July 2014 by ANZSNM

ISSN : 2200-9876

The official publication of the Australian and New Zealand Society of Nuclear Medicine

July 2014, Issue 12

Contents

www.anzsnm.org.au

Welcome

President’s Report

Branch News

Western Australia

South Australia

New South Wales

ACT

Find a Word

Accreditation

ANZSNM ASM 2014 Award winners

What’s That? 13 AGM 2014 Draft Minutes 16 Financials Year end December 31 2013 22 2014 ASM Report 24 Scientific Advisory Panel Research Grants – Conditions of award 28 Case Studies

Lacrimal Scan 32

Too much pain from two ossa 33

Benefits of a SPECT/CT Scan 34

Benefits of a SPECT/CT Scan (2) 35

Deadlines The deadlines for each issue of Gamma Gazette for this year are set out below. These deadlines must be strictly adhered to in order to get the journal out on time. Do not leave the submission of copy until the last minute. For advice on how to submit material please go to the website www.anzsnm.org.au March – February 1

July – June 1

November – October 1

Welcome Welcome to the 12th Edition of the Gamma Gazette, put together by the Queensland Branch of the ANZSNM. This is the first Gamma Gazette I have been directly involved with since becoming the Chairperson of the Queensland Branch in December 2012. I would like to thank all the sponsors and the co-contributors. The Annual Scientific Meeting was held recently in Adelaide and it was a great success. Congratulations to the organising committee. We have included some photo highlights from the conference in this edition. This year the Queensland Branch has already had two successful meetings. After the Adelaide conference we were privileged to have Professor Chaitan Divgi speak to us on Molecular Imaging Biomarkers. He is a lovely humble man who is widely regarded in his field and we would like to thank him for his time after such a big schedule at the Adelaide conference. We have two more meetings planned for this year, a dinner meeting in September and Radpharm presentations at the end of the year. We encourage as many members to attend and support these meetings. We hope you enjoy this edition of the Gamma Gazette. Melinda Wilson Qld Branch Chairperson

ANZSNM Membership Fees are now overdue ANZSNM is almost entirely dependent on membership fees for funding. The current membership management system used by the Secretariat is imperfect in many ways and as a result of these problems some members may have not received at the beginning of this year, their renewal notice for 2014. If you or one of your colleagues is in this situation, please contact the Secretariat immediately to arrange payment. Email secretariat@anzsnm.org.au

Journal Staff

Editorial copy & Advertising copy

Andrew St John General Manager ANZSNM Secretariat PO Box 6178, Vermont South, VIC 3133 Tel: 1300 330 402 Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au

The Australian and New Zealand Society of Nuclear Medicine Limited

Design & Production

Rachel Bullard Deep Blue Design Studio Email: deepbluedesign1@mac.com

Aims and Objectives

The objectives of the Society are as follows: 1. Promote a) the advancement of clinical practice of nuclear medicine in Australia and New Zealand;

b) research in nuclear medicine;

c) public education regarding the principles and applications of nuclear medicine techniques in medicine and biology at national and regional levels;

d) co-operation between organisations and individuals interested in nuclear medicine; and

e) the training of persons in all facets of nuclear medicine.

This issue compiled by the Queensland branch.

Submissions Scientific submissions on all aspects of nuclear medicine are encouraged and should be forwarded to the Secretariat (see instructions for authors published on line at www.anzsnm.org. au). Letters to the Editor or points of view for discussion are also welcome. If original or public domain articles are found and considered to be of general interest to the membership, then they should be recommended to the Editor who may seek permission to reprint.The view expressed in any signed article in the journal do not necessarily represent those of the Society. The individual rights of all authors are acknowledged.

2. Provide opportunities for collective discussion on all or any aspect of nuclear medicine through standing committees and special interest groups: a) The Technical Standards Committee sets minimum standards and develops quality control procedures for nuclear medicine instrumentation in Australia and New Zealand.

The ANZSNM Gamma Gazette is published three times a year: March, July and November. Deadlines for each issue of the journal are the first of each month prior to publishing. ÂŠ 2014 The Australian and New Zealand Society of Nuclear Medicine Inc. Copyright is transferred to the Australian and New Zealand Society of Nuclear Medicine once an article/paper has been published in the ANZSNM Gamma Gazette (except where it is reprinted from another publication). ANZSNM website address: www.anzsnm.org.au

4 Gamma Gazette July 2014

b) The Technologists Special Interest Group. With the introduction of National Registration for Nuclear Medicine Technologists / Scientists as of 1st July 2012, the future role of the Accreditation Board was reviewed and federal council made a decision to disband the current Accreditation Board and reallocate ongoing responsibilities to the ANZSNM â&#x20AC;&#x201C; Technology Special Interest Group (TSIG). The PDY and mentor program, CPD program, department accreditation and the overseas qualification exam are now managed by sub-committees of the TSIG. 2) The Radiopharmaceutical Science SIG and a Physics SIG that maintain standards of practice for their particular speciality and provide a forum for development in Australia and New Zealand.

Office Bearers Any changes or additions to the details listed should be forwarded in writing to the Secretariat as soon as possible. President Vice President Past President Treasurer Committee

Prof Vijay Kumar (IRC), email: vijay.kumar@health.nsw.gov.auu Prof Dale Bailey (NSW), email: dale.bailey@sydney.edu.au Dr Elizabeth Bailey (TSIG), email: Elizabeth.Bailey2@health.nsw.gov.au Dr Sue O’Malley (NZ), email: sue@omalley.co.nz Ms Lyndajane Michel (QLD), email: ljmichel@bigpond.com Mr Dominic Mensforth (SA), email: dominic.mensforth@i-med.com.au A/Prof Roslyn Francis (WA), email: roslyn.francis@uwa.edu.au Dr Doug Smyth (Radiopharmaceutical Science Rep), email: Douglas.Smyth@health.sa.gov.au Justin Williamson (NZ), email: Justin.Williamson@hawkesbaydhb.govt.nz Dr Sam Berlangieri (Physicians Rep), email: salvatore.berlangieri@austin.org.au Ms Sharon Mosley (ACT), email: Sharon.Mosley@act.gov.au Mr David Thomas (VIC/TAS), email: David.Thomas@austin.org.au Dr Darin O’Keefe (Physics Rep), email: darin.okeeffe@cdhb.govt.nz

General Manager & Secretariat

Dr Andrew St John and Drajon Management Pty Ltd

All correspondence ANZSNM Secretariat PO Box 6178, Vermont South VIC 3133 Tel: 1300 330 402 Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au Branch Secretaries Australian Capital Territory New South Wales Queensland South Australia Victoria/Tasmania Western Australia New Zealand

Ms Maree Wright, email: Maree.Wright@act.gov.au Position vacant, interim contact is Acting President Ms Liz Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au Ms Nikki Weinert & Ms Kathy Roy, email: qldbranchsecretaryanzsnm@gmail.com Ms Nicole Ayars, email: nicole.ayars@health.sa.gov.au Dr Zlata Ivanov, email: zlata.ivanov@arpansa.gov.au Ms Georgina Santich, email: wabranchsecretary@hotmail.com Ms Dianne Wills, email: Dianne.Wills@cdhb.health.nz

Special Interest Groups Technologists Radiopharmaceutical/Science Physics/Computer Science

Dr Elizabeth Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au CPD Program Sub-committee: Dr Clayton Frater, email: clayton.frater@sswahs.nsw.gov.au PDY Program Sub-committee: Ms Tale Liiv, email: Tale.Liiv@health.qld.gov.au Ms Jennifer Guille, email: jennifer.guille@sesiahs.health.nsw.gov.au Dr Darin O’Keeffe, email: darin.okeeffe@cdhb.health.nz

Technical Standards Committee Scientific Advisory Panel International Relations Committee Nurse Member Liaison Research Grant Committee

Chairperson: Dr Darin O’Keeffe (acting), email: darin.okeeffe@cdhb.health.nz Chairperson: Professor Andrew Scott, email: Andrew.Scott@ludwig.edu.au Mr Erwin Lupango, email: Erwin.lupango@sessiahs.health.nsw.gov.au Chairperson: Dr Graeme O’Keefe

Reporting of Abnormal Behaviour of Radiopharmaceuticals The Society maintains a register of reports of abnormal behaviour of radiopharmaceuticals. Abnormal behaviour can be reported either by telephone fax or e-mail, or in writing to: Dr John Baldas, ARPANSA Mr J. Gordon Chan 619 Lower Plenty Road Department of Nuclear Medicine, Yallambie VIC 3085 Austin & Repatriation Medical Centre, Heidelberg VIC 3084 Tel: (03) 9433 2211 Tel: (03) 9496 3336 Fax: (03) 9432 1835 Fax: (03) 9457 6605 email: john.baldas@arpansa.gov.au email: gordon.chan@petnm.unimelb.edu.au

Australian and New Zealand Society of Nuclear Medicine Limited ABN: 35 133 630 029

Isotopes, Imaging and Identity – The History of Nuclear Medicine in Australia Book

Order and Payment Form ANZSNM Members:

AU $25 (inc.GST) Qty.

