July 2015 gg

ISSN : 2200-9876

The official publication of the Australian and New Zealand Society of Nuclear Medicine

July 2015, Issue 15

Contents

www.anzsnm.org.au

Welcome

3

President’s Report

7

Branch News

Western Australia

8

New South Wales

8

New Zealand

8

South Australia

8

Queensland

9

Technical Standards

9

SIG

Physics

10

2015 ASM Award Winners 11 2016 ASM Update 12 Accreditation

13

Diary Dates

13

What’s That? 14 Life Membership: John Morris AM 15 Word Search 16 2015 ASM Report 18 Case Studies

Abdominal Mass on Bone Scan 20

Parathyroid Primer 22

Deadlines The deadlines for each issue of Gamma Gazette for this year are set out below. These deadlines must be strictly adhered to in order to get the journal out on time. Do not leave the submission of copy until the last minute. For advice on how to submit material please go to the website www.anzsnm.org.au March – February 1

2

July – June 1

November – October 1

Welcome Welcome to the July 2015 edition of Gamma Gazette.This issue is jointly brought to you by New Zealand and South Australia.

The focus for the NZ Nuclear Medicine Community (NMC) is the putting together of the 46th ANZSNM meeting to be held in Rotorua in the North Island of New Zealand, 22-25 April 2016. The task of pitching the meeting to fulfil the academic appetite of the ever widening range of members, has been greatly assisted by the Scientific Advisory Council which was formed two years ago. This has been a big help in guiding the theme, speakers and key notes. Smaller centres such as NZ, don’t have the resources to single handedly provide the level of meeting we have come to enjoy over many years now. For those who run meetings, there is continuous compromise of wanting to provide against the fiscal constraints with more competitive drive for the sponsorship dollar. Without industry sponsorship, our meetings would be much more modest affairs with greatly reduced extra-Australasian speakers, and self funded meals.

In an effort to engage our NMC in contributing to the 2016 meeting and thereby taking ownership of this event, a photo competition was widely advertised with a free registration prize. The quality of the photos were outstanding which had to advertise some aspect of NZ life with our conference logo. However only a handful of motivated individuals contributed. It was suggested that greater participation might have occurred with a Liquor prize.

Great meetings are created by all of us. We need our members to be active in our NMC and step up to new roles. We want engagement so that each of us has a say in the way our Society is moving. The changes that have evolved are not by accident but by strong committees, groups of like minded individuals wanting better things for our members.

Holding the main ANZSNM meetings in smaller centres is financially challenging and this may one of the last such meetings in a small centre. What many of us remember of the meetings is the overall package: the location, the speaker calibre, and most importantly the social events. We have to be inventive at cost saving so we can host well. Be prepared to try new incentives.

The thread of this introduction is to encourage participation in our Society and having a say about direction.

We hope that we can bring to all members an Explosive Meeting in Rotorua that we will be proud to host and will be outstanding.

Sue O’Malley Elected NZ Branch Chair

This is the first Gamma Gazette I have been directly involved with since becoming the Chairperson of the South Australian Branch in December 2013. I would like to thank all the sponsors and the co-contributors.

The Annual Scientific Meeting was held recently in Brisbane and it was a great success. Congratulations to the organising committee. After the Brisbane conference, the South Australian branch was lucky to have Professor Markus Schwaiger give a post conference presentation on the future role of molecular imaging and theranostics.

He also presented ‘Molecular Imaging as translational tool in Oncology’ at the Royal Adelaide Hospital Grand Rounds. He is widely regarded in his field and we would like to thank him for his time.

We hope you enjoy this edition of the Gamma Gazette.

Holly Turner SA Branch Chairperson

3

Journal Staff

Editorial copy & Advertising copy

Andrew St John General Manager ANZSNM Secretariat PO Box 6178, Vermont South, VIC 3133 Tel: 1300 330 402 Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au

The Australian and New Zealand Society of Nuclear Medicine Limited

Design & Production

Rachel Bullard Deep Blue Design Studio Email: deepbluedesign1@me.com

Aims and Objectives

The objectives of the Society are as follows: 1. Promote a) the advancement of clinical practice of nuclear

medicine in Australia and New Zealand;

b) research in nuclear medicine;

c) public education regarding the principles and

applications of nuclear medicine techniques in

medicine and biology at national and regional levels;

d) co-operation between organisations and individuals

interested in nuclear medicine; and

e) the training of persons in all facets of nuclear medicine.

This issue compiled by the New Zealand and South Australia branches.

Submissions Scientific submissions on all aspects of nuclear medicine are encouraged and should be forwarded to the Secretariat (see instructions for authors published on line 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 view expressed in any signed article in the journal do not necessarily represent those of the Society. The individual rights of all authors are acknowledged.

2. Provide opportunities for collective discussion on all or any aspect of nuclear medicine through standing committees and special interest groups: a) The Technical Standards Committee sets minimum

standards and develops quality control procedures

for nuclear medicine instrumentation in Australia

and New Zealand.

The ANZSNM Gamma Gazette is published three times a year: March, July and November.

Deadlines for each issue of the journal are the first of each month prior to publishing. Š 2015 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).

ANZSNM website address: www.anzsnm.org.au

4 Gamma Gazette July 2015

b) The Technologists Special Interest Group. With the introduction of National Registration for Nuclear Medicine Technologists / Scientists as of 1st July 2012, the future role of the Accreditation Board was reviewed and federal council made a decision to disband the current Accreditation Board and reallocate ongoing responsibilities to the ANZSNM – Technology Special Interest Group (TSIG). The PDY and mentor program, CPD program, department accreditation and the overseas qualification exam are now managed by sub-committees of the TSIG. 2) 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.

