November 2015 Spotlight

President’s Message - ACNM Travel Awards Endowment Campaign
Rathan Subramaniam, MD, PhD, MPH, FACNM
Let’s give generously to the future of Nuclear Medicine……Thanksgiving and Christmas are around the corner and ACNM, in partner with Education and Research Foundation for Nuclear Medicine and Molecular Imaging (ERF), is launching an end of year endowment campaign to raise $ 100, 000. The interest derived from this endowment fund will sponsor 10 travel awards each year to the ACNM annual scientific meeting, to support trainees, practicing nuclear medicine physicians and scientists. We urge 100% of our trainees, members and fellows to donate to this endowment fund, however small, you can afford. This is an investment in our future. (Read more)…..

ACNM Membership Renewal
Thank you for your continued support of the American College of Nuclear Medicine (ACNM). Because of your dedication and involvement I am pleased to report that full ACNM memberships and resident memberships in the Nuclear Medicine Residents Organization (NMRO) are at their highest levels in five years. These numbers help to reinforce the promising future of nuclear medicine and molecular imaging, and the essential role ACNM plays as the only organization focused exclusively on the needs of nuclear medicine physicians, pharmacists and scientists. (Read more)…..

ABNM and ABR Agree: Joint Task Force Proposal Will Not Move Forward  
In a letter sent on November 6 to ABNM diplomates, ABNM Chair Louise E. J. Thomson MBChB announced: The ABNM and the ABR have decided not to move forward with the proposals in the joint statement sent to stakeholders in April 2015.  The boards’ decision was based on stakeholder feedback from the nuclear medicine community indicating absence of the broad support needed to move forward successfully.   The attached letter explains the reasons for the decision in more detail.  (Read more)…..

Submit Your Abstract for the ACNM Annual and SNMMI Mid-Winter Meeting
Attention young professionals—including those in training (residents, physicians, nuclear pharmacists, or scientists) or in practice within 10 years of graduation—abstracts are now being accepted for the ACNM Annual Meeting and SNMMI Mid-Winter Meeting, January 28-31, 2016 in Orlando, Florida. (Read more)…..

ACNM Editorial Fellowship Award
Pareen A. Mehta, MD received the 2016 ACNM Editorial Fellowship Award. This Fellowship includes a $1,000 award provided through funding by the Education and Research Foundation for Nuclear Medicine and Molecular Imaging (ERF).  The ACNM Editorial Fellowship is designed to provide, a young professional in nuclear medicine, with 12 months of first-hand experience with scholarly publication and editorial processes. Dr. Mehta will spend a year under the guidance of the current Editor-in-Chief of Clinical Nuclear Medicine and will also have the opportunity to work directly with the editors of The Scintillator, The Scanner, ACNM Spotlights, and Clinical Nuclear Medicine.

ACNM Leadership and Health Policy Fellowship Award
Ashley Prosper, MD received the 2016 ACNM Leadership and Health Policy Fellowship Award. The Fellowship includes a $250 award provided through funding by the Education and Research Foundation for Nuclear Medicine and Molecular Imaging (ERF).  The fellowship will offer a first-hand experience in the process of leading a professional society and health policy development.

Q&A with Dr. Jaideep Sohi Regarding Managing Teleradiology with a Focus on Cardiac Scintigraphy
Twyla Bartel, DO, MBA, FACNM
Interviewer: Dr. Sohi, please give us a brief background as to why you decided to pursue this route of managing a business related to teleradiology, and particularly, tell us briefly about your own business. (Read more)…..

Myocardial Perfusion Imaging (Rest & Stress) and (Treadmill & pharmacologic testing)
Mickaila Johnston, MD1, Kathleen Love, MD2, and Michael Starsiak, MD1
Background: Our lifetime risk of developing clinically significant coronary artery disease (CAD), at 40 years old, for women is 33% and for men is 50%.  (CAD) is estimated to cost the US $109.9 billion/year.  Approximately 25 percent of patients die of sudden cardiac death without prior symptoms.  Heart disease is the leading cause of death in the US accounting for nearly 1:4 deaths.  (Read more)…..