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Amount to be deducted $ Card Holder’s Name Card Holder’s Signature Email completed form to: secretariat@anzsnm.org.au CHEQUE MADE PAYABLE TO ANZSNM ANZSNM Secretariat PO Box 6178, Vermont South, VIC 3133 Tel: 1300 330 402 Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au

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President’s Report This is my first report since I took over the role as the President of ANZSNM at the annual conference in Adelaide 2014 and I feel it is my great privilege and honour to serve the society. Special thanks to Elizabeth Bailey, the out-going President, her predecessors and their entire team for the hard-work and excellent contribution over many years that shaped up the image of the society to its current level in Australia and its enviable global standing. I hope to continue in the same vein and maintain such high calibre and build up the strength further, with the continued support from the entire team members of the Federal Council. I welcome new members to the Federal Council, Mr. David Thomas (Vic/Tas Rep), Dr Justin Williamson (NZ Rep) and Doug Smythe (RPSC Rep) and thank the out-going FC members for their excellent contribution. I am very happy to tell you that we have a new Secretariat, Drajon Management, to handle the affairs of the society. Orb Management services completed their term in May 2014. We have Dr Andrew St John as the new General Manager and who is assisted by his colleague Rajeev Chandra, both of them with very high levels of expertise in the management of scientific societies similar to ANZSNM. Andrew has a strong background in clinical biochemistry and Raj is a Chartered Accountant, they make an ideal team for managing ANZSNM. They will assist in improving the professional status of our members, membership growth and promote greater awareness of the society within the public and government circles. We hope to work together to address some key issues and build strong fundamentals. One of my primary tasks is to address the current website of the society, which needs revamping due to technical limitations of the existing platform. The hard work, dedication and contribution over the past years by many members of web-committee are highly appreciated and their continued support would be great. We are working with the secretariat to build the website to serve as the “standard platform” to meet the professional needs of the members of the society. The website will be built to perform many tasks such as membership renewal, SIG, CME and accreditation related activities and disseminating information through Gamma Gazette. Federal Council thanks the members of the society for approving a modest increase in the membership fee at the last AGM in Adelaide, to cope with the increasing demands of the society at the national and international levels. The annual conference of ANZSNM held in Adelaide in April was a tremendous success with a very high Australian and overseas attendance with the conspicuous participation by the Presidents of SNMMI and EANM. This trend is set to continue and will improve the bilateral relationship between ANZSNM and overseas associations. This is underpinned by the International Relations Committee (IRC) chaired by Andrew Scott, with a key role to advise the council on issues concerning ANZSNM relations with international Nuclear Medicine bodies. The other key initiative by the society is the formation of the Scientific Advisory Council (SAP) chaired by Dale Bailey. SAP will play a key role in stream-lining the selection of overseas speakers with known expertise and excellent presentation skills. The local organising committee have immediate access to pick the suitable speakers from the pool of overseas experts, a good recipe for success. The International Relations Committee (IRC) worked tirelessly in securing the bid to host the next WFNMB conference (World Federation of Nuclear Medicine & Biology) in Melbourne in 2018 with Andrew Scott as the chairperson and a team of experts in the council. The baton change will happen at the WFNMB conference in Mexico in late August 2014. WFNMB will be instrumental in shaping global nuclear medicine activities especially in education and training activities in the Asia and Oceania region. The past two years has seen much closer collaboration between the ANZSNM and the AANMS, under its current president Paul Roach, and joint ventures such as the clinical trials group, ARTnet, should see this continuing into the future. I am privileged to work with a team of dedicated members in the Federal Council for their patience and support during the transition phase in sorting many key areas including the new Secretariat, new website and going forward to build the society to new heights with new ideas and aspirations. Prof. Vijay Kumar President ANZSNM

Expressions of Interest sought: Convenor and Organising Committee ANZSNM Annual Scientific Meeting 2017 NSW It is NSW’s turn to host the ANZSNM Annual Scientific Meeting in 2017. This is your opportunity to help shape the themes and events for the meeting in the year before the World Federation of Nuclear Medicine & Biology four yearly event in the host city of Melbourne in April 2018. Think outside the box and put in an Expression of Interest (EoI). You will be supported in organising the logistics of the event by the ANZSNM Secretariat and an experienced PCO (Professional Conference Organisers), and the ANZSNM Scientific Advisory Panel will provide assistance in selecting an appropriate theme and suggestions for invited plenary speakers. Note that the meeting does not necessarily need to be held in the city in which you live. It doesn’t even need to be held in NSW! Please submit your name and initial thoughts to express your interest in getting involved to the ANZSNM Scientific Advisory Panel chair: Dale Bailey (Dale.Bailey@sydney.edu.au) by August 25, 2014.

CHANGES TO PDY PROGRAM Dear Members, The Medical Registration Practice Board of Australia (MRPB) have released the Ministry endorsed Supervised Practice program to be overseen by the MRPB. This is due to commence 1st November 2014 and will replace the existing ANZSNM PDY program. The MRPB will continue to endorse the ANZSNM PDY program through to end of March to allow existing PDY’s to complete the program. There are a few things of importance in the new program: • The 1:1 ratio has been removed however there are clauses in the document to ensure adequate and appropriate supervision at all times and the provision that the supervised practitioner cannot work as a sole practitioner; • Only graduates of approved 3-year undergraduate programs and Masters programs’ will be required to complete a supervised practice period. Graduates of approved 4-year programs will be eligible to apply for full registration; • It is essential that the principal supervisors at each site read the attached documents thoroughly and have an understanding of their responsibilities in relation to both the supervised practitioner and the board; Please peruse these documents through the ANZSNM website and feel free to provide comments or concerns to the Secretariat or your State TSIG representative. 1. Medical Radiation Practice - Registration Standard - Supervised Practice 2. Medical Radiation Practice - Guideline - Provisional Registration 3. Medical Radiation Practice - Guideline - Supervised Practice Regards Liz Bailey Chair TSIG

8 Gamma Gazette July 2014

A collaboration between the ANZSNM & AANMS

Calls for Expressions of Interest ARTnet CORE IMAGING LABORATORY FACILITY ARTnet is the imaging & therapy network for nuclear medicine trials in Australia & New Zealand. It facilitates clinical trials that use imaging as a part of a trial. Site initiation and standardisation of the imaging equipment in different facilities is an important part of the work of ARTnet. Expressions of interest are sought from organisations or individuals to provide image analysis services to ARTnet that lead to site initiation for gamma cameras (planar), SPECT or PET imaging systems. ARTnet has established methodology to satisfy the demands of standardisation of imaging equipment. The successful applicant(s) would receive data from ARTnet and provide analysis services to validate potential sites. The scope of the analysis would involve verification of the veracity of the image data supplied and computing quantitative measures, such as the SUV (Standardised Uptake Value) for tomographic emission images (SPECT and PET). It is anticipated that up to 50 site validations might be required per annum. Site validation would not normally involve a representative of the core laboratory to visit the site unless requested by the trial or the site. The EoI should contain the names for the individual(s) applying, the core laboratory site details (address, environment, e.g., university, hospital, hardware and software systems used, etc), qualifications of the core staff, experience in performing similar site initiations, an indicative budget for site initiations for SPECT and PET systems and any other information relevant to this process. The initial appointment would be for 12 months but would be renewable, subject to mutual agreement from both parties, to an extension for a further 12-24 months. EoIs can be sent to, or any further information obtained from, the ANZSNM Secretariat (secretariat@anzsnm.org.au) or the AANMS (ceo@aanms.org.au). Closing Date: Sep 14, 2014.

Branch News WESTERN AUSTRALIA First of all I would like to congratulate Dr Elizabeth Thomas for stepping up to the position of Chairperson in our committee and I would also like to welcome Matthew Patterson from SKG to the WA Branch committee! We have met twice since the last report and during that time the ANZSNM 44th Annual Meeting was held in Adelaide. On Tuesday April 8 we had our pre-conference meeting at Royal Perth Hospital. Dr Michael McCarthy and Dr Terry Huong presented “Early Stage CMM-Sentinel Node assessment FDG imaging” and “What happened at the Thai Massage? (not R rated)” respectively. We then had interesting cases to follow. On Tuesday April 29 we hosted our post conference speaker who spoke at the Harry Perkins Institute of Medical Research. Associate Professor Clemens Decristoforo, a radiopharmacist from Innsbruck Medical University. Austria, presented on the topic “68Ga – replacing 99mTc soon?”. It was an in depth and interesting radiopharmacy presentation and we are very appreciative of his visit. Thank you to everyone involved in the organisation of his visit as well as the meeting. Yet again we are looking forward to our annual continuing professional development workshop which will be held on Saturday August 9 at the University Club of WA in Nedlands. The topic for the day is gastrointestinal and hepatobiliary imaging. Dr Nelson Loh has once again volunteered to do one of his famous quizzes and we hope to see everybody there! Amy Evans WA Branch Committee Member SOUTH AUSTRALIA 2014 has started off well in SA, with meetings happening in both the ANZSNM group and the ANZSNM Technologists group. There has already been two branch meetings so far, one at St. Andrews Hospital and the other at The Queen Elizabeth Hospital. The technologists group has also had a very successful dinner meeting held at The Coopers Alehouse. The 2014 ANZSNM Adelaide Conference also occurred, as many of you know, back in April and was a huge success. The feed back received both internationally and Australia wide has been very positive and full of praise. Many thanks go out to conveners Michael Kitchener and Steve Unger and all involved with the preparation, organisation and running of the conference it couldn’t have been done without you and would not have gone so smoothly. Coming up, the ANZSNM SA Branch has a meeting at the end of July at Calvary hospital and with the Technologists group there will be a Protocol Review in August. Nicole Ayars SA Branch Secretary/Treasurer QUEENSLAND We were fortunate enough to have one of the keynote speakers visit Brisbane following the ANZSNM Conference in Adelaide. The meeting was held on Tuesday April 29 at The Prince Charles Hospital, Chermside, sponsored by Imaxeon, with guest speaker Professor Chaitanya Divgi presenting a talk on “Molecular Imaging Biomarkers”. We are currently planning our next meeting which we hope to hold in early September, details to be advised. Planning for ASM Brisbane 2015 is well in hand and the website is accessible to keep abreast of what’s happening. The website will be constantly updated as more information is confirmed. We look forward to showcasing Brisbane and what it has to offer in April 2015. Nikki Weinert and Kathy Roy Qld Branch Co-Secretaries ACT The ACT Branch has been fairly active of late. Toward the end of May Insight Oceania sponsored a meeting at John James Hospital which Mr Jim Hewlett graciously gave us an interesting presentation on organ specific imaging using a range of non traditional gamma cameras. This presentation provided a different viewpoint on how to manage a typical Nuclear Medicine caseload and was well received by all. We appreciate Jim’s effort in getting to the branch meeting directly following his international flight. Dr Iain Duncan rounded out the evening with a presentation on Musculoskeletal imaging and some interesting cases from his private practice. More recently on July 9 the ACT Branch was treated to some thought provoking presentations delivered by A/Prof Geoff Currie and Miss Samantha O’Loughlin (CSU Honours Student). Samantha recently submitted an abstract to the SNMMI meeting in St Louis which was accepted in the open division of the program and she also won first prize in the cardiovascular division. During the week of her presentation in the ACT, Samantha had received notification that her work had been accepted for publication in the JNMT. The ACT Branch was delighted to hear Samantha give her presentation on the Influence of Ambient Temperature on Cardiac FDG Uptake. Geoff then teased out our grey matter with his presentation on Cardiac Sympathetic Imaging with MIBG finishing the evening in just enough time for State of Origin devotees! We thank all the Wagga Wagga attendees for making the extra long trip to The Canberra Hospital for the evening. Our next meeting will be toward the end of the year. Sharon Mosley ACT Chair 10 Gamma Gazette July 2014

