March 2016

ISSN : 2200-9876

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

March 2016, Issue 17

Contents

www.anzsnm.org.au

Welcome

3

President’s Report

7

What being a member of ANZSNM means? 8 Branch News

New South Wales

10

New Zealand

10

South Australia

11

Victoria/Tasmania 11

Western Australia

11

Technical Standards

14

TSIG CPD Audit results 16

SIG

Diary Dates

19

Word Search 22 What’s That?

15 & 23

Case Studies

Chromobacterium Violaceum Bacteraemia 24

The Use of 18F-FDG PET/CT in Status Epilepticus 26

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 a New Year with the first issue of Gamma Gazette for 2016. Members of the Victorian and Tasmanian branch from Austin Health Department of Molecular Imaging have provided a number of interesting cases for you including a fascinating Case Study on FDG PET in a patient with Chromobacterium Violaceum Bacteraemia, from Wesley Ng highlighting the enormous contribution FDG PET has in infection imaging . As you will note, Jessica Welch has excelled in her contributions to this issue.

My thanks to the committee for their enthusiastic contributions to the branch throughout the past year. We hope you enjoy this issue.

Dr Mary-Anne Keady Branch Chair

Note from the Production Editor Submitting material for publication IMAGES Please send image files saved as JPG or PDF at minimum 200dpi at 10cm wide.

TEXT All text to be submittd in a word file format not PDF.

Any queries please contact the ANZSNM Production Editor at deepbluedesign1@me.com

3

Journal Staff

Editorial copy & Advertising copy

Andrew St John General Manager ANZSNM Secretariat PO Box 2195 Wellington Point, QLD 4160 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 Tasmanian and Victorian 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 2016 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 March 2016

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 2195 Wellington Point, QLD 4160 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 Ms Kimberley Nguyen, email: kimberly.nguyen@bensonradiology.com.au Ms Jessica Welch, email: jessica.welch@austin.org.au 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

Chairperson: Dr Elizabeth Bailey, email: Elizabeth.Bailey2@health.nsw.gov.au Chairperson: Dr Doug Smyth, email: Douglas.Smyth@health.sa.gov.au Chairperson: 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

5

ANZSNM 2016

22-25 April Rotorua, New Zealand

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

Key Dates Early Bird Registration Close – 6 March 2016 Standard Registration Close – 3 April 2016

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 Former 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 WELCOME to the first issue for 2016 of Gamma Gazette, which is our local media coverage of new and exciting things of Society’s activities and I will try to give you an update. Some members of the ANZSNM leadership and I had a fruitful meeting with the SNMMI President and its executives at the SNMMI Annual Scientific conference in Baltimore in June 2015. One of the outcomes of such a meeting is that we secured a third CME session at the SNMMI, 2016 in San Diego, to focus on the current hot topic on 68Ga-PET Radiopharmaceuticals in the theranostic management of neuroendocrine cancer. Previously, we have had two dedicated CME sessions on lung imaging and melanoma The Executive Committee of WFNMB met with the PCO (professional conference organisers) to sort out the major tasks such as venue, scientific sessions and major outline in the selection of invited speakers and satellite meetings etc. for the World Congress in Melbourne in 2018. The local WFNMB executives attended an international conference on Clinical PET-CT and Molecular Imaging at IAEA, Vienna in October 2015. Our presentation on behalf of ANZSNM has been recognised for distinguished work with the presentation of an Award. As part of the Nuclear Medicine Global Initiative (NMGI), the WFNMB (ANZSNM International Relations Committee – Chair AM Scott) and SNMMI are working on a project on Radiopharmaceutical Access and Availability, which is nearing the data collection phase.

The forthcoming annual conference of ANZSNM 2016 in Rotorua, in New Zealand is shaping up very nicely with the participation of a number of influential thinkers in the field as guest speakers. The prominent overseas speakers include: • Prof Giuliano Mariani MD, University of Pisa, Italy; • A/Prof Gilmore David MS, CNMT, President, SNMMI-T, USA • Dr John Humm PhD, Memorial Sloan Kettering Cancer Center, New York, • Prof Richard L. Wahl, M.D., FACR,: Mallinckrodt Institute of Radiology, Washington University School of

Medicine, St Louis.

• Dr. Hosein Jadvar, President, SNMMI, USA • Prof. Mathew Thakur PhD. Ex-President of SNMMI, USA, • Prof. Dong Soo Lee, Korean National University, Seoul.

• Prof Alexander “Sandy” McEwan, Edmonton, Canada You can be certain that these excellent speakers will provide updates on the latest developments in Nuclear Medicine. Their participation will continue to improve the bilateral relationships between ANZSNM and overseas associations. Australian speakers will complement the overseas speakers to provide a high quality education & conference in Rotorua. The local organising committee led by Dr Sue O’Malley and Dr Darin O’Keeffe has been working hard to make it a grand success in New Zealand.

A number of options are available for travelling to Rotorua (see Society’s webpage for further details). The Professional Organising committee, Jo Kelk and her team, will offer the best service to the conference. I am sure it is going to be a rewarding occasion and I wish to see you all attend our premier annual event in Rotorua April 22-25, 2016.

