Browsing Masters Degrees (Nuclear Medicine) by Title
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- ItemThe added value of SPECT/CT in complicated osteomyelitis(Stellenbosch : Stellenbosch University, 2013-12) Tag, Naima; Korowlay, Nisaar A.ENGLISH ABSTRACT: Background: The detection of bone infection can be very difficult especially in bone with altered structure due to prior trauma or surgical procedures. Complicated osteomyelitis (COM) is becoming a public health problem especially with the difficult choice between, high cost surgery and prolonged courses of intravenous or oral antibiotic therapy, as well as the social and psychological effect of longterm disease and disability of the patient. The correct localisation of especially bone infection is still a challenge for the clinician. The single photon emission computed tomography/low dose computed tomography (SPECT/CT), by fusing the functional information with the anatomical parts, is a wellestablished tool used in many nuclear medicine studies. This improves the overall quality of the study with more clear answers. The aim of the study was to determine the added value of SPECT/CT in the management of complicated osteomyelitis (COM) in patients with endo-prosthesis, post traumatic osteomyelitis with and without metal implants and diabetic foot. Methods: This was a prospective study, between February 2010 and February 2012. Patients with suspected COM who fulfilled the selection and inclusion criteria were included. All had abnormal three phase bone scan followed by infection imaging with 99mTc labelled white blood cells and 99mTc -colloid if the99mTc labelled white blood cell study was abnormal. 67Ga citrate was used in vertebral involvement. Planar and SPECT/CT images were reviewed for presence of abnormal uptake and for its localization in bone and soft tissue. Scan results were defined as positive or negative. Both planar and SPECT/CT images were compared regarding diagnosis and precise localization of infection. The final diagnosis was obtained from surgical specimen or microbiological culture as well as clinical follow-up of all patients. Results: There were 72 patients, 29 male and 43 female with mean age of 57 yrs [range 27-88].There were 24 patients with prosthesis, 16 with hip prosthesis (PH=16), and 8 with knee prosthesis (PK=8). There were 44 patients with post traumatic osteomyelitis, 26 with metal implants (TOM=26) and 18 without metal implants (TOWM= 18). Four patients had diabetic foot (DF= 4). Infection was diagnosed in 19/72 patients on planar images and in 21/72 on SPECT/CT. Infection was diagnosed in 4 patients with prosthesis, 16 patients with post traumatic injury and one diabetic foot patient. The four patients with prosthesis, SPECT /CT added diagnostic value by excluding osteomyelitis in 3 patients and by defining the exact extent and localizing soft tissue and bone infection (STI/OM) in one patient. In 16 patients with post traumatic OM on planar images, SPECT /CT added diagnostic value, by excluding OM in 4 patients and confirming only STI, better localisation of the uptake in bone and soft tissue in 5 patients, of them 2 patient was negative on planar, and in 7 patients, confirmed and defined the exact extent of both OM and STI. One diabetic foot was positive for STI on the planar, the SPECT/CT added diagnostic value by defining the extent of the infection. In summary the added value of SPECT/CT was: a. Overall infection: 1. Exclusion of osteomyelitis by confirming only soft tissue involvement: 7 patients (10%) 2. Better localization in bone and soft tissue: 6 patients (8%) 3. Better delineation of extent of infection: 9 patients (12%) 4. None: 50 patients (70%) b. In positive cases only: 1. Exclusion of osteomyelitis by confirming only soft tissue involvement: 7 patients (33%) 2. Better localization in bone and soft tissue: 5 patients (24%) 3. Better delineation of extent of infection: 9 patients (43%) 4. None: 0 patients The overall sensitivity, specificity, positive predictive value, negative predictive value and accuracy for infection, on planar was 90%, 100%, 100%, 97%, 97%, respectively and for SPECT/CT 100%, 100%, 100%, 100%, 100%. For OM on planar, the sensitivity, specificity , positive predictive value, negative predictive value and accuracy was 100%, 89%, 53%, 100%, 90%, respectively and for SPECT/CT 100%, 100%, 100%, 100%, 100%. Conclusion: In complicated osteomyelitis, SPECT/CT is useful in localizing, defining the exact extent of infection where the planar images are abnormal, with no added value if the planar images are negative. We recommend in clinical practice the routine use of hybrid SPECT/CT imaging in complicated osteomyelitis when planar images are abnormal.
- ItemThe added value of SPECT/CT in the evaluation of equivocal skeletal lesions in patients with known malignant disease(Stellenbosch : University of Stellenbosch, 2010-03) Ndlovu, Xolani; Warwick, James M.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH SUMMARY: Introduction: Bone scintigraphy is used extensively in evaluating metastatic disease. There are currently no clear recommendations for the use of SPECT/CT in metastatic bone disease. Existing procedural guidelines from the Society of Nuclear Medicine (SNM) for SPECT/CT do not provide specific indications for use of SPECT/CT in bone scintigraphy, and there are currently no other guidelines for the use of SPECT/CT in bone scintigraphy that the author is aware of. The aim of this study was to investigate the additional value of SPECT/CT, and to identify the clinical indications for which SPECT/CT is most useful in patients with suspected bone metastases. Subjects and Methods: Forty-two patients with equivocal lesions on planar scintigraphy were prospectively recruited and planar imaging, SPECT, and SPECT/CT done on all patients. On reading of SPECT and then SPECT/CT, patients and individual lesions were classified as malignant, benign or equivocal. Radiological studies and available clinical information were also used during reading of scans. Review of clinical information, radiological studies and/or follow-up bone scans were used as gold standard. The results of the SPECT and SPECT/CT were compared in terms of proportion of equivocal findings and accuracy. Results: Forty-two patients with 189 skeletal lesions were examined. There was a diverse variety of primary tumours, although the majority had breast (n=22) or prostate cancer (n=8). Overall, SPECT/CT resulted in a significant reduction in the proportion of equivocal findings on both a patient-wise (p=0.0015) and lesion-wise basis (p<0.0001). The overall accuracy of SPECT/CT was significantly higher than that of SPECT on both a patient-wise (p=0.0026) and lesion-wise basis (p<0.0001). Generally SPECT/CT decreased the proportion of equivocal findings and increased the accuracy independent of the presence of bone pain, type of primary tumour, or skeletal region involved. SPECT/CT did not significantly improve the diagnostic confidence of readers in equivocal lumbar lesions although accuracy was significantly improved in this region. Conclusion: SPECT/CT performs significantly better than SPECT alone for the interpretation of equivocal planar lesions. There is no evidence that the benefit of SPECT/CT is dependent on the type of primary tumour or the presence of bone pain. Where resources are limited, SPECT/CT is indicated only in those patients in whom correct classification of the lesions in question is expected to alter the patient’s management. SPECT/CT images should be interpreted with the aid of a diagnostic radiologist or nuclear medicine physicians should acquire sufficient experience in Computed Tomographic image interpretation in order to optimise diagnostic benefit from SPECT/CT.
