nuclear medicine makes news at snm annual...

Nuclear Medicine Makes News atSNM Annual Meeting

World attention was directed toward the 51st An-nual Meeting of the SNM, June 19–23, at thePennsylvania Convention Center in Philadel-

phia. More than 4,000 nuclear medicine physicians,scientists, physicists, pharmacists, technologists, and in-dustry representatives attended the 4 days of special pro-grams, educational sessions, scientific presentations, andauxiliary events. In the exhibition hall, more than 2,000exhibitors and vendors showed their products and dis-cussed their work with attendees.

Working with a list of presenters prepared by theSNM Program Committee, Society staff and consultantsprepared a series of scientific press releases for distribu-tion at the meeting. Extensive coverage followed, includ-ing synopses on major broadcast networks and cable newschannels, in newspapers around the world, and on radionews. Among the foci of especially intense interest werethe potential benefits of new technologies; techniques forthe early diagnosis of Alzheimer’s disease (AD); ad-vanced imaging for the diagnosis, staging, and treatmentof cancer; nuclear cardiology; and growing collaborationbetween nuclear medicine and bioengineering. Thismonth, Newsline looks at a few of the presentations thatreceived international notice.

The Discriminating Power of PET/CTAntoch et al. from University Hospital Essen (Ger-

many) reported in a session on June 20 on the accuracy of

18F-FDG PET/CT in tumor staging in 260 patients with arange of oncologic disease (Fig. 1). All patients under-went PET/CT for staging, and designated reader teamssubsequently evaluated (using the TNM system) CT im-ages alone, PET images alone, and CT plus PET viewedseparately. The results were compared with the results offused imaging and with baseline references of histopa-thology and clinical follow-up. The authors found that218 patients (84%) were correctly staged with PET/CT,197 (76%) with side-by-side CT and PET, 163 (63%)with CT alone, and 166 (64%) with PET alone. Sensitivityand specificity for PET/CT were 92% and 93%, respec-tively, better than for any of the separate or side-by-side

An insider’s look at SNM 2004 in Philadelphia.

Figure 1. Sixty-eight–year old male with hepatocellular car-cinoma. On CT alone (left) a small lesion of the pericardiumwas not determined to represent thoracic disease. PET alone(center) demonstrated an area of increased glucose metab-olism falsely diagnosed as a pulmonary metastasis. FusedPET/CT datasets (right) accurately pointed the area of in-creased glucose metabolism to the small pericardial lesion.The pericardial metastasis was verified on follow-up.

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modality interpretations. The authors concluded that tumorstaging with PET/CT is significantly more accurate thanPET or CT alone or side-by-side display of images, a diag-nostic advantage that in this study translated into beneficialchanges in management for a number of patients. Antochnoted, “We are ecstatic with the results. Obviously, whendealing with all types of cancers, the sooner we can get to thetreatment the better. The new tumor imaging method usingthe integrated PET/CT will now allow doctors and patientsto get an earlier jump on the disease.”

On June 22, Namdar et al. from University Hospital(Zurich, Switzerland) presented an evaluation of PET/CTimage quality in coronary lesion anatomy and pathophys-iologic severity in a group of 25 patients with previouslydocumented coronary artery disease (Fig. 2). The additionof PET integrated with CT angiography was significant.Of the 15 false-positive coronary segments identified byangiography, 13 were correctly labeled as normal by PET.In the 14 lesions without patent bypass graft, PET re-vealed stress-induced ischemia in 7 lesions in 6 patients,thus relieving the 8 remaining patients of the financial andphysical burden of unnecessary revascularization. Ac-cording to Namdar, “ In the medical community, we arealways looking for new ways to approach old problems.Any time you can avoid invasive procedures withoutsacrificing accuracy or increasing risk, you’ re doing agreat service to the patient. In the case of the combinedPET/CT scanner, we have found a very accurate methodof diagnosing potential heart risks that is much easier onthe patient.”

While PET/CT applications in oncology continue toexpand, the fused modality is also gaining ground inimaging infection. Keidar et al. from the Rambam Med-ical Center presented results on June 21 on the use of18F-FDG PET/CT for the evaluation and differentiation oflocalized osteomyelitis adjacent to pedal soft-tissue infec-

tion in diabetic patients. Osteomyelitis occurs in up to onethird of diabetic foot infections, often as a result of directcontamination from a soft-tissue lesion. Early diagnosisand initiation of antibiotic therapy are essential in sparingthe limb. The study included 13 patients with diabeteswho underwent PET/CT imaging for suspected osteomy-elitis of the foot. PET/CT images were evaluated, as wereseparate PET and CT images, and the results were com-pared with definitive diagnoses at surgery or clinicalfollow-up. 18F-FDG uptake on PET imaging alone provedeffective in correctly identifying 8 patients with infection.PET/CT helped to refine these diagnoses in 5 patientswith uptake in bone (indicating osteomyelitis), as well asto identify the 3 patients in whom infection was confinedto soft tissue. The authors concluded that PET is helpfulin imaging diabetes-related infection and that PET/CTadds a level of precise anatomic localization that canprove crucial in initiating early and effective therapy.Keidar told the press, “ If we can detect the precise loca-tion of infection, the treatment strategy will be easier todefine. Our study shows how advances in imaging tech-nology can directly affect patient care and make a bigdifference for patients with complications of diabetes.”

Wide Range of PET TopicsInfection was also the focus of a study reported in a

poster session by Fukuchi and Ishida from The NationalCardiovascular Center (Osaka, Japan). The team investi-gated the use of 18F-FDG PET in the differentiation ofinfected from noninfected vascular grafts. The study in-cluded 15 patients, some with suspected infected graftsand others with stable, noninfected grafts. Diagnosesbased on PET were compared with final diagnoses basedon surgical results or clinical follow-up. PET successfullyidentified inflammatory foci in all 7 patients with infec-tion. Fukuchi noted, “ Infection of vascular prostheticgrafts remains a major surgical challenge, because it canbe reduced but not eradicated by avoiding risk factors andby applying antibiotic therapy.” PET studies appear toaccurately, safely, and specifically diagnose graft infec-tion and facilitate the timely initiation of appropriatetherapy.

In a report that received the international media cov-erage at the SNM annual meeting, Wang et al. of the U.S.Department of Energy’s Brookhaven National Laboratory(Upton, NY) reported on the use of 18F-FDG PET toelucidate the functional neurologic connections betweenhunger and the stimulating presence of food. The studyincluded 12 healthy individuals, in whom brain responsewas measured in 3 different situations: food stimulation,neutral stimulation, and no stimulation. Before each sit-uational testing (on separate days), participants were fooddeprived for 18 hours. Participants’ regional brain meta-bolic activities were assessed by PET when presentedwith food (visual, olfactory, auditory, and gustatory dis-play of food), when presented with non-food-related

Figure 2. Visualizing the coronary artery tree with PET/CT.The narrowed coronary artery indicated is reducing bloodflow to the heart muscle it serves, demonstrated by areas ofreduced perfusion shown in blue.

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14N THE JOURNAL OF NUCLEAR MEDICINE • Vol. 45 • No. 9 • September 2004

items, and at baseline with no stimulation. Restraint,disinhibition, and hunger factors were scored separatelyand correlated with metabolic activity. The authors foundthat food stimulation significantly increased brain meta-bolic activity. According to Wang, “ individuals for whomfood is more reinforcing have to rely more on cognitivecontrol to not eat when they have the desire to eat. Ourresults showed that people who have higher metabolicchanges in the left ventral striatum of the brain duringfood stimulation need more cognitive restraint; in otherwords, for those who are more sensitive to food stimula-tion, it is more difficult and takes more effort to diet.” Headded, “ if we know how the brain reacts to food andhunger, we can figure out what occurs chemically duringperceived abnormal responses. The hope is that, if weunderstand the brain’s chemical response to food, then wewill be able to manage things like eating disorders andfind new and innovative treatment options.”

On June 22, Tawakol et al. from Massachusetts Gen-eral Hospital (Boston, MA) reported on the use of 18F-FDG PET in imaging carotid plaque and providing anoninvasive index of inflammation. The study included 9patients with moderate-to-high-grade carotid stenosiswho underwent PET imaging that was coregistered withcarotid MR studies. In each patient, standard uptake val-ues (SUVs) were assessed for assigned quadrants every2.5 mm along the length of the carotid plaque. Plaquetracer uptake was reported as a ratio of plaque to sepa-rately measured blood SUV. Results were compared withhistologic examination of carotid specimens collectedduring endarterectomy within 1 month of imaging. Theresults revealed a high correlation of 18F-FDG uptake onPET with the degree of plaque inflammation. “This is thefirst time FDG PET imaging has been used to provide anindex of vascular inflammation in human subjects,” saidTawakol. “The potential applications of the study arenumerous. Obviously, early detection and better charac-terization of carotid plaque could enhance our ability tocombat stroke. We also anticipate that the FDG-PETmethod could be used to test plaque-stabilizing drugs.Moreover, we hope that a similar method might be de-veloped to detect coronary artery disease in the future.”

PET continues to be a focus of efforts assessingmethods to definitively detect and quantify progression inAD (Fig. 3). On June 22, Kepe et al. from the Universityof California at Los Angeles–David Geffen School ofMedicine reported on PET studies to establish patterns ofbinding distribution of 18F-FDDNP as an in vivo measureof AD pathology progression. The study included 13patients diagnosed with AD and 10 control subjects. Allindividuals underwent both 18F-FDDNP PET and 18F-FDG PET imaging. Regional SUVs for 18F-FDDNP werefound to be elevated in the medial temporal lobe, parietallobe, and prefrontal area in patients with AD comparedwith control participants. 18F-FDG PET imaging for theAD patients showed parallel decreases in glucose metab-

olism in temporoparietal regions and correlated well withthe increased global 18F-FDDNP binding also observed inthese patients. These observations were in agreement withknown patterns of post mortem pathology reported in theliterature. The authors concluded that “All tested mea-sures of 18F-FDDNP binding very well separate AD andcontrol populations, which, together with the pattern ofthe binding distribution, gives a very good indication ofdisease involvement.” Kepe told the press, “This opensopportunities for the use of PET with 18F-FDDNP, notonly for possible diagnosis in early stages of the diseasebut also for testing the effects of future experimentaldrugs developed to prevent lesion formation and for mon-itoring the effects of the drugs aimed at removing thelesions.”

