ISSN : 2200-9876
The official publication of the Australian and New Zealand Society of Nuclear Medicine
July 2016, Issue 18
Contents
www.anzsnm.org.au
Welcome
3
President’s Report
7
Past President Report? 8 Vale Donald Keam 9 Branch News
New Zealand
10
Queensland
10
South Australia
11
Victoria/Tasmania 11
Western Australia
12
SIG
Radipharmaceutical Science 13
Technical Standards
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2016 Research Grant Award 14 What’s That? 15 Word Search 17 2016 AGM Minutes 18 Diary Dates
19
2015 Financials 20 2016 ASM Report 22 Case Studies Ga-PSMA in teh staging of renal cell carcinoma (RCC) 27
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Abnormal myocardial uptake in bone scan 28
Reviewed Paper
2014 and 2015 Austrlian Nuclear Medicine traceability program 29
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 18th Edition of the Gamma Gazette, put together by the Queensland Branch of the ANZSNM. My thanks to the committee members for their help and support in collating the material for this – James Turner, Emma Snow, Louis Gray and Clare Radley. I would like to thank the sponsors of the Gamma Gazette. We have several cases studies. The first submitted by Sarah Gales from QScan and the other submitted by Chris Sharpe from Princess Alexandra Hospital. I hope you find the cases interesting and informative. Our “What’s that” picture has been provided by James Turner and Judy Duong from the Princess Alexandra Hospital. Our find a word has been provided by Clare Radley from CitiScan. We hope you enjoy this edition of the Gamma Gazette.
Ms Melinda Wilson Chairperson Qld Branch ANZSNM
Note from the Production Editor Submitting material for publication IMAGES Please send image files saved as JPG or PDF at minimum 200dpi at 10cm wide
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
Nuclear Medicine bench shields and syringe shields 1 x Suitable for PET $4000 Lead glass window 40x30x3.5cm thick 1 x suitable for Tc99m work $1000 Lead glass window 30x30x0.8cm thick
14 syringe shields, lead glass windows $100 ono each, 1x 10ml, 6x 5ml, 7x 2ml
Jonathon Thwaites +61 419 924 355 Jonathon.thwaites@uwa.edu.au We design facilities and shielding http://medicalandscientificservices.com.au
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Journal Staff Editorial copy & Advertising copy
Design & Production
Andrew St John General Manager ANZSNM Secretariat PO Box 2195 Wellington Point, QLD 4160 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 Queensland branch.
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
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.
e) the training of persons in all facets of nuclear medicine.
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 2016 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
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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 Giancarlo Pascali (Radiopharmaceutical Science Rep), email: gianp@ansto.gov.au Dr Susan O’Malley (NZ), email: sue@omalley.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 Dr Elizabeth Bailey (TSIG), email: Elizabeth.Bailey2@health.nsw.gov.au
General Manager & Secretariat
Dr Andrew St John and Drajon Management Pty Ltd
All correspondence ANZSNM Secretariat PO Box 2195 Wellington Point, QLD 4160 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 Dr Liz Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au Mr James Turner and Mr Louis Gray, email: qldbranchsecretaryanzsnm@gmail.com Ms Kimberley Nguyen, email: kimberly.nguyen@bensonradiology.com.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: Dr Elizabeth Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au Chairperson: Dr Giancarlo Pascali, email: gianp@ansto.gov.au Chairperson: Dr Daniel Badger (SA), 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
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President’s Report Planning for our future WHEN I was first approached to consider serving as president of the Australian and New Zealand Society of Nuclear Medicine for the next two years, I immediately considered what I would like to change or improve in the way that the Society functions. I felt that the central theme for the next two years should be to make the Society a vital entity for all professionals involved in nuclear medicine in Australia and New Zealand. We have many different roles, from those involved in basic research in developing new tools and probes, to those who represent the large organisations that make the sophisticated machinery that we rely upon, to those running a business employing people and providing an essential service, and finally to those involved in the clinical hospital environment with all of the challenges that this encompasses today. To satisfy such a diverse membership relies on solid basics: maintaining a healthy Society budget, reaching out to all involved no matter in which part of the discipline they work, recognising the diversity in people and practices that exists, and meeting the real needs of the members. We should not lose sight of the fact that, for all the faults we can find, nuclear medicine in Australia is in a healthy position at present. This will continue as long as we stay committed to our core values and practices and continue to innovate. With some imagination, and a good degree of determination, we have been able to offer patients many of the latest developments in the field. In the management of neuroendocrine tumours we are the envy of our colleagues in North America and many European countries; also, the relatively recent introduction of PET scanning for prostate cancer with radiolabelled PSMA has probably had the greatest penetration in Australia of any country internationally at present, with partner therapies now beginning to emerge. Such innovation attracts funding. The local biotech scene is gathering momentum, especially in the area of radiopharmaceuticals and theranostics, with companies like Sirtex leading the way with their profile on the international stage. A number of others are looking to follow in their path. ANSTO has one of the few “young” nuclear reactors worldwide which uses low-enriched uranium fuel, with tremendous production capacity to provide the basic nuclides that we will need into the future such as 99 Mo and 177Lu. Alan Kay, the US computer scientist, once said that “the best way to predict the future is to invent it”. We find ourselves in that position today. Which direction will multimodality hybrid imaging take? What new theranostics are just around the corner? How we involve ourselves in and prepare for these developments and embrace them will help to shape our future. Nuclear medicine has never enjoyed a more essential role in clinical medicine than it does today. The ANZSNM is moving towards developing the foundations for individuals involved in nuclear medicine to maintain best practice, embrace the early adoption of new technologies, and help to deliver the evidence required to translate these new developments into the mainstream. The future is indeed now. Dale Bailey President ANZSNM
