Podcasts about Technetium

In this episode, we dive into the history of polymyalgia rheumatica, how it was discovered and its link to giant cell arteritis. Intro 0:01 In this episode 0:10 What is polymyalgia rheumatica (PMR)? 0:24 The history of PMR 02:12 PMR in the 1950s: A formally recognized disease 04:52 What was probably PMR in the 1880s 06:27 Naming PMR: Senile rheumatic gout 07:26 1957: The witch's shot and finally landing on polymyalgia rheumatica 08:30 Where is PMR coming from? 14:42 Injecting joins with saline 16:39 A biopsy study in 1964 19:54 Technetium bone scintigraphy in 1971 and bone scan history 23:01 First look at a PMR ultrasound in 1993 27:00 1997: First use of MRI on PMR patients in Italy 27:49 Going back to 1962: PMRs association with giant cell arteritis 30:40 A paper on muscular involvement in giant cell arteritis: 80-year-old ‘robust' partially blind seaman 32:15 First systematic approach: The link between PMR and giant cell arteritis 35:14 80 cases of PMR 38:13 Swedish autopsy studies 41:07 Introduction of advanced imaging in the 1990s 42:40 Summing up PMR through the decades 43:28 That is the end! 45:25 Thanks for listening 45:50 We'd love to hear from you! Send your comments/questions to Dr. Brown at rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum. References: Bruk MI. Ann Rheum Dis. 1967;doi:10.1136/ard.26.2.103. Cantini F, et al. J Rheumatol. 2001;28(5):1049-55. De Miguel E, et al. Rheumatology (Oxford). 2024;doi:10.1093/rheumatology/kead189. Dixon AS, et al. Ann Rheum Dis. 1966;doi:10.1136/ard.25.3.203. Hamrin B, et al. Ann Rheum Dis. 1968;doi:10.1136/ard.27.5.397. Salvarani C, et al. Ann Intern Med. 1997;doi:10.7326/0003-4819-127-1-199707010-00005. Shah S, et al. Rheumatology (Oxford). 2025;doi:10.1093/rheumatology/keae569. Disclosures: Brown reports no relevant financial disclosures.

Commentary by Dr. Sabahat Bokhari.

This recording features audio versions of January 2024 Journal of Vascular and Interventional Radiology (JVIR) abstracts:Association between End-Stage Renal Disease and Major Adverse Limb Events after Peripheral Vascular Intervention ReadPercutaneous CT-Guided Cryoablation for Locally Recurrent Prostate Cancer: Technical Feasibility, Safety, and Effectiveness ReadHydrogel Augmentation of the Lumbar Intervertebral Disc: An Early Feasibility Study of a Treatment for Discogenic Low Back Pain ReadProgression toward Vertebral Collapse of Vertebral Metastases Treated with Percutaneous Vertebroplasty: Rate and Risk Factors ReadA Pilot Study of Percutaneous Cholecystoenteric Anastomosis: A New Option for High-Risk Patients with Symptomatic Gallstones ReadMeasurement of the Tumor-to-Normal Ratio for Radioembolization of Hepatocellular Carcinoma: A Prospective Study Comparing 2-Dimensional Perfusion Angiography, Technetium-99m Macroaggregated Albumin, and Yttrium-90 SPECT/CT ReadJVIR and SIR thank all those who helped record this episode:Host:Rommell Noche, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutAudio editor:Siddhi Hegde, MBBS, Massachusetts General HospitalAbstract readers:Justin Cook, University of Central Florida College of MedicineColin Standifird, Kirk Kerkorian School of Medicine at University of Nevada, Las VegasAnna Hu, George Washington University School of Medicine and Health Sciences, D.C.Jack Ficke, Frank H. Netter MD School of Medicine at Quinnipiac University, ConnecticutEric Chang, MS, University of Illinois College of MedicineBrian Ng, Saint Louis University School of Medicine, Missouri©  Society of Interventional RadiologySupport the show

I 1972 mangler 200 kilo beriget uran på et fransk berigelsesværk. Uran nok til seks atombomber. Det leder af omveje til, at der bliver rykket ved idéen om, at technetium kun har eksisteret som et menneskeskabt grundstof.Periodisk – en RAKKERPAK original produceret af Rakkerpak Productions. Historierne du hører bygger på journalistisk research og fakta. De kan indeholde fiktive elementer som for eksempel dialog. Hvis du kan lide min fortælling, så husk at gå ind og abonnér, give en anmeldelse og fortæl dine venner om Periodisk. Podcasten er blevet til med støtte fra Novo Nordisk Fonden. Hvis du vil vide mere kan du besøge vores website periodisk.dk Afsnittet er skrevet og tilrettelagt af Frederik Holst Tor Arnbjørn og Dorte Palle er producere Rene Slott står for lyddesign og mix Simon Bennebjerg er vært