Predicting OutcomesThe ability of nuclear imaging to accurately stage

oncologic disease is being rapidly expanded to include theprediction of outcomes after surgery and to a range ofpotential therapies. Outlining what some press coveragedescribed as “crystal ball” capabilities, Eschmann et al.from the University of Tubingen (Germany) reported onJune 21 on the prognostic effect of 18F-fluoromisonidazol(18F-MISO) PET in the management of patients withnon-small cell lung cancer (NSCLC) and head and neckcancer (HNC). The study included 31 patients (NSCLC �20; HNC � 11) who underwent both dynamic and staticPET scans at 2 and 4 hours after injection of 400 MBq18F-MISO. All patients were scheduled for curative radio-therapy. PET data were correlated with clinical follow-up

Figure 3. Representative examples of 3 PET scans per-formed in a patient with Alzheimer’s disease (AD) (upper row)and in a cognitively normal control subject (lower row). Thepatient with AD has decreased glucose metabolic rate(�20%) in the temporal lobe (middle column) and decreasedserotonin 1A receptor density (50%–60%) in the hippocampiindicative of significant level of cell loss in those regions (rightcolumn); in contrast, 18F-FDDNP binding is elevated in allcortical areas demonstrating presence of neurofibrillary tan-gles and senile plaques (left column).

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(available on 19 patients only). The authors found thatuptake values for the tracer were nondiagnostic at 2 hoursafter injection but that uptake values at 4 hours afterinjection clearly separated those patients who would ex-perience local recurrence from those who would not.Tumor-to-muscle ratios (TMRs) assessed at 4 hours afterinjection also correlated with the risk of relapse. Nopatient with a TMR � 1.4 (n � 3) presented with tumorrecurrence, whereas 50% of patients with TMRs of 1.4–2(n � 6) and 90% of patients with TMRs � 10 (n � 10)experienced recurrence. The authors concluded that theresults of radiotherapy can be predicted in this group ofpatients on the basis of the kinetic behavior of 18F-MISOin tumor tissue and that accumulation, high uptake, andhigh TMR are highly suggestive for an incomplete re-sponse to treatment. Eschmann said, “Should this tech-nique become standard practice—using 18F-MISO PETimages to predict the possible recurrence of tumor—thentreatment methods can correspond to prognosis. We be-lieve that 18F-MISO PET represents a valuable tool forpatient discrimination. Patients with increased risk ofrelapse may be introduced to an intensified therapeuticregimen.”

SPECT was featured in a study to predict clinicalresponse of adult patients with attention deficit hyperac-tivity disorder (ADHD) to methylphenidate (MPH;Ritalin) treatment (Fig. 4). On June 22, la Fougere et al.from the University of Munich (Germany) reported on astudy designed to determine whether the degree of bind-ing of 99mTc-TRODAT-1 to striatal dopamine transporterscould predict response to MPH as measured by the Clin-ical Global Impressions (CGI) scale before and aftertreatment. Because 20%–30% of patients with ADHD do

not respond to MPH therapy, a method of predictingtherapeutic response would eliminate unnecessary medi-cation and facilitate the initiation of alternative therapies.The study included 18 adult patients, 13 of whom showedhigh levels of dopamine transporter binding. Of these, 12showed significant improvement of symptoms after initi-ation of MPH therapy. None of the 5 patients who showedreduced uptake was seen to improve with MPH. Accord-ing la Fougere, “Our results indicate that measurement ofdopamine transporter may be an important prognosticpredictor for therapeutic response to Ritalin. If we candetermine who will respond to the drug and who will notrespond, then only those patients who will benefit will betreated.”

Targeted and Genetic TherapiesThe role of external radiation beam therapy in mantle

cell lymphoma has been limited by the systemic nature ofthe disease. Radioimmunotherapy (RIT) offers a promis-ing alternative, but one that must be carefully coordinatedwith chemotherapeutic regimens. On June 22, Divgi et al.from the Memorial Sloan–Kettering Cancer Center (NewYork, NY) reported on a sequential regimen using tosi-tumomab (Bexxar) RIT for cytoreduction (to provideoptimal crossfire) followed by CHOP chemotherapy. Thestudy included 13 patients with untreated mantle celllymphoma who showed measurable disease with less than25% bone marrow involvement. Each patient underwent atositumomab/131I-tositumomab regimen followed 13–16weeks later by 6 cycles of CHOP. After all sequentialtreatments were completed, the overall response rate was75%. Of the 10 participants who finished all treatments, 9achieved a complete response. Side effects and toxicitieswere within acceptable limits. According to Divgi, “al-though further follow-up is necessary to determine if thisnovel therapeutic approach represents a treatment ad-vance in mantle cell lymphoma, the results of this par-ticular study—a 90% complete remission rate—wereoutstanding.”

A reversed sequential use of Bexxar was reported byKostakoglu et al. from the Weill Cornell Medical Centerand the Center for Lymphoma and Myeloma (New York,NY) and the Corixa Corporation (San Francisco, CA) onJune 22. This group looked at the efficacy of sequentialadministration of fludarabine followed by RIT with thetositumomab/131I-tositumomab regimen in patients withuntreated non-Hodgkin’s lymphoma (NHL). The studyincluded 38 patients with NHL (51% follicular mixed and49% follicular small cleaved). All but 1 patient werecategorized as having stage III or IV disease. All patientsunderwent 3 cycles of fludarabine therapy (3 patientsdropped out of the study during this phase). The responseto fludarabine among the remaining patients was 89%(3 complete responses, 28 partial responses). After

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Figure 4. Attention deficit hyperactivity disorder (ADHD)patients who demonstrated high levels of dopamine trans-porter molecules in the brain responded better to therapywith methylphenidate, a dopamine transporter-blocking drug,than those with low binding values. Measurement of dopa-mine transporter levels may be useful in predicting whichADHD patients will respond to treatment with methyl-phenidate.

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Michael J. Welch ReceivesCassen Award

Michael J. Welch, PhD, codirector of the Divisionof Radiological Sciences at Washington Univer-sity’s Mallinckrodt Institute of Radiology (St.

Louis, MO) and head of the institute’s RadiochemistryLaboratory, was presented with the 2004 Benedict CassenAward at the SNM Annual Meeting on June 22. Thebiennial honor, given by the Education and ResearchFoundation for the SNM, is awarded to a living scientistor physician-scientist whose work has led to a majoradvance in basic or clinical nuclear medicine science.

Donated by the estate of Mary Wylie Cassen, theaward honors Benedict Cassen, whose invention of therectilinear radioisotope scanner—the first instrument ca-pable of making an image of a body organ in a patient—was seminal to the development of clinical nuclear med-icine. Welch’s highly regarded work on rapid synthesis ofpositron-labeled organic chemicals was of vital impor-tance in the development of PET at Mallinckrodt Institutein the early 1970s and in the technology’s subsequentapplication to diagnostic medicine. “It is a great honor forme to receive the Cassen Prize,” said Welch. “Although Iam the 6th awardee of the prize, I am the first ‘syntheticchemist’ to be so honored. I believe that the synthesis ofnew radiopharmaceuticals is one of the cornerstones ofnuclear medicine and will continue to be so into theforeseeable future. The expansion of our field will dependupon the continued development of novel agents for themolecular targets being discovered today and in the fu-ture.”

Welch received his undergraduate and initial graduatedegrees from Cambridge University and earned his doc-torate in radiochemistry from the University of London in1965. Applying modern organic chemistry to the prepa-ration of radioactive elements used in medical imaging,

he developed rapid methods to synthesize positron-labeled organic chemicals, a process essential in makingPET into a practical clinical modality. In the late 1980s,he and colleagues demonstrated that PET scans usingradiolabeled estrogen could locate human receptors forthe hormone. Subsequent PET studies with radiolabeledcompounds provided a rapid and sensitive way to studybiological processes in the nervous system. These andother efforts also helped PET gain acceptance for detect-ing breast and other cancers and for making beneficialchoices in patient management.

The National Institutes of Health (NIH) recently ex-tended the funding mechanism for “Cyclotron-ProducedIsotopes in Biology and Medicine,” which, at 44 years, isamong the longest continuously renewed NIH researchgrants. The grant has been extended for another 5 yearswith an additional $11 million in funding. Welch has beena principle investigator since 1979.

Additional current research at Mallinckrodt involvesradiolabeling agents that can be utilized to assess thereceptor status of breast tumors, the preparation of otherligands with higher binding affinity for greater contrast inimaging, and the application of microwave heating toincrease the rate of chemical reactions leading to radio-labeled compounds. Welch’s group is also investigatingthe potential for both diagnosis and therapy with metalradionuclides.

Welch was elected to the Institute of Medicine in1999 and was president of the SNM in 1984. Among hismany honors are the SNM’s Georg Charles de HevesyNuclear Medicine Pioneer Award (1992); the Paul C.Aebersold Award (1980); and the Berson–Yalow Award(1988, 1990); as well as the American Chemical Society’sSt. Louis (1988), MidWest (1991), and National (1990)Awards for Nuclear Chemistry. He has served for manyyears on the editorial board ofThe Journal of NuclearMedicine.

Past recipients of the Cassen Award have includedHal O. Anger, DSc (1994), for his invention of the scin-tillation camera; David E. Kuhl, MD (1996), for hisdevelopment of emission reconstruction tomography andquantitative measurements of brain physiology; Henry N.Wagner, Jr., MD (1998), for his contributions to nuclearmedicine as a scientist, teacher, and clinician; Gerald L.DeNardo, MD, and Sally J. DeNardo, MD (2000), fortheir work contributing to the development of radiola-beled antibodies and radioimmunotherapy; and MichaelE. Phelps, PhD (2002), for his involvement and work intranslating PET science into clinical medical practice.

Michael Devous (left) congratulated Michael Welch afterthe Cassen Lecture and award presentation.

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Aebersold Award Presentedto Hank F. Kung

Hank F. Kung, PhD, professor of radiology and phar-macology at the University of Pennsylvania (Phila-delphia), was presented with the 2004 Aebersold

Award for outstanding achievement in basic science appliedto nuclear medicine at the 51st Annual Meeting of the SNMon June 20 in Philadelphia. Kung is known for his work inthe development of radiopharmaceuticals. He was instru-mental in developing PET and SPECT imaging agents fordopamine and serotonin neurotransmitters, and his labora-tory group’s research activities cover a wide spectrum ofscientific disciplines including drug design, organic synthe-sis, radiochemistry, receptor pharmacology, pharmacokinet-ics, and PET and SPECT imaging.

“I am dedicating this award to my wife, Dr. Mei-PingKung, who is the real scientist in the family,” said Kung inaccepting the award. “She is the best-kept secret of my lab.I also want to thank the Society of Nuclear Medicine and mycurrent and former lab members. Especially, I want to thankDr. Robert Mach, professor of radiology, Washington Uni-versity, St. Louis, for his friendship and long-standing col-

laboration. Our work is built on the contributions of manycolleagues and collaborators around the world.”