- ItemBrain SPECT in patients with neuropsychiatric SLE : the additional value of semi-quantitative analysis(Stellenbosch : University Stellenbosch, 2009-12) Khider, Mohamed Abdelrahman; Warwick, James; Whitelaw, Dave; University of Stellenbosch. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH ABSTRACT: Introduction: There is conflicting data on the value of single photon emission tomography (SPECT) for the diagnosis of neuropsychiatric SLE (NPSLE). Visual assessment of brain SPECT scans is the standard approach in clinical practice. However the definition and identification of significant changes may be limited by a high interobserver variability, especially in centres with limited experience. This may be reduced by a more objective semi-quantitative assessment. The objectives of this study were to determine the sensitivity and specificity of SPECT for the detection of NPSLE at our institution using visual assesment, to determine the additional value of using an objective semi-quantitative diagnostic criterion, and to investigate the correlation between abnormal perfusion pattern and clinical NPSLE classification in patients with active NPSLE. Material and methods: Nineteen patients with NPSLE and 19 normal controls were studied with brain SPECT. Scans were interpreted blindly by two nuclear medicine physicians using two methods; visual and semi-quantitative assessments. In the visual method, overall visual impression was recorded for each scan using a four point scale, where A=normal, B=probably normal, C=probably abnormal, and D=abnormal. In addition, each brain region was assigned a severity score from 0=normal perfusion to 3=severe hypoperfusion. In the semi-quantitative assessment, ten-band color scale was used, and perfusion deficit was quantified on the side with the lower color intensity comparing to the contralateral side. A score was given to the region with perfusion deficit according to the difference (in color bands) between the two hemispheres. Analysis was performed for the visual assessment method (overall impression and severity scores) and the semi-quantitative assessment method using a receiver operator characteristic (ROC) curve. Optimal cut-off points were determined and the accuracy of the different techniques was also compared statistically. Finally, the correlation was determined between the SPECT perfusion pattern and the clinical pattern of disease. Results: An ROC curve analysis for the overall visual impression resulted in an area under the curve of 0.76. At a cut-off point of C (probably abnormal), brain SPECT had 89% sensitivity and 57% specificity for the diagnosis of NPSLE. The severity score which include the total severity score and the modified total severity score resulted in areas under the curve of 0.75 and 0.79 respectively. The semi-quantitative assessment resulted in areas under the ROC curve of 0.80. Statistically, there was no difference between the overall visual impression, visual severity scores, and the semi-quantitative assessment. Agreement analysis between the SPECT pattern and clinical pattern of disease showed agreement in 91.6% in the diffuse pattern, whereas agreement in the focal pattern was seen in only 42.8%. Discussion and Conclusion: In this study, we found that brain SPECT is able to diagnose active NPSLE with a high sensitivity and moderate specificity. The overall visual impression, visual severity scores, and the semi-quantitative assessment showed no significant differences between the techniques. The use of the semi-quantitative assessment described may be useful in centers with limited experience in the interpretation of brain SPECT. The correlation between the SPECT pattern and clinical disease pattern may provide some insights into the pathophysiology of NPSLE.
- ItemThe effect of reconstruction algorithms (iterative versus filtered backprojection) on the diagnosis of single pulmonary nodules using Thallium-201 and Technetium-99m MIBI SPECT(Stellenbosch : Stellenbosch University, 2004-04) Ambayi, Rudo; Ghoorun, S.; Dupont, P.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH ABSTRACT: This study involved 33 patients, 19 men and 14 women. The age range was wide (20-90 years) and median age was 57 years. These patients had a single pulmonary nodule (SPN) defined radiologically as a well defined, round or oval intrapulmonary lung lesion not associated with atelectasis or adenopathy on chest radiography or computed tomography. Patients were investigated with Tc-99m MIBI and TI-201 (25 patients) and with Tc-99m MIBI alone (8 patients). Single photon emission computed tomography images were reconstructed using both iterative reconstruction (Ordered Subsets - Expectation Maximisation: aSEM) and filtered backprojection (FBP), on the Hermes system. Transverse, coronal and sagittal slices were displayed on the screen using a grey scale. The aSEM and FBP images for each study were co-registered semi-automatically using the multimodality programme on the Hermes. The best slice for the lesion was chosen according to the best view used to locate the SPN on chest radiograph. Regions of interest (Ral) were drawn manually outside the outer margin of the detected lesion, first on the aSEM image. This was automatically mirrored on the co-registered FBP image. For most patients, the background was automatically mirrored horizontally on the contralateral side, again, first on the OSEM then automatically on the FBP image. Automatic vertical mirroring or manual horizontal mirroring was used when background was found to be in a visually 'hot' area like the heart or vertebrae. The average counts and standard deviation of the Ral and background were generated automatically. Semi-quantitative image analysis was done by calculating the signal-to-noise ratio (SNR) and tumour-to-background (TIB) ratio using the following formulae: SNR = Mean counts ROI(lesion) - Mean counts background Standard deviation background TIB rati.o = -M---e-a-n-'--c-o--u-n-'t-s- ROI(lesion) Mean counts background Detection was found to be the same for the two reconstruction algorithms, that is, every lesion detected by using OSEM could also be detected by using FBP. However lesion detection did differ between Tl-201 and Tc-99m-MIBI. Sensitivity and specificity were calculated for different thresholds of SNR and TIB ratios. Receiver operating characteristics (ROC) curves were drawn to represent the different sensitivities and specificities at each threshold. Tuberculosis (TB) was not included in this analysis as uptake of Tl-20l was found to be significantly high and comparable to that of malignant nodules. However the effect of OSEM and FBP on the 'positive' TB nodules was assessed separately. By calculating the area under the ROC curves, TI-201 using OSEM was shown to be more accurate at differentiating malignant nodules from benign ones than FBP. Although this difference was not statistically significant (p=0.1 0), there was a clear tendency. The two reconstruction algorithms were found to be almost equally accurate, when using Tc-99m-MIBI, the difference between them being considerably insignificant. In conclusion, it was shown that there is a tendency that OSEM outperforms FBP for studies using Tl-201 but not for Tc-99m-MIBI.
