INTRODUCTION: Nuclear medicine has a crucial role in interventional strategies where a combination between the increasing use of targeted radiotracers and intraprocedural detection modalities... Show moreINTRODUCTION: Nuclear medicine has a crucial role in interventional strategies where a combination between the increasing use of targeted radiotracers and intraprocedural detection modalities enable novel, but often complex, targeted procedures in both the fields of interventional radiology and surgery. 3D navigation approaches could assist the interventional radiologist or surgeon in such complex procedures.EVIDENCE ACQUISITION: This review aimed to provide a comprehensive overview of the current application of computer-assisted navigation strategies based on nuclear imaging to assist in interventional radiology and image-guided surgery. This work starts with a brief overview of the typical navigation workflow from a technical perspective, which is followed by the different clinical applications organized based on their anatomical organ of interest.EVIDENCE SYNTHESIS: Although many studies have proven the feasibility of PET- and SPECT-based navigation strategies for various clinical applications in both interventional radiology and surgery, the strategies are spread widely in both navigation workflows and clinical indications, evaluated in small patient groups. Hence, no golden standard has yet been established.CONCLUSIONS: Despite that the clinical outcome is yet to be determined in large patient cohorts, navigation seems to be a promising technology to translate nuclear medicine findings, provided by PET- and SPECT-based molecular imaging, to the intervention and operating room. Interventional Nuclear Medicine (iNM) has an exciting future to come using both PET- and SPECT-based navigation. Show less
In locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional... Show moreIn locally or locally advanced solid tumors, surgery still remains a fundamental treatment method. However, conservative resection is associated with high collateral damage and functional limitations of the patient. Furthermore, the presence of residual tumor tissue following conservative surgical treatment is currently a common cause of locally recurrent cancer or of distant metastases. Reliable intraoperative detection of small cancerous tissue would allow surgeons to selectively resect malignant areas: this task can be achieved by means of image-guided surgery, such as beta radioguided surgery (RGS). In this paper, a comprehensive review of beta RGS is given, starting from the physical .principles that differentiate beta from gamma radiation, that already has its place in current surgical practice. Also, the recent clinical feasibility of using Cerenkov radiation is discussed. Despite being first proposed several decades ago, only in the last years a remarkable interest in beta RGS has been observed, probably driven by the diffusion of PET radiotracers. Today several different approaches are being pursued to assess the effectiveness of such a technique, including both beta+ and beta- emitting radiophannaceuticals. Beta RGS shows some peculiarities that can present it as a very promising complementary technique to standard procedures. Good results are being obtained in several tests, both ex vivo and in vivo. This might however be the time to initiate the trials to demonstrate the real clinical value of these technologies with seemingly clear potential. Show less
Wurnschimmel, C.; Wenzel, M.; Maurer, T.; Valdes Olmos, R.A.; Vidal-Sicart, S. 2021
Recent technical advances and implementation of novel radiotracers have further increased the potential of radioguided surgery for a broad variety of malignancies. Indeed, the possibilities for... Show moreRecent technical advances and implementation of novel radiotracers have further increased the potential of radioguided surgery for a broad variety of malignancies. Indeed, the possibilities for future applications of novel radiotracers in diverse degrees neologiesl strategies has become more promising than ever. This literature review aims to provide a contemporary update on a selected group of radiotracers and evaluates the usability of radioguided surgery and sentinel node procedures, focusing on most promising advances. For example, the impact of targeted radiotracers on prostate specific membrane antigen (PSMA), CD206 receptor-targeted agents (Tc-99(m)-tilmanocept), and hybrid tracers adding fluorescence to radioguidance (ICG-Tc-99(m)-nanocolloid) as well as targeting hypoxia-induced carbonic anhydrase IX (CAIX) will be covered. Furthermore, future outlooks on the implementation of gold nanoparticles (AuNP's), but also technical advances in improved radiotracer detection by hybrid gamma devices will be discussed. Show less
Dickhoff, L.R.; Peeters, M.J.V.; Bosman, P.A.; Alderliesten, T. 2021
