Spotlights Newsletter - July 2015



Words from Rathan M Subramaniam, MD, PhD        
ACNM President 2015

Law of Nature:  Future of Nuclear Medicine Training and Practice

Rathan M. Subamaniam, MD, PhD, President ACNM

There is a law of nature…..  The most significant attributes to any successful field is its adaptability to the evolving environment.  All successful species (and practices), in nature, demonstrate this phenomenon through centuries.  Those who adapt, collaborate and innovate eventually go on to become extremely successful, and those who refuse to check the reality, collaborate and adapt will eventually undergo attrition and demise, slowly but surely (Read more)

ABNM & ABR Collaboration
Erin Grady, MD

As you may have heard during the SNMMI Annual Meeting in Baltimore, MD, the American Board of Nuclear Medicine (ABNM) and American Board of Radiology (ABR) are engaged in ongoing discussions exploring the benefits of closer collaboration. The proposal, which will be available for comment soon, has a few different components: (Read more)

Highlights of ACNM visit in China
Simin Dadparvar, MD

In May of 2015, I had the honor to be the first ACNM Delegate to attend the third Sino American Meeting. Along with several members of the Nuclear Medicine Resident Organization,Young professionals, and SNMMI leadership, including Drs. Peter Herschkovitz (President), Hossein Jadvar (Vice President), and Sally Schwartz (Vice President-Elect), we attended the third Sino American Conference in Shanghai, China,  on May 3-6, 2015. (Read more)  

2015 American Medical Association (AMA) Annual Meeting / House of Delegates
Hadyn Williams, MD, FACNM, FACR

American College of Nuclear Medicine Delegate to the AMA

  1. More transparent, physician-friendly Maintenance of Certification (MOC).  Call for moratorium on MOC - Referred to Committee.
  2. Requested two-year grace period for ICD-10 implementation.
  3. Reducing Gun Violence – Referred to Committee. (Read more)

ACNM Welcomes New Members

Bital Savir-Baruch, MD                                             Maywood, IL

Nandakisho Y. Khedkar, MD                                    Oak Brook, IL

Xiao-Feng Li, MD, PhD                                             Forest Hills, NY

Izzat Chalabi, MD                                                   Elkridge, MD

Jason Wachsman, MD                                             Dallas, TX

Bulin Du, MD                                                           Shenyang, China

Prof. Yaming Li, MD, PhD                                         Shenyang, China

Helen Nadel, MD                                                     Vancouver, BC, CA

Rene Baez, MD, MS                                                 Cagus, PR    

Nuclear Medicine and Molecular Imaging in Hong Kong
Hongyun June Zhu, MD, DABR®, Clinical Assistant Professor, Department of Diagnostic Radiology, Queen Mary Hospital, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
Wai-yin Ho, MBBS, MSc, FHKCR, FHKAM (Radiology), Consultant in Nuclear Medicine, Nuclear Medicine Unit, Department of Radiology, Queen Mary Hospital, Hong Kong

Nuclear Medicine Physicians in Hong Kong enjoy a large range of practices from diagnostic to therapeutic imaging and run an independent service. The training is six years with a very limited number being trained each year. The Nuclear Medicine Physicians are enjoying a protected practice. The medical council of Hong Kong gives limited registration for physicians trained from the UK and US under the umbrella of the universities and the Hospital Authority of Hong Kong (Read more).

ACNM International Committee
David Ng, MD and Saabry Osmany, MD

The ACNM International Affairs Committee (IAC) is embarking on an international membership drive.  We know that there are many members in developing countries which would like to join us, but the cost of the membership fee is too high.  Thus, IAC has introduced an international associate membership with reduced fees, but also with reduced rights and privileges to enable Nuclear Medicine physicians in developing countries to join us.  The IAC membership fee will be USD 100-200, and physicians have to be working in countries classified by the world bank as low income or low/upper middle economies to qualify. (Read more)

Neuroendocrine Tumors: A Review of CT and MRI Findings
Pareen Mehta, MD and Patrick M. Colletti, MD

Neuroendocrine tumors, including pancreatic neuroendocrine tumors and carcinoid tumors, are rare neoplasms that arise from a common precursor, the APUD cell (amine precursor uptake and decarboxylation). All neuroendocrine tumors have the ability to produce and secrete peptides and hormones, although many do not. Functional tumors, those that secrete hormones, tend to present early with small tumors due to the resulting clinical syndrome related to the excess hormone secretion. Conversely, non-functioning tumors (those without hormone secretion) tend to present later and with larger tumor size. For this reason, functional tumors can be sometime be very difficult, if not impossible, to identify on imaging due to small size. (Read more)

