Podcasts about pet ct

As we roll into the 4th season of CollaborationRA we brough on guest host, Nicole Ozinga, a registered PET/CT Nuclear Medicine technologist to visit with us about some of the legislation and professional advocacy that has been going on.  We cover many topics and share personal experiences in our advocacy, be sure to listen in and get inspired! Timeline:·      (00:51) Reece opens season four of CollaborationRA.·      (01:47) Introducing Nicole Ozinga.·      (04:30) Nicole shares how she first got exposed to the Nuclear Medicine.·      (06:10) Understanding on the differences between Nuclear Medicine and PET CT and why those certifications are valuable.·      (08:59) Discussing patient's understanding of radiation and developing a healthy understanding.·      (10:44) Digging in deep to learn to learn how improving patient's exams led to Nicole's personal advocacy efforts.·      (15:18) Sharing our advocacy stories and how they relate to best patient care practices·      (17:46) Going to “Hill Day” and visiting the nation's capital, an inside perspective.·      (24:36) Societies give you a safe space to be uncomfortable and build on professional strengths.·      (27:03) Understanding the “Find Act” and the 2025 push that gained success with CMS.·      (31:58) Discussing the RA, NMAA, Nuclear Medicine advocacy and supporting each other with state licensure in the future.·      (37:00) Gaining knowledge that one sentence in legislation can have major outcomes on our professionals.·      (42:52) Offering paygrades for advanced certifications and job roles as a retention model.·      (44:18) Discussing the NMAA and the RA, the push for professional recognition.·      (48:20) The radiologist shortage and how the extenders can be a “part” of the solution.·      (52:51) Professional advocacy and workplace happiness can aid in retention efforts.·      (53:57) Closing the episode out! We hope that you gain new perspectives and understanding with each discussion we have.  Our profession is vital to the care patients receive and nothing showcases that better than sharing our stories.  If you want to come on and share your perspective, find us at collaborationra@gmail.com and let us know!  

Dr. William Makis is the most followed oncologist in the world on social media, with 360,000 followers (including 300,000 on Twitter/X) and 25 million monthly readers. He now offers cancer consultations internationally. To reach him directly, email makisw79@yahoo.com.He is a pioneer in the use of repurposed drugs for cancer treatment, including Ivermectin, Mebendazole, Fenbendazole, Melatonin, and CBD oil. He has internationally recognized expertise in radiology, oncology, immunology, PET/CT, theranostics, and targeted radionuclide therapy.Dr. Makis is the author of over 106 peer-reviewed medical publications in international journals across three continents. He is also a best-selling medical author on Substack.com, with over 1,000 medical articles at makismd.substack.com and readers in more than 160 countries.Additionally, he is an expert on COVID-19 vaccine adverse events, a pioneer in research on mRNA-induced turbo cancer, and a published researcher.Thank you to our sponsor EpicNotes.proCo-host Sarah GreenSupport the showFor more Informed Dissent visit our website at Informed Dissent Media Follow us on Social media @InformedDissentMedia

Dr. William Makis is the most followed oncologist in the world on social media, with 360,000 followers (including 300,000 on Twitter/X) and 25 million monthly readers. He now offers cancer consultations internationally. To reach him directly, email makisw79@yahoo.com.He is a pioneer in the use of repurposed drugs for cancer treatment, including Ivermectin, Mebendazole, Fenbendazole, Melatonin, and CBD oil. He has internationally recognized expertise in radiology, oncology, immunology, PET/CT, theranostics, and targeted radionuclide therapy.Dr. Makis is the author of over 106 peer-reviewed medical publications in international journals across three continents. He is also a best-selling medical author on Substack.com, with over 1,000 medical articles at makismd.substack.com and readers in more than 160 countries.Additionally, he is an expert on COVID-19 vaccine adverse events, a pioneer in research on mRNA-induced turbo cancer, and a published researcher.Thank you to our sponsor EpicNotes.proCo-host Sarah GreenSupport the showFor more Informed Dissent visit our website at Informed Dissent Media Follow us on Social media @InformedDissentMedia

Dr. William Makis, MD, is a Canadian physician with expertise in nuclear medicine, radiology, and oncology. He formerly worked as a nuclear medicine radiologist at the Cross Cancer Institute in Edmonton, Alberta, contributing to one of North America's largest clinics for Targeted Radionuclide Therapy for cancer. Dr. Makis has conducted over 10,000 cancer diagnoses using sophisticated tools like PET/CT. Additionally, he has published more than 100 peer-reviewed articles in international medical journals, with a focus on nuclear medicine, PET/CT imaging, and targeted radionuclide therapy. We discuss all things cancer and treatments. Cornerstone Forum ‘25 https://www.showpass.com/cornerstone25/ Contribute to the new SNP Studio E-transfer here: shaunnewmanpodcast@gmail.com Get your voice heard: Text Shaun 587-217-8500 Substack:https://open.substack.com/pub/shaunnewmanpodcast Silver Gold Bull Links: Website: https://silvergoldbull.ca/ Email: SNP@silvergoldbull.com Text Grahame: (587) 441-9100

Dr. William Makis, MD, is a Canadian physician with expertise in nuclear medicine, radiology, and oncology. He formerly worked as a nuclear medicine radiologist at the Cross Cancer Institute in Edmonton, Alberta, contributing to one of North America's largest clinics for Targeted Radionuclide Therapy for cancer. Dr. Makis has conducted over 10,000 cancer diagnoses using sophisticated tools like PET/CT. Additionally, he has published more than 100 peer-reviewed articles in international medical journals, with a focus on nuclear medicine, PET/CT imaging, and targeted radionuclide therapy. We discuss the harassment he has faced in the past 9 years, the growth of his audience internationally and facing possible jail time. Cornerstone Forum ‘25 https://www.showpass.com/cornerstone25/ Contribute to the new SNP Studio E-transfer here: shaunnewmanpodcast@gmail.com Get your voice heard: Text Shaun 587-217-8500 Substack:https://open.substack.com/pub/shaunnewmanpodcast Silver Gold Bull Links: Website: https://silvergoldbull.ca/ Email: SNP@silvergoldbull.com Text Grahame: (587) 441-9100

Conversations in IFN-y explores the latest advancements in understanding and managing secondary hemophagocytic lymphohistiocytosis (HLH) and macrophage activation syndrome (MAS), with updates from ASH 2024. Featuring discussions by leading experts, the educational activity covers breakthroughs in diagnostic technologies. Topics covered include AI-based histology models and PET/CT imaging, therapeutic innovations such as emapalumab and reduced-intensity conditioning for HSCT. The implications of these findings for improving outcomes in diverse patient populations, including malignancy- and pregnancy-associated HLH will also be discussed.Launch Date: January 9, 2025Release Date: January 9, 2025Expiration Date: December 31, 2025FACULTYPui Lee, MDAssistant Professor of PediatricsBoston Childrens HospitalAshish Kumar, MD, PhDProfessor of PediatricsCincinnati Children's Hospital Medical CenterAlexei Grom, MDProfessor of PediatricsResearch DirectorDivision of RheumatologyCincinnati Children's Hospital Medical CenterThis podcast provides accredited continuing education credits.  To receive your credit, please read the accreditation information provided in this link prior to listening to this podcast.

The UROONCO RCC editorial board chief editor Dr. Carmen Mir, and associate editors Dr. Teele Kuusk and Dr. Riccardo Bertolo share highlights of the important kidney cancer developments for 2024. They summarise the results on several important trials such as FASTRACK, ZIRCON, KEYNOTE-564 and IMmotion010. They also discuss the developments on surgical aspects too.To learn more on the highlights discussed in this podcast, you can read the below Articles of the Month, listen to the podcasts or watch the videos.Stereotactic ablative body radiotherapy for primary kidney cancer (TROG 15.03 FASTRACK II): a non-randomised phase 2 trial[89Zr]Zr-girentuximab for PET–CT imaging of clear-cell renal cell carcinoma: a prospective, open-label, multicentre, phase 3 trialASCO GU24 special: Assoc. Prof. Barata discusses the results of KEYNOTE-564 and CheckMate-914ASCO GU24 special: Prof. Michael Hofman talks about a novel CA IX-targeting peptideASCO2024 special: Circulating kidney injury molecule-1 biomarker analysis in IMmotion010Present and future of robotic surgery for RCCThe treatment of locally advanced and metastatic renal cancerFor more EAU podcasts, please go to your favourite podcast app and subscribe to our podcast channel for regular updates: Apple Podcasts, Spotify, Google Podcasts.

Analiză: Valul extremist și nevoia de reformă a partidelor (DW) - România în Schengen. Marile proiecte de infrastructură rutieră și feroviară la frontierele cu Bulgaria și Ungaria (Economedia) - România, pe locul 1 în Uniunea Europeană la numărul de decese din cauze tratabile. Avem cel mai mare număr de paturi de spital, dar sunt servicii pentru pacienți la care stăm dezastruos (HotNews) - STUDIU OMS Peste 22% dintre copiii români de 11-15 ani suferă de sevraj psihologic, atunci când le este tăiat accesul la telefon (Edupedu) Ce ministere urmează să dispară din viitorul Guvern și câte portofolii pot avea PSD-PNL-USR-UDMR – Surse (Libertatea)Marcel Ciolacu (PSD), Ilie Bolojan (PNL), Elena Lasconi (USR) și Kelemen Hunor (UDMR) au convenit că viitorul guvern, care trebuie format până pe 21 decembrie, va avea cu măcar două ministere mai puțin decât în prezent, au declarat miercuri, 11 decembrie, surse politice pentru Libertatea.În acest moment, sunt 18 ministere, iar numărul va scădea cel puțin până la 16, au stabilit reprezentanții celor 4 partide la negocierile de la Palatul Victoria.Concret, Ministerul Familiei condus acum de Natalia Intotero (PSD) va fi integrat în Ministerul Muncii condus acum de Simona Bucura Oprescu (PSD), iar Ministerul Energiei condus acum de Sebastian Burduja (PNL) va fi comasat cu Ministerul Economiei condus acum de Radu Oprea (PSD), potrivit informațiilor Libertatea. „O altă variantă pe care am discutat-o a fost ca Ministerul Turismului să fie comasat cu Ministerul Culturii”, au explicat participanții la discuții pentru Libertatea.În privința portofoliilor, în acest moment s-a convenit ca ministerele să fie împărțite astfel: PSD – 7 ministere PNL – 4 ministere USR – 3 ministere UDMR – 2 ministere. Analiză: Valul extremist și nevoia de reformă a partidelor (DW)Dezamăgirea românilor față de partidele tradiționale e o realitate pe care politicienii nu au luat-o în seamă. Și-au spus că merge și așa, că oamenii pot fi păcăliți în continuare, că electoratul de stânga rămâne în veci de stânga iar electoratul de dreapta rămâne de dreapta. În realitate, o mare parte a votanților nu au nici o treabă cu ideologiile „tradiționale“, ele însele nefiind limpede conturate și aplicate în exercițiul guvernării.Masa de manevră de la urne e privită de sus, dacă nu chiar disprețuită. Tocmai aici e una din piesele cele mai importante, dacă nu cea mai importantă, a instrumentarului partidelor extremiste. Sunt vocale și dau impresia oamenilor că le ascultă problemele și că sunt singurele care le pot rezolva dacă ajung să guverneze.Oamenilor trebuie să li se spună cinstit ce poate și ce nu poate să facă pentru ei un partid sau o coaliție care guvernează. Liderii politici livrează programe electorale stufoase, de care mulți alegători nici nu au auzit. Limbajul simplu, la obiect, fără înflorituri demagogice, nu e la îndemâna clasei politice, scrie jurnalistul George Arun pe pagina DW.Pe fondul neîncrederii în clasa politică și-a clădit Călin Georgescu delirul de salvator al neamului: „Nu vor mai fi partide politice în această țară. Niciunul nu va mai fi“, pentru ca într-un alt mesaj să spună că „politicienii trebuie să aducă fericire și prosperitate tuturor, aceasta trebuie să le fie misiunea“. Nu e nevoie de partide politice, dar e nevoie de politicieni, spune Georgescu. Această fractură de logică pentru mulți nu a contat, după cum s-a văzut la vot. România în Schengen. Marile proiecte de infrastructură rutieră și feroviară la frontierele cu Bulgaria și Ungaria (Economedia)Ministerul Transporturilor, prin Companiile CNAIR, CNIR și CFR Infrastructură, derulează șase mari proiecte de infrastructură rutieră și feroviară cu o valoare de 8,9 miliarde lei aferente și zonelor de frontieră cu Bulgaria și Ungaria, conform unei analize Economedia în contextul anunțului așteptat pentru acceptarea României și Bulgariei în spațiul Schengen și cu frontierele terestre.Reducerea treptată a controalelor și apoi eliminarea acestora va contribui semnificativ la fluența circulației rutiere și feroviare, însă infrastructura de transport rămâne o problemă pentru că între România și Ungaria, trecerea frontierei se face pe autostradă doar la Nădlac II și Borș II, iar la Giurgiu – Ruse, principalul punct de frontieră între România și Bulgaria, trecerea Dunării se face pe Podul Prieteniei cu o singură bandă pe sens, iar cele mai apropiate puncte terestre sunt la distanță foarte mare: Calafat – Vidin (jud. Dolj) și Negru Vodă (Constanța). România, pe locul 1 în Uniunea Europeană la numărul de decese din cauze tratabile. Avem cel mai mare număr de paturi de spital, dar sunt servicii pentru pacienți la care stăm dezastruos (HotNews)În țara noastră mor de 3 ori mai mulți pacienți din cauze tratabile decât media UE, este una dintre concluziile raportului anual „Health at a Glance: Europe 2024. State of Helth in the EU Cycle”, publicat recent de Comisia Europeană și OECD. Cheltuielile cu sănătatea pe cap de locuitor rămân cele mai scăzute dintre țările UE în România, ca și în precedentele ediții ale raportului State of Health in the EU. Chiar dacă speranța de viață este în creștere și în țara noastră, România are una dintre cele mai reduse speranțe de viață sănătoasă din Uniunea Europeană. Românii trăiesc mai puțini ani sănătoși decât locuitorii altor țări din UE. Cu o medie de 57,8 ani sănătoși, suntem pe locul 22 din 27 de țări, scrie HotNews.România are cel mai mare număr de paturi de spital din Europa, reiese din raportul „Health at a Glance: Europe 2024, însă stă dezastruos la capitole precum prevenție, screening, vaccinare sau la numărul de pacienți care au acces la examinări medicale imagistice de înaltă performanță – CT, RMN sau PET/CT.  STUDIU OMS Peste 22% dintre copiii români de 11-15 ani suferă de sevraj psihologic, atunci când le este tăiat accesul la telefon. Cercetătoarea Diana Tăut: Le-am dat o cheie digitală de gât și i-am abandonat în spațiul virtual. Prima linie de intervenție sunt părinții (EduPedu)În premieră, România este pe primul loc în 44 de țări în privința consumului problematic de social media. Concret, 22% dintre copiii și adolescenții de 11-15 ani din România au dificultăți în a se opri din verificatul telefonului, nu mai au timp să-și facă temele, nu mai vor să iasă afară, stau cu telefoanele în cameră pe parcursul nopții, au insomnii și sentimente de inutilitate sau de tristețe profundă. Datele au fost publicate de Organizația Mondială a Sănătății, sunt cuprinse în raportul „Health Behaviour in School-aged Children (HBSC)”, studiu realizat periodic, și au fost explicate pe larg pentru Edupedu.ro de către cercetătoarea Diana Tăut, investigator principal pentru România în studiul OMS. 

Join Andrew Nish, MD, and Dave Lacey, MD, an interventional radiologist, as they discuss PET/CT scanning and how it has advanced in recent years.

