• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.3
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• pp.123-131
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• 2009

Purpose: We tested a sample of nuclear medicine workers at Korean healthcare institutions for internal contamination with radioactive isotopes, measuring concentrations and evaluating doses of individual exposure. Materials and Methods: The detection and measurement was performed on urine samples collected from 25 nuclear medicine workers at three large hospitals located in Seoul. Urine samples were collected once a week, 100~200 mL samples were gathered up to 6~10 times weekly. A high-purity germanium detector was used to measure gamma radiations in urine samples for the presence of radioactive isotopes. Based on the detection results, we estimated the amounts of intake and committed effective doses using IMBA software. In cases where committed effective doses could not be adequately evaluated with IMBA software, we estimated individual committed effective doses for radionuclides with a very short half life such as $^{99m}Tc$ and $^{123}I$, using the methods recommended by International Atomic Energy Agency. Results: Radionuclides detected through the analysis of urine samples included $^{99m}Tc$, $^{123}I$, $^{131}I$ and $^{201}Tl$, as well as $^{18}F$, a nuclide used in Positron Emission Tomography examinations. The committed effective doses, calculated based on the radionuclide concentrations in urine samples, ranged from 0 to 5 mSv, but were, in the majority of cases, less than 1 mSv. The committed effective dose exceeded 1 mSv in three of the samples, and all three were workers directly handling radioactive sources. No nurses were found to have a committed effective dose in excess of 1 mSv. Conclusions: To improve the accuracy of results, it may be necessary to conduct a long-term study, performed over a time span wide enough to allow the clear determination of the influence of seasonal factors. A larger sample should also help increase the reliability of results. However, as most Korean nuclear medicine workers are currently not necessary to monitored routinely for internal contamination with radionuclides. Notwithstanding, a continuous effort is recommended to reduce any unnecessary exposure to radioactive substances, even if in inconsequential amounts, by regularly surveying workplace environments and frequently monitoring atmospheric concentrations of radionuclides.

• The Korean Journal of Nuclear Medicine
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• v.36 no.5
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• pp.288-297
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• 2002

Purpose: Soft tissue attenuation and scattering are major methodological limitations of myocardial perfusion SPECT. To overcome these limitations, algorithms for attenuation, scatter correction and resolution recovery (ASCRR) is being developed, while quantitative myocardial SPECT has also become available. In this study, we investigated the efficacy of an ASCRR-corrected quantitative myocardial SPECT method for the diagnosis of coronary artery disease (CAD). Materials and Methods: Seventy-five patients (M:F=51:24, $61.0{\pm}8.9$ years old) suspected of CAD who underwent coronary angiography (CAG) within $7{\pm}12$ days of SPECT(Group-I) and 20 subjects (M:F=10:10, age $40.6{\pm}9.4$) with a low likelihood of coronary artery disease (Group-II) were enrolled. Tl-201 rest/ dipyridamole-stress Tc-99m-MIBI gated myocardial SPECT was performed. ASCRR correction was peformed using a Gd-153 line source and automatic software (Vantage-Pro; ADAC Labs, USA). Using a 20-segment model, segmental perfusion was automatically quantified on both the ASCRR-corrected and uncorrected images using an automatic quantifying software (AutoQUANT; ADAC Labs.). Using these quantified values, CAD was diagnosed in each of the 3 coronary arterial territories. The diagnostic performance of ASCRR-corrected SPECT was compared with that of non-corrected SPECT. Results: Among the 75 patients of Group-I, 9 patients had normal CAG while the remaining 66 patients had 155 arterial lesions; 61 left anterior descending (LAD), 48 left circumflex (LCX) and 46 right coronary (RCA) arterial lesions. For the LAD and LCX lesions, there was no significant difference in diagnostic performance. In Group-II patients, the overall normalcy rate improved but this improvement was not statistically significant (p=0.07). However, for RCA lesions, specificity improved significantly but sensitivity worsened significantly with ASCRR correction (both p<0.05). Overall accuracy was the same. Conclusion: The ASCRR correction did not improve diagnostic performance significantly although the diagnostic specificity for RCA lesions improved on quantitative myocardial SPECT. The clinical application of the ASC-RR correction requires more discretion regarding cost and efficacy.

