Gamma Gazette Winter Edition 2020 - The Australian and New Zealand Society of Nuclear Medicine

2020 WINTER EDITION ISSUE 30

LIVING WITH THE PANDEMIC

2020 WINTER EDITION ISSUE 30

Contents From the President

3

Introduction

6 7

Branch News

16 • Technologists Special Interest Group • International Relations Committee • Quality and Technical Standards Committee

21

50th Annual Scientific Meeting

26

• Challenging Times, Living with the Pandemic • 2020 Lowenthal Lecturer • 2020 Pioneer Lecturer • 2020 Annual General Meeting - President's Report • 2020 ASM Program

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• COVID-19 from the other side: how did it affect our education institutions? - An opinion piece • Management of clinical services during COVID-19, An Austin Health Special Report - Department of Molecular Imaging and Therapy (MIT) Austin Health

Technical Standards Article

43

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• A Bloody Good Label: The Positives and Pitfalls of Red Blood Cell Labelling • Two’s a crowd - Duplex Kidney Case Study • Pre-Lung and Heart Transplant V/Q Scan • Acetazolamide Challenge Cerebral Perfusion Scans: A Case Study • What's That? The Case of the Missing Lung

Industry News

Honorary Life Member

Living with the Pandemic

Education and Continuing Professional Development (CPD)

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• Prostate Theranostics & Imaging Centre of Excellence (ProsTIC) launched at the Peter MacCallum Cancer Centre • GE Healthcare News • SensaWeb News - The next step for radiation monitoring?

People in Nuclear Medicine

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• Retirement Dr Trevor Fitzjohn • VALE Professor Sanjiv (Sam) Gambhir

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Take a Break

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Office Bearers

• A stronger radiation safety culture in medicine and an IAEA competition

Design & Production Ester Gomez, Creative Director Enovate Studio ester@enovatestudio.com www.enovatestudio.com

Disclaimer

Editorial

Events & Advertising Enquiries

Rajeev Chandra, General Manager PO Box 6178, Vermont South, VIC 3133 1300 330 402 (03) 8677 2970 secretariat@anzsnm.org.au

marketing@anzsnm.org.au

Submissions

secretariat@anzsnm.org.au

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. © 2020 The Australian and New Zealand Society of Nuclear Medicine.

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).

From the President

I

am writing this, my first report as President of the ANZSNM, from my home office. Things have changed rapidly everywhere around the world, and like many others, I've been working from home when I don't have to be at the hospital to carry out my clinical duties.

Most of our members are not working from home due to clinical requirements of their roles, and so have been faithfully going to work under very trying circumstances - although possibly thankful for the reduction in traffic on the way! We have been dealing with issues around the supply of radiopharmaceuticals and PPE, extra infection control precautions and working with the risks of virus transfer from our patients, preparing for an influx of people sick with COVID-19 and many other struggles, both professional and personal. I was really starting to get worried about running out of toilet paper at home after not being able to get any in the shops for many weeks - even turning up early in the morning at the special time for healthcare workers! Some of our friends and colleagues overseas are still in the thick of it, but it has been great to see the many webinars sharing ideas and successes in adapting Nuclear Medicine practice to this new situation.

F

or those who haven't met me, I'm a Medical Physicist, specialising in Nuclear Medicine and I work for SA Health at The Queen Elizabeth and Lyell McEwin Hospitals in South Australia. I've been on the ANZSNM Federal Council since 2015 when I became the chair and council representative of the Physics SIG (Prab Takhar is the current SIG chair, while I have retained the rep position). I've spent most of the last two years learning the ropes from our outgoing president Ros Francis, who you'll agree has done a great job leading the Society in that time through many changes and crises.

I come into the role in a world of rapid change. As you this read this, the 50th Annual Scientific Meeting is under way online, having launched on the 28th of May. I want to thank the Local Organising Committee (LOC), Geoff Currie, Matt Ayers, Socrates Angelides and Hosen Kiat, who put in a huge amount of work to organise a special 50th meeting. Unfortunately their plans were dashed

by COVID-19 induced travel and group gathering restrictions. We have been able to retain almost all of the scientific program for the online Meeting. I also want to thank the Federal Council and other volunteer members who suddenly had to jump in to reinvent the meeting for this new sociallydistanced, virtual-meeting world.

Many thanks to Ros Francis for her leadership and work over the last two years, and to all the other volunteers: the Federal Council, Branch committees, Special Interest Groups, advisory committees and others who put in countless hours of work behind the scenes to keep the Society running, contributing to keep Nuclear Medicine relevant, up to date and cutting edge.

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From the President (Continued) Thanks also to the LOC for 2021, who have adapted to the shift in location of the 2021 ASM from Perth to Sydney. We assume things will have settled down enough to hold a face to face meeting in May 2021, but if not, the Society is now well placed to run it online if required. We all hope it will not come to that, as there is nothing like actually being there! Standing in the line for the barista coffee between sessions, sitting next to and meeting a new colleague from another state or country, getting up on the dance floor at the gala dinner or catching up with old friends. Don't forget to put the dates of May 2224, 2021 into your calendar!

Looking to the future, once COVID-19 is controlled and we start to get back to "normal", we still have much to do. Research into and the implementation of radionuclide therapy is an important emerging area in Nuclear Medicine, and it is encouraging to see the opportunities for clinical research trials in Australia and New Zealand. ARTnet has been a very successful joint venture with AANMS, and we continue to look towards further collaborative opportunities to strengthen our Nuclear Medicine community. Education remains a key focus, with the CPD content being available from the ASM and more content being added for Edutrace. We continue to work towards keeping our membership connected through local branch activities and through our website and social media platforms.

I love that the Nuclear Medicine community is like a big family, with the different professions working together as a team. Physicians, technologists, physicists, radiopharmacutical scientists are all essential for the operation and advancement of our work, as well as our nursing and administrative colleagues.

I look forward to working toward the goals of the Society – the advancement of Nuclear Medicine in Australia and New Zealand – but this will only happen effectively if we work together as a team!

Daniel

Daniel Badger - MANZSNM, President

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2020 Winter Edition

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2020 Winter Edition gamma GAZETTE 5

Introduction to the Winter Edition Welcome to the Winter Edition of the Gamma Gazette. The world has certainly changed quite a lot since the last edition was released. Looking back over the previous editions, there in no mention of coronavirus or COVID-19, which probably seems strange to us all in these pandemic times.

One of the biggest impacts of the virus, and its ensuing lockdowns has been the cancellation of the Annual Scientific meeting as an in-person event. The conveners have worked extremely hard to modify the content and speakers planned to an online event; a feat which they should be congratulated for.

I hope as many of our members as possible are able to take advantage of this unique opportunity to hear world class speakers from the comfort of their own home. Indeed, the series of webinars may even allow more of our community to partake in these lectures and presentations.

COVID-19 has impacted all of lives in so many different ways, from home schooling to social distancing and Zoom meetings.

As I write this, we will surely experience new and different challenges to overcome in the coming months.

We as a community have shown great strength at coping with adversity with the tracer shortages over the last few years, so I am sure we will rise to whatever challenges we are presented with admirably.

50th Annual Scientific Meeting of the Australian and New Zealand Society of Nuclear Medicine

FOLLOW

Kim Jasper - MANZSNM Branch Chair, Victoria/Tasmania

@anzsnmasm2020

VIRTUAL EDITION MAY-SEPT 2020

Lo ca l In no va tio n, Gl

You can still register and access all live sessions and on-demand presentations

. ion t ira p ns lI a ob

Branch News New South Wales Branch News

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he NSW Branch held its AGM as a virtual meeting on Wednesday June 24. The following members were elected to the positions as shown: Leighton Rogan (I-Med Coffs Harbour ), Branch Committee member, and Kevin London (The Children’s Hospital Westmead), ANZSNM Federal Council Representative for NSW and Branch Committee member. They join Andrew Cluff (RNSH, Sydney) and James Player (POWH, Sydney) on the NSW Branch Committee.

A range of possible options under the current circumstances for a “new look” at activities for the branch were discussed and it will be for the new committee to see what they think might work. These included having branch meetings “live” with members in satellite locations around the state with catering, or on-line from home/office with presentation(s) from members either from NSW or interstate, teaming up with other states to “share” streaming of presentations on a national basis, or to have dedicated day workshops (perhaps on a Saturday) in a single location.

I gave my last branch report at the AGM below: "This report brings to a close my tenure as a member of the New South Wales branch committee and as its representative on the ANZSNM Federal Council. I joined the branch committee in 2012 and was elected as its representative to Federal Council later that year. In this time there have been some great changes & some great events, culminating in being involved in hosting the World Congress of Nuclear Medicine and Biology in 2018. I became the Chair of the NSW branch, by default, in 2016.

The ANZSNM was created 50 years ago. At the time, nuclear medicine was only practised in the big hospitals of the major cities. The Society was built on a federal structure with representation from each state branch and the Special Interest Groups for the specialty areas. If you look back at the history of the Society in our book “Isotopes, Images and Identity” you will see that there were a number of debates at the time as to where this new emerging specialty of nuclear medicine should be situated from a professional point of view. The College of Radiologists was seen as one potential home.

I

t is a great credit to the founding fathers that, from the outset, the Society was one of inclusion for all clinicians, scientists, allied health workers, nurses and industry partners and found its home in

the Royal Australian College of Physicians. This egalitarianism continues to be one of the strengths of the Society and distinguishes it from almost every other professional group nationally.

Sadly, the branch has been relatively inactive in the past few years. The last mid-week branch meeting that was held was on 28th June 2017 at POWH. Other than the speaker and his colleagues and the loyal members from the host institution, less than half a dozen others turned up. This reflected a trend which had been ongoing for some time. It seems to me that the mid-week branch meeting, which was often the only way to participate in continuing education, is now a thing of the past, even in a pre-COVID

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Branch News New South Wales Branch News (Continued) world. Increasing work pressures, especially for clinical and other meetings outside of business hours, the grind of Sydney traffic, and the multiplicity of alternative ways to conveniently access updates in the field and ongoing professional education means that the former branch meetings held quarterly hold less interest these days, and probably only really contribute to maintaining contact and friendships with colleagues from other institutions.

This is unfortunate as it continues to silo us, however, it would appear to be here to stay. We have introduced the November symposium that is held in conjunction with the RAINS Annual CPD meeting. The programs on offer on Saturday at this symposium over the past few years have been wide-ranging and of very high quality.

The practice of nuclear medicine in Australia is, of course, very different to what it was 50 years ago.

There are now regional and rural practices scattered throughout the state. The relevance of a metropolitanbased branch in this context is diminished. It might have worked in 1969 but it is not the best model today. It will be up to the Society moving into the next decade to decide what is an appropriate model for today.

You are all too aware that we were to host the annual scientific meeting in April this year in Sydney. Over two years of planning, recruiting of speakers and building a celebratory program to mark our 50th anniversary took place. I am aware that some people were critical of the Society and the organisers for appearing to be slow to disseminate information prior to the cancellation of the meeting & subsequent to the cancellation, however, having been involved in the processes I can assure you that we responded as rapidly as we could. The scale of the financial loss incurred is not insignificant. However, when you are planning for two years and paying for professional conference organisers, deposits, speaker engagements and the like there is no way to avoid the costs involved. It is planned to hold next year’s meeting in Sydney as well, with the venue still to be confirmed.

At this stage none of us can predict what travel arrangements will be in place come April or May 2021.

We have also been through a number of years now of radiopharmaceutical supply issues. Each has been due to a different cause but the impacts have been similar.

The Society has been working closely with ANSTO, the AANMS and RAINS to try to minimise the impact on 8

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every practice and to make sure that there is equity in the distribution of the available technetium. Hopefully, each time we get a little better at doing this. The challenges of COVID-19 have been, initially, dealing with decreased production from the need to rationalise the staff on the ANSTO production line, and, secondly, the lack of flights available to transport the generators.

We have been helped enormously by the chair of the federal government’s emergency Transport and Freight Taskforce to try to get to as many locations as possible.

Groups like this taskforce work with the professional bodies that represent their memberships, and the Society has played a leading role in these logistical challenges.

What now, though, for the NSW branch of the Society?

It is for you, the members, to determine what activities the branch can provide for you. Some of the branches in the smaller states and cities still have a very active program (prior to COVID-19) of regular meetings with invited speakers in the traditional format. You will need to decide whether this is still something that the NSW branch wants to do. One thought might be, on a certain day, to have a number of small “satellite” get togethers, of practices and departments in close proximity to each other, and have some food first to be followed by an invited speaker who could be in a different location within the state and using today’s modern technology to reach all. I think if there is to be any activity of our branch on a regular basis it will take something like this form. How the sponsorship and other necessary support is provided would need to be worked out. If getting some of this going sounds of interest and the possibilities excite you I would encourage you to make it happen working with the NSW branch.

In conclusion, it has been a great pleasure (most of the time) to be involved in our Society and our community.

I am leaving this official role at a time when the future of nuclear medicine has never looked brighter. I wish the new committee, chair and Federal Council representative the best of luck as they shape the next few years of our professional body."

Dale Bailey - MANZSNM Branch Chair, New South Wales, June 24, 2020

Branch News New Zealand Branch News

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t is hard to believe that we are already half-way through 2020. What a year it has been so far! I do not think any of us could have imagined or prepared ourselves for the many challenges and changes we have been faced with over the past few months. The COVID-19 Pandemic has impacted all of us, not only in the way we work, but how we socialise and go about our regular day to day.

New Zealand entered Alert Level 4 Lockdown on Wednesday 25 March 2020 @ 11:59pm. During this time essential services remained open, including both public and private Nuclear Medicine and PET CT departments. New Zealand closed its borders except for Citizens and Permanent Residents returning from overseas and cargo. Once the border closed, flight availability rapidly decreased which had a huge impact on radiation availability, especially 99mTc/Moly99 Generators which are shipped from outside of NZ. In some instances, certain isotopes were no longer available to be shipped to NZ, including I-131 Capsules, I123 MIBG, Ga67, EDTA and FBB. All non-essential construction was stopped which meant sites undergoing installs, refurbishment, and rebuilds had projects put on hold.

Nuclear Medicine departments were restricted to scanning urgent indications only. For most departments this meant Oncology patients or those patients requiring urgent (<2 weeks) surgical or other medical intervention. All PETCT centres remained fully open, although capacity was reduced due to changes in the flight availability for delivery of PET tracers. For larger centres flights were reduced to one per day, and many cities had their airports closed completely, which meant additional transport via road needed to be facilitated. A huge thanks for Cyclotek NZ, and our own Nuclear Medicine liaison group, for the fantastic communication around the multitude of flight changes and for adapting supply continually to provide necessary isotope to facilitate demand. All departments dealt with massive changes to rostering and scheduling. Many departments adopted a “pod” or “work bubble” protocol which separated staff into groups to ensure departments could potentially remain open should a team member become exposed to or test positive for COVID-19.

Some dual trained NM Technologists were moved to general Xray and CT departments, to facilitate

a need for extra staff in these areas. Physical distancing procedures were implemented in the workplace and in wait areas. Additional cleaning of workspaces, especially between patients, all contributing to longer exam times and less capacity for most sites.

On Monday 27 April 2020 @ 11:59pm NZ moved to Alert Level 3. At this level, all radiology services could open, and scanning was no longer restricted to urgent cases only. Nuclear Medicine and PETCT Departments were still required to abide by the new rules around physical distancing and hygiene practices implemented in Level 4. We continued to see massive impacts around schedule changes and rostering. Many Technologists and Doctors were required to work staggered shifts, change their regular working hours, or work weekends, to accommodate the availability of the radiation and increasing waitlists of patients. Supply of 99m Tc/Moly99 Generators was still very limited.

Therefore, the entire Nuclear Medicine Community in NZ shared whatever radiation was available.