Office Bearers Any changes or additions to the details listed should be forwarded in writing to the Secretariat as soon as possible.

President Vice President Past President Treasurer Committee

Prof Vijay Kumar (IRC), email: vijay.kumar@health.nsw.gov.au Prof Dale Bailey (NSW), email: dale.bailey@sydney.edu.au Dr Elizabeth Bailey (TSIG), email: Elizabeth.Bailey2@health.nsw.gov.au Mr Dominic Mensforth (SA), email: dominic.mensforth@i-med.com.au A/Prof Roslyn Francis (WA), email: roslyn.francis@uwa.edu.au Dr Doug Smyth (Radiopharmaceutical Science Rep), email: Douglas.Smyth@health.sa.gov.au Dr Susan O’Malley (NZ), email: sue@omalley.co.nz Dr Sam Berlangieri (Physicians Rep), email: berlangieri@mac.com Ms Sharon Mosley (ACT), email: Sharon.Mosley@act.gov.au Mr David Thomas (VIC/TAS), email: David.Thomas@austin.org.au Dr Daniel Badger (SA), daniel.badger@health.sa.gov.au Ms Clare Radley (NZ), hairyfairy56_NZ@yahoo.co.nz

General Manager & Secretariat

Dr Andrew St John and Drajon Management Pty Ltd

All correspondence ANZSNM Secretariat

PO Box 6178, Vermont South VIC 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

Ms Maree Wright, email: Maree.Wright@act.gov.au Dr Liz Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au Mr James Turner and Mr Louis Gray, email: qldbranchsecretaryanzsnm@gmail.com Kimberley Nguyen, email: kimberly.nguyen@bensonradiology.com.au vacant Ms Georgina Santich, email: wabranchsecretary@hotmail.com Ms Pru Burns, email: pru.burns@prg.co.nz

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

Dr Elizabeth Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au Dr Doug Smyth, email: Douglas.Smyth@health.sa.gov.au Dr Daniel Badger (SA), daniel.badger@health.sa.gov.au Chairperson: Dr Darin O’Keeffe, email: darin.okeeffe@cdhb.govt.nz Chairperson: Prof Dale Bailey, email: dale.bailey@sydney.edu.au Chairperson: Professor Andrew Scott, email: Andrew.Scott@ludwig.edu.au Mr Erwin Lupango, email: Erwin.lupango@sessiahs.health.nsw.gov.au

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: Dr John Baldas, ARPANSA Mr J. Gordon Chan 619 Lower Plenty Road Department of Nuclear Medicine, Yallambie VIC 3085 Austin & Repatriation Medical Centre, Heidelberg VIC 3084 Tel: (03) 9433 2211 Tel: (03) 9496 3336 Fax: (03) 9432 1835 Fax: (03) 9457 6605 email: john.baldas@arpansa.gov.au email: gordon.chan@petnm.unimelb.edu.au

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ANZSNM 2016

22-25 April Rotorua, New Zealand

Hot Science: An Eruption of Isotopes Energy Events Centre , Rotorua 2016

Key Dates Abstract Submissions Open - October 2015 Registration Open - October 2015

Invited Speakers A/Prof David Gilmore Associate Dean, Undergraduate Academic Affairs Program Director of Medical Imaging Programs Regis College, Boston, USA Dr John L. Humm, PhD Medical Physicist Memorial Sloan Kettering Cancer Center New York, USA Prof Giuliano Mariani Professor and Chief of Nuclear Medicine Director of Post Graduate Specialty of Nuclear Medicine, University of Pisa, Italy Prof Richard Wahl Elizabeth E. Mallinckrodt Professor Head: Department of Radiology Director: Mallinckrodt Institute of Radiology Washington University School of Medicine, St Louis, USA

www.anzsnm2016.com

President’s Report I am delighted to be able to inform you that the premier annual event, the Annual Scientific Meeting of ANZSNM 2015 in Brisbane, was a tremendous success. The conference was attended by more than 500 delegates and exhibitors to make it a memorable mega-event.

Invited delegates included the President of SNMMI, Dr Peter Herscovitch, President of SNMMI-TS, Dr David Gilmour, the President of ARCCNM (Asian Regional Co-operation Council in Nuclear Medicine), Dr Henry Bom and IAEA representative Dr Uday Bhonsle.

Their participation will continue to enrich the bilateral relationships between ANZSNM and overseas organisations. The invited overseas speakers Prof. Marcus Schwaiger (Germany), Prof. Frank Roesch (Germany), A/Prof Hojjat Ahmadzadehfar, (Germany), Dr Michael Knopp, and Dr John J. Mahmarian (USA), all made a major contribution to the ANZSNM conference as they provided the latest developments in Nuclear Medicine, particularly in Ga-68 radiopharmaceuticals and their pivotal role in theranostic management of neuroendocrine tumours and prostate cancer. High quality scientific information was disseminated on current hot topics such as PET-MR hybrid imaging and liver cancer management.

The Australian speakers complemented the overseas speakers to provide a high quality education in Brisbane. The local organising committee led by Dr Joseph Wong and Lynda Jane Michel worked hard to make it a grand success in Brisbane. Emeritus Professor John Morris AO was presented with “Honorary Life Membership” at the Brisbane conference, in absentia, as he was unable to be present at the conference. The Professional Conference Organiser (PCO) led by Phil Plevin, offered their trademark high quality professional service to make the conference run smoothly.