It is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed... Show moreIt is well known nowadays that radioactivity can destroy the living cells it interacts with. It is therefore unsurprising that radioactive sources, such as iodine-125, were historically developed for treatment purposes within radiation oncology with the goal of damaging malignant cells. However, since then, new techniques have been invented that make creative use of the same radioactivity properties of these sources for medical applications. Here, we review two distinct kinds of therapeutic uses of radioactive sources with applications to prostate. cervical, and breast cancer: brachytherapy and radioactive seed localization. In brachytherapy (BT), the radioactive sources are used for internal radiation treatment. Current approaches make use of real-time image guidance, for instance by means of magnetic resonance imaging, ultrasound. computed tomography, and sometimes positron emission tomography, depending on clinical availability and cancer type. Such image-guided BT for prostate and cervical cancer presents a promising alternative and/or addition to external beam radiation treatments or surgical resections. Radioactive sources can also be used for radio-guided tumor localization during surgery, for which the example of iodine-125 seed use in breast cancer is given. Radioactive seed localization (RSL) is increasingly popular as an alternative tumor localization technique during breast cancer surgery. Advantages of applying RSI, include added flexibility in the clinical scheduling logistics, an increase in tumor localization accuracy, and higher patient satisfaction; safety measures do however have to be employed. We exemply the implementation of RSL in a clinic through our experiences at the Netherlands Cancer Institute. Show less
Within interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of... Show moreWithin interventional nuclear medicine (iNM) a prominent role is allocated for the sub-discipline of radioguided surgery. Unique for this discipline is the fact that an increasing number of clinical indications (e.g. lymphatic mapping, local tumor demarcation and/or tumor receptor targeted applications) have been adopted into routine care. The clinical integration is further strengthened by technical innovations in chemistry and engineering that enhance the translational potential of radioguided procedures in iNM. Together, these features not only ensure ongoing expansion of iNM but also warrant a lasting clinical impact for the sub-discipline of radioguided surgery. Show less
Dotinga, M.; Vriens, D.; Velden, F. van; Heijmen, L.; Nagarajah, J.; Hicks, R.; ... ; Geus-Oei, L.F. de 2020
Poor responses to iodine-131 (I-131) therapy can relate to either low iodine uptake and retention in thyroid cancer cells or to increased radioresistance. Both mechanisms are currently termed... Show morePoor responses to iodine-131 (I-131) therapy can relate to either low iodine uptake and retention in thyroid cancer cells or to increased radioresistance. Both mechanisms are currently termed radioactive iodine (RAI)-refractory (RAI-R) thyroid cancer but the first reflects unsuitability for I-131 therapy that can be evaluated in advance of treatment, whereas the other can only be identified post hoc. Management of both represents a considerable challenge in clinical practice as failure of I-131 therapy, the most effective treatment of metastatic thyroid cancer, is associated with a poor overall prognosis. The development of targeted therapies has shown substantial promise in the treatment of RAI-R thyroid cancer in progressive patients. Recent studies show that selective tyrosine kinase inhibitors (TKIs) targeting B-type rapidly accelerated fibrosarcoma kinase (BRAF) and mitogen-activated protein kinase (MEK) can be used as redifferentiation agents to re-induce RAI uptake, thereby (re)enabling I-131 therapy. The use of dosimetry prior- and post-TKI treatment can assist in quantifying RAI uptake and improve identification of patients that will benefit from I-131 therapy. It also potentially offers the prospect of calculating individualized therapeutic administered activities to enhance efficacy and limit toxicity. In this review, we present an overview of the regulation of RAI uptake and clinically investigated redifferentiation agents, both reimbursed and in experimental setting, that induce renewed RAI uptake. We describe the role of dosimetry in redifferentiation and subsequent I-131 therapy in RAI-R thyroid cancer, explain different dosimetry approaches and discuss limitations and considerations in the field. Show less
Noortman, W.A.; Vriens, D.; Grootjans, W.; Tao, Q.; Geus-Oei, L.F. de; Velden, F.H. van 2020