Find a word Isotopes + Radiopharmacuticals + Medications E

ADENOSINE CARBIDOPA DIAMOX DMSA DTPA GALLIUM HMPAO LASIX MDP MOLYBDENUM OCTREOTIDE TECHNETIUM ZEVAIN

ATC CCK DIPYRIDAMOLE ECD GLUCAGON INDIUM LUGOLS MIBG MORPHINE PERTECHNETATE THALLIUM

CAPTOPRIL CHROMIUM DISIDA DOTATATE FDG HDP LANREOTIDE MAA MIBI MYOVIEW PHYTATE YTTRIUM 11

Accreditation Congratulations to the following departments which were granted Accreditation or Re-Accreditation for the training of PDY Technologists: Sunraysia Medical Imaging Bendigo Radiology Royal North Shore Hospital Lake Imaging

124 137 55 108

Congratulations to the following technologists who were granted Accreditation: Claudia Bonomini Matthew Patterson James Player Simon Clausen Amanda Gobell Hajar Hamwi Karen Lindsay Jack Meadows Lewis O’Brien Christopher Reece Jennifer Neff Kerry Tse Briony Tomlin Shannon Taylor

ANZSNM Awards

presented at the ASM 2014 in Adelaide • • • • • • •

12 Gamma Gazette July 2014

Mallinckrodt Award: Scott Evans ANSTO Award: Vijay Kumar Radpharm Award: Danielle Lutze Honorary Life Member Award: Peter Collins, Robert Howman-Giles Gammasonics: Kathy Willowson GMS Poster Award: My Linh Diep AANMS Registrar Award: Dr Jui (Tim) Liu

Answer on page 30

What’s that? Submitted by Ingrid Holmes and James Turner Department of Nuclear Medicine & Specialised PET Services Queensland Royal Brisbane & Women’s Hospital

A 79-year-old male is referred for a nuclear medicine procedure with elevated creatinine levels of 827 μmol/L. The treating team were questioning the cause for this. What radiopharmaceutical was used and what is the possible pathology? Initial Dynamic

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ANZSNM Annual General Meeting 2014 DRAFT MINUTES Date: Time: Venue:

Sunday, 27th April 2014 Opened at 12.10am Hall C, Adelaide Convention Centre

1. ATTENDANCE 1.1 Present: Elizabeth Bailey, Sze Ting Lee, Sam Berlangieri, Dale Bailey, LJ Michel, Dominic Mensforth, Darin O’Keefe, Jennifer Guille, Vijay Kumar, Sue O’Malley, David Binns, Andrew Scott, Roslyn Francis, Nicholas Farnham, Marcia Wood, Bridget Chappell, Sharon Mosley, Victor Kalff, Ian Kirkwood, Liz Thomb, Yung Kao, Daphne James, Douglas Smyth, Rochelle McCredie, Dale Seavey, Deborah Calnan, Nicole Ayars, Prue Gilby, Rebecca Chapman, Chantal Amoraro, Dawn Mathers, Debra Huddleston, Rebecca Hussey, Paul Sotiropoulos, Andrew Russon,. Justin Williamson, Robyn Francis, Mehrdad Ghasemzedah, Peter Collins, Giovanni Biblo, Mary-Anne Kealy, Fiona Murton, Jarryd Whebell, Jeanette Farmilo, Jacqui Bague, Martin Blake, Naomi Basserabie, Karen Jones, Diana Gentilcore, Rachael Dunlop, Christina Blefari, Michael Kitchener, Robert Howman-Giles, Diane Cheong, Jennifer Brand, Rhonda Harrup, Reza Garzan, Laurel Knott, Richard Dutschke, Chek Poh Beh, Jon Boelchoud, Daniel Armao, Monica Rossleigh, Andrew Scott, Trish Mead, Melanie Crowther, Vicky Sigalas, Sara Knayfati, Dai Nguyen, Barry Chatterton, Kevin Smidt, Amy Bubner, Mathew Haase, Alana Martin, James Green, Narida Nuimann, Lauren Umersbach, Rahel Pralhoten, Karen Lindsay, Sarah Hatzinikoleis, Rey Casse, Alan Scott, David Bell, Eunice Boake-Dankwa, Katherine Stanton, Adam Freeborn, Paul Marks, Michael Hofman, Gabrielle Cehio, Zlatko Capari, Jo-Anne Pinson, Danielle Lutze, Christine Pavell, Andrea Alfaro-Pique, Georgina Santich, Tahne Watson, Tim Cain, Jacky Maggs, Annette Cotter, Michael Kelly, Dianne Liolls, Lynda Murray, James Schuster, Salnia Mohamed, Tony Kidd, Tui Tuinh, Mihaslan Matusira, Max Bellon, Ben Crouch, David Vuong, Nicholas Siebera, Jessica Welch, Bridget Chappell, Marcia Wood, Anna Bedford, Steve Mathews, Jane Cameron, Madison Annandale, Nick Daur, Jim Bilney, Mandeep Mathui, Manoj Bhatt, Johan Asp, Adrian Suavicalepare, Alex Fok, Tess Smith, Elyse Langeludolecke, Kristos Kyriacou, Rachel Watherston, Amanda Nutt, Justine Trpezanovski, Nicole Sorenson, Anne-Maree Holmes, James Shephard, Alla Turiakou, Bill MacDonald 1.2 Apologies: Martin Cherk, Eva Wegnerm Aurora Poon, David Thomas, Zlatka Ivanov 2. MINUTES OF THE PREVIOUS MEETING Moved Lynda Jane Michel, Seconded Sue O’Malley That the Minutes from the ANZSNM AGM held on 14th of April 2013 at the Perth Convention and Exhibition Centre be confirmed and accepted as a true record. CARRIED 3. BUSINESS ARISING FROM PREVIOUS MINUTES No items were raised.

16 Gamma Gazette July 2014

4. REPORTS – attached as indicated 4.1 President’s Report – attached. Moved Sze Ting Lee Seconded Nick Farnham That the President’s Report be received. CARRIED Sue O’Malley acknowledged the contribution of Liz Bailey to the ANZSNM during her 2 year term as president. 4.2 Treasurer’s Report – attached. Moved Dale Bailey Seconded Sam Berlangieri That the Treasurer’s Report be received. CARRIED 4.3 ANZSNMT – attached 4.4 AANMS - attached 4.5 Physics SIG - attached 4.6 Radiopharmaceutical Science SIG – attached 4.7 Scientific Advisory Panel (SAP) – attached 4.8 Technical Standards Committee (TSC) – attached 4.9 International Relations Committee (IRC) – attached 4.10 Future ANZSNM Annual Scientific Meetings 4.10.1 2015 Queensland– attached 4.10.2 2016 Rotorua, New Zealand – attached 5. SPECIAL RESOLUTION MOTION: That the Constitution of the Society be amended by: 1) Altering Clause 9 Under Membership: 9. The annual subscription payable by members of the Society will be such as the Society in general meeting will from time to time prescribe. To 9. The annual subscription payable by members of the Society will be such as the Federal Council will from time to time prescribe. An increase in annual subscription of greater than 20% must be ratified by the members of the Society at the Society Annual General Meeting. (as circulated to Members and attached to this agenda) Proposer: Susan O’Malley Seconder: Elizabeth Bailey CARRIED 6.

FEDERAL COUNCIL POSITIONS President – Vijay Kumar Treasurer – Sue O’Malley (12 months) & Dominic Mensforth (12 months)

Branch Representatives NSW Dale Bailey Vic/Tas David Thomas Qld Lyndajane Michel SA Dominic Mensforth WA Roslyn Francis ACT Sharon Mosley NZ Justin Williamson

SIG Representatives Physics Radiopharmacy Science ANZSNMT

Darin O’Keefe Doug Smyth Elizabeth Bailey

Sue O’Malley will continue as treasurer for 12 months and then handover to Dominic Mensforth. Special thanks to Sze Ting Lee for her role on the committee, most recently as past president. 7. BUSINESS WITHOUT NOTICE RANZCR/AIR/ACPSEM workshop 8. DATE & VENUE OF 2015 AGM Brisbane Convention and Exhibition Centre, April 20154 10. CLOSE President Elizabeth Bailey thanked all in attendance and closed the meeting at 1.00pm. Agenda Item 4.1 Presidents Report It has been an exciting time of change for the society over the last 12 months. We have had a professional secretariat and General Manager working to improve the administrative and financial support to the members and to assist the council with developing a 5 year strategic plan for the society. The strategic plan was finalised in June 2013 and is available via the ANZSNM website (www.anzsnm.org.au) The ANZSNM have been contracted by the MRPB (AHPRA) until December 2014 to provide the supervised practice or PDY program for graduates with no new enrolments to be accepted after 31st October 2014. After this time, the supervised practice program will be overseen by the Accreditation Council of the MRPB, including course accreditation, The MRPB anticipate having the revised competency standards available for comment in the next 2 to 3 months. The Scientific Advisory Panel have been working on the program for the combined RANZCZR/AIR/ACPSEM meeting to be held on Saturday 6th September 2014 at the Melbourne Convention and Exhibition Centre, with a theme of PET in Radiotherapy Planning. A one-day registration will cost $250 to $300 with full access to all sessions including radiology and radiation oncology. A flyer and weblink promoting the meeting will be distributed to members after the conference, The SAP have been working closely with the LOC for Brisbane to finalise speakers and awards promotion. I am pleased to report that the history project is now complete with the final book Isotopes, Imaging & Identity – The History of Nuclear Medicine in Australia and New Zealand being distributed and available to members in February this year. The society wishes to acknowledge our numerous members and colleagues for their varied contributions. The book will soon be available through wikibooks and we encourage members to continue to update and document important achievements for the society and its’ members Those photos that were not included in the book will be available on the website via the member login soon. The ANZSNM has collaborated with the AANMS to form a joint venture and registered the Australasian Radiopharmaceuticals Trials network (ARTnet) a clinical trials network to support and facilitate the development of research expertise and protocols within Australia and New Zealand. ARTnet was officially launched yesterday, during the conference with the membership of the Executive Board and Scientific Committee now finalised, as listed below. This is an exciting venture and we hope that members will actively engage with this group. The website is now live and

