ANZSNM Gamma Gazette 2024_25 Spring_Summer Final

2024/2025 SUMMER EDITION ISSUE 43

An updated review of 18F-FDG PET/CT in Lymphoma on Radiotherapy and Theranostics

Salivary Aspiration: A hard truth to swallow The early PET catches the Worm Fusion & Scintillation Down Under. Early use in

Australia & New Zealand 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 1 A new partnership between Queensland Health and GAMMA GAZETTE Royal Melbourne Institute of Technology (RMIT)

2024/2025 SUMMER EDITION ISSUE 43

CONTENTS

24 Meet the new Rural/Regional Branch Chair, Joshua Morigi

3 From the President 6

6 Branches News 12 Special Interest Group/Committee News Technologists Special Interest Group.

Quality and Technical Standards Special Interest Group.

Radiopharmaceuticals Sciences Special Interest Group.

Physics Special interest Group.

34 Submitted Articles & Case Studies

12

What's That: The early PET catches the worm.

Interesting Case - Salivary Aspiration: A hart truth to swallow.

Launch of the Lancet Oncology Commission Report on Radiotherapy and Theranostics.

An updated review of 18F-FDG PET/CT in Lymphoma Article.

Expanding the pipeline for Nuclear Medicine Scientists/Technologists into Queensland Article.

Fusion & Scintillation Down Under. Early use in Australia & New Zealand.

34

54

People in Nuclear Medicine Vale Dr Alireza (Ali) Aslani.

54

46 55

55 58

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Job Vacancies Office Bearers

FROM THE PRESIDENT

Karen Jones President “Almost everything will work again if you unplug it for a few minutes, including you.” Anne Lamott.

As I write the introduction to the final edition of the Gamma Gazette for 2024, Summer is well and truly upon us, and we can start to wind down for the year, look forward to a break and time to recharge.

Our cover features Dr Joshua Morigi, the inaugural Chair of the Rural/Regional Branch. Established earlier this year, the branch provides a voice for our rural, regional and remote ANZSNM members. The NSW/ACT Branch has also been reinvigorated with a new and highly motivated Executive Committee, led by Dr Jeremy Hoang. Please read more about the committee members as they introduce themselves in this edition. An important outcome of the 2023 ANZSNM Nuclear Medicine Technologist Workforce Summit was the establishment of Nuclear Medicine Student grants, an ANZSNM initiative, in collaboration with the AANMS, to provide financial assistance to students while on placement. A total of 13 grants were awarded in Semester 2 and we will offer more grants in 2025. The Summit brought together key stakeholders from across the nuclear medicine community and provided an opportunity for effective discussion and increased collaboration to tackle the workforce shortage.

Following the Summit, discussions between Queensland Nuclear Medicine Sites (both public and private) with RMIT progressed, culminating in the recent establishment of 8 embedded education places per annum for nuclear medicine scientists (NMS)/ technologists across Queensland Health, with associated scholarships of $15,000 per student to combat placement poverty.

Commencing in March 2025, Travis Pearson has championed the program, working closely with Queensland government and colleagues at RMIT, to make the Queensland Health NMS Embedded Student Program & Scholarship a reality. You can read more about the education program in this edition. The TSIG ran a highly successful Technologist Day Symposium in August this year. - In collaboration with the Hunter Imaging Group, a jam-packed program of CPD was provided to a record number of delegates. ARTnet celebrated its 10th anniversary and welcomed a new Project manager, Samantha Hawkins.

The Lancet Oncology Commission, led by Professor Andrew Scott in collaboration with international experts, published their white paper in Lancet Oncology. The paper discusses both the challenges and opportunities inherent in the rapid growth of Theranostics, as well as strategies to optimise safety and equitable global access. This edition of the Gamma Gazette also features the history of nuclear medicine and our Society. Led by Prof Dale Bailey, this represents one of many ‘chapters’ collated by the WFNMB to produce a book detailing the history of nuclear medicine around the globe. You will also find Branch and committee reports and some interesting case studies in this edition. I thank the authors for their valuable contributions.

It is, of course, not only Summer, but ANZSNM membership renewal time. I encourage you to continue supporting your professional Society. We are pleased to offer the same low rate as 2024. Renew your membership by 31 December to take advantage of the ‘early bird’ rate.

A reminder that the 55th ANZSNM Annual Scientific Meeting will be held in Melbourne, 23-25 May, 2025. The organising committee are hard at work to ensure a terrific program of educational and social events. Registration is now open with a substantial discount for ANZSNM members. - I look forward to seeing you there!

Finally, a big thank you to our committee members and staff for their commitment and hard work this year - and to the valued members of our Society. I wish you all a wonderful holiday season. I hope you will take the advice of US-novelist, Anne Lamott, and take the time to unplug and recharge, so that you are ready to tackle 2025 with vigour. Stay safe.

Best wishes

OUR CONTRIBUTORS EDITORIAL COORDINATOR Rajeev Chandra General Manager PO Box 6178, Vermont South, VIC 3133 T 1300 330 402 F (03) 8677 2970 gm@anzsnm.org.au

Joshua Morigi

Royal Darwin Hospital

Suzanne McGavin Royal Darwin Hospital

EVENTS & ADVERTISING ENQUIRIES marketing@anzsnm.org.au

SUBMISSIONS secretariat@anzsnm.org.au

DESIGN & PRODUCTION Enovate Studio www.enovatestudio.com

PUBLISHED IN Winter & Summer

CONTENT SUBMISSIONS

Travis Pearson

Metro North Health

Andrew Scott Austin Health

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-gazettecontent-submission-and-guidelines/).

Letters to the Editor or points of view for discussion are also welcome.

Karan Singh

The Prince of Wales Hospital

Darin O’Keeffe

Christchurch Hospital

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 two times per year. Deadlines for each issue of the journal can be found on our website anzsnm.org.au

DISCLAIMER 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.

Erin Hemingway Gosford Hospital

Angelina McDonnell Sunshine Coast University Hospital

The Australian and New Zealand Society of nuclear medicine © 2024 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).

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BRANCHES NEWS

BRANCHES UPDATE I open the branches update this issue with a warm welcome to our new Rural/Regional branch and rejuvenated NSW/ACT branch.

Both committees are off to a flying start, having eagerly embarked on setting up their branches and planning their inaugural events.

As the year draws to a close, all branches have held their Radpharm Award presentations and AGMs, with some changes to local committees to be announced soon.

Christian Testa, MANZSNM Chair of Branches

Queensland News

Victoria & Tasmania News

Branch Meeting – Gold Coast (GC): This meeting was initially planned as the biannual symposium but has postponed to August-September 2025 due to time and resource constraints. Despite this, the branch meeting had a great turnout, with strong participation from both private and public practices.

Mark Scalzo presented on the RMIT Embedded Education Program, set to launch in Queensland next year. This program, part of the ANZSNM Workforce Summit initiative, will provide domestic students pursuing tertiary qualifications with support from RMIT and Queensland Health, including placements in Queensland facilities.

The branch also held our Annual Day Symposium on October 26th, which was a hybrid event also encompassing the Radpharm and Student Award presentations and AGM. We extend our congratulations to our Radpharm finalist Jacob Zanatta.

In the last few months, the Queensland branch has held two important events:

Radpharm and AGM Meeting: During the AGM, Joel Williams from RBWH was awarded the Radpharm prize. There were also updates regarding changes within the branch committee: • • • •

Joel Williams (Co-Secretary) and Candiace Nish (Treasurer) have resigned from their positions.

Kayal Scarpe from South Coast Radiology is set to join the committee.

Anisa Kumari has officially taken responsibility of chair Currently, the Treasurer and Co-Secretary positions are vacant.

The VIC/TAS branch hosted our inaugural Case Presentation night on the 3rd of July in conjunction with RMIT. The event was highly successful, with several case studies presented by both technologists and undergraduate students, and excellent attendance both in-person and online. The evening concluded with announcement of some informal audience-voted awards recognising the enthusiasm our presenters brought to the event. Following on from our success, we are hopeful of this becoming an annual event.

South Australian & Northern Territory News

As we close out 2024, the SA/NT Branch of the ANZSNM reflects on a successful year of growth and engagement.

Our regular meetings continued to attract strong participation, offering valuable scientific content. A major highlight was hosting the ANZSNM Annual Scientific Meeting (ASM), which saw a record number of registrants and provided excellent opportunities for networking and education. A big thank you to the Convenors, Local Organising Committee, and all who contributed to the success of the ASM. This year, we also trialled a Friday night format for our popular AGM and Quiz Night, enhancing its social

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BRANCHES NEWS

appeal. The event was a success, and we look forward to building on it in the future. Additionally, our inaugural social night was a resounding success, providing a fun and relaxed opportunity for members to connect outside of the usual meetings.

Our deepest thanks to the outgoing committee members Alexis, Alessandra, Sunny and Victoria for their dedication and unwavering support.

Looking ahead to 2025, we are excited to welcome the new branch leaders and continue building on our achievements. We aim to maintain strong membership and foster even greater member involvement. Thank you all for your ongoing support – here’s to another successful year ahead!

Western Australia News

Ending September, we have two more branch meetings under our belts in WA. PSMA therapy of all kinds has been a big topic of recent presentations, alongside AI and burnout. A big thank you to our recent presenters: Russell Francis, Dr Zeyad Al-Ogaili, Dr Reece Parry, Murray Wachtel, Mehrdad Ghasemzadeh, Dr Nat Lenzo, Melissa Sheilds, Shiphrah Tagore, and Huy Vuong. As always, thank you to our sponsors of these two meetings, Siemens sponsoring our Fiona Stanley Hospital meeting, and GE sponsoring our Perth Rad Clinic meeting – your support allows us to run these meetings so effectively.

Our most recent meeting at Perth Rad Clinic incorporated the WA Radpharm award. We had two excellent entries: “Glow and Behold, Nuclear Medicine’s bright role” presented by Shiphrah Tagore, and “The Invisible Lung”

by Huy Vuong. Both were excellent and quite unique cases, with the award ultimately going to Shiphrah – we wish her the best of luck at the conference next year!

Shiphrah is also presenting at the upcoming EANM on behalf of Telemed Vet on their feline work.

for review in due course. We will be meeting again in 2025 in person in Palmerston North.

New South Wales News/Australian Capital Territory

The NSW/ACT branch held our inaugural new branch event, the Radpharm Award presentations, on October 30th. The event was a great success, attended by approximately 40 members. We congratulate our finalist Rachel Edison. We are busy planning for our first event for 2025 which is planned for late February, more details to come.

Rural / Regional

The inaugural Radpharm Award presentations for the Rural & Regional branch were held on November 20th with a strong turnout for our first hybrid event. Caitlin Burt is our successful Radpharm finalist and we wish her well representing our branch at the 2025 ASM. In our first few months since inception, we have been working mainly on the goals for the branch, reaching out to society members and partnering with industry to bridge the gap on remote practice. We look forward to being able to provide new opportunities for networking and collaboration for our branch membership in 2025.

Later in the year, we will get on with the job of planning the program for 2025, so stay tuned.

We are here to assist our members with CPD, networking and advocacy, so we look forward to seeing you all!.

We also recently held the 2024 WA Branch Day Seminar.

This year’s theme was neurology, and an array of neurology and Nuclear Medicine professionals presented on a number of enthralling topics. Our final branch meeting and AGM were then held in late November.

New Zealand News

NZ Branch hosted their online Awards night and AGM on 6 November 2024. It was a great turnout. Unfortunately, we were not able to award the Radpharm Award, however we did have a successful presenter for the Paul Orr Award, which was officially renamed as the Aotearoa NZ Remembrance Award. Our NZ Branch Committee will be reviewing this award and submitting to council GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 7

BRANCHES NEWS

Meet the new NSW/ACT Team

Jeremy Hoang, Chair Where I work – Nuclear Medicine physician at Royal North Shore Hospital & endocrinologist at Hornsby Hospital.

Why NSW/ACT Branch - I am curious, love to be involved and I am passionate about our specialty.

Kevin London - Immediate Past Chair and official ANZSNM NSW/ACT branch lumberjack.

Where I work – The Children’s Hospital at Westmead and, Alfred Nuclear Medicine and Ultrasound. Why NSW/ ACT Branch – I want to learn how our Society functions at a branch level and also to contribute to ongoing educational and research opportunities for our nuclear medicine community.

Karan Singh - Treasurer Where I work – Nuclear Medicine Advanced Trainee at The Prince of Wales Hospital & Sydney Children's Hospital (2024). Why NSW/ACT Branch – I love our specialty, being part of small teams, creating things and having fun.

Holly Spooner - Secretary Role – Secretary. Where I work – Nuclear Medicine Scientist at The Royal Prince Alfred Hospital.

Why NSW/ACT Branch – I’m excited to be involved in something that creates change and brings people together to collaborate in supporting the field of Nuclear Medicine.

Mei Yee Chan- Committee Member Where I work – I’m a 4th-year nuclear medicine student at the University of Newcastle, with clinical experience at major Sydney hospitals.

Why NSW/ACT Branch – I’m excited to join the committee to grow my skills and foster community in Nuclear Medicine.

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BRANCHES NEWS

Meet the new Rural/Regional Team

Joshua Morigi - Branch Chair Where I work – Royal Darwin Hospital.

Why Rural/Regional Branch – Rural practice highlights unique challenges, especially during COVID-19. My Darwin experience since 2019 inspired me to contribute actively, fostering collaboration and ensuring quality nuclear medicine services in underserved regions.

Lachlan Patterson - Branch Secretary Where I work – PRP Diagnostic Imaging Orange, Bathurst & Dubbo.

Why Rural/Regional Branch – I am excited to work with a variety of professions involved within nuclear medicine with a common goal of promoting our regional sites and striving for better outcomes for our regional/rural patients.

Kerry Jewell - Committee Member Where I work – Nuclear Medicine Physician at Peter MacCallum Cancer Centre and Cabrini Health, PhD Candidate at University of Melbourne.

Why Rural/Regional Branch – my home town is Wodonga. I want to help rural and regional patients access world-class healthcare and clinical trials closer to home, and support our Nuclear Medicine community to find innovative solutions so we can.

Caitlin Burt - Rural/Regional Branch Treasurer Where I work – Royal Darwin Hospital Why Rural/Regional Branch – I am passionate about healthcare in rural and regional settings and want to be a part of making nuclear medicine more accessible to all people, no matter their location.

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The Royal Australasian College of Physicians (RACP) developed a new curriculum for Nuclear Medicine in 2023. Following a period of consultation and refinement in early 2024, it has now been approved by the College Education Committee and is available on the College website.

