Gamma Winter 2018

2018 WINTER EDITION | ISSUE 24

THE OFFICIAL PUBLICATION OF THE AUSTRALIAN AND NEW ZEALAND SOCIETY OF NUCLEAR MEDICINE

Page 5 Challenges and Opportunities, From our President

Page 7

Theranostic agent awarded Image of the Year

Page 13

WFNMB 2018 Congress Highlights Special Report

2018 WINTER EDITION | ISSUE 24

CONTENTS Welcome

4

From the President

5

Special Report

7

Theranostics agent awarded image of the year

Corporate Sponsor News Cyclopharm

9

MIPS SIRTEX

WFNMB 2018 Congress Highlights Grants & Awards

13 25

ANZSNM/ANSTO Research Grant 2018 ASM 2018 awards Editorial Andrew St. John, General Manager ANZSNM Secretariat PO Box 6178, Vermont South, VIC 3133 1300 330 402 (03) 8677 2970 secretariat@anzsnm.org.au

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

Education and Continuining Professional Development (CPD)

33

Technical Standards Committee

37

Calendar of Events

39

Financial Statements

41

2018 Annual General Meeting Minutes

44

Office Bearers

46

Welcome A welcome to this Winter issue of the Gamma Gazette from the ACT and WA Branches of the Society.

We hope everyone who managed to get to Melbourne for the WFNMB Congress in April had an enjoyable and educational time. It was a fantastic event, with a big turnout, and the organising committee is to be commended for their efforts in putting together such a comprehensive programme.

We are looking forward to the busy end of the year, with many of our Branches about to host their annual educational events (see WA Branch News later in this edition), the TSIG meeting in South Australia in August and the RAINS conference coming up in Sydney in November. And some of you may be heading to the EANM Meeting in September.

Content for this edition was a joint effort from the ACT and WA Branches, and thanks to those who took the time to contribute.

Maree Wright, ACT Branch Chair

www.imaxeon.com

Winter 2018 | gamma GAZETTE | 4

From the president CHALLENGES AND OPPORTUNITIES As I begin my term as President of ANZSNM I look forward to embracing both the challenges and the opportunities ahead for our Nuclear Medicine community. I am committed to a Society that our members want to be a part of, as we embrace a rapidly changing era of technology, with a focus on personalised medicine, which will see the emergence of new tracers and new therapies. I very much welcome discussion and ideas, and I encourage engagement in ANZSNM as we seek to strengthen collaboration, networking, education and opportunity in our field.

Professor Roslyn Francis President

In terms of challenges, the current situation around Tc-99m supply represents a very significant challenge.

The cooperative effort of the working group, comprising representation from ANZSNM, AANMS and RAINS in combination with GMS and ANSTO is very much appreciated. The working group is providing advice and assistance to facilitate supply of Tc-99m across Australia and to ensure the availability of up-to-date information on the current situation to members. I would like to thank in particular Prof Dale Bailey and Matt Ayers, as the ANZSNM representatives on this group, for their time and commitment to this process. I recognise that even with these efforts there continues to be supply issues that are resulting in disruption, and as a Nuclear Medicine community this is a significant challenge. I encourage you to provide us with feedback of any ongoing problems and issues during this time.

The opportunities in Nuclear Medicine were very much highlighted at the World Federation of Nuclear Medicine and Biology (WFNMB) meeting in Melbourne. This was an impressive meeting of 2000 attendees, a wealth of international speakers and an educational program of the highest quality. The sessions provided unprecedented learning opportunities and were thought-provoking, with a focus on the promising future of our specialty. Congratulations to Prof Andrew Scott, A/Prof Sze-Ting Lee, Prof Dale Bailey, the organising committee, track chairs, and all those associated with bringing such an impressive meeting to Australia.

Thank you also to all the international speakers and attendees who enriched the meeting.

Following the WFNMB meeting in Melbourne I had the opportunity to attend the post congress meeting in Cairns, which was also a huge success and highlighted the rapid changes in prostate cancer imaging and therapy. In Australia, Prof Michael Hofman is leading two promising clinical trials, ProPSMA and TheraP, and the involvement of the ANZSNM/AANMS joint initiative, ARTnet (Australasian Radiopharmaceutical Trials network), has been an important component of these trials. This highlights the innovation and collaboration that is so strong in Australian nuclear medicine.

Continuing the prostate cancer theme, congratulations are extended to Prof Michael Hofman and his team for their impressive achievement of ‘SNMMI Image of the year’ : PSMA PET Imaging of Theranostic for Advanced Prostate Cancer. The image of the year was chosen from more than 2200 abstracts submitted to the SNMMI meeting, and is voted by reviewers and the society leadership as exemplifying the most promising advances in the field of nuclear medicine and molecular imaging. This is a really excellent achievement.

Winter 2018 | gamma GAZETTE | 5

From the president (Continued) 1st May 2018 was a memorable date with the MBS reimbursement of Ga68 Octreotate PET imaging, following the successful submission for MSAC review by AANMS in 2016. This represents the first new PET item number in more than 15 years and is the first non-FDG PET tracer to receive a reimbursement. This is a significant achievement and we are grateful for the work of AANMS in pursuing this important MBS rebate.

As I come to the conclusion of my report I would like to thank Prof Dale Bailey for his Presidency of ANZSNM over the last two years. Dale’s leadership has resulted in a strong and healthy relationship with other professional societies both locally and internationally. He has had many achievements over his term, and in particular has promoted the importance of our multidisciplinary membership, which remains very much our strength. The Federal Council and Secretariat continues to prioritise education, CPD and networking, and we encourage members to utilise the functions and educational links in our new website. I would like to thank all those who contribute to our Society in so many ways, including those that volunteer their time and expertise on the Federal Council, branch committees, interest groups, advisory committees and to our publications and newsletter. Your hard work, dedication and contribution is vital to the success of our Society.

Finally, please remember to mark in your diary April 26th28th, 2019 as the date of the ANZSNM 49th Annual Scientific Meeting. This will be held in the newly refurbished Adelaide Convention Centre, with the pre-congress meeting in the Barossa Valley. The Organising Committee is working hard on ensuring this will be an excellent meeting, with strong educational and networking opportunities.

Prof. Roslyn Francis President

TO VIEW ALL THE LATEST UPDATES ON THE Tc-99m SUPPLY PLEASE VISIT OUR WEBSITE

anzsnm.org.au

Special Report SNMMI: Theranostic agent awarded Image of the Year Author: Wayne Forrest, AuntMinnie.com staff writer

June 27, 2018 -- PHILADELPHIA - A PET image that shows the combined power of the diagnostic and therapeutic (theranostic) use of molecular imaging to identify and treat metastatic castration-resistant prostate cancer has been named this year’s Image of the Year at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) annual meeting.

The image demonstrates the theranostic combination of a PET diagnostic radiotracer consisting of gallium-68 (Ga-68) prostate-specific membrane antigen (PSMA11) that shows the progress of treatment administered with another radiopharmaceutical, lutetium-177 PSMA617 (LuPSMA). LuPSMA is a radiolabeled small molecule that binds with high affinity to PSMA in men with castration-resistant prostate cancer and delivers a therapeutic dose of radiation to prostate cancer cells.

The award-winning image came from a phase II prospective study at the Peter MacCallum Cancer Centre in Melbourne and shows that men with castration-resistant prostate cancer can be treated successfully with LuPSMA as an alternative to external-beam radiation therapy.

“This work reflects an appreciation for all the basic science and translation work that has been performed by many groups over a long period of time to develop prostate-specific membrane antigen theranostics as a paradigmchanging practice for improving patient outcomes,” said lead study author Dr. Michael Hofman.

The study included 30 patients with PSMA-avid metastatic castration-resistant prostate cancer who did not respond to standard therapies. Patients were included if they had high uptake on Ga-68-PSMA11 PET/CT scans, which were defined by images with maximum standardized uptake values (SUVmax) of greater than 1.5 times that of the liver. Subjects were excluded if FDG-PET/CT scans showed sites of PSMA-negative disease.

Patients with high PSMA expression went on to undergo as many as four cycles of LuPSMA therapy every six weeks. The high response rates then were visible in the PET images.

Ga-68-PSMA-11 images were acquired before and after lutetium-177 PSMA617 treatment in eight patients with metastatic prostate cancer who had exhausted standard therapeutic options. PET maximum intensity projection (MIP) images indicate PSA decline of 98% or greater. Disease is identified in red areas, indicating standardized uptake values higher than 3. Images courtesy of Hofman et al, Peter MacCallum Cancer Centre in Melbourne, Australia, and SNMMI. Winter 2018 | gamma GAZETTE | 7

Special Report SNMMI: Theranostic agent awarded Image of the Year (Continued) The primary end point of LuPSMA treatment -- PSA decline of 50% or greater -- was achieved by 17 patients (57%).

That total included 11 men (37%) with a PSA decline of 80% or more. In addition, median PSA progression-free survival was 7.6 months, while median overall survival was 13.5 months.

“In each patient, the extent of tumor spread before and after treatment is visualized with clarity using PSMA PET,” Hofman said. “These patients experienced improved quality of life, including reduction of pain, and correlated with marked reduction of prostate specific antigen.”

SNMMI annually chooses an image that exemplifies the most promising advances in the field of nuclear medicine and molecular imaging. This year’s SNMMI Henry N. Wagner Jr. Image of the Year was chosen from more than 2,200 abstracts submitted to the annual meeting and voted on by reviewers and the society leadership.

“The last decade has seen a blossoming of theranostics to treat tumors with molecularly guided radiotherapy,” said Dr. Umar Mahmood, PhD, chair of the SNMMI Scientific Program Committee. “The expansion of patients benefiting from this approach is remarkable, and it is wonderful to know that this effort is being led by nuclear medicine physicians and scientists.”

Hofman also thanked the Australian Nuclear Science and Technology Organization (ANSTO), which produces lutetium-177, and Endocyte, which produces Lu-177-PSMA617, for making the study possible.

68Ga-PSMA11 PET maximum intensity projection (MIP) images at baseline and 3 months after 177Lu-PSMA617 in 8 patients with PSA decline ≥ 98 percent in a prospective phase II study. Any disease with SUV over 3 is in red.

8 | gamma GAZETTE | Winter 2018

From our

Corporate Sponsors CYCLOPHARM Better defining airways disease with Technegas

Cyclopharm Limited (ASX: CYC) is pleased to announce its core product, Technegas, is the focus of a new clinical trial seeking to develop better tools to diagnose and manage patients suffering from Asthma and Chronic Obstructive Pulmonary Disease (COPD).

Cyclopharm will be working with the Woolcock Institute for Medical Research on the three-year, 100 patient study utilizing nuclear medicine imaging, in collaboration with The University of Sydney and the Northern Sydney Local Health District.

The $387,000 cost of the clinical study, led by Professor Greg King, will be funded by Cyclopharm. James McBrayer, CEO and Managing Director, said, “There are still significant challenges in managing both asthma and COPD. Not all subjects respond to standard treatments. To develop personalised treatments, clinicians need to have better diagnostic tools, such as using Technegas in the measurement of respiratory functionality and heterogeneity.”