The Aebersold Award is named for Dr. Paul C.Aebersold, a pioneer in the biologic and medical appli-cations of radioactive materials and the first director ofthe Atomic Energy Commission’s Division of IsotopeDevelopment at Oak Ridge, TN. The first AebersoldAward was given by the SNM in 1973.

Kung was trained as a medicinal chemist at the Schoolof Pharmacy, State University of New York at Buffalo. Afterpostdoctoral training under Monte Blau at Roswell Park Me-morial Institute, Kung joined the department of nuclear medi-cine at Roswell. He became a member of the department ofradiology at the University of Pennsylvania in 1987.

The work of the Radiopharmaceutical Chemistry groupat Penn covers an extraordinarily wide range of selectiveradiotracers and potential applications. The development of99mTc-TRODAT-1, the first site-specific dopamine transporter-binding agent, under Kung’s direction was widely heralded asa milestone in efforts to achieve both qualitative and quantita-tive imaging of neurodegenerative processes. The first use ofthe agent in human brain imaging was selected as the image ofthe year at the 1996 SNM annual meeting. The article on invivo characterization of the agent received the Springer awardfor the best science paper for the European Journal of NuclearMedicine (1997;24:372–380). Clinical studies have validatedthe use of the tracer as a diagnostic tool for Parkinson’s diseaseand other neurodegenerative diseases.

In the past decade, a number of new 123I-labeled neuro-receptor imaging agents for SPECT were developed inKung’s laboratory. Several have been or are being usedsuccessfully in clinical trials, including TISCH (D1 recep-tor); IBZM, IBF, and FIDA2 (D2 and D3 receptors); andIPT (dopamine transporter). The D2-imaging agent IBZM iscurrently available commercially in Europe, and the D2receptor-imaging agent IBF is being developed in Japan. InMarch of 2003, the first human study of 123I-ADAM, a newserotonin transporter tracer, was performed in the depart-ment by Dr. Andrew Newberg. The group reported on earlyresults of biodistribution and imaging with the agent in TheJournal of Nuclear Medicine (2004;45:834–841) earlier thisyear.

A look at the Web site of Kung’s group (http://sunmac.spect.upenn.edu) shows the range and scope of work in thelab, as well as the multidisciplinary nature of work thatcharacterizes the development of new tracers. Among thedozens of current research projects are the development ofimaging agents for �-amyloid plaque, imaging agents thattarget breast tumor cells, and research into cardiac neuronalfunctioning.

Hank Kung, PhD, and spouse, Mei-Ping Kung, PhD, withthe Aebersold Award at the Society of Nuclear Medicinemeeting in Philadelphia, June 20.

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Alavi Achievements Recognizedwith de Hevesy Award

Abass Alavi, MD, Professor of Radiology and Chiefof the Division of Nuclear Medicine at the Uni-versity of Pennsylvania Medical Center (Philadel-

phia), was named as the recipient of the 2004 GeorgCharles de Hevesy Nuclear Medicine Pioneer Award. Theaward was presented on June 20 during the first plenarysession at the SNM annual meeting in Philadelphia. Alaviwas chosen by Henry Royal, MD, then president of theSNM, for pioneering work that has contributed to theadvancement of nuclear medicine world wide.

Each year the SNM presents the de Hevesy award toan individual or individuals for outstanding contributionsto the field of nuclear medicine. de Hevesy, widely rec-ognized as one of the originators of the field of nuclearmedicine, was the author of several important books andpapers on radiochemistry and the recipient of the 1943Nobel Prize in Chemistry for his investigation of theabsorption, distribution, metabolism, and elimination ofradioactive compounds in the human body. This researchlaid the foundation of nuclear medicine as a tool fordiagnosis and therapy. “Dr. Alavi’s crowning achieve-ment has been his pioneering work in PET,” said Royal inpresenting the award. “We speak of molecular imaging,and PET specifically, as ‘the future,’ but he had theforesight to study PET images as early as the 1970s. Ifyou examine nuclear medicine you will find his name. It

is with great pleasure that we extend our congratulationsto Dr. Alavi on being awarded this prestigious honor.”

Alavi was born in Tabriz, Iran. The example of hispaternal grandfather, who practiced herbal medicine, in-spired him to enter the medical profession. The first in hisfamily to attend college, Alavi graduated from the Univer-sity of Tehran Medical School in 1964. He performed hisrequired military service as a member of the Shah’s NationalHealth Corps. As the only physician for the people of a smallmountain village, he often traveled on horseback to care forillnesses that ranged from measles to anthrax.

In 1966, Alavi arrived in the United States, wherehe served an internship and residency in medicine atPhiladelphia hospitals, earned a hematology/oncologyfellowship at Penn, and completed a 1-year residencyin radiology at Harvard University. He joined the PennSchool of Medicine in 1971 as a research fellow innuclear medicine and found his true professional call-ing while training in nuclear medicine under DavidKuhl, MD, who introduced him to SPECT and PET andbecame a lifelong inspiration and friend.

Today Alavi is an internationally recognized expertin advanced imaging techniques and the clinical appli-cations of PET imaging for the detection of cancer andother disorders, including dementia, seizures, cardio-vascular disease, and infection. In nuclear medicine, hehas enthusiastically pursued interests and activities intoareas as diverse as meditation, acupuncture, gene ther-apy, and angiogenesis, perhaps reflecting his broadexperiences early in his medical career in Iran. He hasintroduced novel techniques that have changed the faceof nuclear medicine, ranging from basic clinical proceduresto others involving sophisticated technologies, such as to-mography.

He has been a pioneer in transitioning PET fromresearch into clinical applications. Along with Kuhl andDr. Marcus Reivich, he was the first to perform braintomography and whole-body imaging with 18F-FDG inpatients in the early 1970s.

He has maintained a strong commitment to educationand trained hundreds of students and physicians from theUnited States and abroad. At the SNM meeting in Phila-delphia, Alavi’s group was ubiquitous, participating inmore than 60 scientific presentations and poster sessions.“This is all due to the efforts of my wonderful studentswho work in our group,” he explained. “I am very proudof the contributions of these young talents.” He is inconstant demand as a speaker and has delivered invitedlectures in more than 50 countries.

(Continued on page 52N)Jane and Abass Alavi with the Award winner’s mother atthe Awards ceremony.

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Devous Honored with 2004Kuhl–Lassen Award

Michael D. Devous, Sr., PhD, Professor of Radiologyat the University of Texas Southwestern MedicalCenter and Professor of Human Development and

Communication Sciences at the University of Texas atDallas, has been named as the recipient of the 2004 Kuhl–Lassen Award. The SNM Brain Imaging Council presentedthe award on June 20 at the SNM annual meeting.

The Kuhl–Lassen award recognizes scientists who havemade significant contributions to the field of functional brainimaging using SPECT or PET. The Brain Imaging Councilcreated the annual award to honor 2 founding pioneers infunctional brain imaging: David E. Kuhl, MD, and NilsLassen, MD. In praising the selection of the 2004 awardee,Kuhl said of Devous, “He has made great contributions toadvancing brain imaging science. At the same time, he hasbeen one of the very best teachers in the field. It is appro-priate that his peers chose to recognize him. Their selectionenhances the stature of the Kuhl–Lassen Award.”

“It is a great honor to be recognized by my peers whohave also contributed so much to this intriguing field of


Tetalman Award Goes to Zaidi

Habib Zaidi, PhD, is the recipient of the 2004 MarkTetalman Award of the SNM Education and Re-search Foundation (ERF). The award recognizes

outstanding achievement among young investigators innuclear medicine and is named after a young nuclearmedicine physician whose death ended a promisingcareer. Zaidi is senior physicist and head of the PETInstrumentation and Neuroscience Laboratory at GenevaUniversity Hospital (Switzerland). “The Tetalman Me-morial Award is beyond a tremendous honor, because itsubstantiates my choice of an academic career in thephysics of nuclear medical imaging,” said Zaidi.

He received a doctorate in medical physics from Ge-neva University for a dissertation on Monte Carlo mod-eling and scatter correction in PET. He is activelyinvolved in developing imaging solutions for biomedicalresearch and clinical diagnosis, in addition to lecturing ingraduate and postgraduate courses on medical physicsand medical imaging. His research is supported by theSwiss National Science Foundation and focuses on do-simetry, image correction, reconstruction and quantifica-tion techniques in emission tomography, and statistical

image analysis in functional brain im-aging. Most recently he has workedon novel designs for dedicated high-resolution PET scanners in collabora-tion with the European Organizationfor Nuclear Research (CERN).

Among the contributions citedby the ERF in honoring Zaidi werehis work relating to Monte Carlomodeling and image correction forPET, including the development of a Monte Carlosimulation package to generate datasets correspondingto the geometry and actual size of most commercial andprototype cylindrical PET scanners. This package hasbeen successfully implemented on a high-performanceparallel platform. His group is also pursuing researchon PET/CT simulation packages PET/CT and a newmethod for determination of the attenuation map in 3Dbrain PET imaging using coregistered MRI.

Zaidi’s research efforts have been recognized with theprestigious 2003 Young Investigator Medical Imaging


Masanori Ichise (left) presented Michael Devous with theKuhl-Lassen Award.

Habib Zaidi

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CASNM Annual Meeting

The Chinese American Society of Nuclear Medicine(CASNM) held its annual meeting on June 20,when about 100 participants gathered in Philadel-

phia at the time of the SNM annual meeting. TheCASNM event included an educational program, inwhich an invited lecture titled “Metabolic Response ofColorectal Metastasis after90Y Radioembolisation” waspresented by C. Oliver Wong, PhD, MD, from the Wil-liam Beaumont Hospital (Troy, MI). Also a part of themeeting activities was a user support session on “IntegralCardiac Applications of PET with Multislice CT Map-ping,” conducted by Jeff Kao, MS, GE Medical Systems.During the meeting, we had the honor of congratulatingand celebrating Dr. Hank F. Kung upon being the firstChinese American to receive the prestigious Paul C.Aebersold Award (2004) from the SNM.

CASNM was established in 1977 as a nonprofit, non-political organization with the objectives of encouragingprofessional contact among members all over the world,facilitating scientific exchanges in research and develop-ment, and promoting international interaction with regard tothe science of nuclear medicine with a special focus in theChinese community. The membership of CASNM is notrestricted to practitioners living in North America. We alsowelcome participants from Europe, Australia, Asia, andelsewhere to join our organization. The current president andsecretary/treasurer of CASNM are Joseph C. Hung, PhD,Mayo Clinic, and C. Oliver Wong, respectively. The nextannual meeting will be held in conjunction with the 52nd

annual meeting of the SNM in Toronto, Canada. For anyonewho is interested in learning more about CASNM, pleasevisit the CASNM Web site at www.casnm.org.