- ItemEvaluation of BCL-2 and PARP-1 as potential therapeutic targets to radiosensitise lung cancer(Stellenbosch : Stellenbosch University, 2021-12) Guillaume, Muteba Mpolesha; Akudugu, John M.; Serafin, Antonio M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH SUMMARY : Lung cancer remains the most incident malignancy worldwide, representing 13% of all cancers. It is also the leading cause of death in the world, accounting for 18 18.2% of global cancer-related deaths. The burden of lung cancer in Africa is increasing due to ag ageing an and population growth, increased prevalence of risks factors such as smoking, occupational exposure, infections, lifestyle changes, and environmental pollutants. The efficacy of many therapeutic strategies has been hindered by normal tissue toxicity and treatment resistance. For many cancer patients, radiotherapy has been the chosen therapeutic option to minimise cancer cell spread by shrinking the tumour while ensuring protection of normal tissue. There is evidence that small molecule inhibitor s can effectively target cell survival signa signalling pathways, but cancer cell cells manage to find molecular escape routes to either repair the damage or evade cell death. Combination therapy appears to be an appropriate approach to address these challenges. Therefore, targeting more than one component of the cell survival signa signalling pathways could potentially sensitise cancer cells to irradiation and improve the outcome of radiotherapy. The purpose of this study was to evaluate the role of targeting the anti-apoptotic (B-cell lymphoma 2 (Bcl -2)) pathway and the DNA repair (poly (ADP ADP-ribose) polymerase 1 (PARPPARP-1)) pathway with specific inhibitors in modulating the radiosensitivity of a lung cancer cell line ( and an apparently normal lung cell line ( For this, Bcl -2 and PARP PARP-1 were inhibited using ABT ABT-737 and ABT ABT-888, respectively. At a dose of 2 Gy, the typical fractional dose in conventional radiotherapy, combined inhibition of Bcl-2 and PARP-1 or inhibition of Bcl-2 alone resulted in significant radio-sensitisation in only the A549 cells. However, at a larger radiation dose of 6 Gy (a potentially useful fractional dose in hypo-fractionated radiotherapy), inhibition of Bcl-2 and PARP-1 markedly radio-sensitised the apparently normal (L132) and malignant (A549) cell lines, respectively. These findings suggest that use of Bcl-2 and PARP-1 inhibitors might be beneficial when combined with conventional radiotherapy, but not with hypo-fractionated radiotherapy when large fractional radiation doses are employed. However, validation of these results with a larger panel of cell lines is warranted.
- ItemEvaluation of the effect of low and intermediate frequency electromagnetic waves on radiosensitivity(Stellenbosch : Stellenbosch University, 2016-12) Chinhengo, Angela; Akudugu, John M.; Serafin, Antonio M.; Stellenbosch University. Faculty of Medicine and Health Science. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH SUMMARY : The incidence of epidemic Kaposi’s sarcoma in HIV/AIDS patients is high due to their compromised immune system. HIV-positive individuals presenting with cancer tend to be more sensitive to ionizing radiation and are at a higher risk of developing severe side effects during radiotherapy, and there is a need to develop non-invasive methods to preferentially sensitize cancer cells and reduce therapeutic doses. Here, the effects of 100 and 1000 Hz electromagnetic fields (EMF) broadcast via an argon plasma ray tube at 50 W on the radio sensitivity of apparently normal Chinese hamster lung fibroblasts (V79) and human malignant melanoma cells (MeWo) were evaluated using the colony forming assay. Pre-exposure of the fibroblasts to both fields had no effect on their radio sensitivity, if X-ray irradiation followed within 2 h or at 6 h. Significant radio sensitization was observed when X-rays were administered 4 h after EMF exposure. For the MeWo cells, pre-exposure to 100 Hz resulted in a significant radioprotection when irradiation followed within 6 h. However, treatment of these cells with a 1000 Hz field significantly potentiated the effect of X-rays. When cells were irradiated prior to EMF exposure, the V79 cells were marginally protected by the 100 Hz field and sensitized by the 1000 Hz field. In contrast, the melanoma cells were slightly protected by the 1000 Hz field and sensitized by the 100 Hz field. The survival rate of the normal fibroblasts when treated with 2 Gy, in two fractions of 1 Gy 6 h apart, was similar to those obtained when cells received an acute dose of 2 Gy 6 h prior to or after exposure to both EMF frequencies. On the other hand, the melanoma cells were significantly sensitized when they were either treated with a combination of X-rays and then 100 Hz EMF 6 h later or with a combination of either of the EMF frequencies and then X-rays 6 h later. These data suggest that use of electromagnetic fields may sensitize tumours to radiation therapy and reduce normal tissue toxicity. Informed and well-designed combinations of low-medium frequency electromagnetic fields and radiation therapy might be beneficial in the management of cancers, especially epidemic Kaposi’s sarcoma.
- ItemExtended Cr-51 RBC combined with Tc-99m RBC for the detection and localisation of occult GIT bleeding(Stellenbosch : Stellenbosch University, 2014-04) Modebe, Emmanuel Obinna; Ellmann, Annare; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology, Nuclear Medicine. Radiodiagnosis.ENGLISH ABSTRACT: Background Occult blood loss from the gastrointestinal tract (GIT), causing iron deficiency often with anaemia, can be diagnostically and therapeutically challenging. This is because the endoscopic and radiologic tests may be negative due to the slow, chronic and intermittent nature of the gastrointestinal bleeding, making timing key in detection and localisation of the bleed. These limitations can be approached using two different radioactive isotopes. Firstly, we tested the sensitivity of extending Cr-51 RBC for 21 days relative to 5 days to detect GIT bleeding and its use to optimise timing of a Tc-99m RBC study for GIT blood loss localisation. Finally, we tested if the information provided by the Tc-99m RBC study aided gastroenterologic intervention for anatomical localisation of a lesion. Method In this retrospective review, after obtaining institutional and ethics committee approval, records of patients referred for evaluation of possible GIT blood loss were reviewed. In each; daily appearance of radiochromium in stool was measured in the whole body counter. In those cases exceeding 50 ml/day, a technetium-99m (Tc-99m) localization study was performed. These studies were correlated with clinical findings. Results A total of 59 Cr-51 RBC studies were carried out in 36 females and 21 males (n = 57). In 32 (54%) the radiochromium results were positive with 75% of the bleeding incidences occurring after 5 days of stool collection. Of 17 cases in whom Tc-99m RBC imaging studies were performed, 14 (82%) were positive with specific anatomical sites successfully defined in twelve. In all patients with blood loss of >100 ml/24h, Tc-99m RBC were positive and localised. Ten of the 17 Tc-99m RBC studies were further investigated and half diagnosed with small-bowel angiodysplasia. Conclusion This sequential twin isotope method is practical in revealing otherwise silent intestinal haemorrhage. Although it has good patient acceptability and clinical as well as diagnostic utility in management, further studies are required to clearly establish a cut-off level of blood loss for performing imaging studies and the impact of the findings on the overall patient management.
