March 2017, Issue 20
ISSN : 2200-9876 ISSN : 2200-9876
21-23 April, 2017 Hobart, Tasmania
The official publication of the Australian and New Zealand Society of Nuclear Medicine
Contents
www.anzsnm.org.au
Welcome
3
President’s Report
7
It's an Honour
9
Branch News
Australian Capital Territory
10
New Zealand
10
Queensland
10
South Australia
10
Victoria/Tasmania 11
Western Australia
11
Radiopharmaceutical Science
12
SIG
What’s That? 13 Diary Dates
14
Word Search 15 Articles
Northern Territory PET scanner support 16
Funding Grants for women's leadership development 17
2015 Research Grant report 20
Case Studies The mystery of the 8-year-old girl who kept falling down 22
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
2
July – June 1
November – October 1
Welcome WELCOME to the first edition of the Gamma Gazette for 2017. I hope you all had a merry Christmas and happy New Year! I’m sure 2017 will be another busy and successful year for us all. Contributions to this edition have been made by the SA and NZ ANZSNM branches and we thank you for your input. Please find the time to have a look through and discover all the exciting things happening around Australia and New Zealand. Two interesting case studies have been provided by New Zealand and the “What’s that?” has been provided by South Australia. There is also a fun puzzle to be solved :) Once again, thank you to the SA and NZ branches for contributing to this edition and to all our sponsors that contribute to the ANZSNM throughout the year. I’m excited to see what 2017 holds for the Nuclear Medicine world. I encourage you all to actively participate in the ANZSNM meetings/activities; the society cannot run without active members! Thank you for taking the time out of your busy day to read our edition and I hope you all have a lovely 2017!
Brittany Martin Chairperson SA Branch ANZSNM
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Journal Staff Editorial copy & Advertising copy
Design & Production
Andrew St John General Manager ANZSNM Secretariat PO Box 6178 Vermont South, Victoria 3133 Tel: 1300 330 402 Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au
Rachel Bullard Deep Blue Design Studio Email: deepbluedesign1@me.com
Aims and Objectives
The Australian and New Zealand Society of Nuclear Medicine Limited 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;
This issue compiled by the SA and NZ branches.
c) public education regarding the principles and applications of nuclear medicine techniques in medicine and biology at national and regional levels;
Submissions
d) co-operation between organisations and individuals interested in nuclear medicine; and
e) the training of persons in all facets of nuclear medicine.
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 views expressed in any signed article in the journal do not necessarily represent those of the Society. The individual rights of all authors are acknowledged. The ANZSNM Gamma Gazette is published three times a year: March, July and November.
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.
Deadlines for each issue of the journal are the first of each month prior to publishing. Š 2017 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 March 2017
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 re-allocate ongoing responsibilities to the ANZSNM – 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 Dale Bailey (NSW), email: dale.bailey@sydney.edu.au A/Prof Roslyn Francis (WA), email: roslyn.francis@uwa.edu.au Prof Vijay Kumar (IRC), email: vijay.kumar@health.nsw.gov.au Mr Dominic Mensforth (SA), email: dominic.mensforth@i-med.com.au Dr Elizabeth Bailey (TSIG), email: Elizabeth.Bailey2@health.nsw.gov.a Dr Giancarlo Pascali (Radiopharmaceutical Science Rep), email: gianp@ansto.gov.au Ms Victoria Brooks (NZ), email: victoria.brooks@fulford.co.nz Dr Paul Roach (AANMS Rep), email: paul.roach@sydney.edu.au Mr David Thomas (VIC/TAS), email: David.Thomas@austin.org.au Dr Daniel Badger (SA): daniel.badger@health.sa.gov.au Ms Clare Radley (NZ): c.e.radley@gmail.com Mr Nicholas Ingold (ACT), email: nick@garranmedicalimaging.com.au
General Manager & Secretariat
Dr Andrew St John and Drajon Management Pty Ltd
All correspondence ANZSNM Secretariat PO Box 6178 Vermont South, Victoria 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
Mrs Rachel Prior, email: rachael1285@gmail.com Dr Liz Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au Ms Leica Baker and Ms Karen Lindsay, email: qldbranchsecretaryanzsnm@gmail.com Ms Dai Nguyen, email: dai.nguyen@sa.gov.au Ms Jessica Welch, email: jessica.welch@austin.org.au Ms Georgina Santich, email: wabranchsecretary@hotmail.com Ms Pru Burns, email: pru.burns@prg.co.nz
Special Interest Groups Technologists Radiopharmaceutical/Science Physics/Computer Science Technical Standards Committee Scientific Advisory Panel International Relations Committee Nurse Member Liaison
Chairperson: Ms Marcia Wood, email: Marcia.Wood@austin.org.au Chairperson: Dr Giancarlo Pascali, email: gianp@ansto.gov.au Chairperson: Dr Daniel Badger, email: daniel.badger@health.sa.gov.au Chairperson: Dr Darin O’Keeffe, email: darin.okeeffe@cdhb.govt.nz Chairperson: Prof Dale Bailey, email: dale.bailey@sydney.edu.au Chairperson: Professor Andrew Scott, email: Andrew.Scott@ludwig.edu.au Mr Erwin Lupango, email: Erwin.lupango@sessiahs.health.nsw.gov.au
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
5
Evidence and Outcomes
47
th
Annual Scientific Meeting of the Australian & New Zealand Society of
NUCLEAR MEDICINE
21-23 April 2017 Hobart, Tasmania
REG I S T ER N O W ! E A RLY BI RD C L O S E S 13 M A R C H 2 0 1 7
It is with great pleasure that we invite you to participate in the 47th Annual Scientific Meeting of the Australian and New Zealand Society of Nuclear Medicine (ANZSNM), 21-23 April 2017 in Hobart, Tasmania. The Meeting will embrace a new format – commencing with the opening plenary Friday afternoon 21 April and concluding Sunday 23 April 2017. It will be held at the Hotel Grand Chancellor, overlooking the beautiful Hobart harbour and within easy walking distance of accommodation, restaurants, entertainment and major retail precincts. The Pre-conference Symposium will be held at the spectacular MONA (Museum of Old and New Art) Friday 21 April, 2017.