• The Korean Journal of Nuclear Medicine Technology
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• v.15 no.1
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• pp.51-57
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• 2011

Purpose: The aim of this study is to identify clinical usefulness of Wide Beam Reconstruction (WBR) which is called Xpress.cardiac$^{TM}$ to confirm the agreement between segmental perfusion and regional wall motion in myocardium compared to conventional OSEM method. Materials and Methods: Subjects were separated two groups. First group was composed of 20 normal control group. Second group was composed of 10 patients (abnormal group) who had coronary artery disease. Subjects underwent myocardial perfusion SPECT ($^{201}Tl$ rest and $^{99m}Tc$-MIBI stress). Image acquisition and reconstruction were that rest stage was each step per 30, 15 seconds and stress stage was each step per 25, 13 seconds, OSEM and WBR methods were applied. Segmental perfusion and regional wall motion were applied 20-segment model of QPS, QGS algorithm in AutoQuant. Status of perfusion was composed of 5 point scoring system (0=normal, 1=mild, 2=moderate, 3=severe hypokinesia, 4=dyskinesia). Status of regional wall motion was also composed of 5 point scoring (0=normal, 1=mild, 2=moderate, 3=severe hypokinesia, 4=dyskinesia). We evaluated the agreement between conventional OSEM and WBR through automatic quantification value. Results: The agreement of rest segmental perfusion between conventional OSEM and WBR in normal patients was 99% (396/400, k=0.662, p<0.0001) and one of rest regional wall motion was 83.8% (335/400, k=0.283), the agreement of stress segmental perfusion was 95.8%(383/400, k=0.656), one of stress regional wall motion was 87.3% (349/400, k=0.390). The match rate of rest segmental perfusion in abnormal patients was 83% (166/200, k=0.605, p<0.0001) and one of rest regional wall motion was 55.5% (111/200, k=0.385), the agreement of stress segmental perfusion was 79.5% (159/200, k=0.682), one of stress regional wall motion was 63.5% (127/200, k=0.486). Conclusion: Compared to conventional OSEM, WBR method had a good agreement of segmental perfusion in myocardium in normal and abnormal groups. However regional wall motion showed meaningful low agreement. Although WBR offers high resolution and contrast ratio, it is not useful method for gated myocardial perfusion SPECT.

• The Korean Journal of Nuclear Medicine
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• v.35 no.6
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• pp.364-370
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• 2001

Purpose: In the revascuarization of ischemic dysfunctional myocardium, stunned myocardium was reported to recover function earlier than hibernating myocardium. It was also suggested that stunning and hibernation could be discriminated by reversibility of perfusion impairment on myocardial SPECT. In this study, we investigated the time course of functional recover after CABG according to reversibility of perfusion impairment. Materials and Methods: In 92 patients with coronary artery disease, Tl-201 rest/dipyridamole stress Tc-99m-MIBI gated SPECT was performed before, 3 months after, and 17 months after CABG. Using a 20-segment model, segmental perfusion and systolic thickening were automatically quantified. Perfusion-impaired segments with abnormal thickening were classified by reversibility into reversible (REV) and irreversible (IRREV) groups. The proportions of function-recovered segments were compared between groups and also between 3 months and 17 months in each group. Results: A total of 129 segments were Included In the analysis, and 76 were REV and 53 were IRREV. At 3 months after CABG, 61 segments (80%) in REV group showed functional recovery while 28 segments (53%) in IRREV group did (p<0.001). However, at 17 months after CABG, 60 segments (79%) in REV group and 37 segments (70%) un IRREV group showed functional recovery (p=n.s.). When comparing 3 months and 17 months in each group, REV group showed no difference, while IRREV group showed significant further improvement (p<0.05). Conclusion: In viable myocardium with ischemic myocardial dysfunction, the segments with reversible perfusion impairment recover function earlier after revascularization than irreversible segments.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.149-152
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• 2014