Sometimes this meant sending 2nd week generators to a different city, or for some sites it meant giving up an onsite generator so that it could be used to distribute unit doses for a multi-site city. This meant every Nuclear Medicine Department in New Zealand, including those more remote and smaller sites were able to acquire the necessary radiation to provide key Nuclear Medicine services to Kiwis. I cannot imagine the logistical difficulty, effort, and countless overtime hours it took to facilitate this by GMS and the Nuclear Medicine Liaison team. On behalf of the NZ Branch of the ANZSNM, and the Nuclear Medicine Community in NZ, I would like to express our sincere thanks to Nuclear Liaison team and GMS NZ for their unwavering support and persistence in securing supply of 99mTc/Moly99 Generators for New Zealand and for the fair and expert distribution of 99mTc throughout NZ during this time.

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Branch News New Zealand Branch News (Continued) On Wednesday 13 May 2020 @ 11:59pm NZ moved to Alert Level 2. At this level as we are able break our bubbles, socialise in greater numbers, attend school, restaurants, bars, and engage in domestic travel. A massive sigh of relief was heard throughout NZ on this day! We are continuing to abide by physical distancing protocols and hygiene practices in the workplace, which is contributing to a potential continuation of reduction in capacity. However, we are seeing the availability of more flights within NZ and internationally which is allowing for the greater availability of Tc99m/Moly99 Generators and other isotopes like Ga67, and I131 Capsules. As of 1 June, NZ only has one active COVID-19 case and has not had a reported new case in 11 days. Director General of Health, Ashley Bloomfield stated “there is no evidence of community transmission in New Zealand.”

Although we continue in New Zealand to show signs that we have achieved control of COVID-19 within our borders, we are still not out of the woods. The impact these past few months have had on our economy, our mental and physical health, our relationships, and our working environments cannot go unnoticed. It is likely to be quite some time before we return to life as it was before COVID-19. We will need to continue to utilise our Kiwi ingenuity, resilience, and perseverance to adapt to change and support each other with kindness and compassion, as we recover from the effects of this pandemic.

I am incredibly proud of the efforts Kiwis have made to keep each other safe during these past few months and I am optimistic the trend will continue for the foreseeable future. Hopefully, it will not be long before a Trans-Tasman bubble can be established and we can once again engage with our Australian colleagues, friends and families, face to face!

From the NZ Branch, Kia kaha, kia maia, kia manawanui Be strong, be brave, be steadfast.

Jessica Fagan – MANZSNM Branch Secretary, New Zealand

31 Oct 1 Nov

NZ Branch Meeting Face to Face & Virtual Meeting

2020 Venue: Rydges Hotel, Wellington Airport, New Zealand 10Stewart Duff Drive, GAZETTE 28 Rongotai 2020 Winter Edition 6022 Wellington Bookings: www.anzsnm.org.au

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Branch News Western Australia Branch News

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s with many states, the WA Branch have not been able to hold face to face meetings for the last few months.

Our last meeting was held at Perth Radiological Clinic Subiaco on March 7th. This was a half day ECG Interpretation Seminar sponsored by MIPS. It was a highly informative session with the possibility of more to build on in the future. The feedback from the seminar was very positive, with many technologists feeling that their ability to recognise ECG changes was increased, but with still much more to be learned.

As restrictions for COVID-19 have eased significantly in WA, we are due to hold our next branch meeting on Tuesday July 28th. We have secured an auditorium to allow for adequate social distancing measures, and changed the schedule for the rest of the year to incorporate the two branch meetings we missed earlier in the year so no CPD hours will be lost.

While we are returning to normal in WA, we know many of our colleagues are still being affected on a daily basis by COVID-19. We hope that lives will soon be able to return to normal and that every one stays safe and well during this difficult time.

Stephanie O’Donnell – MANZSNM Branch Committee Member, Western Australia

South Australia/Northern Territory Branch News

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he South Australian Branch is proud to report that since the start of the COVID-19 pandemic we have undertaken two branch meetings virtually via the Zoom platform. Although not without a few technical issues, both meetings were successful and had a great turnout of 37 and >40 respectively.

We recently re-joined forces with our Northern Territory Nuclear Medicine peers and moving forward we will now be known as the South Australia / Northern Territory ANZSNM Branch. We welcomed our Northern Territory peers during our last Zoom meeting. During the COVID-19 pandemic we have learnt the importance of maintaining communication, providing assistance between workplaces and strengthening connections, and therefore the collaboration of our South Australian and Northern Territory branches is of great significance during this time.

The branch would also like to extend a huge congratulations to our very own, Dr. Gabby Cehic, who was recently awarded as a Member of the Order of Australia on the Queen's Birthday Honours List. Gabby was awarded for her “significant service to medicine, to nuclear oncology and to professional medical groups”.

Congratulations also to Dr. Daniel Badger, who has recently taken over the Presidency of the ANZSNM. Madeline Buttfield – MANZSNM Branch Secretary, South Australia

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Branch News Victoria/Tasmania Branch News

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ike most of the country, the Victoria/Tasmania branch has gone into lockdown over the past few months.

We had plans to hold a Master class in June, but with the Annual conference moving to an online format, we thought we would let that be the focus of our members CPD allocation. As the lockdown restrictions have come back to Victoria, we will need to revisit our plans for our annual day seminar.

We are hoping that by late September/early October we will be able to hold some sort of face-to-face event, but are also investigating online viewing options; whether that be from members’ homes or in “hubs” where smaller groups can come together. The seminar will hopefully include the state final of the Radpharm awards. So we encourage all our members to keep an eye out for any interesting cases. We also plan to look at how COVID-19 has impacted us in various ways in the clinical environment and so welcome any interesting perspectives from our community. Keep your eyes on the ANZSNM website for more details as they become available.

Kim Jasper – MANZSNM Branch Chair, Victoria/Tasmania

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HERE FOR EACH OTHER

REPRESENTATION EDUCATION SUPPORT

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ANZSNM members have a wide access to dedicated resources and expertise that are designed to help them stay connected, access exclusive events, and stay current with the latest issues impacting the Nuclear Medicine industry.

These are just a few of the many member benefits at the Society.

MEMBERSHIP RENEWALS OPENING SEPTEMBER 2020

www.anzsnm.org.au

Branch News Queensland Branch News

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itting down to write this branch report, I’m reflecting on just how much has changed over the past four months.

I’d firstly like to take the opportunity on behalf of the QLD branch to say a heartfelt thank you to all those who have worked and are continuing to work within our hospitals, clinics and health care facilities along with all those who worked to maintain essential services.

We have watched our co-workers and friends come together in a time of crisis to provide high level services and support to those in need. As a Society we have adapted to significant change and strived to maintain our core values, continuing to support one another and share valuable information.

I’d also like to use this opportunity to recognise the local organising committee of this year's ANZSNM ASM that was due to be held in Sydney in April. The effort that was put into organising this event and subsequent transition to a virtual platform has not gone unnoticed, thank you.

The last time the QLD branch of the ANZSNM met was on the 18th of February at The Prince Charles Hospital. Fortunate timing considering what was to come in the months that followed.

The evening started with a presentation from Senior Nuclear Medicine Technologist Christopher Travis from the Gold Coast University Hospital. Chris spoke on “Protocol Optimisation for 18F-PSMA

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PET/CT Imaging” which gave us an insight into the use of list-mode whole-body PET imaging and how it can be used to predict image quality along with the effects of changing standard reconstruction parameters.

The second presenter for the evening was Medical Radiation Physicist Erin O’Mahoney from Princess Alexandra Hospital who spoke on “68GaDOTATATE expression in breastmilk”, a study performed in-house at PAH when it was determined that there is little published data currently available.

The third and final speaker of the evening was myself, I threw on my other hat, State-wide Clinical Educator for Nuclear Medicine at Queensland Health and gave an “Education Update” which included a snapshot of the current University programs that offer Nuclear Medicine and how these programs have changed over the past few years. I also briefly spoke about the new AHPRA professional capabilities which came into effect on the first of March 2020 and what they mean for our profession moving forward.

The QLD ANZSNM Branch are looking forward to the upcoming meeting which is due to be held at the Royal Brisbane and Women’s Hospital on Tuesday the 28th of July. At the time of writing this report restrictions have begun to ease here in Queensland so we aim to hold this meeting in-person and via videoconference to cater to all out members.

Stay safe and well, Sarah Daniel – MANZSNM Branch Chair, Queensland

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Special Interest Group News Technologists Special Interest Group (TSIG)

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t feels like a lifetime when this all hit us. We were just starting to recover from the impact of the bushfires that had devastated communities all across Australia. Then we were hit with the Coronavirus pandemic, filled with confusion and angst. We heard rumours that friends or family may be out of jobs, or at least have reduced hours. We worried about the vulnerable people in our communities, our families, and our patients.

There was tension in the air, as anxiety and stress grew.

But we rose to the challenge. We came together, and we responded to the crisis in heroic fashion. We joined with the international Nuclear Medicine industry to learn from countries harder hit than us, local departments shared their techniques for limiting infection, and we collaborated to work out the logistics of transporting radiopharmaceuticals in this new environment. We learnt how to use Zoom, how to stay connected. We got in our gowns and masks, and stood at the frontline of this battle! The Australian public got behind the cause, and we were treated as heroes. And it seemed like we were winning! Numbers started dropping.

But it still continues on, with no real end in sight. This is where we find ourselves now.

As the chair of the Technologist Special Interest Group I want to take the opportunity to praise my fellow technologists, and to all those within the Nuclear Medicine industry. We have achieved a lot within a short time during this crisis.

The TSIG committee has decided to postpone the Annual TSIG Symposium to February 2021. We are hoping that by then travel between states will have opened up and you will be able to join us in person. It will be a great opportunity to celebrate with fellow technologists and acknowledge the efforts that we have all put in during this time. I think by then we will all need a break, and a trip to Brisbane in the tail end of summer could be just the ticket!

As a committee we will still be focusing on representing you, and providing CPD opportunities, but more importantly, we will offer opportunities for you to connect with friends, colleagues, and fellow technologists.

Nicholas Daw - MANZSNM Chair, TSIG Committee

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Special Interest Group News International Relations Committee (IRC)

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he IRC has continued its role in supporting interactions with international Nuclear Medicine bodies.

Over the last three months there has been extensive involvement of the IRC in representing ANZSNM in engagements with IAEA and other international bodies regarding challenges for Nuclear Medicine and Response to the COVID-19 pandemic.

This has resulted in ANZSNM formally supporting four IAEA webinars:

• Coronavirus disease (COVID-19) Pandemic – Challenges for Nuclear Medicine Departments (25th March, 2020) • COVID-19 Pandemic: Guidance for Nuclear Medicine Departments (16th April, 2020) • COVID-19 Pandemic: Supply of Medical radioisotopes and Radiopharmaceuticals (23rd April, 2020) • COVID-19 Pandemic: Transitioning to a "new-normal" – When and How (13th May, 2020) These webinars are accessible at: https://www.iaea.org/topics/health/infectious-diseases/COVID-19/ webinars The IRC has also engaged with the World Federation of Nuclear Medicine and Biology (WFNMB) to contribute to a project with WHO on guidance for nuclear medicine services for practical implementation of COVID-19 protocols. This project is ongoing.

ANZSNM continues to contribute to the global efforts to support Nuclear Medicine during the COVID-19 recovery phase.

The IRC has also been involved in a Lancet Oncology Commission project on the role of imaging and nuclear medicine in cancer care, which will result in a major publication in the second half of 2020.

Andrew Scott - MANZSNM Chair, International Relations Committee

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Special Interest Group News QATSC Update WE NEED YOUR HELP The

Quality

and

Technical

Standards

Committee (QATSC) needs representatives from the ACT and NSW Branches, and the Technologistâ&#x20AC;&#x2122;s SIG. If you can help out, please talk with your Branch chair or SIG chair. In this role you would be representing the members of your SIG or Branch and helping shape nuclear medicine practice standards in Australia and New Zealand. As a bonus, you can also use this activity for ANZSNM continuing education credits. If you would like more details about the activities of the Committee, please email the chairperson at QATSC@anzsnm.org.au.

WHATâ&#x20AC;&#x2122;S IN A NAME? With the approval of the ANZSNM Federal Council, the Technical Standards Committee has been rebranded the Quality and Technical Standards Committee to reflect the growing importance of quality standards and quality management in clinical practice, and to strategically engage more members in such activities. More details will be available with an update of the webpage for the Committee.

PROJECT UPDATES The Committee hopes to shortly make available a Primer document on the legislation, regulations, and an introduction to quality risk management for the in-house production of radiopharmaceuticals. Thanks very much to Doug Smyth and the working party members for the submission made to the Federal Council that lead to this document. The plan is for a second document that will look more closely at quality risk management for inhouse production of radiopharmaceuticals.

RESOURCES UPDATE If you missed notification of the following free resources, you may find them useful. The ANZSNM has not necessarily endorsed these publications. They are provided here simply for the purpose of notifying members of the existence of the documents. If you have come across a useful quality or technical standard or resource, please email the details to QATSC@anzsnm.org.au so it can be considered for inclusion in future QATSC updates.

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Special Interest Group News Quality and Technical Standards Committee Update (Continued)

EANM “Radiopharmacy: An Update – A Technologist’s Guide” (2019). This is an update to the 2008 technologist’s guide and focusses on daily radiopharmacy practice, such as design, preparation, dispensing and documentation.

IAEA SPECT/CT Atlas of Quality Control and Image Artefacts (2019) – to quote the IAEA, “This atlas presents an overview of quality control procedures in SPECT and SPECT/CT and guides the reader through pitfalls and image artefacts that can be faced using these imaging modalities. In addition to examples of artefacts themselves, descriptions are given on their causes, and the steps that can be taken to avoid their recurrence.”

THE SAFRON SYSTEM AND RADIONUCLIDE THERAPIES SAFRON is the International Atomic Energy Agency’s incident learning system for SAFety in Radiation ONcology. This system has recently been expanded to collect information on radionuclide therapy events and near misses. General information is available here about the SAFRON system and there is a SAFRON update newsletter that contains further details about the launch of the system for radionuclide therapies.

This a voluntary event recording system that will mature the more everyone contributes. Others can learn from our events or near misses and we can all learn from the events of others, if not simply to ask ourselves how that happened and whether we really have systems in place to prevent it happening in our facility. To err is human; to catch it and mitigate the consequences is everyone’s responsibility.

Darin O’Keeffe - MANZSNM Chair, Quality and Technical Standards Committee Contact: QATSC@anzsnm.org.au

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REAL DATA REAL TIME REAL SIMPLE

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Honorary Life Member Vijay Kumar

Special Feature ANZSNM Honorary Life Membership (2020)

ANZSNM Honorary Life Membership

P

rofessor Vijay Kumar has been endorsed for the award of Honorary Life Membership of the ANZSNM in 2020 for his excellent contribution to the Society and profession over a span of four decades. He has a well-earned reputation in the Australasian and international Nuclear Medicine community. He had humble beginnings in Australia as the proud recipient of a Commonwealth Scholarship in June 1974 to pursue a PhD at the Australian National University, Canberra. He describes it as the “game-changer” in his life, which motivated him to be determined to do his best in the new country to make it all “worth-while” after leaving behind the loved ones, family and friends in India.

Vijay came to this country full of determination and commitment to succeed. He faced many challenges and hurdles in the long walk of four decades but he said he was very fortunate to get the professional support from key people when it really mattered.

After completing his PhD in 1977, he worked briefly as Tutor in Biochemistry at UNSW and as Research Officer at St. Vincent’s Hospital (1977-79). He then entered Nuclear Medicine at the Liverpool Hospital in Sydney in 1979.

Currently he is the Principal Scientist and head of Radiopharmaceutical Research at Westmead Hospital and The Children’s Hospital at Westmead. He is also Clinical Professor in the Discipline of Adolescent and Child Health, Sydney Medical School, University of Sydney.