The society’s membership has grown to >960 in 2015, the highest for a long time. The returning financial membership is at >650 for 2016 so far and we urge all members to renew their membership soon to take advantage of the lower registration fee for the Rotorua Conference in April 2016. ANZSNM conducted a very successful NSW Branch meeting in Nov 2015, kindly sponsored by Siemens.

I am delighted to say again that I am privileged to work with a team of dedicated members in the Federal Council, and with the Secretariat, and appreciate their support in all facets of running the activities of the society. The ANZSNM has continued to work closely with the Secretariat and improve the new website for the society.

Prof. Vijay Kumar President ANZSNM vijaykumar493@gmail.com

7

What being a member of ANZSNM means?

The Australian and New Zealand Society of Nuclear Medicine (ANZSNM) is the only professional body in Australia and New Zealand which represents all of the various professional groups which practice nuclear medicine.

Participants on Day 1 of the course.

AS a professional society it fulfils two important functions. It facilitates like-minded people with similar professional interests to share their knowledge and expertise and thereby contributes to the development and advancement of the profession. Second, individual members gain access to resources and expertise from the Society which contributes to their individual professional development.

This is a particularly interesting time to be involved in nuclear medicine with the recent introduction of a number of new PET tracers leading to the most rapid expansion in diagnostic modality and therapeutic management in a decade. While oncology has been the main driving interest, neurosciences, degenerative disorders and cardiovascular medicine will also benefit from new imaging examinations. In addition the technology in radiopharmaceutical sciences and instrumentation continues to advance at a great pace. The ANZSNM is best placed to provide education about these new exciting modalities to its members and help them with their ongoing further development. The society is well placed to attract key organisations from overseas to participate in our Annual Society Meetings (ASM) and it helps foster close relations with them, particularly with IAEA, EANM, SNMMI & ARCCNM. The ANZSNM provides a number of regular and unique activities for its members including: • Regular Branch Meetings of the Society in most States and Territories which keep members up to date with the latest developments in nuclear medicine.

• Access to the Gamma Gazette which 3 times per year, provides a major educational resource in nuclear medicine as well as a means of publication for individual members’ research work.

• Specific education seminars which highlight developing aspects of nuclear medicine.

• The Annual Scientific Meeting which is the major education event for nuclear medicine in Australia and New Zealand and includes international as well as national experts.

All of the above are provided free or at discounted rates to ANZSNM members. Most importantly attendance and involvement in all these activities are recognised as continual professional development (CPD) which is a requirement for the on-going registration of all nuclear medicine professionals under AHPRA. Membership of the ANZSNM allows members to record and track all their CPD activities though the Society Website.

The Society also provides a number of other unique services for its members.

• Specialised interest groups for Technologists, Radiopharmaceutical Scientists and Physicists which focus on promotion of new developments and standards in these specific areas.

• A number of Awards and Honours are offered in recognition of members who contributed for new research and development activities .

8 Gamma Gazette March 2016

u

What being a member of ANZSNM means?

• A Research Grant of $20,000 is offered every year as seed-funding to support a member or team of members for research activities.

• The ANZSNM website provides information about jobs and vacancies that are often not advertised elsewhere.

• Funding of the Australasian Radiopharmaceutical Trials Network or ARTNet, which is dedicated to the support of multicentre clinical trials that utilise radio-pharmaceuticals for imaging or therapy.

In the near future we are looking to introduce a number of new initiatives that will bring additional benefits to ANZSNM membership: • Enhancement of the new Society website to provide more education and training resources including regular webinars, including access to e-proceedings of major conferences (eg. EANM, SNMMI etc) • A mobile phone based application that will improve the management and tracking of CPD activities.

• In 2018 the Society will be hosting the World Federation of Nuclear Medicine, a quadrennial event that happens second time in this part of the world in more than two decades; ANZSNM members will receive substantial discounted registration fees for this international event.

• The introduction of post nominal letters to differentiate and promote your professional development.

All of the above comes for a very modest subscription fee compared to other similar professional healthcare groups. Furthermore your membership fee is fully tax deductible.

If you have not joined the ANZSNM or were previously a member, we encourage you to join up now or renew your membership. The Society values your membership and by being part of the ANZSNM you will play a role in supporting the continuing development of nuclear medicine and its vital contribution to patient care.

Prof. Vijay Kumar President, ANZSNM

9

Branch News NEW SOUTH WALES THE NSW branch now has a working committee and have organised the first branch meeting for the year to be held at Concord Hospital on Wednesday 24th February on ‘SIR-Spheres 2016 – latest developments and current practice’. The branch is planning to record the presentations and make them available on the ANZSNM website with the possibility offering live streaming of meetings in the foreseeable future. At this stage, we plan to organise a half or full day workshop mid-May with the theme and topics yet to be decided. Please contact a committee member if you have any suggestions for topics and/or speakers.