Purpose: At our hospital blood is collected from a patient before an imaging test, with the concern of any effect possible when a nuclear medicine imaging test and an in-vitro test are carried out at the same time. However, occasionally, the blood collection is performed after an imaging test, with the reasons that the patient is not properly guided or the patient doesn't follow the guide correctly. In that case, we prefer to gather blood again after a few days. The purpose of this study is not only to see whether there is any effect of an imaging test on the result of the in-vitro test performed with the blood collected after the imaging test, but also to study how many days waiting after each test is appropriate to take a blood sample, if the effect exists. Materials and Methods: From September to October 2013, blood were collected from 13 patients in our hospital regardless of age and sex each time before and after the injection of the radioactive isotope from the tests : PET-CT, Gated Myocardial SPECT, and DTPA GFR Scan. Considering a half-life, AFP, CA19-9, CEA, TSH, and T3 were carried out right after the blood collection. In case of an iodine therapy, blood were taken each time before and after taking radioactive iodine, and, after AFP, CA19-9, and CEA, the difference between them in consistency and in cpm were compared. Results: With 10 patients after the imaging tests and 3 patients after the iodine therapy, their serum cpm was over 10,000. Over time, the cpm decreased in accordance with the half-life ($^{18}F$ 110minutes, $^{99}mTc$ 6hours, $^{201}Tl$ 72hours, $^{131}I$ 7days). Between the two cases, one before and the other after the injection of the radioactive isotope, the cpm and the results of AFP, CA19-9, CEA, TSH, and T3 from three patients each test, PET-CT, Gated Myocardial SPECT, and DTPA GFR Scan, were very similar. In addition, in case of an iodine therapy, there was also not a meaningful difference in the cpm and the results of AFP, CA19-9, and CEA, from three patients in an iodine therapy, between the two cases, one before and the other after taking the radioactive iodine. Conclusion: In case a blood collection was performed after the imaging test which required a radioactive isotope injection, the cpm increased, differently according to the kind of the radioactive isotope. However, the results of the in-vitro tests like AFP, CA19-9, CEA, TSH, T3, etc were nearly not affected. As the result, it's considered that there will not be any significant effect also from other tests, as the result from the performed seven tests.

• The Korean Journal of Nuclear Medicine Technology
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• v.12 no.3
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• pp.214-221
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• 2008

Purpose: We make a qualitative analysis of whether Fusion SPECT/CT can find lesion's anatomical sites better than existing SPECT or not, and we want to show the usefulness of SPECT/CT through finding out effects of CT attenuation correction on SPECT images. Materials and Method: 1. The evaluation of fusion images: This study comprised patients who was tested $^{131}I$-MIBG, Bone, $^{111}In$-Octreotide, Meckel's diverticulum, Parathyroid MIBI with Precedence 16 or Symbia T2 from 2008 Jan to Aug. We compared SPECT/CT image with non fusion image and make a qualitative analysis. 2. The evaluation of attenuation correction: We classified 38 patients who was tested 201Tl myocardial exam with Symbia T2 into 5 sections by using Cedars Sinai' QPS program - Ant, Inf, Lat, Septum, Apex. And we showed each section's perfusion states by percentage. We compared the each section's perfusion-states differences between CT AC and Non AC by average${\pm}$standard deviation. Results: 1. The evaluation of fusion images : In high energy $^{131}I$ cases, it was hard to grasp exact anatomical lesions due to difference between regions and surrounding lesions' uptake level. After combining with CT, we could grabs anatomical lesion more exactly. And in meckel's diverticulum case or to find lesions around bowels or organs with $^{111}In$ cases, it demonstrates its superiority. Bone SPECT/CT images help to distinguish between disk spaces certainly and give correct results. 2. The evaluation of attenuation correction: There is no significant difference statistically in Ant and Lat (p>0.05), but there is a meaningful difference in Inferior, Apex and Septum (p<0.05). AC perfusion at inferior wall in the 5 sections of myocardium: The perfusion difference between Non AC perfusion image ($68.58{\pm}7.55$) and CT corrected perfusion image ($76.84{\pm}6.52$) was the largest by $8.26{\pm}4.95$ (p<0.01, t=10.29). Conclusion: Nuclear medicine physicians can identify not only molecular image which shows functional activity of lesions but also anatomical location information of lesions with more accuracy using the combination of SPECT and CT systems. Of course this combination helps nuclear medicine physician find out the abnormal parts. Moreover combined data sets help separate between normal group and abnormal group in complicated body part. So clinicians can carry out diagnosis and treatment planning at the same time with a single test image. In addition, when we examine a myocardium in thorax where attenuation can occur easily, we can trust perfusion more in a certain region in SPECT test because CT provides the capability for accurate attenuation correction. In these reasons, we think we can prove the justice after treatment fusion image.

