A. I. Santos

Assessment of salivary gland function in Sjögren's syndrome: The role of salivary gland scintigraphy

Salivary gland scintigraphy (SGS) is a non invasive method of salivary gland function assessment. This technique is easy to perform, reproducible and well tolerated by patients. Additionally, an abnormal salivary gland scintigraphy result is accepted by the American-European consensus group as a criterion for the diagnosis of Sjögrens syndrome. Scintigraphic evaluation of salivary gland function also plays an important role in therapeutic decision and patient follow-up. Schalls categorical classification is usually considered the standard method for salivary scintigraphy interpretation, though subjective and with limited capacity to discriminate borderline results. In order to improve the diagnostic accuracy of SGS, there has been an increasing interest in the quantification of glandular function. However, the debate on the most reliable and suitable parameters for the diagnosis of SS persists.

Estimation of the collective dose in the Portuguese population due to medical procedures in 2010

In a wide range of medical fields, technological advancements have led to an increase in the average collective dose in national populations worldwide. Periodic estimations of the average collective population dose due to medical exposure is, therefore of utmost importance, and is now mandatory in countries within the European Union (article 12 of EURATOM directive 97/43). Presented in this work is a report on the estimation of the collective dose in the Portuguese population due to nuclear medicine diagnostic procedures and the Top 20 diagnostic radiology examinations, which represent the 20 exams that contribute the most to the total collective dose in diagnostic radiology and interventional procedures in Europe. This work involved the collaboration of a multidisciplinary taskforce comprising representatives of all major Portuguese stakeholders (universities, research institutions, public and private healthcare providers, administrative services of the National Healthcare System, scientific and professional associations and private service providers). This allowed us to gather a comprehensive amount of data necessary for a robust estimation of the collective effective dose to the Portuguese population. The methodology used for data collection and dose estimation was based on European Commission recommendations, as this work was performed in the framework of the European wide Dose Datamed II project. This is the first study estimating the collective dose for the population in Portugal, considering such a wide national coverage and range of procedures and consisting of important baseline reference data. The taskforce intends to continue developing periodic collective dose estimations in the future. The estimated annual average effective dose for the Portuguese population was of 0.080±0.017 mSv caput(-1) for nuclear medicine exams and of 0.96±0.68 mSv caput(-1) for the Top 20 diagnostic radiology exams.

Study of nuclear medicine practices in Portugal from an internal dosimetry perspective

Nuclear medicine practices involve the handling of a wide range of pharmaceuticals labelled with different radionuclides, for diagnostic and therapeutic purposes. This work intends to evaluate the potential risks of internal contamination of nuclear medicine staff in several Portuguese nuclear medicine services and to conclude about the requirement of a routine internal monitoring. A methodology proposed by the International Atomic Energy Agency (IAEA), providing a set of criteria to determine the need, or not, for an internal monitoring programme, was applied. The evaluation of the risk of internal contaminations in a given set of working conditions is based on the type and amount of radionuclides being handled, as well as the safety conditions with which they are manipulated. The application of the IAEA criteria showed that 73.1% of all the workers included in this study should be integrated in a routine monitoring programme for internal contaminations; more specifically, 100% of workers performing radioimmunoassay techniques should be monitored. This study suggests that a routine monitoring programme for internal exposures should be implemented in Portugal for most nuclear medicine workers.

An overview of the Clear-PEM breast imaging scanner

We present an overview of the Clear-PEM breast imaging scanner. Clear-PEM is a unique dual-head Positron Emission Mammography scanner using APD-based detector modules that are capable of measuring depth-of-interaction (DOI) with a resolution of 2 mm in 20 mm long LYSO:Ce crystals. Such capability leads to an image spatial resolution of 1.2 mm and a high efficiency, foreseeing the detection of 3 mm breast lesions in less than 7 minutes exams. The full system comprises 192 detector modules in a total of 6144 LYSO:Ce crystals and 384 32-pixel APD arrays readout by ASICs with 192 input channels that represents an unprecedented level of integration in PET systems. Throughout the project and besides the detector module, we had developed dedicated Frontend and Data Acquisition electronics, the mechanical design and construction of the detector heads and the robotic gantry, as well as all the software that include calibration (energy, time and DOI), normalization and image reconstruction algorithms. In this work we will discuss the developments and present the commissioning results of the detector before the beginning of the clinical trials program, scheduled for the end of the present year.

Characterization of the Clear-PEM breast imaging scanner performance

We present results on the characterization of the Clear-PEM breast imaging scanner. Clear-PEM is a dual-head Positron Emission Mammography scanner using APD-based detector modules that are capable of measuring depth-of-interaction (DOI) with a resolution of 2 mm in LYSO:Ce crystals. The full system comprises 192 detector modules in a total of 6144 LYSO:Ce crystals and 384 32-pixel APD arrays readout by ASICs with 192 input channels, which represents an unprecedented level of integration in APD-based PET systems. The system includes Frontend and Data Acquisition electronics and a robotic gantry for detector placement and rotation. The software implements calibration (energy, time and DOI), normalization and image reconstruction algorithms. In this work, the scanner main technical characteristics, calibration strategies and the spectrometric performance in a clinical environment are presented. Images obtained with point sources and extended uniform sources are also presented. The first commissioning results show 99.7% active channels. After calibration, the dispersion of the channels absolute gain is 15.3%, which demonstrate that despite the large number of channels the system is rather uniform. The mean energy resolution at 511 keV is 15.9% for all channels, and the mean DOI constant is 5.9%/mm, which is consistent with a 2 mm DOI resolution, or better. The coincidence time resolution at 511 keV, for a energy window between 400 and 600 keV, is 5.2 ns FWHM. The image resolution measured with point sources was found to be of the order of 1.3 mm FWHM. The DOI capability was found to have a strong impact on the image sharpness. Images of extended uniform 68Ge sources, corrected for sensitivity and for the artifacts due detector dead spaces, have good uniformity. First clinical breast images are presented.