CONTRIBUTION IN THE FIELD OF NUCLEAR MEDICINE FOR OVER 40 YEARS

Vijay started by establishing RIA laboratories and in-house manufacturing of cold-kits at Liverpool Hospital. He was instrumental in initiating these facilities as there was no Radiopharmacy division at Liverpool Hospital before he arrived. He then joined Westmead Hospital and The Children’s Hospital at Westmead in 1996. He played a central role in establishing Radiopharmacy services, and Ga68 & F18 labelled PET radiopharmaceutical production for imaging dopamine transporter and various cancers. Recently, he has also introduced Lu-177 labelled PSMA & DOTATATE for treating the patients with neuroendocrine tumours and prostate cancers. He developed many research projects and new radiopharmaceuticals for imaging infection, arthritis and oncology. He is particularly known for his enthusiastic adoption and promotion of the Ge68/Ga68 generator, realising early on how pivotal this device would be for the field of nuclear medicine. He has several book chapters, peer-reviewed articles, >50 invited lectures at the major forums and >100 abstracts 2020 Winter Edition gamma GAZETTE 21

Honorary Life Member ANZSNM Honorary Life Membership of conference presentations. He has supervised PhD (2), MSc (2) and BSC (Hons x 3) students.

Vijay was thankful to Dr. David Farlow and Prof.

Howman-Giles for their constant support in all his endeavours and particularly for giving professional freedom. He also acknowledged Dilip Boddeti for backing him up alongside his frequent absence from work and his wife Shan for her unconditional support throughout his career.

OTHER AWARDS AND RECOGNITION

Vijay received Australia Day Honours in 2017, as the Member in the General division of “The Order of Australia” (AM) for his significant contribution to Nuclear Medicine, professional organisations and community. He has won the ANSTO award twice (2007 & 2014) and the Life-time achievement award at SNM-India (2012) for his contributions in the advancement of Nuclear Medicine. He has been invited to speak at the monthly seminar series at Harvard Medical School, Molecular Imaging Program at Stanford (MIPS) at Stanford Medical School, and at Medical Grand rounds in MD Anderson Cancer Care centre. He was invited to speak at the Russian Academy of Science (St. Petersburg) and British Nuclear Medicine Society conferences. He has been a regular speaker at all major Nuclear Medicine forums - SNMMI, EANM, WFNMB, ALASBIN and AOFNMB (>50 times) around the globe. He was also a regular visitor to the International Atomic Energy Agency (IAEA) in Vienna, the nuclear arm of the United Nations, for project-based expert missions for many years.

CONTRIBUTIONS TO ANZSNM, WFNMB AND OTHER ORGANISATIONS

Vijay has contributed to ANZSNM in various capacities over a span of more than 20 years.

He was the President of the ANZSNM (20142016), Secretary of IRC (International Relations Committee) (2008-2019), Chair of Radiopharmacy

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SIG (Special Interest Group) (1997-2000), Member of Scientific Advisory Panel (SAP) (2013- 2019), LOC (Local Organising Committee) member for ANZSNM Conference in Darwin, and ANSTOANZSNM Grant convenor from 2013 to 2019. He also chaired many sessions for ANZSNM. Vijay has been actively engaged with these ANZSNM activities for many years, which gave him the opportunity to serve as the Secretary of WFNMB Bid Committee for 8 years (200614) and played a significant role in successfully winning the bid and the right to host the World Congress of Nuclear Medicine & Biology (WFNMB) (2018) in Australia - with Andrew Scott and Peter Collins as the Chairs of the bid committee. He then became the Governing council member of WFNMB and served as the Treasurer and Organising Committee member for the WFNMB conference in Melbourne in 2018, with Andrew Scott, Dale Bailey and Sze Ting Lee.

Vijay has served at the Board of Directors of ISORBE (International Society for Radiolabelled Blood Elements) since 2007. ISORBE’s major focus is in developing labelled cells (Leukocytes) and Radiopharmaceuticals for infection imaging and making the technology available to the developing nations. He has actively participated in many conferences on behalf of ISORBE in Latin American countries and Asia. He is also a member of Board of Directors at AOFNMB since 2019. He also served as the Governing Council member of WFNMB (201418).

1

2 3

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5

6 IMAGE CAPTIONS - FROM TOP TO BOTTOM AND LEFT TO RIGHT.

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1. Vijay receiving the Order of Australia with the Governor of NSW in 2017; 2. A member of the organising committee of the WFNMB 2018; 3. Vijay receiving the Honorary Life Membership; 4. Vijay performing at a concert with orchestra in India; 5. A younger version of Vijay in the 1990s; 6. Vijay receiving the Lifetime Achievement Award from the Society of Nuclear Medicine in India in 2011; 7. Self-confessed party lover, Vijay enjoying a good time with his peers.

Honorary Life Member ANZSNM Honorary Life Membership

ASSOCIATION WITH IAEA AND NUCLEAR MEDICINE IN GENERAL

Vijay has been involved with numerous nuclear medicine committees and represented various professional organisations and has driven local and international projects. He was closely associated with IAEA (International Atomic Energy Agency) activities since 1998. He was invited numerous times as a scientific expert on project based expert missions

by IAEA for various projects, and worked Full Time at IAEA in Vienna as Radiopharmaceutical Science Consultant Scientific Expert for nearly one year in 2010 under Special Services Agreement under United Nations.

Vijay has developed some important documents at IAEA as a member of international expert committee e.g., International Radiopharmacopoeal Monographs, Hospital Radiopharmacy etc, during numerous visits to IAEA, Vienna. He served as steering committee member at IAEA on two occasions. He has been invited as a scientific expert on project based expert missions with the IAEA for Regional Development projects in Africa and national project in Iraq. These projects were undertaken to “capacity building” of these developing nations, which includes providing funds to build-up facilities. He was involved in planning Nuclear Medicine department in Baghdad, and establishing hot-lab facilities. He was responsible for recruiting more than a dozen Iraqi Nuclear Medicine personnel for training in various member states including Westmead Hospital. Vijay also offered mentorship to more than 25 IAEA-Fellowship visitors for training in Radiopharmacy at Westmead Hospital & The Children’s Hospital at Westmead over many years.

Vijay has served as a Scientific expert for QUANUM (Quality Management Audits in Nuclear Medicine practices) for ARASIA (Arabic and Asian Member States) region on six different occasions. The audits are focused in providing expert guidelines to the member states to address their limitations and streamline smooth functioning and departmental layouts. He contributed to two CRP (Cooperative Research Projects) at IAEA, over a 6 year period.

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These CRPs are multi-centre, multinational research projects focused on a particular theme. Usually 15-20 member states participate on a specific project, and meet at 18 month intervals to develop a document at the end. These documents are available for free on the IAEA website and it is a standard reference document and provides guidelines for member states rather than reinventing the wheel. Vijay has been closely associated with DAT (Distance Assisted Teaching) program, where he contributed in developing a number of Teaching Modules for technologists since 1998.

COMMUNITY SERVICE AND HOBBIES

Vijay has some hidden talents that many of you may not know.

Yes, he is a popular singer of Bollywood songs and has performed as lead singer in many concerts for charities in the 80s and 90s in Sydney. He really loved the role as amateur singer and entertained the audience of full houses for many years.

He contributed to Indian community organisations in guiding the young settlers and liaising with the community organisations and the Indian Embassy.

His other passion is for “fast cars”, which may surprise many readers. He fondly remembers driving a Lamborghini on Italian freeways and surviving the ordeal.

He also tested the Indy-500 track as the passenger in the racing car with an adrenaline pumping lap. He describes himself as a party animal and loves good food and wine. He loves fancy dress themes at the ANZSNM gala dinner events. He loves travelling overseas to attend conferences and make friends in all walks of life. He always believes “it is better to be worn out than rusted out”.

Honorary Life Member ANZSNM Honorary Life Membership

ADVICE AND ENCOURAGEMENT TO YOUNG SCIENTISTS

Rewinding the clock 40 years, Vijay recalls - Nuclear Medicine was “Unclear Medicine” then and after 40+ years in the field he proudly says it is now “New and Clear Medicine”. He has seen the changes from whole organ imaging to molecular imaging; from blanket therapy (chemotherapy) to targeted radionuclide therapy; from rectilinear scanning to hybrid imaging (PET/CT & PET/MR) and many more.

Vijay stated “he is not going to give career advice but at the ripe old age of 70 he wanted to share a few lessons that he learnt and cherished over the years”. Vijay advocates passionate micro-ambitious dreams to the pursuit of short-term goals rather than earth-shattering “mega-dreams”. He advises early careerists to “Put your head down and work with pride on whatever is in front of you. You never know where you might end up. Remember you can’t truly take credit for all your successes, nor truly blame others for failures, as you are incalculably lucky to be where you are”. Life will sometimes seem long and tough. There is only one sensible thing to do with this potentially empty existence – so fill it by learning as much as you can and about as much as you can. Take pride in whatever you are doing, have compassion, share ideas and be enthusiastic in all walks of life. “LIFE is an incredibly exciting thing. Live it up!!!”

ANZSNM greatly appreciates the contributions by Professor Vijay Kumar, in his career spanning well over 40+ years and is delighted to confer the prestigious Honorary Life Member of the Society. I wish him well in all his future endeavours personally by myself and on behalf of the Society.

Dale Bailey - MANZSNM Chair, Scientific Advisory Panel

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There is a commonly quoted proverb of “may you live in interesting times” translated from Chinese and intended as irony. And, in 2020 we all have been truly granted that! The Society in its 51st year has experienced some of the challenges that we all, as individuals, as a community and wider society, have dealt with. For instance, the 50th Annual Scientific Meeting was scheduled for Sydney and had a grand programme reflecting this milestone with a large contingent expected. Amongst other adjustments, the ASM had to be quickly pivoted to a virtual meeting utilising virtual web technologies. The phrase “can you unmute” has become a familiar part of the lexicon in amongst many humorous and interesting background images. It has also created new conveniences and in some ways, some greater familiarity.

There has been a fantastic response from the original presenters from near and far who have converted this to a virtual format and, who have generously contributed their time and including from those delegates that have registered and participated. The various technical glitches have been taken with good humour and good grace. Our resilience, patience and goodwill continues to be tested and it continues to define and test our character as a healthcare profession and community.

The program is still ongoing which is indeed a departure from the last forty nine. The following pages represent what we traditionally publish in the Winter edition as updates from the Annual Conference.

Readers will hopefully understand that the content is different to the normal.

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50th Annual Scientific Meeting 2020 Lowenthal Lecturer Dr Kathy Willowson, Royal North Shore Hospital The recipient of the Lowenthal Award and Lectureship for 2020, Kathy Willowson, is a senior medical physicist in the Department of Nuclear Medicine at Royal North Shore (RNS) Hospital, Sydney.

Kathy majored in Physics and Mathematics as part of an Advanced Science Degree at the University of Sydney, graduating with first class honours. She commenced her doctoral studies in medical physics at RNS and the School of Physics of the University of Sydney in 2006. At the time, the RNS Nuclear Medicine Department had just completed the installation of an in-house developed SPECT/CT system incorporating a diagnostic quality CT scanner, which was not commercially available at the time. Kathy’s studies led her to develop the first fully quantitative SPECT reconstructions for 99mTc-labelled radiopharmaceuticals with corrections for attenuation and scattering of the gamma photons using the CT data.

She completed her PhD in 2009 and since that time has been developing clinical applications using the methods she had developed as well as extending the SPECT methodology to other radionuclides.

In 2010 Kathy was the recipient of an Australian government ‘Enterprise Connect’ Researchers-in-Business Award, in collaboration with Sirtex Medical, an Australian biotech company specializing in radioembolisation treatment for liver cancer. In 2011 she received further funding from the Cancer Council NSW and Cure Cancer Australia Foundation in an Innovator’s Grant to continue her work, in collaboration with Sirtex Medical, to investigate improved treatment planning for radiation embolisation of hepatic malignancies, shifting her focus from SPECT to PET. This initiated a long-standing period of active and productive research into radiation dosimetry and dose-response relationships from beta radionuclide therapy, where she has established an international reputation. Kathy was the first to demonstrate that [90Y]-SIR-Spheres could be imaged quantitatively using PET, in spite of the paucity of the signal that was available from 90Y, which is traditionally thought of as a pure beta emitter.

Her work has led us into establishing a radiobiology wet lab to examine the effects of radiation on cancer cells lines under controlled conditions.

During her research career Kathy has been the recipient of numerous awards including the 2005 Insight Oceania Curie Prize, the MedPhys 2007 Postgraduate Prize from the Australian College of Physical Scientists and Engineers in Medicine (ACPSEM) followed by the same college’s Boyce Worthley Award for Young Achievers in 2017, the ANZSNM Gammasonics Award in 2014 and two Ramsay Health Care Travel Fellowships from the Scientific Staff Council of RNS Hospital. In 2014 she was awarded the Eckert & Ziegler Prize at the EANM Annual Congress for “one of the five most convincing abstracts this year” on the correlation between 90Y voxel-based dosimetry and metabolic response in hepatic cancer, and subsequently was given an Honourable Mention by the Therapy Centre of Excellence at the SNMMI Annual Meeting in 2017 for her work on prognostic factors in hepatic radioembolization.

In spite of moving into a tenured clinical medical physics role in the hospital a few years’ ago, Kathy remains in great demand as a lecturer, teacher and researcher. Her input into the treatment of our SIRT patients is much sought after by our physicians, interventional radiologists and surgeons. In her relatively short career to date she has published over 25 papers.

The Lowenthal Lecture remit is for an invited talk in keeping with the theme "The Role of Physical and Biochemical Measurements in Nuclear Medicine" and Kathy’s outstanding and innovative work more than amply satisfies this criterion.

Often the award is made to a more senior member of the Australasian Nuclear Medicine community in recognition of a lifetime’s achievement, but in this case the award has been made to a rising star. We look forward to many more years of Kathy’s influence and contributions to the art of measurement in the field of nuclear medicine.

Dale Bailey - MANZSNM, Royal North Shore Hospital

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50th Annual Scientific Meeting 2020 Pioneer Lecturer Professor Chris Rowe, Austin Hospital Chris Rowe was identified by The Australian in their 2019 survey of Australian research as the field leader for Neurology. He is a nuclear medicine physician and neurologist dividing his time between clinical nuclear medicine, dementia care and research. He is the Director of the Australian Dementia Network (ADNeT) established across the nation in late 2018 at 11 universities and research institutes with funding from the NHMRC National Institute of Dementia Research and philanthropic donors. Chris is also Director of Molecular Imaging Research at Austin Health and the University of Melbourne.

Although his nuclear medicine research career started in epilepsy with his MD thesis work pioneering the development of post-ictal and ictal SPECT for seizure focus localization, his research focus later shifted to molecular brain imaging of neurodegenerative diseases, particularly Alzheimerâ&#x20AC;&#x2122;s disease (AD), for better understanding, earlier more accurate detection, and to facilitate development of early therapeutic interventions. In this area he has been extremely productive and has consistently been a Highly Cited Researcher (top 1% world-wide for neuroscience) since 2016 averaging over 4,500 citations and 20 publications per year, and has received international awards including the US Society of Nuclear Medicine Kuhl-Lassen Award for Outstanding Contribution to Brain Imaging and the Christopher Clark Award for advancing human amyloid imaging. In total he has over 350 publications and has received research funding of over $38 million from the NHMRC and $17 million from other sources.

His current focus is on translation of recent advancements in diagnostics for AD into clinical practice, facilitating clinical trials to prevent dementia and establishing mechanisms to ensure high quality dementia diagnosis and care. He leads research teams at Austin Health and University of Melbourne and has a strong record of national and international collaboration.

Sze Ting Lee - MANZSNM, Austin Hospital

Watch the Lowenthal and Pioneer Lectures On-Demand

Watch the Lowenthal Lecture - Great ExSPECTations.

The Convergence of SPECT and PET.