One of the recent initiatives of ANZSNM is to meet regularly with the President and senior executives of SNMMI at SNMMI Annual Meeting, held this year in Baltimore (USA) in June 2015, to discuss several key issues of mutual benefit to both ANZSNM and SNMMI. I represented ANZSNM along with Prof. Andrew Scott (IRC, ANZSNM and current President, WFNMB) at this forum. The possibility of having an exchange program between young Australian medical and science graduates at major institutions in the United States and vice versa was discussed.

It was well received as such an exchange program existed in the past and it is worthwhile to readdress the issue.

Revising some rules and regulations and funding are being sorted out.by the executives. SNMMI will look into the possibility of providing e-conference presentations to our Society, so that our membership will have access to the proceedings and key presentations of SNMMI for improved Continuing Education resources. This is one initiative where ANZSNM is attempting to exploit advances in technology to deliver improved access to contemporary topics in nuclear medicine. I will be briefing you further about this development in due course. Similar discussions will be held at the EANM conference in Hamburg in October 2015.

We are now the official hosts of the WFNMB (World Federation of Nuclear Medicine & Biology; 2014-2018), and will be focussing on expanding global nuclear medicine activities between now and 2018, particularly in education and training activities in many emergent new world regions e.g., Asia and Oceania. Prof. Andrew Scott has called for a Nuclear Medicine Global Initiative program at the SNMMI conference, with a focus to address many key issues such as (a) Reviewing the Status of Pediatric Administered Radioactivity Project, (b) Overview of a New Project on Availability of Radiopharmaceuticals, and (c) discussion on New Project Actions and Timeline. This new initiative follows the successful publication of the white paper on global standardization of paediatric administered dose.

The ANZSNM and the Secretariat have been working diligently to continuously improve our support and service for our members. The new website for the society has been up and running since December 2014 and it has a new and comprehensive platform for our members. The website will assist in improving the professional status recognition of our members, improve communication, enhance membership benefits, etc. Our Secretariat have been working hard with the Federal Council to incorporate all essential information: to perform many tasks such as membership renewal, SIG, CME and accreditation-related activities, and disseminating information through its on-line presence as well as in Gamma Gazette. The new website is more user friendly and now provides accurate records so our current financial membership is 950. However we know that there remain many working in the profession who are potential members of ANZSNM and we are working on ways to make the Society and its activities a better and more attractive proposition for those current non-members.

I must confess that I feel privileged to work with a team of dedicated members in the Federal Council and the Secretariat and appreciate their support in all facets of running the activities of the Society. I invite comments from the membership as how we can continue to further improve the services provided.

Prof. Vijay Kumar President ANZSNM

7

Branch News WESTERN AUSTRALIA The WA Branch will hold its annual workshop on Saturday August 1st at the University Club at UWA. This year the workshop will focus on the genitourinary system, and will showcase invited speakers from both nuclear medicine and other professions. As always, we have a number of generous sponsors for the event as well. We look forward to seeing everyone for what is sure to be another successful workshop.

The nuclear medicine community of WA say a fond farewell to one of our long standing members, Diane Cheong, who retires to Melbourne at the end of June to start a new, and well deserved, chapter of her personal life. Diane has been an integral part of nuclear medicine in WA through her time here. From her work with Curtin University, to her various roles in both the WA branch and ANZSNM. Diane was chairperson of the WA Branch for many years as well as a representative of the TSIG until late last year, and has continued to be an active member of the committee ever since. Diane, we will miss you greatly here in Perth and on behalf of the WA nuclear medicine community I would like to thank you for everything you have done over the years.

Stephanie O’Donnell WA Branch Treasurer NEW ZEALAND As we head towards the shortest day, I am sure most of us were wishing we were back in sunny Queensland! A contingent of about 20 kiwi’s attended the fantastic Annual Scientific meeting in Brisbane in April. It was a well organised event, with a wide range of speakers and topics, something for everyone. Special congratulations to our NZ Radpharm Award representative, Trish Mead from Auckland DHB. Trish had stiff competition, and once again it was terrific to have a NZ NMT in the running for this Award.

Plans are well underway for the NZ branch meeting of the ANZSNM, “Molecular Imaging amid the Magma”, 4-6 September 2015. This is the highlight of the NZ Nuc Med calendar year … it’s a family reunion of sorts! The program looks great, so check out the website if you would like to come along. All welcome! https://outshine.eventsair.com/QuickEventWebsitePortal/anzsnm-nz/website Also busy behind the scenes are the organising committee for the 2016 Annual Scientific Meeting being held in Rotorua. Dr Sue O’Malley, Dr Darin O’Keeffe and team are putting together an interesting range of speakers and events that will showcase the explosive venue that has been chosen for next years meeting. www.anzsnm2016.com/ Pru Burns NZ Branch Secretary NEW SOUTH WALES Some very exciting news from the branch for this edition of the Gamma Gazette. We have been fortunate to be able to enlist some new members to our committee. Welcome to Dr Eva Wegner, Ashley Goody, Andrew Cluff and Linda McCarthy. Dale Bailey remains our NSW federal representative. Now there is ample assistance for the committee I have resigned from the NSW committee and Liz Bailey will now assume the role of Chair. I’d like to especially thank Liz for all her efforts during my time on this committee and also to the Secretariat who do a fantastic job with the smooth running of the ANZSNM. Unfortunately our scheduled April meeting at St George Hospital with our international guest speakers had to be cancelled due to the horrendous weather conditions. Thank you to Melissa Pack and her team in the organisation of this meeting, it was a shame we had to cancel. Fortunately Dr Hojjat Ahmadzadehfar has agreed to give a presentation to the branch later in the year. Stay tuned for more details .

