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New: Funny cartoons assist nuclear medicine physicians

Help for children during nuclear medical examinations

New: Funny cartoons assist nuclear medicine physicians

Sunny & Tim and their team help children through nuclear medical examinations (Source: Dr Ronald van Rheenen, Floris de Jonge)

Nuclear medical examinations can be stressful for patients – particularly for children. But Sunny the Isotope, Tim the Tracer and Rob the Receptor help reduce the strain. These cartoon characters, which have been developed by Ronald van Rheenen, expert of the European Association of Nuclear Medicine (EANM)., The Visual Education Project that gave birth to these characters provides child patients with age-appropriate information on the imaging examination. They make preparation rules easy to understand and lend a touch of fun and adventure to the procedure.
Undergoing a nuclear medical imaging examination can be quite a challenge. Some of these procedures last over an hour. During this time the patient is required to lie still on the imaging bed and avoid any motions as these might render the images being created useless for diagnostic purposes. For the same reason eating is sometimes not allowed prior to the imaging. All this is particularly demanding for children whose examinations make up an estimated 10 % of all nuclear medical examinations. They are also intimidated by the unfamiliar environment with its large nuclear medicine cameras whose detectors are placed very close to the body and somtetimes directly over the patient“s head. Concerns that the examination might be painful add to young patients“ anxiety. The accompanying parents are not always able to cheer up their child as they themselves might be distressed not knowing what to expect and which results the examination will provide.
In order to alleviate such fears and improve diagnostic accuracy through better cooperation of doctors and their young patients Dr Ronald van Rheenen, Nuclear Medicine Physician at the University Medical Hospital in Groningen (Netherlands) initiated the nonprofit Visual Education Project. Its „heoresheroes“ are Sunny the Isotope and Tim the Tracer, cartoon characters who appear in three different stories where they stand for the radioactive and the tracer substance that together form the radiopharmaceutical the patient is injected with. Tim takes Sunny on a journey through the body and guides him to Rob the Receptor who represents the target organ where the radiopharmaceutical accumulates. There Sunny shines his „special lights“ which reperesent the emitted radiation. This enables the „Photo Doctor“ to take pictures of the diseased areas. While this refers to diagnostic procedures one of the story lines also addresses nuclear medical therapy: This time Sunny & Tim are joined by Sam the Demolisherwho destroys the sick-spot. The stories are freely available as animations on YouTube and can be purchased as picture books (for links see below). Dr. van Rheenen, who pursues these educational activities in his free time, cooperates closely with the graphic designer Floris de Jonge. He brought the characters and storylines to life that Dr. van Rheenen had in mind. Meanwhile both have created three other storylines dealing with radiological imaging examinations.
The adventurous stories, straightforwardly told and catchily illustrated, not only help dissolve anxieties but also guide the childrens“ preparation before and their behaviour during examination. But the education material not only aims at very young readers. It might even help adults with low-health-literacy to understand the procedures and purposes of nuclear medicine. „Our decision to convey information in the form of visualized stories is motivated by the fact that most of the textual or verbal information which is provided prior to our examinations or therapy, is not correctly remembered – if at all,“ says Dr. van Rheenen. The project that started off three years ago as a local initiative based in Groningen has already spread its material considerably. The EANM and several European hospitals as well as patient platforms have the animations running on their websites or refer to it. With the support of the EANM the project is now on the verge of developing into a global initiative. Currently, versions in German, Spanish, French and Cantonese are under way and Dr. van Rheenen is dicussing possibilities of further dissemination with different National Nuclear Medicine Societies.
„It is essential to tailor explanations to the childrens“ grasping ability. Introducing the Visual patient education project to pediatric nuclear medicine and explaining the procedure with cartoon characters is a very promising tool to alleviate fears and apprehension and to transform the nuclear medicine study into a fun experience. This improved patient experience leads to improved cooperation resulting in studies of higher technical quality, ultimately leading to improved diagnostic accuracy“, says Dr. Zvi Bar-Sever, Chairman of the EANM pediatric committee.

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Prostate cancer: Identifying and destroying the tumour through nuclear medicine therapy

(Vienna, December 13, 2016) Prostate cancer patients who are resistant to hormone treatment used to have a poor prognosis. Until recently, the diagnostic and therapeutic possibilities had been limited, but now innovative developments in nuclear medicine imaging and therapy open up promising pathways. Novel substances used with PET/CT (positron-emission tomography combined with computed tomography) not only allow for better diagnosis but also offer treatment options where other therapies have failed. „This offers a glimpse of hope to patients who suffer from this particularly severe form of prostate cancer,“ says EANM expert Prof. Markus Luster.
Prostate cancer is the second most frequently diagnosed cancer in men and causes around 90.000 deaths per year in Europe. Up to every second patient who has his prostate surgically removed or has undergone radiation therapy suffers from relapse. In severe cases the level of testosterone upon which the tumour is dependent to a large extent has to be reduced drastically in order to fight the disease. This is usually done by hormone therapy. However, a considerable number of patients are or will become resistant to this kind of treatment (so called castration-resistant prostate cancer / CRPC). This means that in spite of therapy the tumour has not been destroyed definitively and in many cases is now affecting the lymph nodes or has even extended to the stage of often painful bone metastases. Prognosis of patients who progress to this stage is poor.