More information about Nuclear Medicine curriculum renewal is available on the specialty development page of the RACP website.

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With the ASM theme of Fusion of foundation and frontiers, this unique event promises to be a dynamic experience for our entire nuclear medicine community. With its innovative and thought-provoking approach, this event will bring together the brightest minds and cutting-edge research to create a dynamic and engaging platform utilising the best ideas and latest developments in the field, making for an unforgettable experience.

•

Call for abstract submissions will close on Wednesday 15 January 2025, 11.59pm (AEDT).

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All authors will be notified with the outcome of their submission by Friday 28 February 2025.

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Accepted authors to accept and to be registered: Thursday 20 March 2025.

To learn more and apply click here GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 11

SPECIAL INTEREST GROUP/COMMITTEE NEWS

TECHNOLOGIST SPECIAL INTEREST GROUP (TSIG) Suzanne McGavin, MANZSNM TSIG Chair

The Technologist Special Interest Group (TSIG) has continued to be busy as it works with technologists, for technologists.

The Oversight Committee is made up of two subcommittees which, as a whole, represent the various large interest areas of the Nuclear Medicine Technologist profession. The committees include the Continuing Professional Development and Education Committee (CPD&E), chaired by Erin Hemmingway and the Workforce Advocacy Committee (WFA), chaired by Sarah Daniel.

We also have a University Liaison Officer, Emma Brooke, who works with the universities and our Student Representative Council (SRC), chaired by Jessica Watson.

Suzanne McGavin, MANZSNM, TSIG Chair

Some of our exciting projects that have been launched in 2024 include: •

$10,000 of successful inaugural grants awarded for the first round of the ANZSNM/AANMS Student Clinical Placement scheme across the country. These grants are to support students to attend placements and assist with placement poverty. AANMS matched the contribution of the ANZSNM allowing for $20,000 per year of grants to be awarded to our student members ($10,000 per semester).

•

Collaborative meetings with the EANM/SMNNI/IAEA in the area of Theranostics and how we can assist Nuclear Medicine Technologists in this space. More to come in this area from the ANZSNM.

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Sponsoring undergraduate nuclear medicine societies in their end of year functions or fundraisers at various universities.

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Successful launching of the NSW/ACT and Rural/Regional Branches. This now ensures that members from across the country can be represented by a branch of their residence.

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Confirmation of sponsorship for the Radpharm Award

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Nomination of two NMTs to be on the ANZSNM Quality and Technical Standards Committee.

•

Continuation of the Mentor Program for early career NMTs. The program now has an open uptake all year and members can apply at any time to link with a mentor outside their workplace.

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SPECIAL INTEREST GROUP/COMMITTEE NEWS

We are also launching new projects in the coming months for members to look out for: •

New platform for members to record and track their CPD events. The platform, CPDvalet, will be launched in November in time for the new triennium (AUS) or biennium (NZ). This platform has been built to specifically reflect the MRPBA/NZMRTB requirements and allow PDF

•

download of all information at any point in time. There will be webinars and information sessions for members around this new platform.

•

Forthcoming establishment of the Academic Reference Group to allow academics across Australia and New Zealand to collaborate, have support from the ANZSNM and ultimately improve and advance opportunities for our nuclear medicine programs.

•

Collaboration with ASMIRT in producing career information videos for Nuclear Medicine Technologists and a platform to launch this for career days.

An important part of the TSIG is to reply to correspondence and be involved in feedback processes surrounding the professional duties of nuclear medicine technologists across Australia and New Zealand. This happens through the committee representatives or a collaboration of the committee's responses.

Some of the papers in which the TSIG consulted on recently include: •

National Safety and Quality Medical Imaging Standards

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Invited to meet with the MRPBA Accreditation Board to voice concerns and gain understanding about the nuclear medicine programs in place.

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Various MRPBA factsheets

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Guiding principles and standards for Skilled Migration Assessing Authorities from the Assessing Authority Policy and Assessment team

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Australia and New Zealand Standard Classification of Occupations (ANZSCO) final consultation round

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Allied Health National Workforce Strategy

Other important matters the TSIG has given a voice to include: •

Writing to the Indigenous Allied Health Association (IAHA) for inclusion as an Allied Health Profession

•

Seeking consultation and feedback on a First Nations/Maori acknowledgement statement from the IAHA for our professional association

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Support for the NZ Technologists regarding acknowledgement of qualifications

•

Potential issues or discrepancies with suggested guidelines which may hinder the role of a Nuclear Medicine Technologist in practice

The TSIG is part of the ANZSNM Federal Council which gives voice to issues, celebrations and concerns for the Nuclear Medicine Technologist community. We have a passion about our profession and work tirelessly to ensure we are at the forefront of issues that affect our profession. This year has created many opportunities for us to be a voice for our members and achieve some fantastic results, start some exciting projects, and ensure guidelines and external information protects our profession and also advances it.

I look forward to another year in 2025 of achieving our goals and working for our Technologist members.

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SPECIAL INTEREST GROUP/COMMITTEE NEWS

UNIVERSITY LIAISON REPORT Emma Brook, MANZSNM University Liaison

As we approach the end of the year, I am reminded how quickly the year flies by but also proud of the relationships and tasks we have achieved. It has been a productive and rewarding period, and I am excited to share some of our accomplishments and ongoing initiatives.

Emma Brook, MANZSNM, University Liaison

Key Responsibilities:

1. Facilitating Communication: Acting as a bridge between universities and ANZSNM, ensuring smooth and effective communication.

2. Promoting Educational Initiatives: Supporting and promoting educational programs, workshops, and seminars that benefit students and professionals in Nuclear Medicine.

3. Encouraging Student Participation: Motivating students to engage in ANZSNM activities, such as presenting their research or case studies at conferences and meetings.

4. Supporting Professional Development: Assisting in the development of continuing professional development (CPD) opportunities for Nuclear Medicine Professionals, students, and recent graduates.

5. Building Relationships: Establishing and maintaining strong relationships with university faculty, students, and other stakeholders to enhance collaboration and support within the Nuclear Medicine community.

6. Sharing University Achievements: Highlighting and sharing the achievements and initiatives of universities and their students with the broader ANZSNM community. Please continue reading for the university updates.

Recent Highlights: •

Student Clinical Placement Grants: We would like to congratulate the 13 recipients of the ANZSNM/AANMS Clinical Placement grants, who we are assisting our undergraduate students in attending placements often interstate or away from home. We continually seek to find ways we can support our Nuclear Medicine students, however if you have ideas or want to get involved, please reach out via email to: uniliaison@anzsnm.org.au .

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SPECIAL INTEREST GROUP/COMMITTEE NEWS

•

•

•

Student Open Days: Our SRC have been involved in encouraging prospective students to join Nuclear Medicine at their respective university open days. Attracting prospective students and fostering community engagement is a way to ensure we have the next generation of Nuclear Medicine professionals. One of our SRC members, Jacob Cobner recently got involved in the open day, showing prospective students around the facilities at the University of Newcastle.

Graduation Celebrations: As the year ends, we congratulate our new cohort of Nuclear Medicine graduates. Their hard work and achievements are commendable, and we look forward to working with you as graduates and Nuclear Medicine Technologists/Scientists.

Mentor Program: Don’t forget that the Mentor/ Mentee program is open to connect professionals in Nuclear Medicine. This initiative aims to provide guidance, support, and valuable industry insights to our future leaders. Are you looking to take the next step in your career? Getting connected with a more experienced mentor can provide you with invaluable advice and support. You don’t have to be a new graduate to get involved as a mentee, and the opportunity for new mentors is also open. If you have significant experience and would like to get involved as a mentor or would like to find out more information, please reach out via email to: tsigchair@anzsnm.org.au.

Finally, Thank you for your continued support and engagement this year. Your involvement makes a significant impact on the profession and the community. If you have any specific ideas or initiatives you’d like to discuss, feel free to share at any time via email: uniliaison@anzsnm.org.au.

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SPECIAL INTEREST GROUP/COMMITTEE NEWS

University of Auckland Update - Pippa Bresser PGCertHSc (PET-CT) Certificate

The programme consists of four 15-point courses:

from next year. This course will replace the requirement to complete MEDIMAGE 701: Imaging Anatomy and Pathology as part of the PGDipHSc (Nuclear Medicine) programme.

• •

Mānawa Mai Open Day

We have been working on a proposal for the introduction of a new Postgraduate Certificate in Health Sciences in Positron Emission Tomography-Computed Tomography (PET-CT) which will consist of a combination of academic and clinical components, both of which students must successfully complete to demonstrate competency.

• •

MEDIMAGE 702: Professional Issues in Medical Imaging MEDIMAGE 720: Fundamentals of Clinical Nuclear Medicine CLINIMAG 707: CT Clinical Practice CLINIMAG 725: PET-CT Clinical Practice

Students may choose to complete one or two courses each semester however it is important that the student is aware of the programme regulations with respect to the maximum time allowed for completion being two years. In addition to the academic courses, the student will receive access to an electronic clinical portfolio (ePortfolio) to complete the clinical components. The proposal for the introduction of this certificate is currently moving through the University’s and external higher education processes. In parallel, the New Zealand Medical Radiation Technologists Board (NZMRTB) will be conducting an accreditation visit at the University in November to assess the proposal. We will know the outcome of both these processes at the end of December and can move forward from there.

Theranostics course

We are pleased to have obtained approval for the introduction of a new 15-point course (MEDIMAGE 729: Theranostics) that will be offered in the PGDipHSc Nuclear Medicine suite of courses

Waipapa Taumata Rau, University of Auckland held a vibrant and busy Open Day on Saturday 24th August 2024. Medical Imaging students and staff volunteered their time to highlight the profession of Medical Imaging including postgraduate study options like Nuclear Medicine, MRI and Ultrasound.

Autumn Graduation

Students who completed their programmes in 2023 were invited to graduate at a ceremony on Tuesday 7th May at Spark Arena. It was wonderful to see 22 of our postgraduate students including four Nuclear Medicine graduates walk proudly across the stage to receive their diplomas and degrees. Congratulations to Louisa Bruwer, Jaimee Pike, Te Puawai Mower and Freya Paddison. Special mention to Te Puawai and Freya (below), who received their postgraduate diplomas with Distinction and will be offering support and guidance to the current students who are nearing completion of their programmes.

UniSA update - Katherine Guerrero UniSA has continued to improve and expand the Nuclear Medicine program with excellent graduate outcomes. In August we held the first workshop day as part of UniSA-SA Medical Imaging teaching agreement. This was held at the Women’s and Children’s Hospital and allowed students to spend a day using the equipment and learning from staff there. The initial workshop was a very successful activity, and we will continue to expand and evolve this program. Teaching sessions at Women’s and Children’s hospital will be embedded throughout all Nuclear Medicine courses from 2025 to improve applied learning.

We held a successful Open day – the last one branded as UniSA before the university merger. It was a highly attended event, and we anticipate continual strong demand for our program among applicants. From 2026 our program will continue under the new Adelaide University.

We congratulate our fourth-year students as they embark on their professional careers. The academic team is proud of the achievements of all students acknowledging the sustained commitment and dedication required to graduate as a Nuclear Medicine Technologist.

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SPECIAL INTEREST GROUP/COMMITTEE NEWS

SRC UPDATE

Jess Watson, MANZSNM Co-Chair SRC

The Student Representative Council (SRC) has been actively working to enhance student engagement and representation across universities.

A key initiative has been to increase student representation at local university open days. Congratulations to Jacob Cobner, alongside Jess Watson, MANZSNM, Melissa Shields (pictured) for recently attending the Newcastle Co-Chair SRC University student open day as an ANZSNM SRC representative. By participating in these events, the SRC aims to provide prospective students with greater access to insights from their peers, promoting an inclusive and informed environment for future students.

The SRC has also been dedicated to supporting events that enhance the student experience. We would like to formally thank the ANZSNM for sponsoring the photobooth at the Charles Sturt Uni and UniSA student balls, adding a touch of fun and creating lasting memories for attendees!

Additionally, we have been working towards establishing an online presence through creating a social media profile. SRC member, Byron Russell, has been leading this initiative, which aims to create a greater reach and connection between students across all universities. We look forward to seeing the growth of this project over the coming months.

With the end of the year in sight, I will be leaving the SRC as I will be embarking on my career as a Nuclear Medicine Technologist. I would like to thank the ANZSNM TSIG for the opportunity to be part of the SRC, and my fellow SRC

members for having me as the chairperson for the last two years! A special thank you to Tina Pham who has recently stepped down from the committee, however played a fantastic role in the ground and supported me as co-chair this year. I have really valued the opportunity to get to know the wonderful people in our nuclear medicine community and have enjoyed this experience immensely.

Looking ahead, the SRC is eager to welcome new members as we continue to strengthen our community. We encourage passionate students to consider joining us, with new roles available now. Expressions of interest are now open. This is an exciting opportunity for those looking to make a meaningful impact on student life and contribute to ongoing initiatives.

Congratulations, Melissa Shields

We congratulate Melissa Shields who was recently awarded her PhD in Medical Radiation Science, at the University of Newcastle for her thesis entitled: Occupational burnout in Australian Nuclear Medicine Technologists.

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SPECIAL INTEREST GROUP/COMMITTEE NEWS

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SPECIAL INTEREST GROUP/COMMITTEE NEWS

HIGHLIGHTS FROM THE 2024 TSIG ANNUAL DAY SYMPOSIUM Erin Hemingway, MANZSNM Chair TSIG CPD&E Committee

Hello from the Central Coast NSW, where the cooler winter weather is finally starting to give way to longer days, and a hint of spring is in the air.

On Saturday August 3rd, the technologist community gathered for the 2024 TSIG Annual Day Symposium in the Hunter Valley, NSW. Hosted at the Oaks Cypress Lakes Resort in collaboration with the Hunter Technologists Group, with special thanks to Daphne James and Nicole Kearney, this year’s symposium set a new TSIG record with 105 delegates in attendance. We were very pleased to welcome NMTs from all over the country, including the ACT, NSW, NT, QLD, SA and VIC/TAS. The symposium kicked off with a riveting presentation

by Dr James Lynam, the Director of Medical Oncology at Cavalry Mater Hospital Newcastle, whose insights on prostate cancer management and the role of Nuclear Medicine imaging and therapy set the tone for an engaging and topical day.

A highlight of the symposium was the presentation by the ANZSNM Nuclear Medicine Technologist Award recipient, this year awarded to Travis Pearson, Director of Nuclear Medicine at Royal Brisbane and Women’s Hospital in QLD. The audience was captivated by Travis’ impressive career and his substantial contributions to the nuclear medicine community, especially in tackling the current workforce shortage. Congratulations once again Travis, a very deserving recipient of the award.