we are reviewing the possibility of a regular quarterly newsletter and membership options. The project officer will continue to be contracted for 20hours per month until 31st December 2014 to finalise the website and trial management procedures. Executive Board Liz Bailey (ANZSNM representative) Paul Roach (AANMS representative) CEO AANMS GM ANZSNM Scientific Committee Ros Francis (Chair) Dale Bailey (ANZSNM) Doug Smythe (ANZSNM) Louise Campbell (ANZSNM) Michael Hofman (AANMS) Stuart Ramsay (AANMS) Martin Cherk (AANMS) Andrew Scott (Independent reasearcher) Vince Riviere (Consumer representative) A new General Manager and consulting group have been contracted starting 1st May 2014 til 30th June 2015 to take over the administrative, financial and strategic management of the society. Drajon Management is a management team that includes Andrew St John who has a background as a Clinical Biochemist and executive member of the Australasian Association of Clinical Biochemists (AACB) and his colleague who is a professional chartered accountant. We look forward to working with Andrew and Rajeev to achieve the objectives of the society. I would also like to take this opportunity on behalf of the council and membership to thank Robyn Smith and Genevieve Butler for their hard work over the past 2 years. Robyn has contributed significantly to the operation of the Society providing executive level support to the Federal Council, sub-committees and the SIGs. Robyn has been instrumental in improving the administration support to our membership. We wish her all the best in her future endeavours. My term as President is now complete. I would like to thank you, the members for the opportunity to take on this role which has been both challenging and exciting. It has allowed me the opportunity to improve international, relations for the society, especially technologists, work with an enthusiastic team of people to form ARTnet and to learn and gain skills from collaborations with others professionals. I would like to especially thank all the council members for their support over the past 2 years, it has been a pleasure to work with you. Liz Bailey President, ANZSNM Agenda Item 4.2 Treasurer’s Report – Presented by Sue O’Malley As per the auditors’ report, profit and loss, balance sheet. Agenda Item 4.3 ANZSNMT Report – Presented by Nick Farnham The Technologist Special Interest Group has been very active this year, Consultation Papers, CPD Activities, PDY Program, Scope of Practice and Changes to Mallinckrodt Award. We had several important roles to fulfill. The first was to provide a response to the Reports and papers put out by AHPRA and the 17

MRPBA. In total provided reposes to 10 papers, 3 of which were confidential and response only sort from the two professional bodies and 7 papers that were listed below: • Public consultation on a review of the English language skills and Criminal history registration standards • International criminal history checks - further public consultation • Draft accreditation standards • Draft accreditation process • Supervised practice guidelines • Professional capabilities for medical radiation practitioners • Cross-Board consultation on common guidelines and shared Code of conduct The 5th Annual Day Seminar was held in Coffs Harbour last year. It had a well-balanced program that included presentations on PET Department Setups, Rural PDY Programs and Research. Once again it was well attended and highlighted the TSIG’s push for CPD activities. This year’s annual day seminar will be held in Queenstown NZ on Saturday 26th July. Clayton Frater has continued as chair of the CPD subcommittee and is continually providing suggestions to continue improving and expanding the CPD program of the ANZSNM. In November 2013 the TSIG and ANZSNM renewed its contract with the MRPBA to provide the National Registration Supervised Practice Program for Nuclear Medicine Technologist/Scientists which will run through to November 2014. Geoff Roff has provided statistical reporting to MRPBA and assisted with coordination of the PDY program, working alongside the TSIG to provide a comprehensive Program. Over the past 18 months the Scope of Practice Working Party has been assembling the Scope of Practice Documents for Nuclear Medicine Technologist’s. After TSIG and members consultation the Document will be presented at the Adelaide ASM with a Panel Discussion. Over 12 months ago the idea was brought to the TSIG to look at increasing the profile of research by Nuclear Medicine Technologists/Scientists in Australia and New Zealand. We have looked to achieve this by adapting the prize for the Mallinckrodt Award. Over the past 12 months there have been lengthy discussions between ANZSNM President Elizabeth Bailey and Executive of the SNMMI-TS which has led to an exciting prospect for the ANZSNM. The proposed changes to the award are: • The rules behind presenting the award, how it is judged and reporting requirements have not changed • The prize for winning the Awards is as follows: The monetary prize Sponsored by Mallinckrodt will increase from $1500 to $2000. • The monetary prize will be used to fund the winner to present their successful presentation at the SNMMI Annual Meeting the following year. I.e. The 2014 winner will present at the 2015 SNMMI meeting. The presentation will be held in an ANZSNM run session as part of the Technologist Program • The winner will be invited by the SNMMI-TS to present at this session and will be provided with complimentary registration for the meeting. In line with this the SNMMI-TS will be holding a similar award for Technologists as part of their annual meeting, with the winner of this award to be invited to present at the ANZSNM Annual Scientific 18 Gamma Gazette July 2014

Meeting the following year. Elizabeth Bailey will be taking over as Chairperson of the TSIG after this AGM. Agenda Item 4.4 ANMS Report – Presented by Sam Berlangieri Fellowships Following its change of name and structure in 2012, the AANMS has awarded the first Fellowships of the new Association (FAANMS) over the past 12 months. This initiative has been extremely well received, and 268 Fellowships have been awarded to date. AANMS Fellowships recognise the distinct nuclear medicine training and experience, adherence to a philosophy of quality nuclear medicine and ongoing professional development in the specialty. Training and CPD The AANMS continues its involvement with the training of new nuclear medicine specialists through the Joint Specialist Advisory Committee, the Basic Sciences Course and the Continuous Assessment Program. The AANMS Basic Sciences Course is an important part of the training program for new specialists and the AANMS greatly appreciates the ongoing involvement of a number of physicists and radiopharmacists who provide excellent lectures and practical session supervision for this course, both at the course venue, and also in the Nuclear Medicine Departments where the practical sessions are provided. The Cross-Sectional Anatomy Course is now in its ninth year, and continues to attract both nuclear medicine physicians and trainees, and radiology and radiation oncology trainees, as well as medical trainees and practitioners from other streams (e.g. RMOs and Basic Physician Trainees). The AANMS will hold its inaugural Masterclass on Thyroid and Parathyroid Disease over 22 – 26 September 2014 in Rarotonga, Cook Islands. The key speakers will be the internationallyrenowned thyroid specialist, Professor Mike Tuttle from Memorial Sloan Kettering Cancer Centre, and A/Prof. Mark Sywak from Royal North Shore Hospital. Government and Industry Liaison The AANMS has continued its involvement in discussions on diagnostic imaging, access to radiopharmaceuticals and expanded public funding of PET services. These are ongoing activities. In relation to PET, the AANMS is preparing a number of MSAC applications seeking new Medicare items for PET services. ARPANSA continues to promote nuclear medicine diagnostic reference levels (DRLs); the AANMS has representation on the committee working on this project. The Association has also run several workshops on radiopharmaceuticals, bringing together representatives from the AANMS, ANZSNM, industry and government to discuss important issues such as access, funding, substitution and registration. These workshops have allowed the AANMS to more closely define the future agenda for registration of new radiopharmaceuticals and in negotiations with the TGA. Ongoing liaison with ANZSNM Unusually, the two current Presidents of the AANMS and ANZSNM are located in the same nuclear medicine department, so liaison has stepped up several notches over the past year! This has been a good development and we hope to continue this closer

level of communication in coming years. The formal launch of the joint venture between the AANMS and ANZSNM to establish a cooperative research entity in nuclear medicine – the Australasian Radiopharmaceutical Trials Network – is an exciting development for the two organisations and both organisations are looking forward to the implementation of this proposal. A close working relationship between our two organisations will be particularly important in the lead up to the WFNMB meeting in Melbourne in 2018, which was secured by the Society last year. Sam Berlangieri FRACP FAANMS AANMS representative Agenda Item 4.5 PHYSICS SIG Report – presented by Darin O’Keeffe The ANZSNM Physics SIG AGM was held on Saturday 26 April 2014. The minutes of the AGM will be available on the Society website in due course. The Physics SIG held a very successful joint Physics SIG – Radiopharmaceutical Sciences SIG Symposium on “Theranostics: Hot Science, Cold Facts” at the Austin Hospital in February. Thank you again to the organising committee and the commercial sponsors. Most of the PDFs from the presentations will soon be on the ANZSNM Physics SIG CPD pages. We have the University of Sydney booked for Friday 13 February 2015 for the next Physics SIG Symposium, with the topic still being finalised. Some members of the Physics SIG are participating in a project being led by Peter Collins & Erin McKay on software tools for scheduling, processing and recording the results of quality control testing of gamma cameras. We hope more details of this will come out over the coming year. Finally, with a move to dual-training of diagnostic imaging medical physicists in diagnostic radiology and nuclear medicine, it is unclear how a nuclear medicine department could employ a dedicated nuclear medicine physics trainee as part of succession planning. This requires further exploration because it is a concern with an ageing workforce. Darin O’Keeffe Physics SIG Chairperson Agenda Item 4.6 Radiopharmaceutical Science SIG Report – presented by Jennifer Guille 1. Professional registration. Guidelines for the registration of radiopharmaceutical scientists (RPS) have been developed, and are currently being ratified by ACPSEM. Upon acceptance of the guidelines, RPS will be invited to apply to be included on the Register. Initially, ‘limited’ Registration, based on qualifications and experience, will apply. The registered RPS will receive ‘unlimited‘ registration on completion of the Certification programme. 2. Competency Standards. Competency standards are currently being developed by a working party. They are near to completion, with segments sent to various groups for comment. We still intend having the weekend working party to finalise details, but need to choose a time when most people are available. The process determines competency in a range of general and specialist areas, requiring the submission of a portfolio to the examining committee. A successful submission will confer ‘Certification’ on the applicant. Certification is being managed through ACPSEM.