Professor King commented, “Respiratory function is predominantly measured by spirometry which has limitations that are universally recognised. Despite its wide acceptance as the gold standard, spirometry is neither sensitive nor specific in diagnosing airways disease and is insensitive to treatment responses. Spirometry is an overall measure of lung function but it fails to measure the underlying complexity of pathophysiology in disease.”

“A recent Lancet Commission report identified the need for innovative ways to study asthma 1 and calls for better characterisation of the highly-varied group of diseases collectively called asthma. VSPECTA ventilation imaging, using Technegas as the imaging agent, could fulfill the criteria of a novel and effective measurement tool. By having better research tools, particularly in lung imaging, we can probe what is happening in the lungs of asthma patients. This is desperately needed if, as suggested in the Lancet Commission report, we are to make any significant advances in the study of asthma, which has hit a ‘road-block’.”

Professor King said, “The Airway Physiology and Imaging Group at Woolcock has a long history of clinical research using VSPECT with Technegas. I first used Technegas imaging in the mid 1990’s to study ventilation patterns in healthy and asthmatic subjects 2&3 . Twenty years later, with modern imaging methods and technologies, I believe Technegas VSPECT imaging has the potential for many more applications.”

Professor King also noted, “The outcomes of this study will advance the understanding of treatment responses and make a strong case for Technegas VSPECT imaging to be used as an important tool in development of new Asthma and COPD treatment regimes, disease characterisation in routine practice and to monitor the success and progress of treatment.”

The specifics of the study are as follows: In patients with Asthma the study is seeking to: 1. Determine immediate response to therapy as measured by regional VSPECT ventilation distribution following administration of reliever medications and also after 2 months treatment with high-dose combination therapy.

2. Determine the relationships between changes in VSPECT with treatment and; patient characteristics (e.g. symptoms, age, disease duration), and markers of allergic inflammation.

Winter 2018 | gamma GAZETTE | 9

From our

Corporate Sponsors

CYCLOPHARM - Better defining airways disease with Technegas (Continued) In patients with COPD the study is seeking to: 1. Determine and describe ventilation distribution in mild and moderate COPD 2. Evaluate the relationships between VSPECT and other diagnostic techniques to include spirometry, forced oscillation impedance and multiple breath nitrogen.

3. Determine the relationship between the short-term response to long acting bronchodilators, as measured by spirometry and forced oscillation impedance, and ventilation distribution.

4. Determine the relationship between ventilation distribution and symptoms in mild and moderate COPD. Professor Carol Armour, the Executive Director of The Woolcock Institute of Medical Research, stated ​​​​​​​“The Woolcock Institute is committed to developing targeted, more effective treatment in airways diseases.

Collaboration with industry is one of the ways we do this. We are very excited to embark on this work with Cyclopharm using 3-Dimensional imaging of ventilation in airways disease as it could lead to greater understanding of these conditions and from there to more effective treatments.”

James McBrayer stated that, “We are thrilled to be working with collaboration led by Professor King and the Woolcock Institute of Medical Research. This initiative is another example of our strategic priority of expanding the use of Technegas. The global incidence of lung disease is increasing rapidly every year. The World Health Organisation rates COPD as the 4th leading cause of death globally and is expected to rise to the 3rd leading cause of death by 2030. We believe functional lung imaging using Technegas will offer new clinical insights in both the diagnosis and management in these chronic and deadly diseases for millions of patients.”

SIRTEX News Sirtex developed and supplies SIR-Spheres® Y-90 resin microspheres, an innovative cancer therapy that is used to treat unresectable liver tumours. It was PMA approved for the treatment of colorectal cancer liver metastases in combination with FUDR intra-arterial chemotherapy by the US Food & Drug Administration in 2002, and is approved for the treatment of unresectable liver tumours within the European Union under a CE Mark, as well as in many countries around the world. SIR-Spheres® Y-90 resin microspheres are available at more than 700 specialist centres worldwide, with more than 40,000 patient treatments supplied to date. ®SIR-Spheres is a Registered Trademark of Sirtex SIR-Spheres Pty Ltd

10 | gamma GAZETTE | Winter 2018

From our

Corporate Sponsors MEDICAL INDEMNITY PROTECTION SOCIETY (MIPS)

Mandatory reporting 101 by MIPS Section 140 of the National Law requires that a registered health practitioner must notify the Board if, in the course of practising their profession, they form a reasonable belief that another registered health practitioner has behaved in a way that constitutes notifiable conduct.

This creates a responsibility for all registered healthcare practitioners in relation to all others, not just within their discipline. This means nuclear medicine technicians, doctors, nurses, dentists, physios etc have the same responsibility to make mandatory reports concerning all disciplines of registered healthcare practitioners.

Notifiable conduct is defined as when a practitioner has: • • • •

Practised the profession while intoxicated by alcohol or drugs, or Engaged in sexual misconduct in connection with their profession, or Placed the public at risk of substantial harm in their practice because they have an impairment, or Placed the public at risk of harm during their practice because of a significant departure from professional standards.

The National Law AHPRA national law objectives are to provide for the protection of the public by ensuring that only health practitioners who are suitably trained and qualified to practise in a competent and ethical manner are registered.

Restrictions on the practice of a health professional are to be imposed only if it is necessary to ensure health services are provided safely and are of appropriate quality.

All practitioners have a professional and ethical obligation to protect and promote public health and safe healthcare and under the National Law. Health practitioners, employers and education providers have mandatory reporting responsibilities. The intention is to prevent the public being harmed or placed at risk.

The guidelines for mandatory notifications are available from the Medical and Dental Board websites. These are relevant to you as practitioners, employers and education providers (who are required to report impaired students) and it applies to all health practitioners - not just those within the practitioner’s own health profession.

The focus is on serious instances of substandard practice, conduct or impairment that places the public at risk. These include patient/practitioner sexual conduct, practitioner demonstrating cognitive impairment and practitioner who demonstrates evidence of alcohol or drug use on the job.

As the aim is to protect the public, practitioners should only notify AHPRA if they believe that another practitioner has behaved in a way which presents a risk of substantial harm to the public rather than simply not liking the way someone has performed a task or feeling they could have done their job better.

Reasonable belief is a stronger level of knowledge than mere suspicion. It generally involves direct knowledge or observation of the behaviour or a report from reliable sources (such as someone who has experienced firsthand eg sexual misconduct). Mere speculation, rumours, gossip or innuendo are insufficient to form a reasonable belief.

Winter 2018 | gamma GAZETTE | 11

From our

Corporate Sponsors MIPS- Mandatory reporting 101 by MIPS (Continued) How do I make a notification?

It is recommended that you submit to AHPRA as soon as practical once you form a ‘reasonable belief’ that a practitioner has engaged in notifiable conduct.

Notify AHPRA by: • • •

Calling 1300 419 495 Completing a notification form and submitting it online or by post In person at an AHPRA office

Notifications can be made verbally or in writing.

Exceptions • • •

WA - treating practitioners are not required to make mandatory notifications about health practitioner patients or clients.

QLD (in certain circumstances) – where providing a health service to a colleague and public not at risk otherwise report to OHO. The clinico-legal advisers of indemnity providers, such as MIPS, are also exempt, and will not report your notifiable conduct.

Clinico-legal advisers with your indemnity provider, such as a MIPS, are exempt from mandatory reporting as they are your personal legal representatives. If you have concerns about a malpractising colleague you can contact your indemnity provider. MIPS can be contacted 24/7 on 1800 061 113.

References

You can easily find online the AHPRA National Board guidelines for registered health practitioners Guidelines for Mandatory Notifications from ahpra.gov.au The Medical Indemnity Protection Society also offer an on-demand webinar on Mandatory Reporting and you can earn one hour CPD if you watch the full recorded webinar on mips.com.au This article was prepared by the Medical Indemnity Protection Society for the Gamma Gazette.

After 24 years, the 12th Congress of the World Federation of Nuclear Medicine and Biology (WFNMB) returned to Australia, and was held in Melbourne from the 20th to 24th of April, 2018, and was held in conjunction with the 48th Annual Scientific Meeting of the ANZSNM. Proudly co-hosted by WFNMB and the ANZSNM, the 12th WFNMB Congress attracted over 2000 delegates from 78 countries around the world, and was the largest Nuclear Medicine Conference ever held in the Southern Hemisphere. The last time the WFNMB Congress was held in Australia was in 1994, in Sydney, under the Presidency of the WFNMB at the time, Prof Proven Murray.

The LOC of WFNMB 1994 Congress and Governer-General.

From LEFT to RIGHT: Brian Hutton (co-Scientific Chair), Brenda Walker (Treasurer, WFNMB), Richard Smart (Secretary-General, WFNMB), IPC (Provan) Murray (President, WFNMB), Dallas Hayden (Wife of Governor-General), Bill Hayden (Governor-General), Vivienne Bush (Technologist rep), Michael Kelly (co-Scientific Chair), Vince Antico (Sponsorship Chair).

The Australian Contingent at the Milan meeting in 2012, where the bid was won.

From LEFT to RIGHT: Heather Patterson, Kunthi Pathmaraj, Geoff Roff (behind), Sam Berlangieri, Sze Ting Lee, Peter Collins, Andrew Scott, Barry Elison, Vijay Kumar, Dale Bailey, Sylvia Gong.

The privilege of hosting this Congress again in 2018 was the result of years of lobbying, and voted for

by WFNMB Member Countries at the EANM meeting held in Milan in 2012. This was the start of years of planning for the big event which was recently held.

Special Report: WFNMB 2018 Congress, Event Highlights

(Continued)

The 12th Congress of the WFNMB was presided by the current President of the WFNMB, Prof Andrew Scott, who was also the co-scientific chair of the Congress together with the President of the ANZSNM at the time, Prof Dale Bailey. The remainder of the Local Organising Committee included the Secretary-General, Treasurer and Scientific Administrator of the WFNMB, Sze Ting Lee, Vijay Kumar and Fiona Scott respectively. For the last 6 years, this local organising committee have been heavily invested in ensuring that the highest quality WFNMB Congress would be hosted in Melbourne, and remain in the memories of all attendees for decades to come.

Being the WFNMB Congress, this was held under the auspices of the international regional associations, including the IAEA, SNMMI, EANM, AOFNMB, and ALASBIMN whereby Presidents of all these associations participated in the Congress and Opening Ceremony.

The LOC of the 12th WFNMB Congress LOC with the Official WFNMB Bell.

From LEFT to RIGHT: Vijay Kumar (Treasurer, WFNMB), Andrew Scott (President, WFNMB & Co-Scientific Chair), Fiona Scott (Scientific Administrator, WFNMB), Sze Ting Lee (Secretary-General, WFNMB), Dale Bailey (Co-Scientific Chair).

Ribbon cutting ceremony during the Opening ceremony of the 12th WFNMB Congress, with Presidents of International Organisations involved.

Together, with a carefully selected Scientific Subcommittee, with internationally renowned track chairs in 14 tracks (listed below), an exceptional scientific program was designed and attracted the large audience to Melbourne for the 5 day scientific program, which was deemed a huge success from a scientific and networking perspective.