Watch the Pioneer Lecture - Molecular Neuroimaging of Dementia: Research and Clinical Application.

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50th Annual Scientific Meeting 2020 Annual General Meeting President's Report President's AGM Presentation: For those who missed it here is the President's presentation reproduced. For those who are members the video presentation with audio is available in the Members Portal

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50th Annual Scientific Meeting 2020 Annual General Meeting President's Report

President's AGM Presentation (Continues)

2020 Winter Edition gamma GAZETTE

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50th Annual Scientific Meeting 2020 Annual General Meeting President's Report President's AGM Presentation (Continues)

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50 th Annual Scientific Meeting 2020 of the Australian and New Zealand Society of Nuclear Medicine

VIRTUAL MEETING

Live Sessions and On-Demand Program

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50th Annual Scientific Virtual Meeting 2020 — On Demand Program

WELCOME The 2020 Annual Scientific Meeting consists of eight themed sessions of pre-recorded content (listed in purple text) hosted by the ANZSNM. Each session commences with a live meeting hosted on Zoom (listed in black text). The live meetings consists of the AGM, the award sessions, the Pioneer and Lowenthal Lectures, ARTNET update and the Gala event and award presentation. The pre-recorded content for the session will then be available for two weeks from the end of the live meeting. Each live meeting will be recorded and also made available for later viewing for those who cannot attend live. During the two week period, discussion or panel events will likely be held for each session, in various formats.

Submitted posters will also be released onto the website at intervals in the eight sessions.

SESSION 28th May 18:00 AEST

TOPIC AGM and Meeting opening

SPEAKERS ANZSNM President and Local Organising Committee

(Live Presentation)

Dr Geoff Currie

Session 1 On-Demand 28th May – 11th June

Cultural Proficiency Workshop

28th May 18:00 AEST

Cultural Proficiency Workshop Discussion

Dr Geoff Currie

11th June 18:00 AEST

Pioneer Lecture

(Live Presentation)

Prof Christopher Rowe Topic: Molecular Neuroimaging of Dementia: Research and Clinical Application

Session 2 On-Demand 11th – 25th June

Diversity workshop

Dr K Elizabeth Hawk

23rd June 13:00 AEST

Live Discussion Diversity workshop

(Pre-recorded content)

(Live Zoom Session)

(Pre-recorded content)

Dr K Elizabeth Hawk

(Live Zoom Session)

25th June 17:00 AEST

Lowenthal Lecture

Dr Kathy Willowson

(Live Presentation)

Topic: Great ExSPECTations the convergence of SPECT and PET

Session 3 On-Demand 25th June – 9th July

10th July 10:30 AEST

Prostate (Pre-recorded content)

AANMS Registrar Award (Live Presentation moderated

by Dr Michelle Nottage )

34 www.anzsnm.org.au/events/ASM2020

1. Advances in prostate cancer imaging - A/Prof Louise Emmett 2. Advances in prostate cancer therapy – Prof Michael Hofman 1. Introduction - Dr Michelle Nottage 2. The diagnostic value of 67Ga-citrate in the evaluation of patients with a suspected site of infection - Dr Sally Ayesa 3. The value of 68Ga-PSMA PET/CT in assessing treatment response in men with oligometastatic prostate cancer treated with stereotactic ablative body radiotherapy (SABR) - Dr Melissa Cheng 4. Quantitative MRI and FDG-PET/CT Imaging of Tumoural Heterogeneity in cervical carcinoma - Dr Bridgid Connolly 5. Excellent suppression of physiological myocardial FDG activity in patients with known or suspected cardiac sarcoidosis prepared with a 24-hour high fat very low carbohydrate diet and prolonged fasting - Dr Shyam Sankaran

50th Annual Scientific Virtual Meeting 2020 — On Demand Program

SESSION

TOPIC

Session 4 On-Demand 10th – 23rd July

(Pre-recorded content)

15th July 16:30 AEST

(Live Webinar*)

Cardiology

Cardiology

This session is sponsored by

SPEAKERS 1.

2.

3.

4.

New applications of cardiac PET/CT – Prof Henry Bom Cardiac PET – Dr David Gilmore Cardiac sarcoidosis - Mark Crosthwaite Nuclear cardiology; what’s new in blood flow and flow reserve - Mark Crosthwaite

“Could this be Amyloid? Review of imaging modalities in the diagnosis of cardiac amyloidosis.”

by Prof Stuart Ramsay * Separate log in details will be sent to all registrants to this webinar

15th July 18:00 AEST

Prostate Imaging (Live Moderated Discussion Panel)

23rd July 18:00 AEST

Prof Michael Hofman, A/Prof Louise Emmett and A/Prof David Pattison

ARTNET Update

A/Prof Ros Francis, Prof Michael Hofman, A/Prof Louise

Live Discussion Panel

Emmett, Prof Andrew Scott, A/Prof Paul Thomas, and A/Prof Stuart Ramsay.

TOPICS WILL INCLUDE: 1. What is ARTnet and what does it do?

2. What are the ProPSMA, TheraP, Upfront PSMA, and ENZAp trials and where are they headed?

3. What is the update on the clinical trial on glioma?

4. What about research opportunities in XPECT /Cardiac Amyloid?

Session 5 On-Demand 23rd July – 6th August

Radiochemistry (Pre-recorded content)

6th August 18:00 AEST

Shimadzu Award (Live Presentations)

Session 6 On-Demand 6th – 20th August

Emerging PET Tracers (Pre-recorded content)

17th August 18:00 AEST

1. Harnessing bioorthogonal click chemistry for pretargeted PET imaging and radioimmunotherapy – Dr Brian Zeglis 2. 18F prosthetic groups - Dr Lidia Matesic 3. Emerging reactor and cyclotron produced radionuclides – Leena Hogan 1. [18F]Ethenesulfonyl Fluoride: Making Radiofluorination Reactions Accessible – A/Prof Giancarlo Pascali 1. Emerging new PET Tracers and their impact on clinical imaging and therapy – Prof Vijay Kumar 2. Is Ga-68 the “new” Tc-99m: expanding use beyond DOTATATE and PSMA – Prof Michael Hofman 3. 18F; past, present and future – A/Prof Giancarlo Pascali 4. The development of novel approaches to the site-specific radiolabeling of antibodies – Dr Brian Zeglis

Radiochemistry and Emerging PET tracers (Live Moderated Joint Discussion Panel)

www.anzsnm.org.au/events/ASM2020 35

50th Annual Scientific Virtual Meeting 2020 — On Demand Program

SESSION 20th August 18:00 AEST

TOPIC Radpharm Award (Live Presentations)

Undergraduate Student Award (Live Presentations)

Session 7 On-Demand Therapy (Pre-recorded content) 20th August – 3rd September

3rd Sept 18:00 AEST

Curium Award (Live Presentations)

SPEAKERS 1. PSMA - Not Specifically for Prostate Cancer – Megan Storm 2. SDHA genetic variant. A case study – Clare McKenzie 3. Utilising Fluorine-18 Florbetaben (18F-FBB) as a diagnostic tool for the assessment of cardiac amyloidosis – Maddison Carroll 4. Combination BRAF and MEK inhibitor therapy for redifferentiation of radioiodine refractory BRAF mutated papillary thyroid cancer: a Case Study – Nicholas Daw 5. Almost The Same Shunt Different Day - Briony Hunter 6. The Role of a Nuclear Arthrogram in Imaging for an Infected Prosthesis – Madeleine Smith 1. What Comes First? The patient or education? – Laetitia Mai 2. Bone scintigraphy: a snapshot analysis of current practice in an adult population across South Australia Medical Imaging (SAMI) sites – Xinyuan Ren 3. Is there antibody out there? 89Zr-mAbs are taking over the world! – Wendy Phan 1. Trends in the use of alpha emitters in radionuclide therapy - Prof Lionel Zuckier 2. Alpha therapies today and tomorrow - Prof Eric Rohren 3. Radium-223 in clinical practice - Prof John Buscombe 4. 90Y microsphere dosimetry; partition model versus BSA - Dr Sean Yan 5. Dosimetry for therapy – Prof Dale Bailey 6. 32P OncoSil™ administered under endoscopic Ultrasound (EUS) guidance with combined chemotherapy in locally advanced pancreatic cancer can change management.

- Prof Dylan Bartholomeusz 1. Interobserver variability in interpretation of Ventilation-Perfusion lung scans (VQ scans) – Sarah Thomas

Session 8 On-Demand Artificial Intelligence 3rd – 17th September (Pre-recorded content)

1. Introduction to A.I., ML and DL– A/Prof Geoff Currie 2. Artificial intelligence applications in medical imaging – Dr K Elizabeth Hawk 3. Deep learning in diagnosis, therapy and clinical applications; part 1 - Prof Lionel Zuckier 4. Deep learning in diagnosis, therapy and clinical applications; part 2 - Prof Ran Klein 5. A.I. and big data in nuclear medicine and radiology; a programmatic perspective - Prof Eric Rohren

Awards presentation 17th Sept and Meeting close 18:00 AEST Gala Event: Dress up, (Live Presentations) bring your drinks nibbles and enjoy!

Award Presentations - Conference Review and Close

36 www.anzsnm.org.au/events/ASM2020

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Living with the Pandemic COVID-19 from the other side: how did it affect our education institutions? - An opinion piece Author: Suzanne McGavin, MANZSNM, Royal Melbourne Institute of Technology University (RMIT)

My experience of COVID-19 was strange, abstract and came from a perspective I was not used to. Being a traditional clinical Nuclear Medicine Tech for so long, it was strange to watch the health pandemic from my university office. It seemed like I was watching a movie from the outside of a glass house. It wasn’t long until the windows opened and universities across the country found themselves adjusting to the COVID-19 crisis. It started with moving some classes online and hoping to keep practicals running in the labs, staff remaining on campus and the only change being course delivery. This literally changed overnight. I woke to an email outlining that the entire university would be moved to online just like the teaching in accordance with social distancing guidelines. I had heard from friends in clinical settings about the rapid changes but didn’t think it would apply so much to education. I remember there being a feeling of confusion as staff tried to work out how to transfer their office to their home combined with the assumption that we may not return to campus for a long time. However, the students seemed to be cheering “no more uni!”. They appeared to envisage long sleep ins, no transporting all the way out to campus, uni in bed, really living the life!

The nuclear medicine industry has lived through multiple challenges, but people managed these with professionalism, communication and most importantly (I think) humour. I cannot applaud our clinical sites enough; their response to the pandemic and for taking the time to focus on student progression, which I think may not have been a clinical priority at this time. Perhaps this goes to show that we are not a narrow-visioned profession because at a time of crisis, we were still thinking of the wider Nuclear Medicine community at large, thank you!

Additionally, we had student placements to worry about; a critical aspect of any student’s education in healthcare. What should we do? Sites were consistently receiving updates and information, things were changing by the hour, and we were left wondering whether all placements should be cancelled. But if we did this, when would we fit all the essential placements back into the program? The vision of waking up with a coffee and strolling into the office were not realistic.

There were long sleepless nights, weekend discussions with placement sites, emails flying a million miles an hour between sites, academics, students and administration. Students were unsure of what to do.

Is their placement their priority? External/media hysteria surrounding the pandemic was also affecting the student’s mental health and their living situation.

Second semester will bring some return of campus life as practical labs recommence and planning has started for a staggered return by staff. It is early days and we will have to wait and see as returning to campus is dependent on State government guidelines. But I feel I can say that the experience of COVID-19 brought to life the fact that social interaction is necessary for good mental health. It has really made me think more about our patients and others, who may be alone all day. I have more time for people now, I always have, but something about a deeper appreciation is what I can hope most people gained from this.

I quickly realised how fortunate we are to have the Nuclear Medicine community that we have.

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So after nearly 3 months since we commenced working off campus; how is it? Well, let’s not lie, on the cold, rainy Melbourne days, having that coffee and walking to the room next door is the dream. But other days, I think there are possibly many people like me who need social interaction. Yes, the video conference opportunities are amazing, they fill the gap (a little).

But like my colleagues, we miss the students. We don’t see their faces, as we lecture into a void of cameras and have become keyboard warriors. Speaking to the students, the honeymoon is over; they are ready to come back to uni as they miss campus, they also miss people, and strangely, us.

From an academic’s perspective, the COVID-19 experience outside the hospital was strange and quite different. At one point I felt quite removed but on the other hand, I also felt connected by our Nuclear Medicine community. Another crisis worked through; we got this Nuclear Medicine!

Living with the Pandemic Management of clinical services during COVID-19, An Austin Health Special Report - Department of Molecular Imaging and Therapy (MIT) Austin Health Author: Kunthi Pathmaraj, Chief Technologist (NM, PET and BMD), Department of Molecular Imaging and Therapy, Austin Health, 28th May 2020 Every Nuclear Medicine department has no doubt felt the impact of COVID-19 on their ability to deliver an efficient clinical service. We have all had to adjust and remodel the manner in which we deliver a safe and optimal service within the framework of COVID-19 restrictions.

At Austin Health, we started revising clinical operations quite early in the pandemic â&#x20AC;&#x201C; late January to be precise. We found ourselves having to quickly amend our service provision and work practices to align with advisories from the Commonwealth Government, as well as the Victorian Department of Human Health Services (DHHS), together with the guidelines from the Austin Health Executive.

Patient screening questionnaires - Our first measure in early

February 2020 was the formulation of a patient pre-screening questionnaire, and also an on-site screening questionnaire used to screen patients for symptoms of COVID-19. The questionnaires were designed based on advice being provided by Austin Health and DHHS, which was quite dynamic in the initial phases of the pandemic, changing from initially screening for travel from mainland China to later

include South Korea, Iran, Japan and eventually the whole world.

Interestingly, soon after, an article published on April 1st by the Journal of Nuclear Medicine [1] by a panel of expert authors discussed the implementation of similar screening or triaging measures in multiple Nuclear Medicines Departments around the world.

The pre-screening questionnaire was completed by reception staff when they contacted patients to make the booking. The screening questionnaire was again employed when patients presented at our reception for a procedure. Completed screening questionnaires were scanned into our electronic information system linked to the patient record. Staff were given instructions on what to do if a patient answered yes to any of the questions, such as isolating the patient to a designated room, patient donning a N95 mask and contacting Department of Infection Control for advice. In our Department, this has thus far only happened in two instances, and notably early in the pandemic. Both patients were sent home without the scan being performed, as per advice from Infection Control.

MIT Local COVID-19 guideline â&#x20AC;&#x201C; This was formulated in early

likelihood of the declaration of a pandemic, possible lock down measures that may be enforced by the federal government, as well as the possible requirement to cease non-essential services. This local guideline was critical in forward planning and management of our operations in the event of a pandemic. We have used the guideline as a communication tool to inform MIT staff of proposed plans to modify clinical operations, revise booking schedules, rostering changes, operating in teams to reduce risk of multiple staff being infected if one staff member contracted COVID-19, appropriate use and training of Personal Protective Equipment (PPE) for front line staff, hand sanitisation and cleaning measures, graded reduction of non-essential services in the event of the declaration of a pandemic and/or reduced levels of staffing if staff fell sick. This guideline served as a framework for the ensuing months, enabling us to be nimble and flexible to adjust to the avalanche of changes that the pandemic was to enforce.

Importantly, an Information Statement from ASNC and SNMMI [2] published recently in the Journal of Nuclear Medicine advocates for many of these safety measures that we sought to implement in our Department.

March 2020, pre-empting the high

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Living with the Pandemic Management of clinical services during COVID-19, An Austin Health Special Report - Department of Molecular Imaging and Therapy (MIT), Austin Health (Continued) Personal Protective Equipment (PPE) – Our staff are familiar with

wearing PPE when dealing with infectious patients with airborne and droplet precautions. Training staff to wear appropriate PPE for suspected COVID-19 patients was therefore not a great challenge.