NET imaging with SPECT/CT
Erik Mittra, MD, PhD

While imaging of neuroendocrine tumors with somatostatin receptor agonists or antagonists for PET receives most of the attention these days, gamma camera imaging of somatostatin receptor agonists or norepinephrine analogs have been used for decades and remains the workhorse of functional imaging for these tumor types across the world. This article will summarize the role of SPECT/CT imaging for neuroendocrine tumors.  (Read more)

PET in Evaluation of Neuroendocrine Tumors
Manohar Kuruva, Twyla Bartel, Saabry Osmany

Neuroendocrine tumors (NETs) are distinctive tumors which arise from cells which have neural and hormonal origins. The most common clinically-encountered NETs are gastroenteropancreatic tumors (GEP NETs), lung carcinoids, pheochromocytoma, and medullary thyroid carcinoma.  Imaging plays a key role in the evaluation of these tumors including detection, staging, response assessment, and prognostication. (Read More)

Lutetium-177 Labelled Peptides for Therapy of Neuroendocrine Tumors
Rakesh Kumar, MBBS, PhD and Simin Dadparvar, MD

With newer developments in oncological therapies, there is a new focus on targeted therapies. These targeted therapies are aimed at various specific receptors therefore, are less toxic and more effective. Peptide receptor radionuclide therapy (PRRT) with radiolabelled somatostatin analogues is a promising new tool in the management of patients with neuroendocrine tumor (NET). Somatostatin receptors (SSTR) are overexpressed by NET. PET/CT imaging with 68Gallium-1, 4, 7, 10-tetraazacyclododecane-1, 4, 7, 10-tetraacetic acid (68Ga-DOTA) peptides is emerging as the method of choice for SSTR expressing tumors. (Read more)

Saabry Osmany, FACNM

1. Biomed Res Int. 2015;2015:917968. doi: 10.1155/2015/917968. Epub 2015 Mar 24.

Somatostatin receptor based imaging and radionuclide therapy.

Xu C et al.

This is a review article with online access and covers radionuclide imaging as well as nuclear medicine therapy. (Read more)

Announcement for Nuc Core Review Questions
Twyla Bartel DO, MBA, FACNM

ACNM is pleased to announce the completion of NucCore, review questions under the Qevlar section of IMAIOS ( the benefit of every taking radiology or nuclear medicine boards or even recertification. If you are an ACNM member, this is free, and you should have received an email directly from IMAIOS on how to access these questions. Please follow this link for further directions on how to access these and a sample case (Read more)

Answer to May 2015 Case of the Month
Twyla Bartel DO, MBA, FACNM

HISTORY: A 15 year-old female with a history of three prior embolizations of a cerebral AVM developed a persistent headache after the most recent embolization procedure.

IMAGES:  Please see images on IMAIOS website 

IMAGE FINDINGS:  Noncontrast CT: Diffuse subarachnoid hyperdensities consistent with a mixture o f subarachnoid hemorrhage and radiological contrast.  There are also hyperdensities consistent with hemorrhage in the right frontotemporal region.  Brain swelling and midline shift is also noted.    Angiography:  frontoparietal AVM with feeders from the right MCA, ACA, and posterior cerebral artery branches.  Right MCA catheterization was complicatred by rupture of the feeders/AVM nidus resulting in the bleeds.  Brain Flow Scintigraphy: Focal accumulation in the right high cerebral hemisphere.

DIAGNOSIS:  Intraoperative rupture of the right frontopareital AVM – Procedure-related brain hemorrhage.

July 2015 Case of the Month
Saabry Osmany, MD

HISTORY: A 59 year-old female presented for imaging with a history of pancreatic neuroendocrine tumor with liver metastasis.

IMAGES:  Please see images on IMAIOS website

IMAGE FINDINGS:  Images of all performed near the same timepoint.  A: Fused Ga-68 DOTATATE PET/CT;  B: Ga-68 DOTATATE PET Only; C: Fused FDG PET/CT; FDG PET Only, Image 1:  The arrows are pointing at the primary pancreatic tail tumor/mass and demonstrates some FDG activity but marked avidity for Ga-68-DOTATATE.   Image 2: The arrow is pointing at one of the hepatic metastatic lesions with central necrosis, no FDG avidity, and peripheral Ga-68 avidity.  Image 3:  Nonenhanced CT shows multiple hepatic metastases. 

DIAGNOSIS:  What is the likely cause of the different uptake pattern in the tumor for the two radiotracers utilized?

Editors and Contributors:

Simin Dadparvar, MD     Editor in chief
Twyla Bartel, DO, MBA
Patrick Colletti, MD
Erin Grady, MD
Rakesh Kumar, MD, PhD
Manohar Kuruva, MD
Pareen Mehta, MD
Erik Mittra, MD, PhD
David Ng, MD
Saabry Osmany, MD
Rathan Subramanian, MD, PhD
Hadyn Williams, MD
June Zhu, MD