Invited Speakers Include Sally Barrington Reader in Nuclear Medicine, PET Imaging Centre at St Thomas', UK
Leslee Shaw
PhD, FACC, FASNC, FAHA
Professor of Medicine, Division of Cardiology, Emory University School of Medicine, USA
Hossein Jadvar MD, PhD, MPH, MBA, FACNM, FSNMMI
Associate Professor of Radiology and Biomedical Engineering, University of Southern California, USA
Sara G. Johnson MBA, CNMT, NCT, FSNMMI-TS
Mark ANZSNM 2017 in your diary and plan to take the Tasmanian holiday you promised yourself – fresh local produce, smart restaurants, MONA art gallery, and some of Australia’s oldest historic precincts all within easy reach.
President, SNMMI-TS, USA
Please refer to the Conference website for more information, and to be added to the mailing list.
Meera Venkatesh
See you in Hobart in April 2017! A/Prof Barry Elison & Jennifer Calcott Co-convenors ANZSNM 2017 Department of Nuclear Medicine Wollongong Hospital
Sally W. Schwarz RPh, MS, BCNP Professor of Radiology, Washington University School of Medicine, USA Director, Division of Physical and Chemical Sciences, International Atomic Energy Agency, Austria Pre-conference Symposium The Pre-conference Symposium will have a cardiology theme and be held at spectacular MONA (Museum of Old and New Art) Friday 21 April, 2017.
Further Information anzsnm2017@plevin.com.au
www.anzsnmconference.com/ANZSNM2017/
President’s Report The Cost of Living (and Working) IN case you hadn’t noticed, economics has become the dominating factor of modern life in Western nations. Everything is seen through economic goggles and any innovation or reform must be justified economically. As Bill Clinton was famously instructed in his bid for the Presidency, his focus needed to be “the economy, stupid”. So we have endless cost-benefit analyses required or the need to develop “the business case” and so on, while other important factors in our society such as developing appropriate housing, providing a social welfare system for those in desperate need, providing improved benefits and outcomes for patients or taking action on climate change all have to play second fiddle to the economic argument. In such a highly leveraged society we have become slaves to the economic rationalists, and we are a poorer and less flexible society for it. For the record, in the last year where figures are available Australia spent $3.3b on diagnostic imaging services via Medicare alone, and that does not take into account inpatient procedures. With much of this comes the infrastructure required to ensure that the taxpayers dollars are being spent wisely and efficiently – the new bureaucracy. We have wide-ranging national accreditation systems today – covering medical, scientific, nursing and now technologist roles in nuclear medicine. These provide a mechanism to ensure that the most appropriate services are being provided by practitioners with the most up-to-date knowledge, which is good, but they all come with a price tag. Government may pay for some of this, but who funds the government? – the taxpayer (i.e., you and I). To do so entirely from government funding would mean either raising taxes, which is politically undesirable, taking funding from one agency to give to another, or simply going further into debt. The alternative, and this is where you and I come in, is that the cost of these accreditation schemes are passed on to the practitioners (tax-deductible, of course). As I move around and discuss the Society’s role with many of you, two issues repeatedly come to the fore – the need for a constant supply of up-to-the-minute resources for on-going professional development & the tools to log this, and the challenge of paying for these. As I have previously noted, we are living in a time of rapid advancement and expansion in nuclear medicine in both diagnostic and therapeutic procedures – a new “golden age”. It is therefore appropriate that we do all we can to remain at the cutting edge of the latest developments. In terms of online resources for CPD, CME etc the Society has struggled to provide adequate reserves of material. We haven’t really dealt with the issue of who pays for this yet, either. This is predominantly an issue for the technologists, who comprise 65% of the Society’s members, as the medical (20%) and scientific staff (7%) have professional colleges through which many obtain their required yearly quota of professional development points, and for which they pay, often handsomely. At present we have three main mechanisms within the Society for participating in events which qualify for CPD – the Annual Scientific Meeting (ASM), branch meetings & SIGs, and online personal study. Each have their own issues – the ASM represents a significant cost (financially and time commitment), especially if this must be borne personally (i.e., your employer or business does not pay for you to attend), branches tend to be metro-based and so regional members, or even those working on the outskirts of our big cities, find it difficult to participate, and the online resources need significant financing and constant website management to function effectively. Another frequently mentioned barrier is the level of the registration fee for the ASM. When added to airfare and accommodation this can be a significant personal impost if it is self-funded. In general, the feedback on the content and quality of the ASMs in recent years has been very positive. Naturally, all of this has to be paid for, and is a component of the registration fee. Reductions could potentially be achieved if certain events were made optional and not included in
7
the blanket registration. As it is, all registrants have an “access all areas” pass and this does have the positive effect of bringing everyone together, both professionally and socially. Would a reduction of, say, $200 on the price of registration for the ASM, with some restrictions to certain events, influence whether you would attend or not, given all of the other expenses involved? It is certainly something that we would like to get feedback on. We are too small a Society to fund a large online CPD resource without a significant influx of new money. Like government, we could increase our revenue by raising annual subscriptions (akin to raising taxes and equally unpalatable), or we could take from one area to provide to another (although in reality we have very little room to move in our budget), or we could seek external funding via educational grants from other organisations. The Secretariat and the Federal Council welcomes your input into this. The reality is that we will probably need to implement all of these approaches to some extent to provide the services that the membership expect. We are making progress and will be judged by you as to whether it has been successful, or not. We’ll get back you ... One final update. At the instigation of the Society, a small working party comprising members from ANZSNM, AANMS and ANSTO has been formed and will be known as the Nuclear Medicine Liaison Group. The aim of this group is not to give scientific or clinical advice to ANSTO like an advisory board might, but to have a mechanism in place to permit communication between ANSTO and ourselves about issues such as radiopharmaceutical availability, pricing, impending shortages and desirable new agents. As nuclear medicine becomes an increasing focus for ANSTO (for example, Mo-99 production upscaling and Lu-177 provision) we want to make sure that the nuclear medicine community helps to keep ANSTO moving in the right direction in an affordable (there’s that economic argument again!) and sustainable way that benefits all of the Australian community. When this group gets going we will let you know how to make contact to pass on any issues of concern.