Today's witnesses are from Matthew West's website called popwe.org. If you don't know who Matthew West is, he is a singer, songwriter, and storyteller. This website is for the non-profit that he has with his father, a pastor. Matthew and his father encourage people to share their stories. They have various categories of stories. Today, I chose three testimonies from the God Stories Category. Often, we can hear our own story in someone else's story. When we listen to others tell their story, it helps us see that we are not alone. When we hear how God worked in their situation, it gives us hope that He will work in ours, too! I pray when you hear this testimony, you get the faith and hope to believe that miracles can happen in your situation, also. I pray you know that God is there with you, and if you invite Him into your situation, He can help. I hope you enjoy these testimonies.Sarah-Jane: I've been going through many trails the past several months. I faced a breakdown in my marriage due to mental and financial abuse.  I was depressed and life in general was getting a hold on me. I started to shut down and isolate from people and life. Best to do things on my own, or so I thought.  But it didn't work out great.I eventually shared my struggles with my close friends and family. They were the ones who cared for me and loved me.  I was so ashamed and embarrassed of the situation that I was in.But I am fortunate to have a loving church community that has been on my journey with me. I have handed everything to God. I have forgiven people that have hurt me.I believe that since I've opened my heart more to God, He has filled me to overflowing with the Holy Spirit just at the times I needed it. Whether it was through a worship song, a sermon or a Bible verse. He has the spirit pour over me in the past few weeks.  One day at church, we were invited to come to the front before the mercy seat, I couldn't speak, but within seconds, I just lost it and was crying tears of joy and trembling with laughter.God has shown me so much mercy and grace and it is good to know that I'm never alone. I'm forever blessed to have such a loving God who has made me whole, and He has given me peace and comfort in my trials. If God wasn't in my life, I don't know where I'd be today. He has opened many closed doors.  He provided a nice home and my children visit often. He has helped my anxiety and depression to be manageable. I am a much stronger woman and I'm grateful for God's love.1 Thessalonians 5:23-24 – “May God himself, the God of peace, sanctify you through and through. May your whole spirit, soul and body be kept blameless at the coming of our Lord Jesus Christ. The one who calls you is faithful, and he will do it.”Jenelle: I had the next chemotherapy treatment today. It was number 4. I had a PET-CT scan last week which showed that the metastatic ovarian cancer has reduced in size, and nothing new has grown since the last scan in June. This is the 7th time I have had chemotherapy in 13 years. It has been quite a journey.Because of my experience I can speak with authority to others who are experiencing metastatic cancer and encourage them that God has not forgotten them, and that He always has a purpose for us.Kathie, a fellow traveler, needs prayer. She has metastatic bowel cancer and is questioning not only her doctors, but God. I keep encouraging her to trust God. I have told her that most people don't consider what will happen when they die. I've sent her Bible verses to encourage her. We are the privileged ones because God has given us time.I've had 13 years to plan my funeral! This life is just the shadow. We look forward to the real world that will go on for eternity.For me to live is Christ, and to die is gain! For me, Kathie, and everyone who submits their lives to Jesus, cannot lose! It's definitely a win-win situation! And I for one cannot wait to get to heaven!Jon- My name is Jon, and I want to tell you a story about how the Lord challenged me to trust Him during trials where I frankly thought it would be easier to just end my life. About 15-16 years ago, I blew out a disc in my lumbar spine. At the time, I had never experienced that type of pain, yet I didn't know it that God was giving me a practice session for what was to come. I was treated and it got better but then it came back with a vengeance, and I was taking pain medication like they were Tic Tacs, just to stay functional.I ended up having surgery and praised the Lord when I woke up, because the pain was gone… Again, the Lord was just giving me a break, before the big game started.Six months later, I was diagnosed with severe Rheumatoid Arthritis. I was in a blue funk for a long time. RA is incurable. They don't really know what causes it and all the different medications were only to prevent more damage from happening.But God… He used this time to take someone who really had little patience with people and change that. God made me thankful for the blessings that I had previously not really paid a lot of attention to, and He compelled me to share those blessings. For a long time, my life verse has been Psalms 119:71 “It is good for me that I was afflicted, so that I may learn Your statutes.”Just recently, I was really depressed because I knew I was about to be laid off for the second time in a calendar year. That's when my wife introduced me to Matthew's song “How good of God.” We had been praying for direction in what to do when I found out that I was right and that I was laid off.But “How Good of God!” People I haven't talk to in years came out of the woodwork to help me find a new job. A lot of folks will say, “sure I'll keep an eye out,” but then never do anything. One person I had never met paid for a tool that helped me make my resume better. How good of God! More importantly, I'm saved! My wife is saved! My kids are saved! He has blessed me beyond measure, so I hope that if you're suffering or challenged that you'll remember how good God is. You may not understand but you can always trust Him.Thank you so much for sharing your stories. You may not think it is a big deal but the more we hear how God is working in other people's lives, the more we will see him work in our own lives. Your testimony is helping build the faith of others. Thank you! God is so good!! www.findingtruenorthcoaching.comCLICK HERE TO DONATECLICK HERE to sign up for Mentoring CLICK HERE to sign up for Daily "Word from the Lord" emailsCLICK HERE to sign up for my newsletter & receive a free audio training about inviting Jesus into your daily lifeCLICK HERE to buy my book Total Trust in God's Safe Embrace

- Theo phản ánh của báo chí, thời gian qua, nhiều bệnh viện tại TP.HCM cạn thuốc phóng xạ, gây khó khăn trong việc chụp Pet-CT trong chẩn đoán ung thư, trả lời báo chí liên quan đến vấn đề này, Bộ Khoa học và công nghệ cho biết, Viện Năng lượng Nguyên tử Việt Nam đang xây dựng đề án hợp tác doanh nghiệp giúp khôi phục sản xuất thuốc phóng xạ, phục vụ nhu cầu cấp thiết cho bệnh nhân. Tinh thần chung là xử lý khẩn trương nhưng thận trọng bởi đây là lĩnh vực đặc thù. Chủ đề : thiếu thuốc, phóng xạ --- Support this podcast: https://podcasters.spotify.com/pod/show/vov1tintuc/support

La Dra. Gabriela Regalado Porras y el Dr. Guillermo Olivares Beltrán, médicos especialistas en oncología en el Centro Médico ABC, dan información sobre los tipos de tratamiento disponibles para tratar el cáncer de mama ¡No te lo pierdas! 01:17 ¿Cuáles son los principales tratamientos avalados por la ciencia para tratar el cáncer de mama? 02:47 ¿Qué es la cirugía conservadora y cuándo se recomienda? 09:11¿Qué opinan de la mastectomía como un método de prevención? ¿Es verdad que reduce el riesgo? 10:37 ¿En qué consiste el tratamiento de quimioterapia? 14:28 Sabemos que existe un casco frío para evitar la pérdida del cabello tras las quimioterapias, ¿Qué tanto funciona, es recomendable? 18:16 ¿Qué es la radioterapia? 20:12 ¿En qué consiste la terapia hormonal y para qué tipo de pacientes es recomendable? 26:54 ¿Cómo se debe tratar emocionalmente una persona y su familia que esté viviendo este proceso? 29:34 ¿Qué tan importantes son las redes de apoyo de familiares, amigos o asociaciones frente a este diagnóstico? 32:02 ¿En qué consiste el Círculo de Ganadores del ABC? 36:57 ¿Qué es el PET-CT y cuándo se realiza? 40:32 Si hubo un proceso de mastectomía, ¿todas las mujeres son candidatas a una reconstrucción de mama? 42:51 ¿Cuál es el porcentaje de recurrencia del cáncer de mama? 46:09 Si hay recurrencia, ¿suele regresar en el mismo lugar o puede regresar en otro órgano? 48:41 ¿Qué recomiendan para afrontar emocionalmente la recurrencia de cáncer? 51:40 ¿Qué cambios recomiendan implementar en el estilo de vida de una persona que está padeciendo o padeció cáncer de mama? 54:42 El cáncer de mama siempre causa una protuberancia en el seno, ¿verdad o mito? 55:42 Los brassieres y desodorantes causan cáncer de mama ¿verdad o mito? 56:00 ¿Verdad o mito? Las personas con implantes de seno pueden tener un mayor riesgo de desarrollar cáncer de mama 56:59 La radiación de las mastografías puede causar cáncer de mama ¿Verdad o mito? 57:51 ¿Verdad o mito? Los tratamientos de cáncer de mama siempre causan efectos secundarios graves 59:08 Consumir azúcar alimenta a las células cancerígenas ¿Verdad o mito? 1:00:12 ¿Verdad o mito? Consumir alimentos procesados, calentar alimentos en plásticos aumenta el riesgo de padecer cáncer Información actualizada al 15/10/2024. El contenido de este material es únicamente para fines informativos y no sustituye en ninguna circunstancia o condición a una consulta con el médico especialista. En caso de requerir más información, te sugerimos contactar directamente al médico especialista. Revisado por: Dra. Gabriela Regalado Porras y el Dr. Guillermo Olivares Beltrán, médicos especialistas en oncología en el Centro Médico ABC

Dnes se budeme věnovat novinkám ve vyšetřovacích metodách. Technologie PET/CT je považována za nejmodernější metodu v diagnostice nádorových onemocnění. Současná medicína začala disponovat novou generací tohoto přístroje. V čem je pro pacienta bezpečnější, jak takové vyšetření vypadá, a v čem pomáhá lékařům při lepší diagnostice? Pozvání přijali Doc. MUDr. David Zogala, onkoložka Ph.D., MUDr. Ludmila Křížová, a paní Martina, pacientka, která taková vyšetření podstupuje.

An oncologic radiology update! Hannah chats with Amish and David about the emerging use of whole-body MRI and whole-body PET-CT in cancer management. Plus Frank and Andrew mention Divinity Original Sin II, The Kid LAROI, Sabrina Carpenter and Chappel Roan, thus proving they are still very much in touch with the youth of today.    Our lecture collection ► https://radiopaedia.org/courses/lecture-collections Become a supporter ► https://radiopaedia.org/supporters Get an All-Access Pass ► https://radiopaedia.org/courses/all-access-course-pass Radiopaedia Community chat ► http://radiopaedia.org/chat Ideas and Feedback ► podcast@radiopaedia.org   The Reading Room is a radiology podcast intended primarily for radiologists, radiology registrars and residents. 

How to use Prostate-Specific Membrane Antigen-Positron Emission Tomography/CT in the Management of Relapsing Prostate Cancer Patients following Local Therapy with Curative Intent CME Available: https://auau.auanet.org/node/41124 At the conclusion of this activity, participants will be able to: 1. Identify the clinical scenario in which PSMA PET/CT is most helpful to identify the localization and extent of locoregional or systemic metastatic disease. 2. Identify the pitfalls of false-positive and false-negative PSMA PET/CT findings. 3. Apply the findings of PSMA PET/CT for the best individual therapeutic approach. 4. Identify patients with radiorecurrent organ-confined prostate cancer. 5. Identify those patients who are candidates for local therapy of oligometastatic disease in relapsing prostate cancer. ACKNOWLEDGEMENTS This educational activity is supported by independent educational grants from: Astellas, Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC, Lantheus Medical Imaging, Merck & Co., Inc., Novartis Pharmaceuticals Corporation, Pfizer, Inc.