In this episode of ASCO Educational podcasts, we'll explore how we interpret and integrate recently reported clinical research into practice. The first scenario involves a 72-year old man with high-risk, localized prostate cancer progressing to hormone-sensitive metastatic disease.  Our guests are Dr. Kriti Mittal (UMass Chan Medical School) and Dr. Jorge Garcia (Case Western Reserve University School of Medicine). Together they present the patient scenario (1:12), review research evidence regarding systemic and radiation therapy for high-risk localized disease (5:45), and reflect on the importance of genetic testing and (10:57) and considerations for treatment approaches at progression to metastatic disease (16:13).  Speaker Disclosures Dr. Kriti Mittal:  Honoraria – IntrinsiQ; Targeted Oncology; Medpage; Aptitude Health; Cardinal Health  Consulting or Advisory Role – Bayer; Aveo; Dendreon; Myovant; Fletcher; Curio Science; AVEO; Janssen; Dedham Group  Research Funding - Pfizer Dr. Jorge Garcia:  Honoraria - MJH Associates: Aptitude Health; Janssen Consulting or Advisor – Eisai; Targeted Oncology Research Funding – Merck; Pfizer; Orion Pharma GmbH; Janssen Oncology;  Genentech/Roche; Lilly  Other Relationship - FDA Resources  ASCO Article: Implementation of Germline Testing for Prostate Cancer: Philadelphia Prostate Cancer Consensus Conference 2019 ASCO Course: How Do I Integrate Metastasis-directed Therapy in Patients with Oligometastatic Prostate Cancer? (Free to Full and Allied ASCO Members) If you liked this episode, please follow the show. To explore other educational content, including courses, visit education.asco.org. Contact us at education@asco.org. TRANSCRIPT Dr. Kriti Mittal: Hello and welcome to this episode of the ASCO Education Podcast. Today we'll explore how we interpret and integrate recently reported clinical research into practice, focusing on two clinical scenarios: localized prostate cancer progressing to hormone-sensitive metastatic disease; and a case of de novo metastatic hormone-sensitive prostate cancer progressing to castration-resistant disease.   My name is Kriti Mittal and I am the Medical Director of GU Oncology at the University of Massachusetts. I am delighted to co-host today's discussion with my colleague, Dr. Jorge Garcia. Dr. Garcia is a Professor of Medicine and Urology at Case Western Reserve University School of Medicine. He is also the George and Edith Richmond Distinguished Scientist chair and the current chair of the Solid Tumor Oncology Division at University Hospital's Seidman Cancer Center. Let me begin by presenting the first patient scenario.  Case 1: A 72-year-old male was referred to urology for evaluation of hematuria. A rectal exam revealed an enlarged prostate without any nodules. A CT urogram was performed that revealed an enlarged prostate with bladder trabeculations. A cystoscopy revealed no stones or tumors in the bladder, but the prostatic urethra appeared to be abnormal looking. Transurethral resection of the prostate was performed. The pathology revealed Gleason score 4+5=9 prostate cancer, involving 90% of the submitted tissue. PSA was performed one week later and was elevated at 50. Patient declined the option of radical prostatectomy and was referred to radiation and medical oncology.   So I guess the question at this point is, Dr. Garcia, in 2023, how do you stage patients with high-risk localized prostate cancer and how would you approach this case? Dr. Jorge Garcia: That's a great question and a great case, by the way, sort of what you and I in our practice will call ‘bread and butter'. Patients like this type of case that you just presented come from different places to our practice.  So either they come through urology or oftentimes they may come through radiation oncology. And certainly, it depends where you practice in the United States, at ‘X', US, they may come through medical oncology.   So I think that the first question that I have is in whatever role I'm playing in this case, where the patient has seen a urologist or a rad onc or me first, I think it's important for us in medical oncology, at least in the prostate cancer space, to talk about how do we think of their case and put those comments into context for the patient. It's very simple for you to tell a patient you can probably have surgery, radiation therapy, but at the end of the day, how do you counsel that patient as to the implications of the features of his disease is going to be really important. I use very simple examples that I relate to my patients, but really this patient is a patient that has very high-risk prostate cancer based upon the NCCN guidelines and how we actually stratify patients into what we call low-risk, intermediate-, and high-risk, and between those very low and very high risk.  So his PSA is high, very high, I would argue. His Gleason score, now, what we call group grading is high. He has high-volume disease. So the first question that I would have is, what are the choices for treatment for a patient like this? But even before you and I may talk about treatment options, we really want to understand the volume of their disease and whether or not they have localized prostate cancer with high-risk features or whether or not they have locally advanced or hopefully not metastatic disease. So back in the days prior to the FDA approval for PSMA PET imaging, we probably will have a Technetium-99 whole-body bone scan, and/or we probably will actually use CT scanning. Most people in the past, we used to do just a CT of the abdomen and pelvic region. As you know, with the movement of oral agents in the advanced setting, I think most of us will do a chest CT, abdomen and pelvic region, and certainly we also probably will have a Technetium-99 bone scan.  Now, with the utility and the use of PET imaging, I think most people like him will probably undergo PET PSMA, where you use F-18 PSMA or Gallium-68 PSMA. I think the importance depends on how you look at the approval of these two technologies. I think that PET PSMA imaging is here to stay. It's probably what most of us will use. And based upon that, we will define yet the truest stage of this patient. So right now, what we know is he has high-risk features. Hopefully, their disease is localized. We'll probably put the patient through an imaging technology. If you don't have access to a PET, then obviously CT and a bone scan will do. But if you do, the PET will actually help us define if the patient has disease outside of the prostate region, in the pelvic area, or even if they have distant metastases. Dr. Kriti Mittal: I would agree with that approach, Dr. Garcia. I think in the United States, we've been late adopters of PSMA scans. I think this patient with high-risk localized disease, if insurance allows at our institution, would get a PSMA for staging. There are still some patients where insurance companies, despite peer-to-peer evaluations, are not approving PSMAs. And in those situations, the patient would benefit from conventional CTs and a bone scan. So let's say this patient had a PSMA and was found not to have any regional or distant metastases. He decided against surgery, and he is seeing you as his medical oncologist together with radiation. What would your recommendations be?  