3. Registrars positions. We are in talks to try and arrange some funded training positions that will enable new graduates to work under a mentor to gain appropriate experience. 4. The SIG is well represented on a variety of panels and committees. This is both a consequence of, and recognition that we are functioning as an increasingly cohesive group. • Federal Council J Guille • Technical Standards Committee J Guille, G Snowden – Dose Calibrator Survey – PET Dose Calibrator Survey • Scientific Advisory Panel V Kumar • RACI Liason Committee A Katsifis • Nuclear Medicine Liason Panel ARPANSA D Bodetti, J Baldas, Z Ivanov • Accreditation SubCommittee J Guille (Chair), E Browne, A Katsifis, P Lam, D Henderson, G Chan, T Boudier, J Poon, V Kumar, D Bodetti, D Kumar • TGA Working Party G Chan • ARTnet Scientific Committee D Smyth 5. Education. Six students will graduate with Masters of Radiopharmaceutical Science by July 2014. A further student intake will occur in 2015. Macquarie University are working with us to provide the units as online offerings which will ultimately enable education of potential students outside the Sydney area. 6. QC Harmonisation Project. The aim of this project is to verify the most common practices against the appropriate monographs. The reason is there are a large number of QC procedures in use in Australia that have not been verified. When complete the recommended methods will be placed on the ANZSNM website. This will be a slow process due to the amount of work required and limited resources. 7. A register of contacts for specialty practices will be available to upload to the ANZSNM website in the near future. 8. The Radiopharmacy Practice Guidelines are currently under review. Divesh Kumar and Gordon Chan are undertaking this project. 9. Executive Committee. The AGM of the RPS SIG accepted the nomination of Douglas Smyth as Chair of the SIG 2014 – 2016. Gordon Chan remains as Secretary, Jennifer Guille as Immediate Past Chair. 10. Improving continuity of the Executive. Currently, the Executive consists of the Chair, Secretary, and Immediate Past Chair. This does not work well for the encouragement of potential from the next generation, nor, in some cases when the outgoing Chair leaves the field. Thus, it was suggested that the Executive consist of: • The Chair – a 2 year appointment • Secretary – a 2 Year appointment • Outgoing Chair – a one year appointment (Yr 1) • Incoming Chair – a one year appointment (Yr 2) This would keep the Executive at 3, but allow a year overlap for the outgoing Chair to support the new Chair, and a year overlap of the incoming Chair to gain some insight to the requirements of the position. This was not ratified by the meeting, but left for future discussion. Jennifer Guille Chair Radiopharmaceutical Science SIG

19 u

Agenda Item 4.7 Scientific Advisory Panel - presented by Dale Bailey

Agenda Item 4.8 Technical Standards Committee Report – presented by Darin O’Keefe Thank you to Richard Smart, the outgoing Technical Standards Committee (TSC) Chairperson, for his much appreciated role over the past few years and for his continuing role on one of the working parties, even though he has retired from the committee. The TSC welcomes Chris McLaren as the ACT representative and Stuart Ramsay who has replaced Alex Pitman as the AANMS representative. We are still missing New South Wales and Queensland branch representatives on the committee, so please make yourself known to your branch chairperson if you are interested in being the representative for these branches. The TSC has four active working parties: Dose calibrator calibration checks The dose calibrator proficiency testing program working party is working with Mark Reinhard from ANSTO on calibration checks for dose calibrators. ANSTO is using the title the “Australian Nuclear Medicine Traceability Program”. We believe there are still some details of this program to be discussed with ANSTO to achieve maximum benefit for the ANZSNM membership. However, I would like to reinforce that the administered activity is our primary determinant of patient dose (and indirectly image quality) and we endorse the importance of National traceability of dose calibrator calibration for individual radionuclides. Gamma camera minimum quality control programme The ANZSNM document ‘Minimum Quality Control Schedule for Gamma Cameras’ has been endorsed by the Federal Council and I will be introducing that document at a workshop this afternoon. We hope to follow-up with another workshop at the Brisbane Annual Scientific Meeting next year. I do need to point out that due to a communication problem on my part the document was tabled too late with the AANMS to receive feedback from their members. We will be forwarding that document along with the final draft of the supporting ‘guidelines’ document for comment by the AANMS. Software phantoms and clinical software validation There has been a lot of hard work by Peter Collins and Robbie Barnett 20 Gamma Gazette July 2014

on this project, but they now require beta testers and persons from each branch to provide ongoing support for use of the tools that have been developed. A request went out to each branch chair asking for such a person, but they have only received one response from the Victorian Branch. This is a great tool for running software audits and as a training tool for you to compare your processing with pre-established clinical results. If you are interested in participating, please talk with your branch chairperson or Peter Collins. Finally, we have a relatively new working party looking at paediatric administered activity schedules and that working party is meeting for the first time after this AGM. Our objective is to make a recommendation to the Federal Council on a paediatric administered activity schedule, especially the adjustment of administered activity by patient morphology. On this last point, I would like to take this opportunity to mention that the Nuclear Medicine Global Initiative plans to launch an online global paediatric administered activity survey in May and it will run for only two weeks. The survey will allow us to see our results for Australia and New Zealand as well as globally. So please make the effort to complete it for your facility for three reasons: (a) to contribute to the global data collection; (b) to provide regional results that we can use; (c) to show our northern hemisphere colleagues that we have a significant contribution to make as a region. Darin O’Keefe TSC Chair Agenda Item 4.9 International Relations Committee Report – presented by Andrew Scott The IRC has increased its activity over the last 12 months, as a prelude to taking over the leadership of the World Federation of Nuclear Medicine and Biology (WFNMB) in August 2014. These activities have primarily involved a series of meetings with the leadership of major overseas Nuclear Medicine societies, and planning new initiatives in advocacy, technical standards, teaching and quality programs. At the SNMMI Annual Scientific Meeting in Vancouver in June, Prof. Andrew Scott with President Elizabeth Bailey met with the SNMMI leadership to discuss a range of issues relevant to each Society,

including teaching and training, credentialling, Mo-99 supply, workforce planning, and reimbursement issues. The participation of the ANZSNM in the SNMMI Global Dose Optimization initiative, through the active involvement of Dr Darin O’Keeffe, was also gratefully acknowledged. Further meetings at the SNMMI conference were also held with the Asia-Oceania Federation of Nuclear Medicine and Biology (AOFNMB) Executive, and WFNMB Executive, with Prof. Andrew Scott, Prof. Vijay Kumar, and Dr Sam Berlangieri participating. Important outcomes from the meetings included engagement of the ANZSNM in planning for major teaching and training programs within Asia-Oceania, and confirmation of plans for ANZSNM to participate in the WFNMB conference in 2014. There was also acknowledgement of our support for the creation of a new nuclear medicine journal in the Asia-Oceania region – the Asia-Oceania Journal of Nuclear Medicine and Biology – which has Prof. Dale Bailey as an Associate Editor. The IRC has also been involved in the organisation of an IAEA International Conference on Integrated Medical Imaging in Cardiovascular Diseases, held in Austria in September 2013, with A/ Prof. Nathan Better and Prof. Barry Elison representing Australia in the Program. In November 2015, members will be participating in the International Conference on Clinical PET and Molecular Nuclear Medicine (iPET III): Trends in clinical PET and radiopharmaceutical development. In the meantime, Ms Kunthi Pathmaraj has also been involved with the IAEA initiative, QUANUM (Quality Management Assurance in Nuclear Medicine Practices) in the Asia-Pacific Region, and is an official consultant and auditor of this IAEA program. Ms Heather Patterson has continued to be the key coordinator for the Foundations in PET-CT course, which is an annual 2 week course held in Sydney open to all professionals in Nuclear Medicine in the region. Heather also continues in her role in the DATOL (Distance Assisted Training On-Line) project, with support from IAEA and availability of materials through the IAEA website in the future. The structured courses with assessment will still be through National Registration, coordinated and monitored through Australia. At the European Association of Nuclear Medicine (EANM) Annual Scientific Meeting in Lyon in October, Prof Andrew Scott and Dr Sze Ting Lee met with current Presidents of the World Association of Radionuclide Therapy (WARMTH) and WFNMB, and have agreed to foster closer relationships and collaborative efforts of both Societies and the World Journal of Nuclear Medicine. President Elizabeth Bailey, Prof Andrew Scott, Dr Sze Ting Lee and Dr Peter Collins also met with the executive of various international societies. The ANZSNM will have two CME sessions at the upcoming SNMMI Annual Scientific Meeting in St Louis in 2014, and President Bailey has also secured a CME session at the EANM technologist group in Sweden in 2014. Following on from these closer relationships with our international counterparts, there will be senior executive representation from the SNMMI and EANM at the ANZSNM Annual Scientific Meeting in Adelaide, including the current President of the SNMMI, Dr Gary Dillehay, and the EANM representative, Prof Wim Oyen. Planning is also underway for the leadership of the WFNMB to be assumed by Prof Andrew Scott and his executive in 2014, at the WFNMB congress. In view of the health of the current President of the WFNMB (Prof Estrada) and the upcoming WFNMB Congress in Cancun, he has requested that Andrew Scott take the lead in the strategic planning and WFNMB activities over the next 5 years. The plan is for the initiatives of the WFNMB to be more engaged in developing strategic policies and programs for teaching, training and quality engagement with the IAEA and WHO leading up to the WFNMB congress are being pursued. These activities will be separate from that of the IRC.