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Past-President’s Report IT is time to say good bye, and I would like to say thanks for the opportunity to serve as the President of the society for the past 2 years. It was an exciting experience and the members of the executive committee, federal council members and the secretariat have been wonderful to work with. I want the younger community members to come forward and contribute for the betterment of the society and its activities. We have a clear path for the youngsters to get involved with the society. You can talk to your Branch secretary or the secretariat for further information. A change is always refreshing. The society has selected an excellent team to succeed me with Prof. Dale Bailey as the incumbent President, A/Prof. Roslyn Francis as the vice-President and Dominic Mensforth as the treasurer, duly supported by very enthusiastic federal council members. I am sure the new team will be implementing lots of changes, starting from changing the website from “Serving Nuclear Medicine Science since 1969” to “The one organisation for all Nuclear Medicine professionals in Australia & New Zealand”. It requires lots of input from individual groups to make it functional and professional. Other areas requiring revamping include the conference Handbook. I may indicate that it is a great opportunity for the young members of the society with IT skills to come forward and contribute to make these areas more professional and up to date. The last annual conference of ANZSNM 2016 in Rotorua, in New Zealand was a grand success and it was enjoyable with the participation of a number of influential thinkers in the field as guest speakers. They provided updates on the latest developments in Nuclear Medicine, and their participation will continue to improve the bilateral relationships between ANZSNM and overseas associations. The local organising committee led by Dr Sue O’Malley, Dr Darin O’Keeffe and Jo Kelk worked hard and made it a grand success. Some members of the ANZSNM leadership and I will be meeting with the SNMMI President and its executives at Annual Scientific conference in San Diego in Jun 2016 to discuss exchange of young scientists/medicos between USA and Australia, ART-Net activities QA programs etc. As part of the Nuclear Medicine Global Initiative (NMGI), the WFNMB (led by ANZSNM International Relations Committee Chair Prof. AM Scott) and SNMMI are working on a project on Radiopharmaceutical Access and Availability, which is nearing the data collection phase. The executive of WFNMB will be having a Governing council meeting to discuss the progress of the federation and finance. The executive committee of WFNMB and the PCO (professional conference organisers) have been working hard to address major tasks such as scientific sessions, selection of invited speakers and satellite meetings etc. for the World Congress in Melbourne in 2018. The WFNMB executives have attended selective conferences overseas to promote the forthcoming conference. The society’s membership has grown to >960 in 2015, the highest for a long time. The current financial membership is at around 700+ for 2016 so far and we urge all members to renew their membership. I am delighted to say again that I was privileged to work with a team of dedicated members in the Federal Council, and the Secretariat, and appreciate their support in all facets of running the activities of the society for the past 2 years and I ask for the continued support to the incoming team. Prof. Vijay Kumar Immediate Past-President ANZSNM
8 Gamma Gazette July 2016
Vale Donald Keam 1925-2016
Donald Keam, passed away on January 22, 2016 aged 91. Don was an ANZSNM committee member over many years, mainly in the 1970s, rising to President of the Society (1977-78). He retired from the Australian Radiation Laboratory in the mid 1980s. Don was a life member of the Society and proudly displayed this award at his home, and later at the aged care facility where he lived for the last couple of years.
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Branch News NEW ZEALAND The Radiation Safety Act 2016 replacing current Radiation Protection Act 1965 AFTER 50 years, New Zealand has a new Radiation Safety Act which received Royal assent on 7 March 2016 and comes into full force on 7 March 2017. The Act and Regulations were out-of-date in many areas (the main one being the dose limits), but the driver for the update was alignment with the international treaties and conventions on suppression of acts of nuclear terrorism and the protection of nuclear material. The next two steps are the issuing of new Radiation Safety Regulations (currently in draft for consultation), and the development and consultation on new codes of practice arising from the Act. According to the Act, bodies such as the NZ Branch of the ANZSNM will be consulted on the codes of practice. We need to be both prepared and responsive when asked to comment on a draft code for Nuclear Medicine/PET because it could have a significant impact on NZ Branch members. Darin O’Keeffe QHP, Christchurch Hospital Queen’s Birthday Honours List In the 2016 Queen’s Birthday Honours List, Dr Trevor Fitzjohn from Pacific Radiology in Wellington, was made an Officer of the NZ Order of Merit for services to Radiology. The NZ branch wishes to congratulate Trevor on this well deserved award. Save the Date 2016 NZ Branch Meeting, 3 & 4 September, Christchurch PLANS are well underway for our NZ branch meeting in Christchurch on 3 & 4 September. This is always an excellent meeting, with a good mix of scientific papers and social events. Keep an eye out for a flyer coming soon from the Christchurch Hospital Nuclear Medicine Organising group. Closure of the Nuclear Medicine Department at Wairau Hospital, Blenheim THE NM Department at Wairau Hospital, Blenheim opened with funding from both local Rotary and The Cancer Society, on 10 January 1990 under the leadership of Dr Hamish Fraser, Radiologist with Nuclear Medicine training, and the sole charge MRT, Ron McNeil. Scans are done on both Nelson and Blenheim patients in the Nelson Marlborough region. The untimely death of Ron in early 1992 saw the department closed until Maureen Ellwood started in November 1992, after her move from Christchurch to Nelson. She has commuted to Blenheim 2 x 10 hour days per week, staying overnight in Blenheim. Dr Hamish Fraser moved to Christchurch in 2000 and continued reporting the scans until Dr Kevin Smidt took over in July 2001, until his retirement at the end of 2015. The department has outsourced scans since then, due to no licence holder. There has been 3 “not new” cameras, the last a dual head GE Millenium installed in 2009 (exChristchurch). Unfortunately in March 2015, one camera head failed irreparably, and scans were done with 1 camera head only. The NMDHB have made the decision to close the department and outsource all scans. Maureen retired on June 1 after 33 1/2 years, the first 10 years at Christchurch Hospital Nuclear Medicine, followed by an 11 year break and 3 children, before her family’s move to Nelson. Maureen has done a fantastic job at keeping this service running, and while we will miss her at branch and scientific meetings, we wish her well in a deserved retirement! NZ Branch
QUEENSLAND AT the end of 2015 we had our final meeting for the year which was for the Queensland Radpharm presentations. The meeting was sponsored by GMS – we extend our thanks for the sponsorship. The first meeting of 2016 was held at The Prince Charles Hospital in February. The meeting was sponsored by Gamma Gurus, we would like to extend our thanks for their generous sponsorship for the night. We had two speakers – Mark Whitby who spoke about radiation dose risks particularly pertaining to pregnant staff. Our other speaker was Dr John Blazak who spoke on the basics of MRI made easy. Both were very informative talks and we thank the speakers for their time. Our second meeting was held at the Princess Alexandra Hospital in May and we had two guest speakers. Mr Neil Hicks who is the Chair of the Medical Radiation Practice Board and he gave an overview of the Board’s past year and the new CPD requirements for practitioners. Our second speaker was Suzi McGavin who is the State 10 Gamma Gazette July 2016