Dr. Jorge Garcia: I think the bigger question is, do we have any data to suggest or to demonstrate that if in the absence of metastatic disease with conventional imaging or with emerging technologies such as PSMA PET, there is no evidence of distant disease, which I think you probably agree with me, that would be sort of unlikely with a patient with these features not to have some form of PSMA uptake somewhere in their body. But let's assume that indeed then the PSMA PET was negative, so we're really talking about high-risk localized prostate cancer. So I don't think we can tell a patient that radical prostatectomy would not be a standard of care. We never had a randomized trial comparing surgery against radiation therapy. This patient has already made that decision and surgery is not an option for him. If he, indeed, had elected radiotherapy, the three bigger questions that I ask myself are where are you going to aim the beam of that radiation therapy? What technology, dose, and fractionation are you going to use? And lastly, what sort of systemic therapy do you need, if any, for that matter? Where we do have some data maybe less controversial today in 2023 compared to the past? But I think the question is, do we do radiation to the prostate only or do we expand the field of that radiation to include the pelvic nodes?  Secondly, do we use IMRT? Do you use proton beam or not? Again, that's a big question that I think that opens up significant discussions. But more important, in my opinion, is the term of hypofractionation. I think the field of radiation oncology has shifted away from the old standard, five, seven weeks of radiation therapy to more hypofractionation, which in simple terms means a higher dose over a short period of time. And there was a concern in the past that when you give more radiation on a short period of time, toxicities or side effects would increase. And I think that there is plenty of data right now, very elegant data, demonstrated that hypofractionation is not worse with regards to side effects. I think most of us will be doing or supporting hypofractionation. And perhaps even to stretch that, the question now is of SBRT. Can we offer SBRT to a selected group of patients with high-risk prostate cancer? And again, those are discussions that we will naturally, I assume, in your practice, in your group, you probably also have along with radiation oncology.  Now, the bigger question, which in my mind is really not debatable today in the United States, is the need for systemic therapy. And I think we all will go back to the old data from the European EORTC data looking at the duration of androgen deprivation therapy. And I think most of us would suggest that at the very least, 24 months of androgen deprivation therapy is the standard of care for men with high-risk prostate cancer who elect to have local definitive radiation therapy as their modality of treatment. I think that whether or not it's 24 or 36, I think that the Canadian data looking at 18 months didn't hit the mark. But I think the radiation oncology community in the prostate cancer space probably has agreed that 24 months clinically is the right sort of the sweetest spot.  What I think is a bit different right now is whether or not these patients need treatment intensification. And we have now very elegant data from the British group and also from the French group, suggesting, in fact, that patients with very high-risk prostate cancer who don't have evidence of objective metastasis may, in fact, benefit from ADT plus one of the novel hormonal agents, in this case, the use of an adrenal biosynthesis inhibitor such as abiraterone acetate. So I think in my practice, what I would counsel this patient is to probably embark on radiotherapy as local definitive therapy and also to consider 24 months of androgen deprivation therapy. But I would, based upon his Gleason score of group grading, his high-volume disease in the prostate gland, and his PSA, to probably consider the use of the addition of abiraterone in that context. Dr. Kriti Mittal: That is in fact how this patient was offered treatment. The patient decided to proceed with radiation therapy with two years of androgen deprivation. And based on data from the multi-arm STAMPEDE platform, the patient met two of the following three high-risk features Gleason score >8, PSA >40, and clinical >T3 disease. He was offered two years of abiraterone therapy. Unfortunately, the patient chose to decline upfront intensification of therapy. In addition, given the diagnosis of high-risk localized prostate cancer, the patient was also referred to genetic counseling based on the current Philadelphia Consensus Conference guidelines. Germline testing should be considered in patients with high-risk localized node-positive or metastatic prostate cancer, regardless of their family history. In addition, patients with intermediate-risk prostate cancer who have cribriform histology should also consider germline genetic testing.  Access to genetic counseling remains a challenge at several sites across the US, including ours. There is a growing need to educate urologists and medical oncologists to make them feel comfortable administering pretest counseling themselves and potentially ordering the test while waiting for the results and then referring patients who are found to have abnormalities for a formal genetics evaluation. In fact, the Philadelphia Consensus Conference Guideline offers a very elegant framework to help implement this workflow paradigm in clinical practice. And at our site, one of our fellows is actually using this as a research project so that patients don't have to wait months to be seen by genetics. This will have implications, as we will see later in this podcast, not only for this individual patient as we talk about the role of PARP inhibitors but also has implications for cascade testing and preventative cancer screening in the next of kin. Dr. Jorge Garcia: Dr. Mittal, I think that we cannot