Our last meeting was held on Tuesday 16 June at St Vincent’s Clinic on a very interesting topic of the Emerging Role of Prostate Cancer Management with presentations from Dr Louise Emmett and Dr Laurence Krieger. This meeting was kindly sponsored by Bayer, Imaxeon and GMS. Remember all future NSW branch meeting details are on the website and are regularly updated so don’t forget to check what’s coming up.

Please contact the Secretariat if your details change as we send lots of branch information via email.

Tracey Trevaskis NSW Branch Chairperson SOUTH AUSTRALIA The SA branch of the ANZSNM has already had a variety of speakers address us this year.

Firstly we were lucky enough to have Prof Markus Schwaiger – the Director of Nuclear Medicine at TUM’s rechts 8 Gamma Gazette July 2015

u

Branch News

continued

der Isar clinic present after the Brisbane ANZSNM conference. He was very charismatic and obliging - in fact when asked how long his talk would be, his reply was ‘However long you would like it to be’. His passion for Nuclear Medicine and it’s role with complementary imaging modalities could clearly be felt. Though he had visited Australia previously, he had not held a Koala, so he was taken on a day trip to Cleland National Park where he made friends with our furry natives.

Secondly at our most recent branch meeting we had a presentation by Marianne Keller a National Imaging Facility Fellow at SAHMRI entitled ‘Pre-clinical imaging modalities at SAHMRI’. With SAHMRI (South Australian Health and Medical Research Institute) promoting SA’s research opportunities, it was fantastic to learn a little about how the machines we use every day in medical imaging are being used (albeit in shrunk down versions) to help with research both in our state and nationally.

Holly Turner SA Branch Chairperson QUEENSLAND At the end of 2014 we had our final meeting for the year which was for the Queensland Radpharm presentations.

The meeting was sponsored by GMS. We had three entrants and our successful entrant was Ingrid Holmes from the RBWH. Ingrid went on to the Annual Scientific Meeting and was the winner!! Congratulations Ingrid.

We had several committee members step down from their positions. Co-secretaries Nikki Weinert and Kathy Roy, Treasurer Tale Liiv and Federal Representative LJ Michel. I would like to extend my thanks to all these girls who have made my job as Chairperson much easier over the past few years. A special thanks to LJ Michel who has been in her position for several terms.

Our new committee members are James Turner and Louis Gray who will fill the co-secretary role, Emma Snow – Treasurer and Clare Radley is the new Federal Rep. I would like to welcome the new committee.

The first meeting of 2015 was held at The Prince Charles Hospital. The meeting was sponsored by Siemens. We would like to extend our thanks to our 2 speakers for the night, Dr Bruce Goodwin and Deborah Tout.

Our next meeting will be held at the Queensland Pathology Learning Centre and we have two guest speakers.

Dr Emlyn Jones will give his Pioneer lecture from the Annual Scientific Meeting and Simon Critchley from Radiation Health will talk to us about Use licence regulations. The night is kindly sponsored by Mallinckrodt Pharmaceuticals.

Melinda Wilson QLD Branch Chairperson

Special Interest Group News TECHNICAL STANDARDS COMMITTEE There is not a lot to report on at this stage because the annual meeting of the Technical Standards Committee takes place straight after this AGM. We welcome Nicholas Forwood as NSW Representative and James Green replacing Liz Bailey as the TSIG Representative. We are still looking for a Queensland Representative, so please see me if you are interested.

There are currently five main projects within the Technical Standards Committee: 1) Dose calibrator minimum quality control schedule – nearing completion.

2) Minimum quality control requirements for gamma cameras – adopted by the Federal Council, but still waiting on the supporting guidelines document.

3) Software phantoms and clinical software validation –this has stalled a little but plan to regroup and move forward.

4) Paediatric administered activity working party – this is on-hold awaiting publication of Part 2 of the Nuclear Medicine Global Initiative whitepaper on paediatric administered activities.

5) In-house production of radiopharmaceuticals – the working party is currently being formed. The terms of reference are to review “regulatory, technical, legal, and ethical implications of the in-house synthesis of radiolabelled compounds, especially for PET and radionuclide therapy applications, and the staff who are qualified to undertake such operations”.

Darin O’Keeffe Technical Standards Committee Chairperson

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Special Interest Group News continued PHYSICS The Physics SIG AGM was held on Saturday 18 April 2015. The minutes will be available on the ANZSNM website in due course. We elected Daniel Badger as the Physics SIG Chairperson and Andrew Chicco as the Secretary/Treasurer. I would like to thank Chithra Sathiakumar (Treasurer) and Sylvia Gong (Secretary) for their many years of service on the SIG committee.

The Physics SIG held a successful symposium at the University of Sydney on Friday 13th February on “Back to the future: Functional imaging in radiation oncology”. Thank you to Dale Bailey and Chithra Sathiakumar for helping to organise it, and to all the presenters for taking the time to travel and present. I would also like to thank the sponsors who make holding these symposia financially viable. The presentations included an impressive remote presentation by Dr Stephen Bowen, University of Washington, on “PET/CT & SPECT/CT in Radiation Therapy”. It is worth considering remote presentations for other symposia and meetings. The next symposium is on Friday 12 February 2016 at the University of Sydney, topic TBD. We have run a couple of the “Column8” columns in the Gamma Gazette Newsletter. We don’t know if these are of interest, so if anyone has any feedback please let me know.

This address brings my four years as the Physics SIG Chairperson to a close and I would like to thank all those people who supported me as both Chair and during my time on the Federal Council.