Myocardial Perfusion Scintigraphy and the Use of Prior CT Imaging
Pareen Mehta, MD
Myocardial perfusion scans remain a vital component in the evaluation of chest pain, coronary artery reserve and risk stratification.  Normal perfusion scans indicate a very low risk for an adverse cardiac event in the next two years, even in higher risk patients. Patients with matching perfusion defects in the resting and stress states may have an area of infarction or hibernating myocardium. Stress-induced defects, on the other hand, typically represent an area of myocardial ischemia. Accuracy in these patients is paramount in order to identify which patients should undergo further evaluation and possible therapy with coronary angiography, and which patients should be optimized with medical management. (Read more)…..

Coronary Artery Calcium Scoring: An Educational Review
Dr. Lorraine E. De Blanche, MD with editing by Dr. Twyla Bartel
Introduction: Coronary artery disease (CAD) remains the main cause of mortality in the Unites States. In addition, CAD also results in a large economic burden from impairment and treatment of those patients who survive the acute event. Rumberger et al1 in 1995 compared the coronary artery calcium and the burden of plaque at autopsy. They found that coronary artery calcium is a specific marker for atherosclerosis. The development of a scoring system based on computed tomography has become a useful tool in assessment of asymptomatic and intermediate risk patients.2  This coronary artery calcium scoring (CAC) has also been proven to be very helpful in patients with high risk for CAD, where other scoring systems have not been accurate enough to guide intervention. (Read more)…..

Equilibrium Gated Blood Pool Studies
Chiayi Ni, MD, Gholam R. Berenji, MD
MUGA (multigated acquisition) scan or radionuclide ventriculography (RVG) is a non-invasive diagnostic imaging method for analyzing global and regional ventricular function. This article briefly reviews the application of MUGA in clinical practice.
Two commonly used methods are briefly discussed below:
1. First Pass study
2. MUGA or RVG  (Read more)…..

Brief Summary of Cardiac PET
Tracy L Yarbrough, MD, PhD and Twyla B Bartel, DO, MBA, FACNM
Over the past several years, the literature has increasingly stressed the value of myocardial perfusion imaging (MPI) with positron emission tomography (PET). Its superiority in patients after an indeterminate or unsatisfactory 99m-Technetium sestamibi SPECT (single photon emission tomography) study has now been well-established, in that PET myocardial perfusion imaging (PET MPI) affords good prognostication, improved patient throughput, higher reader certainty, and lower patient radiation dose, among other benefits. (Read more)…..

Cardiac MRI
Yuxin Li, MD, PhD, Gholam R. Berenji, MD
Cardiac magnetic resonance imaging (MRI) is a well-established and evolving imaging modality with an expanding range of clinical indications.  It is considered as a comprehensive cardiac imaging technology which can evaluate cardiac morphology, function, perfusion, viability, blood flow, coronary arteries, and other major vessels.  The lack of ionizing radiation with a wide range of applications has made it an ideal imaging modality for the heart, particularly in pediatrics.  Despite of these advantages, cardiac MRI has not been used vastly in the clinical setting.  Echocardiography, SPECT myocardial perfusion, and angiography remain the mainstream imaging modalities in most institutions.  The drawbacks of cardiac MRI include limited availability of equipment and appropriately trained staff, higher costs and reimbursement issues, prolonged imaging times, and patient safety and compliance.  The imaging applications and techniques available for cardiac MRI are still expanding and evolving.  There is no single cardiac MRI acquisition protocol that is suitable for all clinical settings.  It is important for the technologists and physicians to be familiar with imaging protocols and choose the right technique. (Read more)…..

10 Interesting Articles on Radionuclide Cardiac Imaging
Saabry Osmany, MD
1. Am J Cardiol. 2015 Sep 3. pii: S0002-9149(15)01852-4. F-18-Fluorodeoxyglucose Positron Emission Tomography-Guided Sampling of Mediastinal Lymph Nodes in the Diagnosis of Cardiac Sarcoidosis.; Simonen P et al. A retrospective study of 68 patients 57 of whom underwent FDG PET/CT for cardiac sarcoidosis. 39 had extra cardiac sites of FDG uptake, 38 in mediastinal nodes. 24 patients (20 with prior nondiagnostic endomyocardial biopsy) underwent sampling of FDG positive nodes and all 24 were positive for diagnostic noncaseating granulomatous inflammation. (Read more)…..