One of the original goals of the TSIG symposium is to provide technologists with content specifically tailored to their needs and interests, and to facilitate engagement in a relaxed setting. Throughout the day, attendees were able to participate in “Questions & Panel Discussion” segments, which created a dynamic and interactive atmosphere between speakers and delegates.

them. We concluded the symposium with post-event drinks, sponsored by GMS, during the golden hour overlooking the valley, followed by a dinner of wings, pizza and pasta Erin Hemingway, MANZSNM, at Harrigan’s to refuel Chair TSIG CPD&E Committee after a long day. The meeting is always a great chance to connect with both new and old friends, share ideas and explore potential collaborations, and what better location to do this than wine country!

I would like to extend a huge thanks to our sponsors.

Without their generous support, we wouldn’t have been able to host such a high-calibre meeting while keeping registration fees affordable. Your commitment to the technologist community is greatly appreciated.

Lastly, a heartfelt thank you to the wonderful planning committee - Melissa Shields, Shikha Sharma, Kym Barry, Eleanor Kelliher, Emma Brooks, Suzi McGavin, Daphne James and Nicole Kearney – whose efforts and countless volunteer hours made the day the success that it was. It already feels strange not to see you online every other week!

Registrants have been emailed a link to an online feedback form. If you haven’t had the chance to share your thoughts yet, we’d really appreciate your input.

We’re excited to announce that the 2025 TSIG Annual Day Symposium will be hosted in sunny QLD! As always, the meeting will take place on the first Saturday in August, falling on Saturday 3rd August 2025. Looking forward to seeing you all there

Towards the end of the day, we heard from Liz Bailey, Chief Nuclear Medicine Technologist at Royal North Shore Hospital NSW. The audience was captivated by the incredible images produced by their new total body PET/CT and the remarkably short time required to obtain

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 19

SPECIAL INTEREST GROUP/COMMITTEE NEWS

QUALITY AND TECHNICAL STANDARDS COMMITTEE (QATSC) Darin O’Keeffe, MANZSNM QATSC Chairperson (QATSC@anzsnm.org.au)

A farewell and Welcome We farewell Catherine Robson from the committee as TSIG representative, and welcome Julie Crouch and John Barlow who will together represent the TSIG. This dual representation is a new arrangement for the committee, with the agreement that they will have one combined ratification vote (or perhaps half a vote each if they disagree ☺). The contact details for Julie and John can be found on the members only QATSC page on the ANZSNM website.

Inaugural QATSC session at the Annual Scientific Meeting in Christchurch We held an inaugural QATSC session at the Annual Scientific Meeting in Christchurch in April 2024.

The session was titled “Right from the beginning: Essential QA in the Radiopharmacy” and included presentations on “Getting the activity right” (Darin O’Keeffe), “Getting the radiopharmaceutical right” (Maggie Aulsebrook), and “Trying to get SPECT quantitative imaging right” (Erin McKay). The feedback we received was great and we plan to negotiate with future conference convenors to run further QATSC sessions.

In-house production of radiopharmaceuticals Earlier in the year the QATSC released a draft of the second part of a document on the in-house production of radiopharmaceuticals. There were a number of submissions made and we are still working our way through them to address concerns. These submissions mostly focussed on professional roles but there were some constructive technical comments that have already been incorporated into the document. Thank you to all the individuals and groups who took the time to make submissions.

Radiopharmaceutical quality control (QC) The focus on risk with the in-house production of radiopharmaceuticals has raised the question of the user quality control of routine, commercial radiopharmaceuticals. There is interest in looking at this topic, and we note that there is some regulatory precedence. For example, the Victoria State Government has requirements for quality control checks on Tc-99m generators for every elution. If your state or territory has similar requirements for, say, routine radiopharmaceutical QC, please email QATSC@anzsnm.org.au to inform us.

GFR measurements – are you interested?

The QATSC was asked a question recently about radionuclide-based GFR measurements for planning chemotherapy dose regimes. A comment will be out soon addressing that question, but in the meantime, some questions have been posed about radionuclide-based GFR measurements in general. We plan to shoulder tap some individuals to join a working party that will look at this topic, but if you have an interest in this area, even just reviewing draft proposals, please email QATSC@anzsnm.org.au with the subject “GFR measurements”.

Attention ring bearers!

Do you wear a Landauer ring badge? Do you, also, leave them behind when you work with radionuclides? Can you never find them when it’s time to return them?

20 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

SPECIAL INTEREST GROUP/COMMITTEE NEWS

Have we got something for you!

3D printed ring holders (along with local terminology!)

The monocle

The phallus

The key ring

The inverted ovaries

Simply pop it over the clip on the back.

Grab the 3D printer STL files from Tinkercad: https://www.tinkercad.com/ then search “Landauer” or “Luxel.”

Get to a 3D printer and give your problems the ring finger.

Not recommended or endorsed by Landauer or the QATSC. Use at your own volition.

Debate corner With the growing success of new radionuclide therapies, and thought being given to the role of radiation dosimetry, the question was recently raised about whether we should be clear in our use of the term ‘dose’. Many use the term to refer to administered activity, as in ‘drawing up a dose’, but it equally applies to radiation (absorbed) dose to, say, the tumour or organs at risk. And from there the debate started. There was no clear winner and perhaps there isn’t, but it does highlight the importance of being clear in context, especially when talking with other professions.

Resources update The ANZSNM does not necessarily endorse these free resources. They are provided here simply to notify members of their existence. If you come across a useful quality or technical standard, or other resource, please email the details to QATSC@anzsnm.org.au so it can be considered for inclusion in future QATSC updates.

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 21

SPECIAL INTEREST GROUP/COMMITTEE NEWS

Beyond Becquerel and Biology to Precision Radiomolecular Oncology: Festschrift in Honor of Richard P. Baum (Open Access) Vikas Prasad, editor.

To quote the publisher: “It includes commentaries, reviews and some thought-provoking novel ideas on radionuclide precision oncology, covering topics such as various aspects of theranostics and molecular radiotherapy like radiolabeled peptides, radiolabeled antibodies, dosimetry, and quality control as well as the diagnosis and treatment of specific tumor types.”

This free publication has some well-known international and local contributors, both as authors and through numerous cited papers.

NEMA NU-1 Performance Measurements of Gamma Cameras (2023) We realise this will not be the most exciting read for all members, but NEMA have made the latest update on gamma camera performance measurements available free to download. Great for trainees, or if you want to check something about how manufacturers specify a performance parameter.

Dosimetry for Radiopharmaceutical Therapy (IAEA, April 2024) At just on 300 pages, this IAEA publication by Yuni Dewaraja and Katarina SjögreenGleisner is not to be ignored if you have an interest in radionuclide therapies, and especially implementing clinical dosimetry. It is based on a 2018 consultation meeting and has an impressive line-up of contributors, but don’t expect the citing of a bunch of recent publications – most are 2020 and earlier. That aside, this publication is relatively easy to read, and we think it gives a solid foundation on aspects of dosimetry in radiopharmaceutical therapy.

New IAEA Radiopharmacy Database: Enhancing Development, Collaboration and Research From the IAEA website: “A new IAEA radiopharmacy database will facilitate research, collaboration and the sustainability of safe radiopharmaceuticals for clinical use. The IAEA is currently collecting information on facilities that produce radiopharmaceuticals, as well as those producing medical radioisotopes for use in radiopharmaceuticals worldwide, to be collated into the new online database. The database aims to create greater insight into radiopharmaceutical trends. It will highlight any supply gaps and facilitate connections among the different producers of these products, improving access to radioisotopes and radiopharmaceutical products in such facilities.”

Darin O’Keeffe QATSC Chairperson (QATSC@anzsnm.org.au)

22 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

We are excited to bring our members a new digital platform for recording and managing your CPD – CPDValet. This will become your one stop shop for all your CPD needs. You can record your CPD activities, capture your reflections, store evidence and generate an activity statement for compliance purposes.

Learn more about CPDValet by watching the CPDValet Training Webinar on Edutrace. https://nucleus.anzsnm.org.au/edutrace/ viewdocument/cpdvalet-training-webinar-26novemb?CommunityKey=f739b6b7-cb0d-481a-a1bd6af60486543f CPDValet is available to all 2025 ANZSNM Members.

Manage Your CPD Everywhere A new digital platform for recording and managing your CPD!

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 23

SPECIAL INTEREST GROUP/COMMITTEE NEWS

RADIOPHARMACEUTICAL SCIENCES SPECIAL INTEREST GROUP (RPS) Nigel Lengkeek, MANZSNM Chair, RPS SIG

Dear Fellow Radiochemists and Radiopharmaceutical Scientists, Your representative committee, Melissa Latter (RBWH), Maggie Aulsebrook (Monash Uni), Brett Paterson (UQ), Md Mokarrom Hossain (Liverpool Hospital) and I have been working on ways to reinvigorate our community engagement beyond the ANZSNM Annual Scientific Meeting. I am pleased to announce that starting February 2025 we will be commencing a regular scientific seminar series, the cadence will be bimonthly to start. The committee have reached out members from across the country and have a received strong positive response. If you are interested in presenting or supporting the seminar series, please reach out to me via email (Nigel.Lengkeek@health.nsw.gov.au). The first notifications will be out in early 2025.

Our members in NSW are participating in the Health Services Union-led award reform occurring in NSW Health for allied health workers. Our members have contributed to the drafting and negotiation of claims for a new RPS award that will recognise our unique and critical contributions to the provision of Nuclear Medicine services in NSW Health. A number will be part of the groups directly negotiating with NSW Health. If successful the new award would see RPS members move out of the Hospital Scientist award, that primarily represents NSW Health Pathology, and into the Medical Radiation Scientists Award alongside our Nuclear Medicine Technologist colleagues, Physicists, Radiographers, Sonographers and Radiation Therapists.

The proposed pay and condition improvements are likely to impact future award negotiations around Australia so we will keep you updated.

more (or all!) of your team to a local conference in 2025, while still being able to maintain routine Nigel Lengkeek, MANZSNM, production RPS SIG Chair requirements at your site. For those of you working in or interested in cyclotron facilities the details for the annual Australian Cyclotron Users Group will be announced soon.

The RPS SIG committee would warmly welcome additional members onto the committee, so if you are interested in being involved please reach out to me (email above) or one of the other committee members to find out how you can get involved.

For those in our community that celebrate Christmas, I wish you and your family a Joyous Christmas. For all of our members I hope you have a relaxing and safe festive period filled with wonderful meals and memories. May your new year be happy and prosperous, and I sincerely hope that you have managed to make time with your family and friends over the new year and into January.

For many in the RPS community you may be faced with the tough choice of attending the iSRS meeting on the Gold Coast or the ANZSNM ASM in Melbourne. I will refrain from trying to justify why you should attend the ANZSNM ASM over the iSRS, rather take the opportunity to suggest that it provides a unique opportunity to send

24 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

Australasian Cyclotron Users Group Meeting 2025 Thursday 22nd May 2025 Austin Health Education Centre Level 4, Austin Tower 145 Studley Road Heidelberg, Vic, 3084 Please join the cyclotron community for a day of presentations, networking and round table discussions.

An excellent opportunity to share your experience, challenges and success around your work with cyclotrons.

No registration fee

Register Here For any queries please contact Harris Panopoulos harris.panopoulos@austin.org.au

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 25

SPECIAL INTEREST GROUP/COMMITTEE NEWS

PHYSICS SPECIAL INTEREST GROUP

George McGill, MANZSNM Chair, Physics SIG

An Invitation to join the Physics SIG Leadership Group ACPSEM MOU / Joint ANZSNM ACPSEM Symposium – Feb 2025

Therefore, subject to an overwhelming deluge of applications from a small and extremely under-resourced profession, a number of you will be invited to provide input to the revised group.

ARTNet Physicist invitation Dear Friends and Colleagues, May I start by thanking you all for your contributions over the last year. 2024 has been a significant year for change and recognition of the achievements of our profession. Your observations have been welcome and I will continue to listen very intently to issues affecting our physicists (new and old), RPS, clinicians and NMS and will continue to promote NM practice on your behalf.

The demand for physics support remains high and would not be as effective if not for us being able to work collaboratively. NM Physicists continue to participate in a number of key committees in ANZSNM and in other societies and it remains unfair to continually expect so much from so few. I remain thankful none the less even if we don’t always show our appreciation to those silently working on our behalf both here and abroad.

So it was with much relief that the Physics SIG last met online in October 2024, with 23 participants giving up their lunch break to contribute to the group development. Our ever enthusiastic and encouraging President, Prof Karen Jones, being a welcome observer, helpfully making a number of useful suggestions.

Opportunities to collaborate across organisations and societies is increasing and working together with other societies will promote higher standards for us all.

Earlier it was resolved to reinvigorate the leadership of the Physics SIG by reorganising and attracting new participants. A call for EOI to participate being issued earlier in the year by the Secretariat.

I would expect an update to our SIG Terms of Reference will help refocus our efforts, subject to approval by the Executive. Re-engaging with the other SIGS and cognate societies should be beneficial. Building on recognition of your success a priority.

As the ACPSEM applies for registered NM Physicists to transition from a voluntary to a statutory register, it remains a dynamic situation filled with discussions on professional detriments and benefits. So maintaining a supportive and well rounded experienced workforce respecting each others views constructively should be in all our long term interests. More will no doubt follow in the next few months.

Nevertheless, one of the benefits of being a physics member of ANZSNM remains the ability to work closely with a wide range of world experts: namely our clinicians, scientists and researchers, on practical clinical applications. Their dedication to promoting better Nuclear Medicine practice based on a wide range of valued experience, is admirable. I know we would not be here if not for the dedication and generosity of those Clinicians, NMS, RPS, and Physicists.

While the Physics MOU with ACPSEM remains materially useful, its effectiveness should be reviewed periodically to make sure we are making the best of it. In the meantime, the ACPSEM and ANZSNM Physics SIG chairs met under the MOU to promote collaboration efforts and it was resolved to establish an ACPSEM Theranostic Physics Group with agreement to hold a Joint ANZSNM ACPSEM NM Physics Symposium on Dosimetry in Brisbane. This will be held towards the end of February

26 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

SPECIAL INTEREST GROUP/COMMITTEE NEWS

PHYSICS SPECIAL INTEREST GROUP (Continued) 2025 While a physics focussed symposium, it will be accessible to all interested ANZSNM members. Details to follow soon.

As to more recent news, due to the rapid expansion of theranostic and other imaging trials, there are increasing demands on ARTNet to qualify departments in a timely manner. ARTNets growth is one of ANZSNMs and AANMS success stories over the last 10 years and effectiveness has been dependent on high calibre ANZSNM members volunteering their time and experience on ARTNet committees.