stress enough the importance of genetic testing for these patients. Oftentimes I think one of the challenges that our patients are facing is how they come into the system. If you come through urology, especially in the community side, what I have heard is that there are challenges trying to get to that genetic counsel. Not so much because you cannot do the test, but rather the interpretation of the testing and the downstream effect as you're describing the consequences of having a positive test and how you're going to counsel that patient. If you disregard the potential of you having an active agent based upon your genomic alteration, is the downstream of how your family may be impacted by a finding such as the DNA repair deficiency or something of that nature. So for us at major academic institutions because the flow how those patients come through us, and certainly the bigger utilization of multi-disciplinary clinics where we actually have more proximity with radiation oncology urology, and we actually maybe finesse those cases through the three teams more often than not, at least discuss them, then I think that's less likely to occur. But I think the bigger question is the timing of when we do testing and how we do it.  So there are two ways -- and I'd love to hear how you do it at your institution -- because there are two ways that I can think one can do that. The low-hanging fruit is you have tissue material from the biopsy specimen. So what you do, you actually use any of the commercial platforms to do genomic or next-generation sequencing or you can do in-house sequencing if your facility has an in-house lab that can do testing. And that only gets you to what we call ‘somatic testing', which is really epigenetic changes over time that are only found in abnormal cells. It may not tell you the entire story of that patient because you may be missing the potential of identifying a germline finding. So when you do that, did you do germline testing at the same time that you do somatic testing or did you start with one and then you send to genetic counseling and then they define who gets germline testing? Dr. Kriti Mittal: So at our site, we start with germline genetic testing. We use either blood testing or a cheek swab assay and we send the full 84-gene multigene panel. Dr. Jorge Garcia: Yeah, and I think for our audience, Dr. Mittal, that's great. I don't think you and I will be too draconian deciding which platform one uses. It's just that we want to make sure that at least you test those patients. And I think the importance of this is if you look at the New England Journal paper from many years ago, from the Pritchard data looking at the incidence of DNA repair deficiency in men with prostate cancer in North America, that was about what,  around 10% or so, take it or leave it. So if you were to look only for germline testing, you only will, in theory, capture around 10% of patients. But if you add somatic changes that are also impacting the DNA pathway, then you may add around 23%, 25% of patients. So we really are talking that if we only do one type of testing, we may be missing a significant proportion of patients who still may be candidates, maybe not for family counseling if you had a somatic change, rather than germline testing, the positivity, but if you do have somatic, then you can add into that equation the potential for that patient to embark on PARP inhibitors down the road as you stated earlier. It may not change how we think of the patient today, or the treatment for that matter. But you may allow to counsel that patient differently and may allow to sequence your treatments in a different way based upon the findings that you have. So I could not stress the importance of the NCCN guidelines and the importance of doing genetic testing for pretty much the vast majority of our patients with prostate cancer. Dr. Kriti Mittal: Going back to our patient, three years after completion of his therapy, the patient was noted to have a rising PSA. On surveillance testing, his PSA rose from 0.05 a few months prior to 12.2 at the time of his medical oncology appointment. He was also noted to have worsening low back pain. A PSMA scan was performed that was noteworthy for innumerable intensely PSMA avid osseous lesions throughout his axial and appendicular skeleton. The largest lesion involved the right acetabulum and the right ischium. Multiple additional sizable lesions were seen throughout the pelvis and spine without any evidence of pathologic fractures. So the question is, what do we do next? Dr. Jorge Garcia: The first question that I would have is, the patient completed ADT, right? So the patient did not have treatment intensification, but at the very least he got at least systemic therapy based upon the EORTC data. And therefore, one would predict that his outcome will have been improved compared to those patients who receive either no ADT or less time on ADT. But what I'm interested in understanding is his nadir PSA matters to me while he was on radiation and ADT. I would like to know if his nadir PSA was undetectable, that's one thing. If he was unable to achieve an undetectable PSA nadir, that would be a different thought process for me.   And secondly, before I can comment, I would like to know if you have access to his testosterone level. Because notably, what happens to patients like this maybe is that you will drive down testosterone while you get ADT, PSAs become undetectable. Any of us could assume that the undetectability is the result of the radiation therapy. But the true benefit of the combination of radiation and ADT in that context really comes to be seen when the patient has got off the ADT, has recovered testosterone, and only when your testosterone has normalized or is not castrated, then we'll know what happens with your serologic changes. If you rise your PSA while you recover testosterone, that is one makeup of patient. But if you rise your PSA while you have a testosterone at the castrated level, that would be a different makeup of a patient. So do we have a sense as to when the patient recovered testosterone and whether or not if his PSA rose after recovery?  