Joseph C. Hung, PhDMayo Clinic

Rochester, MNC. Oliver Wong, MD, PhD

William Beaumont HospitalRoyal Oak, MI

IASNM Annual Meeting

Nearly 90 members and guests attended the annualdinner and awards ceremony of the Indo-American Society of Nuclear Medicine (IASNM)

at the Passage to India restaurant on June 19 during theannual meeting of the SNM in Philadelphia, PA. TheIASNM Gopal Subramanian Life Time AchievementAward 2004 was presented to Dr. Diwakar Jain, a nuclearcardiologist at Drexel University in Philadelphia, PA. Aspresident of the IASNM in 1993, he led a delegation ofexperts to India and was responsible for a stellar scientificprogram at that year’s SNM(I) annual meeting.

Travel fellowships were awarded to a physician and ascientist from India to enable their attendance at thisyear’s SNM meeting. At the IASNM meeting, the bestabstract in the clinical sciences category was awarded toDr. Sandeep Basu from the Radiation Medicine Centre inBombay, and the best abstract in the basic sciences cat-

egory was awarded to Dr. Jaya Shukla from the All-IndiaInstitute of Medical Sciences in New Delhi. Awards to


At the CASNM meeting in Philadelphia (left to right): Drs.Chyng Yann Shiue (president, 1999–2001), Chris Pak(president, 1992–1993), Wei Chang (president, 1987–1988),Ban An Khaw (president, 1990–1992), Hank F. Kung (re-cipient of 2004 Paul C. Aebersold Award), Joseph C. Hung(current president), Samuel D. Yeh (president, 1981–1983),C. Oliver Wong (current secretary/treasurer), and Wei-JenShih (president, 1993–1995).

Dr. Diawkar Jain (left) received the Gopal SubramanianLifetime Achievement award from Dr. Chaitanya Divgi(right), as Dr. Sanjiv Gambhir looked on.

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From the SNM President

Toward the end of every annual meeting of theSNM, there is a change of guard. The president ofthe previous year becomes the immediate past

president, and the president-elect takes the helm as thepresident of this great organization. The president’s re-sponsibility is primarily fiduciary, but he or she must alsotake care of ongoing issues as well as create new initia-tives that may substantially influence the future of theorganization and better serve its membership. Twelvemonths may seem a long time, but in a democratic pro-cess that requires one to follow set channels this is a shortperiod in which to bring new initiatives to conclusion andfruition. For example, as president-elect, I initiated thecreation of a lifetime membership status in SNM, whichis seemingly advantageous both to members and to theSociety. It has been approved by the Board of Directors(BOD) at their June 2004 meeting but still requires abylaws change, review by the membership, and House ofDelegates (HOD) approval of revised bylaws before it canbe implemented. The next scheduled HOD meeting is notuntil the SNM Mid-Winter Meeting in January 2005.

During my term as the president-elect, I initiated theNational Radionuclide Availability Program. Now, aspresident I have initiated the Molecular Imaging TaskForce and the International Task Force, obtained fundsfor regularly sending 25 copies ofThe Journal of NuclearMedicine (JNM) to developing countries, and formed aPast Presidents Task Force as a think tank to supportcertain SNM activities. The initiatives identified throughthe SNM strategic plan will continue, and work will beginon the new goals identified by the BOD for this year. Allthese processes take time and effort to bring to fruition.None can be accomplished by one individual. It takes agreat deal of input from many experts and a great deal ofwork from administrative staff. Ours is a voluntary orga-nization. Demands on every expert’s time are extremelyheavy. Despite this, I feel fortunate that everyone I haveasked to do something within his or her expertise for theSNM cause has not only agreed but also actively contrib-uted toward accomplishing the goal. Our councils andcommittees are revitalized and have prepared their pro-active agendas for the coming year. I am very pleasedabout this and am grateful to them. The society is com-posed of its membership, BOD, HOD, committees, coun-cils, and chapters. Every single contribution in any shapeor form, every abstract written, every paper published,and every nuclear medicine–related lecture givenstrengthens our society.

We are continuously improvingour educational programs, perhapsone of the primary goals of our or-ganization. The annual meeting inPhiladelphia was a great success––socially,professionallyandcommer-cially. JNM, with an impact factorof 4.899, is now ranked third in theentire range of imaging periodicals.Our PET Learning Center and PETCenter of Excellence activities arecontinuously expanding. As a resultof our own efforts and those of otherorganizations, such as the Academy of Molecular Imaging,comprehensive reimbursement for Alzheimer’s disease isnow only a matter of time.

At the SNM annual meeting, the Food and DrugAdministration team, led by Dr. George Miller, directorof the Center for Drug Evaluation and Research, outlinedthe revised and modified guidelines for Investigative NewDrug applications, Radioactive Drug Research Commit-tees, and a vision for accelerated approval for radiophar-maceuticals. Such approvals invigorate and encourageour industry and provide us with new means for improvedpatient care and for management of fatal diseases, Imme-diately after the SNM meeting, on July 2, the FDAannounced a long-awaited approval of NeutroSpec (a99mTc murine monoclonal antibody that labels neutrophilsin vivo) for imaging appendicitis.

In other news, the National Cancer Institute (NCI) issoliciting proposals for funding from small businesses todesign targets to produce novel radionuclides for thecreation of radiochemicals. The easier availability of suchradionuclides as64Cu or 124I could lead investigators tothe development of novel radiopharmaceuticals for PET-based molecular imaging and for therapy. This NCI ini-tiative is highly complementary to the current SNMprogram for national radionuclide availability and is oneresult of the joint SNM–NCI workshop held in September2003. This noteworthy event is highly encouraging.

We must not, however, be self satisfied with theseexciting events. We must continue to press on the initia-tives we have undertaken and work hard to steer the SNMship in the right direction in this ocean of competition andcomplexity.

Mathew Thakur, PhDSNM President

Mathew Thakur, PhDSNM President

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SNM Leadership UpdateSNM Councils

Specialty councils have existed for many years atSNM. Organized around a specific area of practice, coun-cils were established to allow members to concentrate onissues that affect their specialty within the framework ofthe larger Society. These specialty groups are an idealframework for developing and offering educational pro-grams, networking events, mentoring activities, paths forinformation dissemination, and other valuable specialty-specific activities.

In the past year, SNM and its councils have focusedon restructuring and rejuvenating the councils to makethem an increasingly valuable resource for members. InOctober 2003, SNM held a retreat at which council lead-ership could brainstorm ways to maximize the potentialbenefits provided by the councils, rethink the supportingstructure, and participate in strategic planning. Eachcouncil subsequently created new goals, bylaws, and stan-dard operating procedures. These have now been ap-proved by the council memberships. In creating thesegoals and organizing the necessary structure and fundingto support them, the councils and their leaders haveachieved what we hope will result in a significant en-hancement to the benefits of belonging to SNM. It hasbeen a massive effort that has tested and proved theabilities of these excellent leaders.

The councils have created draft business plans andbudgets and presented them to the SNM Board of Direc-tors for approval. Not surprisingly, the plans strike somecommon themes.

Education. A major goal for most of the councils is tocontinue and expand educational offerings in their special-ties with new conference sessions, categorical sessions,continuing medical education courses, workshops, and/orsymposia. Exhibits and road shows have been proposed byseveral councils this year to bring specialized training toprofessional conferences or to SNM chapters. Many of thecouncils are looking at innovative ways to provide neweducational programs via satellite, Internet, or CD-ROM.

Information. Councils plan to communicate informa-tion of value (research developments, professional news,case studies, regulatory information, SNM information) totheir members via printed newsletters, e-letters, and otherpublications as well as through Web sites and communities.All of the councils plan to improve their Web sites withprofessional news, links, and educational material. The newcommunities debuted by SNM this year (which includelistserv functions and forums) will be actively used forposting and sharing information and for discussion.

Strategic Planning. Councils will focus on strategicplanning for their specialty areas, including discussing thefuture of the profession and planning for that future,

evaluating ways to educate mem-bers about developments in theprofession and train them in newtechnologies, and planning curric-ula of study.

Outreach. Several councilsplan to increase interaction withrelated organizations for informa-tion sharing and networking. Oth-ers will focus on educating regu-lators about their specialty areasand supporting the Society’s posi-tions on quality assurance, streamlined regulatory pro-cesses, and reimbursement.

Awards, Fellowships, Grants. Some of the councilsplan to introduce new awards to stimulate participation inthe annual meeting or to foster innovation. Others hope tooffer new fellowships, scholarships, or grants to subsidizeprojects and new researchers in their areas of specialization.

Networking. Council membership offers a unique op-portunity for networking. Councils will offer educationalprograms at the annual meeting and elsewhere, opportunitiesfor participation and involvement in council activities, men-toring, and joint activities with parallel organizations.

Structure. Most of the councils have now completedtheir organizational changes and will concentrate theirefforts in the coming year on the activities mentioned.However, the Academic Council will concentrate thisyear on revitalization. Its vision is to be an “umbrellaorganization” that contains both the Nuclear MedicineResidency Program directors and the Young Profession-als organizations as well as providing a forum for all whoare involved or interested in education and early careerdevelopment of the next generation of nuclear medicinephysicians and scientists.

SNM councils include the Academic Council, theBrain Imaging Council, the Cardiovascular Council, theComputer and Instrumentation Council, the CorrelativeImaging Council, the Nuclear Oncology Diagnosis andTherapy Council, the Pediatric Imaging Council, and theRadiopharmaceutical Sciences Council.

This process of goal setting and improving the bene-fits of council membership will continue all year. Severalcouncils have planned surveys to help assess how tobetter serve their members. Other councils have plannedspecific activities to reach out to and plan programs fortechnologists in their specialty areas. Future LeadershipUpdates will highlight many of the specific programs andactivities proposed by the councils.

Virginia Pappas, CAEExecutive Director, SNM

Virginia Pappas, CAESNM Executive Director

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NEWSBRIEFS2005 Proposed PhysicianFee Schedule Available

The Centers for Medicare &Medicaid Services (CMS) MedicareProgram; Revisions to Payment Pol-icies Under the Physician Fee Schedulefor Calendar Year 2005 (CMS-1429-P)went on display at the Office of theFederal Register on July 27 and waspublished in the Federal RegisteronAugust 5. The document is availablenow on the CMS Web site (www.cms.hhs.gov/regulations/pfs/2005/1429p.asp). The comment period onthese revisions will close on Septem-ber 24, and instructions for submis-sion of comments are included on thesite. See the SNM Web site (www.snm.org) for specific comments fromthe Society on revisions that may af-fect nuclear medicine reimburse-ment.