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Wide Educator for Nuclear Medicine in Queensland Health. Suzi spoke on Learning and Teaching styles. Thanks to our two speakers. Our next meeting will be a half day seminar held in September with a location to be advised. It will be a Saturday morning so hopefully members can take this opportunity for accrue some CPD hours. We ask if anyone is interested in presenting a case study or talk at this seminar to please contact the Qld committee. I extend my thanks to the committee members James Turner, Louis Gray, Emma Snow, Rowena Reichel and Clare Radley for all their hard work. At the end of 2016, there will be several committee members stepping down from their positions. Likely vacant positions are Chairperson, Secretary and Treasurer. Would Queensland members please consider nominating for these positions as it is an important committee to keep going. Ms Melinda Wilson Chairperson
SOUTH AUSTRALIA THE SA Banch have held two meetings so far this year with myself settling into the new position as chair person. Both meetings were well attended. During our first meeting, we were introduced to the new Technologist Group which will be run by the Women’s and Children’s Hospital for the next two years. There have been some major staffing changes with the University of South Australia. We welcome former technologists into these new education roles. Students now have the opportunity to complete placement at SAHMRI, in order to gain some radiochemistry experience. The scientific meeting had some interesting cases on VQ spect/ct imaging for lobular quantitation for preoperative assessment which showed a promising new path for the role of nuclear medicine. Our second meeting was well attended considering the far location (Flinders Hospital). Daniel Badger, a representative from the Technical Standards and Radiation Safety Group brought up a few issues that have been discussed and resolved and encouraged each department to have a representative join the group. We heard reports that the AGM in rotorua was a massive success and was well attended by South Australian Technologists, doctors and physicists. The education report had big news for students. They now have the opportunity to complete rural placement in Ballarat, Mildura and Townsville, allowing them to meet the AHPRA rural requirements. The scientific meeting presented 131-I therapy and imaging cases, as well as a compilation of interesting cases. The technologist group had their first meeting which had strong attendance. The next meeting will be held on 21 September, focussing on thyroid protocol review with a bowling tournament to follow. The next scheduled ANZSNM Branch Meeting is 27 July at The Royal Adelaide Hospital. Brittany Martin ANZSNM SA Branch Chair Person
VICTORIA/TASMANIA SINCE the last branch report from January, 2016, the Victorian members of the Victorian Tasmanian ANZSNM committee have been busy organising a number of events which include pre and post conference meetings. Professor Wahl presented a talk on “ Defining Tumour Biology through quantitative Nuclear Medicine” at Peter MacCallum Cancer Institute on 18 April. Despite technical issues with the projector, the talk was very well received with 32 of the 48 people who sent an RSVP, attending. On 26 April, Professor Jadvar presented a talk on “Molecular Imaging and Endoradiotherapy of Prostate Cancer” at Austin Health. The presentation was excellent, although unfortunately only 21 people attended. This year a booth has been submitted to the 2016 Virtual Careers Expo. This is an exciting new concept that enables rural Victorian Secondary School students to investigate different career options in the format of an online virtual expo. We will be able to obtain statistics from the virtual expo to determine whether this platform is successful in promoting careers in Nuclear Medicine. The Committee has started organising Speakers for the Annual Day Seminar on Saturday 17 September at Crowne Plaza, Melbourne. I would like to sincerely thank the branch executive for all their support over the past twelve months. I am really grateful and would like to publically acknowledge their incredibly hard work, commitment and efforts in ensuring Victorian and Tasmanian ANZSNM members have access to interesting and useful professional development activities. Due to other commitments, I am unable to fill the position of the Branch Chair from June 2016. At this stage the position has not been filled and is open to interested members. Dr Mary-Anne Keady Victoria/Tasmania Branch Chair
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WESTERN AUSTRALIA SINCE the beginning of the year, the WA Branch has had three meetings, all well attended with excellent speakers. PRC hosted the first meeting of the year, with Dr Mike McCarthy and Dr Terry Hung presenting. Our pre-conference meeting was held at SKG and featured presentations from Dr Nelson Loh and Mr Pete Tually. On the Tuesday following the ANZSNM ASM we hosted Professor Mariani from the University of Pisa, who gave an insightful presentation entitled “Changing Paradigms in Radioguided Surgery”. Thank you to everyone who has taken the time to present to the branch so far this year. Our next meeting is due to be held at Princess Margaret Hospital. Once again we expect to have a number of excellent speakers, including our recent Radpharm entrant at the Rotorua conference, Julie Crouch. The WA Branch is hard at work preparing for our annual workshop, to be held on Saturday 6 August. We have invited speakers from WA and interstate to present at our Head and Neck Workshop at the University Club of UWA. We expect to have a great turnout again this year. The program for the workshop will be posted to the ANZSNM website once it is finalised and we encourage everyone from both WA and interstate to attend. Stephanie O’Donnell WA Branch Treasurer
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Special Interest Group News RADIOPHARMACEUTICAL SCIENCE SIG Executive and Reps As of the ASM in Rotorua, the new SIG Executive for the next 12 months is: New Chairperson: Dr Giancarlo Pascali (ANSTO) Secretary: Immediate Past Chair: Dr Douglas Smyth (SAHMRI) The SAP Rep: Chair Elect: Mr Divesh Kumar (Fiona Stanley)
Mr Gordon Chan (Austin) Prof Vijay Kumar (Westmead)
ACPSEM Certification of Radiopharmaceutical Scientists Guidelines have been approved by the Professional Standards Board (PSB) of the ACPSEM for RPS to apply to be on the register of RPSs. A Certification panel of 7 members has been convened. Assessment criteria for certification of RPS with more than 7 years experience finalised including assessment criteria and submitted to PSB for approval. TEAP program in final draft form. Macquarie University Masters Program in Radiopharmaceutical Science The Masters Program is hoped to help address shortage of trained workforce in radiopharmaceutical science. Currently 6 students are enrolled. Further work towards making this program available to distance students is underway. Potential for Masters by Research to become available. NSW Ministry of Health has 20 scholarships over 5 years available for the Macquarie Masters course. RPS SIG Communications A new email account rps@anzsnm.org.au has been created but is not maintained with a list of current ANZSNM members. It is hoped this will be managed by the Secretariat soon. A LinkedIn group has been created – contact Melissa Latter (melissa.latter@health.qld.gov.au) if you wish to join. New Shimadzu Australasia Award Shimadzu Australasia have agreed to sponsor a new award for best RPS paper presented at the 2017 ASM. Award details and conditions to be finalised shortly. Doug Smythe TECHNICAL STANDARDS COMMITTEE REPORT The Technical Standards Committee (TSC) currently has five projects on the go, some more active than others, but all of importance. Back in 2013 the ANZSNM Federal Council approved a “Minimum Quality Control Schedule for Gamma Cameras”. In this document was the statement ‘A separate technical guidance document is available that provides information on the way in which the QC tests may be performed’. This was issued with the expectation that the supporting guidance document would be prepared by the time the schedule was ratified by the Council. However, since that time it has remained in draft and I have received