Special Report: WFNMB 2018 Congress, Event Highlights TRACK Cardiology

(Continued)

TRACK CHAIR A/Prof. Nathan Better, Melbourne Health and Cabrini Medical Centre, Australia.

Prof Joao Vitola, Quanta Diagnosis and Therapy, Curitiba, Brazil.

Emerging Leaders

Prof. Henry Bom, Chonnam National University Medical School & Hospital, Korea.

Endocrinology/Renal

A/Prof. Monica Rossleigh, Prince of Wales & Sydney Children’s Hospitals, Australia.

Infection/Inflammation

Prof. Mike Sathekge, University of Pretoria & Steve Biko Academic Hospital, South Africa.

Molecular Imaging Musculoskeletal Neuroscience Nuclear Medicine Innovation

Prof. Anna Wu, University of California Los Angeles, USA. Prof. Steven Meikle, University of Sydney, Australia.

Dr. Gopinath Gnanasegaran, Royal Free London NHS Foundation Trust, UK. Dr Stephen Allwright, Mater & Northern Beaches Hospitals, Australia.

Prof. Christopher Rowe, Austin Health, Australia.

Prof. Thomas Beyer, Medical University Vienna, Austria.

Prof. Osman Ratib, University Hospital of Geneva, Switzerland.

Oncology

Prof. Homer Macapinlac, MD Anderson Cancer Centre, USA.

Paediatrics

Prof. Robert Howman-Giles, The Children’s Hospital at Westmead, Australia.

Physics

Prof. Frederic H. Fahey, Boston Children’s Hospital, USA.

Pulmonary

A/Prof. Paul Roach, Royal North Shore Hospital, Australia.

Radiopharmaceutical Sciences Radionuclide Therapy

Prof. Alan Packard, Boston Children’s Hospital/Harvard Medical School, USA. Prof. Sally Schwartz, Washington University School of Medicine, USA. Prof. Richard Baum, Zentralklinik, Bad Berka Germany.

Ms. Kunthi Pathmaraj, Austin Health, Australia.

Technologists

A/Prof. Geoffrey Currie, Charles Sturt University, Australia.

Dr Elizabeth Bailey, Royal North Shore Hospital, Australia.

The program involved 257 invited presentations, including 4 plenary sessions, with presentations by two Australian Nobel Laureates, as well as renowned local and international clinical and nuclear medicine experts.

The remainder of the scientific program consisted of 93 sessions, of which 67 were Continuing Medical Education sessions, accredited by the European Accreditation Council for Continuing Medical Education (EACCME®), with up to 34 ECMEC® credits up for grabs. There were 704 abstracts submitted and were reviewed to be appropriate for presentation at dedicated poster sessions held over 3 days, with vigorous poster debate sessions.

Nobel Laureate Professor Brian Schmidt Australian National University

Opening Plenary: Dr Diana Paez, International Atomic Energy Agency (IAEA), Vienna, Austria.

Nobel Laureate Professor Peter Doherty The University of Melbourne, Victoria, Australia

Special Report: WFNMB 2018 Congress, Event Highlights

Plenary 2: Neurology LEFT: Prof Christopher Rowe, Austin Health & The University of Melbourne.

RIGHT: Prof Satoshi Minoshima University of Utah, USA.

Plenary 3: Oncology From LEFT to RIGHT: Nobel Laureate Prof Peter Doherty, The University of Melbourne; Prof Sherene Loi & Prof Rodney Hicks, Peter MacCallum Cancer Centre.

(Continued)

Plenary 4: The Future of Nuclear Medicine and Molecular Imaging From LEFT to RIGHT: Prof Ignasi Carrio, Hospital San Pau, Barcelona, Spain; A/Prof Roslyn Francis, University of Western Australia; Prof Sanjiv (Sam) Gambhir, Stanford University, USA.

The highest ranking posters in each track were Judged by a panel of expert judges. The WFNMB Best Poster awards in each track were presented at the Gala and Awards Dinner on Monday 23rd April 2018.

Poster Track

Award Recipient

Poster Title

Cardiology

Zhonglin Liu, USA

Assessment of left ventricular remodeling and angiogenesis in ischemic-reperfused rat hearts protected by dodecafluoropentane oxygen-carrier

Endocrinology

Veera Ahtiainen, Finland

13-year outcomes after low vs. high activity of radioiodine to ablate the thyroid after thyroidectomy for cancer: A prospective randomized study

Infection/Inflammation Edward Hsiao, Australia

FDG PET/CT assessment of large and craniofacial vessel involvement in patients with clinically suspected giant cell arteritis - interim data of a prospective trial

Molecular Imaging

Yukie Yoshii, Japan

Evaluation of a PET-guided surgery with 64Cu-labeled cetuximab to resect tumors deeply located in the mouse peritoneal cavity

Musculoskeletal

Yun Young Choi, South Korea

Enhanced Diagnostic Performance of Three Phase Bone SPECT/CT for Osteomyelitis

by Addition of Blood Pool SPECT/CT

Nuclear Medicine Innovation

Tatiana Kochetova,Russia

The role of bone seeking radiopharmaceuticals in overall survival of breast cancer patients with multiple bone metastases

Neuroscience

Ying Xia, Australia

Cerebrovascular pathology in Alzheimer’s disease: findings from the Australian Imaging, Biomarkers and Lifestyle study of aging

Oncology

Jayamanee Govindasamy, Australia

FDG PET/CT findings in melanoma patients exhibiting treatment-related inflammatory events during immunotherapy

Paediatrics

Sanowar Hossain, Bangladesh

Comparison of iodine deficiency, selenium level and goiter prevalence among the primary school going children of endemic and non-endemic area of Bangladesh

Physics

Taiga Yamaya, Japan

Imaging performance evaluation of a “helmet-neck” brain PET prototype

Pulmonary

Jann Mortensen, Denmark

Lobar Quantification by V/Q SPECT/CT in Patients With Severe Emphysema Undergoing Endobronchial Lung Volume Reduction

Radionuclide Therapy

Gonçalo Ferreira, Portugal

Results of peptide receptor radionuclide therapy with 177Lu-DOTATATE in patients with head and neck paragangliomas

Radiopharmaceutical Sciences

Hiroki Hashimoto, Japan

The simultaneous measurement method for the molar radioactivity, radiochemical purity, and chemical impurity of the [11C]choline injection

Technologist

Kei Wagatsuma, Japan

Optimization of reconstruction conditions for tau PET imaging using [18F]THK5351

Special Report: WFNMB 2018 Congress, Event Highlights

(Continued)

The usual awards presented at the ANZSNM Annual Scientific Meeting were also presented, with the award winners listed below.

ANZSNM Awards 2018

Award Recipient

Presentation Title Molecular Breast Imaging for Pre-Operative Assessment in Women with Dense Breast Tissue Undergoing Treatment With Breast-Conserving Surgery for Biopsy-Proven Breast Cancer: A Pilot Study

ANSTO/ANZSNM Research Award

Rhonda Harrup

Curium Award

Brittany Robinson

GMS Poster Award

Grace Kong

The role of 68Ga-DOTA-Octreotate (GaTate) PET/CT in follow-up of patients with SDH-associated pheochromocytoma and paraganglioma (PPGL)

Gammasonics Award

Erin McKay

A Simulation-Based Evaluation of Voxel Level Dosimetry for Lu-177 Octreotate

RadPharm Award

Cassandra Tran

Amyloidosis Cardiac Scan: A Case Study of Transthyretin Amyloidosis (ATTR)

Shimadzu Award

Nigel Lengkeek

Development and Delivery of the Ommunoscintigraphic Agent 67Ga-MILGa (Miltuximab™) For a First-in-Human Phase 1 Clinical Trial

AANMS Registrar Research Award

Robert Khor

Non-Invasive Assessment of Acute Graft vs Host Disease of the Gastrointestinal Tract Following Allogeneic Haematopoietic Stem Cell Transplantation Using FDG PET

FDG PET/CT cardiac sarcoid imaging: monitoring ketone levels to avoid inadequate suppression of physiologic myocardial uptake

18

As usual, a Congress of such a magnitude would not have been possible if not for our generous sponsors and exhibitors, which all participated in the largest exhibition the nuclear medicine community has ever seen on Australian shores.

We would like to thank our premier sponsors: Diamond Sponsor: Chartwell Medical Instruments Ltd. Major Partners: ANSTO, GE, Philips, Siemens Healthineers Supporting Partners: Cyclomedica, Genesis Care Theranostics, IBA, Telix Radiopharmaceuticals Post-Congress Symposium Major Partners: Imaxeon, IPSEN Supporting Partner: ANSTO We would also like to thank our exhibitors, listed below: Exhibitors • • • • • • • • • • • • • • • • •

AAA / IDB Holland bv Abx Gmbh ABX-CRO advanced pharmaceutical services ANMI S.a.

ANSTO Biodex Bruker Biospin Charles River Chartwell Medical Care Management Co Ltd Clarity Pharmaceuticals Crystal Photonics Curium Cyclomedica Epsilon Elektronik San. ve Tic. A.Ş.

Gamma Gurus / Rotem Industries Gammasonics Institute For Medical Research GE Healthcare Global Medical Solutions

• • • • • • • • • • • • • • • • • •

Global Medical Solutions Australia Huayi Isotopes IBA Imaxeon Institute of Isotopes Co Ltd INVIA Medical Imaging Solutions Iphase Technologies IPSEN Lablogic Systems Limited MAP Medical Technologies OY Medical Technologies Australia Mediso Medlmage, Inc. Milabs MIM Software Molecubes MR Solutions Ltd National Centre for Nuclear Research

• • • • • • • • • • • • • •

Radioisotope Centre Polatom ORA-NEPTIS PARS Isotope PerkinElmer Pty Ltd Philips Healthcare PMB-ALCEN Qscan Radtronics Shimadzu Siemens Healthcare Pty Ltd Sirtex Australia Sumitomo Heavy Industries, Ltd. Taiyo Nippon Sanso CorporationTelix Radiopharmaceuticals Trasis Landauer Triskem International

Special Report: WFNMB 2018 Congress, Event Highlights

(Continued)

Society Booths • • •

• • • • • •

American Society of Nuclear Cardiology Arab Societies of Nuclear Medicine Asian Regional Cooperative Council for Nuclear Medicine / Asia and Oceania Federation of Nuclear Medicine and Biology Asian School of Nuclear Medicine Australian and New Zealand Society of Nuclear Medicine Canadian Association of Nuclear Medicine Chinese Society of Nuclear Medicine Dr Saul Hertz and The Origin of Nuclear Medicine European Association of Nuclear Medicine

• • • • • • • • • •

Hellenic Society of Nuclear Medicine International Atomic Energy Association International Society of Radiolabeled Blood Elements (ISORBE) Japanese Society of Nuclear Medicine (WFNMB22) Norwegian Society of Nuclear Medicine and Molecular Imaging Oncidium Foundation RCA Regional Office Society of Nuclear Medicine and Molecular Imaging Society of Nuclear Medicine India The Korean Society of Nuclear Medicine

• • • •

Unicorn Foundation World Association of Radiopharmaceutical and Molecular Therapy (WARMTH) World Federation of Nuclear Medicine and Biology World Molecular Imaging Society

Exhibitors at conference

Busy poster session at the 12th WFNMB Congress, Melbourne.