Elizabeth Bailey Chair NSW branch NEW ZEALAND I won’t talk about the cricket! The first one day International between NZ and Australia is on today in Auckland. Good luck to the Black Caps!

Annual Scientific Meeting, Rotorua 22nd to 25th April 2016 Abstract entries have now closed and reviewers will be allocated shortly. Many thanks to those who have taken the time to enter abstracts, the LOC have been very impressed with the calibre of presenters and variety of topics.

NZ Branch Meeting, Christchurch 3rd & 4th of September 2016 Christchurch will host our annual branch meeting, theme and venue to be confirmed.

Many thanks to Karen Wiki who is stepping down as Branch Treasurer after 3 years in the role. Karen has put a lot of time and effort into the smooth running of the finances for the branch, with the hard job of liaising and transferring funds between the branch in NZ and the larger Society in Australia. This role and that of Branch Secretary will be up for nomination at the meeting in Christchurch in September.

The possibility of PET MR being part of the Health Precinct in Christchurch is developing. This is likely to be a joint venture with the University, Canterbury DHB and other parties.

Dr Michael Rutland has retired after many years at the helm of the Nuclear Medicine Department at Auckland Hospital. He will be much missed in that department and the wider Auckland region. We will honour his time during the Annual Scientific Meeting in Rotorua.

The Radiation Safety Bill had its second reading in Parliament at the end of 2015 and all going well it looks set to be enacted in 2016. This will change the licensing of those responsible for radioactive materials and will force a rewrite of the NZ regulations and codes of practice, including the code of practice for nuclear medicine. One of the requirements of the new Bill/Act is the need for public consultation on these codes, so keep an eye out for the draft documents.

As of the 11 January this year, Fulford Radiology Services Limited at Taranaki Base Hospital is now officially run by the Taranaki DHB. For the past 17 years, the Radiology Department was a co-owned public/private imaging department, the only kind in New Zealand. This new move by the DHB to run it’s own department is seen as a step forward for both the public and staff working at Taranaki Base Hospital. We wish the two NMT’s there, Victoria Brooks and Heather Flowers, all the best in this new venture.

Pru Burns NZ Branch Secretary SOUTH AUSTRALIA THE South Australian Branch of the ANZSNM concluded 2015 by holding the annual AGM & Quiz Night at the Belgian Beer Cafe. At this meeting elections for the role of chairperson and State Representative for the SA Branch were held. Dominic Mensforth was re-elected as the State Representative. Thank you to our outgoing Branch Chairperson Holly Turner for all her hard work during her time in this role. We warmly welcome Brittany Martin, who will be taking over from Holly. We also said farewell to Peter Collins at this meeting, who retired from service from the Royal Adelaide Hospital after 44 years of contribution to the SA/ Australian and International Nuclear Medicine community.

Peter has made a huge impact on the Nuclear Medicine community in his time and we wish him all the best in the future, he will be missed by all.

The Technologist group also held their AGM/Radpharm Award Presentations at Toptai Restaurant. Sophie Liddicoat was awarded the SA Branch Radpharm award for her presentation. Russell Edwards and Nicholas Farnham from the Lyell McEwin Hospital concluded their term coordinating the Technologist group and handed this role over to the Women’s and Children’s Hospital.

10 Gamma Gazette March 2016

u

Branch News

continued

Both of the final meetings for the year had strong attendance, and were a great way to conclude 2015 for our branch. I would like to extend a very big thank you to all those who have helped to make meetings in 2015 interesting and successful. The 2016 SA Branch meeting schedule has recently been sent out to members, with the first meeting to be held at Radiology SA on the 2nd March 2016, details for each meeting will be posted on the ANZSNM website prior to the meetings.

SA Branch Meetings 2016 Wed 2 March – Radiology SA Wed 4 May – Flinders Medical Centre Wed 27 July – Royal Adelaide Hospital Wed 26 October – Dr Jones & Partners Wed 30 November AGM & Quiz Night – Venue TBA Kimberly Nguyen SA Branch Secretary/Treasurer VICTORIA/TASMANIA SINCE the last Branch report of August 2015, the Victoria/Tasmania Branch held the Annual Day Seminar on Saturday 24 October at the Crowne Plaza Hotel. Over 50 attendees participated in a most informative focus on current and future therapy Price Jackson and Mark Scalzo from the Peter MacCallum Cancer Institute provided an excellent overview and update on clinical and technical Reconstruction in xSPECT and Quantitative SPECT imaging. Peter Eu followed with uptake on Radium in his legendary style with his talk entitled “Radium from self luminous watch paint and Radioactive quackery to a USD 69 000.00 Nuclear Medicine Treatment.” Further updates on the Radium experience at the Royal Melbourne Hospital with Georgina Adams who discussed the Technologist’s perspective and Dr Meir Lichtenstein’s cost benefit analysis of Radium’s clinical use. Our final therapy update was provided by Dr Dishan Herath of the Royal Melbourne and Western Hospital on the use of immuno therapy for lung cancer. The day ended with a panel discussion on the future of radionuclide therapy chaired by Dr HB Toh. A highlight of this year’s seminar was the inaugural Victoria Tasmania branch Pioneer speaker David Bell who recently retired from his position at Lantheus Medical Imaging. David’s speech covered an entertaining overview of his more memorable experiences during his distinguished career in Nuclear Medicine as a technologist from outset to his days as Chief Technologist at the Queen Victoria Medical Centre, Maroondah Hospital and Monash Medical Centre. We were reminded of the extra ordinary change in Nuclear Medicine within several decades. Few of the lobby could recall the good old days of the more hands-on in-vivo and in-vitro investigations by Nuclear Medicine Technologists beside which one of Mona’s most famous exhibits would pale in comparison. Most, in fact, were delighted to be reminded of how lucky we are to be working in Nuclear Medicine in the 21st Century.