Dale Bailey President ANZSNM president@anzsnm.org.au
Winner ANSTO/ANZSNM Research Grant 2017 The winner of ANSTO/ANZSNM Research Grant for 2017 of $20,000 is Dr Nelson Loh from the Sir Charles Gairdner Hospital in Perth, for the project entitled "Establishing an Australian reference range for striatal binding in patients with Parkinson's disease and healthy controls with 6-[18F]-fluoro-L-3,4-dihydroxyphenylalanine (F-DOPA) PET". The abstract and photos will be published in the July 2017 issue of Gamma Gazette.
8 Gamma Gazette March 2017
It’s an honour Many of you will be aware that three members of the nuclear medicine community in Australia received awards in the recent Australia Day Honours’ lists. These awards recognise a longstanding commitment to aspects of our society and recognition of service above and beyond the call of duty.
Those recognised most recently were: Clinical Associate Professor Rob Howman-Giles, Head of the Department of Nuclear Medicine at the Children’s Hospital at Westmead, Sydney; the citation was for “service to nuclear medicine and to professional organisations”. Rob was awarded the Medal of the Order of Australia (OAM) for his contributions;
Clinical Professor Vijay Kumar, Principal Radiochemist in the Department of Nuclear Medicine at Westmead Hospital, Sydney; the citation was for “significant service to medical research in the disciplines of nuclear medicine and biology, to professional organisations, and to the community”. Vijay was appointed a Member of the Order of Australia (AM);
Professor Andrew Scott, Scientific Director of Positron Emission Tomography, Department of Medical Imaging and Therapeutics, Austin Health, Melbourne; Andrew’s citation was for “significant service to nuclear medicine and Cancer research as an academic, and to professional organisations”. Andrew was appointed a Member of the Order of Australia (AM).
We wholeheartedly congratulate Rob, Vijay and Andrew on these very significant awards which are thoroughly deserved. They join former recipients of Australian honours from our field including: • IPC (Provan) Murray (AM,1994): In recognition for service to medicine, particularly nuclear medicine; • John G Morris (AO,1999): For service to the development of nuclear medicine through the establishment of the National Medical Cyclotron and the Nuclear Medicine Positron Emission Tomography (PET) Centre; • RG (Rick) McLean (AM,2014): For significant service to medicine, particularly in the fields of rural health and nuclear medicine as a clinician, academic and mentor; • Yvonne Ho (AM,2015): For significant service to radiology and nuclear medicine, as a practitioner and educator, and through professional organisations; • Paul AC Richards (AM,2015): For significant service to medical radiation sciences, and to the community, particularly through providing emergency patient and family accommodation. I am sure that you will all join with me in celebrating these individuals’ recognition and contributions to our discipline and our society. Well done all. Dale L Bailey President ANZSNM
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Branch News AUSTRALIAN CAPITAL TERRITORY THE ACT Branch had a meeting on Thursday March 3. We said a fond farewell to Chris McLaren as he announced his retirement from Nuclear Medicine. We are honored to have worked with him and have him as a member who has made significant contributions to our profession. Rachael Prior ACT ANZSNM Branch Secretary/Treasurer NEW ZEALAND FIRSTLY I would like to take the opportunity to thank Dr Sue O' Malley for all her hard work over the past 8 years. Her energy and enthusiasm is second to none and I know she will be a very hard act to follow. It is great to know Prue Burns is continuing in the role of Secretary and welcome to Arminder Kaur our new Treasurer. Again the South Island has been hit by devastating earthquakes which has impacted many people. On 14 November some of us were awoken by an incredibly large earthquake lasting nearly 2 mins, this was scary enough in New Plymouth which is quite a way from Kaikoura but our hearts went out to all those whose lives were so badly affected, and of course again it was our Wellington and Christchurch colleagues that were also constantly worrying yet again. The quakes seem to be continuing across both islands, but predominantly in the south, and it is most certainly an issue that is always in our minds, but everyone seems to have the "Life Goes On" approach! We can just hope things settle down very soon. The Radiation Act 2016 was enacted in March 2016 and comes fully into force on 7 March 2017. It will repeal and replace the current Radiation Protection Act 1965 and its Regulations. This Act is administered by the Ministry of Health’s Office of Radiation safety. From this, the Code of Practice for Nuclear Medicine: Draft for consultation, is under consideration and due to concerns across this document as a whole, many of us feel that there is a need to meet, and together draft a submission .This can of course be done by individual licence holders but as a united group seems to be a good solution. We have been granted an extension until 17 March. Victoria Brooks NZ Secretary QUEENSLAND WELCOME to 2017 from our new committee in Queensland. As the new QLD Branch Chairperson, I would like to introduce myself for what we hope will be a promising year for the ANZSNM and Nuclear Medicine. I am a Nuclear Medicine Scientist at Royal Brisbane and Women’s Hospital and also the current State-wide Educator for QLD Health Nuclear Medicine. Before my move to Brisbane in 2014, I worked at Wollongong Hospital and served on a number of committees, namely the President of the NSWSNMS. I am looking forward to this new role. At our QLD Branch AGM in November 2016, we were unfortunate to lose our experienced committee who has done a phenomenal job over the last few years. I would like to take this opportunity to thank the committee for their work and high standard of meetings. Resultantly we have a brand new committee consisting of Lecia Baker and Karen Lindsay, both from RBWH (Co-Secretaries) and Karen Eccles from TPCH (Treasurer). Our new committee is eagerly awaiting the opportunity to follow in some big footsteps and we are excited about the ideas and opportunities we hope to bring to our members. The AGM was also the QLD Branch Radpharm Award which brought a high level of competition; the winner was Judy Doung from Princess Alexandra Hospital, congratulations Judy and we look forward to Tasmania this year. A warm welcome to our new graduates in Queensland and also other colleagues who have taken up residency in the state, we hope to meet you soon. The new committee and I look forward to the