a number of inquiries about this from members. There are a number of compounding reasons for the document not being issued yet, including the challenge of writing a generalised document without system-specific nuances. We are currently negotiating with Siemens and GE regarding some guidelines on implementing the QC schedule on their systems. We hope Insight/Philips will also join us to represent their customers. Once this is done, we will be in a better position to issue the guidance document. With regards to the other projects, keep a watch out for upcoming documents on the minimum quality control of dose calibrators, recommendations on paediatric administered activities, and the in-house production of radiopharmaceuticals. These documents will all be released once the respective working parties have made their recommendations to the Federal Council. The working party that needs some help at present is the one looking at software quality assurance. This working party has developed a great online tool for the collection and presentation of audit results for clinical processing. It also includes a self-assessment function whereby you can download and process images and compare your analysis results with established values. This audit/education software is 90% ready and the other 10% will require the drive from a clinical project with both a desired outcome and planned patience to debug the last of the functionality. So we are looking for a suitable project that people will engage in. One suggestion is implementation of the SNMMI analysis guidelines for gastric emptying. If you support this idea or have others you would like to recommend, please contact Darin O’Keeffe (darin.okeeffe@cdhb.health.nz). Participation in the TSC and working parties is a voluntary and often thankless task. I would like to take this opportunity to thank all the TSC members and non-TSC working party participants for the great work they have done and continue to do. Much appreciated! Darin O’Keeffe Technical Standards Committee Chairperson
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ANZSNM Research Grant Award 2016 IT IS with pleasure that I can announce that the ANZSNM Research Grant for 2016 has been awarded to Nicholas Forwood of the Royal North Shore Hospital (RNSH) in Sydney for a project entitled “In Vitro Studies of Cell Survival Comparing External Beam Radiotherapy to Radionuclides”. The award is for up to $20,000 for one year. Nicholas is a physicist in the Department of Nuclear Medicine at RNSH and a doctoral candidate in the Faculty of Health Sciences at the University of Sydney working on a project to develop accurate calibration & dosimetry measurements with 90Y. The aims of the project from the application are: Primary - to derive cell survival curves and fit radiobiology parameters (from the linear quadratic model: α, β, α/β) for both external beam irradiation and 90Y radionuclide irradiation of in vitro cell lines specific to colorectal carcinoma, in order to assess differences in treatment derived absorbed dose and biological effective dose values, and, Secondary - to compare cell kill mechanisms between the two irradiation processes. As nuclear medicine is being increasingly used to introduce new radionuclide therapies which may be used in conjunction with prior or subsequent external beam radiotherapy this project was judged as having significant merit. We congratulate Nicholas and look forward to hearing the results of the research at a future meeting of the Society. From this year the award will become the ANSTO/ANZSNM Research Award with significant support coming from ANSTO. Keep an eye out for the upcoming call for applications for the 2017 award in future editions of the Gamma Gazette. Vijay Kumar PhD Research Award Co-ordinator ANZSNM Scientific Advisory Panel
ANZSNM ASM Award Entry Members please remmber that The Award Rules state that you need to be a financial member of the ANZSNM for six months prior to the ANZSNM Annual Scientific Meeting to be considered for an award.
14 Gamma Gazette July 2016
Answer on page 24
What’s that?
Image 2: Patient’s 68Gallium-PSMA Scan.
Image 1: Normal biodistribution of 68 Gallium-PSMA. Clinical history A 62-year-old male with known metastatic prostate cancer and a PSA level of 500 ng/mL was referred for a 68Gallium-PSMA PET/CT scan to evaluate the extent of the disease. The patient was intravenously injected with 157 MBq of 68Gallium-PSMA and was scanned from vertex to mid thigh after a 47 minute uptake period. Introduction Human PSMA expression can be found in a variety of normal tissue; brain, salivary glands, breast, liver, oesophagus, stomach, small intestine, colon, adrenal glands, kidney, ovary, fallopian tube, testis, bladder and prostate.1,2 Prostate cancer cells show a significantly increased expression of PSMA in comparison to these tissues. The normal biodistribution of 68Gallium-PSMA often demonstrates intense radiotracer uptake within the salivary glands, kidneys and bladder, as well as moderate uptake in the lacrimal glands, nasal mucosa, liver, spleen, bowel and prostate gland.2 In this patient’s case, the PET/CT scan showed abnormal 68Gallium-PSMA uptake in the skull, ribs, cervical, thoracic and lumbar spine. Additionally, there is unusual uptake within the pelvic bones and the left femur.
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Inviting applications for
ANSTO/ANZSNM Research Grant 2017 Closing date: October 7, 2016 to commence in 2017 For further information on Research Grant conditions & applications visit www.anzsnm.org.au/resources/awards-grants ANSTO and the ANZSNM (“the Society”) are pleased to offer a competitive grant aimed at encouraging research in nuclear medicine in Australia and New Zealand. The grant is up to the value of $20,000 and is expected to run for approximately one year. ANSTO is Australia’s government-funded nuclear science organisation. Its vision is to deliver excellence in innovation, insight, and discovery through its people, partnerships, nuclear expertise and landmark infrastructure. In assessing applications for the grant, preference will be given to early career researchers in order to provide seed funding for pilot investigations that could lead on to further grant applications. The grant will be offered yearly but the evaluating committee reserves the right to not award the grant if there is no suitable application.
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All aspects of nuclear medicine will be considered for this grant including, but not restricted to: novel developments in radiopharmaceuticals; hardware and software innovation; epidemiology and audit activities; pilot clinical trials; retrospective studies on outcomes in diagnostic and therapeutic procedures in nuclear medicine; education, training and professional development activities.
The ANSTO/ANZSNM Research Grant is intended to achieve one or more of the following: 1. Approach a meaningful conclusion in one year; 2. Assist investigators striving to establish new programs or new directions; 3. Fund initial exploratory research for which external funding will be sought subsequently; 4. Address circumscribed clinical problems of a sort unlikely to attract industry funding; 5. Survey groups of patients to assess the success rate, sequelae, safety or any other aspect of diagnostic or radionuclide therapy protocols; 6. Bridge the gap of a year between completion of one external grant and the commencement of another. The evaluating committee will consist of one representative from ANSTO, one member of the Society’s Scientific Advisory Panel and the ANZSNM President or their delegate. The successful applicant/team is expected to acknowledge ANSTO’s and the Society’s support in any publications and provide a report to be published in the Gamma Gazette upon completion. The applicant will ideally present the outcome(s) of the research at the next ANZSNM ASM.