- ItemImaging of renal hyperparathyroidism using SPECT/CT with low-dose localizing CT(Stellenbosch : Stellenbosch University, 2013-12) Doruyter, Alexander Govert George; Warwick, James Matthew; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Division of Nuclear Medicine.ENGLISH ABSTRACT: Background: Hybrid imaging using single photon emission computed tomography/low dose (x-ray) computed tomography (SPECT/LDCT) is of benefit in preoperative scintigraphy of primary hyperparathyroidism. The role of SPECT/LDCT in preoperative assessment of renal hyperparathyroidism has not yet been examined. The aim of the study was to determine whether SPECT/LDCT conferred any benefit over SPECT alone in terms of detection and/or localization of hyperfunctioning parathyroid tissue in this patient group. Methods: A retrospective study of patients with renal hyperparathyroidism and positive planar and SPECT scintigraphy was undertaken. All patients underwent planar scintigraphy using 99mTc-pertechnetate immediately followed by 99mTc-sestamibi as well as SPECT/LDCT 60 min after sestamibi injection and a delayed static image to assess for differential washout at 2-3 hours. Planar subtraction images were generated. For each patient, two nuclear physicians reported on planar+ SPECT images followed by planar + SPECT/LDCT images (assisted by a radiologist). Confidence for the presence of hyperfunctioning parathyroid tissue as well as confidence of location was scored on a Likert-type scale. Interpretation of planar + SPECT was compared with interpretation of planar + SPECT/LDCT. The impact of LDCT on equivocal lesions and number of ectopic lesions detected was also assessed. Results: Twenty patients (M:13; F:7) imaged between February 2008 and June 2011 were included [mean age: 40 years (24 – 55)]. Mean creatinine was 687 μmol/l (169-1213), mean corrected calcium: 2.55 mmol/l (1.95-3.33) and median PTH 167 pmol/l (2.4 - >201). Thirty-five lesions were detected on planar and SPECT and this was unchanged after assessment of the LDCT data. Confidence for the presence of parathyroid pathology changed in 5 patients (5 lesions) with the addition of LDCT. LDCT changed the mean confidence of parathyroid pathology from 3.17 to 3.29 (p=0.16). Addition of LDCT reduced the number of equivocal lesions from 18 (14 patients) to 14 (10 patients) (p=0.13). The addition of LDCT changed localization in 4 lesions (3 patients). Confidence in localization of pathology changed in 9 lesions (7 patients) and the mean localization confidence score was improved from 4.2 to 4.46 (p=0.002) with LDCT. The number of lesions classified as ectopic increased from 5 (on planar+SPECT) to 8 (with addition of LDCT) (p=0.25). Conclusion: In renal hyperparathyroidism SPECT/LDCT altered localization of lesions detected on planar and SPECT alone and improved reader confidence of localization accuracy. SPECT/LDCT conferred no additional benefit over SPECT in terms of detection, confidence of parathyroid pathology or ability to distinguish equivocal from non-equivocal parathyroid lesions. The addition of LDCT did not detect significantly more ectopic lesions. Whereas the minor improvement in reader confidence of localization (with addition of LDCT) was of questionable clinical significance, we speculate that the changed and presumably improved localization of lesions on SPECT/LDCT had potential clinical impact in a significant proportion of patients. On this basis we recommend the use of hybrid SPECT/LDCT in imaging of renal hyperparathyroidism when surgery is considered.
- ItemInfluence of acquisition time and smoothing parameters on Ga-68 wholebody PET/CT image quality(Stellenbosch : Stellenbosch University, 2020-12) Diale, Boitshoko Phenyo; Moalosi, Tumelo C. G.; Mix, Michael; Ellmann, Annare; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH SUMMARY : PET/CT image optimization has been extensively investigated for 18F–FDG PET imaging. Although 68Ga–tracers are already widely used in PET, optimized imaging and reconstruction are still missing. The aim of this research was to optimize image quality for 68Ga scans under the constraint that the administered dose to a patient and acquisition time are limited. Materials and Methods : A Gemini TF Big Bore PET/CT system manufactured by Philips was used to acquire the images. The experimental data was formulated by retrospectively collecting data from patient scans, who had undergone wholebody (WB) PET/CT using 68Ga–DOTANOC for oncological imaging. The patient data sets were analyzed for this study to plan phantom measurements which simulated a typical activity distribution like in the patient scans. The NEMA (IEC) body phantom filled with low contrast and high contrast activity ratios was scanned on the Gemini TF Big Bore PET/CT scanner using the patient acquisition protocol. The data was reconstructed using a default WB reconstruction protocol with different smoothing parameters and varying scan acquisition times for low and high contrast data. Additionally a HN protocol with smaller voxel sizes was also used on high contrast data. The set images were analyzed using R Studio. Image quality parameters such as coefficient of variation (COV%), contrast to noise ratio (CNR), signal to noise ratio (SNR), recovery coefficient (RC%) and uniformity in terms of standardized uptake value (SUV) were acquired. Results: For low contrast COV%, CNR, SNR values varied as follows: 0.89 – 0.99%, 0.96 – 1.08, 0.99 – 1.05, respectively. Values for high contrast varied as follows: 1.03 – 1.16%, 0.84 – 0.91, 0.80 – 0.97. When comparing COV%, CNR and SNR, low contrast images appeared to be superior to high contrast images. The RC% was found to be consistent in both low contrast and high contrast irrespective of the smoothing parameter. Conclusion: The results obtained from the phantom study demonstrated the Philips Gemini TF Big Bore PET scanner’s stability of good uniformity when assessing maximum activity concentration among the different acquisitions, and ability of the scanner to detect or recover radioactivity in low and high contrast images for all reconstruction parameters. From the phantom study results, incorporating the smoothing reconstruction parameter ”smooth” on low contrast images, allowed the reduction of acquisition time to 180 seconds while maintaining acceptable image quality.
