Nuclear medicine is a branch of medicine and medical imaging that uses unsealed radioactive substances in diagnosis and therapy. These substances consist of radionuclides, or pharmaceuticals that have been labeled with radionuclides (radiopharmaceuticals). In diagnosis, radioactive substances are administered to patients and the radiation emitted is measured. The majority of these diagnostic tests involve the formation of an image using a gamma camera. Imaging may also be referred to as radionuclide imaging or nuclear scintigraphy. Other diagnostic tests use probes to acquire measurements from parts of the body, or counters for the measurement of samples taken from the patient. In therapy, radionuclides are administered to treat disease or provide palliative pain relief. For example, administration of iodine-131 is often used for the treatment of thyrotoxicosis and thyroid cancer.

Nuclear medicine imaging tests differ from most other imaging modalities in that the tests primarily show the physiological function of the system being investigated as opposed to the anatomy. In some centres, the nuclear medicine images can be superimposed on images from modalities such as CT or MRI to highlight which part of the body the radiopharmaceutical is concentrated in. This practice is often referred to as image fusion.

Nuclear medicine diagnostic tests are usually provided by a dedicated department within a hospital and may include facilities for the preparation of radiopharmaceuticals. The specific name of a department can vary from hospital to hospital, with the most common names being the nuclear medicine department and the radioisotope department.

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Permanent Nuclear Medicine Job in Northern Michigan Michigan with Medical Placement and Search International
MICHIGAN, Northern Michigan Easy Living - Women's Imager OR Neuro Radiologist OR Nuclear Medicine Lucrative Northern Michigan to $600K Private Group in Northern Michigan with state-of-the-art equipment
Permanent Nuclear Medicine Job in Statewide Pennsylvania with The Doctor Job
Looking for a job in a big city? Even if you've heard that a market is "saturated", wecan help! Many job openings for physicians may be hidden and unavailable unless you knowwhere to
Permanent Nuclear Medicine Job in Statewide Virginia with The Doctor Job
Looking for a job in a big city? Even if you've heard that a market is "saturated", we can help! Many job openings for physicians may be hidden and unavailable unless you know where to look. An excellent