Prof Scott will also be representing the ANZSNM at the Technical Meeting on Future of Nuclear Medicine and Diagnostic Imaging, to be held at the IAEA headquarters in May, 2014. The expected output of the meeting is to acquire a clear picture on the regional needs, scientific trends, and vision of the societies which will shape the Nuclear Medicine and Diagnostic Imaging path in the future and obtain advice from experts to be considered in planning of International initiatives and in particular for strategizing the activities of the Nuclear Medicine and Diagnostic Imaging Section of IAEA. We would like to thank the Federal Council for their continued support, with Prof Vijay Kumar being accepted by Council to take over from Dr Sze Ting Lee, who steps off Council at the April meeting, who has been the IRC representative on Council over the last few years. Prof Andrew Scott Chair, IRC Agenda Item 4.10.1 Conference Update Queensland 2015 • Plevin & Associates have taken over the reigns as PCO for 2015. A handover has been given to them from Robyn Smith and we are working together to get back on track. • Logo and Masterhead have been agreed on and are now available • Website has been established: www.anzsnm2015.com.au • Plevins will be liaising with this year’s sponsors in order to encourage them to participate in ANZSNM 2015. Sponsorship packages offered are hoped to be similar to those of 2014. They have prepared a prospectus. • Confirmed speakers are: – Dr David Lisle – Dr Robert Howman-Giles – Dr Markus Schwaiger (Munich) – Steven Zedler (Pioneer Lecture) – Marissa Bartlett (Lowenthall Lecture) After some rejections, invitations have gone out to Dr Frank Roesch (Mainz) and April Mann (SSNMI-T). We are still waiting for replies. LJ Michel Federal Council Rep LOC New Zealand 2016 New Zealand is hosting the 2016 meeting in Rotorua 23-25 April 2016. The PCO for this event is Outshine, who were the PCO for the ASM in 2004 (Wellington) and 2010 (Auckland). The main venue is the Rotorua Conference Centre which is located in the heart of Rotorua. This venue has been secured with required deposit. The other locations are under consideration, but the LOC have visited potential locations for the pre-conference symposium, Gala dinner, Saturday Night Party and Physicians dinner. There are 2 direct flights from Sydney to Rotorua twice weekly and this is scheduled to increase by 2016 leaving from other large Australian cities providing direct flights. There is also plans to increase the aircraft capacity from Auckland to Rotorua. The Scientific committee has been considering the theme and has been in consultation with the Scientific Advisory Panel. The idea of Quantitation in Nuclear medicine is being considered. Matters are well in hand with our designated PCO and the formation of our committee which consists of 3 scientific committee members and 3 social committee members. We are hoping for a bumper turnout with this meeting. There is much to attract our members to this meeting with a fabulous site and good solid scientific meeting. Dr Sue O’Malley Co-convenor for the ASM 2016 21

Australian and New Zealand Society of Nuclear Medicine Limited ABNpresented 35 133 630 Financial statements to 029 the 2014 AGM of â&#x20AC;&#x201C; Australian and New Zealand Society of Nuclear Medicine Limited STATEMENT OF PROFIT OR LOSS AND OTHER COMPREHENSIVE INCOME FOR THE YEAR ENDED 31ST DECEMBER, 2013 Note Revenue Accreditation projects Conference, meeting and committee expenses Journal expenses Research Grant Management costs Administration expenses Depreciation expenses

2013

2012

260,827

334,000

(167,174)

(132,529)

(27,585)

(19,010)

(130,064)

(50,755)

(31,869)

(94,242)

(569)

(761)

Secretarial Services

Website Development and maintenance costs

(45,041)

(9,406)

(14,716)

(105,840)

(23,054)

Net current year surplus/(loss)

(105,840)

(23,054)

Other comprehensive income

Total other comprehensive income for the year

Total comprehensive income for the year

(105,840)

(23,054)

Total comprehensive income (loss) attributable to the members of Australian and New Zealand Society of the entity

(105,840)

Current year surplus/(loss) before income tax

Income tax expense

(23,054) Nuclear Medicine Limited

ABN 35 133 630 029

The accompanying notes form part of these financial statements.

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31ST DECEMBER, 2013 Note

2013

2012

CASH FLOW FROM OPERATING ACTIVITIES Receipts from members & other operating activities Interest received Payments to suppliers and contractors Other Payments Net cash (used in)/generated from operating activities

241,968

301,645

13,656

27,730

(355,376)

(391,422)

(99,752)

(62,047)

CASH FLOW FROM INVESTING ACTIVITIES Payment for property, plant and equipment

Payment for intangible asset

Net cash used in investing activities

Net Increase/(decrease) in cash held

(99,752)

(62,047)

Cash at the beginning of the financial year

811,866

873,913

Cash at the end of the financial year

712,114

811,866 Page 6 of 21

The accompanying notes form part of these financial statements.

22 Gamma Gazette July 2014

Australian and New Zealand Society of Nuclear Medicine Limited ABN 35 133 630 029

STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31ST DECEMBER, 2013 Retained Earnings

Total

Balance at 1 January 2012

880,952

Surplus (loss) attributable to the entity

(23,054)

857,898

(105,840)

752,058

Balance at 31 December 2012 Surplus (loss) attributable to the entity Balance at 31st December, 2013

880,952

Australian and New Zealand Society of Nuclear Medicine Limited ABN 35 133 630 029 The accompanying notes form part of these financial statements.

STATEMENT OF FINANCIAL POSITION AS AT 31ST DECEMBER, 2013 Note

2013

2012

ASSETS CURRENT ASSETS Cash and cash equivalents

712,114

811,866

Trade and other receivables

9,828

4,625

Inventories

Other assets

TOTAL CURRENT ASSETS

26,732

37,454

748,674

853,945

3,384

3,953

NON-CURRENT ASSETS Property, plant and equipment

Intangible assets

TOTAL NON-CURRENT ASSETS TOTAL ASSETS

3,384

3,953

752,058

857,898

CURRENT LIABILITIES Trade and other payables

Income in advance

TOTAL CURRENT LIABILITIES

TOTAL LIABILITIES

NET ASSETS

752,058

857,898

Retained earnings

752,058

857,898

TOTAL EQUITY

752,058

857,898

EQUITY

Page 8 of 21

The accompanying notes form part of these financial statements.

A full financial report is available on the ANZSNM website anzsnm.org.au 23

The 44th Annual Scientific Meeting Adelaide Convention Centre April 25-28, 2014 THERE were 475 attendees, including 191 from NSW, 96 from SA and 72 from Victoria, as well as 56 from overseas. The stimulating scientific program reflected the theme of “A Fusion of Ideas, Modalities and Disciplines”, by bringing together a variety of speakers to present different perspectives on our specialty and its interactions with other competing or complementary imaging modalities. We were extremely fortunate to have several renowned international speakers: Professor Wim Oyen from the Radboud Univeristy, the Netherlands; Professor Jamshid Maddahi from UCLA in the USA; Professor Chaitanya Divgi from Columbia University, USA; Ass/Prof Clemens Decristoforo from the Innsbruck Medical University, Austria; Professor Peter Faulhaber from Case Western Reserve University USA; and Ms Brenda King, immediate past-president of the SNMMI-TS. They were well complemented by our Australian contingent of invited speakers, including Chris Rowe, Michael Hofman, Rob Howman-Giles, Dylan Bartholomeusz and Vijay Kumar. The Pre-Meeting Symposium, “Lymphatics in Cancer: The Grapes of Wrath” was held on April 25 at The Farm Barossa Function Centre, in a beautiful setting in the Barossa Valley, and was accompanied by gourmet local food and wine tasting. The Pre-Conference Symposium was attended by 140 delegates, and 100% of respondents rated the

symposium and venue as a “good to very good” on the postconference survey. The pre-conference sessions followed the main conference theme. The morning session addressed staging of breast cancer, with local invited speakers Dr James Kollias providing a surgeon’s perspective of the clinical importance of sentinel node localisation, and Dr Michelle Reintals giving us a radiologist’s guide to staging of axillary lymph nodes. Professor Robert Howman-Giles from Sydney gave an update on optimising sentinel node lymphoscintigraphy, followed by a presentation on the potential value of PET/MRI in diagnosis and staging or breast cancer from Professor Peter Faulhaber. The afternoon session provided an update on the role of nuclear medicine in lymphoma. The use of PET imaging in lymphoma was discussed by Professor Wim Oyen, as well a local physician, Dr Pratyush Giri, followed by an overview of the role of radioimmunotherapy for lymphoma by Dr Michael Hofman from the Peter MacCallum Cancer Centre. The main conference was officially opened by Liz Bailey, and the quality of scientific presentations throughout was excellent. Abstract submissions resulted in 50 oral and 62 poster presentations at the conference, with categories of oncology/therapy and radiopharmacy having the largest number of abstracts submitted. The Exhibition Hall at the Convention Centre was well set out and attended, with special extras such as lucky prize draws, , as well

“A Fusion of Ideas, Modalities and Disciplines”

as shoulder massages, a caricature artist, sponsored coffee baristas and great food keeping attendees close to the sponsors’ booths during each break. A sponsors’ dinner for exhibition staff was held on the Friday night. The Technologists Symposium included talks from both Brenda King and Karen Jones (University of Adelaide), who reflected on the need for NM technologists to adapt in the new era and careers in research respectively. Within the Physicians symposium, an impressive 8 AANMS Award presentations were heard, in addition to the Cardiology interactive session and an update on a new PET cardiac imaging agent by Professor Maddahi. Ass/Prof Decristoforo gave an overview of Ga-68 labelled radiopharmaceuticals and Dr Fares Al-Ejeh from the QIMR Berghofer Medical Research Institute presented a preclinical perspective on targeted radionuclide therapy during the Radiopharmacy Symposium. Plenary sessions included “Imaging Markers and Therapy Response” with presentations by Professors Divgi and Oyen; “Infection and Inflammation” with updates on general nuclear medicine agents by Dr Vijay Kumar from the University of Sydney, PET imaging by Professor Oyen, and new frontiers including fungal infection imaging by Ass/Prof Decristoforo; and updates on cardiac imaging by Professor Maddahi and thyroid cancer therapy by Prof Divgi.

In addition, interactive Cardiology and PET “Read with the Experts” sessions were held using mobile phone applications for the first time, with good feedback from both the presenters and audience articipants. A “Controversy Corner” session on radiation effects with presentations from Prof Pam Sykes (Flinders University) and Dr Zoe Brady (the Alfred Hospital) was extremely informative and entertaining, provoking much discussion. The Lowenthal Lecture was presented by Dr Leighton Barnden form the Queen Elizabeth Hospital, while the Pioneer Lecture was given by Max Bellon form the Royal Adelaide Hospital. At the completion of the conference, Drs Ghee Chew and Dylan Bartholomeusz summarised the highlights for those that stayed to the end. On the social side, Golf with Gordon was a great success at the scenic Mt Osmond Golf Club, with spectacular views over the city. The

25 u

“A Fusion of Ideas, Modalities and Disciplines”

Welcome reception was held at the Convention Centre on Saturday evening, and was followed by the Nucs Party (“Welcome to the Lion’s Den”) at the Lion Hotel in North Adelaide, with everyone dressing up in jungle costume. The nuclear medicine specialists (AANMS) dinner, re-introduced last year, was held at the Auge restaurant and a great time was had by all. The Gala Dinner on Sunday night at the Convention Centre was hosted by Greg Ritchie, with a “Sporting Legends Night of Nights” theme, and music by Keep the Change kept the dance floor full. Almost everyone managed to dress up in bizarre costumes for the Photo Booth, and the lounge furniture in the adjacent chill-out zone was afterwards donated to the local St Vincent de Paul’s charity. As co-conveners, we would like to thank everyone who attended Adelaide 2014, and in particular all of our speakers and sponsors. We would like to express our appreciation to the members of our organising committee, in particular Diana Gentilcore as chairperson of the scientific committee, for generously giving their time, and without whom the conference would not have been a success. Finally, a very special thank you to Phil Plevin and Associates, who were absolutely brilliant in their organisation and management, and contributed greatly to the overall success of the meeting, with extremely positive feedback from almost all conference attendees. We look forward to seeing everyone in Brisbane in 2015. Steven Unger & Michael Kitchener On behalf of the 2014 organising committee: Dylan Bartholomeusz, Cristina Blefari, Rachael Dunlop, Adam Freeborn, Diana Gentilcore, Dominic Mensforth, Douglas Smyth, Daniel Badger and Stan Penglis

Diary dates Email the Production Editor at the Secretariat on secretariat@anzsnm.org.au to list your upcoming conference and meeting dates on the diary page.