developments of 2017. Suzanne McGavin ANZSNM-QLD Chair SOUTH AUSTRALIA The South Australian ANZSNM had a great year in 2016 with all meetings being very well attended. Our AGM and quiz night was held on the 15th November 2016 and concluded our meetings for the year. It was well attended with everyone having a great night. The 4th year students held their annual student conference in November, which I had the pleasure of attending and adjudicating along with Vicky Sigalas (chairperson of our techs group). The two Nuclear Medicine students spoke extremely well, however there could only be one winner. Reanna Raslan was the winner of the student conference prize which was kindly donated by the ANZSNM. Jenna La Dru, the other nuclear medicine student presenter, also took home the prize for best overall presentation as voted by the academics. We are extremely proud of all our students! Sadly we farewelled our secretary/treasurer, Kimberly Nguyen as her term came to an end and she headed to 10 Gamma Gazette March 2017
u
Branch News
continued
the UK to pursue her career. This position has been filled by Dai Nguyen, voted in at the AGM. We welcome Dai and wish her all the best in this position. Other staffing changes within the University of South Australia will occur this year with Cristina Blefari returning from maternity leave and Amber Bidner stepping in to fill the role of Kathy Guerrero for 12 months while she is on maternity leave. Amber has come from Sydney so we welcome her to South Australia and hope she enjoys her time here. The meeting schedule for this year is as follows: Wednesday 1 March – The Queen Elizabeth Hospital Wednesday 3 May – The Women’s & Children’s Hospital Wednesday 26 July – Benson Radiology Wednesday 25 October – The Royal Adelaide Hospital Wednesday 29 November – AGM & Quiz Night, Venue TBA Lastly, the ANZSNMT group will be holding a protocol review during one of their meetings this year. If you have a protocol that you think would be suitable for review please email Tracy Benger, Tracy.Benger@sa.gov.au Brittany Martin Chairperson SA Branch VICTORIA/TASMANIA AFTER the business of organising our Day Seminar on September 2016, we at the Vic/Tas Branch have had a very quiet few months as everyone enjoys the summer (and recovers from Christmas!). We have had a Branch meeting to officially welcome our two new members as well as Dr David Nadebaum who has also joined our committee. We again hosted Dr Kim William in January, who gave an educational and refreshing talk on “Scintigraphic Assessment of Myocardial Infiltration” which was well attended. It was the Branch’s first use of the Attendo app, which seemed to be well received and we look forward to using it at all future meetings. We are also looking towards April, and planning speakers for Pre and Post conference engagements, as well as putting plans into place for our Day Seminar later this year. Kim Jasper Victoria/Tasmania Branch Chair WESTERN AUSTRALIA WISHING everyone a nice start to 2017 and hoping it is a great year ahead. Hoping everyone has got back into the swing of things after the Christmas and New Year break and has been keeping cool in the hot weather. The WA ANZSNM calendar finished up with our Annual General Meeting being held at Harry Perkins (south) hosted by Fiona Stanley Hospital. There were some interesting case studies presented by Adrian Sciancalepore, Rhonda Brown and Yasmin Tasker which had the whole room enthused. We would also like to thank Dr Nat Lenzo for his insightful and captivating recap of the 4th Theranostics World Congress held in Melbourne in November. A special thank you to GE for generously providing a delicious dinner held in the foyer of the Harry Perkins building. During our ANZSNM Annual General meeting the members present voted for Shiphrah Tagore to join the WA Branch Committee, we would like to welcome Shiphrah and thank her for her nomination. There has been an email sent out with the dates for the 2017 ANZSNM WA Branch meetings, we hope to see you all there. The first meeting will be hosted by SKG in March and followed by SCGH for the preconference in April. We are looking into getting a recording of one or more presentations from the ANZSNM Annual Scientific Meeting to be held in Tasmania this April. Therefore we will not have a post conference speaker and instead show this recording in our post conference meeting held in June. The WA Branch have also been organising this year’s Annual Workshop to be held in August. We are hoping most of the WA Nuclear Medicine community will be in attendance for yet another successful day. Anyone interested in joining us from the greater Nuclear Medicine Community is also very welcome and we hope to have a program on the website soon. The ANZSNM WA committee would like to thank Stephanie O’Donnell for all her hard work as treasurer; she will be stepping down but will remain on the committee. Tiffany Langton from Fiona Stanley Hospital will be taking on this role. Amy Evans was the winner of this year’s WA Radpharm Aaward and will be presenting her case study: “Seen but not heard” in Tasmania on 21-23 April at the Annual Scientific Meeting, we wish her good luck in her presentation. Finally, we would like to thank all our members, sponsors and the greater nuclear medicine community for their ongoing support and we are looking forward to a great 2017. Tiffany Langton WA Branch Treasurer
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Special Interest Group News RADIOPHARMACEUTICAL SCIENCE ACPSEM Certification of Radiopharmaceutical Scientists There are currently 2 pathways to Certification, and consequently Registration, offered to Radiopharmaceutical Scientists (RPS) by ACPSEM: 1. By completing the Training, Education and Assessment Program (TEAP), a three year, mentored, workplace training program which must be completed in a facility (single institution or a co-operative) accredited to train RPS, and under the supervision of a Certified RPS. Details can be found on the ACPSEM website under TEAP. 2. As an experienced RPS, with greater than 7 years experience, by completing the Application for Certification (Experienced), also available on the website under Radiopharmaceutical Science. The application will be examined by the RPS Certification Panel, with the applicant being required to undergo an ‘interview’ in support of their application. Both pathways were launched in May 2016, and there are currently 5 Registrars enrolled in TEAP, with 3 more to commence within the coming month, all DoH funded. Several less experienced RPS in a number of institutions have also indicated an interest in enrolling in the program, and will be welcome. Jennifer Guille, air, RPS Certification Panel