International Classification of Diseases revision 10 (ICD-10)
GR Berenji, MD
On October 1st, 2015, CMS mandated all claims submitted using ICD-10 instead of ICD-9. The change had been proposed several years ago, but had been postponed a few times out of concerns about its impact on medical community. This short article briefly reviews ICD as a standard with a more focused coverage of ICD-10. (Read more)…..

Using Myocardial Perfusion Imaging Appropriately to Avoid Financial Penalties
Erica J. Cohen, DO, MPH
It is not uncommon for nuclear medicine practices to receive requests for imaging studies that are inappropriate for specific patient diagnosis, contraindicated, redundant, poorly timed, or otherwise unnecessary. This results in an increased cost of medical care, increased radiation dose to patients, increased patient wait times, inconvenience for patients who travel long distances, and physician distractions from clinical care to administrative work. (Read more)…..

Nuclear Medicine in Singapore
Saabry Osmany, MD, FACNM
Nuclear medicine is one of the recognized 35 medical specialties in Singapore. In Singapore the scope of nuclear medicine includes radionuclide therapy, planar radionuclide imaging, radionuclide imaging with positron emission tomography (PET/CT or PET/MRI), neck ultrasound and bone densitometry. Most practitioners work in a hospital setting with the largest being Singapore General Hospital (SGH) with a few working in a non-hospital based setting. Most of the specialist physician training for nuclear medicine in Singapore is at SGH while the National University Hospital (NUH) of Singapore also has a nuclear medicine training program. (Read more)…..

Answer to September 2015 Case of the Month
The case involved a 55 year-old male with recently resected cutaneous melanoma of the left cheek.  Asked previously were what the findings were and/or what other information was needed for a diagnosis?  The answer/key to the case was requesting an additional view to assist in localization of the sentinel node. Please click here for entire case.  

November 2015 Case of the Month
A 60 year-old male with moderate risk factors for cardiovascular disease and an incident of chest pain presents for myocardial perfusion imaging in your Nuclear Medicine department.  What is the most likely cause of the findings in the inferolateral wall? Please click here for images. 

Nomination for ACNM Fellow
ACNM is seeking outstanding candidates for to be nominated as fellows in the year 2016.
Please review the eligibility information and fill out the application and send it along with two recommendation letters from current ACNM fellows to: American College of Nuclear Medicine c/o Fellow Application - Nikki Wenzel-Lamb. For additional information, please contact Nikki Wenzel-Lamb at 703-652-6766 or by email at acnm@acnmonline.org. The deadline for fellowship nomination is December 1, 2015.  (Read more)…..

Nomination for Annual Mentorship Award
ACNM is currently accepting applications for the Mentor Awards. The deadline is for the 2016 award is December 1, 2015. ACNM values the outstanding ACNM mentors who have assisted the residents/ fellows to achieve their goals throughout the past year. The NEW ACNM Best Mentor Awards for Best Clinical and Best Personal Mentor Awards are given to exceptional individuals who have dedicated their lives to mentoring others. (Read more)…..

Education Committee Update
Twyla Bartel, DO, MBA, FACNM
The last of our new 2015 ACNM-SNMMI Joint Webinar series was given by Shana Elman on Nuclear Imaging of Cardiac Sarcoidosis, our first with SAMS.(Read more)…..

Editor’s Corner
Simin Dadparvar, MD
This issue celebrates Spotlight’s 1st Anniversary. This year has been incredibly productive thanks to editors and many contributors who worked tirelessly to make it possible. Your input by clicking on the article will let us know if the article was read or not (as we are collecting data on for this). Please make recommendations for future topics of your interest, or if you would like to participate, please send your e-mail to: sdadparvar@gmail.com (Read more)…..

Editors and Contributors:
Editor in Chief: Simin Dadparvar, MD

Co-editors and Contributors:
Twyla Bartel, DO, MBA
Golam R. Berenji, MD
Erica Cohen, DO, MPH
Lorraine E. De Blanche, MD
Mickaila Johnston, MD
Yuxin Li, MD, PhD
Kathleen Love, MD
Pareen Mehta, MD
Chiayi Ni, MD
Saabry Osmany, MD
Michael Starsiak, MD
Rathan Subramaniam, MD
Tracy L. Yarbrough, MD, PhD