- ItemAn investigation of the contribution of Single Photon Emission Computed Tomography to the diagnosis of skeletal metastases using bone scan in the African context(Stellenbosch : Stellenbosch University, 2003-12) Elmadani, Ahmed Elkhidir; Warwick, James M.; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Nuclear Medicine.ENGLISH ABSTRACT: Planar bone scintigraphy is highly sensitive but it may not be sensitive enough to detect subtle lesions in complex bony structures such as the spine. The accurate anatomic localisation of lesions in regions such as this is also limited using planar images. Single Photon Emission Computed Tomography (SPECT) results in a higher lesion contrast resulting in an improved sensitivity for the detection of subtle lesions. SPECT also enables improved lesion localisation, often valuable in distinguishing benign from malignant disease in the spine. A number of previous studies have demonstrated that the addition of SPECT of the spine significantly enhances the value of bone scintigraphy for the detection of bone metastases compared to planar imaging alone. These studies were however not done in the African context where patients typically present with more advanced disease. In a retrospective study of 576 patients with known primary tumors sent to our institution for bone scintigraphy for the diagnosis of bone metastases, we evaluated 119 patients in whom both planar imaging and SPECT were obtained. The studies were graded for the probability of metastatic disease, and the number of spinal lesions was determined with and without SPECT. The influence of adding SPECT on the interpretation of the study was determined in terms of the reported probability of metastatic disease, the exclusion and confirmation of metastatic disease, the decisiveness of interpretation, and the number of spinal lesions. The addition of SPEeT resulted in a statistically significant change in the interpretation of studies, although the actual numbers of patients affected were relatively small. SPEeT resulted in a more decisive interpretation of bone scintigraphy. There was a significant increase in the number of spinal lesions detected after the addition of SPEeT. It was concluded that although the use of SPEeT is ideal, acceptable results could be achieved using planar imaging alone in this patient population. This is particularly relevant in the African context, where SPEeT is often unavailable or scarce and in great demand.
- ItemMonitoring various eluate characteristics of the iThemba LABS SnO2-based 68Ge/68Ga generator over time and validation of quality control methods for the radiochemical purity assessment of 68Ga-labelled DOTA peptide formulations(Stellenbosch : Stellenbosch University, 2017-03) Davids, Claudia Ruby; Rubow, Sietske Margarete; Rossouw, Daniel; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear MedicineENGLISH SUMMARY : PET imaging with gallium-68 (68Ga) has become widely used due to the availability of 68Ge/68Ga generators and DOTA-derivatised peptide ligands for radiolabelling. The purpose of this study was to monitor the eluate of two iThemba LABS 68Ge/68Ga generators over a period of 12 months to ascertain whether all quality parameters of the 68Ga eluate remained stable and to validate different analytical methods used to determine the radiochemical purity of 68Ga-labelled peptides. Two 1850 MBq (50 mCi) generators were eluted daily with 0.6 M HCl and metal contaminants, 68Ge breakthrough, 68Ga yield, pH, sterility and endotoxin concentrations were determined on a monthly basis. The radiochemical purity of 68Ga-labelled peptides was ascertained using high performance liquid chromatography (HPLC) and instant thin layer chromatography (iTLC). iTLC experiments were performed using both dried and undried iTLC plates. iTLC was also carried out on labelled peptide solution that was spiked with 68GaCl3. These results were also compared with those using HPLC. After 12 months the 68Ga yields, total metal contaminants, sterility and endotoxin concentration remained within European Pharmacopoeial limits. The 68Ge breakthrough increased as the generator aged. This can however be minimised by fractionated elution and post-labelling processing of the eluate by anion or cation exchange chromatography. Separation between 68GaCl3 and 68Ga-labelled peptides was obtained using both 0.1 M citrate buffer pH 5.0 (mobile phase 1) and 1 M ammonium acetate : methanol (1:1) (mobile phase 2). The results also showed that the distribution of radioactivity on the iTLC strip could be determined using a dose calibrator when a TLC scanner is not available. Experiments performed using both undried and dried iTLC-SG chromatography paper, demonstrated that despite the statistically significant difference between the sets of results, in practice either undried or dried iTLC may be used. When purified 68Ga-labelled peptides were spiked with 2% of 68GaCl3, separation between the two was obtained on both HPLC and iTLC. However, iTLC underestimated and HPLC overestimated 68GaCl3 content. Of the two iTLC methods investigated, the method using mobile phase 2 was able to separate colloidal 68Ga impurities from the 68Ga-labelled peptides while the method using mobile phase 1 and the HPLC method could not. In conclusion, the iThemba LABS 68Ge/68Ga generator can be considered stable and of use for up to one year after its manufacture. Both the iTLC method and the HPLC method could detect 68GaCl3 amounts less than 2%. The pharmacopoeia states that 68Ga must be less than 3 % on iTLC and less than 2 % on HPLC. Either dried or undried iTLC strips can be used and if a radio-TLC scanner is not available, the iTLC strips developed with mobile phase 1 can be cut at a suitable distance from the origin and the activity on each section can be read in a dose calibrator. iTLC chromatography using ammonium acetate/methanol seems to be the optimal system for routine analysis of 68Ga labelled DOTA-peptides, as it separates both 68GaCl3 and colloidal impurities from the labelled peptides and is a fast and easy technique.