Prof Vijay Kumar PhD Member, Scientific Advisory Pane AZNSNM
16 Gamma Gazette July 2016
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Australian and New Zealand Society of Nuclear Medicine 2016 Annual General Meeting Minutes Date: Sunday April 24, 2016 Time: 1:05 PM Location: Bay Trust Forum, Energy Events Centre, Rotorua, NZ 1. Attendance Ninety four members were present which under the Constitution was a quorum. Evidence of these attendees was by way of sign in sheets maintained by the Secretariat. 2. Apologies There were no apologies received. 3. Confirmation of Minutes of the 2015 Annual General Meeting The minutes of the previous AGM at the Plaza Auditorium, Brisbane Convention Centre, Brisbane on 19th April, 2015 were accepted as a true record. 4. Business arising from the Minutes No items were raised. 5. President’s Report from the Council 2015/16 The President Vijay Kumar made a presentation and reported on matters including: • Current composition of Council, Executive and the Secretariat. • A successful 2016 ASM in Rotorua with a vote of thanks to the organising committee. • Current Strategic Plan and its planned review in 2017/18. • Regular Branch meetings around the country and a thanks to all Branch Committees. • The continuing activities of all Special Interest Groups (TSIG, Physics, Radio- pharmaceuticals and Technical Standards) including yearly symposia and the development of new professional standards. • Scientific Advisory Panel which was assisting the Local Organising Committees of all Annual Conferences with their scientific programmes. • ARTNet including the winning of a grant of $1.3 million from the Prostate Cancer Foundation to fund a trial of PSMA. In response to a question from Dr Dinesh Sivaratnam about support for nuclear medicine procedures in cardiology in the light of the MBS review, Dr Bill MacDonald outlined what the AANMS had done and Dr Dale Bailey requested that he write to the ANZSNM Secretariat in more detail about the issue and expected outcomes. Daniel Badger corrected a detail from the President’s report to say that the 2017 Physics Symposium would be in Sydney. There were no further points of discussion. 6. Treasurer’s Report – Dominic Mensforth A summary of the audited accounts for 2015 was visually presented and compared to 2014 which showed a deficit of $3,200; the full accounts were available on the ANZSNM website. A deficit of $55,000 is likely to be incurred in a budget for the current financial year 2016 due to lower but expected conference revenues and was always dictated by this and member numbers. The aim was to continue to achieve a balanced budget in 18 Gamma Gazette July 2016
2-3 years with the assistance of regular surpluses from annual conferences including the one in 2018. Membership fees will remain the same in 2017. There were no matters raised for discussion. 7. Changes to Constitution – Dale Bailey It was noted that the proposed changes to the Constitution had been previously circulated to the membership. Dale Bailey verbally summarised the changes and the various reasons and categories that he had classified them in. Overall, the changes were related to bringing the Constitution up to date with gender neutral references and to make processes more efficient such as life memberships and budgets. It was resolved that the: special motion as circulated, “That all of the changes to the Society’s constitution recommended by Federal Council be approved” moved by Dr Bill McDonald, seconded by Ms Clare Radley was carried unanimously. 8. Future meetings – Vijay Kumar invited various convenors to podium i. 2017 Hobart Dr Barry Elison reported that the 2017 meeting would be two and a half days and the present international speakers would include Sally Barrington & Leslie Shaw. A short video was shown of the tourist attractions in Hobart. ii. 2018 WFNMB Prof Andrew Scott first described the activities of the World Federation which was the peak body in nuclear medicine and currently led by himself, Sze Ting Lee and Vijay Kumar. The 2018 Congress would take place in Melbourne from April 20-24 2018 and 2000 delegates were expected. Conjoint programs would operate for a number of organisations including ANZSNM and there would be a Post-congress meeting in Cairns. iii. The 2019 and 2020 meetings would take place in Perth and Sydney respectively. Federal Council Three members were retiring from Council; these were Sharon Mosley, Doug Smyth and Sam Berlangieri and the President thanked them for their services. New council members Giancarlo Pascali as Chair of the Radiopharmaceuticals SIG and Paul Roach as AANMS representative were welcomed to Council. There was to be a change in the Presidency and Vice Presidency with Dale Bailey and Ros Francis taking over from the end of the meeting. Business without notice In response to a question about the changes to the calendar of annual meetings Dale Bailey responded that ASMs will be located in the eastern states every 2 out of 3 years with the 3rd year location being elsewhere at smaller venues. There were no further items for business without notice. The meeting was closed at 1400. Vijay Kumar President
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
23 July 8th Annual TSIG Symposium National Press Club, Canberra, ACT 27 July 2016 HIRF Oncology Symposium UQCCR Auditorium Queensland 27 July South Australia Branch Meeting The Royal Adelaide Hospital, SA 6 August WA Head and Neck workshop University Club of Western Australia 26-27 August 2016 International Molecular Imaging Symposium SAHMRI Auditorium North Terrace, Adelaide, South Australia
September Queensland Half Day Seminar 31 October - 4 November Interregional Training Course on Targeted Radionuclide Therapies, under the framework of TC Project INT/6/056 - Supporting Quality Management Audits in Nuclear Medicine Practices (QUANUM) Houston, Texas, USA Contact: ANSTO International Liaison office international.liaison@ansto.gov.au 7-9 November 4th Theranostics World Congress 2016 Melbourne Convention and Exhibition Centre Melbourne, Australia 27 November – 2 December RSNA 102nd Scientific Assembly & Annual Meeting Chicago, USA
6 August WA Annual Workshop University Club of Western Australia
2017
3-4 September New Zealand Branch Meeting Christchurch, NZ
20 – 24 April 2017 ANZSNM Annual Scientific Meeting Hobart, Tasmania, Australia
17 September Victorian Annual Day Seminar Crowne Plaza, Melbourne
2018
21 September SA Technologist Group Meeting Thyroid Protocol review followed by a bowling tournament
20 – 24 April 2018 WFNMB 2018 Congress Melbourne, Australia
VACANCIES IN NUCLEAR MEDICINE The advertising of vacancies is generally a free of charge service provided to members of the ANZSNM. All vacancies should be authorised by the Chief Technologist (who should be current financial members of the Society) for placement on the website and distribution to members. Please email Secretariat secretariat@anzsnm.org.au for the next placement of your vacancy.