Darin O’Keeffe Physics SIG Chairperson

10 Gamma Gazette July 2015

2015 ASM

Award Winners Mallinckrodt award

Lauren Dorn Frequency of apparent peripheral bony uptake of Iodine-131 on whole body scans

Radpharm award

Ingrid Holmes The Value of 68Ga-PSMA PET/CT in Detecting Recurrent Prostate Cancer: A Case Study

ANSTO award

Michael Hofman Improved Survival of Poor Prognosis FDG-avid Neuroendocrine Tumours with Lu-177 Octreotate Peptide Receptor Chemoradionuclide therapy (PRCRT)

Poster award

Amir Iravani Rare case of Richter’s Transformation of Chronic Lymphocytic Leukemia to Hodgkin’s Lymphoma demonstrated on FDG PET

Gammasonics award

Sylvia Gong Dosimetry of 124I-PEG-AVP0458 Diabody in Patients with TAG-72 Positive Ovarian or Prostate Cancer

AANMS award

Chian Aun Chang Ga-68 DOTA-Octreotate (Gatate) and F-18 Fluorodeoxyglucose (FDG) PET/CT in the assessment of paragangliomas and pheochromocytomas

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ANZSNM ASM 2016 Update Thank you to all of those that visited the ‘Coolest Hot Spot’ booth during the 2015 ASM at the ANZSNM booth. We hope you enjoyed the range of New Zealand confectionary and mud masks! We look forward to seeing you all in Rotorua at the ANZSNM ASM 2016.

We are pleased to announce that the winner of the “Find The Hidden Word” Competition held at the ANZSNM booth, was Sarah Frecker, from the Royal Brisbane Women’s Hospital. Sarah has won three complimentary nights’ accommodation at the Novotel Rotorua during the 2016 ASM. Congratulations!

The winner of the New Zealand Branch Photo Competition draw and complimentary registration for the 2016 ASM in Rotorua was Heather Flowers. Heather’s photo is below.

Check out our Facebook page for the fantastic range of entry images. Thank you to the New Zealand Branch Community who have helped us with our marketing campaign.

Like us on Facebook to receive the latest news, and information regarding the ANZSNM ASM 2016. www.facebook.com/ANZSNM or visit www.anzsnm2016.com

Above: Heather Flowers’ winning photograph in the NZ Branch “Promote ASM 2016” campaign.

Left: “NZ’s coolest Hot Spot” at the 2015 ASM in Brisbane.

12 Gamma Gazette July 2015

Accreditation Congratulations to the following technologist who was granted Accreditation:

William Mowbray

Diary dates Email the Production Editor at the Secretariat at secretariat@anzsnm.org.au to list your upcoming conference and meeting dates on the diary page.

2015 1 August WA Annual Workshop: Genitourinary System University Club, WA 6-8 August Nuclear Medicine Update Holiday Inn Atrium, Singapore register@eventsthreesixty.com.sg 5 – 6 September New Zealand Annual Scientific Meeting Auckland Hilton Hotel Auckland, New Zealand 12 September Hunter Technologist Group Seminar Crowne Plaza Resort, Hunter Valley 5 – 9 October International Conference of Clinical PET_CT and Molecular Imaging Vienna, Austria 10 – 14 October EANM15 Hamburg, Germany eanm15.eanm.org/ 24 October Vic/Tas Branch Annua Day Seminar Crowne Plaza, Melbourne

31 October – 4 November AOFNMB 2015 Asia Oceanic Congress of Nuclear Medicine and Biology Jeju, Korea www.aocnmb2015.com/ 7-8 November 12th Annual CPD Conference RAINS Integrative Imaging Symposium Rydges, Port Macquarie, NSW, Australia www.anzsnm.org.au/events/event/rainsintegrative-imaging-symposium 15-16 November Advanced Workshop in Thyroid and Parathyroid Imaging North Shore Hospital, Sydney, NSW, Australia www.anzsnm.org.au/events/event/advancedworkshop-thyroid-and-parathyroid-imaging

2016 22 – 25 April 2016 ANZSNM Annual Scientific Meeting Rotorua, New Zealand www.anzsnm2016.com

2018 20 – 24 April 2018 WFNMB 2018 Congress Melbourne, Australia

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Answer on page 17

What’s that?

Submitted by Dr E L Thomas WA PET Service, Sir Charles Gairdner Hospital

A 9-year-old boy with NMDA encephalitis was referred for a F18- FDG PET/CT for evaluation of a possible paraneoplastic syndrome.

He presented to hospital 3 weeks prior with fever, confusion and bizarre behavior.

A diagnosis of NMDA encephalitis was made on the basis of MRI findings and the identification of anti NMDA receptor antibodies in his CSF. He was treated with IV methylprednisolone and IV gammaglobulin. He made progressive neurological improvement and was discharged home on oral prednisolone.

He attended the WA PET Service as an outpatient. He had standard preparation for his FDG PET scan, including a minimum 6 hour fast. His blood sugar level prior to tracer administration was 5.0mmol/L. His PET-CT is shown above. What do you notice? What do you think is the most likely explanation for the scan findings?

14 Gamma Gazette July 2015

Life Membership

John Morris AM JOHN’S achievements are well-known to all and legendary. John was the driver for taking the nascent nuclear medicine service in the University of Sydney’s Medical School in the 1960s into mainstream clinical practice at Royal Price Alfred Hospital where he established an empire of considerable strength in nuclear medicine.