Dr. Kriti Mittal: At the time his PSA rose to 12, his testosterone was 275. Dr. Jorge Garcia: Okay, perfect. You and I would call this patient castration-naive or castration-sensitive. I know that it's semantics. A lot of people struggle with the castration-naive and castration-sensitive state. What that means really to me, castration-naive is not necessarily that you have not seen ADT before. It's just that your cancer progression is dependent on the primary fuel that is feeding prostate cancer, in this case, testosterone or dihydrotestosterone, which is the active metabolite of testosterone. So in this case, recognizing the patient had a testosterone recovery and his biochemical recurrence, which is the rising of his PSA occur when you have recovery of testosterone, makes this patient castration-sensitive. Now the PET scan demonstrates now progression of his disease. So clearly he has a serologic progression, he has radiographic progression. I assume that the patient may have no symptoms, right, from his disease?  Dr. Kriti Mittal: This patient had some low back pain at the time of this visit. So I think we can conclude he has clinical progression as well. Dr. Jorge Garcia: Okay, so he had the triple progression, serologic, clinical, and radiographic progression. The first order of business for me would be to understand the volume of his disease and whether we use the US CHAARTED definition of high volume or low volume, or whether we use the French definition for high volume from Latitude, or whether we use STAMPEDE variation for definition, it does appear to me that this patient does have high-volume disease. Why? If you follow the French, it's a Gleason score of >8, more than three bone metastases, and the presence of visceral disease, and you need to have two out of the three. If you follow CHAARTED definition, we did not use Gleason scoring, the US definition. We only use either the presence of visceral metastases or the presence of more than four bone lesions, two of which had to be outside the appendicular skeleton. So if we were to follow either/or, this patient would be high-volume in nature.  So the standard of care for someone with metastatic disease, regardless of volume, is treatment intensification, is you suppress testosterone with androgen deprivation therapy. And in this case, I'd love to hear how you do it in Massachusetts, but here, for the most part, I would actually use a GnRH agonist-based approach, any of the agents that we have. Having said that, I think there is a role to do GnRH antagonist-based therapy. In this case, degarelix, or the oral GnRH antagonist, relugolix, is easier to get patients on a three-month injection or six-month injection with GnRH agonist than what it is on a monthly basis. But I think it's also fair for our audience to realize that there is data suggesting that perhaps degarelix can render testosterone at a lower level, meaning that you can castrate even further or have very low levels of testosterone contrary to GnRH agonist-based approaches.  And also for patients maybe like this patient that you're describing, you can minimize the flare that possibly you could get with a GnRH agonist by transiently raising the DHT before the hypothalamic-pituitary axis would shut it down. So either/or would be fine with me. Relugolix, as you know, the attraction of relugolix for us right now, based upon the HERO data, is that you may have possibly less cardiovascular side effects. My rationale not to use a lot of relugolix when I need treatment intensification is quite simple. I'm not aware, I don't know if you can mitigate or minimize that potential cardiovascular benefit by adding abiraterone or adding one of the ARIs, because ARIs and abiraterone by themselves also have cardiovascular side effects. But either/or would be fine with me. The goal of the game is to suppress your male hormone.  But very important is that regardless of volume, high or low, every patient with metastatic disease requires treatment intensification. You can do an adrenal biosynthesis inhibitor such as abiraterone acetate. You can pick an androgen receptor inhibitor such as apalutamide or enzalutamide if that's the case. The subtleties in how people feel comfortable using these agents, I think, none of us – as you know, Dr. Mittal - can comment that one oral agent is better than the other one. Independently, each of these three oral agents have randomized level 1, phase III data demonstrating survival improvement when you do treatment intensification with each respective agent. But we don't have, obviously, head-to-head data looking at this.  What I think is different right now, as you know, is the data with the ARASENS data, which was a randomized phase III trial, an international effort looking at triple therapy, and that is male hormone suppression plus docetaxel-based chemotherapy against testosterone suppression plus docetaxel-based chemotherapy plus the novel androgen receptor inhibitor known as darolutamide. This trial demonstrated an outcome survival improvement when you do triple therapy for those high-volume patients. And therefore, what I can tell you in my personal opinion and when I define a patient of mine who is in need of chemotherapy, then the standard of care in my practice will be triple therapy. So if I know you are a candidate for chemotherapy, however, I make that decision that I want you to get on docetaxel upfront. If you have high-volume features, then the standard of care would not be ADT and chemo alone, it would be ADT, chemo, and darolutamide.  What I don't know, and what we don't know, as you know, is whether or not triple therapy for a high-volume patient is better, the same, equivalent, or less than giving someone ADT plus a novel hormonal agent. That is the data that we don't have. There are some meta-analyses looking at the data, but I can tell you that at the very least, if you prefer chemo, it should be triple therapy. If you prefer an oral agent, it certainly should be either apalutamide, abiraterone acetate, and/or enzalutamide. But either/or, patients do need treatment intensification, and what is perplexing to me, and I know for you as well, is that a significant proportion of our patients in North America are still not getting treatment intensification, which is really sub-optimal and sub-standard for our practice.  Dr. Kriti Mittal: Thank you, Dr. Garcia, for a terrific discussion on the application of recent advances in prostate cancer to clinical practice. In an upcoming podcast, we will continue that discussion exploring management of de novo metastatic prostate cancer.   The ASCO Education Podcast is where we explore topics ranging from implementing new cancer treatments and improving patient care to oncologists' well-being and professional development. If you have an idea for a topic or a guest you'd like to see on the ASCO Education Podcast, please email us at education@asco.org. To stay up to date with the latest episodes and explore other educational content, please visit education.asco.org. 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.    