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Special Report: WFNMB 2018 Congress, Event Highlights

(Continued)

Melbourne turned on a week of unprecedented perfect April weather to welcome our international and interstate guests, with rain setting in only on the final afternoon as delegates were preparing to return home.

The Friday was given over to concurrent meetings of other societies such as the 4th Annual Asian Nuclear Medicine Academic Forum (ANMAF), WARMTH 13th International Conference on Radiopharmaceutical Therapy and the 48th Annual Scientific Meeting of the ANZSNM comprising the compulsory Annual General Meeting, Special Interest Group meetings and Award paper presentations.

The Plenary session comprised the Opening Ceremony of the ANMAF followed by the ANMAF Highlight Country presentation – Past present and Future of Nuclear Medicine in Bangladesh by Prof Raihan Hussein. Prof Hussein provided an entertaining and interesting history of Nuclear Medicine in Bangladesh from humble beginnings in 1958 in a tin shed known as the “Radioisotope Centre” to the current status of 22 nuclear medicine establishments with PET/CT, SPECT/CT, over 100 physicians, 150 technologists and 10 radiochemists.

With Plenary sessions by world renowned experts, including two Nobel Laureates and six or seven concurrent sessions each day, the Congress program was filled with an outstanding array of presentations, workshops and education sessions and a large poster presentation. The only drawback to this was that of choosing which of the sessions to attend of the many streams on offer each day!

The opening plenary on Saturday contained the Opening Ceremony and Welcome followed by a presentation on Nuclear Medicine – a Global Perspective, by Diana Paez MD, Head of the Nuclear Medicine and Diagnostic Imaging section of IAEA and then the first of the Nobel Laureate speakers, Prof Brian Schmidt Vice Chancellor of ANU presenting on Science and Discovery in the 21st Century. The Sunday plenary was on Neuroscience imaging in dementia with an excellent review of the current best practice for dementia diagnosis which laid the background for presentations on Amyloid, Tau and FDG PET imaging in dementia. Monday’s plenary was on Immunology and saw the second Nobel Laureate presentation by Prof Peter Doherty from University of Melbourne with an excellent presentation titled The Killer Defence which gave the background and development of immunotherapy and was followed by presentations on Targeting Immune Checkpoints in Solid Tumours, and the role of Molecular Imaging in monitoring immunotherapy. The Final plenary on Tuesday was on the Future of Nuclear Medicine Imaging with presentations on Precision Health and its impact on the Future of Nuclear Medicine, The European perspective on the future of Nuclear Medicine and the role of Multicentre clinical trials in enhancing the future of Nuclear Medicine.

Among the many excellent presentations from the congress some of my own personal favourites were, Prof Doherty’s presentation on immunology and the perils of being a Nobel Laureate (funny outfits and having a street in Brisbane named after you – which runs past Boggo Rd jail!), the Dementia imaging plenary and an excellent Renal session chaired by and containing two presentations by Dr Andrew Hilson (of Hilson’s Perfusion Index fame) who is a very entertaining and amusing speaker. The cardiology Controversy Corner provided two excellent debates on Anatomy vs Function in cardiac imaging and cardiac PET vs SPECT with four stellar speakers and mediated by A/Prof Nathan Better and A/Prof Barry Ellison.

The social events as always were enjoyed by all, from the Opening Ceremony Welcome Drinks, to the Gala Dinner at Crown Palladium and a special thanks must go to the RAINS group for organizing the technologists party.

The World Congress was an excellent opportunity to see world class speakers and to meet new colleagues from all over the world and catch up with old friends and I recommend it to anyone who gets the opportunity to attend.

The next World Congress of WFNMB will be held in Kyoto, Japan in 2022. Put it in your diary!

Special Report: WFNMB 2018 Congress, Event Highlights

(Continued)

The 2018 WFNMB World Congress - a Radiopharmaceutical Scientist perspective The Friday session consisted of concurrent meetings of other societies such as the Annual Scientific Meeting of the ANZSNM, the 4th Annual Asian Nuclear Medicine Academic Forum (ANMAF) and WARMTH 13th International Conference on Radiopharmaceutical Therapy.

The 48th Annual Scientific Meeting of the ANZSNM consisted of Radiopharmaceutical Scientists Special Interest Group (SIG) combined with the Society of Radiopharmaceutical Sciences (SRS). There were 3 key note speakers for each of the 3 sessions. Prof. Jason Lewis started the session with a comprehensive presentation on latest advances in cancer theranostics. Session 2 was followed by a dynamic presentation by Prof. Weibo Cai titled “Harnessing the Power of Molecular Imaging for Precision Medicine”. The final session by Prof Clemens Decristoforo introduced the audience to 68Ga/89Zr labelled new bio-conjugates. Dr. Sanjay Gambhir talked about the return of extra-pulmonary tuberculosis in India and the role of 18F-FDG. All the sessions were at full capacity and many attendees were not able to get a seat in the room.

The sessions also comprised of 4 presentations for the Shimadzu award. The winning presentation was titled “Development and delivery of the immuno-scintigraphic agent [67Ga]MILGa (Miltuximab) for the first in human phase 1 clinical trial” was by Dr Nigel Lengkeek. The SIG appreciates the support of Shimadzu and Mr. John Hewetson, Managing Director of Scientific Division of Shimadzu Australasia in promoting quality radiopharmaceutical research in Australia.

The opening plenary on Saturday was a presentation on Nuclear Medicine – a Global Perspective, by Dr. Diana Paez, Head of the Nuclear Medicine and Diagnostic Imaging section of IAEA, followed by Prof Brian Schmidt Vice Chancellor of ANU presenting on Science and Discovery in the 21st Century.

Amongst many outstanding presentations, workshops and educational sessions, there was a large display of posters.

The breakfast sessions organized by industry exhibitors were excellent. I always make a point of attending paediatric sessions in any conference. Dr. London and Prof Howman-Giles presentations on the use of PET/MRI technology in neuro-oncology and evaluation of uncommon and rare malignancies were well received.

The educational sessions on translating radiopharmaceuticals from the laboratory to patients in USA, Europe, Australia and Asia was insightful. The speakers shared their regulatory challenges and experiences.

The social events were enjoyable, from the opening ceremony (welcome drinks), to the Gala Dinner at Crown Palladium (I was told this is the same venue for the AFL Brownlow medal dinner).

This was the first World Congress meeting that I have attended and it was an excellent. I had the opportunity to see world class speakers and to meet new colleagues from different countries and catch up with some old friends. I look forward to the next meeting in 2022.

Divesh Kumar RPS SIG Immediate Past Chair

Special Report: WFNMB 2018 Congress, Event Highlights (Continued) Special Report: WFNMB 2018 Congress, Event Highlights (Continued)

Award to Heather Patterson by Asian Nuclear Medicine Board At the recent World Federation of Nuclear Medicine and Biology (WFNMB), prominent nuclear medicine educator and long-standing ANZSNM member, Heather Patterson, was awarded an Honorary Fellowship of the Faculty of the Asian Nuclear Medicine Board (FANMB) in recognition of her sustained contribution of over 30 years to education and training in nuclear medicine in Asia.

Heather trained as a radiotherapist in her native Northern Island (where she was incidentally a barefoot water ski champion) and made her way to Australia via New Zealand. She arrived at Royal Prince Alfred Hospital (RPAH) as a nuclear medicine technologist at the time that the department was rapidly expanding into digital computerised nuclear medicine, especially in nuclear cardiology. Heather became the senior technologist who analysed the functional data from the gamma cameras using novel hardware & software that was being developed by Roger Fulton, John Cormack and Brian Hutton on the PDP-11 platform.

The RPAH Dept of Nuclear Medicine was heavily involved at the time in developing training programmes for the IAEA under a Regional Cooperative Agreement (RCA) for Research, Development and Training Related to Nuclear Science and Technology for Asia and the Pacific, an intergovernmental agreement among the IAEA Member States that are located in South Asia, South East Asia, the Pacific region and the Far East. Heather was instrumental in running the first “Computers in Nuclear Medicine” course for the RCA in 1986. Numerous other courses and training placements followed and Heather moved to Westmead Hospital in the mid-1990s, working with Brian Hutton, and expanding the training programmes.

From this background the Distance-Assisted Training (DAT) Programme was born - the scheme for nuclear medicine technologists in Asia, particularly SE Asia with Thailand and the Philippines as some of the first countries to become involved. Heather co-ordinated the development of all course material, “trained the trainers”, and helped get the DAT material translated into local languages. This programme was so successful that it was replicated in Latin America.

Heather moved from her Westmead base to the University of Sydney in the mid-2000s to take advantage of the regional/global aspirations of the university and an encouraging academic environment. She also became increasingly involved with ANSTO as the local agency for IAEA matters. From 2010 Heather introduced the two week long residential “Foundations of PET/CT” Course at the University of Sydney. The course had been particularly designed to train nuclear medicine practitioners from neighbouring countries in our region who were introducing PET into their countries for the first time. This training has been endorsed and supported by the PET vendors as providing the training that they recognise is needed when introducing new technology. To this day Heather is strongly supported by IAEA, ANSTO and the University.

Heather’s contribution to training in our region has been immense and programmes and material that she has developed would have been used by thousands of individuals to help raise the standard of nuclear medicine globally. She has always approached this role with enormous passion and enthusiasm. This prestigious award is thoroughly deserved and on behalf of all ANZSNM members, we offer her our congratulations.

Awards Abstracts Curium Award Award Recipient: Brittany Robinson FDG PET/CT Cardiac Sarcoid Imaging: monitoring ketone levels to avoid inadequate suppression of physiologic myocardial uptake.

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Authors: Brittany Robinson-Senior Nuclear Medicine Scientist (The Royal Brisbane & Women’s Hospital); Dr David Pattison-Nuclear Medicine Specialist (The Royal Brisbane & Women’s Hospital); Dr Kevin Lee-Nuclear Medicine Specialist (The Royal Brisbane & Women’s Hospital)

Background/Aim: 18F-FDG PET/CT is now in routine clinical use for cardiac sarcoidosis (CS) (1). Literature suggests possible pitfalls of

interpretation related to physiologic cardiac FDG uptake (2). Guidelines recommend low carbohydrate high fat (LCHF) diets with fasting to suppress such uptake, however adequacy of dietary preparation is often uncertain in clinical practice, particularly given concerns regarding the accuracy and reliability of self-reported food intake (3,4). A recent study showed direct intravenous infusion of ketone bodies can suppress physiologic myocardial FDG uptake (5). This study investigates the potential use of urinary and capillary ketone levels as markers of dietary and fasting preparation.

Method: Retrospective analysis of case series of patients undergoing FDG PET/CT for CS. Patients were separated into 3 groups: Group 1 (patients that followed a 24hr diet + 12 hr fast and did not have their ketones measured), Group 2 (patients that followed 24 hr diet + 12 hr fast and had their urinary and capillary ketones measured) and Group 3 (patients that followed a 48 hr diet + 18 hr fast and had their ketones measured). The PET scans were interpreted using the Japanese Society of Nuclear Cardiology (JSNC) diagnostic criteria as a guideline to describe the pattern of FDG uptake within the myocardium. This study complies with local ethics committee guidelines.