John helped establish nuclear medicine as a discipline of internal medicine in Australia, firmly planting its roots and training in the Royal Australian College of Physicians where it remains to this day. While at times this has been contentious it has avoided nuclear medicine from becoming a purely “radiological” discipline and maintained its emphasis on physiological function. He was a founding member of the ANZAPNM. John always had a strong commitment to teaching and training, not just of local practitioners, but also of our regional neighbours. Many of today’s heads of departments trained under John’s leadership at RPA. He had a strong commitment to the physical sciences and many of today’s physicists spent their early days at RPA. He was also committed to supporting the technologists and nurses in their training and vocation. He was instrumental in garnering IAEA support to offer training courses in Australia, under the Regional Co-operative Agreement (RCA), which continue to this day.

John was a commissioner at the AAEC and saw its transition through to becoming ANSTO, where he was re-appointed as a Board member.He was the main protagonist for accessing Federal funding to introduce PET and the medical cyclotron into Australia, a long process of over 20 years of lobbying successive bureaucrats, administrations and governments. Without John’s efforts the introduction of PET would have been even further delayed in Australia.

Glancing through the ANZSNM’s recent publication Isotopes, Images and Identity sees John mentioned throughout the entire history of nuclear medicine in Australia.

In recognition of his achievements he was awarded the Order of Australia (AO) in 1999 “for service to the development of Nuclear Medicine through the establishment of the National Medical Cyclotron and the nuclear medicine Positron Emission Tomography (PET) centre (GAZ S214. QB 1999). He has also been recognised by the Australian Nuclear Association with its Pioneer Award.

In short, nuclear medicine in Australia bears a strong legacy from John’s influence – I think it is not hyperbole to describe him as a “giant” of Australian nuclear medicine. At times controversial, he has always been generous with his resources and single-minded in his ambitions for nuclear medicine in Australia and in our region.

Prof Dale Bailey

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word search

R A D I D T P A U T C E O L A P H I U D C E P S T A N N O U S E Y E C D A R T C T M P H P I B I M A T S E S X O C R U C I B L E P G T S I C T A L Y Q A I O L F H P M Y L U H R S P E R F U S I O N Q I G D F T L A B O C F T E C H N E T I U M J

16 Gamma Gazette July 2015

ALARA

ECD

PERFUSION

COBALT

HDP

PMT

COLLIMATOR

HOT

SESTAMIBI

CRUCIBLE

ICTAL

SPECT

DIDA

ISOTOPE

STANNOUS

DTPA

LYMPHFLO

TECHNETIUM

From page 14

What’s that? ... answer The most striking abnormality on the PET scan is the prominent diffuse increased FDG-activity in the subcutaneous white adipose tissue (WAT). There is relatively reduced activity in the skeletal muscle, myocardium and liver.

The most likely mechanism is steroid-induced adipocyte hypertrophy and hyperplasia, as is seen in iatrogenic Cushing’s syndrome. This has recently been described in the literature.1 The scan is not of diagnostic quality and an occult malignancy could not be excluded.

1. Pattison DA, Hofman MS, Lau E, Ware R, Hicks R. Enhanced white adipose tissue metabolism in iatrogenic Cushing’s syndrome with FDG PET/CT. J Clin Enodcrinol Metab. 2014 Sep 14;99(9):3041-2

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The 45th Annual Scientific Meeting of the ANZSNM was held in Brisbane, with the theme of “Wheel of Change” reflecting the continuing revolution in nuclear medicine and PET. The Pre-Conference Symposium was held at the scenic Victoria Park on Friday 17 April. The speakers were Dr David Lisle and Prof. Ken Miles from Brisbane, Prof.

Robert Howman-Giles from Sydney, and Profs. Markus Schwaiger and Frank Roesch from Germany. Dr Lisle and Prof. HowmanGiles provided insights on MRI and PET imaging in paediatric medicine, Prof. Miles on evidence based medicine and PET/MRI, Prof. Schwaiger on the challenges facing multimodality imaging and Prof. Roesch on the Ga-68 generator. 110 delegates attended the symposium.

The Welcome Reception was held on Friday evening of 17 April, and the formal presentations commenced from Saturday 18 April to Monday 21 April at the Brisbane Convention and Exhibition Centre (BCEC) at South Bank.

The plenary speakers were Profs. John Mahmarian from Houston and Michael

Knopp from Columbus, US, and Profs.

Hojjat Ahmadzadehfar, Frank Roesch and Markus Schwaiger from Germany.

Prof. Mahmarian’s focus was on nuclear cardiology, Prof. Knopp on the new digital detector technology for PET/ CT, Prof. Ahmadzadehfar on tumour radioembolization, Prof. Roesch on the Ga68 generator technology and theranostics with Lu-177 and Prof. Schwaiger on PSMA PET. We gratefully acknowledge the sponsors of the speakers, with Insight for Prof. Knopp, Siemens for Prof. Schwaiger, and Sirtex for Prof. Ahmadzadehfar.

The Lowenthal lecture was given by Dr Marissa Bartlett and the Pioneer lecture by

Dr Emlyn Jones.

We introduced a session called Queensland Perspectives to highlight areas of work and knowledge at the various major imaging facilities in Queensland. The presenters were Dr David Wong on PSMA PET/CT, Prof. Ken Miles on Queensland Health’s PET/MRI Project, Assoc Prof. Paul Thomas on novel research radiotracers and the new Human Research Imaging Facility, and Dr Joseph Wong on fracture risk estimation with DXA. There were also special presentations

by Dr Peter Herscovitch, President of the SNMMI on neurological PET, Professor Vijay Kumar, President of the ANZSNM on

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ASM 2015: WHEEL OF CHANGE

rheumatological imaging and Dr Uday Bhonsle from the IAEA providing an update on the organisation’s operations.