Centers for Medicare & MedicaidServices

SNMTS AnnouncesScholarships

The SNMTS Professional Devel-opment and Education Fund (PDEF)announced in July its sponsorship of2 $5,000 scholarships for technolo-gists in 2005.

The PDEF Mickey Williams Mi-nority Student Scholarship offers assis-tance for a minority student currentlyaccepted or enrolled in a nuclear med-icine technology program at the time ofapplication for the scholarship. Theaward is open to students in associateand baccalaureate level programs only.Individuals with previous certificatesor degrees in nuclear medicine sci-ences are ineligible. The scholarshiphonors the memory of MickeyWilliams, SNMTS president in 1991.

The PDEF Professional Develop-ment Scholarship assists a nuclearmedicine technologist in his or herpursuit of a master’s or doctoral de-gree related to the advancement of acareer in nuclear medicine.

Scholarship recipients are chosenby a committee that ranks applicantsbased on financial need, previous ac-ademic performance, recommenda-tions, and other factors. Each carriesa $5,000 award, and both are fundedthrough the support of the CorporateFriends of the PDEF. Award monieswill be available in January 2005.

The SNMTS PDEF supports theadvancement and practice of nuclearmedicine technology through activi-ties that ensure an adequate supply ofqualified nuclear medicine technolo-gists; encourage research studies,publications, and papers in nuclearmedicine technology that promotethe development of best-practicetechniques; advance the educationalbackground of clinical nuclear medi-cine instructors, practicing nuclearmedicine technologists, and thosejust entering the field; and advancethe education and research programsof SNMTS.

Deadline for scholarship applica-tion submission is October 15. Com-plete information and submissionforms are available at www.snm.org.

Sokoloff HonoredThe Intramural Research Pro-

gram of the National Institute ofMental Health hosted a reception anddinner on July 10 to honor LouisSokoloff, MD, chief of the Labora-tory of Cerebral Metabolism and itsSection on Developmental Neuro-chemistry and a major contributor tothe understanding of biochemistryand physiologic function in the cen-tral nervous system. Sokoloff re-ceived his BA from the University ofPennsylvania College of Arts andSciences in 1943 and his MD fromthe university’s school of medicine in1946. His postdoctoral work focusedon general circulatory and cerebralphysiology, pharmacology, and me-tabolism. His laboratory studies themechanisms responsible for the inter-actions of cerebral blood flow, en-

ergy metabolism, and functionalactivity. Methods developed in hislaboratory to measure local rates ofblood flow, glucose utilization, andprotein synthesis in laboratory ani-mals have been central to the devel-opment and advancement of clinicaland research PET imaging. He hasreceived the F.O. Schmitt Medal inNeuroscience (1980), the AlbertLasker Clinical Medical ResearchAward (1981), the National Acad-emy of Sciences Award in the Neu-rosciences (1988), and the RalphGerard Award of the Society of Neu-roscience (1996). Sokoloff waselected to the National Academy ofSciences in 1981 and the Institute ofMedicine in 1997.

National Institute of Mental Health

Pinpointing NMTRadiation Exposure

In a report published in a recentissue of Radiation Protection andDosimetry (2004;109:201–209), R.Smart, from the 500-bed St. GeorgeHospital (Kogarah, Australia) moni-tored nuclear medicine technologist(NMT) workflow to assess whichpoints in the management of radioac-tive patients are most likely to resultin NMT radiation exposure. NMTswore dosimeters that measured andrecorded dose rates in microsievertsper hour every 32 seconds. The majorsources of exposure were associatedwith transferring incapacitated pa-tients from the imaging table to agurney, performing difficult injec-tions without syringe shields, andpreparing and positioning patients forgated myocardial scans. The averagedoses to the NMT for each of theseprocedures are detailed in the article.The author suggests that “staff wait-ing for assistance with patient trans-fers stand away from the patient, thattungsten syringe shields be used forall radiopharmaceutical injections,and that a 0.5-mm lead apron beworn when attending patients con-

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taining high activities of 99mTc radio-pharmaceuticals, such as those hav-ing myocardial imaging.”Radiation Protection and Dosimetry

HHS and HealthInformation TechnologyReform Goals

On July 21, U.S. Health and Hu-man Services (HHS) SecretaryTommy G. Thompson released thefirst report on a 10-year plan to trans-form the delivery of health care bybuilding a new health information in-frastructure, including electronichealth records (EHR) and a new net-work to link health records nationwide.At the same time, he announced anumber of new steps to help advancehealth information technology in thenear term. The plan, prepared by thenew National Coordinator for HealthInformation Technology, David J.Brailer, MD, PhD, lays out the broadsteps needed to achieve always-current, always-available EHR in theUnited States. EHR systems wouldalso enable physicians and otherhealth professionals to electronicallytap into a wealth of treatment infor-mation as they care for patients. Thereport was released in Washington,DC, at a Secretarial Summit onHealth Information Technologybringing together the nation’s tech-nology and health leaders.

The report, titled The Decade ofHealth Information Technology:Delivering Consumer-centric andInformation-Rich Health Care,saysfederal leadership can help hasten ef-forts to be carried out by the privatesector. The report identifies 4 majorgoals, with strategic action areas foreach: (1) inform clinical practice:bring information tools to the point ofcare, especially by investing in EHRsystems in physician offices and hos-pitals; (2) interconnect clinicians:build an interoperable health infor-mation infrastructure, so that recordsfollow the patient and clinicians haveaccess to critical health care informa-tion when treatment decisions are be-ing made; (3) personalize care: use

health information technology to giveconsumers more access and involve-ment in health decisions; and (4) im-prove population health: expand thecapacity for public health monitoring,quality of care measurement, and bringresearch advances more quickly intomedical practice.

In addition, the report identifiespotential policy options for providingincentives for EHR adoption, includinggrants, low-rate loans for EHR adop-tion, adjustments in Medicare reim-bursements, demonstration projects,and “updating federal rules on physi-cian self-referral that may unintention-ally restrict investment and networks.”

Secretary Thompson announcedhe would appoint a special leadershippanel to assess total costs and bene-fits of health information technologyand report to him by fall 2004. Healso announced efforts underway todevelop private sector certification forhealth information technology prod-ucts. And he said HHS will beginreviewing the feasibility of a privatesector consortium to plan and de-velop a new nationwide network forhealth information.

Department of Health and HumanServices

Biomedical InformaticsSymposium ProceedingsAvailable

A symposium on “BiomedicalInformatics for Clinical Decision Sup-port: A Vision for the 21st Century”was conducted on June 21–22 at theNatcher Conference Center at the Na-tional Institutes of Health (NIH) inBethesda, MD. The symposium wasjointly conducted by the NIH Bio-engineering Consortium and theBiomedical Information Science andTechnology Consortium. The pur-pose of the meeting was to identifyopportunities, needs, and directionsfor applying computer science andinformatics principles and methods toclinical decision support. Specific ar-eas covered during the meeting in-cluded data management (databasesand digital libraries), enabling technol-

ogies (modeling, software tools, andtechniques), and translational informat-ics. Approximately 400 people at-tended the symposium. Presentationsfrom all speakers are available at www.becon.nih.gov/symposium2004.htm.

National Institutes of Health

Report on HospitalDeaths from MedicalErrors

HealthGrades, Inc., a Lakewood,CO-based health care quality assess-ment firm, issued a report on July 28indicating that an average of 195,000people in the United States died as aresult of in-hospital medical errors ineach of the years 2000, 2001, and2002. The study was based on a re-view of 37 million patient recordsfrom across the country. The PatientSafety in American Hospitalsstudy isthe first to look at the mortality andeconomic effects of medical errorsand injuries that occurred duringMedicare hospital admissions nation-wide from 2000 to 2002. The result-ing annual number of deaths is morethan double the number estimated inthe widely read 1999 Institute ofMedicine (IOM) report, To Err isHuman. “The HealthGrades studyshows that the IOM report may haveunderestimated the number of deathsdue to medical errors, and, moreover,that there is little evidence that pa-tient safety has improved in the last 5years,” said Dr. Samantha Collier,HealthGrades’ vice president of med-ical affairs. “The equivalent of 390jumbo jets full of people are dyingeach year due to likely preventable,in-hospital medical errors, makingthis one of the leading killers in theU.S.”

HealthGrades examined 16 of the20 patient safety indicators definedby the Agency for Healthcare Re-search and Quality (AHRQ), frombedsores to postoperative sepsis,omitting 4 obstetrics-related indica-tors not represented in the Medicaredata used in the study. Of these 16,the mortality associated with 2, fail-ure to rescue and death in low-risk

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hospital admissions, accounted forthe majority of deaths associated withpatient safety incidents. “If we couldfocus our efforts on just 4 key ar-eas––failure to rescue, bed sores,postoperative sepsis, and postopera-tive pulmonary embolism––and re-duce these incidents by just 20%, wecould save 39,000 people from dyingevery year,” said Dr. Collier.

The complete study, includingthe list of AHRQ patient-safety indi-cators, can be accessed at www.healthgrades.com.

HealthGrades, Inc.

JCAHO SupportsIncreased Accountability,Opens Public Info Site

On July 20, the Joint Commissionon Accreditation of Healthcare Orga-nizations (JCAHO) announced itssupport of a proposal made that dayby Representative Pete Stark (D-CA)and Senator Chuck Grassley (R-IA)to develop legislative language thatwould make the JCAHO hospital ac-creditation program specifically ac-countable to the federal governmentfor deemed status purposes. “Weview this as a major opportunity toenhance the longstanding, successfulpublic/private-sector partnership be-tween the Joint Commission and theCenters for Medicare & MedicaidServices (CMS) in overseeing theperformance of America’s hospitals,”said Dennis S. O’Leary, MD, presi-dent of the JCAHO. “We look for-ward to working with CMS and theCongress to strengthen the govern-ment’s mechanisms for oversight ofthe Joint Commission.”

For more than 20 years, the JointCommission has worked with CMS,formerly the Health Care FinancingAdministration, to assure that federalperformance expectations for hospi-tals are met and to afford the govern-ment access to and application ofstate-of-the-art standards and evalua-tion methods.

“We are very pleased that CMSacknowledges, in its last 3 reports toCongress, that Joint Commission–

accredited hospitals are in compli-ance with Medicare standards 98% ofthe time,” O’Leary said. The congres-sional proposal would, in essence,provide the same deemed statusframework for hospitals that existsfor other federal deemed status rela-tionships. The JCAHO has 6 otherdeemed status relationships that aresubject to oversight by the secretaryof the Department of Health andHuman Services. Similar federaldeeming relationships with other ac-crediting bodies exist as well.