Autoimmune neurology is a rapidly evolving subspecialty that focuses on neurologic disorders with atypical immune responses. In this episode, Aaron Berkowitz, MD, PhD FAAN, speaks with Sean J. Pittock, MD, an author of the article “Overview and Diagnostic Approach in Autoimmune Neurology,” in the Continuum August 2024 Autoimmune Neurology issue. Dr. Berkowitz is a Continuum® Audio interviewer and professor of neurology at the University of California San Francisco, Department of Neurology and a neurohospitalist, general neurologist, and a clinician educator at the San Francisco VA Medical Center and San Francisco General Hospital in San Francisco, California. Dr. Pittock is the director for the Center for Multiple Sclerosis and Autoimmune Neurology at Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: Overview and Diagnostic Approach in Autoimmune Neurology Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @AaronLBerkowitz Transcript Full transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME.    Dr Berkowitz: This is Dr Aaron Berkowitz, and today, I'm interviewing Dr Sean Pittock about his article, “Introduction to Autoimmune Neurology and Diagnostic Approach”, which he wrote with his colleague, Dr Andrew McKeon. This article is a part of the August 2024 Continuum issue on autoimmune neurology. Welcome to the podcast, Dr Pittock. Could you introduce yourself to our audience?    Dr Pittock: Well, thank you very much, Dr Berkowitz. So, yeah, I'm a neurologist at the Mayo Clinic. I direct the neuroimmunology laboratory with Dr McKeon and Dr Mills here, and I have also been very much involved in the autoimmune neurology section at the American Academy of Neurology.    Dr Berkowitz: So, many of you probably know Dr Pittock - or if you don't know, you've certainly diagnosed diseases that he has described and written about, and so it's a real honor to get to talk to you today and pick your brain a little bit about some of these complex diseases. So, autoimmune neurology is certainly one of the most exciting subspecialties of our field. I feel like when I talk to students and they ask me to make a case for why they should consider neurology as a career, I tell them, “Of course, I have many reasons I love neurology”, but one thing I mention is that, although many other fields of medicine may have made incredible advances as far as treatments, I can't think of too many other fields outside neurology where entirely new diseases have been described since I've been in training and come out of training - and many of those have been in your field of autoimmune neurology. I can think of cases where I've heard you or one of your colleagues on a neurology podcast describing a new antibody, new disease, and a few weeks later, we see that disease and give a patient a diagnosis that had been elusive from other physicians and hospitals. It's a very exciting, gratifying area. It's also daunting, like, every time I go to the AAN and hear one of your colleagues, there's a new disease, and we realize, “Oops! Was I missing that?” or, “Am I going to see this?” And so, hoping to pick your brain a bit today about some of the key concepts and how to keep them in mind so our listeners can recognize, diagnose, and treat these conditions, even if they can't remember every single antibody in your article and all the new ones you and your colleagues will probably discover between now and when this, um, podcast is released. So, before we get into some of the important clinical aspects of these conditions, could you just lay out sort of the broad breaststrokes, the lay of the land of cell-mediated versus antibody-mediated paraneoplastic versus nonparaneoplastic cell surface versus intracellular - how can we sort of organize this area in our minds?    Dr Pittock: Yeah. It's complex, and it's really an evolving story. But the importance, really, from the perspective of the reader and the perspective of the clinician is that we're talking about disorders where we can actually do something - we can actually impact patients.  And we think about the concept of stopping and restoring in neurology now. We're talking about disorders where we have the potential to stop these inflammatory immune-mediated disorders and, potentially, by stopping early, we may be able to restore function - so, a really important new and evolving field in neurology, because you don't want to miss these conditions. Trying to get your head around the complexity of these entities is difficult, but what we've done in this chapter is, really, to try and lay the groundwork for the following chapters, but provide somewhat of a simplistic approach, but a practical approach that really, I think, can help clinicians. So, the way I think of it, a lot of autoimmune neurology really has stemmed from the discovery of antibodies that cause neurological disease, and the examples of those would be going back to myasthenia gravis (with antibodies to the acetylcholine receptor), going back to Lambert-Eaton syndrome. And then, you know, even if you go back to the older traditional paraneoplastic disorders (the Hu, the Ri, the Yo), at the end of the day, you really have two essential entities, if you want to be very simple. The first is disorders that are caused by an antibody, and the second are disorders where the antibodies you detect are not causing the disorder, but they're telling you that there's predominantly a cellular or T-cell mediated attack of the nervous system. And I think thinking about the diseases in those kind of simple terms helps us when we think about what would be the best treatment to use in these types of cases.   Dr Berkowitz: Fantastic. I think that's very helpful. And just to make sure it's clear in the minds of our listeners when we're dividing into these sort of causative antibodies versus antibodies that might be, uh (I don't know if I'm using the word properly), but, sort of epiphenomena (or they're present, but they're not causative) as you said, can you just give some examples of the ones on either side and how making this distinction helps us in practice?    Dr Pittock: Yes. So, antibodies that are causative of disease - I think, you know, the one that I've done a lot of work on is in neuromyelitis optica, where you have antibodies that are targeting a water channel that sits on an astrocyte, and so it causes NMOSD, or what we consider an autoimmune astrocytopathy. And we know that when the antibody binds to the target, many things can happen. So, when aquaporin-4 antibodies bind to aquaporin-4, they can do a lot of things. They can cause internalization, they can activate complement that results in the killing of the cell - but there can be other situations. For example, when NMDA-receptor antibodies bind to the NMDA receptor, then a variety of different things can occur different to water channel autoimmunity - where, for example, the receptor (the NMDA receptor) is downregulated off the cell surface, and that results, to some extent, in the neuropsychiatric phenomenon that we see in NMDA-receptor autoimmunity. And, obviously, when you have a situation where the antibodies are causing the disease, removal of those antibodies, or the reduction in the production of those antibodies, is going to help patients. Now, on the other side, we have antibodies that we detect in the blood or in the spinal fluid, and those antibodies are targeting proteins that are inside the cell - so those antibodies we don't consider as being pathogenic. Now, remember, there are sometimes situations where proteins that are inside the cell occasionally can be available for antibodies to bind at certain situations. So, for example, in the synapse, amphiphysin or the septins, may at times become available. And so, sometimes, there are targets or antibodies that are somewhat in between those two simplistic concepts. But when we're talking about antibodies that are targeting proteins on the inside of the cell, remember that antibodies don't just suddenly occur. There's a whole process of presentation of target antigen at the lymph node, and then both a T- and a B-cell response. The B-cell response potentially produces the antibodies but also triggers and stimulates T-cells, and those T-cells then go on to cause the disease. And those T-cells are very problematic, because those classical paraneoplastic and the newer ones we've described (and many have described) - these are associated with quite severe neurological disability, and they're very, very difficult to treat. And if you ask me, “Where is the holy grail of autoimmune neurology therapeutic research?” It's in trying to actually figure out ways of treating the predominantly T-cell mediated paraneoplastic and autoimmune neurological disorders. We're making great headway in terms of the treatments of the antibody-mediated neurological disorders.   Dr Berkowitz: That's a helpful overview. So, sticking with this framework, you mentioned as sort of the “causative antibody” category and the antibodies that are predominantly for intracellular antigens, but not believed to be causative - I want to make sure I'm understanding this correctly and we can convey it to our listeners - I believe you said in your paper, then, that the antibodies that are predominantly causative are more likely to be associated with conditions that are very treatable, as compared to the intracellular antibodies that are not thought to be causative, as you just said the disability can be irrecoverable or very hard to treat. And I believe another theme in your paper that you brought out is the antibodies that tend to be causative tend to be cell surface and tend to be less likely to be associated with underlying cancer (although not a perfect rule), and the intracellular antigens more commonly associated with cancer in those cases to look very hard for a cancer before giving up. Are those themes that I understand them from your paper properly, or anything else to add there?    Dr Pittock: Yes, I think that that's exactly the message that we were trying to get across, so that's good news that you've picked up on the themes. I think, yeah, in simple terms, remember that when a cytotoxic T-cell identifies the peptide that its T-cell receptor will target, the ultimate outcome is poor, all right? T-cells are like the marines - they don't mess around. Once they find their target, they eliminate that target, and so, it's really difficult to treat those types of diseases if you get them late. And most patients with cytotoxic T-cell mediated paraneoplastic neurological disorders, oftentimes, by the time they get to a center of excellence, the boat has left the dock in many respects - in other words, it's too late. So, you know, I will often see patients, for example, with progressive cerebellar degeneration (say, in the context of Purkinje cell autoantibody type 1 antibodies and a breast cancer), and if those patients are in a wheelchair at the time that I see them, there's very, very little that we can do. So, you really want to try and get that patient into the office, you know, when they're using a cane (or not), and then, potentially, you have the opportunity - using very aggressive immunosuppressive medications - to make a difference. And that is quite different to other scenarios, where, for example, if you have NMDA-receptor encephalitis - as many of the readers will know, this is a condition that is very treatable, and most patients do very well, because the antibodies, they're disrupting function, but they're not killing the neuron, as we see in those more aggressive, paraneoplastic cytotoxic T-cell mediated diseases.   Dr Berkowitz: Also, in terms of searching for an underlying cancer, another theme in your paper as I understood (but want to make sure I'm understanding and conveying to our listeners and hear your thoughts), that the cell surface and treatable antibody-mediated syndromes, as you mentioned (NMO, NMDA) tend to be less associated with underlying cancers (although can be), whereas the intracellular antigens, um, a much higher percentage of those patients are going to end up having underlying cancers. Is that correct, or any notable exceptions to be aware of in that framework?    Dr Pittock: Yeah, I think the major exception to the rule for the antibodies that are targeting intracellular antigens is the GAD65 antibody story. We generally don't consider the stiff person syndrome, cerebellar ataxia, or other autoimmune neurological disorders associated with very high levels of GAD65 antibodies - those are generally not paraneoplastic. And then there are always exceptions on both sides. You know, one of the benefits of understanding the implications of certain antibodies is trying to understand, you know, what is the likelihood of identifying a malignancy, which antibodies are high-risk antibodies (in other words, high-risk paraneoplastological disorders), and which are low risk in terms of cancer? And, you know, age and the demographic of the individual is often important, because we know, for example, with NMDA-receptor antibodies, the frequency of ovarian teratoma varies with the age of the patient.   Dr Berkowitz: Fantastic. And we encourage our listeners to read your articles – certainly, some very helpful tables and figures that help to elucidate some of these broad distinctions Dr Pittock is making - but just to summarize for the antibody-related part of autoimmune neurology, we have one category of cell-surface antibodies and another of intracellular antibodies. Both can cause very severe and varied neurologic presentations, but the cell surface tend to be more treatable, less likely to be associated with the underlying cancer, and the intracellular less treatable, more likely to be associated with the underlying cancer - but, as with everything in neurology and medicine, exceptions on both sides. Is that a fair aerial view of some of the details we've discussed so far, Dr Pittock?    Dr Pittock: Yeah, I think so. I mean, I also think that, you know, not only, at least, for the antibody-mediated disorders (you know, as we discussed) we have drugs that will reduce the production of those antibodies, but we're also learning a lot more about the cytokine and chemokine signatures of these disorders. For example, NMO, water-channel antibody-mediated diseases are associated with elevated levels of IL-6. We know, for example, in LGI1 encephalitis and other encephalitides, that IL-6 also is elevated at the time of that encephalitic process. And so, the potential to target IL-6 with, you know, drugs that inhibit IL-6 and the IL-6 receptor, these potentially have, you know, a role to play in the management of these types of patients - whereas in the T-cell mediated disorders, you know, no advance has been made in the treatment of those conditions, I would say, in over 50 years. So, for example, the standard of treatment is steroids and then drugs that impact the bone marrow, and so we really haven't moved forward in that respect. And that, I think, is an area that really needs drive and enthusiastic out-of-the-box thinking so that we can try to get better treatments for those patients.   Dr Berkowitz: This has been a helpful overview. I look to dive into some of the scenarios that frontline practitioners will be facing thinking about these diseases. An important point you make in your article is that autoimmune and antibody-mediated neurologic syndromes can affect any level of the neuraxis. Even just our discussion so far, you've talked about anti-NMDA receptor encephalitis, you've talked about myasthenia gravis (that's at the neuromuscular junction), you've talked about paraneoplastic cerebellar degeneration - there can be an “itis” of any of our neurologic structures and that “itis” can be antibody-mediated. So, one of the key messages you give us is, one, that these are sort of in the differential diagnosis for any presenting neurologic syndrome, and, two, sort of one of the key features of the history, really, to keep in mind (since we could be anywhere along the neuraxis) is the subacute presentation when this should really sort of be top of mind in our differential diagnosis - so, many of these patients are going to be mystery cases at the outset. And one striking element you bring out in the paper is that, sometimes, the MRI, CSF, electrophysiology studies may be normal or nonspecifically abnormal, and although it's very helpful when we can send these antibody panels out, in some cases, resources are limited or institutions have certain thresholds before you can send these out (because neurologists love to send them in). Sometimes, they are not necessarily appropriate. So, love to hear your thoughts on when we should be sending these panels. What are some clues? Um we have a subacute neurologic presentation at any level of the neuraxis, and when it's not anti-NMDA receptor encephalitis, that is sort of a clear phenotype in many cases. How you would approach a patient, maybe, where the MRI is either normal or borderline abnormal (or people are squinting at the medial temporal lobe and saying, “Maybe they're a little brighter than normal”), CSF is maybe normal or nonspecifically, um, and the protein is a little high, but no cells? What clues do you use to say, you know, “These are the patients where we should be digging deep into antibody panels and making sure these are sent and not miss this diagnosis?”    Dr Pittock: Well, thank you. That's a good question. So, I think, you know, first of all, these are complex cases. So, the patient is sitting in front of you and you're trying to figure out, first of all, Is this a hardware or a software problem? Are we definitively dealing with an encephalitis or an organic neurological entity that's immune-mediated? And, you know, the way I think of it is, for me, you see a patient, it's a twenty-five-piece jigsaw puzzle and you've got two pieces, and you're trying to say, “Well, if I step back and look at those two pieces, do I have any sense of where we're going with this patient?” So, the first thing you need to do is to collect data, both the clinical story that the patient tells you (and I think you make the good point that that subacute onset is really a big clue), but subacute onset, also fluctuating course, sometimes, can be important. The history of the patient - you know, Is the patient somebody who has a known history of autoimmune disease? Because we know that patients that have thyroid autoimmunity are more likely to have diabetes, they're more likely to have gastrointestinal motility or dysmotility, they're more likely to have a variety of different immune-mediated conditions. So, is there a family history or a personal history of autoimmunity? Is the patient at high risk for malignancy? Are there clues that this potentially could be a tumor-initiated immune process affecting the nervous system? The neurological exam also is extremely important because, again, that helps you, first of all, kind of define and get some objectivity around what you're dealing with. So, does the patient have hyperreflexia? Are there signs that there is neurological involvement? And then, really, what I think we need to do is to try and frame the predominant neurological presentation. So, what is the major issue? Because a lot of these patients will have multiple complaints, multiple symptoms, and it's very important to try and identify the major presentation. And that's important, because the neural autoantibody tests are now presentation-defined - in other words, they're built around the neurological presentation, because the old approach of just doing, apparently, a plastic evaluation is gone, because we've got to a stage where we have now so many neural antibodies, you can't test every single neural antibody. So, if you're suspecting that there may be an autoimmune neurological component, then you really need to think about what would be the most appropriate comprehensive evaluation I need to do for this patient. So, for example, if a patient comes in with a subacute-onset encephalopathy, you're probably going to want the autoimmune encephalitis evaluation, and then you have to pick whether it's going to be serum or spinal fluid - and as we outlined in the paper, there are certain antibodies that are better detected in serum versus spinal fluid. So, for example, in adults over the age of 50, LGI1 is much more accurately detected in serum than spinal fluid, and the absolute opposite is true for NMDA-receptor antibody detection. One of the most important components of the neurological evaluation is the spinal fluid, but actually looking at the white cell count - and in fact, sometimes, it's quite interesting to me that I'll often see patients referred with a diagnosis of encephalitis and autoimmune encephalitis, and yet they haven't had a spinal fluid examination. So, the presence of a white cell count, you know, greater than five is hugely helpful - it's like two pieces of that twenty-five-piece jigsaw, because that really tells you that there is something inflammatory going on. And now, in terms of imaging, you're right - some patients will have normal MRI. And if you really do think that there's evidence of - you know, for example, you do an MRI, but you're getting a good sense that there's a temporal lobe seizure occurring, MRI looks normal, the EEG shows some abnormalities in the mesial temporal area - you know, considering additional imaging modalities (like PET scan of the brain), I think, is reasonable. We know that in NMDA-receptor encephalitis cases, 30% of patients will have normal MRI but they'll often have abnormalities on the PET scans. So, I think, what we do is we try to gather data and gather information that allows us to add in pieces of that jigsaw so that, eventually, after we've done this evaluation, we can see now we have ten pieces. If we step back, we say, “Yes, now we know what this condition is”, and then we essentially plan out the therapeutic approach dependent on what we've found. In terms of identification of underlying malignancy, you know, different people have different approaches. Our approach generally has been to try to get a PET-CT scan of the body as our first go-to test, because, actually, we found that CT chest abdomen and pelvis really actually delivers the same amount of radiation - and from a cost perspective, it's about the same - and we have found that PET-CTs really do provide a higher sensitivity for cancer detection.   Dr Berkowitz: Perfect. A lot of very helpful clinical pearls there. So, in closing, Dr Pittock, I've learned a lot from you today. I'm sure our listeners will as well. What does the future hold in this field? What's coming down the pipeline? What are we going to be learning from you and your colleagues that are going to help us take care of patients with these diseases going forward?    Dr Pittock: Well, thank you, Dr Berkowitz, for that question. I think the future is very bright and very exciting, and, hopefully, some of the more junior members will be enthused by this Continuum series, and, hopefully, we'll go into this area. So, let's talk about the future. The future, I think, is going to be of great interest. Firstly, there's going to be continued discovery of novel biomarkers, and the reasons for that is because of the technical and technological advances we've seen. So, for example, there have been many, many antibodies discovered by us and others that have been discovered on the basis of, for example, phage technology. In fact, the Kelch 11 biomarker discovery in collaboration with UCSF and our group was done on the basis of Joe DeRisi and Michael Wilson's phage approach. And we're actually using that now at Mayo Clinic, and we've discovered about three or four new antibodies just in the last couple of years using this technology (and that here is led by John Mills and Div Dubey). And then, we're also going to see, I think, the evolution of protoarrays much more in biomarker discovery, so, we'll have more antibodies, and again, I think, generally, those antibodies will fall into the two categories we kind of described - so, you know, in terms of the approach to those conditions, maybe not so much change. I do think, though, that the introduction and the utility of comprehensive cytokine and chemokine analysis in the future will assist us in making diagnoses of seronegative encephalitis, but also potentially will direct therapy. So, for example, cytokine A is elevated - maybe that would be a potential target for therapy that's available for these patients with rare and potentially very disabling disorders. Then, when we look at the cytotoxic T-cell mediated disorders, I think the major areas of advance are going to be in better understanding the immunophenotype of cytotoxic T-cell mediated diseases, and then the potential development of tolerization strategies using the specific targets, those specific epitope targets that are involved in paraneoplastic and nonparaneoplastic diseases, and seeing if we can vaccinate patients, but move that immune response into more of a tolerogenic immune response rather than a cytotoxic killing response. And then I think, lastly, we're going to see a dramatic revolution in CAR-T therapeutic approaches to these types of disorders moving forward - and not just, you know, CAR-T therapies that are targeting, you know, CD19 or CD20, but CAR-Ts that are actually personalized and developed so that they can target the specific B- and T-cells in an individual patient and actually do a very fine removal of that autoimmune pathologic process that I think would have significant benefit for patients not only in stopping progression, but also in significantly reducing the potential of side effects - so, a much more targeted approach. So, that's where I think the next ten years is going to be. I think it's very exciting. It's going to require the collaboration of neurologists with, you know, immunologists, hematologists, you know, across the board. So, a very exciting future, I think, for this field.    Dr Berkowitz: Exciting, indeed. And we have learned so much from you and your colleagues at the Mayo Clinic about these conditions, and I definitely encourage our listeners to read your article on this phenomenal issue that really gives us a modern, up-to-date overview of this field and what's coming down the pipeline. So, a real honor to get to speak with you, pick your brain about some of the clinical elements, pitfalls and challenges, and also hear about some of the exciting signs. Thank you so much, Dr Pittock, for joining me today on Continuum Audio.   Dr Pittock: Thank you very much.    Dr Berkowitz: Again, today, I've been interviewing Dr Sean Pittock, whose article with Dr Andrew McKeon on an introduction to autoimmune neurology and diagnostic approach appears in the most recent issue of Continuum on autoimmune neurology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you so much to our listeners for joining us today.    Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at Continpub.com/audioCME. Thank you for listening to Continuum Audio.