Macquarie University, Masters of Radiopharmaceutical Science The Masters program is about to commence its third year, with the first group completing the specialist core unit Application of Nuclear Science to Medicine in November, 2016. The standard of student was very pleasing, all demonstrating good chemistry background. We look forward to the next group in 2017. Andrew Katsifis Convenor RPS Speakers in the next Annual Meeting Two high profile Radiopharmaceutical experts have been invited to give lectures at the next ANZSNM Annual Scientific Conference (Hobart, 21-31 April 2017). Dr Meera Venkatesh (IAEA, Director of Division of Physical and Chemical Sciences in the Department of Nuclear Applications) will speak about “Role of IAEA projects in Global Nuclear Medicine”. With Meera’s vast experience in the application of nuclear technologies for radioisotopes’ production, will outline the impact and fruitful collaboration of IAEA in providing the best possible Health services. Representing SNMMI as President, Prof Sally Schwarz will deliver a lecture on “US GMP Regulations for both Clinical and Research”. Widely recognized as one of the most influential PET radiopharmaceutical experts, Sally has been involved in setting the framework allowing the translation of research PET tracers towards clinical applications, and she will provide a view of the current US situation in this field. The RPS SIG hopes that these lectures will inform and inspire a wide range of participants, in addition to the Radiopharmaceutical Scientists. Giancarlo Pascali RPS SIG Chair
Note from the Production Editor Submitting material for publishing in Gamma Gazette IMAGES: Please send image files saved as a separate JPG or PDF at minimum 200dpi, no smaller than 10cm wide and NOT embedded within the text file. TEXT: All text to be submittd in a word file format not PDF. Any queries please contact the ANZSNM Production Editor at deepbluedesign1@me.com
12 Gamma Gazette March 2017
Answer on page 24
What’s that?
Submitted by: Benson Radiology
Clinical history Hyperparathyroidism A 74-year-old male presented to the Nuclear Medicine department for a parathyroid scan after blood tests confirmed hyperparathyroidism. A parathyroid scan was performed using 844MBq of 99mTc-Sestamibi with early and delayed images aquired. An early 5 minute anterior static was performed as well as an early SPECT. Delayed imaging after (2-3 hours) consisted of a 10 minute anterior static followed by a SPECT/CT of the neck and chest. On both the early and the delayed images, a focal area of increased uptake can be seen within the chest on the left. This focal area could be an ectopic parathyroid gland or some other pathology accounting for it’s presence.
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Diary dates Email the Production Editor at the Secretariat at secretariat@anzsnm.org.au to list your upcoming conference and meeting dates on the diary page. All events are on the ANZSNM website: www.anzsnm.org.au/events
March 8 29
14th Annual ENETS Conference NSW Branch Meeting St Vincents Hospital St Vincents Clinic Function Room
April 4
WA Branch Meeting, Sir Charles Gairdner Hospital, Nedlands 5 SA Branch NMT Group Meeting, Women’s and Children’s Hospital, Adelaide 21 – 23 ANZSNM 47th Annual Scientific Meeting, Hobart, Tasmania, Australia 26 QLD Branch Meeting Royal Brisbane and Women’s Hospital TBA ACT Branch Meeting TBA VIC/TAS Branch Meeting May 3 TBA
SA Branch Meeting, Women’s and Children’s Hospital, Adelaide QLD Branch Meeting
June 10 - 14 SNMMI Annual Meeting Denver, Colorado, USA 13 WA Branch Meeting, Royal Perth Hospital/ Fiona Stanley Hospital 17-23 AANMS Basic Sciences Course 25 NSW Branch Meeting Prince of Wales Hospital July 22 26
9th Annual TSIG Seminar Sovereign Hill, Bendigo, VIC SA Branch Meeting Benson Radiology, Adelaide
August TBA ACT Branch Meeting 5 WA Branch Annual Workshop University of Western Australia, Crawley
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September 6 Branch NMT Group Meeting, Women’s and Children’s Hospital, Adelaide 9 Hunter Technologist Group Workshop Crowne Plaza Hunter Valley 16 NSW Branch Workshop 16-17 NZ Branch Annual Meeting WINTEC, Hamilton, New Zealand TBA QLD Branch Meeting TBA VIC/TAS Branch Annual Day Seminar 19 WA Branch Radpharm Award Night Princess Margaret Hospital, Subiaco October 21-25 EANM Congress Vienna, Austria 25 SA Branch Meeting Royal Adelaide Hospital November TBA QLD Branch Meeting 4 RAINS 2017 CT Accreditation Course 21 WA Branch AGM Perth Radiological Clinic 26-1 Dec RSNA Annual Meeting, Chicago, USA 29 SA Branch AGM & Quiz Night December 13 SA Branch NMT Group AGM & Radpharm Award Night 29 NSW Branch Meeting
2018 April 20-24 WFNMB 2018 Congress Melbourne, Australia
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Radiation Protection Search-A-Word by Pru Burns, Pacific Radiology Wellington
T I M E A V D G A T W E L P W B X M B C E C N A T S I D D S C E S Q T E U R U Z G E Z H S R A L A R A F Y F M C D I E G X V E H C N Q A Y O G E
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Source: http://www.abc.net.au/news/2017-01-18/nt-$6-million-short-for-pet-scanner-and-on-site-cyclotron/8192564?pfmredir=sm
NT Health Minister says $6 million more needed to support Darwin's PET scanner By Sara Everingham
PHOTO: The NT Government needs a further $6 million for a cyclotron to be used with a PET scanner. (ABC News: Laurence Palk)
NORTHERN Territory Health Minister Natasha Fyles says she plans to talk to her new federal counterpart to see if the Commonwealth can put up more money to support the PET scanner promised for Darwin. Last federal election both Labor and the federal Coalition promised the Northern Territory a PET scanner and an on-site cyclotron — a machine that produces radioactive isotopes. But the Northern Territory Government now says the Coalition's $15 million promise was not enough to cover the cost of a cyclotron, and isotopes would have to be flown from interstate. Natasha Fyles said the Health Department had done a thorough investigation in preparing a funding application for the Commonwealth. "The breakdown is that the $15 million covers the PET scanner, construction, and construction to house a cyclotron but not to purchase it. "As I have said I am hopeful with the new Federal Health Minister [Greg Hunt] we may be able to negotiate further funds," Ms Fyles said. Ms Fyles said the Territory Government was still committed to delivering a cyclotron but that an extra $6 million was needed. "The $15 million was an estimate developed quickly at the time of the federal election," she said. This week the Territory Government also revealed that its revised plan for the scanner