During the same week, the JCAHOlaunched a new Web site for reportinghealth care information about the qual-ity and safety of care provided in itsaccredited health care organizationsacross the country.

Quality Check (www.qualitycheck.org) will provide data to individualsthat will permit them to compare lo-cal hospitals, home care agencies,nursing homes, laboratories, and am-bulatory care organizations with oth-ers on state and national bases. Forthe first time, the JCAHO will pro-vide hospital-specific informationabout clinical performance in the careof patients with 4 major conditions:heart attack, heart failure, pneumo-nia, and pregnancy and pregnancy-related conditions. Individuals willalso be able to determine how healthcare organizations compare with oth-ers in meeting national requirementsthat help prevent medical accidents.Health care organizations can besearched on the site by name, type,and/or location.

Joint Commission on Accreditationof Healthcare Organizations

Alzheimer’s Spending,Numbers Expected toIncrease Rapidly

In little more than a decade, U.S.spending on Alzheimer’s disease(AD) may triple, according to projec-tions made by presenters at the9th International Conference onAlzheimer’s Disease and RelatedDisorders, held July 17–22 in Phila-delphia, PA. The growth in spending

will outpace even the predicted ex-plosion in numbers of individualsaffected by the disease. Recent esti-mates have put the current number ofindividuals in the United States withAD at 4.5 million, and projectionssee 11–16 million individuals withAD in 2050. Moreover, several re-searchers at the annual conventionsponsored by the Alzheimer’s Asso-ciation predicted rising numbers ofAD cases in minorities.

“Unless a prevention or cure isfound soon, Alzheimer’s disease willoverwhelm our already stretchedhealth care system and bankruptMedicare and Medicaid,” said Shel-don Goldberg, president and CEO ofthe Alzheimer’s Association. “Medi-care expenditures for people withAlzheimer’s are almost 3 timeshigher than the average for all bene-ficiaries. And, Medicare spending forbeneficiaries with Alzheimer’s willtriple between now and 2015, from$62 billion in 2000 to $189 billion in2015. State and federal Medicaidspending on people with Alzheimer’sdisease, for nursing home care only,is estimated to rise from $19 billionin 2000 to $27 billion in 2015.”Groups of researchers from DukeUniversity (Durham, NC) and theUniversity of Pennsylvania (Philadel-phia) reported in 3 studies on risingcost of care for individuals with AD.

Among the most striking findingsfrom the meeting were conclusionsoffered from research on the risingtoll of AD in minority groups in theUnited States. Clark et al. from theUniversity of Pennsylvania describeda study evaluating 119 Latinos and55 non-Latino AD patients and theirfamilies at 5 National Institute onAging–sponsored AD Centers. Theyfound that the first symptoms of ADbegan 6.8 years earlier in Latinoscompared with non-Latinos, after ad-justment for differences in sex andyears of education. Unadjusted meanage of onset for the 2 groups was67.6 (Latino) versus 73.1 (non-Latino) years. AD and related de-mentias are projected to increasemore than 6-fold among Hispanics in

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the United States during the first halfof the 21st century, according to areport released earlier this year by theAlzheimer’s Association. This in-crease means that 1.3 million Hispan-ics will have AD by 2050, comparedwith fewer than 200,000 currentlyliving with the disease.

High rates of AD were also iden-tified among African Americans in astudy by Laditka et al. of the Univer-sity of South Carolina at Columbia.South Carolina is the only state tokeep a comprehensive database of in-dividuals diagnosed with AD. Theresearch team found that AfricanAmericans aged 55–64 years weremore than 3 times as likely to haveAD as their European Americancounterparts. At ages 65–84, AfricanAmericans were more than twice aslikely to have AD. Even over the ageof 85 African Americans have anAlzheimer’s rate nearly 1.5 timeshigher. Marenberg et al. from theUniversity of Pennsylvania School ofMedicine, however, cautioned againsta tendency to overestimate the num-ber of African Americans with earlysigns of AD, noting that screeningtests must be adapted to cultural dif-ferences. The team’s research on alarge population indicated that mildcognitive impairment (MCI; increas-ingly looked to as a precursor forAD) was overdiagnosed in AfricanAmericans when using traditionaltesting methods. “In order to accu-rately identify African Americanswith MCI, we need to develop toolsthat correct for the fact that manyneuropsychological tests are not sen-sitive to cultural differences,” saidMarenberg.

Alzheimer’s Association

DOE Science EducationInitiative Launched

Secretary of Energy SpencerAbraham announced on July 8 thatthe U.S. Department of Energy(DOE) and its national laboratorieswill launch an initiative to promotescience literacy and help develop“the next generation of scientists and

engineers.” The initiative will beginwith a 7-step program called STARS:Scientists Teaching and ReachingStudents. The program is designed toenhance the training of America’smathematics and science teachers;grow students’ interest in science andmath, especially in the critical middleschool years; draw attention to thewomen and men who have contrib-uted to DOE science; and encourageyoung people and prospective teach-ers to pursue careers in math andscience. “The risks of a scientificallyilliterate nation in the 21st centuryare too great for business as usual,”Secretary Abraham said. “We willwork with our partners at the Na-tional Science Foundation, the De-partment of Education and others aswe explore new opportunities to at-tack this challenge.” A number ofDOE outreach programs to be coor-dinated through the national labora-tories were outlined and will bedirected through a new DOE Officeof Science Education.

U.S. Department of Energy

From the Literature

Each month the editor of Newslineselects articles on therapeutic, diag-nostic, research, and practice issues innuclear medicine from a range of in-ternational publications. Most selec-tions come from outside the standardcanon of nuclear medicine and radiol-ogy journals. These briefs are offeredas a monthly window on the broadarena of medical and scientific en-deavor in which nuclear medicine nowplays an essential role.

Research

Monitoring AngiogenicGene Therapy

The growing involvement of nu-clear medicine tools and techniquesin the most innovative areas of med-ical research is evident in articlespublished across the spectrum ofpractice and investigation. Small an-imal PET in particular promises not

only to aid in novel investigations ofdisease but to provide a means toradically transform the process ofvalidation of imaging techniques andtracers and to revolutionize the pro-cess of pharmaceutical trial and de-velopment. During 2004, the numberof articles published in the medicalliterature on research applications ofsmall animal PET has more than dou-bled every quarter.

Of recent note was a study by Wuet al. from the University of Californiaat Los Angeles on the use of microPETin rats to monitor transgene expressionand function in angiogenic gene ther-apy. The results were published aheadof print in Circulation on July 26. Anangiogenic gene linked to a PET re-porter gene was transfected into rat em-bryonic cardiomyoblasts in vitro andthen injected into the left anterior de-scending artery in rats with sites ofpreviously induced infarction. Smallanimal PET assessed the uptake of9-(4-18F-fluorohydroxymethylbutyl)-guanine (18F-FHBG) PET reporterprobe by cells expressing the PET re-porter gene. Cardiac transgene expres-sion was found to peak at day 1 anddecline over the next 2 weeks. Al-though the angiogenic gene therapyinduced significant increases in capil-laries and small blood vessels, theseresults did not yield significant im-provements in functional parameters asmeasured by echocardiography, 13Nperfusion, or 18F-FDG PET. The au-thors concluded that the findings “es-tablish the feasibility of molecularimaging for monitoring angiogenicgene expression with a PET reportergene and probe noninvasively, quanti-tatively, and repetitively.” They alsonoted that the principles demonstratedin this investigation can be translated instudies of other therapeutic genes inanimal models before the initiation ofclinical trials.

Circulation

Mouse Model Validationof PET in Breast Cancer

In a study e-published ahead ofprint on July 26 in the Proceedings of

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the National Academy of Sciences ofthe USA, Abbey et al. from the Uni-versity of California–Davis reportedon the use of 18F-FDG PET to mon-itor the longitudinal development ofmammary intraepithelial neoplasiaoutgrowths in immunocompetentFVN/NJ mice. The study was widelycovered in the scientific press andprovided evidence suggesting theutility of PET imaging for breast can-cer in humans. The neoplasia imagedin the mouse model mimics the pro-gression of breast cancer from pre-malignant ductal carcinoma in situ toinvasive carcinoma. The results ofthe study not only showed progres-sion of the disease and a correlationof 18F-FDG uptake with histology butalso yielded quantitative markers thataccurately tracked the progressionand proliferation of disease overtime.

Proceedings of the NationalAcademy of Sciences of the USA

Specifications andPerformance of themicroPET II

Performance specifications on ahigh-resolution small animal PETunit were reported by Yang et al.from the University of California–Davis in the June 21 issue of Physicsin Medicine and Biology (2004;49:2527–2545). The microPET II in-cludes 17,640 lutetium oxyorthosili-cate crystals arranged in 42contiguous rings, with axial andtransaxial fields of view of 4.9 and8.5 cm, respectively. Performancewas evaluated in mouse and rat stud-ies. Image resolution was found tovary greatly with the reconstructionalgorithm applied, and different scan-ner settings were needed to optimizenoise-equivalent count rate, depend-ing on the size of the animal and theinjected dose of tracer. The authorsreported on the results of both phan-tom and in vivo animal studies withthe microPET II and discussed possi-ble applications and advantages.

Physics in Medicine and Biology

In Vivo Evaluation of�1-AR Density

Wagner et al. from University Hos-pital Munster (Germany) reported in theAugust issue of Bioorganic and Medici-nal Chemistry (2004;12:4117–4132) onresearch to design a high-affinity selec-tive �1-adrenoceptor (AR) radioli-gand for noninvasive in vivo SPECTimaging of cardiac �1-AR in humans.Although published results of cardiacbiopsies suggest that myocardial�1-AR density is reduced in patientswith chronic heart failure, changes incardiac �1-ARs vary and have notpreviously been imaged or quantifiedin vivo. As part of the research, 6pairs of new compounds with the3-aryloxy-2-propanolamine core of theselective �1-AR ligand, ICI 89,406 (X:CN, Y: H), were synthesized. Eachpair consisted of the racemic and the(S)-aryloxypropanolamine deriva-tives. The comparison of racemic(11a: X: I, 11b: X: 125I, 11c: X: 123I,Y: COOH) with (S)- (15a: X: I, 15b:X: 125I, 15c: X: 123I, Y: COOH) com-pounds indicated that the (S)-enantio-mer should improve the feasibility ofSPECT imaging of �1-AR densitynoninvasively. Biodistribution andmetabolism studies in rats indicatedthat there is a specific heart uptake of11b-c and especially 15b-c accompa-nied by rapid metabolism of the ra-dioligands, so that radioiodinated 11cand 15c appeared to be unpromisingSPECT radioligands for assessing �1-Ars in vivo in the rat. The authorsnoted that the rat may metabolize�1-AR ligands more rapidly thanother species (as has been demon-strated for a structurallly related ra-dioligand) and called for studies in adifferent animal model.