The importance of recognition and diagnosis of cardiac amyloidosis is at an all-time high due to its high prevalence and improved therapeutic strategies. Here we discuss what CardioNerds need to know about the manifestations, diagnosis, and management of transthyretin (ATTR) and light chain (AL) cardiac amyloidosis. Join Dr. Dan Ambinder (CardioNerds Cofounder), Dr. Dinu-Valentin Balanescu (Series Cochair, Chief Resident at Beaumont Health, and soon FIT at Mayo Clinic), and Dr. Dan Davies (Episode FIT Lead and FIT at Mayo Clinic) as they discuss cardiac amyloidosis with Dr. Omar Siddiqi, cardiologist at the Boston University Amyloidosis Center and program director for the general cardiovascular fellowship program at Boston University, a CardioNerds Healy Honor Roll Program. Episode notes were drafted by Dr. Dan Davies. Audio editing by CardioNerds Academy Intern, student doctor Chelsea Amo Tweneboah. Access the CardioNerds Cardiac Amyloidosis Series for a deep dive into this important topic. This episode is supported by a grant from Pfizer Inc. This CardioNerds Cardio-Oncology series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Giselle Suero Abreu, Dr. Dinu Balanescu, and Dr. Teodora Donisan.  Pearls • Notes • References • Production Team CardioNerds Cardio-Oncology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes Cardiac amyloidosis is no longer considered a rare disease, especially transthyretin amyloidosis in older male patients with HFpEF and aortic stenosis. Echocardiogram is the “gate keeper” of cardiac imaging and provides initial evidence of amyloid infiltration, while cardiac MRI can help refine the presence of an infiltrative cardiomyopathy versus other causes of increased wall thickness. The most clinically important types of amyloid heart disease are transthyretin (ATTR) and light chain (AL) amyloidosis. The workup to differentiate these disorders includes a gammopathy panel to screen for the presence of potentially amyloidogenic light chains (serum and urine electrophoresis WITH immunofixation and serum free light chains), and cardiac scintigraphy with Technetium-99m-labeled bone-seeking tracers (PYP, DPD, etc.) to identify cardiac aTTR infiltration if the gammopathy panel is unrevealing. There is still a role for endomyocardial biopsy in the diagnosis of cardiac amyloidosis! All patients in whom there is concern for cardiac amyloidosis and gammopathy panel indicates the presence of monoclonal light chains should have a biopsy to obtain a tissue diagnosis of likely AL amyloidosis. Alternatively, an endocardial biopsy may prove valuable in patients who have confusing phenotypic features between amyloid types, such as a patient with abnormal monoclonal protein and positive PYP imaging. Be suspicious of heart failure patients that do not tolerate typical medications that lower heart rate. In the restrictive cardiomyopathy of cardiac amyloidosis, patients are reliant on higher heart rates to compensate for the inability to augment stroke volume. Be suspicious of amyloidosis in patients with recurrent left atrial thrombi despite anticoagulation. Show notes CardioNerds Cardiac Amyloid, updated 1.20.21 1. What is cardiac amyloidosis and how common is it? Cardiac amyloidosis is adisorder caused by misfolding of proteins into insoluble forms which are deposited into extracellular spaces of the heart, commonly causing a stiff and thick heart with progressive diastolic dysfunction with restrictive hemodynamics and ensuing heart failure. The two most common types of amyloid protein that affect the heart are transthyretin (ATTR) and light chain (AL).