While a small number of Physics SIG members currently volunteer their time to ARTNet, it is now time to attract additional support across Australia and New Zealand to assist this expansion.

If you are an NM Physicist interested in supporting requests to assist departments acquire the necessary data, please make yourself known to myself (George. mcgill@health.qld.gov.au) or Sam, the ARTnet Project Manager, projectmanager@artnet.org.au. We need physicists from all across Australia and New Zealand to meet demand for support.

And before we have too many prawns on the beach, now seems as good a time as any to remind us of the Mid January abstract submission deadline for the 2025 ASM in Melbourne. I’ll be looking forward to seeing more of the great innovative work from our physicists from Australia and New Zealand. I know you want to share!

So, as the end of the year approaches, have a very safe summer vacation and a pleasantly peaceful holiday season and please enjoy a happy new year when it comes. I will hopefully see many of you suitably refreshed at the Joint ANZSNM ACPSEM Physics Symposium in late February.

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 27

28 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

SPECIAL ARTICLE

MEET THE NEW RURAL BRANCH CHAIR

Joshua Morigi Josh, can you tell us about your journey in I try to bring those same concepts in my current role of Clinical Director at the Public Darwin Hospital where Nuclear Medicine?

I am from Italy originally and I studied medicine in the city of Bologna. Bologna Is a mid size medieval city between Florence and Milan, known for great food and gelato (I attended the local Gelato University last year!).

It is also the oldest university in the Western World so it made sense for me to stay there for my training.

I’ve been since 2019. Being an active ANZSNM member has allowed me to gain considerable insight over the state of Nuclear medicine in Australia and New Zealand, and participating in the Society's Annual Conference provides me with the platform to network and stay updated, which is paramount when working rurally.

What inspired you to take on the role of When I was approaching the end of medical school, Chairperson for the Rural Branch?

I had a few options but my good friend in radiation oncology suggested I check out Nuclear Medicine. Little did I know Nuclear Medicine in Bologna was a global powerhouse led by Prof. Stefano Fanti, who I was lucky to have as mentor first and as good friend now.

I spent four wonderful years learning the ins and outs of PET and SPECT imaging in a dynamic and international environment, where education and collectiveness were valued and promoted. I was lucky enough to attend my first EANM conference before I even graduated from medicine!

In 2015 I had the chance to spend three months working at St Vincents Hospital in Sydney, assisting Prof. Louise Emmett in the first prospective trial for PSMA imaging in biochemical recurrence, and in 2016 I returned to Vinnies as fellow once my training in Italy was completed.

I thought I’d be in Australia for six months, but then as it happens, things snowballed. I got a job at Peter Mac and then one at the Austin gaining full RACP fellowship.

At PeterMac and the Austin I was fortunate to witness the excellence of research conducted in Australia and the high level of professionalism in the field.

My passion for rural and regional practice in nuclear medicine has grown since 2019 when I took on the role here in Darwin. I also have had the opportunity to become very aware of the many difficulties and challenges encountered when working rurally, which were put on full display during the COVID 19 pandemic.

This has given me the desire to contribute in a more active way, and when the COI came up, it felt natural to take the opportunity to put my hand up.

What are the key objectives you have set for the Rural Branch?

There are three very broad objectives we have set up for the branch, which had its first meeting only two months ago: 1 - Advocacy (with a particular focus on workforce issues): As we unite under a single branch, realities from all over the country, Darwin to Bendigo to Townsville to Dubbo, we are uniquely placed to address some pressing issues of our community with a loud and clear voice. We want to ensure rural and regional practice can be represented equally across the different society positions and more importantly we want society members and in particular NMTs to know what’s out there for them.

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 29

SPECIAL ARTICLE

Joshua Morigi with Suzanne McGavin at Darwin Hospital

2-Research: Regional centres need to have access to research as much as main hubs. We want to promote accessibility to research for all centres, expand accreditation processes liaising with existing entities like ARTNET. An initiative to further expand the reach of theranostics outside of regional centres is another main focus.

3-First Nations representation: We can be vessels for change if we truly elevate first nations voices. This is the most complex and ambitious of the three focuses we have given ourselves as a committee. Increasing cultural safety practices on a national scale is something we wish to promote and engage everyone with, as it will benefit all patients not just first nations. Our RDH department is currently being painted by a Larrakia artist, and it looks beautiful. But the work needs to go much deeper than this.

We want to operate as a hinge between the needs of the rural and remote nuclear medicine community and the opportunities that are usually reserved for the bigger cities. For example we are talking to several stakeholders to imagine avenues of funding to provide CPD opportunities or grants specifically targeted towards rural and regional practice. We are at early days, but we have a lot of ideas.

How does the Rural Branch plan to support NMTs and other members working in rural What are your strategies for fostering relationships and building networks among areas? rural practices?

I think it is very important that we keep an open channel of communication with all the society members living and working remotely. Australia is such a huge country and Nuclear Medicine is no longer the specialty of big cities. More and more regional centres are becoming mini hubs of cancer care for example, and this means more capillary diffusion of PET services around the country.

Fostering relationships among rural practices is essential to overcoming the sense of professional isolation that can often occur in remote settings. Our committee’s diverse membership, which spans across different states and territories, provides a unique opportunity to connect practitioners from Darwin to regional centers in WA, Victoria, and NSW.

30 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

SPECIAL ARTICLE

We aim to develop initiatives that encourage collaboration, such as establishing and utilising new and existing resources (e.g. Nucleus) as centralised communication platforms for rural practitioners to share resources, case studies, and best practices. Partnerships with metropolitan centers and academic institutions will also play a key role. By facilitating mentorship programs, we hope to pair early-career professionals in rural areas with experienced practitioners who can guide them through the challenges of working in less-resourced environments. Additionally, organising regional workshops and online webinars will provide opportunities for skill-building and professional development without requiring travel to major cities.

For workforce retention, we aim to create targeted incentives such as rural-specific grants, scholarships, and continuing professional development (CPD) opportunities. Partnering with educational institutions to offer specialised rural placement programs could also encourage new graduates to consider careers in regional centers. Additionally, we’re investigating the feasibility of providing remote access to training and mentorship through telemedicine platforms, enabling professionals in isolated areas to stay connected with the wider nuclear medicine community.

In your view, what opportunities exist for growth in rural nuclear medicine?

There is immense potential for growth in rural nuclear

What are some of the biggest challenges you medicine, particularly in the expansion of theranostics see in rural nuclear medicine today? and other cutting-edge technologies. By introducing One of the most pressing challenges in rural nuclear medicine is ensuring equitable access to diagnostic and therapeutic services. Geographic isolation often means that patients face delays in receiving prompt and accurate imaging studies, which can impact their treatment outcomes. Addressing this disparity requires systemic efforts to expand access to advanced nuclear medicine technologies and ensure that rural centers are equipped with the tools and training necessary to deliver high-quality care.

Another major challenge is workforce retention. Rural and regional centers often struggle to attract and retain skilled Nuclear Medicine Technologists (NMTs), radiologists, and other professionals due to limited resources, professional isolation, and fewer career advancement opportunities. This shortage creates additional pressure on the existing workforce, leading to burnout and further attrition.

How does the Rural Branch intend to address these challenges?

Addressing these challenges requires a multi-faceted approach. To improve patient access, the Rural Branch is advocating for increased funding and policy changes that prioritise investment in rural healthcare infrastructure. We are exploring opportunities to introduce mobile PET/SPECT imaging units that can serve multiple communities, bridging the gap for patients in remote areas.

these advanced treatments to rural centers, we can not only improve patient outcomes but also position these centers as hubs for innovation and excellence.

Another area of opportunity lies in the integration of artificial intelligence (AI) and telehealth into rural practice. AI-powered diagnostic tools can enhance the accuracy of imaging interpretations, while telehealth platforms can connect rural practitioners with urban specialists for real-time consultations. These innovations can help overcome resource limitations and elevate the standard of care in regional settings.

How can current Society members and colleagues support the efforts of the Rural Branch?

Collaboration and active participation from Society members are vital to the success of the Rural Branch. Urban practitioners can support their rural colleagues by offering mentorship, sharing resources, and participating in case discussions. Members can also advocate for policy changes that prioritise rural healthcare and seek out opportunities to collaborate on research projects that include rural centers.

We encourage colleagues to attend Rural Branch meetings, present interesting cases, and share their experiences to foster a sense of community. By working together, we can ensure that the voices of rural professionals are heard and that their unique challenges are addressed effectively.

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 31

SPECIAL ARTICLE

professionals dedicated to advancing rural healthcare.

I hope to see a vibrant community of practitioners who feel supported, connected, and empowered to deliver exceptional care, no matter their location. By elevating the profile of rural nuclear medicine, we aim to contribute to the broader advancement of the field across Australia and New Zealand.

What message would you like to share with NMTs and other nuclear medicine professionals in rural areas?

To all the NMTs and nuclear medicine professionals working in rural and regional areas: your work is vital and deeply appreciated. You are the backbone of healthcare delivery in some of the most challenging and rewarding environments. Remember that you are not alone—our Rural Branch is here to support you, advocate for your needs, and provide opportunities to grow professionally. Together, we can make a meaningful impact on the lives of patients in rural communities.

Where do you see the Rural Branch in five years?

In five years, I envision the Rural Branch as a wellestablished and influential entity within the Society.

Our efforts will have significantly improved access to nuclear medicine services in rural areas, expanded research opportunities, and fostered a strong network of

32 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

The Nuclear Medicine Team at Darwin Hospital

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CONNECT, COMMUNICATE, COLL ABORATE

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Join NUCLEUS and connect with your peers, participate in members-only conversations, seek answers to your questions, share insights, access exclusive resources available to members only and more!

CONNECT TODAY GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 33 www.anzsnm.org.au/resources/nucleus

EDUCATION & CPD | Case study

CASE STUDY

WHAT’S THAT? – THE EARLY PET CATCHES THE WORM

Angelina McDonnell & Remi Hillery Nuclear Medicine Technologists - Sunshine Coast University Hospital, QLD Introduction A 48-year-old female presented to the Medical Imaging department fo r a 1 8 F l u o r i n e – Flurodeoxyglucose Positron Emission Tomography (18F-FDG PET/CT) scan with a pelvic mass and recent abdominal pain and fevers. Her symptoms included dizziness, ongoing diarrhoea, nausea and vomiting and her blood tests demonstrated increased Figure 1: MIP liver function tests. The patient had a known cystic mass, though the nature of this mass was unknown. Her referring team were concerned of a diagnosis of neuroendocrine tumour, an abscess with long latency or a bowel or gynaecological pathology.

Method: 264MBq of 18F-FDG was administered intravenously through a 24G cannula in the right hand.

Following an uptake period of 61 minutes, a vertex to thigh PET scan was acquired with low-dose CT for attenuation correction and lesion localisation.

Findings: The imaging demonstrated physiological FDG uptake throughout the brain, adrenal glands, kidneys, spleen and pancreas. No suspicious FDG avid lesions in the head, neck, chest or spine. A cystic mass measuring 13 x 10 x 12cm was evident within the pelvis, demonstrating peripheral moderate FDG uptake (SUXmax = 3.3). The

mass had thin internal septations that were not FDG avid, and displaced her uterus, bladder and ureters, without renal obstruction. What’s that?

CLUE – This patient lives on a farm Background Echinococcus granulosus is a species of tapeworm that is the most common cause of hydatid disease in humans.

Countries in the temperate zone (South America, central Asia, the Mediterranean and Australia) have the greatest prevalence of hydatid disease.

There is a female predominance and age of presentation is usually around 40 years old (Bhatnagar et al. 2017).

Canines serve as the definitive host for this tapeworm with Figure 2: Fused Coronal PET/CT livestock such as sheep, pigs or cattle being intermediate hosts (Paul et al. 2017). These tapeworms inhabit the small bowel, and infected ova are shed in faeces (Bhatnagar et al. 2017). Ingestion of parasitic eggs, either directly from contact with dogs, or more frequently through ingestion of contaminated food or water cause humans to become infected (Srinivas, Deepashri & Lakshmeesha 2016).

Larvae from the eggs enter portal circulation and form cystic lesions with three layered walls including

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EDUCATION & CPD | Case study

Case Study: WHAT’S THAT? – The early PET catches the Worm (Continued)

an outer dense fibrous capsule produced by the host’s inflammatory system (Victoria Health, 2022). While cysts can develop anywhere throughout the body, they most commonly occur in the liver (63%) and lungs (25%).

Secondary pelvic hydatid cysts can occur following rupture of primary hepatic, splenic or mesenteric cysts (Pandey et al. 2018). Primary pelvic cysts are extremely rare (0.2 - 2.25%) with 80% of cases affecting the ovary or uterus (Cattorini et al. 2011). It can take 5-20 years for cysts to become symptomatic (Bhatnagar et al. 2017). Symptoms of pelvic cysts are usually due to its mass effect on other organs and can be confused with obstructive uropathy, appendicitis, ovarian cysts or malignancy (Pandey et al. 2018). Once identified, the most effective treatment is preoperative chemotherapy with antiparasitic medications such as albendazole or mebendazole followed by surgical excision and postoperative chemotherapy (Pandey et al. 2018).

particular importance is its ability to reveal the doughnut sign from the cyst’s peripheral enhancement. FDG PET works in conjunction with other imaging techniques and clinical context to achieve a final diagnosis (Kumar et al.

2015).

Conclusion Along with its use in assessing disease extent and treatment response, 18F-FDG PET/CT can play a role in establishing a diagnosis of hydatid cyst (ruptured or infected or both). Detection of the inflammatory component through this modality can help determine the diagnosis (Kumar et al. 2015).

The patient underwent pre-operative high-dose treatment with Albendazole, an anthelminitic medicine used for treatment of a variety of intestinal parasite infections.

Plans were put in place to image after 1 month with the view to remove the mass surgically. After 1 month of this treatment, MRI imaging demonstrated the hydatid cyst was beginning to resolve.

Following a further 5 months of treatment, patient was re-imaged with MRI, which demonstrated the hydatid cyst in the pouch of Douglas was continuing to resolve, with no cystic component and only fibrous tissue remaining.

This nearly complete resolution of the pelvic hydatid cyst meant the patient did not have to undergo surgery, and due to the resolved infection with clinical and radiological response, she was discharged from these clinics.

Discussion In accompaniment with serological testing, a variety of imaging techniques can be used to diagnose a hydatid cyst. The most effective modality depends on the stage of disease and the affected organ. Ultrasound demonstrates internal debris and daughter cysts, Computed Tomography (CT) is best for imaging bone involvement and calcification, while Magnetic Resonance Imaging (MRI) is effective for determining neural involvement (Srinivas, Deepashri & Lakshmeesha 2016).