2014 2 August WA Annual Workshop University Club, UWA

11 October Hunter Technologist Seminar Crowne Plaza Hunter Valley www.huntertechnologistgroup.com

9 August Annual Continuing Professional Development Workshop University Club of WA, Nedlands

11 October Vic/TAS Annual Day Seminar Crowne Plaza, Melbourne

9 August Tasmanian Winter Seminar Royal Botanical Gardens, Hobart

18-22 October EANM Annual Congress of the European Association of Nuclear Medicine Goteborg ,Sweden

19 August NSW Branch Meeting, Concord Hospital 22-31 August 11th Congress of the World Federation of Nuclear Medicine and Biology Cancun Mexico 4-7 September 2014 Combined Scientific Meeting incorporating ANZSNM workshop: PET/CT in Radiotherapy Planning Melbourne, Australia

2015 17 â&#x20AC;&#x201C; 20 April 2015 ANZSNM 45th Annual Scientific Meeting Brisbane, Queensland 31 Oct â&#x20AC;&#x201C; 4 Nov 2015 AOFNMB 2015 Asia Oceanic Congress of Nuclear Medicine and Biology Jeju, Korea

Call to apply for ANZSNM Research Grant for 2015 Closing date 11 October 2014 for Research Grant to commence in 2015 The Australian and New Zealand Society of Nuclear Medicine (ANZSNM) offers an annual Research Grant to Society Members, consisting of one or more research grants up to a total value of $A20,000. Based on a competitive process, the Research Grant is funded with the aim of supporting investigation, clinical projects or subjects. It is recognised that clinical and collaborative arrangements may dictate that some aspects of work funded may be carried out at other sites. ANZSNM Research Grants are intended to achieve one or more of the following: 1. Approach a meaningful conclusion in one year. 3. Assist investigators striving to establish new programs or new directions. 4. Fund initial exploratory research for which external funding will be sought subsequently. 5. Address circumscribed clinical problems of a sort unlikely to attract industry funding. 6. Survey groups of patients to assess the success rate, squeal, safety or any other aspect of diagnostic or radionuclide therapy protocols. 7. Bridge the gap of a year between completion of one external grant and the commencement of another.

SCIENTIFIC ADVISORY PANEL RESEARCH GRANTS – CONDITIONS OF AWARD A. ADMINISTRATIVE ASPECTS 1. TITLE OF PROPOSAL 2. APPLICANT (S) - give name, highest formal qualification, current department, appointment and address, and if different, the proposed appointment and the department in which the project would be carried out. The Principal Investigator must state the number of years of their nuclear medicine experience. Indicate the number of hours per week each applicant expects to devote to this project. 3. APPLICATIONS FOR RESEARCH SUPPORT CURRENTLY PENDING – itemise by funding agency, project title, and funds requested for each year. 4. CURRENT RESEARCH SUPPORT – itemise for each applicant, giving value of support for each year that support has been granted. Funds from all sources must be included. 5. RELATIONSHIP OF SUPPORT REQUESTED IN THIS APPLICATION TO EXISTING RESEARCH SUPPORT, AND THAT REQUESTED CURRENTLY FROM OTHER BODIES – specify why existing support cannot be utilised to support the research proposed in this application. 6. ETHICAL REVIEW – indicate when ethical review (human or animal) was or is to be sought for the studies in this proposal. Please note that documented ethical clearance must be obtained and forwarded to the Scientific Advisory Panel before the commencement of the grant. 7. CERTIFICATION – all applications must carry certification by the Head of Department/Division “that appropriate general facilities will be available to the investigator if successful and that the project will be carried out strictly in accordance with NHMRC Ethical and Scientific Practice Guidelines”. 8. SCIENTIFIC REFEREES – nominate a minimum of three scientific referees who are expert in the field of this application. Please provide email addresses together with phone and fax numbers and full street addresses. They must not be from your campus, nor associated with the project, nor have collaborated with the applicant(s) scientifically in the past five years. If you require, you may also list one referee who you do not want to assess your project. B. RESEARCH PROPOSAL • The maximum budget which may be applied for is $20,000 • Proposals from new Investigators will be given some preference during assessment • Research Grants are awarded for one year – and can only be extended (up to 18 months) by written application to the Chairman Scientific Advisory Panel 1. AIMS

½ page maximum

2. SCIENTIFIC AND/OR TECHNOLOGICAL MERIT ½ page maximum 3. ETHICAL CONSIDERATIONS 28 Gamma Gazette July 2014

½ page maximum

4. BACKGROUND and RESEARCH PLAN 3 pages maximum Applicants are reminded this section should generally include clear definition of study end points, statistical methods to be used, power calculations and an explanation of the relationship of the study to the applicants’ longer-term research agenda. 5. REFERENCES 1 page maximum (with up to 6 key references marked with asterisks) 6. SUMMARY OF MAJOR EXPECTED OUTCOMES OF PROJECT ½ page maximum 7. BUDGET 1 page maximum A financial summary of the total amount requested (exclusive of GST), itemised under the headings: • Equipment (over $2000) (the Society will not support projects in which the funding sought is primarily to purchase expensive items of equipment) • General operating costs (including consumables, minor equipment (under $2000) etc.) • Salaries 8. JUSTIFICATION OF BUDGET

½ page maximum

C. PREVIOUS RESEARCH ACTIVITY AND ACHIEVEMENTS OF APPLICANTS 1. PREVIOUS RESEARCH SUPPORT TO APPLICANTS – this should be itemised for the last 4 years, giving the same information as for current research support. 2. PUBLICATIONS OF APPLICANTS – please list a maximum of 8 most relevant recent publications per applicant. Abstracts should not be listed. ** For a new researcher, with little or no previous support, a brief CV/track record is required. D. DECLARATION The principal investigator must make a formal declaration, signed and date, as follow: “I confirm that all information included in this application is true and correct. I also confirm that I am a named principal investigator on this application only, and that I am a named investigator on no more than two other applications” E. APPLICATION SUBMISSION Applications must be presented in a minimum of 12-pitch type face. Please submit your application by email as a Word document through the ANZSNM Secretariat at secretariat@anzsnm.org.au by the closing date below. The original (hard copy) signed application should be forwarded to: Chairman, Scientific Advisory Panel c/- ANZSNM Secretariat, PO Box 6178 Vermont Sth, Victoria 3133 APPLICATIONS CLOSE 11 October 2015 ANZSNM Secretariat Phone +61 1300 330 402 Fax +61 (0) 3 8677 2970 Email: secretariat@anzsnm.org.au

SCIENTIFIC ADVISORY PANEL RESEARCH GRANTS – CONDITIONS OF AWARD A. INTRODUCTION AND OBJECTIVES

Applications that do not fulfil these criteria will not be considered.

The Australian and New Zealand Society of Nuclear Medicine (ANZSNM) is offering one Research Grant per year under a competitive process. The Grant is funded with the aim of supporting investigation, clinical projects or experimentation aimed at the discovery and interpretation of facts or the development or application of theories in the field of Nuclear Medicine/ Molecular Biology. Clinical Projects are defined as projects that centre on groups of patients or other human subjects. It is recognised that clinical and collaborative arrangements may dictate that some aspects of work funded may be carried out at other sites.

The maximum funding per application is $20,000

ANZSNM Research Grants are intended to achieve one or more of the following: 1. Approach a meaningful conclusion in one year. 2. Support young investigators initiated clinical projects (as defined above). 3. Assist young investigators striving to establish new programs or new directions. 4. Fund initial exploratory research for which external funding will be sought subsequently. 5. Address circumscribed clinical problems of a sort unlikely to attract industry funding. 6. Survey groups of patients to assess the success rate, sequelae, safety or any other aspect of diagnostic or radionuclide therapy protocols. 7. Bridge the gap of a year between completion of one external grant and the commencement of another. Young Investigators seeking to establish a program will receive preference. Collaboration between the various disciplines of ANZSNM (Physicians/Radiologists, Physicists, Radiopharmacists, Technologists and Nurses) will be encouraged. Pre marketing or post marketing studies of pharmaceuticals agents under patent will not normally be funded. The information contained in the application will be used for the purpose of assessing that proposal. Personal information contained in the proposal may be made available to external referees and the Scientific Advisory Panel and ANZSNM Federal committee. The ANZSNM may seek reports from referees, where appropriate, to assess the scientific merit and clinical importance of the proposal. If the Investigator has submitted the same or similar titled project grant application to another funding body, and the application is subsequently successful, please be advised that the application will be withdrawn from consideration by the Scientific Advisory Panel ANZSNM. The awards are intended to cover maintenance or minor equipment or to employ technical or clerical staff. They are not intended for funding of higher degree students or postdoctoral staff. While minor equipment items may be funded, they should not be the major component of the budget.