Radioactive and toxic Technetium-99 and Trichloroethylene contamination in Paducah is at a high never before seen! The Regional Gravel Aquifer is seeing a significant spike in contamination.  The time to act is now if we want Metropolis and Paducah to survive and become the Metropolis utopia that was originally planned back in the 70s. VERY HIGH TECHNETIUM-99 LEVELS FROM 2020-PRESENT.  Why?

We all take part in the progression of minerals in our bodies from the day we are conceived.  And as they built our bodies we learn about the minerals and how they are forming us.  We learn of carbon and silicium which are integral to our early existence as are calcium phosphorus and the other salts and partial salts in the tissue salts. Mineral remedies are therefore often well indicated remedies for babies and young children because their development is reliant on substances that are building blocks of the system.  In Jan Scholten's look at the minerals as well as Sankaran, we see this unfolding of growing, growing up and growing old as natural of the progression in each of the series and the specific remedy that falls under each stage. We do not need to ask where the teacher from the mineral kingdom has gone, because we have so many of them in Ontario.  They are taught as a profession, separate from their subject matter.  When they teach they need to stick only to the specific material and any deviation is seen as moving into realm in which they have no expertise. The science teachers are given higher positions in expertise and a doctor of something is even used as a form of reference to a teacher who has achieved  what is perceived to be a higher form or achievement. The mineral destruction of animals and plants is not at a point where it has invaded the world as the main perception of a large group of people.  The WEF as well as the World Bank, the WHO and the New Reset instructions as seen in the WEF outline of how they would like to see the world be the best world for the mineral perception.  The Economy and money based on gold and silver are all part of their world.  The inclusion now of technology and its currencies also included in the world and representing the uranium series and other minerals. So, the teacher we see today who is considered as a great teacher is a mineral one who falls within stage 7. The word invaded can come from many kingdoms, such as invasive species of plants, the fungi who have invasion as their main sensitivity, and the ants that invade other nests as well as the invasion of kings and queens to overtake lands and conquer to rule supreme  as seen in the minerals.  Looking at the mental decision to become a teacher and the perspective of the teaching profession in the world today, it is best to look at stage 7 of the periodic table.  Once we have a look at the teachers and the words specific to the mineral teacher we see the lack of diversity today – which is ironic considering the claim that the schools have become more diverse.  Looking at how diversity has been eradicated because people are not healthy and their perceptions have clouded their judgement to the point that they can only see everyone as reflections of themselves. The teachers and the different series that connect with this stage 7. Manganum – the teacher, Technetium- car mechanic teaching/helping others to restore Vintage Cars, Promethium-teaches others how to run their businesses well, Rhenium – the manager who leads, Neptunium – cooperating in spirituality, the one who has made the link between the DNA and intuition as seen in their genetic diseases and their desire to rule and lead and teach not only their own generation or their own area, but also the world or even the universe! Question for today: What has made us so ill on all levels, life choices, dream world, physical symptoms and mental emotional health today? All views presented are based on credible sources, but they are explained through the individual's viewpoint.  Doing your own research while integrating new information is always important when forming your own viewpoint. The information in this podcast is not meant to address individual health needs, it is general in nature and should not be used as medical information for your health unless used in combination with your health practitioner.  