Dr. Ashwin Singh Parihar discusses the role of multiparametric MRI and 18F-PSMA-1007 PET/CT for the detection of clinically significant prostate cancer with Dr. Bastiaan Privé. This episode is sponsored by Mayo Clinic. Multiparametric MRI and 18F-PSMA-1007 PET/CT for the Detection of Clinically Significant Prostate Cancer. Privé et al. Radiology 2024; 311(2):e231879.

How is AI making waves in medical diagnosis and drug discovery?Have you heard about AI-powered robotic surgeries happening worldwide?How is AI reducing inefficiencies in healthcare across many areas?How is AI enhancing patient experiences and revolutionizing medical practices?Are you curious to discover how AI can improve patient experiences and data management in healthcare?Whether you're curious to know about how AI is making an impact in healthcare, this episode is a must-watch!Hey there, tech enthusiasts!

The Accelerators (Drs. Matt Spraker and Simul Parikh) host Sam Mazin, Ph.D. and Sean Shirvani, MD, CTO and CMO of RefleXion. This Rad Onc startup have created a linear accelerator with on board PET/CT. This allows for SCINTIX biology-guided radiotherapy for bone and lung disease. Sam and Sean join the show to share their story in medical entrepreneurship, discuss the technology, and their vision for the future of our field. Why is SCINTIX any better than fusing a PET/CT to a standard CT simulation? PET/CT on board and in real time offers potential safety advantages and opportunities for personalized therapy. Many would argue that novel radio-molecules and total metastatic ablation are the future of our field. Sam and Sean invite us to think bigger and a lot more creatively about how that future might look for our patients. Here are some other things that were discussed during the show.Bob Timmerman and Nina Sanford on TAP, Parts 1 and 2RefleXion Research Program InformationShankar Siva and others with a good discussion about total metastatic ablation, XSCINTIX receives FDA clearance, RefleXion

Positron Emission Tomography (PET) combined with Computed Tomography (CT) is a powerful imaging modality used in oncology for diagnosis, staging, and treatment monitoring. However, one limitation of PET/CT is the need for accurate attenuation correction (AC) to account for tissue density variations. Traditionally, low-dose CT scans are used for AC, but these contribute to patient radiation exposure. In a new study, researchers Kevin C. Ma, Esther Mena, Liza Lindenberg, Nathan S. Lay, Phillip Eclarinal, Deborah E. Citrin, Peter A. Pinto, Bradford J. Wood, William L. Dahut, James L. Gulley, Ravi A. Madan, Peter L. Choyke, Ismail Baris Turkbey, and Stephanie A. Harmon from the National Cancer Institute proposed an artificial intelligence (AI) tool to generate attenuation-corrected PET (AC-PET) images directly from non-attenuation-corrected PET (NAC-PET) images, reducing the reliance on CT scans. Their research paper was published in Oncotarget's Volume 15 on May 7, 2024, entitled, “Deep learning-based whole-body PSMA PET/CT attenuation correction utilizing Pix-2-Pix GAN.” Full blog - https://www.oncotarget.org/2024/07/11/ai-for-improved-pet-ct-attenuation-correction-in-prostate-cancer-imaging/ Paper DOI - https://doi.org/10.18632/oncotarget.28583 Correspondence to - Stephanie A. Harmon - stephanie.harmon@nih.gov Video short - https://www.youtube.com/watch?v=0mZItCB8AtI Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28583 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ Keywords - cancer, deep learning, PSMA PET, attenuation correction About Oncotarget Oncotarget is an open-access, peer-reviewed journal that has published primarily oncology-focused research papers since 2010. These papers are available to readers (at no cost and free of subscription barriers) in a continuous publishing format at Oncotarget.com. Oncotarget is indexed and archived by PubMed/Medline, PubMed Central, Scopus, EMBASE, META (Chan Zuckerberg Initiative) (2018-2022), and Dimensions (Digital Science). To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM

The Cancer Care at home fundraising campaign wrapped up with a big announcement last night, (PET scan equipment for the Cape Breton Cancer Centre), we find out what difference this will make for patients here.

GUEST 1 OVERVIEW: Dr. William Makis provides in-depth intelligence on Covid-19, sudden deaths, mRNA vaccines, vaccine injuries, new pandemics, and more at makismd.substack.com. He is an expert in Radiology, Oncology and Immunology and ran one of the largest Targeted Radionuclide Therapy Cancer Clinics in North America and diagnosed over 10,000 cancer patients with state-of-the-art diagnostics such as PET/CT. He is a Board Member of The Wellness Company Canada (twc.health) as the Chief of Nuclear Medicine and Oncology. And he is the author of 100+ peer-reviewed medical publications. GUEST 2 OVERVIEW: Ryan is the 'Founder' and 'Editor' of 'The Last American Vagabond'. (TLAV).

This is a controversial podcast about what has been the most taboo topic in medicine for over half a century - vaccine-induced harm. Revolutionary ideas are often seen as heretical before time proves them otherwise. Individuals like Marc are deemed heretics by the regime until they are proven right. Will Marc be proven right? Only time will tell, but there is enough signal on this issue that it merits serious scholarly investigation, which is what Marc has done with his new book, “The Needle's Secret”.About the Guest:Marc Girardot is a French-American father of four children who has spent his career in the world of tech and biotech. He holds an MBA from INSEAD, as well as a Master's in Economics and Business from ESSEC. With deep experience in innovation and complex systems, Marc has worked for Cisco, Booz Allen, and Air Liquide. As a seasoned strategy consultant trained in the scientific method with experience in Automotive, Biotech, and Energy, Marc is a regular lecturer and keynote speaker at leading business schools and corporations. In recent years, Marc has supported a promising anti-cancer DNA vaccine company.He is now the author of the new book “The Needle's Secret: Unraveling the Mystery of Vaccine Harm, and the Bolus Theory Revolution”.Support Marc's Courageous Work: Buy the book NOW: The Needle's Secret on AmazonJoin Us as We Explore:A potentially revolutionary theory that it is the how about vaccines that is more impactful on human health than the what - THE BOLUS THEORY.Are we living through the largest medical malpractice catastrophe in history?Why Marc believes the chances of his investigation being incorrect are 1.1 trillion to 1!!!If most cancer is a man-made induced phenomenon?The avoidable tragedy of autism.Can a change in vaccine application technique bring the medical benefits of vaccines we designed them to offer?Mentions:Study: Nakahara et al., Assessment of Myocardial 18F-FDG Uptake at PET/CT in Asymptomatic SARS-CoV-2–vaccinated and Nonvaccinated Patients. Read moreStudy: Buergin et al., Sex-specific differences in myocardial injury incidence after COVID-19 mRNA-1273 booster vaccination. Read moreStudy: Rancourt et al., “Researchers Find COVID Vaccines Causally Linked to Increased Mortality, Estimate 17 Million Deaths”. Support the Show.Follow Steve's socials: Instagram | LinkedIn | YouTube | Facebook | Twitter | TikTokSupport the show on Patreon:As much as we love doing it, there are costs involved and any contribution will allow us to keep going and keep finding the best guests in the world to share their health expertise with you. I'd be grateful and feel so blessed by your support: https://www.patreon.com/MadeToThriveShowSend me a WhatsApp to +27 64 871 0308. Disclaimer: Please see the link for our disclaimer policy for all of our content: https://madetothrive.co.za/terms-and-conditions-and-privacy-policy/

Positron Corporation (OTC: POSC), a leading molecular imaging medical device company offering Positron Emission Tomography/Computed Tomography (PET and PET-CT) imaging systems and clinical services, is pleased to announce its membership in the national alliance Cardiac PET Industry Coalition, an organization at the forefront of quality of patient care, advocacy and innovation to advance the field of cardiovascular PET imaging. Forbes has published 2024 Forbes The Global 2000 ranking. Ping An Insurance (Group) Company of China , Ltd. (HKEX: 2318 / 82318; SSE: 601318) ranked 29th among global enterprises. It is number 2 among global insurance companies, number 6 among Chinese companies and number 1 among China's insurance companies. For more information, please visit StockDayMedia.com

Escuchemos este episodio con nuestro invitado especial José Alejandro Estévez, Técnico en imágenes PET-CT en CIMEN.En este episodio conversamos con José, sobre el nuevo equipo PET-CT Biograph mCT con el que cuentan en CIMEN en Santiago, República Dominicana, también conversamos con él sobre los beneficios y la preparación que conlleva contar con un equipo de esta gran magnitud, desde su perspectiva como persona que trabaja de la mano con los pacientes. Para más información: https://diss.com/podcast/nuevo-pet-ct-en-cimen/

In this second of three episodes on managing bone metastases in MBC, we bring you a broad review of the major interventions to treat and manage bone mets. We explain the differences among the specialties of Radiology (think x-rays and PET/CT scans) vs. Radiation Oncology (external beam, Stereotactic Radiation Surgery (SRS) or Stereotactic Body Radiation Therapy (SBRT) and Interventional Radiology (Biopsies, Cryoablation, Radiofrequency Ablation among others). The majority of patients with MBC have bone metastases and may have been treated with some form of radiation.  For patients with "oligometastatic" disease, where the number of distant sites of metastatic spread is generally considered to be 5 or less, radiation treatment may be “curative”. It gets a little less clear in those of us with heavier tumor burden and more widespread disease. In that case, radiation is often offered for pain and neurologic considerations, such as preventing a tumor from pressing on the spinal cord, possibly resulting in serious spinal cord compression. But, can different radiation strategies be helpful in disease management, beyond pain management? We ask these questions of both experts here – the first Dr. Shalom Kalnicki, Professor of Radiation Oncology and Associate Director of the Montefiore Einstein Comprehensive Cancer Center in New York City. Our second expert clinician is Dr. Rory Goodwin, who leads the Duke Center for Brain and Spine Metastasis in Durham, North Carolina. He'll talk about this innovative Center's approach to managing bone mets, including offering some lesser-known treatment approaches like Cryoablation (freezing the tumor), and Radiofrequency Ablation (heating the tumor). We also address an emerging therapy called “Theranostics” which is when a radioactive tracer (like the ones used in PET/CT scans) is bound to a radiation treatment that can deliver a lethal dose directly to the bound cancer cell. So listen here and learn with us, and check out the more detailed show notes on our website for the links to what's covered in the episode. 

Commentary by Dr. Candice Silversides

Show notes and links: https://www.chrisbeatcancer.com/dr-jenn-simmons-author-of-the-smart-womans-guide-to-breast-cancer-on-protecting-yourself-from-pet-ct-and-mammogram-radiation-and-new-safe-screening-options/

BUFFALO, NY- May 8, 2024 – A new research paper was published in Oncotarget's Volume 15 on May 7, 2024, entitled, “Deep learning-based whole-body PSMA PET/CT attenuation correction utilizing Pix-2-Pix GAN.” The sequential PET/CT studies oncology patients can undergo during their treatment follow-up course is limited by radiation dosage. In this new study, researchers Kevin C. Ma, Esther Mena, Liza Lindenberg, Nathan S. Lay, Phillip Eclarinal, Deborah E. Citrin, Peter A. Pinto, Bradford J. Wood, William L. Dahut, James L. Gulley, Ravi A. Madan, Peter L. Choyke, Ismail Baris Turkbey, and Stephanie A. Harmon from the National Institutes of Health's National Cancer Institute proposed an artificial intelligence (AI) tool to produce attenuation-corrected PET (AC-PET) images from non-attenuation-corrected PET (NAC-PET) images to reduce need for low-dose CT scans. “AI-generated PET images has clinical potential for reducing the need for CT scans for attenuation correction while preserving quantitative markers and image quality in prostate cancer patients.” Methods: A deep learning algorithm based on 2D Pix-2-Pix generative adversarial network (GAN) architecture was developed from paired AC-PET and NAC-PET images. 18F-DCFPyL PSMA (prostate-specific membrane antigen) PET-CT studies from 302 prostate cancer patients, split into training, validation, and testing cohorts (n = 183, 60, 59, respectively). Models were trained with two normalization strategies: Standard Uptake Value (SUV)-based and SUV-Nyul-based. Scan-level performance was evaluated by normalized mean square error (NMSE), mean absolute error (MAE), structural similarity index (SSIM), and peak signal-to-noise ratio (PSNR). Lesion-level analysis was performed in regions-of-interest prospectively from nuclear medicine physicians. SUV metrics were evaluated using intraclass correlation coefficient (ICC), repeatability coefficient (RC), and linear mixed-effects modeling. Results: Median NMSE, MAE, SSIM, and PSNR were 13.26%, 3.59%, 0.891, and 26.82, respectively, in the independent test cohort. ICC for SUVmax and SUVmean were 0.88 and 0.89, which indicated a high correlation between original and AI-generated quantitative imaging markers. Lesion location, density (Hounsfield units), and lesion uptake were all shown to impact relative error in generated SUV metrics (all p < 0.05). “The Pix-2-Pix GAN model for generating AC-PET demonstrates SUV metrics that highly correlate with original images. AI-generated PET images show clinical potential for reducing the need for CT scans for attenuation correction while preserving quantitative markers and image quality.” DOI - https://doi.org/10.18632/oncotarget.28583 Correspondence to - Stephanie A. Harmon - stephanie.harmon@nih.gov Sign up for free Altmetric alerts about this article - https://oncotarget.altmetric.com/details/email_updates?id=10.18632%2Foncotarget.28583 Subscribe for free publication alerts from Oncotarget - https://www.oncotarget.com/subscribe/ About Oncotarget Oncotarget (a primarily oncology-focused, peer-reviewed, open access journal) aims to maximize research impact through insightful peer-review; eliminate borders between specialties by linking different fields of oncology, cancer research and biomedical sciences; and foster application of basic and clinical science. To learn more about Oncotarget, please visit https://www.oncotarget.com and connect with us: Facebook - https://www.facebook.com/Oncotarget/ X - https://twitter.com/oncotarget Instagram - https://www.instagram.com/oncotargetjrnl/ YouTube - https://www.youtube.com/@OncotargetJournal LinkedIn - https://www.linkedin.com/company/oncotarget Pinterest - https://www.pinterest.com/oncotarget/ Reddit - https://www.reddit.com/user/Oncotarget/ Spotify - https://open.spotify.com/show/0gRwT6BqYWJzxzmjPJwtVh MEDIA@IMPACTJOURNALS.COM

Dr. John Simon, CEO and Founder of SimonMed Imaging makes various medical imaging technologies available, including X-rays, ultrasound, MRI, and PET/CT scans, which have traditionally been used for diagnosis and tracking changes. With the SimonONE whole-body MRI scan, SimonMed offers an affordable preventative screening approach that, with the assistance of AI and advancements in imaging technology, looks for abnormalities and detects subtle changes. Ideally, MRI scans will become more routine in annual exams to catch treatable conditions sooner. John elaborates, "About 20, 25 years ago, diagnostic imaging went from a very limited specialty within the hospital setting to an often-used technology. This great technology is used in the outpatient setting. So, I founded my first outpatient radiology office over 20 years ago, and it included some of the most advanced equipment you could obtain at that time, including cardiac CT and MRI scanners, which were incredibly fast for that time. What that technology enabled us to do was to do outpatient imaging studies very quickly, less expensively, and very accurately." "A whole-body MRI involves a series of MRI sequences, more than one, looking at the body. Typically, we look at the head, neck, chest, abdomen, and pelvis. We do specialized sequences within those areas looking for aneurysms, looking for vascular changes in the body, looking at the health of the brain for not only excluding particularly cancers in the brain, for example, but also looking for early signs of Alzheimer's disease. In the neck, we look for cancers as well as other abnormalities." "In the chest, abdomen, and pelvis, we not only look for vascular abnormalities but also for early signs of cancer and other abnormalities, including metabolic abnormalities within the liver. There is something called fatty liver disease, which is common in the US. So, the process involves a noninvasive MRI study with multiple different sequences looking at different areas within the body, and we put them all together in one visit."  #SimonMedImaging #MRI #WholeBodyScan #Diagnostics #AI #MedicalImaging #PreventativeMedicine SimonMed.com Download the transcript here