pubmed: 0161-5505

From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors.
Wahl RL, Jacene H, Kasamon Y, Lodge MA Related Articles From RECIST to PERCIST: Evolving Considerations for PET response criteria in solid tumors. J Nucl Med. 2009 May;50 Suppl 1:122S-50S Authors: Wahl RL, Jacene H, Kasamon Y, Lodge MA The purpose of this article is to review the status and limitations of anatomic tumor response metrics including the World Health Organization (WHO) criteria, the Response Evaluation Criteria in Solid Tumors (RECIST), and RECIST 1.1. This article also reviews qualitative and quantitative approaches to metabolic tumor response assessment with (18)F-FDG PET and proposes a draft framework for PET Response Criteria in Solid Tumors (PERCIST), version 1.0. METHODS: PubMed searches, including searches for the terms RECIST, positron, WHO, FDG, cancer (including specific types), treatment response, region of interest, and derivative references, were performed. Abstracts and articles judged most relevant to the goals of this report were reviewed with emphasis on limitations and strengths of the anatomic and PET approaches to treatment response assessment. On the basis of these data and the authors' experience, draft criteria were formulated for PET tumor response to treatment. RESULTS: Approximately 3,000 potentially relevant references were screened. Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria is widely applied but still has limitations in response assessments. For example, despite effective treatment, changes in tumor size can be minimal in tumors such as lymphomas, sarcoma, hepatomas, mesothelioma, and gastrointestinal stromal tumor. CT tumor density, contrast enhancement, or MRI characteristics appear more informative than size but are not yet routinely applied. RECIST criteria may show progression of tumor more slowly than WHO criteria. RECIST 1.1 criteria (assessing a maximum of 5 tumor foci, vs. 10 in RECIST) result in a higher complete response rate than the original RECIST criteria, at least in lymph nodes. Variability appears greater in assessing progression than in assessing response. Qualitative and quantitative approaches to (18)F-FDG PET response assessment have been applied and require a consistent PET methodology to allow quantitative assessments. Statistically significant changes in tumor standardized uptake value (SUV) occur in careful test-retest studies of high-SUV tumors, with a change of 20% in SUV of a region 1 cm or larger in diameter; however, medically relevant beneficial changes are often associated with a 30% or greater decline. The more extensive the therapy, the greater the decline in SUV with most effective treatments. Important components of the proposed PERCIST criteria include assessing normal reference tissue values in a 3-cm-diameter region of interest in the liver, using a consistent PET protocol, using a fixed small region of interest about 1 cm(3) in volume (1.2-cm diameter) in the most active region of metabolically active tumors to minimize statistical variability, assessing tumor size, treating SUV lean measurements in the 1 (up to 5 optional) most metabolically active tumor focus as a continuous variable, requiring a 30% decline in SUV for "response," and deferring to RECIST 1.1 in cases that do not have (18)F-FDG avidity or are technically unsuitable. Criteria to define progression of tumor-absent new lesions are uncertain but are proposed. CONCLUSION: Anatomic imaging alone using standard WHO, RECIST, and RECIST 1.1 criteria have limitations, particularly in assessing the activity of newer cancer therapies that stabilize disease, whereas (18)F-FDG PET appears particularly valuable in such cases. The proposed PERCIST 1.0 criteria should serve as a starting point for use in clinical trials and in structured quantitative clinical reporting. Undoubtedly, subsequent revisions and enhancements will be required as validation studies are undertaken in varying diseases and treatments. PMID: 19403881 [PubMed - in process]
Monitoring predominantly cytostatic treatment response with 18F-FDG PET.
Contractor KB, Aboagye EO Related Articles Monitoring predominantly cytostatic treatment response with 18F-FDG PET. J Nucl Med. 2009 May;50 Suppl 1:97S-105S Authors: Contractor KB, Aboagye EO (18)F-FDG PET and, more recently, PET/CT have been established as response biomarkers for monitoring cytotoxic or cytoreductive cancer therapies. With the advent of targeted cancer therapies, which are predominantly cytostatic, (18)F-FDG PET is increasingly being used to monitor the therapeutic response to these agents as well. The impressive outcome of (18)F-FDG PET studies in patients with gastrointestinal stromal tumors treated with imatinib mesylate brought to the forefront the use of this biomarker for assessing the response to targeted therapies. The use of (18)F-FDG PET for this purpose has practical challenges, including quantitative analysis and timing of scans. This review provides a summary of clinical studies of targeted therapies done to date with (18)F-FDG PET and provides guidance on practical issues to ensure the optimal interpretation of imaging data in drug development and for patient care. PMID: 19403880 [PubMed - in process]
Monitoring and predicting response to therapy with 18F-FDG PET in colorectal cancer: a systematic review.
de Geus-Oei LF, Vriens D, van Laarhoven HW, van der Graaf WT, Oyen WJ Related Articles Monitoring and predicting response to therapy with 18F-FDG PET in colorectal cancer: a systematic review. J Nucl Med. 2009 May;50 Suppl 1:43S-54S Authors: de Geus-Oei LF, Vriens D, van Laarhoven HW, van der Graaf WT, Oyen WJ Molecular imaging with (18)F-FDG PET has been proven useful in the management of colorectal cancer. (18)F-FDG PET plays a pivotal role in staging before surgical resection of recurrent colorectal cancer and metastases, in the localization of recurrence in patients with an unexplained rise in serum carcinoembryonic antigen levels, and in the assessment of residual masses after treatment. Currently, there is increasing interest in the role of (18)F-FDG PET beyond staging. The technique appears to have significant potential for the characterization of tumors and for the prediction of prognosis in the context of treatment stratification and early assessment of tumor response to therapy. This systematic review provides an overview of the literature on the value of (18)F-FDG PET for monitoring and predicting the response to therapy in colorectal cancer. The review covers chemotherapy response monitoring in advanced colorectal cancer, monitoring of the effects of local ablative therapies, and preoperative radiotherapy and multimodality treatment response evaluation in primary rectal cancer. Given the added value of (18)F-FDG PET for these indications, implementation in clinical practice and systematic inclusion in therapeutic trials to exploit the potential of (18)F-FDG PET are warranted. PMID: 19403879 [PubMed - in process]

pubmed: 1532-6551

Implications of randomized studies of medical therapy vs revascularization for reducing rising costs of health care.
Beller GA Related Articles Implications of randomized studies of medical therapy vs revascularization for reducing rising costs of health care. J Nucl Cardiol. 2009 Jun 27; Authors: Beller GA PMID: 19562423 [PubMed - as supplied by publisher]

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