We have started the 2016 Continuing Education Program with Professor Kim William’s Famous Annual Nuclear Medicine Cardiology Lecture coinciding with the Australian Open. This year Professor Williams providing a scintillating discussion which included role of serial Myocardial Perfusion Imaging in the evaluation of optimised medical therapy. Subsequent discussions on the effect of a single high fat meal on endothelial function and the Ornish and Esseltstyn diets and programs left most in the audience inspired enough to avoid a pizza or Macca’s meal that night.

This year our Continuing Professional Activities goals include pre and post conference meetings and the Annual Day Seminar.

I would like to thank the dedicated members of the Victoria/Tasmania Branch for their hard work and contributions since their election in June 2015, including our Super Secretary Jessica Welch, committed Treasurer Kim Jasper, Federal Representative David Thomas, TSIG Representative Marcia Wood, Lauren Thomas (nee Dorn). I am fortunate to also have the assistance of fellow Taswegian member Lauren Moon.

Dr Mary-Anne Keady Victoria/Tasmania Branch Chair WESTERN AUSTRALIA HELLO to everyone from the WA Branch, I hope your year has started well professionally and that very few of you have been adversely affected by the unseasonal weather and the bushfires that have been burning in multiple areas across Australia.

u

11

Branch News

continued

The WA Branch finished 2015 with our Annual General Meeting, hosted by SKG, with a very interesting presentation by Dr Richard Gauci from Sir Charles Gairdner Hospital. It was about 2nd Generation Thyroglobulin Assays, asking us if follow-up with stimulated whole-body imaging is still necessary? We then enjoyed dinner in the courtyard and our thanks go to Matt Patterson for organising a relaxing evening. At the AGM those present voted for Tiffany Langton from Fiona Stanley Hospital to be the newest member of the WA Branch Committee. We would like to officially welcome Tiffany and we thank her for joining us.

The first couple of meetings for 2016 will be hosted by PRC at the Mount and then at SKG Subiaco. We are also looking forward to hearing from one of the international speakers who will be first attending the Annual Scientific Meeting. The WA Branch is also busy organising the Annual Workshop, to be held on Saturday 6th August at our usual venue, the University Club of WA. The topic for this year will be “Head and Neck” and we hope most of our WA Nuclear Medicine Community can join us on the day. If you are interested in coming across from interstate we would most certainly welcome you and I will be sure to have the program up on the website as soon as it is finalised.

Finally, Julie Crouch is the WA entrant for the RadPharm Award at the upcoming Annual Scientific Meeting and on behalf of the WA Nuclear Medicine Community, we would like to wish her good luck with her presentation. We hope everyone who is attending from WA has a great time.

WA Branch Meetings 2016 Start Times (unless advised otherwise): 5:30pm – Nibbles and Drinks 6:00pm – Meeting and Scientific Presentation Tuesday 5th April – SKG, Pre Conference Wednesday 15th June – PMH, Post Conference Saturday 6th August – University Club of WA, WA Branch Annual Workshop. Topic: TBA Tuesday 20th September – SCGH, Radpharm Presentation Night Wednesday 23rd November – FSH, AGM Georgina Santich WA Branch Secretary

12 Gamma Gazette November 2015

Australian and New Zealand Society of Nuclear Medicine Limited ABN: 35 133 630 029

Isotopes, Imaging and Identity – The History of Nuclear Medicine in Australia Book

Order and Payment Form ANZSNM Members:

AU $25 (inc.GST) Qty.

Name: Preferred mailing address please: Street: State: Postcode: Email: CREDIT CARD PAYMENT: Mastercard/Visa (Please circle) Expiry:

/

CSV:

Amount to be deducted $ Card Holder’s Name Card Holder’s Signature Email completed form to: secretariat@anzsnm.org.au CHEQUE MADE PAYABLE TO ANZSNM ANZSNM Secretariat PO Box 2195 Wellington Point, QLD 4160 Tel: 1300 330 402 Fax: (03) 8677 2970 Email: secretariat@anzsnm.org.au