18F-FDG PET/CT is primarily used to exclude malignancy when a diagnosis is uncertain. It plays an important role in characterising inflammatory or infective processes. Of

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Case Study: WHAT’S THAT? – The early PET catches the Worm (Continued) References 1.

2.

Bhatnagar, N, Kishan, H, Sura, S, Lingaiah, P, Jaikumar, K. (2017). Pelvic

5.

Paul, S, Mandal, S, Upadhyaya, M, Pramanik, SR, Biswas, SC, Biswas,

Hydatid Disease: A Case Report and Review of Literature. National

RR. (2017). Primary pelvic hydatid cyst in a postmenopausal female:

Library of Medicine. 7(4), p.PMC5702697. [Online]. Available at:

a surgical challenge. National Library of Medicine. 7(2), pp.49-54.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5702697/ [Accessed

[Online]. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/

18 September 2024].

PMC5507569/ [Accessed 18 September 2024].

Cattorini, L, Trastulli, S, Milani, D, Cirocchi, R, Giovannelli, G, Avenia,

6.

Srinivas, MR, Deepashri, B, Lakshmeesha, MT. (2016). Imaging

N, S. (2011). Ovarian hydatid cyst: A case report. International

Spectrum of Hydatid Disease: Usual and Unusual Locations. Polish

Journal of Surgery Case Reports. 2(6), pp.100-102. [Online].

Journal of Radiology. 81(2016), pp.190 - 205. [Online]. Available at:

Available at: https://www.sciencedirect.com/science/article/pii/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4868106/ [Accessed

S2210261211000307#:~:text=Abstract,localized%20in% [Accessed 18

18 September 2024].

September 2024].

7.

3.

Kumar, NS, Barve, K, Joshi, J, Basu, S. (2015). Incidental Diagnosis of

Department of health Victoria. Last Updated: 04 March 2022. Available

an Asymptomatic Hydatid Cyst Through Low-Grade 18F-FDG Uptake

at: https://www.health.vic.gov.au/infectious-diseases/hydatid-disease-

in the Peripheral Rim. Journal of Nuclear Medicine Technology. 43(4),

echinococcosis [Accessed 18 September 2024].

pp.292 - 294. [Online]. Available at: https://tech.snmjournals.org/ content/43/4/292 [Accessed 18 September 2024].

4.

Victoria Health. (2022). Hydatid disease (echinococcosis). [Online].

Pandey, S, Singh, V, Sinha, RJ, Sharma, A. (2018). Pelvic hydatid: the great masquerader. BMJ Case Reports. 2018(.). [Online]. Available at: https://casereports.bmj.com/content/2018/bcr-2018-227409.citationtools [Accessed 18 September 2024].

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CASE STUDY INTERESTING CASE - SALIVARY ASPIRATION: A HARD TRUTH TO SWALLOW

Phoebe Nguyen & Serena Hollande The Alfred Hospital, VIC

C

ase Description: A 53-year-old female presented to the Nuclear Medicine department with symptoms of ongoing coughing and dyspnoea querying salivary aspiration in relation to complaints of salivary overproduction. These symptoms have been present since her thyroidectomy in 2022 and has been previously investigated with a barium swallow and CT Chest in 2023, but both were negative for aspiration. To treat her hypersecretion of saliva, the patient has received injections of Botox into the salivary glands on multiple occasions, however the symptoms are still persisting.

Background Salivary aspiration is when saliva accumulates in the lungs. This can occur from various pathologies including neurologic impairment, pulmonary or supraglottic disease, along with invasive procedures that affect the gastrointestinal/oesophageal pathway(1).

Foreign matter in the lungs, such as saliva, can trigger an inflammatory response – which, if occurring frequently, can induce further morbidities like pneumonia, fibrosis, bronchiolitis & be more susceptible to respiratory infections(2).

These pathologies, particularly in the older population, are associated with increased mortality rates(3).

Therefore, identifying salivary aspiration in its early stages is important to prevent further damage to the lungs.

Role of Nuclear Medicine There are multiple methods to assess salivary aspiration, including a barium swallow and fibreoptic evaluation of swallowing(4). Although they are the most common

methods for evaluating swallowing and aspiration, barium swallows in particular have been shown to have a significant rate of false negative results for aspiration pneumonia (5).

A Nuclear Medicine study will be beneficial for patients investigated for salivary aspiration, particularly in early detection, as its advantages include ease of performance and therefore cooperation of patients, consistency with normal physiological swallowing and ability to perform long term monitoring (3) Procedure Performed There was no patient preparation required for this study and all images were acquired on the GE NM/CT 870 DR SPECT/CT camera.

To perform this study, 74 MBq of Tc99m Stannous Fluoride Colloid was diluted in 20mL of plain water and administered orally via a 150cm long 0.1cm diameter tube, using an infusion pump over the course of 30 minutes, at a rate of 40mls per hour. The distal end of the tube was placed inside of the patient’s mouth and the patient was instructed to swallow saliva as normal during the infusion period.

Simultaneously, a supine dynamic image [Figure 1] was acquired over the infusion period at a rate of 30sec per frame for 60 frames. The detector was centred over the patient’s chest, ensuring that all of the lungs were in the field of view. Immediately following the dynamic, an anterior and posterior 3-minute static image was obtained [Figure 2].

The patient then drank 100mL of plain water to clear the oesophagus and stomach before continuing with a SPECT/CT [Figure 3].

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Case Study: Interesting case - Salivary aspiration: A hard truth to swallow (Continued) Case Findings

Figure 1: Ant/Post Dynamic Display – Normal passage of orally administered radiotracer through the oesophagus and into the stomach

Figure 2: Ant/Post Static Display – Accumulation of the radiotracer outside of the regular gastro-oesophageal tract

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Case Study: Interesting case - Salivary aspiration: A hard truth to swallow (Continued)

Figure 3: SPECT/CT Screencap – Accumulation of radiotracer in the left main bronchus, proximal and superior aspects of the lower lobe bronchus

The outcome of this study was concluded to be positive for salivary aspiration. It is noted in the patient’s follow up consultation that the referring doctors recommended the patient to be considered for oral Glycopyrrolate and Endep, continue with Botox injections and be referred to speech pathology for further assistance.

Discussion Hypersecretion of saliva is known to be difficult to treat.

However, some treatments can include physical therapy to strengthen the oral cavity musculature, removal of offending drugs, adding an anti-muscarinic drug, surgery or radiation. The more permanent solutions such as surgery and radiation come with significant risk and side effects (6,7).

The patient was recommended to consider oral Glycopyrrolate to reduce symptoms of excess salivation.

This drug works by acting as a muscarinic receptor antagonist to block acetylcholine – a neurotransmitter involved with involuntary muscle movement such as in the secretory glands. Therefore, blocking the receptors of acetylcholine will reduce the rate of salivation. However,

amongst other adverse side effects, prolonged use of Glycopyrrolate may increase the chance of dental and gum disease(8).

The alternative medication recommended was Endep, an antidepressant with the same mechanism of action as Glycopyrrolate(9). This patient will likely undergo extensive discussion with their doctors to consider which pathway is most suitable.

The importance of ongoing and delayed imaging in Nuclear Medicine was also considered in this case study.

The protocol for salivary aspiration studies as dictated by the department physicians, states to perform a 30minute dynamic image simultaneous to the infusion, with the addition of a SPECT/CT if there was an abnormal finding. If the initial dynamic was found to be uneventful, the protocol states to perform a 6-hour delayed static.

In this particular case however, it was a lucky accident that a static image was performed immediately after the dynamic, where there happened to appear an abnormality in the passage of the radiotracer. Although the study would still be likely to be positive if the early static was

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Case Study: Interesting case - Salivary aspiration: A hard truth to swallow (Continued) not performed, the patient would have been required to return to the department after 6 hours of waiting which can be quite inconvenient and unpleasant for the patient.

The feasibility of this study can be limited by the facilities available to a department. To replicate this method, the department would require an infusion pump, large volume syringes and extension tubing – all of which may not be readily available to smaller departments. Performing this study manually would be unreasonable as it would be difficult to accurately replicate a constant infusion of 20mL over 30 minutes, possibility of introducing human error which will threaten the efficacy of the study.

There is limited literature available in the study of salivary aspiration in Nuclear Medicine and it is hopeful that this case may provide some assistance in the development of future protocols.

Conclusion This case study demonstrates that Nuclear Medicine can be utilised for investigating salivary aspiration. Although it is a rare occurrence, knowledge of how it can be done and how to improve upon the current protocol for further optimisation will aid in the future applications of this study.

References 1.

Ficke B, Rajasurya V, Cascella M. Chronic Aspiration [Internet].

PubMed. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560734/

2.

Niederman MS, Cilloniz C. Aspiration pneumonia. Revista Española de Quimioterapia. 2022 Apr 22;35(Suppl1):73–7.

3.

Hou P, Deng H, Wu Z, Liu H, Liu N, Zheng Z, et al. Detection of salivary aspiration using radionuclide salivagram SPECT/CT in patients with COPD exacerbation: a preliminary study. Journal of Thoracic Disease.

2016 Oct;8(10):2730–7.

4.

arneti D, Turroni V, Genovese E. Aspiration: diagnostic contributions from bedside swallowing evaluation and endoscopy. Acta Otorhinolaryngologica Italica. 2018 Dec;38(6):511–6.

5.

Yu KJ, Park D. Clinical characteristics of dysphagic stroke patients with salivary aspiration. Medicine. 2019 Mar;98(12):e14977.

6.

Alhajj M, Babos M. Physiology, Salivation [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2023. Available from: https://www. ncbi.nlm.nih.gov/books/NBK542251

7.

Lakraj AA, Moghimi N, Jabbari B. Sialorrhea: Anatomy, Pathophysiology and Treatment with Emphasis on the Role of Botulinum Toxins. Toxins [Internet]. 2013 May 21 [cited 2020 May 6];5(5):1010–31. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709276/

8.

Gallanosa A, Stevens JB, Quick J. Glycopyrrolate [Internet]. PubMed. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jul 1].

Available from: https://www.ncbi.nlm.nih.gov/books/NBK526035

9.

Consumer Medicine Information. Endep Tablets [Internet]. NPS MedicineWise. 2019. Available from: https://www.nps.org.au/ medicine-finder/endep-tablets

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ARTICLE

ARTICLE Lancet Oncology Commission The Lancet Oncology Commission on Radiotherapy and Theranostics was published online in Lancet Oncology on 30 September, 2024. The Commission was spearheaded by ANZSNM International Relations Committee Representative, Professor Andrew Scott. The Commission represents an important collaboration between the ANZSNM, SNMMI, EANM, WFNMB, JSNM, CANM and IAEA. Professor Jean Luc Urbain, WFNMB Immediate Past President and PresidentElect SNMMI, presented the outcomes of the Commission in a dedicated session at the recent American Society for Radiation Oncology (ASTRO) meeting in Washington DC, on behalf of Professor Scott. The presentation highlighted the data collected by the Commission, as well as the challenges and opportunities arising from the rapid growth of Theranostics. It also proposes actions for ensuring safe and equitable access to Theranostics globally.

The white paper can be accessed online using the following link: https://www.anzsnm.org.au/public/28/files/24TLO0655%20(1). pdf?_zs=JG6Km&_zl=01jA3 The associated podcast is also accessible on the Lancet Oncology website via the following link: https://www.thelancet.com/commissions/radiotherapy-theranostics We congratulate Andrew and the co-authors of the Lancet Oncology Commission report.

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ARTICLE An updated review of 18 F-FDG PET/CT in Lymphoma Karan Singh The Prince of Wales & Sydney Children's Hospitals

Lymphoma represents a group of malignant lymphocytic neoplasms with wide clinical, genetic and molecular heterogeneity. They are characterised by the clonal expansion of abnormal cells typically involving lymph nodes, with potential extranodal involvement via direct invasion or haematogenous spread.1 Whilst there are more than 80 recognised subtypes, lymphoma can be broadly classified as Non Hodgkin Lymphoma (NHL) or Hodgkin lymphoma (HL) with NHL comprising more than 80% of total cases.2 Diffuse Large B Cell Lymphoma (DLBCL) and Follicular Lymphoma (FL) account for more than 50% of cases of NHL.3 Today, 2-deoxy-2-(18F)fluoro-D-glucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) plays a central role in staging, re-staging, prognosticating, monitoring therapy and detecting recurrence in patients with FDG-avid lymphomas (which includes most types of lymphoma with the exception of indolent NHL). Assessment of glucose metabolism with anatomical localisation on low dose CT provides a holistic assessment of the anatomical and functional characteristics of lymphomas. This essay will focus on the role of 18F-FDG PET/CT in FDG-avid lymphomas, including a balanced discussion of limitations and future directions.

Staging Accurate baseline staging is essential for determining treatment paradigms and risk prognostication in lymphoma. Historically, CT was deployed for staging with relative limitations including recognition of lymph node involvement based purely on size and detection of extranodal disease (including focal bone marrow invasion).4 Whilst CT remains more accessible, 18F-FDG PET/CT has become established as standard of care for staging all FDG-avid lymphomas, and is recommended by the 2014 Lugano Criteria, which updated the traditional Ann Arbor classification. 5,6 It provides an accurate, reproducible and overall superior whole-body assessment of metabolically active nodal and extranodal disease.

Many studies of patients with HL, DLBCL and T-Cell Lymphomas have demonstrated that 18F-FDG PET/CT can upstage disease in up to 5-50% compared with CT alone.7-11 One particular study of patients with advanced HL also demonstrated that PET led to downstaging in 6% of patients due to lack of 18F-FDG uptake in enlarged lymph nodes or spleen.7 In fact, there is now broad consensus that bone marrow biopsy can be abandoned in patients with HL staged by 18F-FDG PET/CT and only required in patients with DLBCL if 18F-FDG PET/CT is negative and identifying discordant histology is important for patient management.12,13 Furthermore, 18F-FDG PET/

CT may guide biopsy from a metabolically active and easily accessible site, thereby reducing the risk of a false negative result and surgical complications at diagnosis.

Staging evaluation with 18FFDG PET/CT may also assist with prognostication (see section on ‘Future Directions’).

Broadly speaking, 18F-FDG uptake has been shown to correlate with aggressiveness and lactate dehydrogenase level; a prognostic predictor.14 Furthermore, staging with 18F-FDG PET/CT may also assist in selecting patients for radiation monotherapy and guiding accurate target delineation, especially in patients with localised low grade FL or nodular lymphocyte predominant HL.15-17 Response Assessment 18F-FDG PET/CT has proven beneficial in the management of patients during and following the end of treatment.