However, we were able to retrain our staff in the appropriate use of PPE in the COVID-19 context, including the correct way of donning and doffing PPE and when to wear a surgical mask vs N95 mask, an approach that appears to have been adopted in China [3].

We prepared COVID-19 PPE kits that were stored next to the NM and PET console areas, as well as the nursing bay. Mindful of the potential shortage of PPE that may occur nationwide, we were discerning in our use of PPE and ensured we had secured enough stock based on the projected clinical service and number of suspected or confirmed COVID-19 patients we may encounter.

Staff Patient Contact chart – Based on the concept of contact tracing, we have redesigned our Technical Data Sheets with the ability to record every staff member that comes into contact with every patient. This initiative was taken to enable us to contact trace staff members who came into close contact with patients who later developed COVID-19, after their visit to MIT.

Cleaning Measures – We have

expanded and increased the department cleaning protocols to address the need for extra cleaning

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in the context of coronavirus to prevent possible spread of infection. The importance of thorough cleaning to limit the spread of COVID-19 has been emphasised to Nuclear Medicine professionals in recent publications [1,4]. Our cleaning protocol is quite extensive including cleaning of equipment and scanner rooms with Chloradet solution or Tuffie wipes after every outpatient and inpatient encounter, cleaning tourniquets and syringe shields with Chloradet solution or Tuffie wipes after each use as well as regular cleaning of door handles and contact or touch points. We have revised our booking schedule to permit us to undertake a thorough cleaning between patients.

areas, since there is a requirement for a certain number of staff to operate a scanner to provide optimal patient care and also to perform maintenance works in the cyclotron and laboratory areas. Staff that could work from home, were empowered to do so. Each staffing group (Clinicians, Technologists, Radiopharmacists, Radiochemists, Medical Physicists, Administrative staff) were divided into teams and overlapping of teams was avoided as much as practicable.

Hand Hygiene – 5 moments of hand hygiene, as per the WHO guidelines, is strictly adhered to and we conduct regular hand hygiene audits to monitor compliance.

Clinical Service Provision – This was carefully managed during the various stages of the pandemic.

Using our local COVID-19 guideline and in compliance with advisories from the DHHS and Austin Health, we voluntarily ceased non-urgent services (eg DEXA scans and Dementia scans) when stage 3 restrictions were announced. DEXA scans and dementia scans constitute a decent proportion of our workload, and this together with the ban on nonurgent elective surgeries resulted in our NM services decreasing by 4050%. However, we noted that most NM services globally experienced a far greater reduction in NM services than we did, whilst some countries such as South Korea and Australia were less affected [1, 4].

Our clinical PET service was not affected greatly, decreasing by only 20-25%. Apart from non-urgent

Social Distancing Measures – These were implemented for

the administrative areas, offices, reporting rooms, patient waiting rooms and tea rooms, to comply with the 1.5 m distance between persons and a 4 square meter space per person. We improvised offices and rooms within the Department, to ensure staff could be separated appropriately. This included converting some spaces to temporary patient waiting rooms, reception areas and tea rooms.

It was not practical to always maintain social distancing in the clinical console areas and scientific

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Internal meetings and interdepartmental meetings, involving more than a few people were conducted via video conferencing such as Zoom, to maintain social distancing.

Living with the Pandemic Management of clinical services during COVID-19, An Austin Health Special Report - Department of Molecular Imaging and Therapy (MIT), Austin Health (Continued) •

oncology follow up scans, oncology scan referrals were steady. Surprisingly, only a handful of patients cancelled their appointments due to concerns around COVID-19.

Clinical Trials – As was the case globally, diagnostic clinical trials virtually ceased in our department when stage 3 lockdown measures were announced. We have adhered closely to the advice provided by the Austin Office of Research, and complied with the requirement that new patients could not be recruited into existing trials and new trials could not commence without specific approval from the Office for Research. Some trial activity has continued within the therapeutic trials space.

Minor logistical challenges – Since Austin was

designated as one of the three initial screening clinics in Melbourne, the hospital closed all entries other than the main entrance to the hospital, and the visitor elevator was altered to bypass he floor which accommodated the COVID-19 clinic. We were required to change the patient information letter to provide new directions to our department, which directed patients to enter through the main entrance to the hospital where they would be screened prior to entry and redirect them so that they avoided the floor of the COVID-19 clinic.

Documentation Review - Documentation has always

had a strong focus in our Department. The COVID-19 pandemic downtime presented an ideal opportunity to review and update our documentation, to ensure clinical, technical, scientific, nursing, quality and administrative documents were up to date and aligned to practice on the floor. We undertook the document revision process in a detailed and structured manner.

•

•

A document review spreadsheet was created and tabs were allocated for different imaging modalities and lab documents, to facilitate easy management of documents A comprehensive list of all the existing SOPs, protocols, training manuals, credentialing records, patient information brochures, clinical and technical data sheets and other documents was made

• • •

•

•

These documents were then distributed amongst our staff to review and update • Documents reviewed by junior staff are reviewed and signed off by senior staff • Each document is signed off by the group head A gap analysis was performed to identify obsolete documents and requirement of new documents New documents formulated are sent for approval by the MIT Safety and Quality Committee and the MIT Executive Using a standard SOP template, version control, revision history and archiving of obsolete documents is an integral part of this exercise on document revision We also formulated an MIT SOP register, to capture all the SOPs and documents in the department. The scope of the SOP register includes provisions to record latest updates to SOPs and the ability to record staff members reading and signing off on each SOP All our documents are linked to a central MIT intranet for easy access and ensures all staff are accessing the same documents

Mini Projects - We were able to identify a number

of projects for technologists to improve our clinical practice, and at the same time provide continuing professional development opportunities. These projects were formulated in close collaboration with the senior medical staff and we are hoping to submit a few of these at the ANZSNM 2020 virtual meeting. Some examples include: • • •

•

Inter-observer variability in interpretation of Ventilation-Perfusion lung scans Correlation between PET biomarkers and outcomes in patients with malignant lung masses treated with SABR A Single Sample Glomerular Filtration Rate calculation method as a viable alternative to Conventional Three Sample Slope-Intercept Glomerular Filtration Rate Calculation method in a mixed patient population A proposal to minimise time and radiation exposure to patients when performing FDG PET/ CT imaging of patients with brain metastases 2020 Winter Edition gamma GAZETTE

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Living with the Pandemic Management of clinical services during COVID-19, An Austin Health Special Report - Department of Molecular Imaging and Therapy (MIT), Austin Health (Continued) •

Using Q.MetrixTM to evaluate treatment response to PRRT for Neuroendocrine tumours of gastroenteric or pancreatic origin

Internal Audits and Reviews - We have been able to

invest more time conducting internal reviews and audits in the clinical, scientific and administrative space.

Internal Reviews are designed to evaluate the efficiency of various aspects of the service and identify gaps with a view to improve governance around patient care.

Some examples of internal reviews we performed in the last 3 months include: •

•

• • • • •

Retrospective review for time out compliance – check if patients are identified and procedure matched in accordance with Austin Health polices and National Health and Safety Health Service (NSQHS) standards, before the administration of the radiopharmaceutical Review of injected radioactivity for NM and PET procedures performed to understand if our Facility Reference Levels (FRL) lies within ARPANSA recommended Diagnostic Reference Levels (DRLs) and adheres to Basic Safety Standards (BSS) Perform trend analysis of scanner QC parameters such as linearity, uniformity and sensitivity Review the time taken to triage and book referrals Review radiopharmaceutical synthesis success and failure rates Review of communication of significant findings to referring physicians Review of efficiency of NM and PET workflows

As a result of these reviews, we have introduced some changes to our procedures, largely around governance, to ensure that we are delivering safe patient care.

Of note was our decision to mandate that two staff members should check a radiopharmaceutical dose before administration, including the need for both staff members to check procedure matching as well. ie, two staff members check for correct patient, correct procedure, correct radiopharmaceutical and correct dose.

The last 3 months during the COVID-19 pandemic has been a productive time at Austin Health for the

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Department of Molecular Imaging and Therapy. We have forward planned and adjusted well to changes necessitated by the pandemic, such as operating in teams, observing social distancing, increased hand hygiene and cleaning measures, and revised booking schedules. Our initiatives have closely aligned with measures being taken by Nuclear Medicine Services globally. We have maintained a reasonable clinical service within the limitations of COVID-19 restrictions and been able to achieve considerable progress and success in documentation revision, projects and internal reviews, all of which are ongoing. The management of CoVID-19 in our Department has been very much a collaborative effort across all the disciplines, that has increased cohesiveness and collegiality within staff members.

It would be appropriate to mention that since the recent lifting of some restrictions in Victoria, we are now in the process of gradually recommencing the non-urgent services and research that we had to cease 3 months ago. Again, we are ensuring that we are compliant from a governance perspective with regards to recommencement of non-urgent services, and taking the appropriate measures mandated by the Australian Chief Health Officer, Victorian DHHS and Austin Health to ensure we continue to operate in a CoVID safe manner.

References: 1. Johannes Czernin, Stefano Fanti, Philipp T. Meyer, Martin AllenAuerbach, Marcus Hacker, Mike Sathekge, Rodney Hicks, Andrew M. Scott, Jun Hatazawa, Mijin Yun, Heiko Sch¨oder, Peter Bartenstein,and Ken Herrmann. Nuclear Medicine Operations in the Times of COVID19:Strategies, Precautions, and Experiences. J Nucl Med. May 2020; 61(5). Published on April 1, 2020 as Doi: 10.2967/jnumed.120.245738 2. Zhang, X., Shao, F. & Lan, X. Suggestions for safety and protection control in Department of Nuclear Medicine during the outbreak of COVID-19. Eur J Nucl Med Mol Imaging 47, 1632–1633 (2020) 3. Skali H, Murthy VL, Al-Mallah MH, et al. Guidance and best practices for nuclear cardiology laboratories during the coronavirus disease 2019 (COVID-19) pandemic: An Information Statement from ASNC and SNMMI [published online ahead of print, 2020 May 15]. J Nucl Med. 2020;jnumed.120.246686. doi:10.2967/jnumed.120.246686 4. D. Paez, G. Gnanasegaran, S. Fanti, J. Bomanji, M. Hacker, M. Sathekge, H. S. Bom, J. J. Cerci, A. Chiti, K. Herrmann,A. M. Scott, J. Czernin, N. El-Haj, E. Estrada, O. Pellet, P. Orellana, F. Giammarile, and M. Abdel-Wahab.

COVID-19 pandemic: guidance for nuclear medicine departments. Eur J Nucl Med Mol Imaging. 2020 Apr 15 : 1–5.

Technical Standards Article A stronger radiation safety culture in medicine and an IAEA competition Author: Darin O'Keeffe, Christchurch Hospital, New Zealand

Working in nuclear medicine, we are well aware of the importance of radiation safety: justification, optimisation, limitation; the basic principles of distance, time, shielding, containment and control, etc. These are all well-established principles and procedures. So how could a stronger radiation safety culture improve safety and what would it look like in medicine? The International Atomic Energy Agency (IAEA) took on the challenge of this question by looking at safety in a number of industries, including nuclear and aviation, and they came up with 10 common traits that are essential for a strong radiation safety culture. Notice that I said “a strong radiation safety culture”. The IAEA Human Health Programme originates from one of the articles of their United Nations Statute that says they must “accelerate and enlarge the contribution of atomic energy to peace, health and prosperity throughout the world”. So they are mandated to promote radiation safety and that is what they have focussed on with these 10 common traits. But I wonder whether it could be extended to one safety culture for radiation safety, occupational safety, and patient safety in medicine. That has yet to be determined, but I think it is worth exploring as the programme unfolds.

The 10 common traits are personal accountability, questioning attitude, effective safety communication, leadership safety values and actions, decision-making, respectful work environment, continuous learning, problem identification and resolution, environment for raising concerns, and work processes. Why 10? I personally think it probably could have been 9, but 10 fits nicely with the other IAEA programmes such as “10 Pearls: Radiation protection of patients in CT” and “10 Pearls: Radiation Protection of Patients in Fluoroscopy”. The IAEA have developed a ‘trait talks’ training programme for this safety culture based on work done by the US Nuclear Regulatory Commission and engaging an adult education specialist. The result is a programme designed to train a maximum of around 25 people at a time using a combination of a brief introductory lecture, a scenario to study and discuss as a group, and finishing with a visual digital presentation (because that’s what most of us adults like), and a final group discussion about the trait.

Presentation of my bronze medal by Juan Carlos Lentijo, Deputy Director of the IAEA and Head of the Department of Nuclear Safety and Security.

In March last year the International Atomic Energy Agency (IAEA) launched a competition entitled “Towards a Strong Radiation Safety Culture in Medicine” that was designed to generate the 3 minute digital presentations. The top three participants received a travel grant to present their digital projects at the IAEA in Vienna at the launch of the training.

I thought that sounded like a great opportunity so I entered. It was much more challenging than I expected and I almost gave up trying, but with some acting assistance of staff from the Nuclear Medicine Department and Medical Physics & Bioengineering at Christchurch Hospital (thanks!), I pieced together a home movie quality submission. Very much to my surprise, I got third place in the competition and offered a paid trip to Vienna. But there was a catch: the training package had not been completed and was not going to be launched at this meeting. Instead we were asked to present our projects at a consultancy meeting, be presented our place medal, and then lead an hour long session on our trait, trialling the training material.

It sounded more like hard work than a fun expenses paid trip to Vienna. And it was; three and a half days of work but a great opportunity to interact with some experts in radiation safety and representatives of major organisation such as the IAEA, WHO, European Society of Radiology, and many others.

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Technical Standards Article A stronger radiation safety culture in medicine and an IAEA competition (Continued) The training programme was meant to be launched at an IAEA meeting in Seoul at the end of May, but COVID-19 put an end to that. So we await the official launch. If you have an opportunity to be part of the training programme, take it. Many of the scenarios discussed are outside of nuclear medicine, but they are eye-openers and very educational.

One of the classic wooden panel rooms of the Vienna International Centre. Luis de los Santos (AAPM) giving a very dynamic and interactive presentation as an example of training as part of the radiation safety culture programme.

On a personal note, this was my first time in Vienna and Austria. The consultancy meeting was held in the Vienna International Centre (VIC), home to the IAEA and a major branch of the United Nations. Security was tight getting into the facility but once inside you could roam pretty freely from building to building. The VIC was a truly multi-national facility and going to the main eatery was an experience on its own – the size of a major shopping mall food court, cheap prices, an amazing selection of food, and I've never seen so many suits in one place at one time!

The only thing I would say missing from the consultancy meeting was the lack of a social function – you only really got to chat with others at the breaks. However, I managed to entertain myself with a brief look around Vienna in the evenings and on the last day before I flew out that night. A nice city and very easy and cheap to travel around using public transport and a 7 day travel card. I’ll go back if I have an opportunity.

Darin O’Keeffe, MANZSNM Christchurch Hospital, New Zealand

During a lunchbreak I took the opportunity to catch some sunlight to help get over the jetlag. The cool breeze was not as regular as this photos suggests: 30 photos later I managed to capture the NZ flag in its full glory!

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The Vienna International Centre has a number of gifted artworks throughout the facility, including a number fascinating pieces in the main courtyard area. This one was titled "Woman Free".

gamma GAZETTE 2020 Winter Edition

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Education & CPD Case Study A Bloody Good Label: The Positives and Pitfalls of Red Blood Cell Labelling Author: Stephanie Ruyten, Monash Health

INTRODUCTION Technetium labelled red blood cell studies are commonly performed in Nuclear Medicine to evaluate red blood cell distribution within the body to image GI bleeds, hepatic haemangiomas, functional splenic tissue and gated cardiac imaging. The radiolabelling of red blood cells involves the reduction of stannous ion converting pertechnetate to the oxidative state Tc4+ allowing binding to the haemoglobin in red cells.

The three common labelling techniques include in-vivo, where red blood cells are labelled within the body via an injection of non-radioactive stannous pyrophosphate (PYP) 30 minutes prior to pertechnetate administration.