This document will be a tax invoice for GST when you make a payment

11

Special Interest Group News TECHNOLOGISTS THE ANZSNM Technologist Special Interest Group has a strong focus on continuing professional development and we are currently working on several projects to increase the range and type of CPD activities provided to nuclear medicine professionals. Due to technical difficulties, the first webinar was delayed and will be held at a later date to be advised. The topic will cover the ARPANSA revision of Diagnostic Reference Levels (DRL) for nuclear medicine procedures including paediatrics and PET. The full program of proposed webinar sessions for this year will be available on the ANZSNM website in the next few weeks. If you have a suggested topic or speaker for a webinar please contact your local state representative. We have also been reviewing and developing a range of PET related topics that will be made available on-line as a way for members’ to gain expertise in PET/CT theory and clinical practice. At this stage, it should be available early 2016 and can be used for CPD. The ANZSNMT are also working closely with the University of Queensland to develop an MRI course for nuclear medicine technologists and other allied health professionals with a focus on PET/MRI. If the course is approved by the university then we hope to open enrolement for second semester 2016.

The annual TSIG Symposium for 2016 will be in Canberra on Saturday 23 July at the National Press Club of Australia. Abstract submission and early bird registration opens 29th February with a reduced registration fee offered until 29 May 2016. The program will be based on themed sessions covering current areas of interest and continuing education in multi-modality imaging. A flyer is available on the ANZSNM website and provisional program by the end of the month. We look forward to seeing you in Canberra and remember to bring your coat, scarf and gloves, it will be a little chilly.

The Annual Scientific Meeting will be held in Rotorua New Zealand at the Energy Events Centre April 22-25, and the Technologist Symposium is scheduled for Saturday 23 April with invited technologist speaker A/Prof David Gilmore from Regis College Boston. The TSIG and NZ-LOC will also be hosting CE sessions throughout the scientific program using local invited speakers presenting on their area of expertise. The President of the SNMMI-TS will also be attending the meeting and for the first time the reciprocal Mallinkcrodt Award winner representing the SNMMI-TS will be presenting their award winning abstract as part of the technologist program.

The Mallinckrodt award winner for 2015, Ms Lauren Moon from St Vincents Hospital Melbourne will be presenting her award winning presentation at the Society of Nuclear Medicine and Molecular Imaging (SNMMI) Annual Meeting Technologist Symposium in San Diego June 2016. For the first time, the Australian Mallinckrodt Award winner will be recognised at the SNMMI Awards ceremony.

We have recently received correspondence from the Government of WA Radiological Council that they have approved three courses of study to meet the requirements for a Nuclear Medicine Technologist to perform diagnostic CT x-rays. Please contact the ANZSNM secretariat (secretariat@anzsnm.org.au) to obtain a copy of this letter. There are now diagnostic CT courses for nuclear medicine technologists approved in all States of Australia and New Zealand. We are working towards achieving the same in MRI. Liz Bailey Chair ANZSNMT

14 Gamma Gazette March 2016

Answer on page 23

What’s that?

An 80-year-old, IDDM male, with Stage IV melanoma excised from the right flank and right inguinal lymph nodes in 2009, was referred for a 18F-FDG PET/CT for restaging.

He presented with a recent change in bowel habit and rectal bleeding.

He had an early morning appointment and followed the standard preparation instructions for the FDG PET scan. His blood sugar level prior to tracer administration was 5.7mmol/L. 250 MBq 18F-FDG was administered intravenously and a 60 minute uptake time was completed.

His PET/CT is displayed above. What do you notice? What do you think is the most likely explanation for the scan findings?

15

ANZSNM TSIG CPD audit results November 2015

In accordance with our previous obligations as a recognised CPD program by the MRPBA, the ANZSNM TSIG undertook a CPD audit of 5% of randomly selected NMT members in the second half of 2015. Requests for proof of CPD activities were sent to a total of 24 NMT’s across all states and territories of the ANZSNM, as shown in Figure 1, 23 responses were obtained and assessed for compliance with the MRPBA guidelines.

Figure 1: Distribution of members for audit by state/territory.

Submissions were made in a variety of formats and with a large variety of programs, departmental activities and external courses such as CPR. In all cases, submissions included activities from both general and substantive CPD categories.

For the purposes of the audit, the MRPBA published CPD standard was used to assess each submission for compliance with MRPBA requirements, or the ANZSNM CPD criteria for NZ practitioners (due to differences between the MRPBA and MRTBNZ). Submissions were checked for the number of hours obtained within the triennium, whether activities were obtained in both substantive and general categories, for appropriate evidence and for appropriate reflection.

Submissions were checked by 2 auditors not being from the state or territory from which the submissions came.

Responses were provided following the audit to the member being audited regarding the submission. These letters provided information on the level of compliance with the MRPBA standard and, if relevant, where improvement was required. In most cases, it was felt that the evidence or attendance provided or the reflective practice component was inadequate. Table 1 shows the number of responses given in each category.

In most cases, a combination of a lack of both evidence and reflective practice led to submissions not meeting the criteria. In many cases, it was felt that the reflective practice was inadequate for the number of hours claimed. As an example, attendance at an Annual Scientific Meeting could be claimed for 21 hours. This implies attendance all day at the meeting for 7 hours per day, not including lunches and other breaks. In addition, the reflective component for 21 hours of CPD should include more than one generic line about seeing talks about emerging technologies, and that further reading was required on the topic discussed.