www.anzsnm.org.au/professional-development/vacancies-in-nuclear-medicine
Financial statements presented to the 2015 AGM of – Australian and New Zealand Society of Nuclear Medicine Limited
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A full financial report is available on the ANZSNM website anzsnm.org.au 21
What you missed at Rotorua! Sue O’Malley, Co-convenor for the 46th ANZSNM ASM 358 people registered for this event. It was held in Rotorua with the glorious autumn colours tinged with gentle earthly scent to remind of us our title: Hot Science: An Eruption of Isotopes. This is the last time the scientific meeting is structured over Saturday to Monday. The format of this meeting was changed to allow the Welcome Event to take place on the Friday night with a formal Powhiri, which was fitting in the Rotorua Events Centre. This year, the Pre conference Symposium was wait listed. It was an early start for all those attending with a 7am bus departure from the main hotels, with an hour long journey to Lake Taupo. The meeting was centred on Quantitation in PET for the morning session and Quantitation in SPECT for the afternoon session. En route back, the bus stopped at local sight Craters of the Moon a natural geothermal spot to wander round and take in the sight and smells. The 4 international invited speakers provided learned and contemporary presentations. Their backgrounds reflected the balance we were seeking reflecting an appetite for both SPECT and PET for scientists, physicians and technologists. We tried hard to have something of interest for everyone. We know there is tremendous expertise on our doorstep. We are able to harness some of the talent with 12 Australasian speakers. With each meeting, the fiscal purse is tighter. We were fortunate in securing good sponsorship but had to work hard to cut
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costs where possible. Our LOC came up with the Green image to reduce costs on printing by going essentially paperless, eliminating satchels / bags and trimming down meals at the conference. This may be such a close thing in the large Australian centres where they are more assured of a large turnout. However 900 great NZ coffees were consumed over this meeting. Often the success of these meetings falls on the quality of the social events. Rotorua did not disappoint. The cultural stirrings with the Powhiri set the scene and honoured the local tribe. The Saturday night party in the Redwoods was an all inclusive event set in the cool open air with loads of easy great food and great NZ wine. It was a memorable night for most. The Sunday night Awards ceremony was a black affair in colour only, it was themed like a grotto with small Punga ferns at
each table. The local entertainment was cheeky and cheerful. It again highlighted the local Maori culture in its raw and honest state. For some who made the trip by bus, some elected to go via Hobbiton. This was a bonus that we had not considered until direct international travel to Rotorua was discontinued. The door to door service was a great way to arrive at the conference centre. As with all of these meetings, there is tremendous work by the LOC and PCO. I want to acknowledge the time and effort put into this event by them and for all of you who made it happen because you came. THANK YOU. LOC: Scientific Committee: Drs Darin O’Keeffe, Sue O’Malley, Justin Williamson Social Committee: Victoria Brooks, Prue Lamerton, Lynda Murray PCO: Outshine with Jo Kelk, Jill Schirnack and Joanne Butler
2016 ASM Award Winners Mallinckrodt Award
GMS Poster Award
Radpharm Award
Gammasonics Abstract Award
ANSTO Award
AANMS Registrar Research Award
Sarah Stephenson Lisa MacFarlane Michael Hofman
Clayton Frater Andrew Scott
David Nadebaum
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From page 15
What’s that? ... answer
Discussion The abnormal 68Gallium-PSMA PET/CT scan appearance was correlated with a bone scan that was performed two months prior. Uptake in the skull, ribs, and throughout the spine were all identified as areas of metastatic disease. After reviewing the bone scan, it was also evident that this patient has Paget’s disease in the pelvic bones and left femur, but why does 68Gallium-PSMA uptake occur? The mechanism of uptake isn’t clear though the literature surrounding this explores two theories.3,4,5 1. Increased radiotracer delivery from hyperaemia 2. Over expression of PSMA in endothelial cells of the neovasculature in Paget’s disease The literature discusses both theories as equal possibilities and further investigations are required to confirm each of them. If the former theory is accurate, patients with underlying hyperaemic pathologies may exhibit false-positive uptake on 68Gallium-PSMA PET/CT scans.
Rt Anterior Lt
Lt Posterior Rt
Image 3: Comparison of 68Gallium-PSMA PET/CT scan and the nuclear medicine bone scan.
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24 Gamma Gazette July 2016
What’s that? ... answer
continued
Image 4: 68Gallium-PSMA PET/CT images.
Conclusion Paget’s disease demonstrates high avidity for 68Gallium-PSMA, the reason for which can be attributed to two theories, and as result will alter the normal biodistribution of the radiopharmaceutical. This case highlights the importance of obtaining a comprehensive clinical history and reviewing previous imaging for all patients, particularly in light of altered or abnormal biodistribution of the radiopharmaceutical. References 1. Kinoshita, Y, Kuratsukuri, K, Landas, S, Imaida, K, Rovito, PM, Wang, CY & Haas, GP 2006, ‘Expression of prostate-specific membrane antigen in normal and malignant human tissues’, World Journal of Surgery, vol. 30, no. 4, pp. 628-636. 2. Afshar-Oromieh, A, Malcher, A, Eder, M, Eisenhut, M, Linhart, HG, Hadaschik, BA, Holland-Letz, T, Giesel, FL, Kratochwil, C, Haufe, S, Haberkorn, U & Zechmann, CM 2013, ‘PET imaging with a [68Ga] gallium-labelled PSMA ligand for the diagnosis of prostate cancer: biodistribution in humans and first evaluation of tumour lesions’, European Journal of Nuclear Medicine and Molecular Imaging, vol. 40, no. 4, pp. 486-495. 3. Artigas, C, Alexiou, J, Garcia, C, Wimana, Z, Otte, FX, Gil, T, Velthoven, R & Flamen, P 2016, ‘Paget bone disease demonstrated on 68Ga-PSMA ligand PET/CT’, European Journal of Nuclear Medicine and Molecular Imaging, vol. 43, no. 1, pp. 195-196. 4. Rowe, SP, Deville, C, Paller, C, Cho, SY, Fishman, EK, Pomper, MG, Ross, AE & Gorin, MA 2015, ‘Uptake of 18F-DCFPyL in paget’s disease of bone, an important potential pitfall in clinical interpretation of PSMA PET studies’, Tomography, vol. 1, no. 2, pp. 81-84. 5. Chang, SS, Reuter, VE, Heston, WDW, Bander, NH, Grauer, LS & Gaudin, PB 1999, ‘Five different anti-prostate-specific membrane antigen (PSMA) antibodies confirm PSMA expression in tumourassociated neovasculature’, Cancer Research, vol. 59, no. 13, pp. 3192-3198.