• The Korean Journal of Nuclear Medicine
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• v.39 no.1
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• pp.9-14
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• 2005

Purpose: Abnormal myocardial perfusion may be caused by ventricular preexcitation, but its location, extent, severity and correlation with accessory pathway (AP) are not established. We evaluated perfusion patterns on myocardial perfusion SPECT and location of AP in patients with WPW (Wolff-Parkinson-White) syndrome. Materials and Methods: Adenosine Tc-99m MIBI or Tl-201 myocardial perfusion SPECT was performed in 11 patients with WPW syndrome. Perfusion defects (PD) were compared to AP location based on ECG with Fitzpatrick's algorithm or electrophysiologic study and radiofrequency catheter ablation. Results: Patients had atypical chest discomfort or no symptom. Risk of coronary artery disease (CAD) was below 0.1 in 11 patients using the nomogram to estimate the probability of CAD. Coronary angiography was performed in 4 patients (mid-LAD 50% in one, normal in others). In 4 patients, AP localization was done by electrophysiologic study and radiofrequency catheter ablation (RFCA). Small to large extent ($11.0{\pm}8.5%$, range:$3{\sim}35%$) and mild to moderate severity ($-71{\pm}42.7%$, range:$-2l7{\sim}-39%$) of reversible (n=9) or fixed (n=1) perfusion defects were noted. One patient with right free wall (right lateral) AP showed normal. PD locations were variable following the location of AP. One patient with left lateral wall AP was followed 6 weeks after RFCA and showed significantly decreased PD on SPECT with successful ablation. Conclusion: Myocardial perfusion defect showed variable extent, severity and location in patients with WPW syndrome. Abnormal perfusion defect showed in most of all patients, but it did not seem to be correlated specifically with location of accessory pathway and coronary artery disease. Therefore myocardial perfusion SPECT should be interpreted carefully in patients with WPW syndrome.

• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.122-126
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• 2014

Purpose: The new reconstruction algorithms (NRA) provided by vendor aim to shorten the acquisition scan time. Whereas depending on the installed version AutoQuant program used for myocardial SPECT quantitative analysis did not contain the normal data that NRA is applied. Thus, the purpose of this paper is to compare the results according to AutoQuant versions in myocardial SPECT applied NRA and half-time scan (HT). Materials and Methods: Rest Tl and stress MIBI data of total 80 (40 men, 40 women) patients were gathered. Data were applied HT acquisition and ASTONISH (Philips) software which is NRA. Modified autoquant of SNUH and old version of AutoQuant (full-time scan) provided by company were compared. Comparison groups were classified as coronary artery disease (CAD), 24 hrs delay and almost normal patients who have a simple pain patient. Perfusion distribution aspect, summed stress score (SSS), summed rest score (SRS), extent and total perfusion deficit (TPD) of each 25 patient who have above diseases were compared and evaluated. Results: The case of CAD, when using re-edited AutoQuant (HT) SSS and SRS showed about 30% reduction (P<0.0001), Extent showed about 38% reduction and TPD showed about 30% reduction in the tendency (P<0.0001). In the score of the perfusion, especially on the part of infero-medium, infero-apical, lateral-medium and lateral-apical regions were the biggest change. The case of the 24 hrs delay patient SRS (P=0.042), Extent (P=0.018) and TPD (P=0.0024) showed about 13-18% reduction. And the case of simple pain patient, comparison of 4 results showed about 5-7% reduction. Conclusion: This study was started based on expectation that results could be affected by normal patient data. Normal patient data is possible to change by race and gender. It was proved that combination of new reconstruction algorithm for reducing scan time and analysis program according to scan protocol with NRA could also be affected to results. Clinical usefulness of gated myocardial SPECT is possibly increased if each hospital properly collects normal patient data for their scan acquisition protocol.

