renamed the Theranostics Conference. These efforts reflect SNMMI's vision to meet the growing demand for theranostics while also tackling challenges such as workforce development, supply shortages, and facility infrastructure-all with a focus on keeping care patient-centered. To broaden its perspective on the challenges and to develop practical solutions with broad support, the SNMMI took a bold step and invited participants from outside of the society to join the discussion. The SNMMI held a stakeholder summit on May 1-3, 2025, where more than 100 stakeholders came together to develop a path forward to ensure that the enormous potential for theranostics for patients could be realized. Herein is a synopsis of that summit.

Theranostics refers to the combination of therapy and diagnostics in a single clinical entity or approach. Theranostics is particularly adaptable to radiopharmaceutical therapy (RPT) based on the unique ability to scintigraphically image radiopharmaceuticals in vivo and thereby noninvasively measure their time-dependent activities in and among target lesions and normal organs. Theranostics with personalized RPT, based on the maximum tolerated dose to the therapy-limiting tissue or the prescribed dose to the target tissue, offers the important advantages of lower toxicity or greater efficacy compared with fixed-administered-activity RPT but requires rather time-consuming, technically challenging patient measurements and analyses. Importantly, however, the perceived obstacles to dosimetry-based RPT have been or are being largely overcome. Further, the currently available dose-response data, though still rather limited, indicate that patient-specific dosimetry may help optimize RPT by minimizing toxicity or maximizing efficacy. Additional dose-response data from prospective multicenter trials are still required to definitively establish the value of patient-specific dosimetry in RPT. Such trials will require standardization of calibration procedures, acquisition protocols, and reconstruction methods among participating institutions.

The field of theranostics is experiencing rapid growth, driven by the expanding pipeline of radiopharmaceutical therapies and increasing clinical demand. This paper provides a comprehensive overview of the current financial landscape, coding and reimbursement strategies, and long-term planning considerations required to financially support clinical theranostics programs in the United States. Emphasis is placed on accurate Current Procedural Terminology and Healthcare Common Procedure Coding System coding, engagement with stakeholders, and the importance of compliance, billing accuracy, and infrastructure investment. Key areas such as dosimetry, amino acid infusion billing, Evaluation and Management codes, and leverage of 340B pricing are explored. The paper also outlines tools and resources available to support correct coding and operational success and provides guidance for projecting a 5-y budget necessary for scaling programs to meet anticipated global market growth of and patient demand for theranostics. The goal is to equip nuclear medicine and theranostics professionals and hospital leaders with practical insights for building financially viable and sustainable theranostics programs that can meet future demand.

Theranostics-a rapidly advancing field that integrates diagnostic imaging with targeted radiotherapy-holds great promise for revolutionizing cancer care. As this paradigm expands, a major challenge to its success lies in building and sustaining a skilled workforce, particularly in radiopharmaceutical development and delivery. A critical yet underrecognized member of this workforce is the nuclear pharmacist (also referred to as a radiopharmacist). Traditionally tasked with the preparation and dispensing of radiopharmaceuticals, nuclear pharmacists are increasingly stepping into clinical roles, especially in academic and theranostic-focused centers. These professionals bring expertise in radiochemistry, pharmacology, regulatory compliance, and patient care-making them uniquely suited to support the growing complexity of theranostic therapies. This article highlights the evolution of radiopharmacy, the specialized training of clinical nuclear pharmacists, and their expanding role in patient-centered care. Emphasizing collaborative practice models and future educational pathways, we argue that integrating clinical nuclear pharmacists into theranostic teams will enhance safety, efficiency, and therapeutic outcomes in this transformative area of medicine.

The rapid expansion of radiopharmaceutical therapy, fueled by new radiopharmaceuticals approved by the Food and Drug Administration and novel theranostic approaches, has created an urgent demand for advanced training beyond foundational nuclear medicine education. To address this gap, the University of Alabama at Birmingham and the Society of Nuclear Medicine and Molecular Imaging launched the Nuclear Medicine Therapy Intensive in 2024. Designed for practicing nuclear medicine technologists and nuclear medicine advanced associates, this program integrates didactic instruction, simulation-based learning, interprofessional collaboration, and innovative capstone experiences (e.g., a nuclear medicine therapy escape room). Participants engage in activities that strengthen their knowledge in radiation safety, dosimetry, patient eligibility, communication, and clinical trial literacy while applying skills in hands-on therapy simulations. Preassessment and postassessment results from 2024 and 2025 cohorts demonstrated marked gains in knowledge and confidence, with most graduates directly working with theranostics services at their institutions. The weeklong intensive serves as a model for preparing professionals to deliver radiopharmaceutical therapies safely and effectively and with patient-centered excellence.

Theranostics, the combination of diagnostic and therapeutic nuclear medicine, has revolutionized the field by offering patient-specific, targeted treatment options. Although the concept dates back to the early use of radioiodine to treat thyroid disorders, modern theranostics encompasses a wide range of diseases and options and is becoming an integral component of precision medicine. Despite rapid advancement, significant barriers, such as geographic disparities, workforce shortages, regulatory burden, inadequate infrastructure, high costs, and low awareness, among providers and patients limit equitable patient access to theranostic services. Overcoming these barriers will require coordinated action among health care institutions, policymakers, educators, and professional societies to harmonize standards, support workforce expansion, and develop flexible, scalable models of care and training. By uniting stakeholder efforts, embracing innovation, and prioritizing equity, the field can fulfill the promise of theranostics and ensure that these therapies reach all patients.