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1 CT 1990 CT (CT ) CT 90% CT CT X CT CT CT GPIIb/IIIa ( 24 )

2 ) ( ) ( ) 2) (free T3, free T4, TSH ) TSH TSH T3 TSH T3 euthyroid Graves 3. TSH macrofollicular adenoma follicular neoplasm 4. CT Tl-201 I I-131

3 SPECT, PET PET SPECT SPECT PET CT γ Tc- 99m kev (PET γ 511 kev) γ γ SPECT ( ) γ γ SPECT 2 γ ( SPECT) 4 1 ECT X CT SPECT, PET 3

4 X CT 1 cm X CT US MRI MRI I- 131 (6β-iodomethyl-19- norcholestenol (I-131)) I-131 MIBG (I-131-meta-iodobenzylguanidine) 25 30% 2 cm I-131 Pre-clinical Cushing ( ) RI MIBG MIBG

5 I-131 1) Coakley J, Kettle AG, Wells CP: Tc99m sestamibi A new agent for parathyroid imaging. Nucl Med Commun 1989; 10: ) O Doherty MJ, Kettle AG, Wells CP, et al: Parathyroid imaging with technetium-99m-sestamibi; Preoperative localization and tissue uptake studies. J Nucl Med 1992; 33: ) Geelhoed GW, Druy EM: Management of the adrenal incidentaloma. Surgery 1982; 92: ) Ross NS, Aron DC: Hormonal evaluation of the patient with an incidentally discovered adrenal mass. N Engl J Med 1990; 323: ) Reincke M, Nieke J, Krestin GP, et al: Preclinical Cushing s syndrome in adrenal incidentalomas ; Comparison with adrenal Cushing s syndrome. J Clin Endocrinol Metab 1992; 75: ) Shapiro B, Copp JE, Sisson JC, et al: 131-Iodinemetaiodobenzylguanidine for the locating of suspected pheochromocytoma; experience in 400 cases. J Nucl Med 1985; 26: ) Krenning EP, Bakker WH, Breemon WAP, et al: Localization of endocrine-related tumors with radioiodinated analogue of somatostatine. Lancet 1989; 1: ) : In-111- DTPA-D-Phe-octreotide 1995; 32: ) Krenning EP, Kwekkeboom DJ, Bakker WH, et al: Somatostatin receptor scintigraphy with (In-111-DTPA- Phe) and (I-123-Try 3 )-octreotide; The Rotterdam experience with more than 1000 patients. Eur J Nucl Med 1993; 20:

6 how & when I-131-OIH SPECT Tc-99m Cr-51-EDTA I-125-iothalamate Tc- 99m-DTPA (GFR) Tc-99m-MAG3 1 Russell Bubeck Piepsz 40 ERPF ( TER) GFR Tc-99m-DTPA (GFR) Tc-99m-MAG3 (ERPF : TER) Tc- 99m-DMSA (functional renal mass) Tc-99m-DTPA (how) (when) (what)

7 ( ) CT ICG 70 80% m Tc- ( 99m Tc-GSA) SPECT 6 GSA 1) GSA GSA LHL15 30 HH15 Rmax 3 Rmax 2 4 Rmax 2) % 6 99% Rmax 3 79% 6 97% 3) 2 Rmax (45%) 1 2 4) 2 3 Rmax 6 3 Rmax Rmax 1 33% 64% 6 3 CT 1 1 2

8 ( ) ( ) (bolus, infusion) 2. ( ) 2 ( ) 2 WINSAAM ()

9 SPECT 1) SPECT 2) SPECT 3) SPECT 1) SPECT SPECT 2) SPECT SPECT i) SPECT CT, MRI luxury perfusion crossed cerebellar diaschisis (remote effect) early postischemic hyperperfusion ii) iii) ( ) SPECT SPECT 3) SPECT 1), 2) SPECT SPECT

10 ( ) A B C D E F 2 RI G

11 Nuclear Medicine Training in the United States Prasuna Inampudi, M.D. Department of Radiology, University of Michigan Medical Center, Ann Arbor, Michigan, U.S.A. Sandi A. Kwee, M.D. Division of Nuclear Medicine, Department of Radiology, University of Washington Medical Center, Seattle, Washington, U.S.A. In the United States, there are two routes for certification to practice Nuclear Medicine: 1) Post-doctoral training in a Diagnostic Radiology Residency program approved by the American Board of Radiology requires 5 years of training including a year of clinical training in medicine, surgery, pediatrics, obstetrics and gynecology, neurology, emergency medicine, family practice or any combination of these. A minimum of 6 months, but no longer than 12 months of Nuclear Medicine training is required during 4 years of training in diagnostic radiology. 2) Post-doctoral training in Nuclear Medicine approved by the American Board of Nuclear Medicine also requires a year of preparatory post-doctoral training in clinical medicine approved by the Board, followed by dedicated training in Nuclear Medicine for a period of 2 years. In addition, the American Board of Nuclear Medicine supports various combined programs with Diagnostic Radiology, Internal Medicine, Cardiology, and Neurology boards. In this session, Nuclear Medicine training will be reviewed by trainees from these two different training approaches, and issues relating to training including their daily work, certification process, research involvement, job opportunities will be discussed. Trainees will offer their candid opinions on diverse facets of Nuclear Medicine training in the United States. Through this discussion, the audience will learn the unique aspects of these two approaches as well as their limitations. Young Nuclear Medicine trainees and physicians are encouraged to attend this session and discuss comparisons of training programs in the USA and Japan.

12 ( ) ( ) tissue characterization 1) Sumiya H, et al: Nuclear imaging in bone tumors: Thallium-201 scintigraphy. Seminars in Musculoskeletal Radiology 2001; 5: ) Sumiya H, et al: Midcourse thallium-201 scintigraphy to predict tumor response in bone and soft-tissue tumors. J Nucl Med 1998; 39: ) Taki J, Sumiya H, et al: Assessment of P-glycoprotein in patients with malignant bone and soft-tissue tumors using technetium-99m-mibi scintigraphy. J Nucl Med 1998; 39: ) Taki J, Sumiya H, et al: Evaluating benign and malignant bone and soft-tissue lesions with technetium-99m- MIBI scintigraphy. J Nucl Med 1997; 38:

13 SPECT SPECT [1] ( ) SPECT sensitivity specificity ( ) (1) attenuation artifact (2) motion artifact (3) hot-spot artifact (1) (2) (3) attenuation artifact 99m Tc motion artifact [2] () () ECG gated SPECT QGS [3] viability fill-in ( ) fill-in [4] 1 [5] ( ) SPECT

14 PET [6] SPECT

(核)41-1(05)報告33-46

(核)41-1(05)報告33-46 33 Report on Survey of the Adverse Reaction to Radiopharmaceuticals (The 28th Survey in 2002) 6 * Subcommittee of Safety Issue for the Radiopharmaceuticals Medical and Pharmaceutical Committee Japan Radioisotope