Results: This study includes 84 patients (51 male and 33 female), median age 54 years old (range 22-79). The

average BMI was 29.30kg/m2 and ranged between 19-49. Group 1 had 39 patients, group 2 had 26 and group 3 had 19. 26% of patients in Group 1 had inconclusive results due to inadequate myocardial suppression. For patients that had their ketones measured (Groups 2 + 3), 7% of patients demonstrated inconclusive results due to inadequate myocardial suppression. Group 2 ketones ranged between 0.2-9.4 mM with an average of 2.1 mM. Group 3 ketones ranged between 0.1-5.4 mM, with an average of 2.5 mM. 15% of patients in Group 2 and 42% of patients in Group 3 demonstrated excellent suppression of physiologic myocardial glucose uptake.

Conclusion: It appears that the higher ketone levels provide greater diagnostic confidence for our reporting

physicians when determining the presence or extent of cardiac sarcoidosis. Currently, there is little research that investigates ketone levels and the pattern of FDG uptake within the myocardium. Further prospective evaluation of the role of urinary and capillary ketones as markers of adequate dietary preparation for cardiac sarcoid FDG PET/CT imaging is warranted.

References: 1. Hulten E, Aslam S, Osborne M, Abbasi S, Bittencourt M, R B. Cardiac Sarcoidosis-state of the art review. Cardiovascular Diagnosis and Therapy. 2016;6(1):50-63.

2. Gormsen L, Christensen N, Bendstrup E, Tolbod L, Nielsen S. Complete somatostatin-induced insulin suppression combined with heparin loading does not signficantly suppress myocardial 18F-FDG uptake in patients with suspected cardiac sarcoidosis. Journal of Nuclear Cardiology. 2013;20(6):1108-1115.

3. Cheng V, Slomka P, Ahlen M, Thomson L, Waxman A, Berman D. Impact of carbohydrate restriction with and without fatty acid loading on myocardial 18F-FDG uptake during PET: A randomized controlled trial. Journal of Nuclear Cardiology. 2010;17(2):286-291.

4. Shim J-S, Oh K, Kim HC. Dietary assessment methods in epidemiologic studies. Epidemiology and Health. 2014;36:e2014009. doi:10.4178/epih/e2014009.

5. Ishida, Yoshio, et al. “Recommendations for 18F-fluorodeoxyglucose positron emission tomography imaging for cardiac sarcoidosis: Japanese Society of Nuclear Cardiology recommendations.” Annals of nuclear medicine 28.4 (2014): 393-403.

Winter 2018 | gamma GAZETTE | 25

Awards Abstracts

AANMS Registrar Research Award Award Recipient: Robert khor Non-Invasive Assessment of Acute Graft vs Host Disease of the Gastrointestinal Tract Following Allogeneic Haematopoietic Stem Cell Transplantation Using FDG PET Authors: R. Khor1, S. Patil2,5, G. Brown3,5, S. Roberts3,5, W. Kemp3, S. Avery2,5, P. Walker2,5, C. McLean4,5, K. Yap1,5, T. Schwarer2, A. Spencer2,5, T. Barber1,5, V. Kalff1,5, M. Cherk1,5

Department of Nuclear Medicine, 2Department of Haematology, 3Department of Gastroenterology, Department of Anatomical Pathology, Alfred Hospital, Melbourne, Australia; and 5Monash University, Melbourne, Australia.

1

4

Abstract Declaration: The authors have no conflicts of interest to disclose.

Background: Acute graft versus host disease (GVHD) of the gastrointestinal tract (GIT) often complicates allogeneic haematopoietic stem cell transplantation (AlloHSCT). FDG PET/CT (PET) is known to detect active inflammation and may be a useful non-invasive screening test for acute GIT GVHD. Aims: To evaluate the diagnostic accuracy of PET in assessing patients with clinically suspected acute GIT GVHD and to define criteria which may reduce endoscopies.

Methods: 51 AlloHSCT patients with clinically suspected acute GIT GVHD prospectively underwent PET

scanning followed by endoscopy within 7 days (mean 3 days). 4 had gastroscopy only 1 colonoscopy and 1 sigmoidoscopy only. Endoscopic biopsies of 3 upper and 5 lower GIT segments were obtained for histology.

The SUVMax of each of the 8 GIT segments (SUVMaxGIT ) was compared with the SUVMean of background mediastinal blood pool (SUVMeanBP) to generate SUVMaxGIT/SUVMeanBP ratios. Results were used to identify the optimal ratio and number of segments to define a positive PET for GVHD, prioritising negative predictive value whilst maintaining reasonable sensitivity and specificity.

Results: 21/45 (47%) participants who underwent both upper and lower endoscopy had biopsy-proven acute GIT GVHD. 18/21 (86%) patients had upper GIT involvement, of which 18/18 (100%) showed concurrent lower GIT involvement. Further, 18/21 (86%) had contiguous involvement of all segments distal to the most proximally (highest) involved segment. The optimal criteria for PET positivity was SUVMaxGIT/SUVMeanBP ≼ 1.4 in at least 2/5 lower GIT segments, giving sensitivity 91%, specificity 44%, PPV 59% and NPV 85% for the detection of acute GIT GVHD (n=47 with lower GIT endoscopy).

Conclusion: The high NPV of PET suggests that it is a useful technique to exclude acute GIT GVHD. However, when PET is positive, limited specificity mandates invasive biopsy to ascertain the aetiology. As the lower GIT was involved in all biopsy-proven cases of upper GIT GVHD, PET and endoscopic evaluation of the upper GIT for acute GVHD may be unnecessary.

26 | gamma GAZETTE | Winter 2018

Awards Abstracts GMS Poster Award Award Recipient: Grace Kong The role of 68Ga-DOTA-Octreotate (GaTate) PET/CT in follow-up of patients with SDH-associated pheochromocytoma and paraganglioma (PPGL) Authors: 1Grace Kong, 2Tess Schenberg, 1Amir Iravani, 1Michael Hofman, 1Aravind Ravikumar, 1Tim Akhurst, 1Rod Hicks 1 Centre for Cancer Imaging, 2Medical Oncology and Familiall Cancer Service, Peter MacCallum Cancer Centre, Victoria, Australia

Background / Aims Germline succinate dehydrogenase (SDHX) mutation carriers, especially SDHB, are at increased malignancy risk and require life-long surveillance. Current guidelines recommend biennial whole body MRI1,2 but several series have documented superior lesion sensitivity with GaTate PET/CT3-5. We assessed the incremental value of GaTate PET/CT compared to MRI or CT in such patients, specifically to assess 1) per-patient and per-lesion sensitivity and specificity; and 2) management impact based on GaTate PET/CT.

Methods SDHX mutation carriers who had GaTate PET/CT were retrospectively reviewed. Detection of lesions on GaTate PET/CT were compared to MRI or CT on a per-patient and per-lesion basis, and management changes were assessed. Lesion numbers were assessed by anatomical regions (adrenal, liver, abdomen/pelvis, lungs, mediastinum, bone, head and neck) with maximum number truncated at 15 per region. Proof of lesions were based on histopathology or clinical/imaging follow-up

Results Twenty consecutive patients (median 46 years, 10 males) were reviewed. Fourteen patients had SDHB, 4 SDHD, 1 SDHC and 1 SDHA mutation, median age at diagnosis at 30 years. Two had no known lesions, 2 organ of Zukerkandl primary, 2 pheochromocytoma, 14 with PGL (3 abdominal, 2 pelvic and 9 head and neck). Fourteen patients had prior surgery Âą radiotherapy. Indications for PET/CT: 9 patients were for surveillance (previously treated or without known disease), 9 with known residual disease, and 2 for raised catecholamines. Median time from PET/CT to MRI/CT was 1.5 months (MRI contraindicated / not performed in 2 patients). GaTate PET/CT parameters: median injected activity 176 MBq (44-237), median uptake time 59min, median highest lesional SUVmax 80 (23-199).

GaTate PET/CT had higher per-patient and per-lesion sensitivity and specificity than conventional imaging (Table 1), and correctly identified the presence and number of small nodal or osseous lesions.

MRI/CT missed small volume nodal and bone metastases, and over-estimated insignificant (false +ve) small nodal and adrenal findings. Change of management resulted in 40% (8/20 pts): 3 with limited disease had localised treatment (radiotherapy and 2 surgeries), 1 changed to observation due to extra disease detected, and 4 with metastatic disease had peptide receptor radionuclide therapy.

Conclusions Incremental diagnostic information and detection rate from GaTate PET/CT compared to conventional anatomical imaging was frequently observed with consequent management impact in pts with SDHXPPGL. We suggest incorporation of GaTate PET/CT and alternating this modality with MRI on an annual or biennial basis to minimise life-time radiation exposure while ensuring more accurate longterm follow-up of such patients.

Winter 2018 | gamma GAZETTE | 27

Awards Abstracts

GMS Poster Award (Continued) Table 1: Per-patient (N=19) and per-lesion sensitivity and specificity

Figure 16 yo, SDHB +ve, with persistently raised normetanephrine after resection of extra-adrenal tumour. GaTate PET/CT showed small avid focus in the resection bed (red arrows). MRI showed no evidence of disease or enhancement (expected location green arrow). Subsequently excised histologically proven PGL, with resolution of normetanephrine levels

References 1. Risk management for paraganglioma-phaeochromocytoma predisposition syndromes (SDHA, SDHB and SDHC gene mutations) Cancer Treatments Online, Cancer Institute NSW. 2. Risk management for paraganglioma-phaeochromocytoma predisposition syndromes (SDHD and SDHAF2 gene mutations). Cancer Treatments Online, Cancer Institute NSW. 3. Janssen I, Chen CC, Taieb D, et al. 68Ga-DOTATATE PET/CT in the Localization of Head and Neck Paragangliomas Compared with Other Functional Imaging Modalities and CT/MRI. J Nucl Med. 2016;57(2):186-191.

4. Janssen I, Chen CC, Millo CM, et al. PET/CT comparing (68)Ga-DOTATATE and other radiopharmaceuticals and in comparison with CT/MRI for the localization of sporadic metastatic pheochromocytoma and paraganglioma. European journal of nuclear medicine and molecular imaging. 2016;43(10):1784-1791.

5. Janssen I, Blanchet EM, Adams K, et al. Superiority of [68Ga]-DOTATATE PET/CT to Other Functional Imaging Modalities in the Localization of SDHB-Associated Metastatic Pheochromocytoma and Paraganglioma. Clinical cancer research : an official journal of the American Association for Cancer Research.

2015;21(17):3888-3895.

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Awards Abstracts

ANSTO/ANZSNM Research Award Award Recipient: Rhonda Harrup Molecular Breast Imaging for pre-operative assessment in women with dense breast tissue undergoing treatment with breast-conserving surgery for biopsy-proven Breast Cancer: a pilot study.