The Lugano Classification (which endorsed the Deauville Criteria) provides a simple 5-point score for response assessment based off comparison of lesional FDG uptake to mediastinal blood pool or hepatic parenchyma and is routinely deployed for response evaluation.5,18 Both interim and end of treatment PET assessment has been associated with patient outcomes. One particular study of patients with advanced HL who underwent 6 cycles of chemotherapy demonstrated a significant increase in progression free survival in patients who had

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ARTICLE: An updated review of 18 F-FDG PET/CT in Lymphoma (Continued) a negative PET (Deauville Score 1-3) post 2 cycles of chemotherapy.19 Similar findings have been reported in advanced NHL.20,21 Several studies have also gone on to demonstrate PET findings post cessation of chemotherapy are also associated with significant increases in progression free and overall survival.22,23 Response-adapted Therapy The association of interim PET findings with prognosis has prompted multiple studies in PET guided treatment strategies in both HL and NHL. In patients with limited stage HL, current literature does not support the omission of radiotherapy in patients with a negative PET after 2-3 cycles of ABVD (Adriamycin, Bleomycin, Vinblastine and Dacarbazine).24 However, the EORTC H10 Trial which included patients with earlystage HL demonstrated that modification of chemotherapy from ABVD to BEACOPP (Bleomycin, Etoposide, Doxorubicin, Cyclophosphamide, Vincristine, Procarbazine and Prednisone) in patients with a positive PET (Deauville Score 4-5) following 2 cycles of chemotherapy resulted in superior disease control.25 No consistent improvement has been demonstrated in NHL, and therefore response adapted therapy in NHL is not routinely deployed in clinical practice.

Immunotherapy In recent times, immunomodulatory agents such as immune checkpoint inhibitors have emerged as a way to manage and maintain several stages and subtypes of lymphoma. 26 Response patterns on 18F-FDG PET/CT may vary following therapy administration.

Some patients may initially appear to experience disease progression before ultimately achieving a favourable clinical picture (ie pseudo-progression).

This is likely related to a flare phenomenon caused by a surge in immune stimulation.27 Pseudo-progression is differentiated from hyper-progression by assessment of the patient’s clinical status and careful imaging follow up. Regardless, this has necessitated modifications to the Lugano Classification such that the LYRIC group has introduced a new category of response ‘indeterminate response’ following which current therapy may be continued for up to 12 weeks prior to repeat imaging and/or histopathological confirmation.

Surveillance/Recurrence Whilst many patients with Lymphoma remain in

remission following primary therapy, a proportion may experience disease recurrence, most commonly within 2 years of treatment cessation.29,30 Relapse rates vary depending on histological subtype and stage. Specifically, lifetime relapse rates have been quoted at 10-15% for HL (early disease) and 40% for both advanced HL and DLBCL. 18F-FDG PET/CT stills play a crucial role in evaluating relapse in patients with clinical symptoms and guiding rebiopsy. In patient with recurrent, aggressive lymphoma, the goal of second line chemotherapy is to induce metabolic remission and facilitate autologous stem cell transplant (ASTC) with the ultimate aim of cure. Current literature highlights the importance of achieving a negative 18F-FDG PET/ CT prior to ASCT to improve cure rates.31 Importantly, many retrospective and prospective trials have explored the use of 18FFDG PET/CT in the surveillance evaluation of patients with lymphoma.32-34 These studies provide a unifying message; that irrespective of histological subtype, there appears to be limited benefit from surveillance 18F-FDG PET/CT in asymptomatic patients with lymphoma in first remission on the basis of a high false positive rate, increased radiation exposure and no difference in overall survival between cohorts of patients with clinical and subclinical, imaging detected recurrence.

Limitations Whilst 18F-FDG PET/CT offers exquisite sensitivity above the resolution limits of PET imaging, the positive predictive value remains moderate at best with many nonmalignant causes of 18F-FDG uptake potentially resulting in false positive interpretations of disease stage or relapsed lymphoma. These include but are not limited to infection, inflammation and granulomatous disease. To minimise the possibility of a false positive PET, it is recommended that PET imaging be performed 3 weeks following chemotherapy and granulocytecolony stimulating factor and 8-12 weeks following radiotherapy.35 Specifically, chemotherapy induced thymic hyperplasia is a benign, immunological rebound phenomenon not uncommonly seen in the paediatric population.36 Additional factors complicating image assessment include uptake in brown adipose tissue (BAT), though this can be attenuated with the administration of Benzodiazepines (eg. Diazepam) or Beta Blockers (eg.

Propranolol) that work to reduce sympathetic nervous system activity in BAT. Additionally, without adjustment

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ARTICLE: An updated review of 18 F-FDG PET/CT in Lymphoma (Continued) of image intensity thresholds, CNS Lymphoma may be difficult to appreciate due to intense physiologic uptake of FDG by normal cerebral tissue.

4.

current limitations and future directions. Nat Rev Clin Oncol. 2017;14(10):631-645. doi:10.1038/ nrclinonc.2017.78 5.

Future Directions Moving forward, technological advances and growing literature suggests that radiomic biomarkers can be cross referenced with established clinical cellular and molecular biomarkers to better aid prognostication and influence clinical decision making in patients with lymphoma. Quantitative indices including Metabolic Tumour Volume (MTV) and Total Lesional Glycolysis (TLG) as defined by the product of the MTV and the mean SUV of that MTV have shown promise in enhancing prognostication in patients with DLBCL, Peripheral T Cell Lymphoma and FL.37-39 For example, in patients with early stage HL treated on the EORTC H10 Trial, Cottereau et al reported that a higher MTV was associated with inferior progression free survival and overall survival.40 However, methods for delineating lesion borders should be standardised and ensured to be reproducible across different users and reconstruction protocols prior to incorporation into routine clinical practice.

Cunningham J, Iyengar S, Sharma B. Evolution of lymphoma staging and response evaluation:

Van Heertum RL, Scarimbolo R, Wolodzko JG, et al. Lugano 2014 criteria for assessing FDG-PET/ CT in lymphoma: an operational approach for clinical trials. Drug Des Devel Ther. 2017;11:17191728. Published 2017 Jun 13. doi:10.2147/DDDT.S136988

6.

Olweny CL. Cotswolds modification of the Ann Arbor staging system for Hodgkin's disease.

J Clin Oncol. 1990;8(9):1598.

7.

Barrington SF, Kirkwood AA, Franceschetto A, et al. PET-CT for staging and early response: results from the Response-Adapted Therapy in Advanced Hodgkin Lymphoma study. Blood.

2016;127(12):1531-1538. doi:10.1182/blood-2015-11-679407

8.

Fuertes S, Setoain X, López-Guillermo A, et al. The value of positron emission tomography/ computed tomography (PET/CT) in the staging of diffuse large B-cell lymphoma]. Med Clin (Barc). 2007;129(18):688-693. doi:10.1157/13112510

9.

Raanani P, Shasha Y, Perry C, et al. Is CT scan still necessary for staging in Hodgkin and non-Hodgkin lymphoma patients in the PET/CT era?. Ann Oncol. 2006;17(1):117-122. doi:10.1093/annonc/mdj024

10.

Elstrom RL, Leonard JP, Coleman M, Brown RK. Combined PET and lowdose, noncontrast CT scanning obviates the need for additional diagnostic contrast-enhanced CT scans in patients undergoing staging or restaging for lymphoma. Ann Oncol. 2008;19(10):1770-1773. doi:10.1093/annonc/mdn282

11.

Casulo C, Schöder H, Feeney J, et al. 18F-fluorodeoxyglucose positron emission tomography in the staging and prognosis of T cell lymphoma. Leuk Lymphoma. 2013;54(10):2163-2167. doi:10.3109/10428194.2013.767901

18F-FDG PET/CT has been established as standard of care in the management of patients with FDG-avid lymphomas, specifically in staging and accurate response assessment. As technological advances in radiomics surge, there is hope for new quantitative indices to provide additional prognostic information, thereby individualising therapy. Regardless, both referring and reporting physicians should understand the limitations of 18F-FDG PET/CT within the context of treatment strategy for each patient and therefore participation in multidisciplinary team meetings remains strongly encouraged.

12.

therapeutic consequence for positron emission tomography/computed tomography-staged treatment-naive patients with Hodgkin lymphoma. J Clin Oncol. 2012;30(36):4508-4514. doi:10.1200/JCO.2012.42.4036 13.

2013;122(1):61-67. doi:10.1182/blood2012-12-473389 14.

before and after Treatment in Patients with Lymphoma. Chin Med J (Engl). 2018;131(15):17761779. doi:10.4103/0366-6999.237392

patients with low-grade lymphoma: results of a multicentre prospective study. Eur J Nucl Med Mol Imaging. 2009;36(3):347- 353. doi:10.1007/s00259-008-0958-z

Virchows Arch. 2011;458(6):637-648. doi:10.1007/s00428-011- 1083-0 16.

non-hodgkin lymphoma. Int J Radiat Oncol Biol Phys. 2008;71(1):213-219. doi:10.1016/j.

Kanas G, Ge W, Quek RGW, Keeven K, Nersesyan K, Jon E Arnason. Epidemiology of diffuse

ijrobp.2007.09.051

large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) in the United States and Western Europe: population-level projections for 2020-2025. Leuk Lymphoma. 2022;63(1):54-63. doi: 10.1080/10428194.2021.1975188

Wirth A, Foo M, Seymour JF, Macmanus MP, Hicks RJ. Impact of [18f] fluorodeoxyglucose positron emission tomography on staging and management of early-stage follicular

PPO.0000000000000451 3.

Scott AM, Gunawardana DH, Wong J, et al. Positron emission tomography changes management, improves prognostic stratification and is superior to gallium scintigraphy in

Taylor CR, Hartsock RJ. Classifications of lymphoma; reflections of time and technology.

de Leval L, Jaffe ES. Lymphoma Classification. Cancer J. 2020;26(3):176- 185. doi:10.1097/

Ucar E, Yalcin H, Kavvasoglu GH, Ilhan G. Correlations between the Maximum Standard Uptake Value of Positron EmissionTomography/Computed Tomography and Laboratory Parameters

References

2.

Khan AB, Barrington SF, Mikhaeel NG, et al. PET-CT staging of DLBCL accurately identifies and provides new insight into the clinical significance of bone marrow involvement. Blood.

15.

1.

El-Galaly TC, d'Amore F, Mylam KJ, et al. Routine bone marrow biopsy has little or no

17.

Janikova A, Bolcak K, Pavlik T, Mayer J, Kral Z. Value of [18F]fluorodeoxyglucose positron emission tomography in the management of follicular lymphoma: the end of a dilemma?.

44 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

ARTICLES

ARTICLE: An updated review of 18 F-FDG PET/CT in Lymphoma (Continued) 30.

Clin Lymphoma Myeloma. 2008;8(5):287-293. doi:10.3816/CLM.2008.n.040 18.

JCO.2014.55.7561

Workshop on Interim-PET-Scan in Lymphoma. Leuk Lymphoma. 2009;50(8):1257-1260.

31.

doi:10.1080/10428190903040048 19.

Gallamini A, Hutchings M, Rigacci L, et al. Early interim 2-[18F]fluoro-2- deoxy-D-glucose positron emission tomography is prognostically superior to international prognostic score

primary therapy. Br J Cancer. 2013;109(2):312- 317. doi:10.1038/bjc.2013.338

Mikhaeel NG, Hutchings M, Fields PA, O'Doherty MJ, Timothy AR. FDG-PET after two to

33.

routine positron emission tomography/computerized tomography imaging is not superior

non-Hodgkin lymphoma. Ann Oncol. 2005;16(9):1514-1523. doi:10.1093/annonc/mdi272

to clinical follow-up for patients with no residual mass. Br J Haematol. 2014;164(5):694-700.

Haioun C, Itti E, Rahmouni A, et al. [18F]fluoro-2-deoxy-D-glucose positron emission

doi:10.1111/bjh.12687 34.

Barnes JA, LaCasce AS, Zukotynski K, et al. End-of-treatment but not interim PET scan predicts outcome in nonbulky limited-stage Hodgkin's lymphoma. Ann Oncol.

doi:10.1200/JCO.2008.16.1513 35.

for response assessment of lymphoma: consensus of the Imaging Subcommittee of

Engert A, Haverkamp H, Kobe C, et al. Reduced-intensity chemotherapy and PET-guided

International Harmonization Project in Lymphoma. J Clin Oncol. 2007;25(5):571-578.

randomised, open-label, phase 3 non-inferiority trial [published correction appears in

doi:10.1200/JCO.2006.08.2305 36.

Lancet. 2012 May 12;379(9828):1790]. Lancet. 2012;379(9828):1791-1799. doi:10.1016/S0140-

after chemotherapy. J Nucl Med. 2001;42(4):591-595.

El-Galaly TC, Villa D, Gormsen LC, Baech J, Lo A, Cheah CY. FDG-PET/CT in the management

37.

the Prognostic Value of the NCCN-IPI in Primary Gastric Diffuse Large B-Cell Lymphoma

doi:10.1111/joim.12813

Patients Treated With the R-CHOP Regimen?. Clin Nucl Med. 2021;46(1):1-7. doi:10.1097/

André MPE, Girinsky T, Federico M, et al. Early Positron Emission Tomography Response-

RLU.000000000000337 38.

EORTC/LYSA/FIL H10 Trial. J Clin Oncol. 2017;35(16):1786-1794. doi:10.1200/JCO.2016.68.6394

Cancer Res Treat. 2021;53(3):837-846. doi:10.4143/crt.2020.123 39.

Guo B, Tan X, Ke Q, Cen H. Prognostic value of baseline metabolic tumor volume

Aide N, Hicks RJ, Le Tourneau C, Lheureux S, Fanti S, Lopci E. FDG PET/CT for assessing

and total lesion glycolysis in patients with lymphoma: A meta-analysis. PLoS One.

tumour response to immunotherapy : Report on the EANM symposium on immune

2019;14(1):e0210224. Published 2019 Jan 9. doi:10.1371/journal.pone.0210224

modulation and recent review of the literature. Eur J Nucl Med Mol Imaging. 2019;46(1):238-

28.

Feng X, Wen X, Li L, et al. Baseline Total Metabolic Tumor Volume and Total Lesion Glycolysis Measured on 18F-FDG PET-CT Predict Outcomes in T-Cell Lymphoblastic Lymphoma.

Hatic H, Sampat D, Goyal G. Immune checkpoint inhibitors in lymphoma: challenges and opportunities. Ann Transl Med. 2021;9(12):1037. doi:10.21037/atm-20-6833

27.