Dr. John Simon, CEO and Founder of SimonMed Imaging makes various medical imaging technologies available, including X-rays, ultrasound, MRI, and PET/CT scans, which have traditionally been used for diagnosis and tracking changes. With the SimonONE whole-body MRI scan, SimonMed offers an affordable preventative screening approach that, with the assistance of AI and advancements in imaging technology, looks for abnormalities and detects subtle changes. Ideally, MRI scans will become more routine in annual exams to catch treatable conditions sooner. John elaborates, "About 20, 25 years ago, diagnostic imaging went from a very limited specialty within the hospital setting to an often-used technology. This great technology is used in the outpatient setting. So, I founded my first outpatient radiology office over 20 years ago, and it included some of the most advanced equipment you could obtain at that time, including cardiac CT and MRI scanners, which were incredibly fast for that time. What that technology enabled us to do was to do outpatient imaging studies very quickly, less expensively, and very accurately." "A whole-body MRI involves a series of MRI sequences, more than one, looking at the body. Typically, we look at the head, neck, chest, abdomen, and pelvis. We do specialized sequences within those areas looking for aneurysms, looking for vascular changes in the body, looking at the health of the brain for not only excluding particularly cancers in the brain, for example, but also looking for early signs of Alzheimer's disease. In the neck, we look for cancers as well as other abnormalities." "In the chest, abdomen, and pelvis, we not only look for vascular abnormalities but also for early signs of cancer and other abnormalities, including metabolic abnormalities within the liver. There is something called fatty liver disease, which is common in the US. So, the process involves a noninvasive MRI study with multiple different sequences looking at different areas within the body, and we put them all together in one visit."  #SimonMedImaging #MRI #WholeBodyScan #Diagnostics #AI #MedicalImaging #PreventativeMedicine SimonMed.com Listen to the podcast here

Doctors Vamsi Velcheti, Sandip Patel, and Michael Zervos discuss recent updates on the management of early-stage non-small cell lung cancer (NSCLC), including the optimization of neoadjuvant and adjuvant treatment options for patients and the role of surgery in the era of targeted therapy and immuno-oncology in lung cancer. TRANSCRIPT Dr. Vamsi Velcheti: Hello, I'm Dr. Vamsi Velcheti, your guest host for the ASCO Daily News Podcast today. I am a professor of medicine and director of thoracic medical oncology at the Perlmutter Cancer Center at NYU Langone Health. On today's episode, we'll be discussing recent updates on the management of early-stage non-small cell lung cancer (NSCLC), including the optimization of neoadjuvant and adjuvant treatment options for our patients, and the evolving role of surgery in the era of targeted therapy and immuno-oncology in lung cancer.  Today, I am delighted to be joined by two renowned experts in this space, Dr. Sandip Patel and Dr. Michael Zervos. Dr. Patel is a professor of medicine and a medical oncologist specializing in lung cancer at UCSD. Dr. Mike Zervos is the clinical chief of the Division of Robotic Thoracic Surgery and Director of General Thoracic Surgery at NYU Langone. Our full disclosures are available in the transcript of this episode, and disclosures relating to all episodes of the podcast are available at asco.org/DNpod. Dr. Patel and Dr. Zervos, it's a great honor to have you on the podcast today. Welcome aboard. Dr. Sandip Patel: Great to be joining you.  Dr. Vamsi Velcheti:  Let's get started with Dr. Patel. As you know, over the last decade we've had dramatic advances in systemic therapy options for patients with metastatic non-small cell lung cancer, in both the realms of targeted therapy and immunotherapy. These have significantly improved outcomes for our patients with metastatic lung cancer. What's exciting is that more recently, we've seen the incorporation of these agents, both targeted therapies and immunotherapies, in early-stage non-small cell lung cancer. Dr. Patel, can you tell our listeners about these exciting recent advances and why do you think it's so important to incorporate these personalized systemic therapy options for our early-stage patients? Dr. Sandip Patel: I think it's a great point and a great question. And so, I think one thing to understand is that non-small cell lung cancer is actually multiple diseases. We give it one name based on how it looks under the microscope, but the vast majority of our advances to improve outcomes for patients have come from our ability to understand specific subgroups.  Many of our therapies have had activity in the advanced setting. We have our patients with metastatic or more widespread disease, which naturally led to the thought that could we utilize these therapies in earlier stage disease and potentially increase the rate of cure for many of our patients, lung cancer being the most common cancer killer worldwide. And so to your point, trying to understand how to best treat a patient really involves personalized medicine, typically driven by understanding the genomic profile of their tumor and two of the genes that have graduated from being tested for in the metastatic setting and now in the localized setting are EGFR and ALK. And these in particular are mutations that confer sensitivity to small molecule inhibitors, EGFR with osimertinib, ALK in the localized setting with alectinib based on the data that we've seen.  And so, one of the areas that's been particularly exciting is our ability to maximize a patient's chance for durable remissions by integrating these therapies after surgery, after chemotherapy when appropriate, and continuing generally for a finite amount of time, two to three years depending on the agent in the study we're discussing for these patients. Additionally, immunotherapy, which has revolutionized our treatment of patients with metastatic disease, may be particularly well-suited for the localized setting of non-small cell lung cancer as well. Dr. Vamsi Velcheti: Excellent points, Sandip. You're absolutely right, in the metastatic setting, we've all come to accept molecular testing, sequencing, and biomarker profiling as a standard, but unfortunately, that hasn't quite yet percolated into the early-stage setting. Can you talk about some of the challenges that we face as we have these therapeutic options available now for more early-stage patients? Dr. Sandip Patel: So, I think there are 3 flavors of localized therapy in non-small cell lung cancer. One is the advanced, unresectable stage 3, for which the approach is often concurrent chemo-radiation followed by some form of consolidated therapy. We're about to hear the results of LAURA, which is the study looking at EGFR-mutated non-small cell lung cancer.  For other patients, historically, the treatment has been durvalumab, an anti-PD-L1 directed immunotherapy. The other two are operative treatment of localized cancer: adjuvant treatment after surgery, or neoadjuvant or perioperative, in which chemoimmunotherapy begins before surgery. And testing depends on the settings. For the stage 3 patient who's likely getting concurrent chemo-radiation, they may have a very small amount of tissue, and so often these are done by pulmonary EBUS biopsies and that's how we pathologically confirm that advanced stage 3B. There may not be a lot of tissue available for molecular testing. In fact, if you look at the PACIFIC analysis, just looking at PD-L1, which is just an IHC off a single slide, a third of patients weren't able to even get a PD-L1, let alone a genomic result. And so, I think that's one of the areas of LAURA that's going to be particularly interesting to see as we try to implement it into our practice after seeing the full data.  I think in the adjuvant setting, we're lucky because our surgeons, Dr. Mike Zervos here, will get us a large amount of tissue in the surgical resection specimen, so we tend to get enough tissue to do genomics while they're under chemotherapy, there tends to be time to wait for their genomic result. Where this really gets complicated is in the neoadjuvant or perioperative setting, where time is everything.  The most important thing we can do for a patient in the localized space is get them to the operating room, get them started on radiation, their curative local modality, and that's where we have a time pressure but also a sample pressure because that is a diagnostic biopsy. It's a very small piece of tissue. Initially, there are multiple stains that have to be done to identify this lung cancer as opposed to another tumor. And so that's an area that I think we're going to need additional approaches given that cell-free DNA tends to have lower yield in lower stage disease in giving us a result. Dr. Vamsi Velcheti: Great points, Sandip. How do you deal with this issue in San Diego? The challenge is now we have a lot of trials, we'll talk about those neoadjuvant immunotherapy trials, but we know that immunotherapy may not be as effective in all patients, especially those with EGFR or ALK or some of these non-smoker, oncogene-driven tumors. So, we don't want to be giving patients treatments that may not necessarily be effective in the neoadjuvant space, especially when there is a time crunch, and we want to get them to surgery and all the complications that come with giving them targeted therapy post-IO with potential risk for adverse events. Dr. Sandip Patel: Absolutely. It is a great point. And so, the multidisciplinary team approach is key, and having a close relationship with the interventional pulmonary oncs, interventional radiology surgery, and radiation oncology to ensure that we get the best treatment for our patients. With the molecularly guided therapies, they are currently more on the adjuvant setting in terms of actually treating. But as you mentioned, when we're making a decision around neoadjuvant or perioperative chemo IO, it's actually the absence of EGFR now that we're looking for because our intervention at the current time is to give chemoimmunotherapy. Going back to the future, we used to use single gene EGFR within 24 hours, which was insufficient for a metastatic panel, but it often required five slides of tissue input. ALK can be done by IHC, and so some of these ‘oldie but goodie' pathologic techniques, and that pathologists, if I haven't emphasized, understanding what we're trying to do at a different context is so key because they are the ones who really hold the result. In the neoadjuvant and perioperative setting, which many of us favor, especially for stage 3A and stage 2B disease, understanding how we can get that result so that we can get the patient to the operating room in an expeditious way is so important. There is a time pressure that we always had in the metastatic setting, but I think we feel much more acutely in the neoadjuvant and perioperative setting in my opinion. Dr. Vamsi Velcheti: Fascinating insights, Dr. Patel.  Turning to Dr. Zervos, from a surgical perspective, there has been an evolution in terms of minimally invasive techniques, robotic approaches, and enhanced recovery protocols, significantly improving outcomes in our patients post-surgery. How do you see the role of surgery evolving, especially with the increasing complexity and efficacy of these systemic therapies? How do you envision the role of surgery in managing these early-stage patients, and what are the key considerations for surgeons in this new era? Dr. Michael Zervos: Thanks, Vamsi. Thanks, Sandip. Thank you for having me on the podcast. Obviously, it's an honor to be a part of such a high-level discussion. I have to say, from a surgeon's perspective, we often listen to you guys talk and realize that there's been a lot of change in this landscape. And I think the thing that I've seen is that the paradigm here has also changed. If we were having this discussion 10 years ago, a lot of the patients that I am operating on now, I would not be operating on. It really has been amazing. And I think the thing that stands out to me the most is how all of this has changed with neoadjuvant chemotherapy checkpoint inhibition. I think, for us as surgeons, that's really been the key. Whether it's CheckMate 816 or whatever you're following, like PACIFIC, the data supports this. And I think what we're seeing is that we're able to do the surgery, we're able to do it safely, and I think that the resectability rates are definitely high up there in the 90% range. And what we're seeing is pretty significant pathologic responses, which I think is really amazing to me.  We're also seeing that this has now shifted over to the oligometastatic realm, and a lot of those patients are also being treated similarly and then getting surgery, which is something that we would not have even thought of ever. When you look at the trials, I think a lot of the surgery, up to this point, has been done more traditionally. There's a specific reason why that happens, specifically, more through thoracotomy, less with VATS, and less with robotic. Sandip, I think you guys have a pretty robust robotic program at UCSD, so I'm sure you're pretty used to seeing that.   As you guys have become so much more sophisticated with the treatments, we have also had to modify what we do operatively to be able to step up to the plate and accept that challenge. But what we are seeing is yes, these treatments work, but the surgeries are slightly more complicated. And when I say slightly, I'm minimizing that a little bit.  And what's complicated about it is that the treatment effect is that the chemo-immune check inhibition actually has a significant response to the tumor antigen, which is the tumor. So it's going to necrose it, it's going to fibrose it, and wherever there is a tumor, that response on the surgical baseline level is going to be significant. In other words, there are going to be lymph nodes that are stuck to the pulmonary artery, lymph nodes that are stuck to the airway, and we've had to modify our approaches to be able to address that.   Now, fortunately, we've been able to innovate and use the existing technology to our advantage. Personally, I think robotics is the way we have progressed with all this, and we are doing these surgeries robotically, mainly because I think it is allowing us, not only to visualize things better, but to have sort of a better understanding of what we're looking at. And for that matter, we are able to do a better lymph node dissection, which is usually the key with a lot of these more complicated surgeries, and then really venturing out into more complicated things, like controlling the pulmonary artery. How do we address all this without having significant complications or injuries during the surgery? Getting these patients through after they've successfully completed their neoadjuvant treatment, getting them to surgery, doing the surgery successfully, and hopefully, with minimal to no morbidity, because at the end, they may be going on to further adjuvant treatment. All of these things I think are super important. I think although it has changed the landscape of how we think of things, it has made it slightly more complicated, but we are up for the challenge. I am definitely excited about all of this. Dr. Vamsi Velcheti: For some reason, like medical oncologists, we only get fixated on the drugs and how much better we're doing, but we don't really talk much about the advances in surgery and the advances in terms of outcomes, like post-op mortality has gone down significantly, especially in larger tertiary care centers. So, our way of thinking, traditionally, the whole intergroup trials, the whole paradigm of pneumonectomies being bad and bad outcomes overall, I think we can't judge and decide on current treatment standards based on surgical standards from decades ago. And I think that's really important to recognize.  Dr. Michael Zervos: All of this stuff has really changed over the past 10 years, and I think technology has helped us evolve over time. And as the science has evolved for you with the clinical trials, the technology has evolved for us to be able to compensate for that and to be able to deal with that. The data is real for this. Personally, what I'm seeing is that the data is better for this than it was for the old intergroup trials. We're able to do the surgery in a better, more efficient, and safer way. The majority of these surgeries for this are not going to be pneumonectomies, they are going to be mostly lobectomies. I think that makes sense. I think for the surgeons who might be listening, it doesn't really matter how you're actually doing these operations. I think if you don't have a very extensive minimally invasive or robotic experience, doing the surgery as open is fine, as long as you're doing the surgery safely and doing it to the standard that you might expect with complete lymph node clearance, mediastinal lymph node clearance, and intrapulmonary lymph node clearance. Really, I think that's where we have to sort of drive home the point, really less about the actual approach, even though our bias is to do it robotically because we feel it's less morbidity for the patient. The patients will recover faster from the treatment and then be able to go on to the next phase treatments. Dr. Vamsi Velcheti: In some of the pre-operative trials, the neoadjuvant trials, there have been some concerns raised about 20% of patients not being able to make it to surgery after induction chemo immunotherapy. Can you comment on that, and why do you think that is the case, Sandip?  Dr. Sandip Patel: Well, I think there are multiple reasons. If you look, about half due to progression of disease, which they might not have been great operative candidates to begin with, because they would have early progression afterwards. And some small minority in a given study, maybe 1% to 2%, it's an immune-related adverse event that's severe. So, it's something that we definitely need to think about. The flip side of that coin, only about 2 in 3 patients get adjuvant therapy, whether it be chemotherapy, immunotherapy, or targeted therapy. And so, our goal is to deliver a full multimodal package, where, of course, the local therapy is hugely important, but also many of these other molecular or immunologically guided agents have a substantial impact.  And I do think the point around neoadjuvant and perioperative is well taken. I think this is a discussion we have to have with our patients. I think, in particular, when you look at higher stage disease, like stage 3A, for example, the risk-benefit calculus of giving therapy upfront given the really phenomenal outcomes we have seen, really frankly starting with the NADIM study, CheckMate816, now moving on into studies like KEYNOTE-671, AEGEAN, it really opens your eyes in stage 3. Now, for someone who's stage 1/1b, is this a patient who's eager to get a tumor out? Is there as much of an impact when we give neoadjuvant therapy, especially if they're not going to respond and may progress from stage 1 and beyond? I think that's a reasonable concern. How to handle stage II is very heterogeneous. I think two points that kind of happen as you give neoadjuvant therapy, especially chemo-IO that I think is worth for folks to understand and this goes to Mike's earlier point, that is this concept if they do get a scan during your neoadjuvant chemo immunotherapy, there is a chance of that nodal flare, where the lymph nodes actually look worse and look like their disease is progressing. Their primary tumor may be smaller or maybe the same. But when we actually go to the OR, those lymph nodes are chock-full of immune cells. There's actually no cancer in those lymph nodes. And so that's a bit of a red herring to watch out for.   And so, I think as we're learning together how to deliver these therapies, because the curative-intent modality is, in my opinion, a local modality. It's what Mike does in the OR, my colleagues here do in the OR. My goal is to maximize the chance of that or really maximize the long-term cure rates. And we know, even as long as the surgery can go, if only 2 or 3 patients are going to get adjuvant therapy then 1 in 10, of which half of those or 1 in 20, are not getting the surgery and that's, of course, a big problem. It's a concern. I think better selecting towards those patients and thinking about how to make these choices is going to be hugely important as we go over. Because in a clinical trial, it's a very selective population. A real-world use of these treatments is different. I think one cautionary tale is that we don't have an approval for the use of neoadjuvant or perioperative therapy for conversion therapy, meaning, someone who's “borderline resectable.” At the time at which you meet the patient, they will be resectable at that moment. That's where our best evidence is, at the current time, for neoadjuvant or perioperative approaches.  Dr. Vamsi Velcheti:   I think the other major issue is like the optimal sequencing of immune checkpoint here. Obviously, at this point, we have multiple different trial readouts, and there are some options that patients can have just neoadjuvant without any adjuvant. Still, we have to figure out how to de-escalate post-surgery immunotherapy interventions. And I think there's a lot of work that needs to be done, and you're certainly involved in some of those exciting clinical trials. What do you do right now in your current clinical practice when you have patients who have a complete pathologic response to neoadjuvant immunotherapy? What is the discussion you have with your patients at that point? Do they need more immunotherapy, or are you ready to de-escalate?  Dr. Sandip Patel: I think MRD-based technologies, cell-free DNA technologies will hopefully help us guide this. Right now, we are flying blind along two axes. One is we don't actually know the contribution of the post-operative component for patients who get preoperative chemo-IO. And so this is actually going to be an ongoing discussion. And for a patient with a pCR, we know the outcomes are really quite good based on CheckMate816, which is a pure neoadjuvant or front-end only approach. Where I actually struggle is where patients who maybe have 50% tumor killing. If a patient has only 10% tumor killing ... the analogy I think in clinic is a traffic light, so the green light if you got a pCR, a yellow light if you have that anywhere from 20%-70% residual viable tumor, and then anything greater than that, you didn't get that much with chemo-IO and you're wondering if getting more chemo-IO, what would that actually do? It's a bit of a red light. And I'm curious, we don't have any data, but my guess would be the benefit of the post-op IO is because patients are in that kind of yellow light zone. So maybe a couple more cycles, we'll get them an even more durable response. But I am curious if we're going to start relying more on MRD-based technologies to define treatment duration. But I think it's a very complicated problem. I think folks want to balance toxicity, both medical and financial, with delivering a curative-intent therapy. And I am curious if this maybe, as we're looking at some of the data, some of the reasons around preferring a perioperative approach where you scale it back, as opposed to a neoadjuvant-only approach where there's not a clean way to add on therapy, if you think that makes sense. But it's probably the most complicated discussions we have in clinic and the discussion around a non-pCR. And frankly, even the tumor board discussions around localized non-small cell lung cancer have gone very complex, for the benefit of our patients, though we just don't have clean data to say this is the right path.   Dr. Vamsi Velcheti: I think that the need for a really true multidisciplinary approach and discussing these patients in the tumor board has never been more significant. Large academic centers, we have the luxury of having all the expertise on hand. How do we scale this approach to the broader community is a big challenge, I think, especially in early-stage patients. Of course, not everyone can travel to Dr. Zervos or you for care at a large tertiary cancer centers. So, I think there needs to be a lot of effort in terms of trying to educate community surgeons, community oncologists on managing these patients. I think it's going to be a challenge. Dr. Michael Zervos: If I could just add one thing here, and I completely agree with everything that has been said. I think the challenge is knowing beforehand. Could you predict which patients are going to have a complete response? And for that matter, say, “Okay. Well, this one has a complete response. Do we necessarily need to operate on this patient?” And that's really the big question that I add. I personally have seen some complete response, but what I'm mostly seeing is major pathologic response, not necessarily CR, but we are seeing more and more CR, I do have to say. The question is how are you going to predict that? Is looking for minimal residual disease after treatment going to be the way to do that? If you guys could speak to that, I think that is just tremendously interesting.  Dr. Vamsi Velcheti: I think as Sandip said, MRD is looking very promising, but I just want to caution that it's not ready for primetime clinical decision making yet. I am really excited about the MRD approach of selecting patients for de-escalation or escalation and surgery or no surgery. I think this is probably not quite there yet in terms of surgery or no surgery decision. Especially for patients who have early-stage cancer, we talk about curative-intent treatment here and surgery is a curative treatment, and not going to surgery is going to be a heavy lift. And I don't think we're anywhere close to that. Yet, I'm glad that we are having those discussions, but I think it may be too hard at this point based on the available technologies to kind of predict CR. We're not there.  Dr. Michael Zervos: Can I ask you guys what your thought process is for evaluating the patient? So, when you're actually thinking about, “Hey, this patient actually had a good response. I'm going to ask the surgeons to come and take a look at this.” What imaging studies are you actually using? Are you just using strictly CT or are you looking for the PET? Should we also be thinking about restaging a lot of these patients? Because obviously, one of the things that I hate as a surgeon is getting into the operating room only to find out that I have multiple nodal stations that are positive. Which really, in my opinion, that's sort of a red flag. And for me, if I have that, I'm thinking more along the lines of not completing that surgery because I'm concerned about not being able to provide an R0 resection or even having surgical staple lines within proximity of cancer, which is not going to be good. It's going to be fraught with complications.  So, a lot of the things that we as surgeons struggle with have to do with this. Personally, I like to evaluate the patients with an IV intravenous CT scan to get a better idea of the nodal involvement, proximity to major blood vessels, and potentially even a PET scan. And though I think in this day and age, a lot of the patients will get the PET beforehand, not necessarily get it approved afterwards. So that's a challenge. And then the one thing I do have to say that I definitely have found helpful is, if there's any question, doing the restaging or the re-EBUS at that point to be particularly helpful.  Dr. Sandip Patel: Yeah, I would concur that having that pathologic nodal assessment is probably one of the most important things we can do for our patients. For a patient with multinodal positive disease, the honest truth is that at our tumor board, that patient is probably going to get definitive chemoradiation followed by their immunotherapy, or potentially soon, if they have an EGFR mutation, osimertinib. For those patients who are clean in the mediastinum and then potentially have nodal flare, oftentimes what our surgeons will do as the first stage of the operation, they'll actually have the EBUS repeated during that same anesthesia session and then go straight into surgery. And so far the vast majority of those patients have proceeded to go to surgery because all we found are immune cells in those lymph nodes.  So, I think it's a great point that it's really the pathologic staging that's driving this and having a close relationship with our pathologists is key. But I think one point that I think we all could agree on is the way that we're going to find more of these patients to help and cure with these therapies is through improved utilization of low-dose CT screening in the appropriate population in primary care. And so, getting buy-in from our primary care doctors so that they can do the appropriate low-dose CT screening along with smoking cessation, and find these patients so that we can offer them these therapies, I think is something that we really, as a community, need to advocate on. Because a lot of what we do with next-generation therapies, at least on the medical oncology side, is kind of preaching to the choir. But getting the buy-in so we can find more of these cases at stage 1, 2 or 3, as opposed to stage 4, I think, is one of the ways we can really make a positive impact for patients. Dr. Vamsi Velcheti: I just want to go back to Mike's point about the nodal, especially for those with nodal multistation disease. In my opinion, those anatomic unresectability is a moving target, especially with evolving, improving systemic therapy options. The utilization for chemo radiation has actually gone down. I think that's a different clinical subgroup that we need to kind of think differently in terms of how we do the next iteration or generation of clinical trials, are they really benefiting from chemo-IO induction? And maybe we can get a subset of those patients in surgery. I personally think surgery is probably a more optimal, higher yield to potentially cure these patients versus chemo radiation. But I think how we identify those patients is a big challenge. And maybe we should do a sequential approach induction chemo-IO with the intent to kind of restage them for surgery. And if they don't, they go to chemo consolidation radiation, I guess. So, I think we need to rethink our approach to those anatomically unresectable stage 3s. But I think it's fascinating that we're having these discussions. You know, we've come to accept chemo radiation as a gold standard, but now we're kind of challenging those assumptions, and I think that means we're really doing well in terms of systemic therapy options for our patients to drive increased cures for these patients. Dr. Michael Zervos: I think from my perspective as a surgeon, if I'm looking at a CT scan and trying to evaluate whether a patient is resectable or not, one of the things that I'm looking for is the extent of the tumor, proximity to mediastinal invasion, lymph nodes size. But if that particular patient is resectable upfront, then usually, that patient that receives induction chemo checkpoint inhibition is going to be resectable afterwards. The ones that are harder are the ones that are borderline resectable upfront or not resectable. And then you're trying to figure out on the back end whether you can actually do the surgery.  Fortunately, we're not really taking many patients to the operating room under those circumstances to find that they're not resectable. Having said that, I did have one of those cases recently where I got in there and there were multiple lymph node stations that were positive. And I have to say that the CT really underestimated the extent of disease that I saw in the operating room. So, there are some challenges surrounding all of these things. Dr. Sandip Patel: Absolutely. And I think for those patients, if upfront identification by EBUS showed multi nodal involvement, we've had excellent outcomes by working with radiation oncologists using modern radiotherapy techniques, with concurrent chemo radiation, followed by their immunotherapy, more targeted therapy, at least it looks like soon. I think finding the right path for the patient is so key, and I think getting that mediastinal pathologic assessment, as opposed to just guessing based on what the PET CT looks like, is so important. If you look at some of the series, 8% to 10% of patients will get a false-positive PET on their mediastinal lymph nodes due to coccidioidomycosis or sarcoidosis or various other things. And the flip side is there's a false-negative rate as well. I think Mike summarized that as well, so I think imaging is helpful, but for me, imaging is really just pointing the target at where we need to get pathologic sampling, most commonly by EBUS. And getting our interventional pulmonary colleagues to help us do that, I think is so important because we have really nice therapeutic options, whether it's curative-intent surgery, curative-intent chemo radiation, where we as medical oncologists can really contribute to that curative-intent local therapy, in my opinion.  Dr. Vamsi Velcheti: Thank you so much Sandip and Mike, it's been an amazing and insightful discussion, with a really dynamic interplay between systemic therapy and surgical innovations. These are really exciting times for our patients and for us. Thank you so much for sharing your expertise and insights with us today on the ASCO Daily News Podcast.   I want to also thank our listeners today for your time. If you value the insights that you hear today, please take a moment to rate, review, and subscribe to the podcast wherever you get your podcasts. Thank you so much. [FH1]   Dr. Sandip Patel: Thank you. Dr. Michael Zervos: Thank you.   Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.   Follow today's speakers: Dr. Vamsidhar Velcheti @VamsiVelcheti Dr. Sandip Patel @PatelOncology Dr. Michael Zervos   Follow ASCO on social media: @ASCO on X (formerly Twitter) ASCO on Facebook ASCO on LinkedIn   Disclosures:  Dr. Vamsidhar Velcheti: Honoraria: ITeos Therapeutics Consulting or Advisory Role: Bristol-Myers Squibb, Merck, Foundation Medicine, AstraZeneca/MedImmune, Novartis, Lilly, EMD Serono, GSK, Amgen, Elevation Oncology, Taiho Oncology, Merus Research Funding (Inst.): Genentech, Trovagene, Eisai, OncoPlex Diagnostics, Alkermes, NantOmics, Genoptix, Altor BioScience, Merck, Bristol-Myers Squibb, Atreca, Heat Biologics, Leap Therapeutics, RSIP Vision, GlaxoSmithKline   Dr. Sandip Patel: Consulting or Advisory Role: Lilly, Novartis, Bristol-Myers Squibb, AstraZeneca/MedImmune, Nektar, Compugen, Illumina, Amgen, Certis, Eli Lilly, Roche/Genentech, Merck, Pfizer, Tempus, Iovance Biotherapeutics. Speakers' Bureau: Merck, Boehringer Ingelheim Research Funding (Inst.):Rubius, Bristol-Myers Squibb, Pfizer, Roche/Genentech, Amgen AstraZenece/MedImmune, Fate, Merck, Iovance, Takeda   Dr. Michael Zervos: No relationships to disclose