Authors: Rhonda Harrup

Molecular Breast Imaging (MBI) with Direct Conversion Solid State Cadmium Zinc Telluride (CZT) Technology is highly sensitive and specific for the detection of invasive breast cancer.

MBI was developed at the Mayo Clinic as a technique for detecting breast cancers that remain occult on mammography due to masking by dense breast parenchyma.

No Australian data has been published on MBI to date using Solid State CZT detector systems as the technology has not been available here until recently.

The occurrence of multifocal, multicentric, or contralateral breast cancers is not uncommon.

However, additional malignancies other than the index lesion may be missed or underestimated by conventional assessment techniques.

The aim of this study is to assess if pre-surgical MBI in women with dense breast tissue can more accurately delineate the extent of disease than conventional assessment techniques.

The primary objective is to determine if preoperative assessment with MBI may alter patient management by influencing the surgical treatment plan.

The secondary objective is to determine if pre-operative MBI may lead to a reduction in the rate of positive surgical margins and therefore a reduction in re-operation rates.

2019 ANSTO/ANZSNM RESEARCH AWARD GUIDELINESS WILL BE MADE PUBLIC SOON ON WWW.ANZSNM.ORG.AU

Winter 2018 | gamma GAZETTE | 29

Awards Abstracts Shimadzu Award Award Recipient: Nigel Lengkeek WFNMB18-ABS-1885, Development and Delivery of the Immunoscintigraphic Agent [67Ga]MILGa (Miltuximab™) for a First-in-Human Phase 1 Clinical Trial Authors: Nigel Lengkeek* 1, Maxine Roberts1, Tien Pham1, Sandra Wissmeuller2, Douglas Campbell2, Bradley Walsh2, Quach Truong2, Ivan Greguric1, Joseph Wong1, Chris Chandler3, Andrew Winthorpe1, Rajeev Sheth1, Mark Calvi1, Angus Bowan1, Andrew Hawes1 1Radioisotopes and Radiotracers, ANSTO, 2Minomic International Ltd, Sydney, 3Auspep Pty Ltd, Melbourne, Australia

Background / Aims: The treatment of metastatic or recurrent urogenital and pancreatic cancer presents a

challenge despite the deployment of anti-androgen and radionuclide therapies. MIL-38 is an IgG1 murine monoclonal antibody directed against Glypican-1 (GPC-1), a proteoglycan that is upregulated in prostate, pancreatic and bladder cancer cell lines. In this study, we present the development of a new immunoscintigraphic agent, [67Ga]MILGa, based on the parent antibody MIL-38, specifically targetting GPCDelivery of [67Ga]MILGa to a phase-1 first-in-human clinical trial is alsopresented.

Methods: Chimeric MIL-38 (chMIL-38) was produced by Catalent Inc (USA). Functionalisation of the antibody with

p-SCN-Bn- DOTA and characterisation was performed by Auspep Pty Ltd. Immunoreactivity of (DOTA)x-chMIL-38 was determined by FACS. Radiochemistry was performed with high purity reagents and gallium-67 (Lantheus, USA). Purification and reformulation was undertaken by centrifugal ultrafiltration. Radiochemical yield (RCY) and product integrity were determined by radioHPLC and radioTLC. Sterile filtration was conducted in a Grade A hotcell. Immunoreactivity of [67Ga]MILGa was determined by a HPLC-based radioimmunoassay (RIA). Pyrogenicity (LAL) was determined using commercial kits (Charles River). Sterility of the radioactive samples was determined at ANSTO Health.

Results: The supply of (DOTA)x-chMIL-38 in multi-milligram quantities was established. The average number of chelators for batches was in the range of x = 3-5 (MALDI-MS). The product was predominately monomeric (>97%, HPLC) and retained high immunoreactivity (FACS). Excellent radiolabelling of (DOTA)x-chMIL-38 with gallium-67 was achieved under mild conditions; pH 5.0, 40 ˚C, <1hr, RCY (HPLC & TLC) >90% (n = 20), >250MBq/ mg. Purification and reformulation (PBS) provided a predominately monomeric (> 85%) product that retained high immunoreactivity (RIA with the GPC-1). A range of quality control and release tests were developed and validated for supply of the product to the phase 1 clinical trial.

Conclusion: A robust production procedure has been developed for the new immunoscintigraphic agent [67Ga]

MILGa. Quality control and release tests for delivery to a phase-1 first-in-human clinical trial have been developed.

As of November 2017, 9 patients have successfully been infused with [67Ga]MILGa with no adverse events.

References:

1. Repetta-Llamazares, A.H.V., et. al.; ‘ 177Lu-DOTA-HH1, a Novel Anti-CD37 Radio-immunoconjugate: A Study of Toxicity in Nude Mice’; PlosOne, 2014, 9(7), e103070 2. Trong,Q.et.al.;‘Glypican-1asaBiomarkerforProstateCancer:IsolationandCharacterization’;J.Cancer,2016,7,1002–1009 3. Ingargiola,M.,et.al.;‘FlowCytometricCell-BasedAssaytoPreselectAntibodyConstructsforRadionuclideConjugation’; Cytometry Part A, 2012, 81A, 865 –873

Disclosure of Interest: N. Lengkeek: None Declared, M. Roberts: None Declared, T. Pham: None Declared, S. Wissmeuller Conflict with: Employee of Minomic International Ltd, D. Campbell Conflict with: Employee of Minomic International Ltd, B. Walsh Conflict with: Employee of Minomic International Ltd, Q. Truong Conflict with: Employee of Minomic International Ltd, I. Greguric: None Declared, J. Wong: None Declared, C. Chandler Conflict with: Employee of Auspep Pty Ltd, A. Winthorpe: None Declared, R. Sheth: None Declared, M. Calvi: None Declared, A. Bowan: None Declared, A. Hawes: None Declared 30 | gamma GAZETTE | Winter 2018

Awards Abstracts RadPharm Award Award Recipient: Cassandra Tan - Technologist WFNMB18-ABS-1518 Amyloidosis Cardiac Scan: A Case Study of Transthyretin Amyloidosis (ATTR) Authors: Cassandra Tran* 1 and Hunter New England Local Health District Nuclear Medicine and PET imaging 1John Hunter and Mater Hospitals, Hunter New England Local Health District Nuclear Medicine and PET imaging, Newcastle, Australia

Background / Aims: To discuss the utility of 99mTc-Pyrophosphate (PYP) for the use of detecting and differentiating between two types of cardiac amyloidosis; ATTR and immunoglobulin light-chain amyloid (AL).

Methods: A 75 year old male with a complex history including heart failure, presented for a 99mTcPYP amyloidosis cardiac scan as a result of echocardiographic findings showing wall thickening of the myocardium. After injection of 847MBq of 99mTc-PYP, imaging was acquired at 1 and 3 hours. Statics, wholebody and SPECT/CT images were acquired.

Results: Images demonstrated intense tracer uptake in the left ventricle and low to moderate diffuse tracer uptake in the right ventricle. Cardiac retention was assessed with quantitative analysis. The mean counts in the heart region of interest over the mean counts in the contralateral chest are defined as the heart to contralateral ration (H/CL). A H/CL of >1.5 is diagnostic of ATTR. The patient had a H/CL ratio of 2.2, consistent with a positive scan for ATTR. Conclusion: The high calcium levels in cardiac amyloidosis binds to phosphate in the radiopharmaceutical, and more preferentially to ATTR. The current gold standard for diagnosing cardiac amyloidosis is cardiac biopsy coupled with immunohistological staining. However, being an invasive procedure amyloidosis cardiac scanning is the only non-invasive modality to provide a differential diagnosis for such an insidious disease.

This case study highlights the opportunity for Nuclear Medicine to become a key diagnostic modality for differentiating ATTR and AL. References: 1. Aljaroudi, W. A., Desai, M. Y., Tang, W. H. W., Phelan, D., Cerqueira, M. D., & Jaber, W. A. (2014). Role of imaging in the diagnosis and management of patients with cardiac amyloidosis: state of the art review and focus on emerging nuclear techniques. Journal of Nuclear Cardiology, 21(2), 271-283. doi: https://dx.doi.org/10.1007/s12350-013-9800-5 2. Ruberg,F.L.,&Berk,J.L.(2012).Transthyretin(TTR)cardiacamyloidosis.Circulation,126(10),1286-1300.doi: https://dx.doi.org/10.1161/CIRCULATIONAHA.111.078915 3. Quarta,C.C.,Kruger,J.L.,&Falk,R.H.(2012).Cardiacamyloidosis.Circulation,126(12),e178-182.doi: https://dx.doi.org/10.1161/CIRCULATIONAHA.111.069195 4. Bokhari,S.,Castano,A.,Pozniakoff,T.,Deslisle,S.,Latif,F.,&Maurer,M.S.(2013).(99m)Tc-pyrophosphatescintigraphyfor differentiating light-chain cardiac amyloidosis from the transthyretin-related familial and senile cardiac amyloidoses. Circulation. Cardiovascular imaging, 6(2), 195-201. doi:https://dx.doi.org/10.1161/CIRCIMAGING.112.000132 5. Disease background- Transthyretin Amyloidosis. (2015). Retrieved fromhttp://www.thaos.net/Physicians/DiseaseBackground.cfm 6. Hassan,W.,Al-Sergani,H.,Mourad,W.,&Tabbaa,R.(2005).Amyloidheartdisease.Newfrontiersandinsightsin pathophysiology, diagnosis, and management. Texas Heart Institute Journal, 32(2),178-184.

7. Rapezzi,C.,Quarta,C.C.,Guidalotti,P.L.,Longhi,S.,Pettinato,C.,Leone,O.,...Branzi,A.(2011).Usefulnessandlimitations of 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid scintigraphy in the aetiological diagnosis of amyloidotic cardiomyopathy. European Journal of Nuclear Medicine & Molecular Imaging, 38(3), 470-478. doi:https://dx.doi.org/10.1007/s00259-010-1642-7

Disclosure of Interest: None Declared

Winter 2018 | gamma GAZETTE | 31

APNETS 2018 Asia Pacific Neuroendocrine Tumour Society

Save the date!

Melbourne Convention & Exhibition Centre

9 - 11 November 2018 Abstract Submission Deadline: 29th June. Early bird Registration Deadline: 29th June.

www.apnets2018.org

Education & CPD Case Study

Nuclear Medicine:

Two interesting cases of muscle uptake on bone scintigraphic studies Author: Angela Cain and Angela Jones

Case 1: A 70 year old male outpatient was referred for

progressively worsening neck and lower back pain. The referring doctor was looking to inject any metabolically active facet joints to relieve the symptoms.

The patient was injected with 809 MBq of Tc99m- HDP. Cervical blood flow, and bloodpool images of the cervical and lumbar spine were performed (Image1).

Early imaging showed no specific areas on increased vascularity in the midline which would indicate active facet joints and no abnormal vascularity of the sacroiliac joints.

Delayed images in the same areas showed diffuse muscular uptake (Image 2). Given initial findings, whole body imaging was performed (Image 3).

Whole body imaging confirms diffuse uptake within the larger skeletal muscles, in particular the muscles around the shoulder girdles, psoas muscles and well as the buttock and thigh muscles.