In the program, there were seven plenary presentations, 62 oral presentations and 82 poster presentations. The oral and poster abstracts will be published in the Internal Medicine Journal.

The bulk of the research nowadays is on PET while most of the clinical work is in general nuclear medicine. To increase the relevance of the meeting to the majority of the nuclear medicine community, we increased the general medicine content through the international speakers and we believe a good balance was achieved. The five invited international speakers presented seven plenary talks, three AANMS talks and one at the Radiopharmacy Symposium. Of these talks, 55% were on PET and 45% on general nuclear medicine.

Of the oral presentations, 62% were on PET

and 38% on general nuclear medicine.

Of the oral PET presentations, 61% was on oncological PET. All of this was expected given the amount of novel PET tracer work being done.

Social events included Golf with Gordon, the Welcome Reception on Friday evening, Nuc’s Party on Saturday night and the finale, the Gala Dinner on Sunday night. Being a landmark 45th meeting, the Gala Dinner was given a sapphire theme.

There were 501 delegates, with 11% being international delegates. 36% of the delegate were technologists, 22% doctors and 9% scientists. A conference app was developed to assist in tracking the meeting as well as the usual Program Book. 21 companies had trade booths and we also had an on-site barista and a masseuse which were well received.

LJ and I, as co-convenors, express our gratitude for the time and effort put in by the Brisbane 2015 Organising Committee.

Zachary King was the Scientific Advisory Representative, Katherine Roy the Secretary, and Melinda Wilson and James Turner the Committee members. We are also grateful for the support from the Federal ANZSNM. We thank all our valued participating sponsors for their continued support of the nuclear medicine profession, the presenters and all the delegates.

Finally, we acknowledge the great work by Phil Plevin and his team Lucy, Rachael and Irene from Plevin and Associates. They have been methodical and resourceful. They kept

Six awards were presented at the 2015 meeting. We congratulate the following award winners: The Mallinckrodt Award for Nuclear Medicine Technologist: Lauren Dorn Radpharm Case Presentation Award: Ingrid Holmes GMS Poster Award: Dr Amir Iravani Gammasonics Award: Dr Sylvia Jie Gong ANSTO Award: Assoc Prof. Michael Hofman AANMS Registrar Research Award: Dr Chian Aun Chang us on the time lines, prioritised our work, anticipated and dealt well with any issues arising.

This report then is our final activity in our journey of planning and executing the Brisbane meeting. We have enjoyed the journey, notwithstanding the expected accompanying stresses and workload!

We trust the delegates have enjoyed the meeting judging from the feedback survey and we pass the baton over to the Rotorua Organising Committee for the 2016 meeting.

Dr Joseph Wong & Ms Lyndajane Michel Brisbane 2015 Conference Co-convenors

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Case Study

Abdominal Mass on Bone Scan Fiona Wells Dr Jones and Partners Medical Imaging, South Australia

History A 46-year-old female referred for a CXR and a WBBS with the clinical indication of newly diagnosed right breast cancer. She had no specific symptoms.

Findings 873MBq 99mTc – HDP was injected. Whole body, static and SPECT/ CT images were obtained >2.5 hours post injection.

Activity indicating degenerative reaction was shown at the L3/4

level, and SPECT/CT confirmed this as involving the intervertebral disc space with degenerative sclerosis on both sides of the joint line.

Low grade sacro-iliac joint arthritis and minor arthritic changes at the Rt acromio-clavicular joint, the patellofemoral joints (Lt > Rt) and the feet.

A significant soft tissue mass was also noted, arising from the mid line anterior lower pelvis. Reasonably homogenous isotopic activity suggested a more solid rather than cystic mass.

Differentials included a pregnancy, a large fibroid or an ovarian mass.

Discussion Breast Ca commonly metastasises to the bones.

Radionuclide bone scanning using 99mTc disphosphonate is often used to detect skeletal metastases. These are usually visualised as areas of increased tracer uptake within the skeleton.

Non-osseous uptake on a bone scan is expected.

The most frequent cause for non-osseous uptake on a bone scan is due to the genitourinary system.

Technical artifacts, such as injection technique and the imaging process itself (out of tune cameras, incorrect flood correction maps, patient motion and the SPECT imaging process) can give rise to apparent soft tissue uptake.

The mechanism of uptake isn’t well defined, although soft tissue calcification is thought to play a major role. Calcium deposition in soft tissues can be found in a variety of disease processes (eg. Ischaemia, necrosis, metastatic calcification in renal failure, or hypercalcaemia of any cause).

For this reason, it is conceivable to find soft tissue uptake of the bone agent in any organ in the body.

In this particular patient’s case, she went on to have a CT Abdomen and Pelvis (02/05/2014) and an MRI (08/05/2014). The CT report confirmed the mass was large, solid and most likely a massive uterine fibroid.

Example of a 32 week intrauterine pregnancy bone scan image http://gamma.wustl.edu/bs097te181.html

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The MRI report reads as follows: “Very large intramural mass in the left uterus.

This most likely represents an atypical fibroid. It is

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Abdominal Mass on Bone Scan

Below is a table of soft tissue uptake that is often clinically significant.