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included putting the equipment at Royal Darwin Hospital instead of the original plan to house it at the Alan Walker Cancer Centre. The Northern Territory Opposition criticised the Government's new plan and questioned why the scanner would now cost more than expected. It also said the plan to bring in short-lived isotopes from interstate was unworkable. "That's not enough time to fly [them] up from the south," Opposition Leader Gary Higgins said. The Northern Territory branch of the AMA said an on-site cyclotron was essential for the scanner to operate efficiently. "Having the PET scanner without an effective cyclotron within the immediate vicinity looks like it's going to be a big white elephant," president Dr Robert Parker said. Professor Dale Bailey from the Faculty of Health Sciences at the University of Sydney said it was possible to operate a PET scanner without an on-site cyclotron. But he said transporting isotopes long distances would become expensive because they decayed by 50 per cent every two hours. "It becomes commercially unacceptable to be making huge amounts of which you realise are only small amounts because of the transport times," Professor Bailey said. But he said in the long term Darwin would need the cyclotron.
Funding grants for women’s leadership development Women & Leadership Australia (WLA) is administering a national initiative to support the development of female leaders across Australia’s health sector. The initiative is providing women with grants to enable participation in a range of leadership development programs. The leadership development programs are part-time and delivered nationally via WLA’s blended learning model. Scholarship funding is strictly limited and will be awarded based on a set of selection criteria being met. Expressions of Interest Find out more and register your interest by completing the Expression of Interest form prior to March 30, 2017 at: www.wla.edu.au/scholarships/health.html
North Shore Radiology and Nuclear Medicine, North Shore Private Hospital St Leonards North Shore Radiology and Nuclear Medicine is a vibrant and busy integrated medical imaging practice in the prestigious North Shore Private Hospital. The Nuclear Medicine department offers comprehensive general Nuclear Medicine services and operates with two Siemens cameras. We are currently looking for a Nuclear Medicine Technologist to work in a permanent parttime position, 3 days per week, from Tuesday to Thursday. That person must have several years experience and SPECT/CT qualifications. Experience with Siemens operating systems is desirable and commitment to a high level of service and patient care is essential. Current registration with the AHPRA board is required. We offer excellent working conditions, and competitive remuneration.
Farrah Souvannavong email: nuclearmedicine@nsrnm.com.au phone: 02 8425 3680
This opportunity will not be extended past March 30
Should you wish to discuss the initiative in more detail, please contact: Alistair Young at the Office of the National Industry Scholarship Program, WLA on (03) 9270 9032 or via ayoung@wla.edu.au
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www.attendo.com.au & www.attendo.co.nz Atten-doh – what is it - FAQ
Dear Member, As many of you will know the Society has been exploring the use of an App to simplify the process of tracking arrivals and recording CPD at events. The original intent was to assist the “organiser” (Branch Committees) of the meeting and to ensure one seamless process and experience for those attending irrespective of location. As the app was tested it become obvious that users (members) were suggesting additional features they would like for themselves when using the app. We have incorporated some of these in the present version and more work being will be done in development for roll-out in early 2017.
Introducing AttendO – and how it will benefit you AttendO is an app available on the Apple (iPhone only, Ipad coming) and Android store for free download by all ANZSNM members. You first create a personal profile which enables you to receive notifications of upcoming events (essential that you select ANZSNM as your organisation when setting up your Profile), to indicate your attendance, find maps as to how to get to the event and, to scan-in on the day to any event that is organised using AttendO. The scan records your attendance. In your profile screen the number of CPD points you have earned is cumulatively recorded each time you scan in. There is also a CPD logbook feature which is now available for you to write your reflections and learning whilst at the event. The feature also allows you to email your records of attendance to your nominated email address. A direct interface with the central ANZSNM database is being developed but initially we will after 5 days of completion of the event be uploading to your personal CPD record and thereafter manually checking every 5 days. AttendO also has an instant feedback form that is designed to appear five minutes before the end of the scheduled event for you to provide instant feedback to the meeting organisers.
What about recording non-AttendO events? The way AttendO presently works is that it relies on QR codes being created and scanned to record your arrival. When there are no QR codes then it is unable to “track” CPD. Another paid version of this app is being developed to allow you to record Journal readings, in-house seminars etc. The current ‘workaround’ is for you to login as an organiser within the app – create an event-receive a QR code and scan that. We see that as too tedious and therefore a better solution is being developed. In the meantime, of course you can still can access and login to the ANZSNM CPD website or try the workaround.
Organiser logins – and how it will benefit you and the branch committees For the majority of members, you will only ever need to login as a guest (see previous section). There is a separate profile that you can create for being an organiser to create AttendO events. As an ANZSNM member and for a limited time you can create your own organiser profiles and organisations (think your hospital section) to create your own events and meetings. This could be of use in your other meetings where you need to keep a record of attendance and strict record compliance with time of attendance. Branch committees, having decided on the relevant meeting details advise the Secretariat to post these on the ANZSNM website. These same details will be entered within the app by the Secretariat. All those who have downloaded AttendO and chosen ANZSNM in their profile will receive instant notification when the event is created and all the relevant details.
