2019 SUMMER EDITION | ISSUE 25
2019 SUMMER EDITION | ISSUE 25
CONTENTS Introduction
3
From the President
5
The 2018 ANSTO Molybdenum Crisis Special Report
7
Branch Updates
22
Special Interest Group News
29
ANZSNM Historical Archive
30
Education and Continuing Professional Development (CPD)
31
• Urine Matters - 3 Case Studies • What’s that?
Editorial Andrew St. John, General Manager ANZSNM Secretariat PO Box 6178, Vermont South, VIC 3133 1300 330 402 (03) 8677 2970 secretariat@anzsnm.org.au
Design & Production Ester Gomez, Creative Director Enovate Studio ester@enovatestudio.com www.enovatestudio.com
Calendar of Events
42
Office Bearers
44
DISCLAIMER: The views expressed in articles and content within this Gazette are purely those of the authors and do not represent the views of the Society.
Introduction An Inevitable Crisis? “The time to repair the roof is when the sun is shining” – President John F Kennedy, State of the Union Address, Jan 11 1962
In the past five months we have experienced enormous difficulties arising from, initially, a breakdown on the production line in Building 23, the molybdenum generator facility, at ANSTO’s Lucas Hts facility. In this issue of the Gamma Gazette, we have focussed on this event and the impact that it has had on nuclear medicine practices in Australia. We have sought opinion from different groups at different levels as we have tried to accommodate the uncertainties in supply of molybdenum generators for technetium radiopharmaceutical production. Some of the commentary in the issue is raw. Some of our members have been hit hard by this crisis, and wanted to let us know. Other groups, particularly in metropolitan Australia, have been largely unaffected. The views expressed here, while not reflecting the views of the ANZSNM directly, certainly capture the views of individual members who wanted to share their experiences. Throughout this crisis, mistakes have been made. Communications have been deficient. We were unprepared for this crisis, in spite of having a plan in place that was last enacted in a similar global molybdenum shortage of 2009 – the roof should have been repaired earlier! Only over time will we come to understand what and why we have had this prolonged period of uncertainty in supply. We are fortunate to have a modern, reliable reactor for molybdenum production, unlike most of the rest of the world. A crisis like this, however, reminds us of how vulnerable we are being so isolated from the larger production centres of Europe and North America (although the US is less of a player than it ought to be). It emphasises why we need robust processes for local production. Vagaries of flight schedules, weather patterns & climate change, pilots’ whims to unload certain cargo, and general logistics has meant that we have been through a period of uncertain molybdenum supply common to many other parts of the world. For the most part, the Lucky Country has been mostly lucky with its supplies of technetium. But in June our luck ran out. This issue will, hopefully, stand as an historical snapshot of what has happened in this crisis, and in which we still find ourselves. It serves as a message to the community, industry, and government about the absolutely essential need for local domestic production capabilities. Dale Bailey PhD NSW Branch Representative, ANZSNM 2019 Summer Edition | gamma GAZETTE | 3
Branch News
SA Branch News Dear Members, Since our last branch report, we have held two SA branch meetings and one technologist’s meeting, all with good attendance. Our last meeting held in July was hosted by Dr Jones and Partners. Topics covered included The Value of P40 in Renal Lasix Scans presented by Dr Michael Kitchener and a review into Colonic Transit Imaging by Dr Barry Chatterton as well as a selection of interesting cases presented by Dr Felix Paterson. The ANZSNM Technologists AGM was held on Wednesday 14th November where nominations for the 2019 Radpharm award were presented as well as presentations from UniSA students. Sadly we are saying goodbye to our secretary/treasurer Dai Nguyen in mid-November. Dai has done a fantastic job behind the scenes organising meetings and events throughout the past two years. Nominations are open for anyone interested in the opportunity to fill the role. Please email nominations to myself or Dai. It is a fantastic way to contribute to the society and get to know the ins and outs of Nuclear Medicine in SA. Finally, we look forward to welcoming everyone to Adelaide for the 49th Annual Scientific Meeting in April 2019. Elyse Langeluddecke ANZSNM SA Branch Chairperson
26 | gamma GAZETTE | 2019 Summer Edition
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Education & CPD Case Study Urine Matters (Continued) - Case Study 3 Discussion: The left kidney is very hydronephrotic with no significant remaining parenchyma and no obvious PSMA activity (Figure 4). Therefore the ureteric activity is not due to physiological “hold-up� of urine. The CT shows solid soft tissue in the ureter, not a tubular/cystic structure (Figure 5). The findings have also slowly progressed since diagnosis. The two main diagnostic options to consider are a PSMAavid separate ureteric TCC or a prostate cancer metastasis. Ureteric prostate cancer metastases are very rare, with only 40-50 reported in the literature. They often present with flank pain. Ureteric metastases are more common with primary breast, colon, lung and lymphomatous malignancies. 90% of ureteric malignancies are TCC, which shows variable PSMA expression/uptake. PSMA-expressing TCC has been associated with a higher stage and decreased patient survival. A decision was made not to investigate the left ureteric lesion further. Given the high-grade level of PSMA avidity in the left ureter is similar to all the other metastatic lesions, it is considered more likely to be an unusual prostate cancer ureteric metastasis. Figure 4 Reference: Liu P et al, A hidden ureteral metastasis that originated from prostate cancer: a case report and literature. Transl Cancer Res 2017;6(3):650-655 Schallier D et al, Ureteral Metastasis: Uncommon manifestation in Prostate Cancer. AntiCancer Research 2015; 35: 6317-6320
Figure 5
36 | gamma GAZETTE | 2019 Summer Edition
Call for Abstracts The Organising Committee invites abstract submissions for presentations at the Australian and New Zealand Society of Nuclear Medicine (ANZSNM) 49th Annual Scientific Meeting 2019. Submissions from all disciplines of Nuclear Medicine are invited for poster and oral presentations. The Committee will integrate sets of individual oral papers into thematic sessions. Length of presentations will be determined once all submissions have been reviewed.