Jiang C, Ding C, Xu J, et al. Will Baseline Total Lesion Glycolysis Play a Role in Improving

of lymphomas: current status and future directions. J Intern Med. 2018;284(4):358-376.

Adapted Treatment in Stage I and II Hodgkin Lymphoma: Final Results of the Randomized

26.

Brink I, Reinhardt MJ, Hoegerle S, Altehoefer C, Moser E, Nitzsche EU. Increased metabolic activity in the thymus gland studied with 18F-FDG PET: age dependency and frequency

6736(11)61940-5

25.

Juweid ME, Stroobants S, Hoekstra OS, et al. Use of positron emission tomography

2011;22(4):910-915. doi:10.1093/annonc/mdq549

radiotherapy in patients with advanced stage Hodgkin's lymphoma (HD15 trial): a

24.

Zinzani PL, Stefoni V, Tani M, et al. Role of [18F]fluorodeoxyglucose positron emission tomography scan in the follow-up of lymphoma. J Clin Oncol. 2009;27(11):1781-1787.

patient outcome. Blood. 2005;106(4):1376-1381. doi:10.1182/blood-2005-01-0272

23.

Dann EJ, Berkahn L, Mashiach T, et al. Hodgkin lymphoma patients in first remission:

three cycles of chemotherapy predicts progression-free and overall survival in high-grade

tomography (FDG-PET) in aggressive lymphoma: an early prognostic tool for predicting

22.

Cheah CY, Hofman MS, Dickinson M, et al. Limited role for surveillance PETCT scanning in patients with diffuse large B-cell lymphoma in complete metabolic remission following

Oncol. 2007;25(24):3746-3752. doi:10.1200/JCO.2007.11.6525

21.

Jauhari S, Nasta SD. PET/CT in the Evaluation of Relapsed or Refractory Hodgkin Lymphoma.

Am J Hematol Oncol. 2016;12(9):8-13.

32.

in advanced-stage Hodgkin's lymphoma: a report from a joint Italian-Danish study. J Clin

20.

Thompson CA, Ghesquieres H, Maurer MJ, et al. Utility of routine posttherapy surveillance imaging in diffuse large B-cell lymphoma. J Clin Oncol. 2014;32(31):3506-3512. doi:10.1200/

Meignan M, Gallamini A, Meignan M, Gallamini A, Haioun C. Report on the First International

40.

Cottereau AS, Versari A, Loft A, et al. Prognostic value of baseline metabolic tumor

250. doi:10.1007/s00259-018-4171-4

volume in early-stage Hodgkin lymphoma in the standard arm of the H10 trial. Blood.

Skusa C, Weber MA, Böttcher S, Thierfelder KM. Criteria-Based Imaging and Response

2018;131(13):1456-1463. doi:10.1182/blood-2017-07-795476

Evaluation of Lymphoma 20 Years After Cheson: What is New?. Kriterien-basierte Bildgebung und Responsebeurteilung bei Lymphomen 20 Jahre nach Cheson: Was gibt es Neues?. Rofo. 2020;192(7):657-668. doi:10.1055/a-1091-8897 29.

Hapgood G, Zheng Y, Sehn LH, et al. Evaluation of the Risk of Relapse in Classical Hodgkin Lymphoma at Event-Free Survival Time Points and Survival Comparison With the General Population in British Columbia. J Clin Oncol. 2016;34(21):2493-2500. doi:10.1200/ JCO.2015.65.4194

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Nuclear Medicine Service

Nuclear Medicine Scientist Embedded Student Program Expression of interest

Unlock the future of cutting edge healthcare with hands-on training to be a nuclear medicine scientist.

Scan the QR code to complete an Expression of Interest

Participants may be eligible for up to $15k per year scholarship to complete

46 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

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ARTICLE Expanding the pipeline for Nuclear Medicine Scientists/Technologists into Queensland Travis Pearson Chair Queensland Health Nuclear Medicine Scientist Implementation Project Working Group For the first time in Queensland’s history, there is now a pathway for students to study and become Nuclear Medicine Scientists/Technologists (NMS) without having to move interstate. This opportunity is made possible through a new partnership between Queensland Health and Royal Melbourne Institute of Technology (RMIT).

In early August 2023, the ANZSNM brought together stakeholders for a Nuclear Medicine Scientist/Technologist workforce summit, held at RMIT University in Melbourne. The program for the day included the specific aim of bringing key stakeholders together to discuss ‘relevant issues associated with the NMS workforce crisis and to develop potential strategies to address this and other issues’. The summit was identified as ‘the beginning of a new and exciting collaboration between our education providers, regulators, and workforce partners, working together to achieve positive outcomes’.

This firm statement was in invitation to participants to genuinely engage rather than be passive meeting attendees.

From my perspective this was the first time I had genuinely engaged in constructive discussions with private imaging providers and met with numerous stakeholders to develop sound ideas and collaborate within the time since. This was the same for many other summit participants.

The subsequently published summit report is readily available and has been discussed at length between attendees and their colleagues and stakeholders. When I reflect on the origins of our current activities focussed on workforce change and development, they can be linked back directly to key themes and outcomes of the summit. This relates in particular, to the development of the Embedded Education model due to commence delivery in Queensland in 2025. The key themes were; • • •

“Create scholarships and other incentives to make placements financially accessible to students, including rural and regional areas” “Explore the design of flexible training programs” “Strengthen University and Industry partnerships for broader geographical coverage of training and diverse learning environments”

In the subsequent months and working within expanding circles of stakeholders, it became apparent that within Queensland we needed to augment existing workforce pipelines (interstate universities and overseas trained graduates) along with the ability to train locals who can learn whilst remaining in their home state. The four Australian education providers offering a degree in NMS, are appreciated for their ongoing efforts to assist students with placement poverty, as funding for clinical placements has become a greater area of focus for all.

In a local response, the Office of the Chief Allied Health Officer (OCAHO) hosted the Nuclear Medicine Workforce Summit in November 2023 specifically to consider the challenges faced in Queensland. The summit brought together a diverse range of stakeholders resulting in the identification of several key priority actions. At the top of the list Gain commitment from a tertiary education provider for course delivery options that allow Queensland students to study closer to home.

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ARTICLE: Expanding the pipeline for Nuclear Medicine Scientists/ Technologists into Queensland (Continued) A positive outcome of the COVID-19 pandemic is that we have learnt that quality education can be delivered extremely effectively virtually., with equally positive outcomes as those delivered locally. Overseas experience using apprentice style models of training helped turn my mind to consider whether advocating for a local likely Brisbane based training provider might not in fact be an ideal solution to the workforce issues. Access for students from Cairns to Toowoomba and the Gold Coast would still be a challenge (due to distances), thus the likelihood of them relocating to train, and then return to their home areas after 4 years would still be challenging.

A visual representation of some relevant discussions from the Queensland Nuclear Medicine Scientist Workforce Summit (November 2023) is represented below:

One year on from the workforce summit and thanks the hard work and dedication of the Queensland Public and Private NMS across Queensland, RMIT and OCAHO teams, expressions of interest are now open for the truly innovative Queensland Health Nuclear Medicine Scientist – Embedded Student Program (NMS-ESP) Queensland Health may support Embedded Education Nuclear Medicine Scientist students who meet the defined criteria, through offering an annual scholarship of up to $15,000 per annum to support them through their studies.

This partnership is planned to extend to supporting students undertaking training with local private departments.

This will take the form of providing access to necessary RMIT training requirements offered by Queensland health facilities, that may not be offered by the relevant private department The intention is for Queensland Health to support up to eight students annually across our facilities and partner with local Private Nuclear Medicine services where appropriate, to meet both the need for exposure to course requirements (including paediatrics and theranostics), and to also broaden the experience for these NMS students.

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ARTICLE: Expanding the pipeline for Nuclear Medicine Scientists/ Technologists into Queensland (Continued) The NMS-ESP is a clinical education program designed for domestic student interested in pursuing an approved undergraduate tertiary qualification with our partner, RMIT University. Launching in 2025, the program will be offered at the following Queensland Health sites: • • • • •

Cairns Hospital Townsville University Hospital Sunshine Coast University Hospital Brisbane (various sites) Gold Coast University Hospital

Embedded student’s will receive comprehensive support from RMIT and Queensland Health throughout their studies and will complete clinical placements in local Queensland facilities during the University semester.

Graduates who successfully complete the program will be job ready and eligible to apply for full registration with the Medical Radiation Practice Board of Australia (MRPBA).

Details of the Queensland Health Embedded Education program are included below:

Travis Pearson and the team who recently were awarded the Metro North Health Staff Excellence Award in Innovation for the Nuclear Medicine Scientist Embedded Student Program.

It should be highlighted that Private Nuclear Medicine Services across the State are also offering pathways to train within this program and ae advertising separately. There is a strong working relationship between the public and private clinical training sites to collaborate and deliver the required student clinical placement needs.

The collective effort of all stakeholders will deliver local training in Queensland, providing a pipeline for locals across the State to train in our Profession.

The pathway for expressions of interest for potential students can be found on the Queensland Health websites, including contact details for queries about the process.

• • •

Nuclear Medicine Scientist Embedded Student Program | Queensland Health Apply for the Nuclear Medicine Scientist Embedded Student scholarship | Queensland Health Prospective students can also email the Office of the Chief Allied Health Officer (Queensland) AH_CETU@health.qld.gov.au

*Note: the term Nuclear Medicine Scientist and Nuclear Medicine Technologist are used interchangably in this article GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 49

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FUSION & SCINTILLATION DOWN UNDER Early Use in Australia & New Zealand

The earliest recorded use of radionuclides in medicine in Australia was in 1911 in the form of radium needles at Sydney Hospital. These were used for superficial treatments of lesions of the skin, female genital tract and breast (1). During WWII General Douglas McCarthy’s US Forces in the Pacific were based in the north of Australia in the state of Queensland (QLD) and US Major Paul McDaniel was able to help the Royal Brisbane Hospital, QLD, import the first unsealed sources of 32P which he obtained from his good friend E.O. Lawrence in Berkeley, CA, who in turn sourced it from the Oak Ridge National Laboratories. After the war the USA began to make artificial radionuclides available to certain countries and Australia started importing radionuclides including 131 I from 1947. New Zealand began importing 131I soon after in 1948. The early years involved transportation by ship, with considerable decay of the product, but this changed to air in 1948. This typifies one of the major challenges that both Australia and New Zealand have always faced – the so-called ‘tyranny of distance’ of being so far away from the major hubs of activity in the northern hemisphere. Australia commenced on the path to self-sufficiency for medical radionuclides with the construction of the first domestic nuclear reactor, the 10 MW ‘HIFAR’ (Hi-Flux Australian Reactor) research reactor at Lucas Heights on the southern outskirts of Sydney, which first achieved criticality on Jan 26, 1958. Once it started to routinely produce medical radionuclides late in the 1960s the Australian Atomic Energy Commission (AAEC) distributed 99mTc-labelled radiopharmaceuticals

and other products around the country on a daily basis free-of-charge in a service colloquially referred to as ‘the milk run’. New Zealand was also supplied by products from HIFAR. Reactor-produced 18F was even being used for bone scanning before 99mTc-labelled alternatives were available. This free service continued until the late 1970s when commercial radiopharmacies offering a wider range of products started to appear in the capital cities of the various states. The first medical cyclotron which was capable of producing both PET radiotracers as well as single photon emitting radiotracers was only installed in Sydney in 1989, meaning that, prior to this, radionuclides produced by the cyclotron such as 67Ga, 111In, 123I and 201Tl needed to be imported.

The Origins of an Antipodean Society of Nuclear Medicine By the late 1960s nuclear medicine was established in all regions of Australia, except the Northern Territory, as well as in New Zealand. It was very much centred on the metropolitan capital cities. Individuals in the field, mostly from the disciplines of Radiation Therapy and Endocrinology, started to discuss the need for an organisation that could assist with training and certification and provide scientific guidance and collegiality. The Royal Australian and New Zealand College of Radiologists (RANZCR) initially expressed a desire to have the specialty of nuclear medicine join as a college under its auspices suggesting that “along American lines, the radiological sciences should stick together”.

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Zealand. The society has twice hosted the quadrennial World Federation of Nuclear Medicine & Biology Congress (1994 and 2018). Australia currently has around 140 PET/CT scanners (~1 per 200,000 people) and about 325 nuclear medicine facilities which are a mix of government-funded public hospital institutions and private practices. There are currently 10 PET/CT systems in New Zealand with a population of ~4m (or 1 per 400,000).

However, a radiology-based college would have had difficulty admitting non-medical graduates as members and it was realised from the outset, due to the highly multidisciplinary nature of nuclear medicine, that scientists and radiographers should be part of any nuclear medicine organisation to form an Australian Society of Nuclear Medicine along the lines of the (US) Society of Nuclear Medicine (2). As it would turn out, for the purposes of medical training and credentialling, the nuclear medicine practitioners at the time formed a specialty group under the Royal Australian College of Physicians (RACP). Since that time their training has seen them graduate as members of an Internal Medicine college rather than from a Radiology college. In recent times, radiologists have been able to cross-train and become nuclear medicine dual-trained specialists. Other examples of individuals cross-training frequently include endocrinologists, paediatricians, gastro-enterologists and, more recently, medical oncologists.

The Australian Society of Nuclear Medicine was inaugurated in May 1969, however, after a number of New Zealanders expressed interest in joining the name was changed in Feb 1970 to the Australian and New Zealand Society of Nuclear Medicine (ANZSNM). Today the society has around 1,000 active members across both countries.

From the outset the society membership and all official roles have been open to everyone working in the field of nuclear medicine including physicians/ radiologists, physicists, technologists, radiopharmaceutical scientists, nurses and industry members. It hosts an Annual Scientific Meeting at rotating venues in both Australia and New

In addition to ANZSNM, nuclear medicine in Australia and New Zealand is also represented and accredited by a medical specialists’ organisation, the Australasian Association of Nuclear Medicine Specialists (AANMS), the physicists and radiopharmaceutical scientists are accredited by the Australasian College of Physical Scientists & Engineers in Medicine (ACPSEM), and the technologists are registered by the Medical Radiation Practice Board of Australia (MRPBA) under the Australian Health Practitioners Regulation Agency (Ahpra) in Australia, and the New Zealand Medical Radiation Training Board (NZMRTB) in New Zealand, with reciprocity of registration under the Trans-Tasman Mutual Recognition Act (TTMRA).