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Leading up to and on the day itself, there is the “Onsite Register” function which allows the committee representative at the door to generate reports of who has arrived and who is yet to arrive including the ability to ‘mark’ those who may not have downloaded the app. This means there is no more need for sign in sheets at the door or the work involved in generating these sheets The other advantages that AttendO provides is that it creates files for generating certificates of attendance and can facilitate follow up by the Secretariat to sign up non-members who have attended ANZSNM events. A visual overview of the AttendO Process: 1. Prior to event:
2. At the event
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2015 Research Grant report
Diagnostic reference levels for patients undergoing PET/CT scans in Australia and New Zealand Peter Kench peter.kench@sydney.edu.au Essam Alkhybari, Kathy Willowson, and Mark McEntee
Aim The aim of this study is to investigate the current patient radiation dose associated with positron emission tomography/computed tomography (PET/CT) scans by revising the previous PET diagnostic reference level (DRL) doses and establishing DRLs for the CT component. Furthermore, this study will provide data on frequently performed PET/CT scans, identify variations in imaging protocols, and propose national standard DRLs for PET/CT scans in Australia and New Zealand (ANZ).
Background Whole body PET/CT has a higher radiation burden to the patient when compared to a PET or CT procedure alone and therefore has a comparatively higher probability of inducing cancer in the patient. It is difficult to estimate the radiation dose associated with PET/CT exams in ANZ due to diversity of equipment and clinical protocols. The most recent ANZ PET DRL survey was conducted in 2008 and included the dose from PET radiotracers only. Since 2008 PET instrumentation has considerably improved and new radiopharmaceuticals are now routinely employed. In 2014-2015 the Australian Radiation Protection and Nuclear Safety (ARPANSA) performed an Australian national DRL (NDRL) Nuclear Medicine survey which included PET/CT. The results of the ARPANSA survey are currently being reviewed by the Nuclear Medicine liaison committee. The ARPANSA Code of Practice, Section 3.1.8 (Radiation Protection Series No. 14): … ‘requires that each practitioner and operator evaluate their administered radiation doses annually, compare these to their patients’ DRLs, and revise the dose if they consistently exceed local DRLs.’
Methodology The investigators are working closely with the ARPANSA to reduce duplication of Australian PET/CT DRL data and ensure new data is included in the future ARPANSA NDRL PET/CT results. We identified Australian states and territories that were underrepresented in the 2014-2015 Nuclear Medicine ARPANSA survey and developed a new PET/CT DRL survey that expanded upon the same methodology and questions as ARPANSA. Our study included both public hospitals and private centres from Queensland, Western Australia and New Zealand. We also included one Children’s Hospital for paediatric data. Data was collected either retrospective or prospectively over a four-week period, or in the case of the Children’s Hospital, for a 26-week period. To determine factors that influence the amount of dose received from a PET/CT procedure we expanded our survey to include CT dose length product (DLP), patient demographics, acquisition protocol and scanner information.
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Results to-date We have now completed human research ethics approvals for four public hospitals and seven private centres with three approvals pending. We have received PET/CT DRL survey data from 8 centres from approximately 930 patients who have had PET/CT procedures. The analysis of this data and findings of this investigations will help establish national PET/CT DRLs for ANZ, understand factors that influence patient dose and proposed methods to optimise the PET/CT protocol. The work to date has resulted in acceptance of an oral presentation at the 2017 Australian and New Zealand Society of Nuclear Medicine annual meeting in Hobart, where results of the New Zealand NDRL will be discussed with representatives of the general nuclear medicine community. Review of the literature has also led to a pending publication examining current international DRL standards.
Issues associated with the study The study protocol was approved by human research ethics committees (HREC) before data collection. Human ethics approval has been one of the most challenging aspects of the investigation and therefore resulted in considerable delays in data collection. The protocol itself is a low or negligible risk study where both the patient and the Nuclear Medicine department providing the information must be de-identified. Considerable thought was put into deciding which was the most appropriate HREC for application lodgement, e.g. university, public hospital, or private centre. In addition to the HREC approved study protocol site specific authorisation (SSA) was also required for each public hospital. There is considerable complexity in performing a multiple centre survey across different countries, states and health care areas as different regulations apply. Below is a more detailed account of some the above challenges. Our initial approach was to submit a low or negligible risk protocol to the University of Sydney HREC for ANZ Nuclear Medicine centres that performed PET/CT procedures. We received feedback that we must have written approval from all
Diagnostic reference levels for patients undergoing PET/CT scans in Australia and New Zealand
participating centres and an application must be submitted directly to centres that have an ethics approval process. As private ANZ Nuclear Medicine centres did not have an ethics approval process we added them to the University of Sydney approved HREC protocol, except the Queensland private centres. The human ethics application process aims to protect the identity and safety of the participants, but who are the participants in a DRL survey, the patients or the staff? The investigators would only receive anonymised patient data, so we identified the staff at the centres as the participants for the University of Sydney HREC. Centres that agreed to participate in the study were given a participant’s information sheet and completed a consent form. The survey sheets were coded so centres were only identifiable by the investigators. We have completed data collection and initial analysis for all private PET/CT centres covered by the University of Sydney HREC. As Australian public hospitals have a HERC, we were required to submit a second ethics application to one of the hospitals participating in the PET/CT DRL survey. The application was completed online using the National Ethics Application Form (NEAF) and submitted to the Royal Brisbane and Woman’s Hospital (RBWH) HREC. On this ethics application, we listed all participating public hospitals within Australia. Unfortunately, we could not include public hospitals from Western Australia (WA) and the Children's Hospital on the same application. WA HREC does not accept ethics approvals from QLD HRECs and it was not appropriate for the RBWH HREC, primarily an adult hospital, to make an ethics decision for a Children's Hospital. As a result, new HREC applications were submitted to the WA Health Department and the Children's Hospital HREC. When completing the NEAF ethics application, it became apparent that we would need to declare that patients were the participants in our study rather than the nuclear medicine staff. This raised the issue of participant informed consent. We successfully argued a waiver for participant consent due to the anonymised data that investigators were unable to identify individuals from the data collected in the survey. Since we elected to submit one ethics application to a single HREC for multiple centres we could no longer apply for a low or negligible risk ethics application; we needed to complete a full ethics application. Since we requested to waive participant consent,