GUEST 1 OVERVIEW: Executive Director of the Alliance of Health Care Sharing Ministries Katy Talento is a veteran policy advisor, health care reformer, epidemiologist and thought leader. As the former top health advisor at the White House Domestic Policy Council, Katy spearheaded transformative policies to protect religious liberty in health care, end secret health care prices across the United States, end predatory medical collections practices, lower prescription drug prices, guarantee health records access and interoperability for patients and their care teams, combat the opioid addiction crisis and eliminate domestic HIV/AIDS. She first developed her take-no-prisoners approach to waste and corruption as an oversight investigator and legislative director on Capitol Hill, born of love and duty toward the hardworking American taxpayers. Prior to her White House appointment, Katy served five U.S. Senators over a 15-year period, including as top health advisor and manager of legislative staff and oversight investigators. She also worked in the private sector helping multinational energy companies protect their global workforce from infectious diseases such as malaria, dengue and the largest community-based HIV/AIDS service organization in the US. On the faculty at Georgetown University Medical School, Katy managed the Washington site of a multi-site NIH-funded pulmonology study. GUEST 2 OVERVIEW: Dr. William Makis provides in-depth intelligence on Covid-19, sudden deaths, mRNA vaccines, vaccine injuries, new pandemics, and more at makismd.substack.com. He is an expert in Radiology, Oncology and Immunology and ran one of the largest Targeted Radionuclide Therapy Cancer Clinics in North America and diagnosed over 10,000 cancer patients with state-of-the-art diagnostics such as PET/CT. He is a Board Member of The Wellness Company Canada (twc.health) as the Chief of Nuclear Medicine and Oncology. And he is the author of 100+ peer-reviewed medical publications.

GUEST OVERVIEW: Dr. William Makis provides in-depth intelligence on Covid-19, sudden deaths, mRNA vaccines, vaccine injuries, new pandemics, and more at makismd.substack.com. He is an expert in Radiology, Oncology and Immunology and ran one of the largest Targeted Radionuclide Therapy Cancer Clinics in North America and diagnosed over 10,000 cancer patients with state-of-the-art diagnostics such as PET/CT. He is a Board Member of The Wellness Company Canada (twc.health) as the Chief of Nuclear Medicine and Oncology. And he is the author of 100+ peer-reviewed medical publications. https://www.makismd.substack.com      

GUEST OVERVIEW: Dr. William Makis provides in-depth intelligence on Covid-19, sudden deaths, mRNA vaccines, vaccine injuries, new pandemics, and more at makismd.substack.com. He is an expert in Radiology, Oncology and Immunology and ran one of the largest Targeted Radionuclide Therapy Cancer Clinics in North America and diagnosed over 10,000 cancer patients with state-of-the-art diagnostics such as PET/CT. He is a Board Member of The Wellness Company Canada (twc.health) as the Chief of Nuclear Medicine and Oncology. And he is the author of 100+ peer-reviewed medical publications.