- ItemOptimal utilization of gamma camera time in Tc-99m MDP bone scintigraphy(Stellenbosch : University of Stellenbosch, 2007-03) Jawa, Zabah Muhammad; Rubow, Sietske; Warwick, James; University of Stellenbosch. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.Introduction: Whole body bone scintigraphy with Tc-99m MDP is able to provide a survey of the entire skeleton. The question arises if it is mandatory to perform a whole body bone scan in all patients, irrespective of the clinical indication. The aim of this study is to determine the implications of performing limited imaging in patients who had whole body bone scan for various clinical patholgy with Tc-99m MDP, in order to determine if limited imaging would be acceptable in selected pathologies. This may enable gamma camera time to be optimally utilized in units with limited facilities. Materials and Methods: Reports of 3015 patients with various clinical pathologies who had whole body bone scans with Tc-99m MDP in our department from January 2002 to December 2004 were retrospectively reviewed. The presence of pathologic radiotracer uptake was analyzed in order to establish the pattern of distribution. Clinically significant skeletal lesions were classified according to the anatomical regions where they were located viz; skull (including the neck), axial skeleton (including the pelvis and shoulders) and limbs. Results: Our results showed that in patients with lung cancer, soft tissue sarcoma, and myeloma, there was an error in more than 25% of patients when limited imaging was performed. In patients with cancer of the breast, prostate, kidney, gastrointestinal system, and reproductive system and lymphoma there is an error in less than 5% of patients when limited imaging is employed. For iv patients with more localized musculoskeletal disorders such as suspected stress fractures, complicated joint prosthesis and avascular necrosis of the femur head, regional imaging of the area of pathology showed a percentage error of less than 6%.
- ItemPulmonary embolism diagnosis : a clinical comparison between conventional planar and SPECT V/Q imaging using Krypton 81m – with CTPA as the gold standard(Stellenbosch : University of Stellenbosch, 2010-03) Ngoya, Patrick Sitati; Korowlay, Nisaar A.; University of Stellenbosch. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH ABSTRACT: Single photon emission computed tomography (SPECT) with a superior contrast resolution has been shown to be more sensitive and specific with a lower nondiagnostic rate than planar imaging in many nuclear medicine studies but it is still not being routinely implemented in V/Q studies at many centres including Tygerberg Hospital. There are many studies on V/Q SPECT using Technegas as a ventilation agent but very limited studies available on 81m Kr gas. Aim: To clinically compare conventional planar and SPECT V/Q imaging using 81mKr gas in the diagnosis of pulmonary embolism, with CTPA as the gold standard. Patients and Methods: All patients referred with clinical suspicion of pulmonary embolism were assessed. The inclusion criteria were normal chest radiograph, normal renal function and no contrast allergy. Exclusion criteria were age below 18 years old, pregnancy, abnormal chest radiograph, abnormal serum creatinine/urea levels and unstable patients. A Well’s score was assigned to each enrolled patient. Perfusion scintigraphy was performed after intravenous injection 125 MBq of 99mTc MAA. Ventilation scintigraphy was performed with 81mKr gas. On a dual head camera, SPECT was done before planar acquisition, while perfusion was done before ventilation imaging in the same position. Planar V/Q images consisted of 6 standard views. All V/Q SPECT images were reconstructed using ordered-subset expectation-maximization (OSEM) algorithm and a post-reconstruction 3D Butterworth filters were applied. V/Q Planar and V/Q SPECT images were later evaluated and reviewed separately and reported based on recent EANM guidelines blinded to the CTPA results. All patients underwent multi-slice CTPA examinations on a 40-detector row scanner. The images were later assessed and reported blinded to the V/Q results. Statistical analysis was done using the Fisher exact test for comparison of categorical variables and the one-way ANOVA for continuous variables (p<0.05 was significant). Results: A total of 104 consecutive patients were referred with clinical suspicion of pulmonary embolism. Seventy-nine patients were excluded from this study mostly due to abnormal serum creatinine/urea levels. Only 25 patients were included in this study, with a mean age of 48 ± 19 years, and 64% being females. When compared to CTPA as gold standard, the prevalence of PE was 16% [5% – 37% at 95% CI], sensitivity 75% [21% – 99% at 95% CI], specificity 90% [68% – 98% at 95% CI], positive predictive value 60% [17% – 93% at 95% CI], negative predictive value 95% [73% – 100% at 95% CI] and diagnostic accuracy 88% [69% – 97%at 95% CI] for both V/Q Planar and SPECT. V/Q Planar showed a lower reader confidence i.e. could only clearly resolve 72% of cases compared to V/Q SPECT, which could precisely interpret all cases, showed more and better delineated mismatch vs match and segmental vs non-segmental defects. All patients who were scored as PE unlikely on Wells’ score (4) had PE ruled out on CTPA (p=0.04581) as well as 89% of patients on V/Q SPECT and V/Q Planar. Conclusion: Based on this study, V/Q Planar and V/Q SPECT have a similar diagnostic performance in patients with a normal or near normal chest X-rays.
- ItemRadiosensitisation of low HER-2 expressing human breast cancer cell lines(Stellenbosch : Stellenbosch University, 2015-04) Hamid, Mogammad Baahith; Akudugu, John M.; Serafin, Antonio M.; Stellenbosch University. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH ABSTRACT: Breast Cancer remains one of the world’s leading causes of cancer related deaths amongst women. Its treatment has evolved from invasive, highly toxic therapies to treatments that possess a higher specificity and a lower toxicity. Despite improvements in overall survival, many patients do not benefit from these agents because of acquired and/or inherent tumour resistance, which could hinder treatment efficacy. Novel treatment strategies are, therefore, warranted to address these challenges and to significantly improve patient responses. Inhibiting components of the HER-2 signalling pathway can significantly sensitise breast cancer cells to low doses of ionising radiation. The objective of this study was to inhibit key molecular targets of the human epidermal growth factor receptor 2 (HER-2) signalling pathway and expose breast cancer cell lines to doses of radiation, so as to establish potential therapeutic targets that may be amenable to combined modality therapy, and formulate a cocktail of inhibitors to evaluate its radiosensitising capability. This study found that pre-treatment of two breast cancer cell lines (MDA-MB-231 and MCF-7) with a HER-2 inhibitor (TAK-165) had little or no effect on radiosensitivity. However, a radiation enhancement was observed when these cells were pre-treated either with BEZ235, a dual inhibitor of phosphoinositide 3-kinase (PI3K) and mammalian target for rapamycin (mTOR), or a cocktail of TAK-165 and BEZ235. These findings suggest that concurrent inhibition of HER-2, PI3K and mTOR during radiotherapy might improve treatment response of breast cancer patients.