The MRPBA has 4 specific questions that need to be answered by learning • What have you learnt?

• How has the CPD activity contributed to your body of knowledge and skills?

16 Gamma Gazette March 2016

u

ANZSNM TSIG CPD audit results November 2015 Table 1: Audit responses to submissions

DESCRIPTION NUMBER OF SUBMISSIONS Full Compliance

3

Reflective Practice missing or not adequate

5

Evidence of attendance & Reflective Practice missing.

10

Insufficient Hours

1

Evidence of attendance /Reflective practice missing (NZMRT standard)

1

Did not meet MRPBA standards for hours, attendance and reflection.

3

• How can you apply this learning to your work and integrate the knowledge and findings into your practice? • What further learning could you undertake?

It is important that each of these aspects are covered in the reflective practice portion to ensure that the reflection is considered to be adequate, and the discussion should be proportional to the complexity of the CPD activity undertaken.

Undertaking this audit was also a useful exercise for the TSIG in examining the way in which the CPD database was used by members and its usefulness in the event of an audit. We identified that there are areas that need improving to aid in extraction of data in a useful manner for the purposes of audit, and that currently this is not possible. Members were able to get lists of hours and activities direct from the interface, but this did not provide the reflective practice. We identified that after entering an activity, it would be nice to be able to print the record or save it as a document for future reference. The audit has given us many ideas on how to improve the CPD database for the membership in the future, with some changes already being introduced.

Although the MRPBA no longer provides CPD program approvals, the ANZSNM will be continuing to provide CPD auditing for our NZ members, and may periodically audit Australian members to help in ensuring that in the event of an MRPBA audit they are prepared, but also to identify future system improvements. We thank all the members who participated in this audit for the time and efforts spent compiling their submissions, and congratulate them on the generally high standard. We look forward to continuing to assist members with their CPD endeavors into the future.

17

Early Bird Registration Closes 6 March – Register Now at www.anzsnm2016.com You are warmly invited to register for the ANZSNM 2016 Annual Scientific Meeting.

Have any questions or require assistance during the registration process, please contact the Conference Managers at: anzsnm@outshine.co.nz

Important Dates • Early bird registration closes 6 March 2016 • Standard registration closes 3 April 2016 • Hotel rooms and conference rates will be held until 20 March 2016 • Abstract submissions have now closed

Get Ready for an Unmissable Social Program!

The Social Program for the ANZSNM Annual Scientific Meeting 2016 is shaping up to be one of the most exciting programs yet… Whether you’re faint-hearted or brave, quietly contemplative or a roaring adventurist, there is a variety of options for everyone!

If getting close to nature is high on your list of priorities, then don’t miss the Redwoods Great Escape on the Saturday night – this is a unique forest adventure, where you can enjoy dinner, drinks and entertainment set in the heart of the beautiful Redwood Forest.

On the other hand, if you’re a die-hard Lord of the Rings movie fan and you haven’t yet visited the Hobbiton Movie Set in Matamata, be sure to sign up for the tour and exclusive buffet feast at the Green Dragon Inn, which takes place on the Thursday evening. You can make your own way there, or hitch a ride on the complimentary bus leaving Auckland’s International Airport at 4.30pm.

For golfing enthusiasts, the traditional Golfing with Gordon event is not-to-be-missed. Sign up to enjoy a unique geothermal golfing experience at Arikapakapa, one of New Zealand’s leading golf courses. A full 18 hole, par 70 course, Arikapakapa provides variety and challenge, with many holes played over and around both dormant and active thermal areas.

And don’t forget the finale of the Social Program – the ANZSNM ASM Awards Dinner! The theme for the evening is Diner en Noir (“dinner in black”) which, as the title suggests, lends itself to a glamorous and dramatic evening, where participants are encouraged to dress head-to-toe in formal black attire… This will be an unforgettable evening, set against a dramatic night sky backdrop, with a starlit dance floor beckoning you to whirl the night away!

Tickets to any of the above activities can be booked during the online registration process, but as numbers may be limited for your activities of choice, make sure you register early to avoid missing out!

Thanks to our Confirmed Sponsors Diamond Sponsor

Gold Sponsor

Silver Sponsor

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.

1 March WA Branch Meeting Mount Medical Centre, 146 Mounts Bay Road 2 March Qld Branch Meeting The Prince Charles Hospital, Chermside 2 March SA Branch Meeting Calvary Hospital, North Adelaide 22-25 April 2016 ANZSNM Annual Scientific Meeting Rotorua, New Zealand www.anzsnm2016.com 11-15 June SNMMI Annual Meeting San Diego Convention Centre, California, USA 23 July 8th Annual TSIG Symposium National Press Club, Canberra, ACT

6 August WA Annual Workshop University Club of Western Australia 3-4 September New Zealand Branch Meeting Christchurch, NZ 27 November – 2 December RSNA 102nd Scientific Assembly & Annual Meeting Chicago, USA

2017 20 – 24 April 2017 ANZSNM Annual Scientific Meeting Hobart, Tasmania, Australia

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

VACANCIES IN NUCLEAR MEDICINE The advertising of vacancies is generally a free of charge service provided to members of the ANZSNM. All vacancies should be authorised by the Chief Technologist (who should be current financial members of the Society) for placement on the website and distribution to members.