A Tradition of Innovation & Training Nuclear medicine in Australia has always enjoyed excellent education and training for medical graduates, scientists and technologists. These academically-oriented ecosystems frequently attract individuals who tend to produce research outputs. This, combined with access to mostly state-of-the art imaging equipment, has allowed those from Downunder to contribute to the global nuclear medicine community in a number of ways including: • 1956: Ron Bracewell’s original use of the inverse Radon transform for image reconstruction (in radioastronomy), the basis of filtered backprojection image reconstruction (CSIRO/University of Sydney) (3); • 1967: Early 99Mo-99mTc generator developed (AAEC); • 1971: [99mTc]SKELTEC I (polyphosphate) and in 1975 SKELTEC II (pyrophosphate) for 99mTc bone scanning; [99mTc]MAFH (macro-aggregated ferrous hydroxide) for lung perfusion imaging (AAEC); • 1975: First development of 99mTc-labelled hepatobiliary agents (Inst. of Medical & Veterinary Sciences, SA) (4); • 1979: Description of the ‘Patlak’ graphical kinetic analysis technique which was first published by Dr Mike Rutland from New Zealand (5); • 1984: Introduction of morphine to help visualise the gall bladder in suspected acute cholecystitis and the development of gall bladder ejection fraction measurements using CCK (6,7);

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ARTICLE: Fusion & Scintillation Down Under. Early use in Australia & New Zealand (Continued)

• • • •

•

• •

•

1985: Invention of the Technegas generator for lung ventilation imaging (Prof Bill Burch, ANU) (8); 1987: Transmission scanning on the gamma camera with 153Gd for SPECT attenuation correction (RPA) (9); 1989: Development of epoxy resin microspheres containing 90Y for radioembolisation in hepatic malignancy (SIR-Spheres) (UWA) (10); 1989: Development of [14C]Urea breath test for the diagnosis of gastric H.Pylori infection which was part of the programme of work that resulted in the awarding of the 2005 Nobel Prize in Medicine or Physiology to Barry Marshall and J Robin Warren from Perth, WA for their discovery of the link between the bacterium and its role in gastritis and peptic ulcer disease; 1993: Hudson and Larkin’s development of accelerated Ordered-Subset EM iterative reconstruction – now used for all PET and SPECT reconstructions and increasingly to facilitate low-dose X-ray CT (Macquarie University) (11); 1999: The first demonstration of segmental GI transit studies and normal ranges using gallium67(RAH) (12); 2002: Evidence from multicentre data collections of FDG PET has been demonstrated in various cancer types in Australia before being adopted by the rest of the world; 2018+: Innovative PSMA imaging and therapy clinical trials (13-16).

Australia has always demonstrated a strong commitment to nuclear medicine training in the region as well.

With support from the IAEA and bilateral government programmes, Australian physicians, physicists, radiopharmaceutical scientists and technologists have trained practitioners from almost all countries in Asia and South-East Asia including India, Pakistan, Thailand, Vietnam, Myanmar, Hong Kong, Taiwan, Bangladesh, Philippines, Indonesia, Brunei, Malaysia and Singapore.

Members of the ANZSNM developed a “Distance Assisted Training online” (DATOL) programme for technologist training for the IAEA which has now been translated into Chinese and Spanish and is being used around the world.

A Favourable Environment for Nuclear Medicine While the HIFAR nuclear reactor made neutron-rich radioisotopes that could be used in nuclear medicine from the 1960s there was a deficiency in proton-rich radioisotopes produced by the cyclotron as Australia did not have a cyclotron capable of providing tracers that could be used in medicine prior to the 1990s. This also meant that positron emission tomography (PET) remained elusive for Australia and New Zealand. This was rectified in the early 1990s when the National Medical Cyclotron facility was developed in Sydney while a hospital-based small cyclotron was installed around the same time at The Austin Hospital in suburban Melbourne. This was at approximately the same time that PET started to develop clinical application in oncology, primarily with whole body [18F]FDG. A major program of data collection and clinical trials for evidence of [18F]FDG PET was initiated in 2001 involving all PET sites around Australia. The Australian PET Data Collection Project collected data on 30,368 consecutive patients undergoing [18F]FDG PET scans for oncology, epilepsy and myocardial viability indications over a 2 year period. In addition, over 900 oncology patients were entered into 8 management impact prospective multi-centre trials (17-21). The results of these trials and data collection process led to Medicare approval of [18F]FDG PET in epilepsy and a number of oncology indications over the subsequent years.

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ARTICLE: Fusion & Sintiallation Down Under. Early use in Australia & New Zealand (Continued)

Today there are 24 medical cyclotrons operating in Australia and New Zealand with no part of either country unable to be supplied with 18F-labelled products. Currently Australia is viewed as an attractive place for Phase I and Phase II clinical imaging trials with both diagnostic and therapeutic radiopharmaceuticals due to a confluence of a number of factors including a well-resourced workforce and installed equipment base, a favourable governance environment for novel radiopharmaceuticals in early phase testing, a national ethics framework for streamlining approvals for multicentre trials and talented clinicians and practitioners able to develop innovative trial protocols in collaboration with enthusiastic, co-operative referrers who provide the patients for the trials. This led to the creation of a nuclear medicinespecific clinical trials organisation known as ARTnet (Australasian Radiopharmaceutical Trials Network) as a joint venture between ANZSNM and AANMS just over 10 years ago (22). ARTnet acts as a co-ordinating and credentialling organisation for trials involving diagnostic and therapeutic radiopharmaceuticals. With the recent rise in activity and interest in theranostics, nuclear medicine in Australia and New Zealand has never been more relevant to clinical practice and it certainly seems that we are experiencing a ‘golden age’ for our specialty Downunder.

Abbreviations AAEC – Australian Atomic Energy Commission (now ANSTO) ANU – Australian National University CSIRO – Commonwealth Scientific & Industrial Research Organisation IAEA – International Atomic Energy Agency RAH – Royal Adleiade Hospital RPA - Royal Prince Alfred Hospital (Sydney) SA – South Australia (state) UWA – University of Western Australia

in Australia and New Zealand as documented by Paul A.C.Richards: ANZSNM; 2014.

3. Bracewell RN. Strip integration in radio astronomy. Aust J Phys. 1956;9:198-217.

4. Baker RJ, Bellen JC, Ronai PM. Technetium 99m-pyridoxylideneglutamate: a new hepatobiliary radiopharmaceutical. I. Experimental aspects. J Nucl Med. 1975;16:720727.

5. Rutland MD. A single injection technique for subtraction of blood background in 131I-hippuran renograms. Br J Radiol. 1979;52:134-137.

6. Choy D, Shi EC, McLean RG, Hoschl R, Murray IP, Ham JM. Cholescintigraphy in acute cholecystitis: use of intravenous morphine. Radiology. 1984;151:203-207.

7. Yap L, Wycherley AG, Morphett AD, Toouli J. Acalculous biliary pain: cholecystectomy alleviates symptoms in patients with abnormal cholescintigraphy. Gastroenterology.

1991;101:786-793.

8. Burch WM, Sullivan PJ, McLaren CJ. Technegas - a new ventilation agent for lung scanning. Nucl Med Commun 1986;7:865.

9. Bailey DL, Hutton BF, Walker PJ. Improved SPECT using simultaneous emission and transmission tomography. J Nucl Med. 1987;28:844-851.

10. Gray BN, Burton MA, Kelleher DK, Anderson J, Klemp P. Selective internal radiation (SIR) therapy for treatment of liver metastases: Measurement of response rate. J Surgical Onco. 1989;42:192-196.

11. Hudson HM, Larkin RS. Accelerated image reconstruction using ordered subsets of projection data. IEEE Trans Med Imag. 1994;MI-13:601-609.

12. Bartholomeusz D, Chatterton BE, Bellen JC, Gaffney R, Hunter A. Segmental Colonic Transit After Oral 67Ga-Citrate in Healthy Subjects and Those with Chronic Idiopathic Constipation. J Nucl Med. 1999;40:277-282.

13. Roach PJ, Francis R, Emmett L, et al. The Impact of (68)Ga-PSMA PET/CT on Management Intent in Prostate Cancer: Results of an Australian Prospective Multicenter Study. J Nucl Med. 2018;59:82-88.

14. Hofman MS, Violet J, Hicks RJ, et al. [(177)Lu]-PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a singlecentre, single-arm, phase 2 study. Lancet Oncol. 2018;19:825-833.

15. Hofman MS, Lawrentschuk N, Francis RJ, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet.

2020;395:1208-1216.

16. Emmett L, Metser U, Bauman G, et al. Prospective, Multisite, International Comparison of 18F-Fluoromethylcholine PET/CT, Multiparametric MRI, and 68Ga-HBED-CC PSMA-11 PET/CT in Men with High-Risk Features and Biochemical Failure After Radical Prostatectomy: Clinical Performance and Patient Outcomes. J Nucl Med. 2019;60:794-800.

17. Scott AM, Gunawardana DH, Kelley B, et al. PET changes management and improves prognostic stratification in patients with recurrent colorectal cancer: results of a multicenter prospective study. J Nucl Med. 2008;49:1451-1457.

18. Scott AM, Gunawardana DH, Bartholomeusz D, Ramshaw JE, Lin P. PET Changes Management and Improves Prognostic Stratification in Patients with Head and Neck Cancer: Results of a Multicenter Prospective Study. J Nucl Med. 2008;49:1593-1600.

19. Scott AM, Gunawardana DH, Wong J, et al. Positron emission tomography changes management, improves prognostic stratification and is superior to gallium scintigraphy in patients with low-grade lymphoma: results of a multicentre prospective study. Eur J Nucl Med Mol Imaging. 2009;36:347-353.

20. Chatterton BE, Ho Shon I, Baldey A, et al. Positron emission tomography changes management and prognostic stratification in patients with oesophageal cancer: results of a multicentre prospective study. Eur J Nucl Med Mol Imaging. 2009;36:354361.

21. Fulham MJ, Carter J, Baldey A, Hicks RJ, Ramshaw JE, Gibson M. The impact of PET-CT in suspected recurrent ovarian cancer: A prospective multi-centre study as part of the Australian PET Data Collection Project. Gynecol Oncol. 2009;112:462-468.

22. Francis RJ, Bailey DL, Hofman MS, Scott AM. The Australasian Radiopharmaceutical Trials Network (ARTnet) - Clinical Trials, Evidence and Opportunity. J Nucl Med. 2020;62:755-756.

References 1. Bray SD. The first use of radium needles in Australia. Med J Aust. 1939;1:849.

2. Batchelor P, ed. Isotopes, Imaging and Identity - The History of Nuclear Medicine

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 53

PEOPLE IN NUCLEAR MEDICINE

VALE DR ALIREZA (ALI) ASLANI

Dr Alireza (Ali) Aslani, who died recently after a relatively short illness, was the Principal Radiopharmaceutical Scientist in the Department of Nuclear Medicine at Royal North Shore (RNS) Hospital, Sydney. Ali started working at RNS over 30 years ago with Prof Ross Smith, a GI surgeon, and Prof Carol Pollock, a renal physician, on a radioisotope-based Total Body Protein Monitor which was hosted by the Department of Nuclear Medicine. He moved from this research role into working as a radiopharmaceutical scientist some 20 years ago. In this role he was instrumental in introducing several of the new diagnostic radiotracers now used at RNS in Nuclear Medicine and PET and, more recently, several novel radionuclide-based therapies that are offering new treatments for oncology patients including those with prostate cancer and neuroendocrine tumours. Ali had long held an honorary academic appointment in the Faculty of Medicine & Health at the University of Sydney and contributed richly to his department and the other departments that rely on nuclear medicine services. Ali was a true gentleman with a great sense of humour and a warm nature who touched all that he worked with. He will be sorely missed by all. Vale Ali. Dale Bailey Paul Roach Department of Nuclear Medicine, Royal North Shore Hospital

54 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

EDUTRACE UPDATES & JOB VACANCIES

JOB VACANCIES Nuclear Medicine/PET Technologist Qscan Annerley is excited to offer an opportunity for a Nuclear Medicine/PET Technologist to join our reputable multidisciplinary team.

Applications Close: 20 December 2024

Nuclear Medicine Technologist We are interested to hear from Nuclear Medicine Technologists that are passionate about advancing skills.

Applications Close: 20 December 2024

Nuclear Medicine Technologist If you are seeking a lifestyle change, then live and work in one of Queensland's most sort after locations; make your career move to Mackay Radiology in Mackay.

Applications Close: 22 December 2024

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 55

Ever wondered what a typical day in nuclear medicine looks like?

Interested in pursuing nuclear medicine as a specialty?

The Royal Australasian College of Physicians (RACP) podcast ‘Pomegranate Health’ has published an episode on ‘A day in the life of a nuclear medicine registrar’. Search ‘Pomegranate Health’ on all major podcast platforms.

Pomegranate Health

You can listen to it on the following links

RACP 56 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

Spotify

GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 57

PRESIDENT Prof Karen Jones (SA/NT) Vice President Vacant Immediate Past President Dr Kevin London (NSW/ACT) Treasurer Dr Daniel Badger (SA/NT) FEDERAL COUNCIL Prof Karen Jones (President) Dr Kevin London (Immediate Past President) Dr Daniel Badger (Treasurer) Ms Suzanne McGavin (Chair TSIG) Dr Nigel Lengkeek (Chair RPS SIG) Dr George McGill (Chair Physics SIG) Mr Christian Testa (Chair of Branches) Ms Jessica Fagan (NZ Rep) Prof Andrew Scott (IRC/Medical Rep) Mrs Victoria Sigalas (ANSTO Rep) Mrs Pru Burns (CCC Rep)

SPECIAL INTEREST GROUPS/ COMMITTEES Technologists Chair: Ms Suzanne McGavin Radiopharmaceutical Science Chair: Dr Nigel Lengkeek Physics Chair: Mr George McGill Quality and Technical Standards Committee Chair: Dr Darin O’Keeffe Scientific Advisory Panel Chair: Prof Dale Bailey International Relations Committee Chair: Prof Andrew Scott Conference Convening Committee Chair Mrs Prudence Burns Scientific Education Committee Chair: Prof Andrew Scott BRANCH SECRETARIES New South Wales/Australian Capital Territory Holly Spooner Queensland Ms Neena Sunny and Mr Joel Williams South Australia/Northern Territory Mr Jagi Sandhu Victoria/Tasmania Ms My Linh Diep Western Australia Ms Georgina Santich New Zealand Ms Trish Mead Rural/Regional Branch Mr Lachlan Patterson

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

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: •

•

•

58 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

The 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.

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GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU 59 59 GAMMA GAZETTE 2024/2025 SUMMER EDITION | ANZSNM.ORG.AU

Mural at Darwin Hospital