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F R A C T U R E I P H B T M D P L A N A R E P A K T I O S T E O B L A S T N S T N I L P S N H I S E P O T X A O A C T C G D T A S R A E I N T A N T C C R V A H N S E M A M Y U N A C S R E P U S O P L S S I A C E A F E I T T R R R N T E I A A O I N O S C E B R H N O T M H C E U I T E T R S P E C T A R T S E A O S T E O M Y E L I T I S
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Case Study
Abnormal myocardial uptake in bone scan Sarah Gales Qscan, Queensland
ANTERIOR
ANTERIOR
Experience has shown that extra osseous findings a bone scans fall into three main categories. Technical issues, urinary tract related or other pathology. This case looks at unexpected myocardial activity in a routine bone scan. A 71-year-old male presented for a bone scan to investigate possible facet joint arthropathy of the cervical spine. A typical bone scanning protocol was followed with early and delayed imaging using 99mTc HDP. Note there is moderately increased, diffuse tracer uptake throughout the myocardium of the left ventricle. It is noteworthy that the left ventricular myocardium was of normal morphology on a prior CT scan from December 2009. Myocardial uptake on bone scans has been described in long-standing congestive heart failure, myocardial infarction, pericarditis, amyloidosis, unstable angina, and postresuscitation or cardioversion.1 The amyloidoses comprise a collection of disorders in which proteins, some native and some mutated, are deposited in tissues. These proteins self-assemble themselves to form an ordered fibrillar matrix termed amyloid2 In the case of senile amyloidosis this is caused deposits of normal transthyretin (TTR) in the heart and other tissues. The exact mechanism by which bone imaging agents accumulate within amyloid is not known. The extracellular deposition of amyloid is thought to increase the local level of calcium and subsequently increase the affinity for bone-seeking agents at the sites of amyloid deposition.3 Senile amyloidosis is a slowly progressive disease that affects the hearts of elderly men. It may be one of the commonest forms of cardiac amyloidosis, but the diagnosis is often missed, either because the physician is unaware of the disease or because symptoms are attributed to other forms of heart disease.4 Impaired heart function caused by amyloid deposition often results in congestive heart failure and can be associated with congestion in the lungs and liver. The first sign of amyloidosis in the heart is occasionally a pressure or dull pain in the chest
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POSTERIOR
POSTERIOR
during exertion or angina. Most cases of angina are due to the blockage of one or more major arteries of the heart due to cholesterol deposits and are unrelated to amyloidosis. Cholesterol blockages can be detected on an angiogram. Amyloid deposits, however, tend to narrow the very small vessels of the heart, which are not seen on an angiogram. Careful measurement of the pressure in the left ventricle at the time of the test may show subtle elevations that suggest that there is indeed an abnormality present. An abnormally slow heart rate occasionally occurs due to amyloid’s effect on the electrical system of the heart. Unusually low complexes on an electrocardiogram in association with thick heart walls seen on echocardiogram are common clues to the existence of the disease.(4) A CT angiography was performed a month later and demonstrated a marked ectasia of the visualised descending thoracic aorta. There was at least mild concentric LV hypertrophy raising the possibility of hypertensive heart disease with a mild burden of coronary artery disease. No potential flow limiting lesion was identified.
References 1. Silberstein EB, Elgazzar AH, Fernandez-Ulloa M, Nishiyama H. Skeletal scintigraphy in non-neoplastic osseous disorders. Henkin RE, Bloes MA, Dillehay GL, et al. Nuclear Medicine. St Louis, Mo: Mosby, 1996; 1141-1197. 2. Simon Dubrey, Amyloid heart disease, Br J Cardiol 2009;16:36413 3. Fard-Esfehani A, Assadi M. Myocardial Tc-99m MDP Uptake on the Bone Scintigraphy in the Hemodialysis-Associated Amyliodosis (an incidental finding). Alasbimn Journal. 2005; 8(30): AJ30-7. 4. www.brighamandwomens.org/Departments_and_Services/ medicine/services/cvcenter/Amyloidosis/patients.aspx
2014 and 2015 Australian Nuclear Medicine Traceability Program B. Howe, T.W. Jackson, W.M. van Wyngaardt, M.L. Smith, M.I. Reinhard Australian Nuclear Science and Technology Organisation (ANSTO)
Abstract The accuracy of radiopharmaceutical doses administered to patients is an important consideration for nuclear medicine practices. Measurement accuracy is underpinned by comparison and calibration of radionuclide dose calibrators with certified reference materials traceable to a national standard. In Australia, national standards for the activity of radionuclides are developed, maintained and disseminated by ANSTO. ANSTO developed the Australian Nuclear Medicine Traceability Program (ANMTP) in consultation with the Australian and New Zealand Society of Nuclear Medicine (ANZSNM). Participants registered in the program receive a dose calibrator measurement assessment and a calibration if required. Assessments are performed using Australian Certified Reference Materials (ACRMs) for the most commonly used radiopharmaceuticals. Tc-99m and I-131 ACRMs were provided to ANMTP participants in 2014 and 2015 and Ga-67 was added to the program in 2015. The majority of dose calibrator measurement results agreed with the activity values of the ACRMs within the associated uncertainties, however several dose calibrators were found to be operating outside the ANSI Standard specification of ± 10% of the stated activity. The calibration factors of these dose calibrators were adjusted so that their measurements were accurately correlated with the ACRM activity and the Australian standard. National dose calibrator measurement data collected under ANMTP allows analysis and reporting of the accuracy of dose calibrators around Australia. Identification and subsequent calibration of dose calibrators operating outside of the accepted specifications can reduce the potential for misadministration, and certified traceability for dose calibrator measurements can assist nuclear medicine practices in satisfying relevant regulatory compliance obligations. Keywords: Radionuclide metrology, traceability, calibration, measurement, standards, Becquerel
Introduction Calibration of dose calibrators should be traceable to a national standard and annual accuracy testing is recommended in the ARPANSA Safety Guide to Radiation Protection in Nuclear Medicine.1 The Australian standard for the activity of radionuclides is maintained by ANSTO. ANSTO is appointed as a Verifying Authority by the National Measurement Institute (NMI) and is authorised to maintain Australia’s radioactivity standards on behalf of the Chief Metrologist under the National Measurement Act 1960. ANSTO is also appointed as a Certifying Authority under the National Measurement Regulations 1999 and produces Australian Certified Reference Materials (ACRMs) which are directly traceable to the Australian primary standard of radioactivity. ANSTO verifies radioactivity standards through formal comparisons administered by the international radionuclide metrology community of which ANSTO is a member. The ANZSNM Technical Standards Committee (TSC) undertook national dose calibrator surveys between 1991 and 2009. The purpose of these surveys was to provide national data on the accuracy and reproducibility of dose calibrators and to provide an opportunity for calibration of the dose calibrators if required.2 As stated in the ANSI Standard for Calibration and Usage of “Dose Calibrator” Ionization Chambers for the Assay of Radionuclides, measurements should be accurate to within 10% and reproducible to within 5%.3 These specifications have been
used informally by ANZSNM for some time, and the 10% accuracy limitation is reiterated in the Guidelines for the Administration of Diagnostic and Therapeutic Radiopharmaceuticals adopted by the NSW Radiation Advisory Council in 2000.4 ANSTO developed ANMTP in consultation with the TSC in order to carry on this function. A pilot program was completed in 2013 by ANSTO and ANZSNM and ANMTP was launched in late 2014. ANSTO runs the program annually, offering a rotating schedule of the most commonly used medical radionuclides to nuclear medicine practices all over Australia.
