Nuclear medicine in multiple myeloma -- more than diagnosis

Multiple myeloma (MM) is a neoplastic monoclonal proliferation of plasma cells, mainly involving bone marrow. To properly stage and manage patients with MM the clinician needs, at first, a complete skeletal survey, being more rarely present also extra skeletal locations. Today none of the available diagnostic imaging methods is able alone to answer to all the questions regarding staging, treatment, and follow up. Continuing to be alive the role of traditional radiology, implemented information can be added by CT and MRI. Concerning nuclear medicine, bone scintigraphy is affected by its low sensitivity. Tc-99m MIBI has been proposed in staging and in follow up, with most relevant clinical information deriving from the correlation of its whole body uptake's distribution with extent and activity of the disease. The prognostic value of MIBI has also been demonstrated. PET-FDG has been proposed in MM for its ability to detect whole-body metabolic active disease, giving relevant information in staging and prognosis. First studies have demonstrated that PET-FDG is more sensitive than other imaging modalities for localizing extra medullary sites of disease.     

Nuclear medicine in Europe: education

The technical developments that have taken place in the preceding years (PET, hybrid imaging) have changed nuclear medicine. The future cooperation with radiologists will be challenging as well as positioning nuclear medicine in an European context. It can also be expected that education in nuclear medicine will undergo a harmonization process in the states of the European Union. In this paper, we describe how nuclear medicine education is organized in several European countries. We aim to stimulate constructive discussions on the future development of the specialization in nuclear medicine in Germany.     

Nuclear medicine and the environment: radiation interactions

The effect of radiation interactions on the environment may be considered from the perspective of the purely physical phenomena occurring or from the effects the interactions produce in organized biological systems. The physical processes by which radiation interacts with the environment are quite well defined. Although these processes differ depending upon the nature (either electromagnetic or particulate) of the primary radiation, the ultimate result is the production in the medium of high-speed, secondary charged particles. Some of the energy of these particles is absorbed by the medium, while a portion may be lost as bremsstrahlung. The energy that is absorbed produces excitation and ionization, which can be disruptive to biological systems. The effects produced by ionizing radiations at the biochemical, cellular, and organ level are less well defined. Nevertheless, available data indicate that certain generalizations are possible. For example, given the ubiquitous nature of water in tissues, macromolecules, regardless of their structural types, tend to serve as acceptors of the energy and products of water radiolysis. However, a deeper insight into the consequences of irradiation requires an understanding of the interplay of such parameters as the type and energy of the radiation, and the dose and rate of its application. Furthermore, at the cellular level, the type and age of the irradiated cells, the concentration of oxygen in their environment, and their cell-cycle phase are all important factors in determining the consequences of irradiation.     

Nuclear medicine in the post-genomic era

The underlying precepts by which medicine operates will be changed forever by the elucidation of the human genomic sequence. The possibility of using limited forms of genetic engineering are present and beset by ethical considerations. However the use of genetic material in both aiding diagnosing disease and helping our understanding of disease processes is being rapidly diffused into clinical medicine. As the only method available for the study of function in vivo, Nuclear Medicine is ideally suited to act as a bridge between the work in the biotechnology laboratory and the patient. This short review will look at some of the issues raised by the this new horizon in medicine and how it will impact on our practice     

Nuclear medicine in Vietnam

Despite the presence of many bright Vietnamese nuclear medicine physicians and scientists, the level of clinical practice languishes seriously behind that of Europe, the United States, Japan and most other parts of the world. This is directly attributable to the country's severe poverty, which places serious constraints on the number of available pieces of functioning imaging equipment, the ability to service equipment and establish appropriate quality assurance and preventative maintenance programs and the ability to purchase adequate radiopharmaceuticals to serve their patients' needs. At this time, the Vietnamese nuclear medicine community is anxious to enhance its contact with colleagues throughout the world. They need and welcome help in obtaining instrumentation, in vivo and in vitro diagnostic kits and educational aids from outside agencies, commercial countries and medical centers that are able to assist them. They would be most appreciative to receive and encourage visits from professional colleagues who would be able to provide lectures, seminars, books, journals and other teaching tools that would contribute to the upgrading of their clinical practice of nuclear medicine.     

Nuclear medicine in Europe

A general view of nuclear medicine's present status and future trends in Europe is given. Nuclear medicine procedures, radiopharmaceuticals, annual examinations, equipment, quality assurance, management, and number of installations of gamma cameras, and computer systems in Europe are considered. Market trends are given. The role of nuclear medicine computer systems, hardware and software, is discussed. The situation of nuclear medicine in Europe, especially in the Federal Republic of Germany (FRG) with regard to economic and medical factors, is investigated.Presented in part at the International Conference: Diagnostic Imaging in Europe, Brussels/Belgium, October 22–23, 1979; Robert S. First Inc., New York-Brussels     

New and emerging concepts in travel medicine

The following article summarises the proceedings of the Travel Medicine Study Day run by the Haywood Club Tri-Service Medical Society at the Medical Society of London on 23 November 2006. The event was attended by over 50 serving and retired DMS personnel, including nurses, MSO's and medical officers and included talks on the historical contribution of the military medical services to the evolution of tropical medicine, the changing face of worldwide illness and insights into the behaviour of travellers that may increase their risk of illness.