Seg 1: The evolution of athletic bravado Athletes have strategically proclaimed their greatness throughout history to emphasize their abilities. This "athlete persona," characterized by confidence and self-aggrandizement, stems from ancient Greek rituals. Guest: Dr. Peter J. Miller, Associate Professor and Chair of the Department of Classics at the University of Winnipeg Seg 2: View From Victoria: BC United is streaming BC United is holding a streaming event tonight with Kevin Falcon rolling out a new advertising campaign. We get a local look at the top political stories with the help of Vancouver Sun columnist Vaughn Palmer. Seg 3: Should politicians be banned from accepting exuberant gifts? Federal Ethics Commissioner Konrad von Finkenstein has decided not to investigate Prime Minister Justin Trudeau's recent vacation to Jamaica, despite opposition calls for scrutiny. Guest: Duff Conacher, Co-founder of Democracy Watch Seg 4: Why is BC investigating police malpractice again? The Human Rights Commissioner of BC has launched an inquiry into police use of force against racialized individuals and those with mental health issues. Guest: Kasari Govender, B.C.'s Human Rights Commissioner Seg 5: Will more funding improve cancer care in BC? The province of British Columbia is undergoing construction for a new cyclotron and radiopharmacy laboratory in Vancouver, aiming to enhance access to PET/CT scans and innovative cancer treatments. Guest: Dr. François Bénard, Senior Executive Director Of Research of BC Cancer Seg 6: Will new leadership improve the Ministry of Family Development? Mitzi Dean's recent departure from the position of Minister of Children and Development reflects the ongoing trend of frequent ministerial changes within this portfolio, with Grace Lore becoming the 14th minister since the ministry's establishment in 1996. Guest: Grace Lore, Minister of Children and Family Development Learn more about your ad choices. Visit megaphone.fm/adchoices

The province of British Columbia is undergoing construction for a new cyclotron and radiopharmacy laboratory in Vancouver, aiming to enhance access to PET/CT scans and innovative cancer treatments. Guest: Dr. François Bénard, Senior Executive Director Of Research of BC Cancer Learn more about your ad choices. Visit megaphone.fm/adchoices

Tim Henrich is a Professor of Medicine and expert in infectious diseases, focused on chronic viral infections at the University of California, San Francisco. He is another member of the titan Long Covid research team who have tracked patients since the beginning of the pandemic (LIINC study) and are making roads into understanding the mechanism of the disease and potentials for treating it.In this week's episode he talks us through some of the exciting work that he is doing, alongside our previous guests Steven Deeks & Michael Peluso.  Using a combination of longitudinal studies, biopsies and high resolution PET / CT imaging, the team have established changes to t cells throughout the bodies of Long Covid patients, and found evidence of viral persistence.  They are currently conducting multiple clinical trials including monoclonal antibodies to act on viral reservoirs, and the anti-viral Ensitrelvir which has undergone several trials in active SARS-COV2 previously, and believe that they are getting to grips with the pathophysiology of the disease.Living with Long Covid? How was your week?Website - https://www.tlcsessions.net/Twitter - @SessionsTlc https://twitter.com/sessionstlcInsta - @tlcsessions https://www.instagram.com/tlcsessions

In today's episode, part of our MBC webinar series, we delve into the San Antonio Breast Cancer Symposium (SABCS). We aim to break down the overwhelming amount of information into digestible insights. We discuss key findings, particularly on inflammatory breast cancer (IBC) and invasive lobular carcinoma (ILC), with insights from Amy Parliman, a member of our MBC leadership team.Amy highlights the advancements in technology that outpace current treatment options and the importance of recognizing the unique challenges of diagnosing IBC and ILC due to their imaging difficulties. She shares that the symposium acknowledged these challenges and that there's growing research focusing on the genomic mutations specific to these types of breast cancer.We also touch on the significance of patient-centric care, reminding listeners that they have the ultimate say in their treatment decisions. Amy shares her personal experience with her treatment regimen and the importance of sticking with what works unless there's a compelling reason to change.The episode also covers the potential of contrasted mammograms and the need for different types of PET-CT scans for accurate diagnosis. We stress the importance of being informed and advocating for oneself, as treatments can vary based on individual cancer properties.As always, we remind our listeners that the information shared is from personal experiences and not a substitute for professional medical advice. We encourage reaching out to your medical care team with any questions or concerns.00:02:46 - Dr. Mankoff's Research on Imaging Technology00:04:02 - Genomic Mutations in Different Breast Cancer Types00:04:34 - Clinical Trials and Research Timelines00:04:56 - Genes Implicated in Inflammatory Breast Cancer00:06:02 - Imaging Challenges with Lobular Breast Cancer00:07:07 - Amino Acid Studies and PET-CT Imaging00:09:19 - Personalized Treatment and Informed QuestionsAttend a free virtual SurvivingBreastCancer.org event:https://www.survivingbreastcancer.org/eventsSurvivingBreastCancer.org's  Mission: To empower those diagnosed with breast cancer and their families from day one and beyond. Follow us on InstagramLaura and Will: https://www.instagram.com/laura_and_will/SurvivingBreastCancer.org: https://www.survivingbreastcancer.org/Breast Cancer Conversations: https://www.instagram.com/breastcancerconversations/About SurvivingBreastCancer.org: SurvivingBreastCancer.org, Inc. (SBC) is a federally recognized 501(c)(3) non-profit virtual platform headquartered in Boston with a national and global reach. Through education, community, and resources, SurvivingBreastCancer.org supports women and men going through breast cancer. We provide a sanctuary of strength, compassion, and empowerment, where those diagnosed with cancer unite to share their stories, learn invaluable coping strategies to manage wellness and mental health, and find solace in the unbreakable bond that fuels hope, resilience, and the courage to conquer adversity.Support the show

Unlock the future of equine health as we welcome Dr. Pablo Espinosa-Mur to Veterinary Vertex. Pablo shares pioneering research on PET CT and tarsal pain in horses. Experience a revelation in diagnostic technology, as we traverse the findings from Pablo's recent JAVMA article. We discuss correlating complex imaging results with lameness scores, and we unravel the technicalities behind PET CT protocols and showcase the clinical significance of these advanced imaging outcomes.As we examine the subtleties of tarsal pain, the conversation takes us through the ways cystic lesions and enthesophytes present on PET scans. Pablo, a radiologist with a wealth of experience in equine lameness, guides us through the maze of imaging and clinical signs, offering a nuanced understanding of these findings. Join us for an episode that will not only inform but also inspire the veterinary community to embrace the next wave of diagnostic innovation in equine medicine and surgery.Full article: https://doi.org/10.2460/javma.23.03.0164INTERESTED IN SUBMITTING YOUR MANUSCRIPT TO JAVMA ® OR AJVR ® ? JAVMA ® : https://avma.org/JAVMAAuthors AJVR ® : https://avma.org/AJVRAuthorsFOLLOW US:JAVMA ® : Facebook: Journal of the American Veterinary Medical Association - JAVMA | Facebook Instagram: JAVMA (@avma_javma) • Instagram photos and videos Twitter: JAVMA (@AVMAJAVMA) / Twitter AJVR ® : Facebook: American Journal of Veterinary Research - AJVR | Facebook Instagram: AJVR (@ajvroa) • Instagram photos and videos Twitter: AJVR (@AJVROA) / Twitter JAVMA ® and AJVR ® LinkedIn: https://linkedin.com/company/avma-journals

Kolonizace Afriky a osudy afrických vojáků černé pleti v první světové válce v souvislosti s francouzským filmem Otec a syn. Jak je snímek věrný historickým faktům, jaké mýty o období kolonialismu panují? Nový přístroj PET/CT a dvě nové gamakamery přibyly v Ústavu nukleární medicíny v Praze. Pomůžou vyšetřit více pacientů. Jaké další přednosti mají? Díky testům DNA se podařilo určit, odkud pochází několik zabavených zásilek. Moderuje Renata Kropáčková.

State Superintendent Ryan Walters is attacking the American Library Association.The state's first mobile PET/CT Scan is coming to Oklahoma.How OKC is working to grow its public transit system.You can find the KOSU Daily wherever you get your podcasts, you can also subscribe, rate us and leave a comment.You can keep up to date on all the latest news throughout the day at KOSU.org and make sure to follow us on Facebook, Twitter and Instagram at KOSU Radio.This is The KOSU Daily, Oklahoma news, every weekday.

Listen to ASCO's Journal of Clinical Oncology essay, “The Gift of Truth” by Dr. Ilana Hellmann, an Attending Physician in the Hematology Department at Meir Medical Center in Israel. The essay is followed by an interview with Hellmann and host Dr. Lidia Schapira. Hellmann shares how it is an immense privilege and grave responsibility for physicians to give bad news to patients who have a terminal disease. TRANSCRIPT It was a hot and humid Tuesday in July, and I distinctly remember being grateful for the air conditioning in the pastel-shaded waiting room of the oncology outpatient clinic. My father sat silently beside me. We knew this room well, as we did the doctor we had arrived to see. He had been my late mother's oncologist until she had passed away just over a year previously from metastatic breast cancer. Dad remembered him being kind yet direct and had requested that he be his oncologist now that he needed one. I watched his hands fidget with the slip of paper bearing the number that would be called over the loud speaker. My father was 84 and a retired university professor of statistics. He spoke seven languages and his friends called him the encyclopedia as he was an endless fountain of knowledge in history, politics, literature, art, etc.…. His number was called, directing us to a room we had been in many times before. After greetings and some small talk about my late mother, Dr Cohen addressed my dad and slowly went through the history.  He had had surgery for a squamous cell carcinoma on his scalp along with skin graft 6 months earlier. Two or 3 months later, he complained of pain in his right hip which seemed to worsen by the day. After some imaging and assessment by an orthopedic surgeon, a diagnosis of osteoarthritis was declared, and the treatment recommended was a total hip replacement. The surgery was performed and my dad, who had been suffering from extreme pain, felt immediate relief. He was delighted with the results of the procedure, delight that dissipated in an instant when the pathology report came back: metastatic squamous cell carcinoma. He had been quickly referred for a course of radiation which had been completed. This meeting was intended to discuss further treatment. Dr Cohen gently explained that my father's cancer was not curable and that there was no good treatment available for him at that time. I do not really remember much of what was said after that. I found myself thanking him for his time and helping my father to the car. The drive home was awful, with awkward silence broken only by a discussion about what he was going to have for lunch. We both pointedly avoided talking about the meaning behind Dr Cohen's explanations. I was stunned. I felt like my father had been fired by his doctor and that I had been left to deal with the consequences. I felt alone, abandoned, and betrayed. The next few days passed quickly as I juggled my busy hospital schedule with family dinners, school runs, and the sporting activities of my three boys—the oldest of whom was 11 years old at the time. The weekend came, and on Saturday morning, my husband and I planned to meet friends at the local swimming pool as we so often did in the hot summer months. Leaving him to clean up honey and pancakes, I went across to the apartment opposite ours to say good morning to my father and tell him we would be gone for the better part of the day. He was sitting up in bed and said: “Before you go, please bring me my phone book.” He still used an alphabetized phone book, mostly in my late mother's hand writing. I found the book and held it out to him. “Find David Green's number” he said, which I did. “Dial it please” he said while looking for his glasses on the bedside table. I dialed and handed him the phone. I then listened as he greeted David—an old colleague from his years in academia. Dad had not spoken to David in many years. He explained that he had cancer, and that he did not have much time, but that he wanted David to know how much he had enjoyed working with him and to thank him particularly for his contribution to an article they had published together. I got up to go and, seeming not to notice, he asked me to dial the number of another friend. Realizing this was going to take some time, I called my husband and told him to take our boys to the swimming pool without me. I sat down next to Dad on his bed and dialed number after number. My parents had lived in a few countries, and my father's academic career had connected him with people all over the world. Over the course of almost 6 hours, he spoke to friends, relatives, old neighbors, and many work colleagues. He had a personal message for every one of them and started each conversation with a clear and brief explanation of the circumstances of his call. There were some people who were not home for his call, and he left long messages on answering machines. Those 6 hours were cathartic for the both of us. It was sad but also terribly beautiful and filled with my dad's signature black humor. Once we had contacted everyone in the phonebook, he continued his mission and gave me a list of people he wanted to be present at his funeral, as well as a second list of those he would prefer not to be there. Then, he handed me an envelope which contained a substantial sum of money. “This” he explained “is for the gentlemen who come to take my body.” My mother had died at home, and he remembered the two ambulance men who had come to take her body to the morgue after she had passed. He had been struck by the difficulty of such thankless work and wanted to make sure they were appropriately compensated. Very soon after that Saturday, my father had a seizure and was diagnosed with brain metastases. As dad had made it very clear that he wanted palliative care and no admissions to the hospital, Dr Cohen connected us with the services of home hospice care. He deteriorated rapidly and died at home, as he had wished, 3 months later. The money in the envelope was duly delivered to its intended recipients, and there are some people who were not at his funeral.  I have often gone back to the conversation in the oncologist's office on that July morning. Oncologists conduct end-of-life discussions with their patients every day. How does one tell the patient the truth without taking away every ounce of hope? Does every patient have to know that he is dying? I had never thought about the immediate consequences of what I say to my patients and their loved ones until I had to get my dad to the car and spend those eternal 20 minutes with him on the drive home. Bad news is difficult for those on the receiving end but no less so for those given the task of delivering it, especially when it concerns a terminal illness. There are some physicians who avoid telling their patients that their disease is terminal altogether. In not telling patients of the terminal nature of their cancer, are we protecting them or ourselves? And are we preventing them from being able to use the time they have left in a way they would wish with the knowledge that time is limited? There are those patients who cannot or will not talk about death. Knowing how much to say to each of our patients, and choosing the appropriate words, is an art. The task entrusted to physicians of giving bad news is both an immense privilege and a grave responsibility. My father received a brutal gift that day. But brutal as it was, it was a gift that enabled him to part, to make peace, and to prepare for his coming death. I have since had countless conversations with my own patients about their imminent demise. I constantly remember my father and that special Saturday. My memories are of tears, and of laughter, and most of all, of a sense of closure for the both of us. I hope that I am able to give my patients their truth in a way that will make it as much a gift for them, as it was for him. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Associate Editor for Art of Oncology and a Professor of Medicine at Stanford University. Today we are joined by Dr. Ilana Hellmann, who is an Attending Physician in the Hematology Department at Meir Medical Center in Israel. In this episode, we will be discussing her Art of Oncology article, “The Gift of Truth.”  At the time of recording, our guest has no disclosures.  Ilana, welcome to our podcast, and thank you for joining us. Dr. Ilana Hellmann: Thank you for inviting me. It's wonderful to be here. Dr. Lidia Schapira: You've been on our show before, so let me just start by diving right into your beautiful article. It honors the memory of your father, a Professor of Statistics, who had an encyclopedic knowledge of the world and spoke seven languages and was known by so many different people. And you start by bringing us to the moment in the waiting room of the oncology department that was familiar to both of you because your mother had been a patient and you had very carefully selected the oncologist for your father. You say it was a July humid day, and his number is called. And then what happened? Dr. Ilana Hellmann: Well, as I wrote, all the moments that you've just repeated from the article are things that are imprinted in my mind as if it happened yesterday. My father passed away in 2014, and there are those moments and many others that I remember very, very clearly. It's something I hear from my patients also all the time. They remember exactly the day they received the diagnosis, the time of day, they tell me what I was wearing when I told them whatever it was I told them. And it's something that struck me that when I went back to that day and many other things that happened afterwards, I remembered every second. I think I knew what the oncologist was going to say in retrospect, but at the time, maybe I didn't think about it.  It's very interesting that we as physicians, especially oncologists, we know exactly, but when it comes to family members, we're a little blind. And I've had this experience a few times since my mother passed away from cancer. My father and my father in law passed away just over a year ago, also from metastatic pancreatic cancer. So we know it very well.  Dr. Lidia Schapira: Sorry.  Dr. Ilana Hellmann: As I wrote in the article, I remember going in with my father. I remember the conversation, or at least the beginning part of it, but once the message hit home that, “This is what we have, the bottom line is there's not a lot we can do. We certainly can't cure your disease.” I don't remember anything else that happened after that. Dr. Lidia Schapira: And you described the ride home after that. You mentioned that you felt your father had been fired, had been fired from anything that was perhaps curative or offered sort of some optimism, perhaps the conversation was a little deeper and supportive and offered some palliation. But what you took away was that this was awful. He was fired. Then you say the ride home was really difficult.  Tell us a little bit about that. What was it like to leave the oncologist office as the sort of informed knowledgeable daughter who had just received this message? Dr. Ilana Hellmann: Exactly that. And I kept thinking in my mind, “How much do I say, what is he thinking? How much does he understand?” I was almost jealous, a little of people who have no medical knowledge. So much easier. Maybe it's not, but I think it's really tough for physicians as family members of patients who are unwell. But my father was, as I described, an exceptionally intelligent person, a real intellectual. He was enormous, not physically, but there was nothing he didn't know. You could ask him anything. He read the dictionary for fun. These are things that he liked to compare languages and cancer made him very small. And it was awful. It was just awful, awful to see. And that moment, it was very emphasized how small he was. He was just silent. There was just nothing, and I didn't know what to say. I felt absolutely helpless. And as I described, that drive is 20 minutes, maybe even a little less. It was endless.  And I remember that I went home with him. It was lunchtime, and I dropped him at home and I went back to work. I think I had taken the day off, to- I didn't know what was going to happen with the oncologist, and I went back to work because it was easier to go back to work than to stay at home. And he was silent. He said nothing. And the next time I understood what he was going through was on that Saturday with everything that happened.  Dr. Lidia Schapira: So fast forward to that Saturday, I imagine that you were busy with your children and your work, and it was easy to– I'm going to use the old fashioned word compartmentalize, put this aside for a little bit. And then on Saturday you're going in to say, “Hey, I'm going to take the children to the pool. How are you?” And he had a completely different idea of how you were going to find yourself spending the day. And I think that's such a powerful scene in the essay when you say that he started one by one asking you to dial his contacts, his friends, his colleagues and give a message. Tell us a little bit about how that felt and bring us to the bedside or to the scene if you can.   Dr. Ilana Hellmann: So there's dad. He's in bed. He's got his morning cup of coffee. He lived with a full-time carer at that stage, who brought him some breakfast and a cup of coffee. At some stage, she brought me a cup of coffee. He was very, very focused. It was like I was an assistant, just doing what he needed so that he could talk to all the people he wanted to talk to. It was crazy. It was like watching something surreal. There were people he hadn't spoken to in 20 years that he called. He had no concept of what time it was in various parts of the world, so he woke people in the middle of the night. It was really quite something. People didn't believe me afterwards when I told them the story, and as I say, some of the conversations were very, very humorous. My father had a wicked sense of humor; very black sense of humor. So, there was lots of laughter mixed in with, “I'm dying, and I have cancer.” Lots of humor, and there were a lot of tears, mostly on my part because my father was not a tearful type. He was emotional, but he didn't cry. But I remember being very tearful. I didn't know all the people. Some of the people were people I'd heard of when I was a child, all sorts of neighbors, people we'd lived next door to years before when I grew up in South Africa.  And when he'd finished, he had this sense of- he was satisfied, “I've done what I had to do.” And then he moved on. He had his list of things he had to do, the money he wanted to give to the ambulance workers, the people he wanted at his funeral, he didn't want to go to his funeral. It was typical of my father to do something like that. He planned everything. And it was like he'd had a box that he had to seal and tie a ribbon and it was done. And then he was finished and he was ready and he let go. It was amazing. It was beautiful. Dr. Lidia Schapira: When I read your essay, I felt that that was the gift he gave you. You have the word ‘gift' in the title. But it's such an amazing scene for a father to be able to do, sort of a review of his life while he's still living. Instead of leaving you a box with all of his memories, he basically showed you and gave you this loving and exhaustive, comprehensive demonstration of what his life had been about. Dr. Ilana Hellmann: Absolutely. Dr. Lidia Schapira: And in some ways, some of the dimensions that he touched were the professional dimensions that perhaps as a child or a young adult he would not have been able to access. But you saw how big he was. What an amazing thing. Did you and he ever talk about that? What it was that led him to do that? Or was that just something that happened and you sort of both understood and just walked on? Dr. Ilana Hellmann: It was beautiful and it's certainly a gift I've been left with. There was the gift he got and the gift I got. It was a little intense. Six hours of calls was exhausting. I remember when my husband came home and I told him, he immediately poured me a glass of wine. It was very, very difficult and it took me a long time to go through. I had no time to recover from one conversation to the next conversation. And he just kept going. He had very little breaks during the day. There were a lot of people he had to talk to, and he wanted to finish it today. He thought he was dying next week. That's not what happened. He never spoke about it again. And that was quite typical of him. He was like, “What's done is done. I've said what I had to say.” There were a lot of things that he said that I heard from the conversations that he had. And as you say, there were various gifts during the day that were told to other people but intended for me and for my younger brother who was not there at the time because he lived in England. But we never discussed it again. That was the way my father was. Dr. Lidia Schapira: You know when we, as physicians, tell patients who are sort of nearing the end of their life to say what they need to say to be prepared, this is exactly why, right? Because very soon after that, he had a seizure. He had brain metastasis. He might not have had the stamina or the ability to do what he did. So that is a very important lesson. I was incredibly moved by that scene, and I've probably read it a dozen times. You've probably thought about it a million times, but certainly this reader took a lot from that very beautifully described scene and so nicely told.  So for the last few minutes, tell us a little bit about how this personal experience has impacted your delivery of news and your relationship with the patients. You start by telling us that often, as oncologists, we give bad news but then we just move on. But people live with this, people go home like this. How has that experience as a daughter impacted your delivery of news?  Dr. Ilana Hellmann: Absolutely. There are a few parts of how it's influenced me. Somebody who read the article when I was writing it had said to me, "Wow, do all physicians have to go through these things to be able to identify with their patients or their family members?" Well, I hope not. It's a terrible thing to think of that each of us– On the other hand, there's no question that when you've been through something, you identify with the person in front of you if you know what they're talking about, you know what it's like to be a mother, you know what it's like to be a daughter. You know or you don't know what it's like to lose a parent or somebody else and the experiences that I had and I imagine anybody else have had with interactions with the medical community, with doctors, with the emergency room, with all sorts of things are things that influence the way I approach patients. So one of the things is true. I'm guilty of the fact that it didn't occur to me that I sit in my room, I see a patient and his daughter, his wife, his whatever, and I give them this news, and then I leave the wife to deal with him outside. Or the fact that when the oncologist said, “We haven't got curative treatment for you,” and I didn't hear anything else after that. Well, we know that when we tell patients something not good, there's often no point in carrying on the conversation and talking about treatment and side effects and whatever because they're not there anymore. And that's something that I remember very clearly from that.   You can't go with the patient, you can't go home with them, you can't get in the car with them, but you can remember it, think about it, choose your words carefully, maybe have a word with the spouse or the family member, whoever it is, as they're leaving outside the door, “If you need anything, call me.” Maybe call them. Sometimes, I've seen that it's difficult, and I've called them the next day. That definitely has influenced me. I'm not sure there's a lot you can do about it, but I think about it. In terms of telling patients that time is limited, that you're not going to live forever, it's hard, and we want to give patients good news. It's so much easier to tell a patient that their PET CT is clear than that it's all come back and the prognosis is not good.  So I try to understand where the patient is and how much they want to go. Most patients will lead the conversation. Most patients know to tell you how far they want you to go. And I've never been sorry about telling the patient that their prognosis is bad and that their disease is terminal. And I've had lots of return conversations from families after patients have passed on about the conversations they had, about the things that they did, about the fact that the patient decided maybe not to have more intensive treatment, went on a holiday, decided not to come to the emergency room with a fever or whatever it was, and elected to stay at home with hospice.  I found that that side of oncology is no less rewarding when you have to accompany a patient on their lost journey. I've found over the years that it's actually no less rewarding than the patients who are cured. And then you see them once a year and they come and they say everything's good.  Dr. Lidia Schapira: And that perhaps is part of what we call the art of oncology, which is the being in relationship, connecting with somebody, being a rock or a source of guidance for them when they're going through incredibly vulnerable times. I think that's not something that perhaps others recognize as being rewarding, but for those of us who are drawn to it, it can be incredibly rewarding.  Thank you, Ilana. This is a beautiful conversation and such a lovely essay. I imagine there's a reason for this taking about ten years to process and write, because the impact is so deep, but you managed to do that. For that, all of the readers of JCO are grateful to you. So I thank you very much.  Dr. Ilana Hellmann: Thank you. Thank you for taking it and publishing it.  Dr. Lidia Schapira: So until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review and be sure to subscribe so you never miss an episode. You can find all of the ASCO shows at asco.org/podcasts. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Show Notes Like, share and subscribe so you never miss an episode and leave a rating or review.  Guest Bio:  Dr. Ilana Hellmann is an Attending Physician in the Hematology Department at Meir Medical Center in Israel.