Method ACRMs were produced and distributed by ANSTO. The following ACRMs with nominal activities were available under ANMTP: 2014 Tc-99m 600 MBq ± 3.0% (k=2) I-131 600 MBq ± 2.4% (k=2) 2015 Tc-99m 600 MBq ± 3.0% (k=2) I-131 600 MBq ± 2.4% (k=2) Ga-67 325 MBq ± 3.0% (k=2)
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2014 and 2015 Australian Nuclear Medicine Traceability Program
Figure 1. Distribution of discrepancies between Tc-99m ACRM activities and dose calibrator measurements in 2014.
Figure 2: Distribution of discrepancies between Tc-99m ACRM activities and dose calibrator measurements in 2015.
Figure 3: Distribution of discrepancies between I-131 ACRM activities and dose calibrator measurements in 2014.
Figure 4: Distribution of discrepancies between I-131 ACRM activities and dose calibrator measurements in 2015.
Figure 5: Distribution of discrepancies between Ga-67 ACRM activities and dose calibrator measurements in 2015.
Radionuclide Metrologists from ANSTO’s Activity Standards Laboratory (ASL) attended nuclear medicine practices around Australia to perform measurement assessments of their dose calibrators using ACRMs. 16 practices participated in ANMTP in 2014 and 15 participated in 2015. 24 dose calibrators were
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assessed in 2014 and 22 were assessed in 2015. Uptake of the available ACRMs varied according to the work undertaken at each practice. The ACRMs were measured ten times in each dose calibrator and the activity response of the dose calibrator was compared against the activity of the ACRM. A further ten measurements were taken, removing and replacing the ACRM between each measurement. Background measurements were subtracted from the readings. Dose calibrators displaying measurement discrepancies approaching or exceeding Âą 10% of the ACRM activity were calibrated by ANSTO Radionuclide Metrologists at the discretion of the Chief Technologist of the practice. The calibration factor for the radionuclide in question was adjusted on these dose calibrators so that the discrepancy was reduced to < 1%. Activity measurements were recorded on a tablet computer with a dedicated ANMTP app developed by ANSTO. The ANMTP app performs real-time comparisons between the ACRM activity and the dose calibrator measured activity and presents any discrepancy as a percentage. This eliminates the need for manual calculation and decay correction by the operator, reducing the risk of error. Data collected by the app is synced with the ANSTO
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2014 and 2015 Australian Nuclear Medicine Traceability Program
server at regular intervals for secure data storage and to prevent data loss caused by malfunction or damage to the tablet.
Results and Discussion Figures 1 and 2 display the results for measurements performed using Tc-99m ACRMs in 2014 and 2015. Over 90% of the dose calibrators assessed in both years were found to be within ± 5% of the ACRM activity. None exceeded the ANSI Standard specification of ± 10%. Three dose calibrators which showed a measurement discrepancy greater than 5% were calibrated at the request of the Chief Technologists. Figures 3 and 4 display the results for measurements performed using I-131 ACRMs in 2014 and 2015. 71% of dose calibrators in 2014 and 86% of dose calibrators in 2015 were within ± 5% of the ACRM activity. 96% of dose calibrators in 2014 and 95% of dose calibrators in 2015 were within ± 10% of the ACRM activity. In each year, one dose calibrator was found to have a discrepancy exceeding ± 10% of the ACRM activity, with the largest being -15.6%. Both dose calibrators were calibrated, and an additional 3 dose calibrators were calibrated at the request of the Chief Technologists as they displayed discrepancies that were approaching 10%. A systematic offset was observed in the results of the I-131 measurements. Every dose calibrator measurement result demonstrated a negative discrepancy, indicating that all dose calibrators assessed were measuring a lower value than the ACRM activity. ANSTO’s primary standard for I-131 was internationally verified in 2009 through a formal comparison exercise conducted by the Asia Pacific Metrology Programme.5 ANSTO will continue to monitor this trend over time. Figure 5 displays the results for measurements performed using Ga-67 ACRMs in 2015. 88% of the dose calibrators assessed were found to be within ± 5% of the ACRM activity. One exceeded the ANSI Standard specification of ± 10% and
was calibrated. All of the dose calibrators examined demonstrated reproducibility within the ANSI Standard of 5%. Participants in ANMTP are provided with a measurement report for each dose calibrator presented for assessment. A certificate of traceability is also issued for each dose calibrator. This certificate establishes traceability to the Australian standard of radioactivity, satisfying the relevant regulatory guidelines for accuracy testing of dose calibrators in terms of technical and legal requirements which may apply. Anonymised dose calibrator measurement data collected and reported under ANMTP will be communicated to the nuclear medicine community following completion of the program annually. ANMTP is currently available across Australia in both metropolitan areas and regional centres. ANSTO intends to offer the service in New Zealand in future in consultation with New Zealand authorities.
References 1. ARPANSA, Safety Guide for Radiation Protection in Nuclear Medicine, Radiation Protection Series No. 14.2, 2008 2. Smart, R. 2009 Australian Radionuclide Dose Calibrator Survey. ANZ Nuclear Medicine, Vol. 41. No. 3, Sep 2010 3. American National Standard: Calibration and usage of “dose calibrator” ionization chambers for the assay of radionuclides. ANSI N42.13-2004 4. Joint Working Party of the NSW Branch of ANZSNM and HURSOG, Proposed guidelines for the administration of diagnostic therapeutic radiopharmaceuticals. ANZ Nuclear Medicine, Vol. 30, No. 2, 1999 5. Yunoki, A. et al. APMP comparison of activity measurements c) of I-131 (APMP.RI(II)-K2.I-131). Metrologia 50, 2013, Tech. Suppl. Series 06022
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