A common means to detect prostate cancer and assess the stage of the disease is the measurement of the level of prostate-specific antigen (PSA), which serves as a biomarker for the presence of cancer cells. However, in patients whose testosterone production has been suppressed medically PSA levels are often too low to be measured. This includes CRPC patients in whom this therapy has failed to eradicate or halt the tumour. Moreover, PSA measurement provides no information about the sites and the extent of the recurrent cancer. However, newly developed nuclear medicine methods have opened up promising diagnostic avenues that might more sensitively and accurately enlighten both patient and physician about the location and extent of disease. At the same time, this new approach also provides new therapeutic modalities which can improve the still poor prognosis of CRPC-patients in the future. The leading part is played by a protein called Prostate-Specific Membrane Antigen (PSMA). It is found abundantly on the surface of prostate cancer cells and its number appears to be increasing with the aggressiveness of the disease. This makes PSMA an ideal target for detecting cancer cells by nuclear imaging. The essential means to achieve this is the Ga-68-PSMA-ligand, a substrate that binds to PSMA – comparable to a key that fits into its lock – which is labelled with the radionuclide Gallium 68. This tracer has already been used successfully in a large number of PET/CT examinations: After the patient has been injected with Ga-68-PSMA-ligand the tracer is taken up by the cancer cells which are made visible for the examining physicians by the radiation. „The substance has proven to be highly sensitive and reliable in detecting carcinoma in lymph nodes as well as metastases in other body regions. Over the past decade or so other substances such as choline have been evaluated and applied but in terms of accuracy and diagnostic outcome Ga-68-PSMA is now state of the art,“ says Prof. Markus Luster.

As he points out PSMA is not only useful for diagnostic but also for treatment purposes: The PSMA-ligand can be labelled with another radionuclide called Lutetium-177 that is able to destroy the cancer cell from inside through radiation. „Several tests have demonstrated that Lu-177-PSMA-therapy can reduce tumour mass and alleviate pain. Patients who have no other treatment options left and whose cancer cells have been shown to take up PSMA-ligands are very likely to benefit from the diagnostic and therapeutic potential of PSMA imaging and therapy,“ says Prof. Markus Luster.
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Alzheimer’s disease: Early diagnosis through novel imaging technique

New nuclear imaging techniques make tau tangles in the brain visible

New nuclear imaging techniques help to detect a key factor involved in Alzheimer“s disease (AD) much earlier and more precisely than before. Recently developed tracers, used with positron emission tomography (PET) make tau tangles in the brain visible. For the first time these deposits which cause severe neuronal malfunctions can be identified and investigated „live“ in the brains of AD patients long before the onset of noticeable mental impairment. „This is an important step towards our goal to develop efficient drugs to fight and eventually cure AD“, says Dr Silvia Morbelli, expert of the European Association of Nuclear Medicine (EANM).
Many important details of the causes and the progress of AD remain to be elucidated. However, recent research results in the field of nuclear imaging have now brought about a major breakthrough in the diagnosis of the disease, raising hopes for early detection and targeted therapeutic approaches. Over the last few years, PET imaging has already enabled the visualization of -amyloid plaques (one of the hallmarks of AD) in the spaces between nerve cells. Now several recently developed PET tracers make it possible to track down tau deposits in the brains of AD patients too. Tau protein is an important building block of the so-called cytoskeleton, which is essential for the proper working of the nerve cells of the brain. In AD patients this protein undergoes changes that trigger the breakdown of the cytoskeleton. At the same time, unbound tau proteins clump together forming neurofibrillary tangles. The harmful impact of tau tangles on brain function is even more clearly established than that of beta-amyloid, making tau deposits a key suspect as a mediator of neurodegeneration. Before this recent breakthrough, these tau tangles could only be analyzed in post mortem brains.

Illuminating tau“s destructive potential
Based on these findings a neuroimaging research group of the University Hospital of Cologne (Germany) has now managed to precisely localize and measure tau tangles in AD patients and attribute them to corresponding neuronal malfunctions. The new tracers were used to measure tau tangles while also studying neuronal dysfunction with radioactively labelled glucose and amyloid tracers to measure amyloid plaques in the same subjects. A link between brain deposits and neuronal dysfunction could only be found for the tau tangles but not for amyloid plaques, thus highlighting the role of tau for the understanding of the development of AD. „The fact that the existing amyloid imaging technique is now able to be used in conjunction with tau imaging will allow us to study these events in patients in a much more comprehensive fashion“, says Dr Silvia Morbelli.

Opening up new treatment avenues
While imaging technologies are advancing rapidly, the development of effective treatments is still lagging behind. Against this backdrop amyloid imaging has already proven its value as it can identify plaques 10 to 15 years before the onset of cognitive symptoms. The same opportunity now exists for the detection of tau tangles. Even though there is no cure so far, certain medications can reduce the symptoms and thus preserve the patients“ mental abilities to a certain degree for a limited time span. „With the emergence of tau PET ligands, drug companies developing new therapeutics designed to halt or reverse AD now have the opportunity to test and monitor their drugs at an early stage of the disease process. The earlier a treatment is started, the greater are the chances of it being effective.“ says Prof Antony Gee, Chairman of the EANM Drug Development committee.
At present, many clinical trials evaluating potentially disease-modifying drugs only enroll AD patients who have been shown to have amyloid plaques using PET. However, with the discovery of tau PET tracers, alternative inclusion criteria can be considered expanded to tau tangles for the evaluation of new AD therapeutics. „Distinguishing more accurately between the clinical consequences of anti-tau and anti-amyloid effects will help to facilitate more effective and faster clinical trials. These are prerequisite for the identification of new AD therapies“, says Dr Silvia Morbelli.
Furthermore: The novel tau tracers are anticipated to help major breakthroughs for the investigation and diagnosis of non-AD related neurodegenerative diseases in which tau deposits play a similarly crucial role. This includes other types of dementia and parkinsonian syndrome.
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Presseagentur für Medizinthemen

Kontakt
impressum health & science communication
Frank von Spee
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20459 Hamburg
040 31786410
vonspee@impressum.de
http://www.impressum.de