- ItemResponse to radioiodine in male hyperthyroid patients at Tygerberg Hospital(Stellenbosch : University of Stellenbosch, 2009-03) Onimode, Yetunde Ajoke; Ellmann, Annare; Korowlay, Nisaar; University of Stellenbosch. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH ABSTRACT: Radioiodine therapy is reputed to yield poorer results in male patients than in females. We retrospectively reviewed the records of 308 patients treated with radioiodine-131 (RAI) for Graves’ disease (n=266, 86.4%), toxic multinodular goitres (n=35, 11.4%) and toxic solitary nodules (n=7, 2.3%). The mean age of the men was 44 ±13.6 years (range 14-77 years). Patients with GD were predominantly in the younger age groups, while those with toxic nodular goitres were in the older range. Two hundred and fifty-nine patients (84.1%) were treated with a single dose of RAI, while 49 (15.9%) required further doses. A second dose had to be administered to 38 patients, while 8 received 3 doses, 2 got 4 doses and 1 patient had 5 doses in all (these included a first dose received prior to referral to our Thyroid Clinic). Cure was determined as euthyroidism or hypothyroidism at the 3-month follow-up visit. The average pre-treatment T4 value was 68.9 ± 31.8 pmol/L (range 5.7 – 155 pmol/L); while the mean Tc-99m pertechnetate uptake value was 15.8 ± 10.9% (range 0.88 - 62.9). Patients with GD presented with more severe hyperthyroidism than the other patients; mean free T4 of 71.9 ± 31.1 pmol/L compared to 51.4 ± 29.9 pmol/L for the TMG group of patients, and 39.6 ± 26.8 pmol/L for the TSN group (ANOVA p<0.0001, confirmed by the Kruskal-Wallis test). Patients with TMG and TSN were treated with higher doses than patients with GD; mean first doses of 349.3 ± 88.5 MBq and 428.1 ± 28.6 MBq respectively, compared to a mean dose of 325.1 ± 69.3 MBq for patients with GD. Treatment with multiple doses of RAI correlated with higher values of T4 and T3 at presentation (p<0.0001). However, none of the baseline variables of age, T4 and T3, and first dose of RAI was significant predictors of free T4 outcome at 3 months. A consistently higher dose was administered to the male patients, compared to female patients of similar age, diagnosis and level of thyrotoxicosis (Tc-99m pertechnetate uptake). Despite this, male patients had similar outcomes as the female patients 3 months after therapy. Our findings lend weight to the theory that male patients are more difficult to treat than their female counterparts, seeing that the former had similar outcomes despite the significantly higher doses of RAI administered to the males.
- ItemSemiquantitative analysis of FDG PET brain scans using Neurostat and SPM(Stellenbosch : Stellenbosch University, 2021-12) Munemo, Lionel Tapiwa; Doruyter, Alex G. G.; Warwick, James; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH SUMMARY : Background: Positron emission tomography using Fluorine-18 2-Fluoro-2-Deoxy-D-Glucose (FDG-PET) has an established role in the investigation of multiple neurological conditions such as neurolupus and epilepsy. FDG PET brain scans are interpreted visually and semi-quantitatively using tools such as Neurostat or SPM. The normal databases used in Neurostat were created over 20 years ago, however since this time there has been a steady advance in camera technology and reconstruction algorithms for semiquantitative analysis. It is possible that results obtained with semiquantitative analysis using Neurostat (old PET databases) are different from results obtained with semiquantitative analysis using SPM (using a new PET database). The aim of this study was to evaluate whether there are differences in study interpretation when the same scans are read in combination with a Neurostat analysis, compared to when they are read in combination with an SPM analysis using a database built with new scan data. Methods: First, a local normal database was built with healthy control data using MATLAB R2014b and SPM12. These scans were obtained from previous research projects and prospectively enrolled participants. All scans were acquired on a Philips Gemini-TF Big bore PET/CT scanner. Second, a test dataset, comprising a mixture of clinical scans and scans of prospectively enrolled participants (other than those included in the normal database), was used to compare interpretation of results when using the SPM-based normal database (SPM) to interpretation results when using Neurostat (NS). Results: A database of normal FDG Brain PET/CT studies for the 19-35 year age group was created from a total of 26 healthy controls (13 men and 13 women – optimally matched for age and gender). The test dataset was comprised of 20 scans in the same age range: 15 clinical cases and 5 controls. Next, two expert readers read scans in the test dataset with the assistance of both the NS outputs and the SPM outputs, in separate reading sessions. There was no statistically significant difference in whether a scan was called normal or abnormal using either Neurostat or SPM. There was also no significant difference when comparing the number of lesions identified. SPM scored lesions as less severe than Neurostat (p=0.006). Conclusion: SPM-based analysis using a locally-developed normal database (with scans acquired on a modern PET-CT scanner) yielded similar results to Neurostat, justifying its continued use. Further evaluation to determine if these results are applicable to older patients with neurodegenerative conditions such as Alzheimer’s disease is planned.
- ItemTargeting the EBFR and PI3K pathways as a therapeutic strategy for prostate cancer(Stellenbosch : Stellenbosch University, 2015-04) Maleka, Sechaba; Akudugu, J. M.; Serafin, A. M.; Stellenbosch University. Faculty of Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH ABSTRACT: Targeted therapy for prostate cancer may offer potential improvement over current conventional therapies because of its specificity. Although conventional treatments are effective, they are not curative and have several limitations. In prostate cancer, activation of both the epidermal growth factor receptor (EGFR) and the phosphatidylinositol 3 – kinase (PI3K)/Akt/mammalian target of rapamycin (mTOR) pathway have been implicated in tumorigenesis and resistance to both conventional and targeted anticancer therapies. Having a better understanding of the molecular mechanisms involved in PCa development, progression and resistance to therapy, could assist in the design of novel therapeutic strategies. The objective of this study was to inhibit key molecular targets of the human epidermal growth factor receptor signalling pathway and expose prostate cell lines to doses of radiation, so as to establish potential therapeutic targets that may be amenable to combined modality therapy, and formulate a cocktail of inhibitors to evaluate its radiosensitising capability. The EGFR/PI3K/mTOR pathway plays an important role in the radiosensitivity of the human prostate carcinoma cell line (DU145) and the normal cell line (1542N). In our study we have shown that AG-1478, an EGFR inhibitor, and BEZ-235, a dual inhibitor of the PI3K/mTOR pathway, singly or in combination, at low and relatively high radiation doses, resulted in radiosensitisation of DU145 cells. Radio-protection was achieved in 1542N cells. AG-1478 had no effect on radiosensitivity.