There is also moderate tracer uptake involving the medial compartment of the right knee joint. SPECT/CT imaging of the cervical spine (Images 4&5) was performed and degenerative disc disease was noted at C5/6 and C6/7, with no active facet joint activity. SPECT/CT imaging of the lumbar spine (Image 6) showed moderately active L4/ L5 facet joint uptake on the right, with prominent psoas muscle and transverse abdominus musculature displayed bilaterally. The report indicated the above findings, with possible polymyositis as a reason for the increased muscular uptake of the tracer. Hypercalcaemia is considered a less likely diagnosis, but assessment of the patientâ&#x20AC;&#x2122;s inflammatory markers, creatinine phosphokinase and serum calcium is recommended in the first instance.

Figure 1: Flow and bloodpool imaging of the cervical and lumbar spine

Figure 2: Delayed cervical and lumbar statics

Unfortunately, for reasons unknown, the patient was not sent for these blood tests until 9 months after the bone scan, by which time all the levels were within normal range.

Case 2: A 77-year-old male inpatient presented to the emergency department after having two falls, the most Winter 2018 | gamma GAZETTE | 33

Figure 3: Delayed wholebody imaging

Education & CPD Case Study

Nuclear Medicine (Continued) recent being 5 weeks before presentation, complaining of right knee pain. Previous medical history included acute on chronic renal failure.

His doctor was looking at either a fracture or a source of infection to explain the knee pain, and the patient was injected with 1009MBq of Tc99m-HDP. Dynamic and static bloodpool images of the knees were performed (Image 7), immediately followed by wholebody bloodpool images (Image 8). Early imaging demonstrated diffuse bilateral high grade soft tissue hyperaemia involving all skeletal muscles of the upper and lower limbs. There was also focal soft tissue hyperaemia at the right 1st metatarsophalangeal joint.

Delayed whole body imaging (Image 9) demonstrated accumulation of bone tracer uptake within the muscles of

Figure 4: Description: SPECT/CT review page of cervical spine

Figure 5: SPECT/CT triangulated images of cervical disc uptake

the shoulders, upper arms, proximal forearms, thighs and legs bilaterally. Focal moderate grade increased periarticular activity at the right 1st metatarsophalangeal joint. SPECT/CT of the knees (Image 10) was also performed. This showed activity due to active arthropathy involving the knees, with asymmetric prominent periarticular tracer uptake at the lateral aspect of the right knee. The report stated that the scintigraphic features were consistent with generalised rhabdomyolysis, with poor visualisation of the underlying bones. There was no scintigraphic evidence of active sinister

34 | gamma GAZETTE | Winter 2018

Education & CPD Case Study Nuclear Medicine (Continued) diagnose, and is often mistaken for muscular dystrophy.

Symptoms may include muscular weakness, muscular wastage, muscular pain and fatigue. The shoulders and hips are usually affected first, and treatment options include corticosteroids, immunosuppressive drugs and physical therapy.

Figure 6: SPECT/CT review page of the lumbar spine osteoblastic process, recent fracture in the axial skeleton, discitis, osteomyelitis or septic arthritis. The active arthropathy in the knees with slightly more prominent uptake at the lateral aspect of the right knee may be related to the patientâ&#x20AC;&#x2122;s history of trauma.

Any activity seen in soft tissue structures on bone scan must first have contamination excluded as a cause. There are many other causes of extraosseous activity on bone scans which include and are not limited to renal failure, the injection site, hepatic necrosis, tissue infarction, free pertechnetate, amyloidosis and soft tissue tumours. In these two cases the most likely causes were polymyositis (case 1) and rhabdomyolysis (case 2).

Rhabdomyolysis is a serious condition caused by muscle injury. When muscle tissue is seriously injured it breaks down and dies, releasing its contents into the bloodstream. In those contents is a protein called myoglobin. Myoglobin is toxic to kidney cells and excessive accumulation can lead to kidney failure.

Rhabdomyolysis can be caused by either direct or indirect injury to muscle tissue such as crush injuries, extreme muscle exertion, as a side effect of some medicines, such as statins, prolonged muscle pressure or high body temperature or heat stroke. Symptoms include muscle pain or tenderness, especially in the shoulders, thighs or lower back, muscle weakness or stiffness, or trouble moving the arms or legs, confusion, dehydration, fever, lack of consciousness, dark red or brown urine, or reduced or no urine output. Treatment is usually in hospital with IV fluids to help produce urine and prevent kidney failure. Early diagnosis and treatment increases the likelihood of a full recovery.

References Mettler & Guiberteau (2006) Essentials of Nuclear Medicine Imaging, 5th Edition, Saunders Elsevier https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polymyositis http://www.healthdirect.gov.au/rhabdomyolysis https://www.redbubble.com/people/medcomic/works/28997893-rhabdomyolysis?p=poster

Polymyositis is a connective tissue disease that triggers inflammation and muscular weakness. The cause is unknown, but thought to be an autoimmune disorder, possibly triggered by a viral infection of muscle tissue.

Symptoms differ between individuals, making it hard to

Winter 2018 | gamma GAZETTE | 35

Technical Standards Committee

Technical Standards Committee Report Author: Darin O’Keeffe

Technical Standards Committee Report The majority of the Technical Standards Committee (TSC) members managed to meet at the World Congress in April to discuss current projects and future plans. For those not familiar with the TSC, our role is to advise the Federal Council on technical and standards issues concerning the practice of Nuclear Medicine and PET; to oversee ANZSNM quality assurance programmes and initiatives; and to draft technical standards documents for consideration and adoption by the Federal Council. The Committee has members from across the ANZ Society with representatives from each state and territory, New Zealand, each SIG, and a representative from the AANMS. At present there is a vacancy for the Technologists SIG representative so please talk with the SIG Chairperson if you are interested. Peter Collins, the South Australia Representative, plans to step down from the Committee and we thank him for his many years of service. Peter is not getting away too easily though and he has agreed to continue assisting with one of the projects to bring it to fruition (much appreciated, Peter!).

Quality management and quality systems are an important component of current clinical practice in nuclear medicine and PET and we would like to rebrand the committee to the “Technical and Quality Standards Committee”, reflecting the importance of both technical and quality management. This suggestion is currently with the ANZSNM President for comment. I would like the activities of the committee to be more visible among the membership because we cannot operate in isolation: we need our representatives to receive requests and feedback from members. Technical and quality standards are important for professional practice, but they need to be workable and not reserved for specialist or well-resourced facilities.

A quick summary of the status of some of the working parties and projects: In-house production of radiopharmaceuticals – thanks to the significant efforts of Doug Smyth, this working party has drafted a document looking at the regulatory, technical, legal and ethical implications of in-house synthesis of radiolabelled compounds (especially for PET and radionuclide therapy applications), and the staff who are qualified to undertake such operations. The document is currently before the Federal Council for comment, after which we would like it to be released to members as a discussion document. It contains recommendations to the Federal Council and to members.

Dose calibrator minimum quality control schedule and the guidance document on gamma camera quality control - both of these documents have stalled for varying reasons. Dragging our feet has not been very beneficial because, for example, in the time in which we have been developing the gamma camera document IPEM (UK) have released a new report on gamma camera quality control (IPEM Report 111), the IAEA have released new training resources and some QC software, and the EANM Technologist Committee has released the Technologists Guide on “Quality Control of Nuclear Medicine Instrumentation and Protocol Standardisation. We now need to decide how to make the best use of these potential reference documents.

Paediatric administered activity working party – this working party was formed following a request from the Federal Council to investigate whether the ANZSNM should endorse a standardised schedule for paediatric administered activities.

The working party was put on-hold while the paediatric administered activity project of the Nuclear Medicine Global Initiative was completed. This project is now complete and the results published so we can now reform the working party and consider the options available. However, in the meantime ARPANSA are about to undertake a review of the diagnostic reference levels for paediatric nuclear medicine. We hope the working party can work with ARPANSA as part of the development of the diagnostic reference levels for paediatric patients.

Winter 2018 | gamma GAZETTE | 37

Technical Standards Committee Technical Standards Committee Report (Continued) Software audit and quality assurance – Peter Collins and Robert Barnett developed a set of online tools for both auditing and the assessment of individual performance in clinical processing. This project never got out of the beta testing stage but we all know it would be a very useful tool. There is a resurgence in interest in bringing this up to a live system ready for use within the ANZSNM. Please help by contributing what you can to the project when the opportunity arises. We will need people to test the interface, the robustness of the system, and to generate results from clinical processing.

NEMA NU-2 and the Requirements for PET Accreditation (Instrumentation & Radiation Safety) - In September 2017 the President of the ANZSNM responded to a request from the Director of the Diagnostic Imaging Section (Department of Health) to remove reference to the NEMA NU-2 PET standard in the “Health Insurance (Diagnostic Imaging Services Table) Regulations”. We believe the motivation behind this was to remove a document that would go out-of-date and had to be purchased by a user (the NEMA NU-2 standard is used by most PET manufacturers to specify the typical performance and often factory acceptance values for PET equipment). The ANZSNM response was to recommend that the health insurance regulations maintain reference to the ANZSNM “Requirements” document in a generic manner (i.e. no date) with the understanding that future versions would be released by the ANZSNM after consultation with both the Australasian Association of Nuclear Medicine Specialists (AANMS), and the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM). Unfortunately, under pressure from the Department of Health the ANZSNM released a draft 3rd edition of the ANZSNM PET document that also had the NEMA NU-2 standard removed and left us referring to an older testing methodology (2001) which the manufacturers no longer use. To make matters worse, the Department of Health updated the health insurance regulations to now refer to PET scanning “... using equipment that meets the requirements set out in Requirements for PET Accreditation (Instrumentation & Radiation Safety) 3rd Edition (2017), issued by the Australian and New Zealand Society of Nuclear Medicine Inc, as existing on 1 July 2018”. So we are now bound by regulation to follow the older method for PET equipment performance testing and any changes to the ANZSNM document will be invalid under the regulations. The Technical Standards Committee is not happy with this situation and we need to work out how to correct it.

38 | gamma GAZETTE | Winter 2018

CALENDAR OF EVENTS AUGUST 2018

11 August

11 August

WA BRANCH CARDIOLOGY WORKSHOP

BIENNIAL DAY SYMPOSIUM AND QLD BRANCH MEETING

Trinity on Hampden Conference Centre, Hampden Road, Crawley WA 6009 6 CPD Points

Mantra Legends Hotel, 25 Laycock Street, Surfers Paradise, QLD 4217 6 CPD Points

SEPTEMBER 2018

1 September

8 September

HUNTER TECHNOLOGIST GROUP MEETING & NSW RADPHARM AWARD

CARDIOLOGY MASTERCLASS AND NETWORKING 6

The European Bier Café, 120 Exhibition St (cnr Lt Collins St), Melbourne CPD Points

15-16 September

19 September

Southland District Hospital, Kew Road, Invercargill CPD Points

Perth Children’s Hospital Nedlands WA

NZ BRANCH ANNUAL MEETING

6

2

Crowne Plaza Resort Pokolbin, Hunter Valley CPD Points

WA BRANCH RADPHARM MEETING

OCTOBER 2018

20 October

CAPITAL REGION FORUM ON NUCLEAR MEDICINE

6

The Rex Hotel, 150 Northbourne Avenue, Braddon, ACT 2612 CPD Points

24 October

SA BRANCH MEETING

Flinders Medical Centre, Flinders Dr, Bedford Park SA 5042

Register at anzsnm.org.au or from your Attendo Plus mobile app

Since 1969, ANZSNM has been the major society for all Nuclear Medicine professionals and the reference body for the latest developments, online education and networking in the field of Nuclear Medicine.