we needed to apply to the QLD Public Health Act (PHA) for approval to access data stored on PACS, RIS, and hospital electronic health records. This required approval from the data managers within each participating public hospital. After obtaining the RBWH HREC and PHA approvals, we then needed to apply for a Site-Specific Application (SSA) for each of the public hospitals participating in the study. The SSA is completed online using Australian Online Forms for Research. Each hospital required the nomination of a Principle Investigator (PI) employed by the hospital that was responsible for the collection of data. The director of the department and financial director also approved the SSA. The Research Governance Office (RGO) required a Research Agreement between the public hospital and the University of Sydney. The RGO's also required the listing of all PIs on the RBWH HREC approval resulting in an amendment to the original application. Before adding QLD private centres to the RBWH HREC approval, we required the owners of the practice the sign a legal document indemnify the HREC against and possible loss from participating in the PET/DRL survey. We also had to submit the PI names and curriculum vitae for the QLD private centres to the RBWH HREC. At the start of the ANZ PET/CT DRL survey, we had not anticipated the complexity and time required to obtain human ethics approval for a national and international negligible risk study. This type of project requires patience and management skills to negotiate a significant number of different processes that must be aligned before obtaining ethics approval. Management of the study has highlighted the inconsistency between states and individual sites with regards to human research ethics applications, and the difficulty this results in when performing data collection at the national level. Fortunately, staff working in Nuclear Medicine centres, HREC, RGO and the University are extremely supportive in providing information and guiding investigators through this complicated process. Investigators would like to acknowledge all the Nuclear Medicine staff that kindly agreed to participate the study and thank the staff in HREC, PHA, RGO, University Contract Offices that assisted the investigations. Nuclear Medicine practitioners who are interested in knowing more about the survey or wish their department to participate the PET/DRL study, are welcome to contact the author.
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Case Study
The mystery of the 8-year-old girl who kept falling down Rachel Wilson Nuclear Medicine Department, Christchurch Hospital, New Zealand
Patients Clinical History An 8-year-old girl presented with a history of several falls diagnosed as faints and 6 months of pain in her right leg. She regularly had night pain and sweats and had a history of meningitis at the age of one. An xray of her lower leg taken in September 2014 and additional xrays of her pelvis and hips in November 2014 showed no abnormality. Image 1 With continued pain she was seen by a private orthopaedic specialist who referred her in February 2015 for a bone scan of her pelvis and right leg. A 3 phase bone scan was performed.
Three Phase Bone Scan The patient received 497MBq of 99mTC-HDP with arterial, blood pool, delayed and SPECT/CT images acquired. A Siemens Symbia T2 camera was used for all imaging. After normal arterial and blood pool phases, her delayed static and SPECT/CT images showed an area of moderately increased activity within the anterior aspect of the right ischial ramus. Findings were consistent with a possible pathological fracture with underlying tumour suggested (Images 2 and 3).
Discussion This patient had several unexplained falls which after admission to Emergency were described as simple faints.
Image 1: Xray pelvis.
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The area of the fracture – query pathological – is an unusual place for a fracture and this was commented on by the radiologists when reporting the films. Stress fractures of the pelvic bones are quite uncommon in children. These fractures are positive on bone scans and also are readily detectable with MR imaging. The key findings include an area of sclerosis which is occasionally associated with periosteal new bone formation.1 Interestingly the appearance of the normal ischiopubic synchondrosis can be misinterpreted for a tumour.1 The location of the patient’s fracture is just anterior to the synchondrosis. Simple falls tend to result in isolated rami fractures.2 Given the patients history of unexplained falls could this be a fracture as a result of the falls?
Image 2: Bone scan.
u
The mystery of the girl who kept falling down
Image 4: Pelvis MRI showing ischial ramus fracture.
Image 5: Scan at 3 months post Bone Scan.
Image 6:. Healed Fracture.
Outcome The patient had a pelvis MRI scan 2 days after the bone scan. This showed appearances of a subacute fracture with the possibility of a pathological fracture through an underlying bony lesion such as histiocyctosis, fibrous dysplasia and infection. Image 4. The imaging results were discussed at an Oncology Multidisciplinary meeting with differential diagnosis including eosinophilic granuloma. A biopsy was considered and she was referred to an orthopaedic consultant in 3 days time. Her blood results including ESR all came back within the normal range along with a normal ECG. Due to the difficult position of the lesion an open biopsy would be required. With her normal blood and ECG results it was decided to wait 1 month to repeat the MRI pelvis. This MRI suggested this was a resolving process. Image 5.
Conclusion After a normal pelvis xray, Nuclear Medicine was able to locate and diagnose a possible pathological fracture. This was able to be further investigated by MRI and along with blood results concluded a stress fracture which self resolved after several months. By the time of the MRI scan in November 15 the fracture had healed. Image 6. Still unresolved are the patients night sweats but her falling has stopped after a period of reduced activity. Nuclear Medicine was a valuable imaging tool for this patient.
References 1 Jadhav SP, Swischuk LE, Jadhav SP. Emergency Musculoskeletal Imaging in Children. (2014) 2 Nunn Heidi. The Pelvis and Hip. Norwich Image Interpretation Course (2015)
Image 3: SPECT/CT Images. 23
From page 13
What’s that? ... answer The delayed SPECT/CT imaging confirmed that the uptake seen within the chest was within the left upper lobe of the lung and had some calcification seen on the low dose CT, which would account for the uptake of sestamibi.
After further discussion with the patient to obtain more relevant history relating to this lung lesion, it was established that it was known and had been found on previous CT imaging. This lung lesion was a stable benign nodule.
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Australian and New Zealand Society of Nuclear Medicine