- ItemValidation of radiochemical purity analysis methods used in two tertiary public hospitals in South Africa(Stellenbosch : Stellenbosch University, 2016-03) Mambilima, Nelia; Rubow, Sietske Margarete; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH SUMMARY : Radiopharmaceutical kits are supplied by manufacturers with package inserts containing information about the kit including validated methods of preparation and radiochemical purity (RCP) analysis. Validated analytical methods are also described in pharmacopoeial monographs. However the information provided is not always complete or practical and in a hospital setting it can be difficult to select and perform adequate RCP testing on the prepared radiopharmaceuticals. This situation has led to modifications or substitution for much quicker, simplified, safe or cost-effective analytical procedures. A number of these procedures have been proposed in published literature and have been incorporated in some hospital settings including radio pharmacies in Africa. Since the responsibility of any method that deviates from the official pharmacopoeial or manufacturer’s method rests with the end user, this study was aimed to determine whether appropriate validation procedures based on the Q2A and Q2B guidelines of the International Harmonisation of Technical Requirements for Registration of Pharmaceuticals for Human Use (ICH) are feasible for use in a resource limited environment, which pertains in most hospital radio pharmacy settings in Southern Africa. A further aim was to develop a prototype protocol for validation of analytical procedures in a hospital radio pharmacy setting. In an attempt to undertake a full analytical method validation, eight validation parameters described in the ICH guidelines were selected for the current study namely specificity, accuracy, precision (repeatability and intermediate precision), linearity, range, limit of detection, limit of quantitation and robustness. To undertake the validation exercise, fast RCP test methods for Tc-99m sestamibi involving the use of Whatman 31ET and Schleicher and Schuell chromatography paper were used. Locally procured Macherey-Nagel (MN) Alox N aluminium oxide TLC strips were intended as control method as the Baker-Flex aluminium oxide TLC strips described in the manufacturer’s instructions could not be sourced. All the tests were performed in triplicate and results were compared. A limited number of tests was also performed on Baker-Flex TLC strips to compare with the results of the substitute MN Alox method. The radiochemical components namely Tc-99m sestamibi, Tc-99m colloid and pertechnetate that were prepared in house and were assumed to be 100 % pure, were each tested on the chromatography strips. Samples containing mixtures of varying concentrations of the radiochemical components were also tested on all the strips. Radiochemical purity test results of sestamibi samples without any added impurities were 99.8 % ± 0.0 % for Macherey-Nagel Alox TLC, 99.5 % ± 0.1 % for Whatman 31ET paper and 99.3 % ± 0.2 % for Schleicher and Schuell paper chromatography strips. When Tc-99m pertechnetate and Tc-99m colloid were added to Tc-99m sestamibi as impurities after completion of kit reconstitution, the values for sestamibi were in all cases higher than the calculated RCP. These higher results could have been due to binding of the added technetium to the sestamibi. Another possibility would be that another technetium compound was formed after mixing the already prepared radiochemical components. This new impurity then co-migrated with the Tc-99m sestamibi on the chromatography strips. The unknown impurity could not be isolated or quantified. This impurity could not be proved to be Tc-99m pentamibi, as it was not possible to prepare this radiochemical component in-house and hence all the analytical methods lacked specificity. The MN Alox test method showed exceptionally high values for sestamibi due to co-elution of the free pertechnetate with sestamibi in addition to the unknown impurity. As a result, the MN Alox RCP test method could not be used as a reference standard. The poor agreement between the nominal (calculated) and observed results had a negative effect on the accuracy and linearity over the range that was selected of all the three analytical procedures. Apart from meeting the acceptance criteria for repeatability and intermediate precision, all three analytical methods were also noted to be robust. For the radiochromatogram scanner, the limit of detection was 59 counts while the limit of quantitation was 177 counts for the scanning speed and distance used. In conclusion, all the eight ICH validation parameters are essential when validating a RCP test method. Also, validating an analytical procedure in a hospital setting is possible once some important prerequisites are met, such as availability of staff trained in radiopharmacy or radiochemistry, availability of specified materials for the reference procedure or control experiments, in house preparation of reference standards, and a template validation protocol for thin layer chromatography (TLC) and paper chromatography. Availability of specialized equipment such as a high performance liquid chromatography (HPLC)system for radiopharmaceuticals that have impurities other than free pertechnetate and colloid, is also a requirement, but HPLC is not currently available in public sector Radiopharmacies in South Africa.
- ItemWorking towards the implementaion of an international accreditation programme in a Nuclear Medicine Department of a South African teaching hospital(Stellenbosch : Stellenbosch University, 2005-04) Eiselen, Thea; Ellmann, Annare; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Medical Imaging and Clinical Oncology. Nuclear Medicine.ENGLISH ABSTRACT: Introduction: Quality assurance in Nuclear Medicine is of utmost importance in order to ensure optimal scintigraphic results and correct patient management. A customised Quality Management System (QMS) should be documented and implemented by following the international guidelines set by the International Standardisation Organization (ISO). Materials & Methods: A Quality Control Manual (QCM), defining the departmental quality policy, mission, vision and objectives was customised following the framework of a tried and tested design. As ISO focuses on client satisfaction and staff harmony, the following departmental objectives were audited in working towards the accreditation of the Nuclear Medicine Department of Tygerberg Hospital: referring physician satisfaction, patient satisfaction as well as staff satisfaction and harmony. Information was collected by means of questionnaires completed by referring physicians and staff members. One-on-one interviews were executed on patients. An international ISO accredited Nuclear Medicine department was visited to establish the suggested path to follow en route to successful ISO accreditation and certification. Results: Referring physicians indicated overall satisfaction with service provision, but a need for electronic report and image transfers seemed too dominant. The patient satisfaction survey resulted into overall satisfaction with personal service providing, but the provision of written and understandable information, long waiting times and t equipment must receive attention. Staff questionnaires indicated a general lack of communication between different professional groups and the need for interpersonal loyalty and team building. Improvement measures were identified to ensure the continuous improvement of the QMS by focusing on these quality parameters. Conclusion: The department has QA procedures in place, but does not meet all criteria for external accreditation. In order to ensure departmental harmony and sustainability of client and staff satisfaction, the departmental objectives in measured and improved where needed. The successful implementation and continuous improvement of a customised QMS, following the guidelines outlined in the QCM will lead to successful accreditation.