Key Dates
Themes
Friday 25 January 2019 Abstract submission close Deadline for abstract submission at 5:00pm ACST (Australian Central Standard Time).
Abstracts may be submitted under the following themes:
To meet publication timelines for the Internal Medicine Journal there will be no extensions. From Monday 25 February 2019 Authors will be notified by email of the result of their abstract submission. Monday 11 March 2019 Presenter registration deadline.
• • • • • • • • • • • • • • •
Cardiology Oncology Neurology Therapy Renal/Urology Gastroentrology Muscoloskeletal Paediatric Infection/Inflammation Technology Physics Radiation Safety Radiopharmacy/Radiochemistry Education/Student General/Other.
How to submit an Abstract To be selected to present you are required to be a member of the Australian and New Zealand Society of Nuclear Medicine and to submit an abstract via the website. All abstracts must be submitted electronically.
Awards Five awards are on offer for the 2019 meeting - GMS Poster Award, The Curium (formerly Mallinckrodt) Award, Shimadzu Award, Radpharm Award* and AANMS Registrar Research Award.
Not a member? Why not join? ANZSNM members receive generous registration fee discounts and the opportunity to submit abstracts for a number of awards. Associate Membership is available for students and medical trainees for free upon approval. Join today here anzsnm.org.au/membership
EVENTS CALENDAR
1
16 January 2019
1-3 April 2019
VIC/TAS Branch Scientific Meeting 'ASNC2018 Highlights'
British Nuclear Medicine Society Spring Meeting
TBA
The King’s Centre, Oxford
CPD Points
www.bnms.org.uk
1-5 April 2019
26-28 April 2019
CNL and TRIUMF 11th Symposium on Targeted Alpha Therapy (TAT11)
49th Annual Scientific Meeting of the Australian and New Zealand Society of Nuclear Medicine
Ottawa, Canada
Adelaide Convention Centre, South Australia
www.tat11.com
6
CPD Points
anzsnm.org.au Attendo Plus mobile App
23-24 FEB 2019
CANCER IMAGING SYMPOSIUM Oncology Onwards
Preliminary Program
Keynote Speaker
Professor Rod Hicks
The right test at the right time Co-Convenors Key Topics Tony Mulcahy & Aarthi Raman PET/MRI Event Contact Hybrid Imaging PET/CT cisymposium2019@gmail.com Multimodality Breast Imaging Registration Details Role of Imaging in Response Assessment https://www.trybooking.com/XOFB Cancer Care Patient Experience
Saturday
Sunday
8.30-9.00 9.00-9.30 9.30-10.00
23rd Feb Registrations Intro + Patient Journey Dr. Rod Hicks – The Right Test at The Right Time 10.00-10.30 NM/MI Techs – PET/CT
9.00-9.30 9.30-10.00
Morning Tea
10.30-11.00
11.00-11.30 Cancer Imaging – Adult General Hospital
11.00-11.30 RECISTing Change – role of CT & MRI in
11.30-12.00 Cancer Imaging – Specialist Hospital
11.30-12.00 RECISTing Change – emerging role of PET in
12.00-12.30 NM Techs – general vs specialist cancer
12.00-12.30 Oncologist – optimising imaging for response
response assessment response assessment care
assessment Lunch
13.30-14.00 PET/MRI – RCH experience 14.00-14.30 PET/MRI – Future prospects for cancer
care 14.30-15.00 PSMA Therapy 15.00-15.30 Sponsor – Guest Speaker
PLATINUM SPONSOR
10.00-10.30 Dr. Kate Moodie – Multi-Modality Breast
Imaging Morning Tea
10.30-11.00
12.30-13.30
PETER MACCALLUM CANCER CENTRE LEVEL 7 LECTURE THEATRE 305 GRATTAN STREET MELBOURNE VIC 3000
24th Feb Registrations Sponsor – Guest Speaker
17.00
Social Function
12.30-13.00
Conclusion