In-vitro, performed using of a biohazard cabinet where blood washing occurs, requires spinning the red blood cells to remove free pertechnetate through the supernatant; or alternatively in-vitro labelling without a cabinet using an Ultra-Tag kit (Callahan, 2006). Lastly, in-vivtro, the modified in-vitro method, involves a combination of both in-vitro and in-vivo techniques. This requires PYP to be injected into the patient and after 30 minutes blood is taken in a syringe containing acid citrate dextrose (ACD) and pertechnetate. The blood is then incubated for a further 30 minutes and reinjected into the patient as radiolabelled red blood cells (Ziessman, O'Malley, Thrall, & Fahey, 2014). The three techniques have their advantages and disadvantages including blood handling, the use of a biohazard cabinet, labelling efficiency and cost; these are contributing factors to the following case.

GAMMA GAZETTE CONTENT SUBMISSIONS Scientific submissions on all aspects of nuclear medicine are encouraged and should be forwarded to the Secretariat - instructions for authors published at https://www.anzsnm.org.au/activities/gamma-gazette-content-submission-and-guidelines/ 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 ANZSNM Gamma Gazette is published three times a year. Deadlines for each issue of the journal can be found on our website anzsnm.org.au

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Education & CPD Case Study A Bloody Good Label: The Positives and Pitfalls of Red Blood Cell Labelling (Continued)

Various drugs and devices can alter the binding of stannous ion to red blood cells, impacting adequate labelling.

These drugs and devices include heparin, methyldopa, chemotherapeutic agents, whole blood transfusions, intravenous catheters, propranolol and iodinated contrast (Callahan, 2006). It is important to take note of these to determine a labelling technique that provides the best labelling outcome. This case study provides a comparison between the two in-vitro methods and how the labelling efficiency can alter due to pre-existing factors.

CASE STUDY HISTORY A 47-year-old Caucasian male presented to the department with previously known cystic lesions in segments 7/8 of the liver; found within the superior portion of the right liver lobe. These lesions were identified on CT and ultrasound, with recent CT revealing changes to the lesions requiring assessment for a potential haemangioma.

INITIAL IMAGING On the patientâ&#x20AC;&#x2122;s original presentation, the Ultra-Tag labelling method was used. Dynamic, early (figure 1) and delayed (figure 2) statics were acquired, where delayed images were acquired 3 hours post injection.

The early static (figure 1) identified expected uptake within the liver and spleen. The delayed statics (figure 2) however, demonstrate tracer distribution within the stomach, thyroid and salivary glands indicating the presence of free pertechnetate and therefore confirming a low yield red blood cell label. After reviewing the labelling process and finding no errors; this prompted an investigation into the patients past medical history.

Figure 1: Early static images

Figure 2: Delayed statics at 4 hours post injection

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Education & CPD Case Study A Bloody Good Label: The Positives and Pitfalls of Red Blood Cell Labelling (Continued)

REPEAT IMAGING The patient returned two months later for further investigation of a potential haemangioma. On this instance an in-vitro label was performed within the biohazard cabinet, washing out any remaining free pertechnetate. The invitro label produced a labelling efficiency of 87%, where normal is considered >80% (Callahan, 2006). Dynamic, early (figure 3) and delayed (figure 4) statics were again performed along with a delayed SPECT/CT (figure 5), all demonstrating normal radiolabel distribution. As evident in figure 5, there was no free pertechnetate using the in-vitro labelling method, providing a diagnostic conclusion of a negative scan.

Figure 3: Early statics.

Figure 5: Delayed SPECT/CT 4 hours post injection.

DISCUSSION When assessing the Ultra-Tag labelling technique, it was confirmed to have been performed to manufacturer specifications, therefore why was the in-vitro method successful and not Ultra-Tag? On further investigation of the patientâ&#x20AC;&#x2122;s medical history it was identified that he had undergone a renal transplant in January of 2016 and was therefore taking immunosuppressive medication mycophenolate and tacrolimus post-transplant.

Figure 4: Delayed Statics 4 hours post injection.

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Education & CPD Case Study A Bloody Good Label: The Positives and Pitfalls of Red Blood Cell Labelling (Continued)

Tacrolimus is a calcineurin inhibitor immunosuppressant prescribed to patients post organ transplant to prevent and treat allograft rejection; it has a half-life between 3.5 and 40.5 hours where most of the drug metabolises in the liver (Prescriber, 1998). Tacrolimus is administered post organ transplants to inhibit calcium dependent events such as gene transcription and cell degradation (Barbarino, Staatz, Venkataramanan, Klein, & Altman, 2013). It is highly bound to red blood cells and 99% bound to plasma proteins with a half-life of 3.5 to 40.5 hours (Australian Prescriber, 1998). The pharmacokinetics of this drug alters depending on the transplanted organ (Marfo, Altshuler, & Lu, 2010).

Tacrolimus elicits immunosuppressant effects via binding to immunophilins known as FK-binding proteins.

These proteins interfere with the activity of calcineurin preventing dephosphorylation to occur, thereby stopping T-cell proliferation (Barbarino J. M., Staatz, Venkataramanan, Klein, & Altman, 2013). Tacrolimus is approximately 99% bound to plasma proteins; its concentration is dependent on erythrocyte distribution with a blood to plasma ratio of 15:1 (Venkataramanan, et al., 1995). The red blood cell distribution of tacrolimus is influenced by factors such as hematocrit, temperature and protein concentration (Marfo, Altshuler, & Lu, Tacrolimus Pharmacokinetic and Pharmacogenomic Differences between Adults and Pediatric Solid Organ Transplant Recipients, 2010). Tacrolimus is administered orally in capsule form with a dose of 75-300 mcg/ kg daily in 2 doses, the medication is adjusted according to patient response and whole blood concentration (Australian Medicines Handbook Pty Ltd, 2020).

The high affinity of Tacrolimus in red blood cells resulted in competitive binding between the drug and radiolabel, thereby increasing overall percentage of unbound free pertechnetate (Zahir, McCaughan, Gleeson, Nand, & McLachlan, 2003). Unlike the extensive washing process involved in the in-vitro method, blood labelling using the Ultra-Tag kit doesnâ&#x20AC;&#x2122;t allow the removal of unbound pertechnetate, increasing competitive binding (Spicer, Hladik, & Mulberry, 1999). It is not possible for a patient on immunosuppression therapy to cease their treatment, therefore methods need to be adapted to best suit the situation.

CONCLUSION This case study demonstrates that it is important to tailor the labelling technique for each individual patient; in particular a comprehensive drug history and questionnaire to eliminate causes for poor red cell labelling is crucial, especially in patients on immunosuppressive medications. In this instance, in-vitro labelling with a biohazard cabinet was the most effective label method, allowing the removal of free pertechnetate to provide a diagnostic outcome. As such, patients on Tacrolimus should ideally have their scan performed in a department that has the equipment and ability to perform blood labelling in a biohazard cabinet.

References Australian Prescriber. (1998, September 01). Tacrolimus. NPS Medicine Wise, 80(3), 21. doi:DOI: 10.18773/austprescr.1998.076; Barbarino, J., Staatz, C. E., Venkataramanan, R., Klein, T. E., & Altman, R. B. (2013, October). PharmGKB summary: cyclosporine and tacrolimus pathways. Pharmacogenet Genomics, 23(10), 563-585. doi:10.1097/FPC.0b013e328364db84 Callahan, R. J. (2006). Radiolabeled Red Blood Cells: Methods and Mechanisms. (J. Norenberg, Ed.) The University of New Mexico Health Sciences Center College of Pharmacy, 12(1), 24.

Retrieved from https://pharmacyce.unm.edu/nuclear_program/freelessonfiles/Vol12Lesson1.pdf; Marfo, K., Altshuler, J., & Lu, A. (2010, September 09). Tacrolimus Pharmacokinetic and Pharmacogenomic Differences between Adults and Pediatric Solid Organ Transplant Recipients. Pharmaceutics, 2(3), 291-299. doi:10.3390/pharmaceutics2030291; Spicer, J. A., Hladik, W. B., & Mulberry, W. E. (1999). The Effects of Selected Antineoplastic Agents on the Labeling of Erythrocytes with Technetium-99m Using the UltraTag RBC Kit. Journal of Nuclear Medicine Technology, 27(2), 132-135.

Venkataramanan, R., Swaminathan, A., Prasad, T., Jain, A., Zuckerman, S., Warty, V., . . . Starzl, T. (2012, October 19). Clinical Pharmacokinetics of Tacrolimus. Clinical Pharmacokinetics, 29, 404-430. doi:10.2165/00003088-199529060-00003; Zahir, H., McCaughan, G., Gleeson, M., Nand, R. A., & McLachlan, A. J. (2003, March 21). Factors affecting variability in distribution of tacrolimus in liver transplant recipients. British Journal of Clinical Pharmacology, 57(3), 298-309. doi:10.1111/j.1365-2125.2003.02008.x; Ziessman, H. A., O'Malley, J. P., Thrall, J. H., & Fahey, F. H. (2014). Nuclear Medicine: The Requisits. Philadelphia: Saunders, Elsevier.

2020 Winter Edition gamma GAZETTE 49

Education & CPD Case Study Twoâ&#x20AC;&#x2122;s a crowd - Duplex Kidney Case Study Author: Courtney King, Royal Melbourne Institute of Technology

BACKGROUND AND PATIENT PRESENTATION A 53-year-old male presented to his GP with right flank pain. He was referred to get a CT scan to investigate this further.

The CT images helped doctors to discover that the patient had a duplex kidney, which can be seen in figure 1. He was born with two pelvicalyceal systems in his right kidney1. This condition occurs due to two ureteral buds arising and developing into ureters during foetal development2. Duplex kidneys are often asymptomatic2; however, this was clearly not this case for this patient.

Vesicoureteral reflux (VUR) is a common condition associated with duplex kidneys2. It involves urine flowing from the bladder into the ureter and pelvis of the kidney. It was important to rule out this potential diagnosis as it can lead to renal scarring, hypertension and renal failure2.

The patient was further referred to get a nuclear medicine renal scan. This was to determine whether this patient had an obstruction or VUR, as well as provide accurate information about the cortical function of each moiety.

INVESTIGATION Tc-MAG3 was the best radiopharmaceutical to be used due to its excellent extraction rate of 55%, more than double that of 99mTc-DTPA1. This characteristic is important in ensuring a high target-to-background ratio4.

99m

Figure 1. CT of patientâ&#x20AC;&#x2122;s abdomen and pelvis

The patient was administered 384MBq of 99m Tc-MAG3. A dynamic acquisition of one frame per three seconds was acquired to show initial blood flow to the kidneys. This

was followed by a dynamic; one frame per minute for twenty minutes. This demonstrated the rate at which his kidneys were taking up and excreting the radiopharmaceutical, which is directly proportional to the rate at which urine is excreted. A one-minute pre micturition and one-minute post micturition images were then acquired.

Lasix was not required due to the radiopharmaceutical clearance in the kidney.

RESULTS The radiopharmaceutical distribution demonstrated no evidence of obstruction. The uptake was prompt and showed asymmetrical reduced cortical uptake in the right kidney compared to the left, particularly involving the lower region of the right kidney.

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Education & CPD Case Study Two’s a crowd - Duplex Kidney Case Study (Continued)

Figure 2. Renogram of upper and lower moieties in the right kidney.

The maximum uptake peak occurred at three minutes for both the left kidney and upper moiety of the right kidney, which is considered normal4. However, the lower moiety of the right kidney uptake was about a quarter of the uptake in the upper moiety. The excretion was also significantly slower, and an uptake peak was not seen.

The regions of interest indicated that the left kidney function is much greater, being 63% compared to 37% for the right, of which the upper pole contributes 80%.

DISCUSSION This case highlights the usefulness of functional imaging. The diagnosis of differential function of the left kidney and right kidney and upper and lower moieties would not have occurred without having a nuclear medicine renal scan. The processing of this scan was different from routine renal scans as regions of interest were drawn around the upper and lower regions of the right kidney to determine the contribution of each moiety.

The reduced function of the right kidney may be the cause of the patients flank pain2. Flank pain along with incontinence, urinary tract infections and haematuria are common indications for a duplex kidney2.

Understanding that the patient’s lower moiety functions significantly less than the upper moiety can hopefully help the patient and doctors to determine a treatment plan. Recommended treatment for this patient may be a urethrectomy or lower pole heminephrectomy2. Surgical approaches can either be laparoscopic or open2. This would decrease his risk of developing urinary tract infections and VUR2.

References REF 1. Mendichovszky, I., Solar, B., Smeulders, N., Easty, M., & Biassoni, L. (2012). Nuclear Medicine in Paediatric Nephro-Urology: An Overview. Seminars in Nuclear Medicine. 47(3):201-228. Doi: 10.1053/2016.12.002 ; REF 2.Davda, S. & Vohra, A. (2013). Adult duplex kidneys: An important differential diagnosis in patients with abnormal cysts. Journal of the royal society of medicine short reports. 4(2):13. Doi: 10.1177/2042533312472126 ; REF 3. Liu, G., Ma, H., & Li, Y. (2012). Multilocular Renal Cell Carcinoma in Lower Pole Moiety of a Duplex kidney. International Journal of Surgical Pathology. 20(6): 613-17. Doi: 10.1177/1066896912438098 ; REF 4. Ziessman, H., O’Malley, J., & Thrall, J 2015). The Requisites- Nuclear Medicine (4th ed). Boston, MA: Elsevier ; REF 5.

Ponto, J. (2012). Mechanisms of radiopharmaceutical Localization. University of New Mexico Health Sciences Centre. 16(4):21

2020 Winter Edition gamma GAZETTE 51

Education & CPD Case Study Pre-Lung and Heart Transplant V/Q Scan Author: Courtney King, Royal Melbourne Institute of Technology.

A 15-year-old boy presented to the nuclear medicine department for a V/Q scan. This scan allowed doctors to assess the patientâ&#x20AC;&#x2122;s ventilation and perfusion. Lung transplants are associated with a significant risk, therefor the patient must undergo many tests to ensure that the transplant is a feasible option and to make sure that the patientâ&#x20AC;&#x2122;s condition is serve enough to require a transplant1. The tests not only look at the heart and lungs but also determine whether the patient has other conditions that could exclude them from being suitable for a transplant2.

The patient was born with an intraventricular septal defect, measuring 39mm. This created a bi-directional cardiac shunt. He was also diagnosed with cyanotic congenital heart disease, pulmonary hypertension and severe cardiomegaly, as shown in figures 1 and 2.

Figure 2: Transverse CT scan Retrieved from: The Alfred Hospital, Melbourne

Figure 1: Coronal CT scan Retrieved from: The Alfred Hospital, Melbourne

INVESTIGATION The patient was administered with 0.5k counts of technegas while laying supine under the gamma camera. This administered dose was below the standard ventilation dose due to his age and pulmonary hypertension. A SPECT image of the lungs was then acquired on a Siemens Symbia Evo gamma camera.

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Education & CPD Case Study Pre-Lung and Heart Transplant V/Q Scan (Continued)

This was followed by the administration of 86MBq of 99mTc-MAA and another SPECT image of the lungs.

RESULTS The ventilation and perfusion images reveal matched heterogeneity throughout both lungs. This is indicative

Figure 3: 3D Ventilation and Perfusion images Retrieved from: The Alfred Hospital, Melbourne

of pulmonary disorders such as pneumonia, chronic obstructive airway disease, infarction and atelectasis3.

The matched pattern indicated that the patient does not have a pulmonary embolism3.

Sub-diaphragmic radiopharmaceutical activity is seen in the perfusion images, which is expected in patients with a right-to-left cardiac shunt2. There is also an abnormally large cardiac shadow due to cardiomegaly.

The contribution of each lung is different. After performing a quantitative analysis it was revealed that the right lobe of the lung contributes approximately 61% and the left lobe of the lung contributes 39%.