In recent years, radiomics, defined as the extraction of large amounts of quantitative features from medical images, has gained emerging interest. Radiomics consists of the extraction of... Show moreIn recent years, radiomics, defined as the extraction of large amounts of quantitative features from medical images, has gained emerging interest. Radiomics consists of the extraction of handcrafted features combined with sophisticated statistical methods or machine learning algorithms for modelling, or deep learning algorithms that both learn features from raw data and perform modelling. These features have the potential to serve as non-invasive biomarkers for tumor characterization, prognostic stratification and response prediction. thereby contributing to precision medicine. However, especially in nuclear medicine, variable results are obtained when using radiomics for these purposes. Individual studies show promising results, but due to small numbers of patients per study and little standardization, it is difficult to compare and validate results on other datasets. This review describes the radiomic pipeline, its applications and the increasing role of artificial intelligence within the field. Furthermore, the challenges that need to be overcome to achieve clinical translation are discussed, so that, eventually, radiomics, combined with clinical data and other biomarkers, can contribute to precision medicine, by providing the right treatment to the right patient, with the right dose. at the right time. Show less
AIM The aim of this paper was to test the ability of technetium-99m labelled synthetic peptide UBI 29-41 scintigraphy (99mTc-UBI 29-41), composed of the antimicrobial peptide ubiquicidin,... Show moreAIM The aim of this paper was to test the ability of technetium-99m labelled synthetic peptide UBI 29-41 scintigraphy (99mTc-UBI 29-41), composed of the antimicrobial peptide ubiquicidin, specifically targets microorganisms in to discriminate between infected and uninfected endocarditis using a rat model previously validated. METHODS 99mTc-UBI 29-41 scintigraphy was evaluated for its accumulation in infective endocarditis (IE) with multidrug resistant Staphylococcus aureus (MRSA) performed in an experimental rat model, resembling early endocarditis in humans. Serial planar scintigraphic and biodistribution analysis of infected vegetations are compared to rats with sterile vegetations. Heart-to-lung uptake ratios (T/NT ratios) were calculated in both with in-vivo scintigraphy and in ex vivo tissue samples. RESULTS Bacterially infected vegetations were already observed at 15 min after injection of 99mTc-UBI 29-41 while no significant uptake was observed in sterile vegetations. Moreover, a good correlation (R2=0.819) was calculated between T/NT ratios of 99mTc-UBI 29-41 and the number of viable MRSA present in the infected vegetation. There was no correlation between the 99mTc-UBI 29-41 uptake and the weight of the vegetations in either case. CONCLUSION In this experimental study in rats, planar 99mTc-UBI 29-41 scintigraphy permitted early and specific detection of MRSA induced endocarditis. Furthermore, accumulation of the tracer depends on the number of viable MRSA and not on the weight of the vegetation. This proof of principle offers much promise that 99mTc-UBI 29-41 scintigraphy can be a dedicated non-invasive imaging tool for the early detection of infective endocarditis. Finally, this model has to be further evaluated with state-of-the art small imaging modalities. Show less
Aim. The aim of this paper was to test the ability of technetium-99m labelled synthetic peptide UBI 29-41 scintigraphy (Tc-99m-UBI 29-41), composed of the antimicrobial peptide ubiquicidin,... Show moreAim. The aim of this paper was to test the ability of technetium-99m labelled synthetic peptide UBI 29-41 scintigraphy (Tc-99m-UBI 29-41), composed of the antimicrobial peptide ubiquicidin, specifically targets microorganisms in to discriminate between infected and uninfected endocarditis using a rat model previously validated. Methods. Tc-99m-UBI 29-41 scintigraphy was evaluated for its accumulation in infective endocarditis (LE) with multidrug resistant Staphylococcus aureus (MRSA) performed in an experimental rat model, resembling early endocarditis in humans. Serial planar scintigraphic and biodistribution analysis of infected vegetations are compared to rats with sterile vegetations. Heart-to-lung uptake ratios (T/NT ratios) were calculated in both with in-vivo scintigraphy and in ex vivo tissue samples. Results. Bacterially infected vegetations were already observed at 15 min after injection of Tc-99m-UBI 29-41 while no significant uptake was observed in sterile vegetations. Moreover, a good correlation (R-2=0.819) was calculated between T/NT ratios of Tc-99m-UBI 29-41 and the number of viable MRSA present in the infected vegetation. There was no correlation between the Tc-99m-UBI 2941 uptake and the weight of the vegetations in either case. Conclusion. In this experimental study in rats, planar Tc-99m-UBI 29-41 scintigraphy permitted early and specific detection of MRSA induced endocarditis. Furthermore, accumulation of the tracer depends on the number of viable MRSA and not on the weight of the vegetation. This proof of principle offers much promise that Tc-99m-UBI 29-41 scintigraphy can be a dedicated non-invasive imaging tool for the early detection of infective endocarditis. Finally, this model has to be further evaluated with state-of-the art small imaging modalities. Show less