This week, we continue our conversation about DLBCL, this time focusing our attention on the management of early stage disease. If you have not done so, we highly recommend you listen to our hemepath series (https://www.thefellowoncall.com/rotationguide-intro-to-hematopathology) before proceeding with this episode. Furthermore, if you have not listened to the introduction to DLBCL episode (Episode 072; https://www.thefellowoncall.com/tfocpodcast/dlbclintro), we highly recommend doing so, as we will be building on these basics this week. Content: - What is the role of PET/CT in diagnosis of DLBCL?- What is the Deauville score?- How do we approach treatment to early stage DLBCL?- What are options without radiation?- What are treatment options for older patients with early stage DLBCL? **This episode is sponsored by HemOnc.org** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

This week, we kick off a new series focusing on diffuse large B-cell lymphoma. In this first episode, we discuss the basics that everyone needs to understand before diving into the management of this disease. We highly recommend listening to our hemepath series before proceeding with this DLBCL series: https://www.thefellowoncall.com/rotationguide-intro-to-hematopathologyContent: - Approach to workup for a patient with suspected lymphoma- FNA vs. Core vs. Excisional biopsy for diagnosis- Use of PET/CT for staging- How to risk-stratify patients - "Double hit" vs. "double expressor"**This episode is sponsored by HemOnc.org** Want to review the show notes for this episode and others? Check out our website: https://www.thefellowoncall.com/our-episodesLove what you hear? Tell a friend and leave a review on our podcast streaming platforms!Twitter: @TheFellowOnCallInstagram: @TheFellowOnCallListen in on: Apple Podcast, Spotify, and Google Podcast

In this episode we talk with Dr. José Ramírez, INCART Director, about the Regional Training Course in Quality Control and Quality Assurance in PET-CT Procedures that was carried out at the facilities of the National Cancer Institute, INCART, in the Dominican Republic, from Monday august 21 to Friday 25.

AUA2023: How to use PSMA-PET/CT in the Management of Relapsing Prostate Cancer Patients following Local Therapy with Curative Intent CME Available: https://auau.auanet.org/node/38312 CME Expiration Date: May, 2024 ACKNOWLEDGEMENTS Independent educational grant support provided by: Astellas AstraZeneca Janssen Biotech, Inc., administered by Janssen Scientific Affairs, LLC Lantheus Medical Imaging Merck & Co., Inc. Pfizer, Inc.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj's unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you've ever wondered how any radiology tool works, this episode is for you. We discuss: Raj's road from engineering to radiology [2:45]; How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [13:00]; Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [22:45]; Ultrasound: Benefits and limitations, and a special use for the heart [36:00]; Detecting breast cancer with mammography: When is works, when you need more testing, and defining ‘sensitivity' and ‘specificity' [46:15]; Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [59:00]; Brain aneurysms: Using MRI to find them and save lives [1:18:45]; Raj's unique MRI technology [1:25:15]; The risk of false positives in cancer detection, and how Raj's MRI can reduce the number of false positives (i.e., increase specificity) [1:38:45]; The unique software Raj created to pair with his MRI machine [1:46:15]; Comparing the radiation exposure of a whole-body PET-CT to Raj's equipment (DWIBS-MRI) [1:48:45]; How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:50:15]; Why a DW-MRI is still not a perfect test [1:54:15]; The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [1:58:00];/li> Are there any commercially available scanners that can match the resolution of Raj's images? [2:01:00]; Machine learning: When and where might machine learning/AI impact the field of radiology? [2:03:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

CardioNerds (Drs. Amit Goyal and Dan Ambinder) join Dr. Mina Fares, Dr. Johannes Bergehr, and Dr. Christina Peter from Cambridge University Hospitals in the UK. They discuss a case involving a man man in his 40's presented with progressive heart failure symptoms. He has extensive background cardiac history including prior episodes of myocarditis and complete heart block status post permanent pacemaker implantation. Ultimately a diagnosis of Danon disease is made. Dr. Sharon Wilson provides the E-CPR for this episode. Audio editing by CardioNerds Academy Intern, Hirsh Elhence. CardioNerds is collaborating with Radcliffe Cardiology and US Cardiology Review journal (USC) for a ‘call for cases', with the intention to co-publish high impact cardiovascular case reports, subject to double-blind peer review. Case Reports that are accepted in USC journal and published as the version of record (VOR), will also be indexed in Scopus and the Directory of Open Access Journals (DOAJ). CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Summary - A Presentation of Heart Failure and Heart Block with Elusive Genetic Origins - Cambridge University A man in his 40s with a history of cardiac issues, including prior myocarditis and complete heart block, presented with progressive heart failure symptoms. Extensive cardiac investigations were conducted, revealing dilated left ventricle, mild to moderate left ventricular systolic dysfunction, normal coronaries, infero-lateral late gadolinium enhancement on cardiac MRI, and low-level uptake on PET-CT. Differential diagnosis included worsening underlying cardiomyopathy, recurrent myocarditis, tachycardia-related cardiomyopathy, pacemaker-induced LV dysfunction, and sarcoidosis. The patient's condition improved with heart failure medications, and cardiac MRI showed a mildly dilated left ventricle with moderate systolic dysfunction and active inflammation in the anterior wall. Further evaluation indicated a family history of hereditary cardiomyopathy, and the patient exhibited phenotypic features such as early-onset heart disease, arrhythmias, family history of cardiomyopathy, learning problems, intellectual disability, and mild proximal myopathy. Genetic testing confirmed a LAMP2 mutation, leading to the diagnosis of Danon disease. Case Media - A Presentation of Heart Failure and Heart Block with Elusive Genetic Origins - Cambridge University Show Notes -A Presentation of Heart Failure and Heart Block with Elusive Genetic Origins - Cambridge University References - Danon, M. J., Oh, S. J., DiMauro, S., Miranda, A., De Vivo, D. C., & Rowland, L. P. (1981). Lysosomal glycogen storage disease with normal acid maltase. Neurology, 31(1), 51-7. Nishino, I., Fu, J., Tanji, K., Nonaka, I., & Ozawa, T. (2000). Mutations in the gene encoding LAMP2 cause Danon disease. Nature, 406(6798), 906-10. Tanaka, K., Nishino, I., Nonaka, I., Fu, J., & Ozawa, T. (2000). Danon disease is caused by mutations in the gene encoding LAMP2, a lysosomal membrane protein. Nature, 406(6798), 902-6. Maron, B. J., Haas, T. S., Ackerman, M. J., Ahluwalia, A., Spirito, P., Nishino, I., ... & Seidman, C. E. (2009). Hypertrophic cardiomyopathy and sudden death in a family with Danon disease. JAMA, 301(12), 1253-9. Hashem, S., Zhang, J., Zhang, Y., Wang, H., Zhang, H., Liu, L., ... & Wang, J. (2015). AAV-mediated gene transfer of LAMP2 improves cardiac function in Danon disease mice. Stem cells, 33(11), 2343-2350. Chi, L., Wang, H., Zhang, J., Zhang, Y., Liu, L., Wang, J., ... & Hashem, S. (2019). CRISPR/Cas9-mediated gene editing of LAMP2 in patient-derived iPSCs ameliorates Danon disease phenotypes.

Internationally recognized neuroradiologist Dr. Bradley Jabour joins Dr. Phil to offer important information about brain bleeds, warning signs and breakthroughs on the treatment of brain degeneration, traumatic brain injury, neuropsychiatric disorders and essential tremors.  “With a head injury, I'd rather err on the side of overreaction rather than underreaction,” Dr. Jabour   Dr. Jabour gained national recognition for developing new techniques in cancer imaging in the head and neck using PET/CT. His most recent interest is in the field of functional MRI (fMRI) and its role in evaluating neurological disorders. For more information: http://drphilintheblanks.com/ Interested in advertising on the show? Visit https://www.advertisecast.com/PhilintheBlanks Learn more about your ad choices. Visit megaphone.fm/adchoices