Bioorganic and MedicinalChemistry

Diagnosis

PET in FUO Work-UpBuysschaert et al. from the Uni-

versity Hospital Gasthuisberg (Lou-vain, Belgium) reported in the June15 issue of the European Journal of

Internal Medicine (2004;15:151–156) on the use of 18F-FDG PET inevaluating patients with fever of un-known origin (FUO). The study in-cluded 74 patients who underwentPET imaging after meeting the crite-ria for classic FUO. Scanning resultswere evaluated against the results ofadditional diagnostic tests andfollow-up, where a final diagnosiswas established (39 [53%] patients).Abnormal scans were categorized ashelpful (if pointing toward the finaldiagnosis) or noncontributory (allother scans). For the 74 patients im-aged, PET scans were abnormal in 53(72%). Of these, 19 scans (36% ofabnormal scans and 26% of all scans)were helpful. In the group in whomfinal diagnoses were established,49% of scans were helpful. 18F-FDGPET contributed positively to the di-agnosis in a quarter of all patientsundergoing work-up for FUO. Theauthors commented that, “against thebackground of the wide array of het-erogeneous disorders that make upthe FUO spectrum and the low num-ber of final diagnoses established (inonly 53% of cases), the diagnosticyield of FDG-PET is encouraging”and should be considered whenever abaseline work-up fails to reveal thecause of a prolonged, febrile illness.

Another note on PET in FUO ap-peared in July in the American Journalof Hematology (2004;76:236–239).Hoshino et al. from the Gunma Univer-sity Hospital (Japan) reported on theuse of PET to diagnose a case of intra-vascular lymphomatosis (IVL) thatwas categorized on presentation asFUO. IVL is a relatively rare systemicdisease in which diagnosis is oftenmade only when the illness has pro-gressed or at post mortem analysis.Both 67Ga scintigraphy and CT werenormal in the patient, but 18F-FDGPET revealed increased uptake in thesternum, left and right vertebra, hu-merus, femur, and the ilium. A defini-tive diagnosis was made after iliacbone marrow biopsy.

European Journal ofInternal Medicine

American Journal of Hematology

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PET and RecurrentCervical Cancer

In a study published in the Julyissue of Gynecologic Oncology (2004;94:212–216), Unger et al. from theLouisiana State University HealthSciences Center (Shreveport) re-ported on the use 18F-FDG PET indetection of recurrent cervical cancerin both asymptomatic and symptom-atic women. The retrospective studyincluded 44 women who had beentreated previously for cervical cancerand who underwent a total of 47whole-body PET scans to detect re-current disease. Of these scans, 26were performed in asymptomaticwomen and 21 were performed inwomen with symptoms suggestingrecurrent disease. PET imagingshowed recurrent disease in 30.8% ofasymptomatic women and 66.7% ofwomen with symptoms. The authorsfound that sensitivity and specificityof PET for recurrent disease were80% and 100%, respectively, inasymptomatic women and 100% and85.7%, respectively, in symptomaticwomen. The authors concluded that“whole-body FDG PET scan is a sen-sitive imaging modality for the detec-tion of recurrent cervical carcinomain both symptomatic and asymptom-atic women.”

Gynecologic Oncology

15O-Water PET andMarathon Running

Kalliokoski et al. from the Uni-versity of Turku (Finland) reportedin the August issue of the Scandina-vian Journal of Medicine and Sciencein Sports (2004;14:208–214) on astudy designed to assess the effects ofmarathon running on cardiac functionand myocardial perfusion. Each of7 endurance-trained men underwentechocardiography and 15O-waterPET imaging before running a 42.2-kmmarathon. Echocardiography was re-peated at 10 and 150 minutes and 20hours after completion of the race, andPET imaging was repeated at 85–115minutes after running. Echocardiogra-phy showed only mild, clinically non-

significant changes in cardiac functionafter running. Rate-pressure–correctedbasal myocardial perfusion was in-creased after running. Adenosine-stimulated perfusion was somewhathigher and perfusion resistance dur-ing adenosine stimulation was signif-icantly lower after running. Plasmafree fatty acid (FFA) concentrationwas significantly increased after run-ning. The authors concluded thatthese “results show that marathonrunning does not cause markedchanges in cardiac function inhealthy men” and that “strenuous ex-ercise also seems to enhance coro-nary reactivity, which could therebyserve as a protective mechanism tovascular events after exercise.”

Scandinavian Journal of Medicineand Science in Sports

PET and ConventionalImaging in MetastaticMelanoma

In a study e-published ahead ofprint on July 12 in the Annals ofSurgical Oncology, Finkelstein et al.from the National Cancer Institute(Bethesda, MD) reported on a studycomparing PET and CT or MR imag-ing in the detection of stage IV meta-static melanoma in patients scheduledto undergo metastasectomy for palli-ation or cure. The study included 18patients who underwent CT or MRand 18F-FDG PET imaging, followedby metastasectomy and serial postop-erative evaluations. Independent ob-servers performed separate analysesof CT or MR alone, PET alone, orPET read with knowledge of the CTor MR results. Results of these anal-yses were compared with clinicaloutcomes and subsequent evalua-tions. A total of 94 lesions werenoted in the 18 patients. Lesion-by-lesion analysis showed sensitivity,specificity, positive predictive value,and negative predictive values of76%, 87%, 86%, and 76%, respec-tively, for CT or MR imaging; 79%,87%, 86%, and 80%, respectively,for PET alone; and 88%, 91%, 91%,88%, respectively for PET plus CT or

MR imaging. The authors concludedthat these results indicate that acombined use of 18F-FDG PET andconventional imaging may be “anaccurate strategy to identify sites ofdisease in patients with stage IV mel-anoma being considered for metasta-sectomy.”

Annals of Surgical Oncology

PET in GallbladderCancer

To counter difficulties in differ-entiation of gallbladder cancer fromcholecystitis or cholethiasis, Rodriguez-Fernandez et al. from the Virgen delas Nieves University Hospital(Granada, Spain) explored the pre-surgical use of 18F-FDG PET indiagnosing gallbladder lesions. Theresults were published in the Augustissue of the American Journal of Sur-gery (2004;188:171–175). The studyincluded 16 patients with clinicalsymptoms suggesting biliary colic orchronic cholecystitis in whom CTand ultrasound findings were incon-clusive for the presence of cancer.All patients underwent 18F-FDG PETimaging, with a sensitivity of 80%,specificity of 82%, and positive andnegative predictive values of 67%and 90%, respectively, for gallblad-der cancer. The authors concludedthat 18F-FDG PET “may be of utilityto establish the diagnosis of gallblad-der cancer in patients with nonspe-cific clinical and imaging findings.”

American Journal of Surgery

Metabolic Bases ofImpairment in Cocaineand Alcohol Addiction

The research group at BrookhavenNational Laboratory (Upton, NY) con-tinues to publish groundbreaking stud-ies illuminating the functional andphysiologic mechanisms underlyinga range of addictions and associatedsymptoms and behaviors. Goldsteinet al. reported in a recent issue ofNeuropsychologia (2004;42:1447–1458) on a study exploring the sever-ity of neuropsychological impairmentin 42 crack/cocaine-addicted individ-

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uals and compared this with simi-lar studies in 40 alcohol-addictedindividuals and 72 controls. Eachparticipant underwent neurocognitivetesting based on a 4-dimensionalmodel of neurocognitive function inwhich verbal knowledge, visual mem-ory, verbal memory, and attention/executive functioning accounted for63% of variance. Each patient thenunderwent 18F-FDG PET imaging tocompare resting glucose metabolismwith the model’s assessment. Resultsshowed that cocaine-addicted indi-viduals had a generalized but mildlevel of neurocognitive impairment.Relative metabolism in the dorsolat-eral prefrontal cortex significantlypredicted the visual memory and ver-bal memory factors of the test model,and relative metabolism in the ante-rior cingulate gyrus significantly pre-dicted the attention/executive factor.The results also indicated that alcoholhas a more detrimental effect onattention/executive functioning. Theauthors concluded that “relative toother psychopathological disorders(such as schizophrenia), the severityof neuropsychological impairment incocaine addiction is modest, albeit notindicative of the absence of neurocog-nitive dysfunction.” The authorsadded that the impact of such smalldifferences in performance on qualityof life and possibly on craving andrelapse may be substantial.

Neuropsychologia

Marrow 18F-FDG Uptakein Hodgkin’s Lymphoma

Elmstrom et al. from the Univer-sity of Pennsylvania Medical Center(Philadelphia) reported in the Juneissue of Clinical Lymphoma (2004;5:62–64) on a case in which a womanwith Hodgkin’s lymphoma was im-aged with 18F-FDG PET for staging.Marked tracer uptake by tumor andbone marrow initially suggested dif-fuse marrow involvement of lym-phoma. However, iliac crest bonemarrow examination showed markedmyeloid hyperplasia without evi-dence of lymphoma. The authors

discussed the implications for inter-pretation of PET imaging of bonemarrow in staging and treatment as-sessment in lymphomas.

Clinical Lymphoma

Early Diagnosis ofProgressive SupranuclearPalsy

Mishina et al. from the NipponMedical School Chiba-Hokusoh Hos-pital (Japan) reported in the Augustissue of Acta Neurologica Scandi-navica (2004;110:128–135) on theuse of 18F-FDG PET in the diagnosisof progressive supranuclear palsy(PSP), which is often misdiagnosedin its earliest manifestations. Thestudy included 15 patients with diag-noses of PSP and 16 healthy individ-uals. All individuals underwent PETimaging. Glucose metabolism in themidbrain was found to be signifi-cantly lower in the PSP patients thanin the control subjects, but thesefindings did not correlate with clin-ical deterioration as measured bytraditional evaluation standards. Sta-tistical maps clearly demonstratedhypometabolism in the midbrain inPSP patients, which the authorscalled “a most promising sign forearly diagnosis of PSP.”