Please email Secretariat secretariat@anzsnm.org.au for the next placement of your vacancy.

www.anzsnm.org.au/professional-development/vacancies-in-nuclear-medicine

19

word search

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

D K F P S Y K E M O M C G Y T P

POSITRON FLUORODEOXYGLUCOSE MALIGNANT METABOLISM ONCOLOGY EPILEPSY DEMENTIA FLUORINE CYCLOTRON FDG ANNIHILATION UPTAKE GATATE TOMOGRAPHY COINCIDENCE LOR

20 Gamma Gazette March 2016

answer on page 25

I D L G H O L S E K A T P U Y F

From page 15

What’s that? ... answer There is diffuse increased skeletal muscle uptake. There is no definite FDG-PET evidence of a metabolically active bowel lesion, but an underlying lesion in the sigmoid and rectum cannot be excluded due to the widespread diffuse FDG uptake resulting in a very poor target to background ratio. A colonoscopy was recommended to further assess this area.

On completion of the PET scan, the technologist questioned the patient again about the timing of his last insulin administration and the patient admitted that he had administered insulin 30 minutes prior to arriving for his PET scan appointment as he felt his blood sugar level was a little high. At the initial interview with the technologist, prior to the procedure commencing, the patient stated that his last insulin injection was the night before.

Unfortunately, the recent insulin administration diminishes the sensitivity of the study. The increased skeletal muscle activity further compromises the diagnostic accuracy of the study.

21

word search answers

POSITRON FLUORODEOXYGLUCOSE MALIGNANT METABOLISM ONCOLOGY EPILEPSY DEMENTIA FLUORINE CYCLOTRON FDG ANNIHILATION UPTAKE GATATE TOMOGRAPHY COINCIDENCE LOR

22 Gamma Gazette March 2016

18

Answer on page 28

What’s that?

Dr Mary-Anne Keady Royal Hobart Hospital

1.

2.

3.

What Radioisotope?

Where ?

What is it?

Clinical History: 73-year-old women who underwent evaluation following total thyroidectomy for an invasive thyroid cancer.

Known residual disease in the Superior Vena Cava.

23

19

Case Study

Chromobacterium Violaceum Bacteraemia Wesley NG, Kunthi Pathmaraj, ST Lee Department of Molecular Imaging and Therapy, Austin Health, Heidelberg, Victoria

Background Chromobacterium violaceum is a rare gram-negative bacillus that causes skin infections when isolated from soil and water in tropical and sub-tropical regions after contact with stagnant water or soil. If untreated, it can progress to septicaemia with lesions to the skin, lymph nodes, liver, lung, spleen and brain leading to multi-organ failure.1 Case report A 28-year-old Sri Lankan man presented to his GP with a two week history of febrile illness associated with sore throat and loss of weight while visiting Solomon Islands. The patient was initially treated with oral antibiotics, but presented to the Emergency Department at the Austin Hospital in septic shock.

24 Gamma Gazette March 2016

Clinical presentations included left jugular vein thrombosis and widespread lymphadenopathy and a diagnostic CT scan with contrast performed 10 days before the PET demonstrated necrotic cervical lymph nodes and cavitating lung lesions. Blood cultures revealed infection with chromobacterium violaceum and the patient initially responded to IV antibiotics and was discharged from intensive care unit. However, he developed repeated episodes of febrile illness again whilst on the ward and a PET/CT scan was requested for further investigation of disease extent.

Eighty-two minutes after intravenous administration of 252MBq of 18F- FDG, emission tomographic images of the body were acquired from skull vertex to toes. A low dose CT (120kVp, 50 mAs) was performed for purposes of attenuation correction and anatomical correlation.

u

Chromobacterium Violaceum Bacteraemia

Findings of the PET scan: • Intense FDG activity in the necrotic level II cervical node deep to the sternocleidomastoid muscle.

• Moderately increased FDG uptake in the solid component in the lateral aspect of the cavitating lesion in the left lung, and smaller pulmonary lesions demonstrated variable FDG-avidity relative to size.

• Linear moderate FDG uptake along the right subclavian vein extending into the superior vena cava consistent with infective thrombus.

• Innumerable FDG-avid subcutaneous nodules throughout bilateral lower limbs, consistent with infective/inflammatory emboli.

• FDG activity in the appendicular skeleton involving the distal right radius, right lunate, bilateral distal femora and proximal tibiae, as well as bilateral distal tibiae adjacent to the ankle joint, consistent with osteomyelitis.

• Diffuse increased FDG uptake throughout the bone marrow, consistent with reactive marrow.