Latest news and developments in nuclear medicine science.

Discounted prices at other State and national events across ANZ.

Access to a community of industry professionals.

Free access to the organisationâ&#x20AC;&#x2122;s online education portal.

MEMBER BENEFITS

Access to an ever growing platform of industry and education resources.

Exclusive access to all State Branch meetings.

Free Attendo PlusTM CPD & compliance planning mobile app.

Selection of various membership types to suit your circumstance.

Financial Statements STATEMENT OF PROFIT OR LOSS AND OTHER COMPREHENSIVE INCOME FOR THE YEAR ENDED 31ST DECEMBER, 2017 Note

Revenue

2(a)

2017

2016

$

$

325,485

247,632

Conference, meeting and committee expenses

(83,580)

(100,765)

Journal expenses

(9,571)

(11,733)

Research grant

(20,000)

(20,000)

Management costs

(147,597)

(139,167)

Administration expenses

(27,542)

(26,749)

(251)

(296)

(30,695)

(10,288)

6,249

(61,366)

-

-

Net profit / (loss) for the year

6,249

(61,366)

Other comprehensive income

-

-

Total other comprehensive income for the year

-

-

Total comprehensive income for the year

6,249

(61,366)

Total comprehensive income attributable to the members of the entity

6,249

(61,366)

Depreciation expenses Website Development and maintenance costs

Profit / (Loss) before income tax for the year Income tax expense

3

Financial Statements

(Continued)

STATEMENT OF STATEMENT OF FINANCIAL POSITION AS AT 31ST DECEMBER, 2017

Note

2017

2016

$

$

645,703

637,769

ASSETS CURRENT ASSETS Cash and cash equivalents

4(a)

Trade and other receivables

5

7,455

13,477

Other assets

6

29,288

64,580

682,446

715,826

2,037

2,288

2,037

2,288

684,483

718,114

8

14,662

6,996

2(b)

47,450

94,996

TOTAL CURRENT LIABILITIES

62,112

101,992

TOTAL LIABILITIES

62,112

101,992

622,371

616,122

Retained earnings

622,371

616,122

TOTAL EQUITY

622,371

616,122

TOTAL CURRENT ASSETS NON-CURRENT ASSETS Property, plant and equipment

7

TOTAL NON-CURRENT ASSETS TOTAL ASSETS CURRENT LIABILITIES Trade and other payables Revenue in advance

NET ASSETS EQUITY

Financial Statements

(Continued)

STATEMENT OF CHANGES IN EQUITY FOR THE YEAR ENDED 31ST DECEMBER, 2017 Retained Earnings

Total

$

$

Balance at 1 January 2016

677,488

677,488

Loss attributable to the entity

(61,366)

(61,366)

Balance at 31st December 2016

616,122

616,122

6,249

6,249

622,371

622,371

Loss attributable to the entity Balance at 31st December, 2017

STATEMENT OF CASH FLOWS FOR THE YEAR ENDED 31ST DECEMBER 2017 Note

2017

2016

$

$

270,251

145,040

10,660

13,065

CASH FLOW FROM OPERATING ACTIVITIES Receipts from members & other operating activities Interest received

(272,977) (347,965)

Payments to suppliers and contractors Net cash provided by operating activities

4(c)

7,934

(189,860)

CASH FLOW FROM INVESTING ACTIVITIES Payment for property, plant and equipment

-

-

Payment for intangible asset

-

-

Net cash used in investing activities

-

-

Net Increase in cash held Cash at the beginning of the financial year Cash at the end of the financial year

4(b)

7,934

(189,860)

637,769

827,629

645,703

637,769

2018 Annual General Meeting Minutes DATE: TIME: LOCATION:

FRIDAY APRIL 20, 2018 12:40 PM ROOM 219, MELBOURNE CONVENTION CENTRE, MELBOURNE

1. Attendance

There was a room change announced by the organisers earlier in the day and they had positioned staff to direct members to the new room. The meeting commenced a little later than scheduled when the quorum was reached under the Constitution. A total of 110 attended the meeting. Evidence of these attendees was by way of AttendO app registration or by sign in sheets maintained by the Secretariat.

2. Apologies

Apologies from Sue O’ Malley and Amy Hollow were received at the start of the meeting.

3. Confirmation of Minutes of the 2017 Annual General Meeting (AGM)

The minutes of the previous AGM at the Concert Hall, Grand Chancellor Hotel, Hobart on 23rd April, 2017 were accepted as a true record.

4. Business arising from the Minutes No items were raised.

5. President’s Report from the Council 2017/18

The President Dale Bailey commenced his presentation with a diagram of the Society’s structure and commented on the achievements and challenges faced during the year plus the recent news of the MBS Rebate approval for [68Ga]DOTATATE – the first new PET indication approved in fifteen years. He commented that ARTnet, a joint venture with the AANMS, continued to be successful and demonstrated the high quality of Nuclear Medicine work undertaken locally.

The President also mentioned that following the WFNMB, Council was of the view that the IRC (International Relations Committee) should carry on after having achieved the objective of bringing the WFNMB to Australia.

Having an IRC allowed the Society to be represented with other international bodies at a prominent level.

The key challenge overall remained from the changes in regulations with AHPRA taking over regulatory functions for technologists and for the Society to remain was relevant for such members. To that end the Society had undertaken various initiatives internally as well as externally including the potential merger with the AANMS; this remained under consideration but had not advanced due to other priorities.

The President concluded with his appreciation of thanks to members of Council and all Society members.

The President received a question from the floor as to how many members were “financial” which he answered.

2018 Annual General Meeting Minutes

(Continued)

There were no further points of discussion.

6. Treasurer’s Report

A summary of the audited accounts for 2017 was visually presented and compared to 2016 which showed a surplus of $6,249 versus a deficit of $61,000; the full accounts were previously available on the Society’s website.

In presenting the Income Statement the Treasurer, Dominic Mensforth the Treasurer indicated that, as mentioned at the previous AGM, the accounts were in surplus in major part by choosing a larger and accessible ASM venue.

This, combined with continuing efforts to reduce costs, meant that the Society was planning for a slight surplus or balanced budget in 2018/19. The Treasurer confirmed that there would be no change in membership fees.

The President added some additional comments about the other efforts taken by Council such as reduction of face-to-face meetings to assist in cost management.

There were no matters raised for discussion and the Treasurer tabled the report to the meeting.

7. Reports from the Special Interest Groups & Branches

The President briefly commented on the activities of various Special Interest Groups and Committees as shown in the presentation and mentioned that they all were operating and contributing to the Society. He made comments on the efforts being made in NSW to run events that are more compatible with demands on members’ time and one such events is being co-hosted with RAINS later in the year.

8. Future Annual Scientific Meetings 2019/2020/2021

The President presented the future ASMs (Annual Scientific Meetings) schedule with 2019 being in Adelaide and the appointed convenors and theme. Sydney would be the location of the 2020 ASM and convenors were also appointed while for 2021 the venue would be Perth with a convenor to be appointed.

10. Federal Council Changes

Three members had retired from Council in the last year up to this meeting; these were Giancarlo Pascali, Divesh Kumar and Vijay Kumar (the latter two completing their term of office at this meeting). The President thanked them all for their significant services and contributions to Council and the Society.

Dr Rajiv Bhalla representing the RPS SIG was announced as a new member of Council.

11. Incoming President

With the relevant business of the Meeting completed, Professor Bailey announced that he was to be replaced by the Vice President, Roslyn Francis who had agreed and been chosen by Council for the next two years. He put to the meeting if there were any objections to this – none were received and the meeting acknowledged her appointment with applause.

12. Business without notice

Two members from the audience, Dr Bill McDonald followed by Mr Peter Tually representing RAINS thanked the (now) outgoing President Dale Bailey for his leadership and efforts whilst President of the Society.

There were no further items for business without notice. The meeting was declared closed at 1:10 PM. Dale Bailey

OFFICE BEARERS President Vice President Past President Treasurer Committee

A/Prof Roslyn Francis (WA) Position Vacant Prof Dale Bailey (NSW) Mr Dominic Mensforth (SA) Ms Marcia Wood (TSIG) Dr Rajiv Bhalla (RPS) Dr Daniel Badger (SA) Mr Nicholas Ingold (ACT) Ms Judy Duong (QLD) Ms Victoria Brooks (NZ) Mr David Thomas (VIC/TAS) AANMS Representative – Position vacant

General Manager & Secretariat

Dr Andrew St John and Drajon Management Pty Ltd

All Correspondence

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

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

Mrs Rachel Prior Vacant Ms Leica Baker and Ms Karen Lindsay Ms Dai Nguyen Ms Jessica Welch Ms Georgina Santich Ms Jessica Fagan

Special Interest Groups Technologists Radiopharmaceutical Science Physics Technical Standards Committee Scientific Advisory Panel International Relations Committee Nurse Member Liaison

Chairperson: Dr Elizabeth Bailey Chairperson: Dr Rajiv Bhalla Chairperson: Dr Daniel Badger Chairperson: Dr Darin O’Keeffe Chairperson: Prof Dale Bailey Chairperson: Professor Andrew Scott Mr Erwin Lupango

Reporting of Abnormal Behaviour of Radiopharmaceuticals The Society maintains a register of reports of abnormal behaviour of radiopharmaceuticals. Abnormal behaviour can be reported either by telephone fax or e-mail, or in writing to: ARPANSA 619 Lower Plenty Road Yallambie VIC 3085 Tel: (03) 9433 2211 Fax: (03) 9432 1835

46 | gamma GAZETTE | Winter 2018

Mr J. Gordon Chan Department of Nuclear Medicine, Austin & Repatriation Medical Centre, Heidelberg VIC 3084 Tel: (03) 9496 3336 Fax: (03) 9457 6605 email: gordon.chan@petnm.unimelb.edu.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: • 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

CONTENT SUBMISSIONS Scientific submissions on all aspects of nuclear medicine are encouraged and should be forwarded to the Secretariat (instructions for authors published at www.anzsnm.org.au).

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

If original or public domain articles are found and considered to be of general interest to the membership, then they should be recommended to the Editor who may seek permission to reprint.

The ANZSNM Gamma Gazette is published three times a year. Deadlines for each issue of the journal can be found on our website anzsnm.org.au/ contributors

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.

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. © 2018 The Australian and New Zealand Society of Nuclear Medicine Inc. Copyright is transferred to the Australian and New Zealand Society of Nuclear Medicine once an article/paper has been published in the ANZSNM Gamma Gazette (except where it is reprinted from another publication).