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Education & CPD Case Study Pre-Lung and Heart Transplant V/Q Scan (Continued)

The image quality is relatively low due to the low radiation dose used; however, the images are still diagnostic.

DISCUSSION The journey that patients go through in order to be considered for a lung and heart transplant is lengthy and involves many health assessments and interactions with multiple healthcare professionals.

Nuclear medicine plays an important role as patients must undergo both a V/Q scan and gated blood pool scan1.

A V/Q scan is non-invasive and successfully identifies ventilation and perfusion defects within lungs, allowing doctors to definitively determine functional tissue3.

In addition to the ventilation and Figure 4: Perfusion Quantification Analysis, Retrieved from The Alfred Hospital, Melbourne perfusion SPECT performed, a SPECT/ CT would have given more accurate quantitative information in regard to the function contribution of each lobe of the lung and increased specificity by characterizing the causes of underlying perfusion defects5

References 1. The Alfred. (2013) Heart Transplant: Patient information. Retrieved from: https://www.alfredhealth.org.au/contents/resources/patient-resources/HEART_ TRANSPLANT_BOOKLET.pdf 2. Heart & Lung Transplant Trust. (2014). Retrieved from: http://www.hlttv.org.au/transplant-journey/pre-transplant 3. Ziessman, H., Oâ&#x20AC;&#x2122;Malley, J., & Thrall, J (2015). The Requisites- Nuclear Medicine (4th ed). Boston, MA: Elsevier 4. Moore, A., Wachsmann,J., Chamarthy, M., Panjikaran, L., Tanabe, Y., & Rajiah, P. (2018). Imagining of acute pulmonary embolism: an update.

Cardiovascular diagnosis and therapy; 8(3): 225-243. Doi: 10.21037/cdt.2017.12.01 5. Roach, P., Schembri, G., & Bailey, D. (2013). V?Q Scanning Using SPECT and SPECT?CT. The Journal of Nuclear Medicine, 54(9): 1588-1596. Doi: 10.2967/ jnumed.113.12460

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Education & CPD Case Study Acetazolamide Challenge Cerebral Perfusion Scans: A Case Study Authors: Mia Bono and Wesley NG, Department of Molecular Imaging and Therapy, Austin Health

BACKGROUND Moya Moya disease is a rare disease affecting <1 per 100000 patients, and involves the cerebral vasculature of the central nervous system, therefore increasing the risk of Transient Ischaemic Attack(TIA)1. Moya Moya can present as unilateral or bilateral with a range of symptoms including headache, vision changes, vertigo, altered gait, muscle weakness and lack of coordination that vary with age. Without treatment, the disease can be terminal due to a high risk of intracranial haemorrhage. Interestingly, the Japanese meaning of Moya Moya is â&#x20AC;&#x153;puff of smokeâ&#x20AC;? relating to the anatomical image of tangled blood vessels formed in the brain to compensate for an occlusion2.

CASE REPORT A 24-year-old female was admitted to the Emergency Department with a sudden lack of coordination and right upper limb weakness, most marked in the right hand when writing and combing her hair. The patient also experienced difficulty gripping objects in right hand. She denied any weakness in left side, headaches, vertigo or altered gait. She was prescribed 100mg of aspirin and 75 mg of clopidogrel for a minimum of three months for stroke prevention and symptoms began to improve over two weeks after initial admission.

MRI and DSA were performed, which suggested Moya Moya disease, with bilateral internal carotid artery (ICA) stenosis and left middle cerebral artery (MCA) territory infarction.

Fifteen days later, the patient presented to the Department of Molecular imaging and Therapy for a SPECT brain scan with Acetazolamide challenge. Acetazolamide is used a cerebral vasodilator to induce an increase in cerebral blood flow, allowing for comparison with baseline brain perfusion. Brain perfusion imaging was performed as a baseline study with 708MBq 99mTc-ECD administered intravenously, with the patient resting and eyes closed. SPECT/CT imaging was performed 30 minutes post-injection on the GE 670 Discovery DR. A low dose CT (120kV, 40mA axial CT) was performed for purposes of attenuation correction and anatomical localisation.

Two days later, the patient presented for the acetazolamide challenge imaging. 1000mg of acetazolamide was infused intravenously over 10 minutes. At 15 minutes post-acetazolamide infusion, 722MBq 99mTc-ECD was administered intravenously with the patient resting and eyes closed. SPECT imaging was acquired 30 minutes post injection of 99mTc-ECD. Images were also compared to a normal subject SPECT database using GE Neurostat 3D-SSP software, to assist in assessing perfusion changes.

FINDINGS OF BRAIN IMAGING On baseline SPECT/CT imaging, a focal area of severe hypoperfusion was identified in the left dorsal frontal cortex with extensive mild hypoperfusion throughout anterior and lateral temporal cortex, sparing the medial frontal cortex. For the Acetazolamide challenge, SPECT images compared to the baseline study showed that there was significant worsening of the perfusion in the left frontal lobe and anterior temporal cortex with partial extension to the parietal lobe (Figure 1 - right page).

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Education & CPD Case Study Acetazolamide Challenge Cerebral Perfusion Scans: A Case Study (Continued)

The baseline images that were compared with the GE 3D-SSP Neurostat database, indicated that there was a significant reduction in perfusion in the left frontal lobe and lateral temporal cortex, which worsened on the post-acetazolamide images. The reduction in perfusion is linked to the Z-score values ranging from -4.5 to -6.5 that is shown on the 3D-rendered images with associated colours relating to Z-score value on the colour bar (Figure 2 - below).

Figure 1: The SPECT/CT images illustrates extensive hypoperfusion in the left middle cerebral artery distribution with evidence of a small area of dorsal frontal cortical infarction.

Brain SPECT IRChangAC Images. Top Row: Baseline SPECT; Middle Row: Post-acetazolamide SPECT; Bottom Row: Subtraction of post-acetazolamide from baseline SPECT

Figure 2: The surface rendered images of the GE 3D-SSP Neurostat database illustrates significant reduction in Z-scores in the left frontal and lateral temporal lobes on post-acetazolamide scan Surface Rendered GE 3D-SSP Neurostat Images

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Education & CPD Case Study Acetazolamide Challenge Cerebral Perfusion Scans: A Case Study (Continued)

DISCUSSION This case is particularly interesting as the SPECT/CT images allow us to appreciate the definitive lack of perfusion in the left MCA vascular territory when comparing baseline images to acetazolamide challenge images, consistent with left MCA territory ischemia with positive steel phenomena suggestive of Moya Moya disease. These findings correspond to the those on the MRI and DSA imaging. By confirming the presence of steel phenomena on the acetazolamide challenge cerebral perfusion scans, the patient will continue on the dual anti-platelet therapy until further follow up and continue to be closely monitored by the stroke prevention clinic. A possible treatment pathway in the future may consist of surgical revascularisation which aims to improve cerebral blood flow by anastomosis of a well perfused ‘donor’ artery and the recipient artery3.

References 1) Kim, J. (2016). Moyamoya Disease: Epidemiology, Clinical Features, and Diagnosis. Journal Of Stroke, 18(1), 2-11. doi: 10.5853/jos.2015.01627 2) Abdulgafoor M. Tharayil, Adel E. Ahmed Ganaw, Nissar Shaikh, Sujith M. Prabhakaran, Arshad H. Chanda, Simi Praveen, Ajith Kumar Choran and Qazi Zeeshan ul Haq (August 20th 2019). Moyamoya Disease: A Rare Vascular Disease of the CNS, Vascular Malformations of the Central Nervous System, Bora Gürer and Pinar Kuru Bektaşoğlu, IntechOpen, DOI: 10.5772/intechopen.88770.

3) Kim, J. (2016). Moyamoya Disease: Epidemiology, Clinical Features, and Diagnosis. Journal Of Stroke, 18(1), 2-11. doi: 10.5853/jos.2015.01627

2020 Winter Edition gamma GAZETTE 59

Education & CPD What’s that What's That? The Case of The Missing Lung Author: Bryce Drowley, Monash Health

INTRODUCTION A 23-year-old patient presented with shortness of breath and haemoptysis for investigation. She initially was investigated with CTPA which yielded non-diagnostic result due to poor contrast opacification of pulmonary vasculatures secondary to altered cardiopulmonary vascular anatomy. No further relevant medical history was provided from the patient prior to the commencement of the V/Q scan.

Technegas was administered to the patient until 0.8 –1 kct/sec was achieved. After acquiring 8 static views for the ventilation images, 167MBq of 99mTc MAA was administered intravenously in the right cubital fossa and the same views were acquired in reverse order. Is there any immediate concern?

Figure 1: Nuclear medicine V/Q planar statics.

METHOD Technegas is produced by instilling 0.1-0.2mL of 99mTc Sodium pertechnetate into a carbon crucible placed in between two electrodes which are fixed in the Technegas machine. This carbon crucible is then heated to approximately 2500 degrees Celsius in the presence of Argon gas1. Once burnt, the chamber consists of small spherical particles which are inhaled by the patient via the Patient Administration Set and then trapped in the alveoli of the lungs2. Particle size of 99mTc MAA is also important. When particles of 20 - 40 µm are administered intravenously, they are trapped in the capillary beds of the lungs and can therefore be imaged3.

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Gamma Gazette is the official publication of the Australian and New Zealand Society of Nuclear Medicine.

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Education & CPD What’s that What's That? The Case of the Missing Lung (Continued)

FINDINGS There was relatively homogenous decreased uptake of tracer in the right lung on the perfusion images with preserved ventilation to both lungs. The differential diagnoses include isolated right proximal pulmonary trunk embolus or mediastinal mass compressing the right proximal pulmonary trunk.

However, once a thorough patient history was conducted, it was discovered that the patient had a Fontan’s procedure as a child for his hypoplastic left heart syndrome.

BACKGROUND OF FONTAN’S PROCEDURE A Fontan’s procedure, or Fontan’s circulation is a tedious surgery to re-direct blood from the lower body straight to the lungs. This is completed by disconnecting the inferior vena cava (IVC) from the right atrium of the heart and reattaching to the inferior side of the pulmonary artery. The superior vena cava (SVC) is also disconnected from the right atrium and connected to the superior side of the pulmonary artery4.

Figure 2 – Fontan’s Circulation4

The reason a Fontan’s procedure was completed for this patient was due to an unbalanced AV septal defect which resulted in a small left ventricle and a dominant right ventricle. This caused a compromise at the origin of the right pulmonary artery (RPA), therefore not allowing enough blood to be pumped into the lungs.

DISCUSSION The reason that only one lung was perfused was un-apparent at first. However, after visualising the patient’s anatomy on their previous CT scan, the pathway of blood flow became much easier to understand. As you can see in Figure 3 (right page), the SVC tracks down and enters the RPA superiorly. Similarly in figure 4 (right page), the IVC is seen to track upwards into the inferior side of the RPA. Due to the significant difference in blood volume supplied via the IVC versus the SVC, there is a pressure gradient difference. The increased volume of blood would cause a greater pressure in the IVC and therefore push any blood from the SVC into the left lung. Hence any blood supplied from the IVC would then track into the right pulmonary artery and eventually into the right lung.

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Education & CPD What’s that What's That? The Case of the Missing Lung (Continued)

Figure 3. Axial slice of CTPA at level of SVC.

Figure 4. Axial slice of CTPA at level of IVC.

In order to perfuse the right lung upon injection, ideally, the IVC needs to supply the lungs with the 99m Tc MAA. This can be achieved by cannulating and injecting in a lower limb. This technique has been supported by CT imaging modalities for CTPA and angiography which both use inferior limb and superior limb injections of contrast5. The same technique can be utilised for VQ scan as half of the dose can be administered in an upper limb and the other half in a lower limb. This will then eliminate the need to correctly time the injections of contrast in CT, as 99mTc MAA is trapped in the capillary beds of the lungs.

CONCLUSION The Fontan’s procedure is a rare surgery which can affect the pathway of 99mTc MAA. In order to combat these issues next time, a more thorough patient history would greatly benefit the patient’s diagnosis. Once a more thorough patient history is gathered, an altered VQ procedure would see a dual injection of tracer in an upper limb and lower limb in order to perfuse both lungs. Thus avoiding a false-positive finding.

References 1. Howarth, D., Lan, L., Thomas, P., & Allen, L. (1998). 99mTc Technegas Ventilation and Perfusion Lung Scintigraphy for the Diagnosis of Pulmonary Embolus. Society Of Nuclear Medicine, 40(4).

2. Lloyd, J., Shields, R., Taylor, C., Lawson, R., James, J., & Testra, H. (1995). Technegas and Pertechnegas particle size distribution. European Journal Of Nuclear Medicine, 22(5), doi: 10.1007/bf00839062 3. Draximage. (2019). DRAXIMAGE® M A A. Retrieved 10 December 2019, from https://www.accessdata.fda.gov/drugsatfda_docs/ label/2009/017881s010lbl.pdf.

4. Heart Information Center: Heart Anatomy | Texas Heart Institute. (2019). Retrieved 5 November 2019, from https://www.texasheart.org/hearthealth/heart-information-center/topics/heart-anatomy/ 5. Sandler, K., Markham, L., Mah, M., Byrum, E., & Williams, J. (2014). Optimizing CT angiography in patients with Fontan physiology: singlecenter experience of dual-site power injection. Clinical Radiology, 69(12), e562-e567. doi: 10.1016/j.crad.2014.09.011

2020 Winter Edition gamma GAZETTE 63

Industry News Prostate Theranostics & Imaging Centre of Excellence (ProsTIC) launched at the Peter MacCallum Cancer Centre The Prostate Theranostics & Imaging Centre of Excellence (ProsTIC) was launched at the Peter MacCallum Cancer Centre on Thursday 11 June, to accelerate research and development of next-generation targeted treatments for prostate cancer.

Originally planned as an in person celebration, the launch was adapted to online due to the current COVID-19 pandemic. Linking San Diego, Los Angeles, Oslo and Melbourne it included key stakeholders. The launch connected members of the Prostate Cancer Foundation (PCF) including Mr Mike Milken, Dr Jonathan Simons, Dr Howard Soule with senior executive staff from the Peter MacCallum Cancer Centre including CEO, Dr Shelley Dolan, the Chair of the Board, The Honorable Maxine Morand, Victorian Parliamentary Secretary for Health, Mr Anthony Carbines MP, key members of the Hospital Executive, ProsTIC Collaborators and our patient advocates.

ProsTIC is made possible via a $US5 million ($AU7.4 million) grant from the US-based Prostate Cancer Foundation (PCF) driven by the generous philanthropy of PCF Board member Mr Stein Erik Hagen. Mr Hagen said, “My family and I are very excited to fund this cutting-edge project at the Peter MacCallum Cancer Centre, which we believe will ultimately transform theranostics for men with advanced prostate cancer across the world. We all look forward to personally visiting the centre in Melbourne as soon as broader conditions allow”.

ProsTIC will comprise a multidisciplinary team led by Centre Director, Professor Michael Hofman and includes nuclear medicine, medical oncology, radiation oncology, urology and laboratory-based doctors and researchers with a strong patient-centered philosophy. It will enable state-of-the-art research to deliver new paradigms for treatment of prostate cancer, driven by seamless integration of clinical trials, preclinical and discovery research. This strategic investment by PCF will ensure that Australia continues to lead the world in discovery science driven PET imaging and theranostics for prostate cancer.

Professor Michael Hofman says “There is little doubt PSMA PET will be a standard-of-care test globally and PSMA radionuclide therapy is a new class of life prolonging therapy for men with prostate cancer. ProsTIC will enable us to accelerate research and we look forward to broad collaborations to further develop these game changing technologies”.

Progress is already being made to identify next clinical trials and preclinical research opportunities.

More information about ProsTIC can be found at www.petermac.org/ prostic and follow @ProsTIC on Twitter.