Discussion The PET/CT findings were consistent with known distribution of Chromobacterium violaceum bacteraemia infection, in our case involving the lungs, lymph nodes and subcutaneous nodules.

Whilst osteomyelitis is not known to be a common sequelae of Chromobacterium violaceum bacteraemia, but in this was found to be the case in this patient. The diagnosis of septic emboli and osteomyelitis detected on the PET/CT scan resulted in long term treatment with antibiotics to clear the infection.

References 1. Chromobacterium violaceum: A rare bacterium isolated from a wound over the scalp. M Ravish Kumar. Int J Appl Basic Med Res. 2012 Jan-Jun; 2(1): 70–72.

25

Case Study

The Use of 18F-FDG PET/CT in Status Epilepticus Saleem S, Welch J, Pathmaraj K, Lee ST, Rowe C Austin Health, Heidelberg, Victoria

Aim To utilise PET/CT imaging in determining the epileptic focus of a patient in Status Epilepticus.

Background Status Epilepticus (SE) is a life-threatening neurologic disorder that is essentially an acute, prolonged epileptic crisis. The workup for potential SE is similar to that for any self-limited seizure but is done more expeditiously to confirm the diagnosis and to abort or limit the seizures. Most patients with status epilepticus who are treated aggressively with medication experience complete cessation of their seizures, however if status epilepticus does not cease, general anesthesia is indicated.

PET studies of epilepsy have been routinely restricted to the inter-ictal state, primarily because of the short half-lives of PET radiotracers, which makes it impractical to plan ictal examinations in patients with infrequent seizures or unpredictable seizure patterns. However, in patients with very frequent seizures, ictal PET imaging is possible.

was eventually transferred to intensive care for thiopentone coma.

However, seizures recurred once anaesthesia was weaned. Other methods employed in an attempt to ease seizure activity included intravenous ketamine infusion, transcranial magnetic stimulation and therapeutic cooling, although, to no avail.

The PET/CT scan was requested to help localise the epileptic focus that may be amenable for surgical intervention.

Method • The patient was intravenously administered with 235MBq 18 F-FDG and allowed to uptake in a dark room.

• 65 minutes post injection, PET/CT imaging of the brain was performed on a Philips Gemini TF64.

• A low dose CT (30mAs, 120kV) was performed for attenuation correction.

• Followed by a 15 minute emission scan.

Patient Presentation A 52-year-old female presented to the department with several Results weeks of intractable jerking of the right elbow, which became PET demonstrated hypermetabolism of the left precentral cortex, increasingly more intense and severe, gradually spreading up and involving left hand and upper limb motor areas and the left middown the arm and ultimately into the shoulder, trunk and proximal frontal cortex. This indicates the ictal focus. leg. The patient had a past history of left fronto-temporal cerebral abscess as a teenager accompanied by extensive left frontal and temporal scarring. The abscess required neurosurgical drainage and as a result, the patient was left with left frontal encephalomalacia and surrounding gliosis. She also developed some seizures in the initial post-abscess period and was treated with phenytoin for a number of years. Seizures eventually abated and she remained seizure and medication free for more than 20 years. Seizures returned in February 2014 and continued relentlessly, gradually worsening despite aggressive pharamacological treatment.

Seizures displayed resistance to numerous antiThe area of hypermetabolism corresponds to the involuntary twitching of the patient’s right hand and convulsants, hence the patient upper arm muscles.

26 Gamma Gazette March 2016

u

The Use of 18F-FDG PET/CT in Status Epilepticus

MRI T2 Volume imaging showed atrophy of the pre and post central gyrus, corresponding to hypermetabolism on PET imaging.

Localisation of the seizure focus led to resection of the left pre and post central gyrus. Post surgery the patient’s condition has markedly improved, however the patient continues to have sporadic focal jerking in the fingers of the right hand.

Conclusion Ictal PET imaging can be employed as a capable diagnostic tool in the management of Status Epilepticus. This case study highlights the benefits of ictal PET imaging due to its ability to aid in locating the

epileptogenic focus. However, it should also be noted that ictal PET imaging is difficult to perform and may be logistically challenging, while in some special circumstances, it has a useful role.

27

From page 23

What’s that? ... answer 1. Radioisotope – Iodine 123 2. Where –from the right thyroid bed extending contiguously inferiorly into the thorax surrounding the superior vena cava.

3. What is it – extensive intensely avid Iodine avid residual disease following previous thyroidectomy.

Note an additional FDG PET was undertaken, revealing variable mild FDG uptake activity, more typical of well differentiated thyroid malignancy, to several areas of higher FDG uptake, suspicious for heterogenous malignancy with less well differentiated pathology than sampled histologically.

There was no separate contralateral loco regional nodal involvement.

The patient subsequently underwent Iodine 131 ablation with no adverse events. The Iodine 131 whole body scan revealed additional pulmonary and lower mediastinal foci.

Acknowledgement: Dr Owen Pointon FRACP FAANMS for providing case.

28 Gamma Gazette March 2016

Australian and New Zealand Society of Nuclear Medicine