Acta Neurologica Scandinavica

Therapy

Amino Acid InfusionEffects in PeptideRadiotherapy

In a study e-published ahead ofprint on July 13 in Nephrology, Dialy-sis, Transplantation, Barone et al. fromthe University of Louvain MedicalSchool (Brussels, Belgium) reportedon a PET study investigating the met-abolic effects associated with the infu-sion of large amounts of amino acids, atechnique that is used for reduction ofrenal uptake during peptide radiother-apy for neuroendocrine tumors. Thestudy included 24 patients, divided into4 groups of 6. All received a 4-hourinfusion of 120 g of mixed amino ac-ids, and 1 group received a 4-hour in-

fusion of 50 g of l-lysine, a secondgroup received a 10-hour infusion of240 g of mixed amino acids; a thirdgroup received a 4-hour infusion of50 g of l-lysine � l-arginine; and 1group received no additional infusion.All underwent underwent 86Y-DOTA(0)-D-Phe(1)-Tyr(3)-octreotideimaging. No clinical side effects oc-curred during the infusions except fornausea and vomiting in the mixedamino acid group, which also showedan increase in serum urea. Varied alter-ations in serum potassium, chloride,and inorganic phosphate levels werenoted in all groups except the controls.The authors concluded that “althoughinfusion of AA solutions can improvethe effect of therapy by allowing theadministration of higher doses of radio-labeled somatostatin analogues, eachpreparation has specific sides effectsthat should be taken into account withthis type of therapy.”

Nephrology, Dialysis,Transplantation

Complete RCC Responseto Semaxanib

Jennens et al. from the RoyalMelbourne Hospital (Parkville, Aus-tralia) reported in the May–June issueof Urologic Oncology (2004;22:193–196) on a case in which SU5416 (se-maxanib) treatment of probable vonHippel-Lindau syndrome and meta-static renal cell cancer (RCC) re-sulted in a complete radiological andmetabolic response. SU5416 is asmall-molecule inhibitor of vascularendothelial growth factor (VEGF) re-ceptors. The patient was enrolled in aclinical trial examining the efficacyof 145 mg/m2 SU5416 administeredtwice weekly for 5 weeks to patientswith metastatic cancer. 18F-FDGshowed an early metabolic responsein the patient after 2 weeks of treat-ment, and subsequent PET (at 9months after therapy) and CT (at 12months after therapy) showed ongo-ing complete radiologic and meta-bolic response. The patient remainedtumor free 18 months after treatment.The authors called for additional

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studies using VEGF inhibitors in pa-tients with von Hippel-Landau syn-drome and RCC.

Urologic Oncology

Functional Imaging andRadiotherapy Planning

In a study published in the Juneissue of Medical Physics (2004;31:1452–1461), Das et al. from DukeUniversity (Durham, NC) reportedon an investigation of the dosimetricfeasibility of delivering radiotherapydoses to lung tumors in proportion to18F-FDG activity measured in tumorson PET. The fact that FDG uptake iscorrelated with tumor cell prolifera-tion rate, the authors reasoned, im-plies that this dose delivery strategy

is theoretically capable of providingthe same duration of local control atall voxels in tumor. Preliminary workwith target dose-delivery calculationsbased on SPECT maps of normallung perfusion was outlined and ad-ditional considerations described. Anintensity modulation optimizationmethodology was developed to de-liver the calculated doses and appliedto 2 patients with lung cancer. Dosi-metric feasibility was assessed bycomparing spatially normalized dose-volume histograms from the nonuni-form dose prescription (18F-FDG PETderived) with those from a uniformdose prescription with equivalent tu-mor integral dose. Although the op-timization methodology was capable

of delivering the nonuniform targetprescription as easily as the uniformtarget prescription, in 1 patient thecritical structure dosage from thenonuniform dose prescription ex-ceeded dose-volume/function limitsand greatly exceeded that from theuniform dose prescription. Adheringto these limits in practice would the-oretically entail reduction of the du-ration of local control. The authorsconcluded that “even though it ap-pears feasible to tailor lung tumordose to the FDG-PET activity distribu-tion. . .strict adherence to dose-volume/function limits could compromise theeffectiveness of functional imageguided radiotherapy.”

Medical Physics

From the SNM Annual Meeting (Continued from page 16N)Bexxar therapy, all patients showed a response, with 83%showing a complete response. Seventy-two percent of allpatients treated are still in complete remission 4.4 yearslater. Kostakoglu noted that “the results are very encour-aging. We feel that further evaluation of the addition ofRIT to chemotherapeutic regimens for patients with fol-licular lymphoma is warranted. This may be the future oftreatment with radiolabeled antibodies.”

The use of radiotracers in gene therapy is among themost rapidly growing areas in medical research. Lee et al.from the Case Western Reserve University (Cleveland,OH), the Thomas Jefferson National Accelerator Facility(Newport News, VA) and the University of Virginia(Charlottesville) reported on small animal 125I-FIAU

imaging of the expression of the HSV1-tk delivered intocystic fibrosis (CF) knockout mice. The authors had pre-viously reported on in vivo imaging of radiolabeled DNAcomplexes containing the therapeutic CF transmem-brane conductance regulator gene and monitored itsdistribution in transgenic CF mice. The HSV1-tk in thecurrent study was delivered in the same fashion. In thisstudy, a custom-built imaging system included bothx-ray and planar gamma scintigraphy. The authorsfound that x-ray images of the mice were readilyaligned with scintigraphic images and that radioactiv-ities detected on day 2 indicated that new geneticmaterial was being expressed in the lungs of the mice.According to Lee, “Although the results are prelimi-nary, they are extremely encouraging.”

de Hevesy Award (Continued from page 36N)Alavi’s contributions to nuclear medicine extend well

beyond his own research. He and his wife, Dr. Jane Alavi,have been long-time supporters of educational and re-search opportunities for students in nuclear medicine.Their names are associated with the Alavi–MandellAwards, which recognize trainees and young scientistswho publish articles as senior authors in The Journal ofNuclear Medicine. Their generosity also supports thePilot Research Grants and the Bradley–Alavi StudentFellowship Awards funded by the Education and Re-search Foundation (ERF) of the SNM. The Alavis notonly continue to contribute to the foundation but are

active in persuading other colleagues to join them in theirsupport of these important endeavors. Most recently,Abass donated time, energy, and funds to his country oforigin, Iran, by assisting physicians and scientists from thatcountry in developing a PET center. He is similarly generouswith his time: he serves on the Society’s ERF board ofdirectors and is also involved in numerous SNM activities.

“I am honored that I was selected by the Society ofNuclear Medicine for such a distinction,” said Alavi. “Ishare this recognition with my family, my mentors, andwith so many students with whom I have worked overthe past 3 decades. This is truly a highlight of mycareer.”

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Kuhl–Lassen Award (Continued from page 38N)study,” said Devous in accepting the award. “I can’timagine a more interesting career, unless as a poet, than tobe part of the effort to unravel one of the last greatmysteries of biology––the intersection between thoughtand the physical functioning of the brain.”

Devous received his undergraduate degree from Wash-ington University in 1970 and earned his doctorate in nu-clear chemistry and physics from Texas A&M University in1976. Among his awards and honors are the SNM Presiden-tial Distinguished Service Award (1997), the Award ofMerit from the Hong Kong Society of Nuclear Medicine(1997), and the Charles A. Dana Foundation award (2001).His wide-ranging investigations include the role of func-tional brain imaging in exploring the biology of psychiatricand neurologic disorders as well as in understanding brain

function and central nervous system pathology in animalmodels. His work with functional brain imaging has in-cluded foci on mood disorders, deafness and speech disor-ders, substance abuse, bipolar disorders, dementia, schizo-phrenia, anxiety disorders, head trauma, epilepsy, andstroke.

Previous recipients of the Kuhl–Lassen award includeDean F. Wong, MD, PhD, Johns Hopkins University;Ronald S. Tikofsky, PhD, Columbia University; Yoshi-haru Yonekura, MD, PhD, Fukui Medical University,Japan; Peter Herscovitch, MD, National Institute of Men-tal Health; Nora Volkow, MD, director of the NationalInstitute of Drug Abuse; Albert H. Gjedde, DSc, MD,Aarhus University, Denmark; Marcus E. Raichle, MD,Washington University; and Louis Sokoloff, MD, Na-tional Institute of Mental Health.

Tetalman Award (Continued from page 38N)Science Award given by the Nuclear Medical Imagingand Sciences Technical Committee of the Institute ofElectrical and Electronics Engineers and the VarianPrize awarded by the Swiss Society of Radiobiologyand Medical Physics. He is a member of the editorialboards of a number of Scientific journals He is the

editor of 2 textbooks on therapeutic applications ofMonte Carlo calculations in nuclear medicine andquantitative analysis in nuclear medicine imaging. Herecently joined the Computed Imaging for MedicalImaging collaboration hosted by CERN to work onnovel design of high-resolution, parallax-freeCompton-enhanced PET scanners.

IASNM (Continued from page 40N)young investigators of Indian origin working in theUnited States went to Dr. Rakesh Kumar from the Uni-versity of Pennsylvania for best abstract in clinical sci-ence and to Dr. S. Vemulapalli from Duke University forbest abstract in basic science.

The relationship between the IASNM and SNM(I) isgrowing, and IASNM is building a relationship between theSNM and the SNM(I). An important milestone for Indians inNorth America was the assumption of the presidency of theSNM by a person of Indian origin. Mathew Thakur, PhD,has contributed significantly to the field, not least with hisdevelopment of white cell labeling techniques. To commem-orate Mathew’s presidency, we plan a strong presencein India at the annual meeting of the SNM(I), December15–18, in Mysore. A number of speakers, including Drs.Tom Miller of Washington University (chair of the SNMScientific Committee), Steve Larson of Memorial Sloan–

Kettering Cancer Center (a director of the American Boardof Nuclear Medicine), and Alexander McEwan from theCross Cancer Institute (president of the Nuclear OncologyCouncil) have agreed to participate. The SNM(I) has gra-ciously drawn up a program that will feature keynote lec-tures by these speakers. A finalized list of speakers andtopics will be available shortly.

During the past year, the IASNM has taken severalsteps toward strengthening the organization and expand-ing its services. The Web site (www.iasnm.org) is fullyfunctional and updated regularly. Jim Strommer at theUniversity of California at Los Angeles has providedvaluable assistance in maintaining the site.

Chaitanya Divgi, MDWeill Medical College of Cornell University

Memorial Sloan–Kettering Cancer CenterNew York, NY

Errata

In the August issue of Newsline, page 20N, Suzuki et al. from the Jikei University School of Medicine(Japan) should have been listed as the authors of the study on differentiation of Parkinson’s disease fromdementia with Lewy bodies discussed in the text and presented in Figure 13.

In the same issue, page 37N, the text should have indicated that “83 FDA-approved RDRCs conducted 280studies” in 2002.

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nuclear medicine makes news at snm annual...

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