B. ELIGIBILITY 1. The Principal Investigator and any other nuclear medicine investigators must be current, fully financial ordinary members of the ANZSNM (of at least 12 months standing) and the project must be either a nuclear medicine department, or an ANZSNM Branch/ SIG initiative. 2. Researchers who have previously received an ANZSNM Research Grant will be ineligible to be considered for a new research grant for a period of three years. C. LIABILITY The ANZSNM accepts no liability or responsibility for any matters arising from the applicant’s project. D. CONDITIONS OF AWARD 1. Only one application per chief investigation is permitted. 2. Department projects must have written authorization from the Department Head. 3. Grants are awarded for one year only. Any unexpended funds will be automatically reclaimed at the beginning of the following year. Grant holders must apply in writing to the Scientific Advisory Panel Chairman before the end of the grant period if they believe they have justifiable grounds for carrying funds over to the next year. However, the project must be completed within 18 months of receiving initial funding approval. 4. The Scientific Advisory Panel reserves the right to nominate independent referees additional to or alternative to the applicant’s nominated referees. 5. Where appropriate, human and animal ethical clearance is required before commencement of the project. 6. A brief synopsis of the project must be published by the successful applicant in the first issue of the Gamma Gazette after funding approval has been granted. 7. Quarterly written reports documenting the progress of the project must be submitted to the Scientific Advisory Panel ANZSNM. 8. At the completion of the project, the work must be presented at the next Annual Scientific Meeting of the Society and submitted to the Gamma Gazette for pier review and publication. 9. Failure to comply with these conditions may result in withdrawal of funding. NOTE: The project must be presented to the ANZSNM Annual Scientific Meeting prior to presentation or publication elsewhere. APPLICATIONS CLOSE 11 October 2015 Chairman, Scientific Advisory Panel C/- ANZSNM Secretariat Phone +61 1300 330 402 Fax +61 (0) 3 8677 2970 Email: secretariat@anzsnm.org.au

From page 13

What’s that? ... answer Initial Whole Body + Statics

24 Hour Delayed Images Bilary excretion

Discussion This is a renal dynamic study using 99mTc-MAG3. Lasix was administered at the time of radiopharmaceutical injection, with the clinical question being the presence of bilateral Pelviureteric Junction (PUJ) obstructions. Dynamic images were acquired over 20 minutes, which revealed no appreciable renal tracer uptake, and photopenic defects at the site of both kidneys. Additional static images, a whole body sweep as well as 24-hour static images were obtained, which showed extensive background blood pool activity and hepatic/biliary/ bowel excretion of the tracer. Having recently been found to have a creatinine level of 827 μmol/L (normal creatinine level is between 70 - 120 μmol/L), the patient was diagnosed with Acute Kidney Injury (AKI) (Formerly known as Acute Renal Failure)1. There are 3 types of AKI2: • Pre-renal- Follows renal hypo perfusion due to a reduction in effective arterial blood flow. • Intrinsic renal failure- Most commonly associated with acute tubular necrosis following a severe systemic insult, such as surgery, trauma or hypotension. • Post-renal- Usually caused by a renal tract obstruction. A recent CT and ultrasound of the kidneys, ureters and bladder found the patient to have polycystic kidneys with bilateral dilatation of the ureters and pelvicocalyceal system as well as suprarenal and infrarenal abdominal aortic aneurysms, which were found to be increasing in size with thrombus. The scan findings of the 99mTcMAG3 study were difficult to explain, given that the patient was producing a normal volume of urine. The marked absence in perfusion and renal tracer uptake of 99mTc-MAG3 would ordinarily suggest a severe vascular insult/ cortical necrosis. The kidneys were noted to be enlarged, as is often the

u 30 Gamma Gazette July 2014

Whatâ&#x20AC;&#x2122;s that? ... answer case with polycystic kidney disease and urine output even following Lasix administration was minimal, as demonstrated by the minimal visualisation of the urinary catheter that was in situ. In this setting the 99mTc-MAG3 scan findings were indicative of AKI and bilateral multi cystic kidneys, however the presence or absence of a PUJ obstruction could not be quantified, due to the lack of uptake demonstrated. Quality control of the radiopharmaceutical was satisfactory (96% labelling) and was again rechecked and confirmed given the unusual scan appearance. As 99mTc-MAG3 has a 95% tubular excretion with minimal glomerular filtration (<5%), to exclude the possibility of a purely tubular disorder, a 99mTc-DTPA (glomerularly filtrated tracer) was suggested.3 This examination was cancelled due to the patientsâ&#x20AC;&#x2122; condition resulting from severe underlying AKI. The patient went on to have ureteric stenting of the right kidney and a nephrostomy of the left kidney and was awaiting dialysis.

References 1. Council for Continuing Pharmaceutical Education. (2014). Tables of Normal Values. Retrieved June 4, 2014 from www.ccpe-cfpc.com/en/pdf_files/ drug_lists/normal_values.pdf 2. Clinical Key, Elsevier. (2013). Acute Kidney Injury. Retrieved June 05th, 2014 from www.clinicalkey. com.au/topics/nephrology/acute-kidney-injury. html 3. Mettler, F., & Guiberteau, M. (2006). Essentials of Nuclear Medicine Imaging, 5th Edition. USA: Saunders Elsevier

Case Study

Lacrimal Scan Kate Wilson Queensland Diagnostic Imaging, Holy Spirit Northside Hopsital Also known as a Dacroscintigraphy, this test is used to assess the flow of tears from the eyes into the nasopharynx. Clinical History A 69-year-old male presented to the department to perform a tear duct study. His clinical history stated excess tear formation in the left eye. Previously, he had vitrectomy surgery to the left eye in September 2013, and a cataract removal to the left eye in February and April 2014. He also had a melanoma removed on the left cheek in November 2013. The over production of tears started after the last cataract removal in the left eye. 150MBq of 99mTc Pertechnetate was made up in 0.2ml in a 1ml syringe diluted with saline. A drop of Pertechnetate was placed into each eye at the lateral part of the conjunctival sac of the lower lid. The patient was put in a semi-erect position, and was told to keep their eyes open throughout imaging. Dynamic imaging immediately began for 10 mins after the drops were administered. After the immediate phase, the patient was instructed to take three big sniffs, and dynamic imaging for two minutes was obtained. After the sniffing phase, the patient was then instructed to blow their nose, three times, and dynamic imaging for two minutes was obtained for the last time. Findings There is normal free drainage of tears from the right eye down the lacrimal duct into the right side of the nose. There is complete obstruction of tear drainage from the left eye. The point of obstruction appears to be proximal at the eyelid itself.

Pictured right top to bottom: • Immediate Phase • Sniffing Phase • Blowing phase 32 Gamma Gazette July 2014

Case Study

Too much pain from two ossa Dr Joseph Wong1 and Lyndajane Michel2 1. Nuclear Medicine, Queensland Diagnostic Imaging 2. Holy Spirit Northside Private Hospital, Chermside, Queensland 4032

Clinical History A 27-year-old female presented for assessment with left foot pain over 2 months. There was no history of acute injury. A plain film did not show any abnormality. What do the bone SPECT/CT images show? Figure A

Figure B

Discussion The bone scan shows moderately intense activity at an os supranaviculare (Figure A) and an os trigonum (Figure B), indicating these ossa as the causes of the painful syndrome in the left foot. Both these ossa are susceptible to repetitive forced plantarflexion injuries. The os supranaviculare is also known as the os talonaviculare dorsale, talonavicular ossicle or Pirie’s bone. It is located at the dorsal aspect of the talonavicular joint. The os has an estimated prevalence of 1%.1 On rare occasions, it may become symptomatic,1 presumably the result of repeated traction injury. The os in the image (Figure A, white arrows) appears well corticated and is unlikely to be due to an avulsion fracture. However, differentiation from an avulsion fracture can be difficult. Features suggesting an avulsion fracture are the presence of a small flake of bone, a history of acute injury and associated soft tissue swelling.1,2 The os trigonum is one of the largest and most common accessory ossicle in the foot. It is connected to the lateral tubercle of the posterior process of the talus by a fibrocartilaginous synchondrosis.1 It may become painful as part of a posterior ankle impingement syndrome or from synchondrotic degeneration.1 The os in the image (Figure B, white arrows) is well corticated. Again, differentiation from a fracture can be difficult. However, a fracture fragment tends to have sharp edges and discontinuity of the cortical lining of the bone or be comminuted over time.1,2 References 1. Mellado JM, Ramos A, Salvadó E, Camins A, Danús M, Saurí A. Accessory ossicles and sesamoid bones of the ankle and foot: Imaging findings, clinical significance and differential diagnosis. European Journal of Radiology 2003; 13 S4: 164-177. 2. Ozkan Kose. The accessory ossicles of the foot and ankle; A diagnostic pitfall in emergency department in context of foot and ankle trauma. Journal of Academic Emergency Medicine 2012; 11(2): 106114.

Case Study

Benefits of a SPECT/CT Scan Richard Boytar Princess Alexandra Hospital, Queensland

With I-123 MIBG imaging it is important to differentiate a foci of disease with increased uptake located in close proximity to sites of normal physiologic activity. This negates the use of renal subtraction imaging.

Unusual uptake of I123-MIBG was seen in the left renal cortical tissue of a 43 year old male who was being investigated for hypertension. The unusual uptake in the I123-MIBG images corresponded to an area of stenosis of the left kidney in the patientâ&#x20AC;&#x2122;s CT renal angiogram. I123-MIBG has been reported to take up in the terminal ends of the sympathetic nerves and can demonstrate sympathetic nerve activity. Increased sympathetic nerve activity can be present in renovascular hypertension. Falsepositive uptake in this situation is an extremely rare occurrence. The result of this study was that the findings are highly suggestive of renal artery stenosis to the left superior branch of the left renal artery.

34 Gamma Gazette July 2014

Case Study

Benefits of a SPECT/CT Scan (2) Richard Boytar Princess Alexandra Hospital, Queensland

Clinical History One month of pleuritic chest pain and shortness of breath. • No proceeding symptoms to suggest infection, D-dimer positive. • CTPA demonstrated no pulmonary embolus, but did show a small right pleural effusion and a small pericardial effusion. The patient developed fevers and elevated anti-inflammatory markers. • A chest x-ray a week later showed ongoing slight prominence of the cardiac silhouette consistent with a recently diagnosed small pericardial effusion. • A gallium scan was requested. The early stage of an infection process will exhibit pathophysiologic change before morphological change is evident. The Gallium Scan was used to investigate chest pain for a patient with fevers, and elevated anti-inflammatory markers. SPECT/CT of the chest localized the Gallium uptake to a pericardial effusion indicating pericarditis.

Australian and New Zealand Society of Nuclear Medicine