• The Korean Journal of Nuclear Medicine
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• v.27 no.2
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• pp.218-222
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• 1993

Lung/heart uptake ratio (L/H R) in $^{201}Tl$ myocardial perfusion scan is a reliable marker for long-term prognosis in patients with coronary artery disease. However, the value of L/H R in $^{99m}Tc-MIBI$ myocardial perfusion scan is controversial in determining the prognosis and severity of the coronary artery disease. The purpose of this study was to determine the clinical implications of L/H R in $^{99m}Tc-MIBI$ myocardial perfusion scan. Forty five patients who received $^{99m}Tc-MIBI$ myocardial perfusion scan were divided into control group and coronary artery disease (CAD) group by their clinical findings, EKGs, and $^{99m}Tc-MIBI$ myocardial perfusion scans. Twenty five patients in CAD group were divided into ischemic group and infarct group according to their results from $^{99m}Tc-MIBI$ myocardial perfusion scan. L/H R was calculated on the anterior planar view, 60 minutes after infusion of dipyridamole. Two regions of interest (ROI) were placed on the left lung area 8 pixel above the left ventricle and on the myocardial area which had the highest radioactivity. In the control group, there were no significant differences of L/H R according to sex and age. No significant difference of L/H R was found between the control and CAD group ($0.26{\pm}0.06,\;0.29{\pm}0.05$, p>0.05). In the CAD group, there was also no significant difference of L/H R between the ischemic group and infarct group ($0.29{\pm}0.07,\;0.30{\pm}0.04$, p>0.05). L/H R in CAD group did not show correlations with the defect area of stress polar map (r=0.18, p >0.05) and with the sum of severity weighted extent score or reversibility score which represent severity and extent of myocardial perfusion defect area in stress (r=0.18, p>0.05). We conclude that it is difficult to use L/H R as a marker for severity of CAD in dipyridamole $^{99m}Tc-MIBI$ myocardial perfusion scan.

• Journal of Food Hygiene and Safety
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• v.18 no.4
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• pp.195-201
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• 2003

An easily available, simultaneous identification/determination procedure for sildenafil, homosildenafil, tadalafil, vardenafil in adulterated health related foods was established by using a combination of three different analytical methods; thin layer chromatography(TLC), liquied chromatography-mass spectrometry (LC/MS) and high-performance liquied chromatography (HPLC)/photo-diode-array detector. The sample solution for TLC was applied to silica gel 60 $F_{254}$ plates with ethylacetate/acetonitrile/25%ammonia (90:10:5) as a developing solvent. Spots were located under UV radiation at 254 nm and dragendolfs reagent. Mass spectra of the compounds by LC/MS were investigated with electrospray ionization (ESI) interface, under positive ion mode. The HPLC analysis was performed on a column of capcell pack $C_{18}$ (UG120, 4.6${\times}$250mm I.D. 5 ${\mu}$m)with 0.1% sodium 1-hexansulfonate (in 0.1% phosphoric acid)/acetnitrile (73:27) as a mobile phase, and effluent was minitored with a photo-diode-applied to commercial foods, Sildenafil content was inthe range of 0.4mg/g~360.9 mg/g from 7 out of 35 samples. Homosildenafil content was in the range of 2.2 mg/g~336.0 mg/g from 7 out of 35 samples. Tadalafil content was 429.3 mg/g, 9.6 mg/500 mg from 2 out of 35 samples. The procedure described here is available for the screening of sildenafil, homosildenafil, tadalafil, vardenafil.