First experimental results with the Clear-PEM detector

First experimental results of the imaging system Clear-PEM for positron emission mammography, under development within the framework of the Crystal Clear Collaboration at CERN, are presented. The quality control procedures of crystal pixels, APD arrays and assembled detector modules are described. The detector module performance was characterized in detail. Results on measurements of light yield, energy resolution, depth-of-interaction and inter-channel cross-talk are discussed. The status of the development of the front-end electronics and of the data acquisition boards is reported.

High-speed Data Acquisition Electronics for a PEM scanner

Positron Emission based mammography systems are expected to constitute a significant breakthrough in the early diagnosis of breast cancer. This may lead to a significant enlargement in the horizon of women life, since breast cancer is considered to be among the most deadly types. With this purpose, a consortium has been built to develop a mammography PET system in the framework of the Clear-PEM Collaboration. The Clear-PEM scanner is a unique Positron Emission Mammography (PEM) scanner using APD-based detectors. It is capable of measuring Depth-of-Interaction (DoI) with a resolution of 2 mm in LYSO:Ce crystals, enabling a spatial resolution of 1.2 mm. An important part of the PEM scanner is a high-speed DAE (Data Acquisition Electronics) system. DAE has been developed to process and acquire data coming from the 12,288 front-end (FE) photo-detector channels. In this paper, an overview of this scanner (system and board-level electronics, mechanical design, service and image reconstruction software) is presented, focusing on the specification and implementation of the DAE which is responsible for real-time retrieving, analyzing, filtering and formatting the data coming from the front-end. The objective is to identify relevant data and after conditioning, according to pre-defined protocols, send the data to an acquisition PC for image reconstruction. Communication between DAE and PC is carried out using the S-Link (proprietary of CERN) protocol. Experimental results of validation and test of the DAE system are presented.

Assessment of the Absorbed Dose in the Kidney of Nuclear Nephrology Paediatric Patients using ICRP Biokinetic Data and Monte Carlo Simulations with Mass-Scaled Paediatric Voxel Phantoms.

The aim of this work is to use Monte Carlo simulations and VOXEL phantoms to estimate the absorbed dose in paediatric patients (aged from 2 weeks to 16 y), with normal renal function, to whom technetium-99m-dimercaptosuccinic acid (99mTc-DMSA) was administered, for diagnostic renal scintigraphy purposes; and compare them with values obtained using the International Commission on Radiological Protection (ICRP) methodology. In the ICRP methodology, the cumulated absorbed dose in the kidneys is estimated by multiplying the administered activity with the corresponding given dose coefficients. The other methods were based on Monte Carlo simulations performed on two paediatric voxel phantoms (CHILD and BABY), and another three phantoms, which were modified to suit the mass of the patients kidneys, and other anatomical factors. Different S-values were estimated using this methodology, which together with solving the ICRP biokinetic model to determine the cumulated activities, allowed for the estimation of absorbed doses different from those obtained with the ICRP method, together with new dose coefficients. The obtained values were then compared. The deviations suggest that the S-values are strongly dependent on the patients total body weight, which could be in contrast with the ICRP data, which is provided by age, regardless of other anatomical parameters.

Estimation of the collective ionizing dose in the Portuguese population for the years 2011 and 2012, due to nuclear medicine exams

OBJECTIVESnIn 2009-2010 a Portuguese consortium was created to implement the methodologies proposed by the Dose Datamed II (DDM2) project, aiming to collect data from diagnostic X-ray and nuclear medicine (NM) procedures, in order to determine the most frequently prescribed exams and the associated ionizing radiation doses for the Portuguese population. The current study is the continuation of this work, although it focuses only on NM exams for the years 2011 and 2012.nnnMATERIAL AND METHODSnThe annual frequency of each of the 28 selected NM exams and the average administered activity per procedure was obtained by means of a nationwide survey sent to the 35 NM centres in Portugal.nnnRESULTSnThe results show a reduction of the number of cardiac exams performed in the last two years compared with 2010, leading to a reduction of the annual average effective dose of Portuguese population due to NM exams from 0.08 mSv ± 0.017 mSv/caput to 0.059 ± 0.011 mSv/caput in 2011 and 0.054 ± 0.011 mSv/caput in 2012. Portuguese total annual average collective effective dose due to medical procedures was estimated to be 625.6 ± 110.9 manSv in 2011 and 565.1 ± 117.3 manSv in 2012, a reduction in comparison with 2010 (840.3 ± 183.8 manSv).nnnCONCLUSIONSnThe most frequent exams and the ones that contributed the most for total population dose were the cardiac and bone exams, although a decrease observed in 2011 and in 2012 was verified. The authors intend to perform this study periodically to identify trends in the annual Portuguese average effective dose and to help to raise awareness about the potential dose optimization.