ORGAN OR TISSUE

PATHOLOGICAL CONDITION

Breast

Breast cancer

Pleural Space

Malignant effusion

Liver

Calcified or necrotic metastases

Heart

Amyloidosis or infarction

Spleen

Sickle Cell Disease

Brain Infarction Muscle

Heterotopic ossification or myositis

Stomach

Hypercalcaemia, metastatic calcification

Lung

Hypercalcaemia, metastatic calcification

Renal Cortex

Hypercalcaemia

Joints Osteochondromatosis Pericardium

Pericarditis or malignant effusion

Soft Tissue tumour

Osteogenic Sarcoma or malignancy

J Nucl Med Technol 2003; 31:149–153

moderately cellular with prominent vessels from the left inferior posterolateral margin. An apparent rim of fluid surrounding this mass is unusual and the differential includes a mass sitting within a second endometrial cavity, although I think this is less likely.

The lack of obvious outer myometrial infiltration makes a sarcoma unlikely.�

The patient was referred onto a gynaecologist and this uterine fibroid was surgically removed.

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Case Study

Parathyroid Primer Dr Sue O’Malley Christchurch Hospital, Christchurch, New Zealand

Ever wondered why the location of parathyroid adenomata are so variable?

This is largely due to the embryonic development of parathyroid glands during week 5 -7 of gestation.

The branchial (pharyngeal) arches are six embryonic arches that give rise to specialised structures in the head and neck in the higher vertebrates, and gills in lower vertebrates (Gr brancia is gills , L arcus is bow). The branchial arches develop in association with the aortic arches that encircle the developing foregut.

Figure 1: View of branchial (pharyngeal arches) Week 6 Gestation.

The parathyroid glands originate from the third and fourth branchial arches from the interaction of the endoderm and neural crest mesenchyme. The fifth branchial arch is transient.

The inferior parathyroid glands arise from the more superior third branchial arch. The dorsal (back) wing develops into the inferior parathyroid glands and the ventral (front) becomes the thymus. At seven weeks, they lose their connection with the pharynx and migrate caudally (towards the feet end) and medially. The thymus migrates further than the inferior parathyroid glands. The connection between the thymus and inferior parathyroid glands is lost.

The superior parathyroid glands arise from the dorsal wing of the fourth branchial arch close to the lateral thyroid. They migrate with the thyroid gland. The final destination is the dorsal surface of the thyroid gland outside the fibrous capsule.

The thyroid gland is the first endocrine organ to develop at 24 days.

This is located on the medial central surface of the pharyngeal floor, caudal to the tongue. The single mass becomes bilobed descending anterior to the gut. The thyroid gland is attached to the tongue by the thyroglossal duct. Its descent follows the heart. The thyroglossal duct solidifies into a solid cord that will form the follicular elements. The proximal end retracts and leaving the foramen (opening) cecum at the junction of the anterior and posterior 2/3 of the tongue. Sometimes this can be seen as a small blind pit. A. pyramidal lobe represents persistence of the inferior end of the thyroglossal duct that has failed to obliterate. The lateral thyroid arises from pharyngeal and neural crest cells, these give rise to parafollicular cells (C cells, secrete calcitonin).

Figure 2: Schematic diagram of branchial arches at 6 weeks gestation.

The blue arrows denote the descent of the inferior parathyroid glands and thymus.

The orange arrows denote the descent of the superior parathyroid glands.

The green arrow indicates the descent of the thyroid gland.

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Figure 3: Expected location of the Parathyroid Glands.

Parathyroid Location Variations These two diagrams on the following page demonstrate the variable final location of the parathyroid glands.

This therefore gives some understanding as to the basis for aberrant locations of the parathyroid glands. The final location of the superior glands is less variable than the inferior ones, in part due to the shorter distance and more direct route of descent compared to

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Parathyroid Primer

Figure 4: Location of the Upper Parathyroid Glands.

Figure 5: Location of Lower Parathyroid Glands.

the inferior parathyroid glands which travel further, more laterally in association with the thymus which descends into the thorax.

Accessory (additional) parathyroid glands are found in 13% autopsy individuals. This is thought to be due to fragmentation of the gland at time of migration.

Ectopic parathyroid glands occur in 15-20% of patients. They can be located near or within either the thymus or thyroid gland. Other common locations are; anterior Mediastinum, less commonly posterior Mediastinum, retroesophageal and prevertebral.

Parathyroid scintigraphy is used for parathyroid adenomata localisation. There are differing protocols to achieve this. There is reasonable agreement between the EANM and SNMMI protocols.

Given the variable location of the parathyroid glands, precise b) anatomical localisation provides valuable pre-operative information, enabling the surgeon to plan their surgical strategy.

This case illustrates the aberrant location of the parathyroid adenoma in the anterior mediastinum.

Above: Figure 7: Coronal View: SPECT CT Localisation of parathyroid Adenomata in Mediastinum Below: Figure 8: Transaxial View: SPECT CT Localisation of Parathyroid Adenomata in Mediastinum Parathyroid Adenoma located on superior surface of the aortic arch.

Figure 6: 10 minutes and 2 hours post Isotope Scintinigraphy showing mediastinal location of the parathyroid adenoma.

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Parathyroid Primer

Figure 9: Low Power Parathryoid Adenoma.

Figure 10: High Power Parathyroid Adenoma (i) With dense collection of intense staining lymphoid cells which mostly consist of nucleus and very little cytoplasm (ii) Fat cells on the edge (iii) Occasional squamous cell

In summary This article is intended to provide some understanding of the mechanism for Parathyroid Gland location in the neck and how aberrant locations come about. Understanding the embryological development of the parathyroid glands, the thyroid gland and the thymus is key to appreciate the expected locations and the aberrant locations of the parathyroid glands.

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Australian and New Zealand Society of Nuclear Medicine