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ProsTIC Strategy and Leadership team, left to right: Prof Scott Williams, Prof Gail Risbridger, A/Prof Arun Azad, Prof Michael Hofman, Prof Declan Murphy, Prof Rick Pearson.

Dr Shelley Dolan (PMCC CEO) and Prof Michael Hofman.

Live Cross - Centre Donor Mr Stein Erik Hagen.

Smaller images, left to right: Dr Jonathan Simons (President & CEO PCF), Dr Howard Soule (EVP & CSO PCF) Hon. Maxine Morand (PMCC Board Chair) & Dr Shelley Dolan( PMCC CEO).

In 1969, the Australian and New Zealand Society of Nuclear Medicine was founded by a group of visionaries.

In 2020, we've grown into a diverse, inclusive community of members including Technologists, Physicists, Radiopharmacists, Physicians, Nurses, Chemists and others practising Nuclear Medicine.

Today, we continue to face new challenges with passion and purpose.

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Explore our heritage at anzsnm.org.au/archive

Industry News GE Healthcare News As a leading global medical technology and digital solutions innovator, GE Healthcare enables clinicians to make faster, more informed decisions through intelligent devices, data analytics, applications and services, supported by its Edison intelligence platform.

With over 100 years of healthcare industry experience and around 50,000 employees globally, the company operates at the centre of an ecosystem working toward precision health, digitizing healthcare, helping drive productivity and improve outcomes for patients, providers, health systems and researchers around the world In Molecular Imaging, we are proud to provide customers with a fully digital experience through a wide array of molecular imaging technologies designed to help customers deliver better patient outcomes.

NUCLEAR MEDICINE Everything Nuclear medicine is an excellent choice for physicians at the forefront of medicine. It has a wide range of available radioisotopes with various energy emission levels and longer half-lives. It also has the flexibility to explore multiple pathways in a single session. These are some of the reasons why we made a commitment to realising the full potential of â&#x20AC;&#x201C; and growing â&#x20AC;&#x201C; this modality. This commitment means driving down daily operational costs and innovating in four key areas: image quality, dose reduction, exam speeds and quantitative applications. All with the end result of enabling better clinical and economic outcomes.

It also includes our vision for a fully digital nuclear medicine experience. An experience that starts with best-in-class hardware and software that collects data in the cloud and then converts that data into actionable insights through deep learning and analytics. All of our systems are designed to leverage this fully digital vision right away. This includes digital detection technology as well, where customers can choose between a system already fitted with CZT-based digital detectors or an adaptable, digital-detection-ready system.

PET/CT The true potential of PET/CT is its ability to enable a true discovery. A true discovery is different, because it provides reproducible evidence that reveals a greater truth about the human body. A truth that has the ability to not only change the life of one patient, but to transcend an individual to benefit all patients.

Our purpose is to provide customers with the tools they need to go in search of true discovery. In PET/CT, this means a commitment to making it more accessible and delivering on the promise of personalised care.

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PET RADIOPHARMACY Everything we do is with the purpose of providing customers with the tools needed to go in search of true discovery. For PET, it requires a commitment to making PET tracer production both accessible and reliable. With this as our focus for over 30 years, we have developed a wide array of ever-evolving PET tracer production technologies and the only complete PET solution in the industry. All designed to help get your PET department up and running right.

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Industry News SensaWeb News - The next step for radiation monitoring?

SensaWeb combines Australian-made devices with IoT technology to make radiation monitoring simple and safer.

The SensaWeb journey began over 10 years ago when co-founder Simon Turner was part of the team decommissioning Australia’s nuclear reactor. During morning checks, he regularly found that the radiation monitoring units were malfunctioning without notifications or alerts, risking staff ’s safety.

When searching for an improved radiation monitoring system, Simon found that most commercially available options were inadequate, expensive, or both. This is when he enlisted SensaWeb’s co-founder Darren Oliver, an expert in IT innovations, to develop a fully-integrated solution for industries where radiation is part of day-to-day operations.

SensaWeb provides end-to-end, real-time radiation monitoring systems that detect, monitor, record, and simplify the reporting of radiation activity. SensaWeb’s area and personal radiation monitoring devices are connected to a live-data visualisation platform which is accessible by phone, tablet, or computer. This enables organisations to monitor and report area and personal exposures automatically, with inbuilt alerts and reports sent directly to anyone who needs to know.

The SensaWeb monitoring system collects exposure data every 5 seconds, utilising a dual Geiger configuration. This enables accurate detection of background and low level radiation levels, and high radiation exposure levels. SensaWeb devices and software can be customised according to a facility’s monitoring requirements, and are manufactured and serviced within Australia.

SensaWeb has partnered with Qlicksmart to bring this innovative system to healthcare. Qlicksmart has been working within the healthcare sector to improve staff and patient safety for over 20 years, particularly in the area of sharps safety. As an established medical manufacturer and distributor, Qlicksmart has a keen understanding of the hospital system and provides in-person or virtual customer service and training to healthcare facilities Australia-wide.

To learn more, visit www.sensaweb.com.au or email hello@qlicksmart.com

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People in Nuclear Medicine Retirement Dr Trevor Fitzjohn In 1986 the Soviet Nuclear reactor at Chenobyl explodes, the Oprah Winfrey Show debuts and Dr Trevor Fitzjohn arrives on the shores of Te Whanga-nui-a-Tara, Aoteroa (Wellington, New Zealand) from the United Kingdom. Trevor graduated from the University of Newcastle-upon-Tyne, UK, with a Bachelor of Medical Science 1975, and Medicine in 1978. He undertook a Radiology Fellowship in Newcastle 1984, and completed his radiology training in neuroradiology in 1986.

Trevor is a Diagnostic and Interventional Radiologist who during his career has had special interests in neuroradiology, nuclear medicine, PET/CT, MRI and neurointerventional imaging.

He has been a visionary for the New Zealand Nuclear Medicine Community, bringing the first CoD gamma camera and then PET/CT scanner to Pacific Radiology Wellington, New Zealand whilst scanning patients using F18 FDG flown in from Cyclotek in Melbourne (late into the night!). Trevor was also the driving force in seeing the establishment of the first and only Cyclotron in Wellington New Zealand, that now provides the majority of the country its PET tracers.

Trevor was awarded FRANZCR in 2005 and in 2016 he received the award of Officer of the New Zealand Order of Merit. This accolade recognised the leadership and innovation that Trevor brought to the profession in New Zealand.

August 2020 will mark Trevor’s retirement. In many ways it is a sad time for us because we are losing an exceptional and inspirational colleague, mentor and friend.

In Trevor’s own words “I am young at heart but I am getting a pension so time to let some younger radiologists take over. I have enjoyed my career immensely bringing new technology to NZ and helping patients. I have been thinking about this now for over a year. My plans for the future will be spending more time on adventures with Frances, family and cider making “ Ka pū te ruha, ka hao te rangatahi.

The old net is cast aside, while the new net goes a-catching.

Haere rā Farewell Karen Roeske on behalf of the Nuclear Medicine Community

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People in Nuclear Medicine VALE Professor Sanjiv (Sam) Gambhir November 23, 1962 â&#x20AC;&#x201C; July 18, 2020

The Australian and New Zealand Nuclear Medicine Community was saddened to learn of the passing of Professor Sanjiv (Sam) Gambhir on July 18, 2020.

For many years Sam had led the Molecular Imaging Program at Stanford University, as well as leading major research efforts in precision medicine, early cancer detection, and novel multimodality imaging technologies.

He was a visionary who appreciated the role of molecular imaging as being indispensable to the practice of precision medicine. He was a towering intellect who was simultaneously humble and an adroit communicator even to the scientifically illiterate.

Sam had strong connections in Australia through individual collaborations, friendships, and his visits to give inspiring talks on the current status and future of molecular imaging and precision medicine.

His legacy will impact not only the practice of nuclear medicine at a global level, but also in the broader scientific community.

SNMMI has provided a detailed tribute to Sam, which can be accessed at https://bit.ly/SanjivGambhir Andrew Scott and Rod Hicks

2020 Winter Edition gamma GAZETTE

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Ta k e a B r e a k RESPIRATORY WORD SE ARCH WORDS TO FIND AEROSOL

MISMATCH

ALVEOLI

PARENCHYMA

ASTHMA

PNEUMATIC

BRONCHIECTASIS

PNEUMONIA

BRONCHIOLE

PNEUMOTHORAX

BRONCHITIS

PROBABILITY

CAPILLARY

RIVAROXABAN

EMBOLISM

SURFACTANT

EMPHYSEMA

THROMBIN

EQUILIBRIUM

THROMBOSIS

FIBROSIS

TURBULANCE

LAMINAR

WELLS

LEIDEN

XENON

RESPIRATORY ABBREVIATIONS & ACRONYMS •

ARDS

____________________________________________________

•

CF

____________________________________________________

•

COPD

____________________________________________________

•

CP

____________________________________________________

•

CPAP

____________________________________________________

•

CTPA

____________________________________________________

•

DTPA

____________________________________________________

•

DVT

____________________________________________________

•

MAA

____________________________________________________

•

OCP

____________________________________________________

•

OSA

____________________________________________________

•

PE

____________________________________________________

•

PH

____________________________________________________

•

V/Q

____________________________________________________ Responses can be found on page number 72

2020 EVENTS CALENDAR 2020 Virtual ASM Session - Shimadzu Award: Live Presentation

2020 Virtual ASM (Session 6: On-Demand) - Emerging PET Tracers

6 August 2020

6 — 20 August 2020

Live Zoom Meeting Time: 6:00 pm

On-Demand Presentations Time: 7:00 pm

2020 Virtual ASM (Session 6): Radpharm and Undergraduate Student Award Live Presentations

2020 Virtual ASM (Session 7: On-Demand) - Therapy

20 August 2020

On-Demand Presentations Time: 7:00 pm

Live Zoom Meeting Time: 6:00 pm

2020 Virtual ASM (Session 8: On-Demand) - Artificial Intelligence 3 — 17 September 2020 On-Demand Presentations Time: 7:00 pm

2020 Virtual ASM Award Presentation and Meeting Close 17 September 2020 Live Zoom Meeting Time: 6:00 pm

WA Branch Meeting AGM 17 November 2020 QScan Time: 6:00 pm

20 Aug — 3 Sep 2020

South Australia Branch Meeting 9 September 2020

2020 Virtual ASM (Session 6): Radiochemistry and Emerging PET Tracers Live Moderated Joint Discussion Panel 17 August 2020 Live Moderated Zoom Session Time: 6:00pm

2020 Virtual ASM (Session 7): Curium Award Live Presentation 3 September 2020 Live Zoom Meeting Time: 6:00 pm

WA Branch Meeting Radpharm Presentation

Royal Adelaide Hospital, Adelaide, SA Time: 5.30pm Refreshments, 6.00pm Presentation

16 September 2020

2020 NZ Branch Meeting

VIC/TAS Branch AGM, Radpharm Award & Student Oral Presentation Award

31 Oct — 1 Nov 2020 Rydges Hotel Wellington, New Zealand Time: 6:00 pm

Topic: Radpharm Presentation Night SKG Radiology Time: 5:30 pm

To be confirmed

(expected Oct/Nov 2020)

Venue and time to be confirmed

SA ANZSNMT AGM Dinner, Radpharm Awards & University Student Presentations 18 November 2020 Venue to be confirmed Time: 5:30 pm

SA Branch Meeting AGM & Quiz Night 2 December 2020* Venue to be confirmed Time: 6:00 pm * Final dates are pending to be confirmed

Please Note: As meetings may be cancelled, or rescheduled as virtual meetings due to COVID-19, refer to the Calendar of Events online for the latest updates on the meetings.

For more details and registration details visit

anzsnm.org.au

Attendo Plus mobile App

AIMS AND OBJECTIVES OF THE AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE 1. Promote: • The advancement of clinical practice of Nuclear Medicine in Australia and New Zealand; • Research in Nuclear Medicine; • Public education regarding the principles and applications of Nuclear Medicine techniques in medicine and biology at national and regional levels; • Co-operation between organisations and individuals interested in Nuclear Medicine; and • The training of persons in all facets of Nuclear Medicine.

2. Provide opportunities for collective discussion on all or any aspect of Nuclear Medicine through standing committees and special groups: • The Quality and Technical Standards Committee sets minimum standards and develops quality control procedures for Nuclear Medicine instrumentation in Australia and New Zealand.

• The TSIG Committee is the group overseeing the Technologist Special Interest Group (TSIG) and ensures that all projects, committees and activities of the TSIG align with the values and strategic plan of the ANZSNM. It reports directly to the ANZSNM Federal Council and oversees the two TSIG working groups: CPD & Education Working Group and Technologist Workforce Advocacy Working Group. The committee is able to form working groups to perform specific tasks as required to provide opportunities for the benefit of Technologist members of the ANZSNM after consultation with the ANZSNM Federal Council.

• 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.

RESPONSES RESPIRATORY ABBREVIATIONS AND ACRONYMS • • • • • • • • • • • • • •

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ARDS Acute Respiratory Distress Syndrome CF Cystic Fibrosis COPD Chronic Obstructive Pulmonary Disease CP Chest pain CPAP Continuous Positive Airway Pressure CTPA Computed Tomography Pulmonary Angiogram DTPA Diethylene Triamine Pentaacetic Acid DVT Deep Vein Thrombosis MAA Macro Aggregated Albumin OCP Oral Contraceptive Pill OSA Obstructive Sleep Apnoea PE Pulmonary Embolism PH Pulmonary Hypertension V/Q Ventilation Perfusion Ratio

2020 Winter Edition

OFFICE BEARERS President Vice President Past President Treasurer Committee

Dr Daniel Badger (SA) Vacant A/Prof Roslyn Francis (WA) Ms Suzanne McGavin (VIC) Prof Karen Jones (TSIG) Dr Rajiv Bhalla (RPS) Dr Kevin London (NSW) Mr Nicholas Ingold (ACT) Ms Judy Duong (QLD) Ms Prudence Burns (NZ) Mr Christian Testa (VIC/TAS) Mrs Victoria Sigalas (SA) Dr Geoff Schembri (AANMS Representative) Prof Andrew Scott (IRC)

General Manager & Secretariat All Correspondence

Mr Rajeev Chandra ANZSNM Secretariat, PO Box 6178, Vermont South, Victoria 3133 Tel: 1300 330 402 | Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au

Archivist

Ms Debra Huddleston

Branch Secretaries Australian Capital Territory New South Wales Queensland South Australia Victoria/Tasmania Western Australia New Zealand

Mrs Rachael Prior Currently Vacant Miss Remi Hillery & Ms Loren Katchel Mrs Tess Smith Ms My Linh Diep Ms Georgina Santich Mrs Jessica Fagan

Special Interest Groups/Committees Technologists Radiopharmaceutical Science Physics Quality and Technical Standards Committee Scientific Advisory Panel International Relations Committee

Chairperson: Mr Nicholas Daw Chairperson: A/Prof Giancarlo Pascali Chairperson: Mr Parabjit Takhar Chairperson: Dr Darin Oâ&#x20AC;&#x2122;Keeffe Chairperson: Prof Dale Bailey Chairperson: Prof Andrew Scott

At the forefront of the Nuclear Medicine Profession in Australia and New Zealand for over 50 years.

o f exc e l l e n c e i n Nuclear Medicine

As one of the oldest Nuclear Medicine societies in the region, over the past 50 years our focus has been promoting excellence in Nuclear Medicine through education, research and a commitment to the highest professional standards both nationally and internationally.

Become a member today and access many resources in the Nuclear Medicine field, including the use of post-nominals MANZSNM (eligible to full members only), access to an ever-growing network of professionals, access to the Society archives, event registration discounts, access to EduTrace (the societyâ&#x20AC;&#x2122;s online education portal), subscription to the Gamma Gazette, immediate notifications of urgent industry news, social media connections to others in your field via LinkedIn, Facebook, and much more.

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