Learn more about Technetium-99, a radioisotope used for medical procedures and imaging. Music used: Bass Vibes - Rollin at 5 by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/ Source: http://incompetech.com/music/royalty-free/index.html?isrc=USUAN1100462 Artist: http://incompetech.com/ Clean Soul - Calming by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/ Source: http://incompetech.com/music/royalty-free/index.html?isrc=USUAN1300033 Artist: http://incompetech.com/

This podcast is an audio excerpt of the Instagram live series Talk alike by Dr Saurav Arora delivered on 18 July 2021. It aimed at discussing the Thyroid disorders and the frequently asked questions related to it such as: Common investigations Relevance of Ft4, TSH and anti TPO antibodies, USG thyroid, RAUI scan, Technetium scan etc. […] The post Thyroid – Frequently Asked Questions appeared first on Dr Saurav Arora.

Commentary by Dr. Valentin Fuster

High-yield summary of Technetium radoopharmaceuticals for on-the-go board review.

Technetium is the thing with the number thing. NASCAR is a thing some people do things with and about. Gamma rays are apparently things as well. M43 is some kind of astronomical thing. George W. Bush was actually a fucking thing - we don't know why. Mushroom head Richard Petty. Find out more at https://gggrinfinite.pinecast.co

Technetium was the first element on the periodic table to be synthesised. It is rare, radioactive and has only a few uses, says Prof Allan Blackman in ep 81 of Elemental.

Technetium was the first element on the periodic table to be synthesised. It is rare, radioactive and has only a few uses, says Prof Allan Blackman in ep 81 of Elemental.

Technetium was the first element on the periodic table to be synthesised. It is rare, radioactive and has only a few uses, says Prof Allan Blackman in ep 81 of Elemental.

Davison Sam Technetium 99m Podcast Radioisotope

Davison Sam Technetium 99m Radioisotope Podcast

In this podcast I will be outlining the specifics of Technetium-99m and it's usage in medicine and scanning

It's only after we gave up searching for this element that we found it out in the universe.

Episode 81 Tc99m - PSMA in Africa With Dr CA KaomaIn this episode we talk to Dr CA Kaoma who has been working with Prof Prof Mike Sathekge.He talks about how Tc99m - PSMA might be used to guide theranostics for prostate cancer.TagsRob Williams, WFNMB, NIF, Nuclear Medicine, Podcast, Nucast.com, SPECT, CT, SPECT/CT, PET, theranostics, radioactive, molecular medicine, nuccast.com, oncology, PSMA, prostate, Technetium.The first part will come as medium quality video for iphones or ipads or AudioPlease let me know what you think about the video versions of the podcast.I am also looking for new material so please get in touch with me if you can contributewith an interview.Direct link to ituneshttp://itunes.apple.com/us/podcast/the-nuclear-medicine-molecular/id94286547?ign-mpt=uo%3D4You can get the podcast page at both http://nuccast.com and http://www.nuccast.com with the feed to put into iTunes or juice or your favorite podcast software can be found at http://molcast.com/.The cardiac subset of the podcast can be found at http://cardiac.nuccast.com/Please pass on information about this podcast to your colleagues and to your CPD provider.link to Video Link to Video fileOr you can subscribe by entering your email address below and you will be informed of new episodesEnter your email address:Delivered by FeedBurnerMost importantly of all please help this podcast by contributing your opinions, Sound files and emailsnucmedpodcast@gmail.comAll contributions welcome, especially as sound files to nucmedpodcast@gmail.com.try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}

Episode 81 Tc99m - PSMA in Africa With Dr CA KaomaIn this episode we talk to Dr CA Kaoma who has been working with Prof Prof Mike Sathekge.He talks about how Tc99m - PSMA might be used to guide theranostics for prostate cancer.TagsRob Williams, WFNMB, NIF, Nuclear Medicine, Podcast, Nucast.com, SPECT, CT, SPECT/CT, PET, theranostics, radioactive, molecular medicine, nuccast.com, oncology, PSMA, prostate, Technetium.The first part will come as medium quality video for iphones or ipads or AudioPlease let me know what you think about the video versions of the podcast.I am also looking for new material so please get in touch with me if you can contributewith an interview.Direct link to ituneshttp://itunes.apple.com/us/podcast/the-nuclear-medicine-molecular/id94286547?ign-mpt=uo%3D4You can get the podcast page at both http://nuccast.com and http://www.nuccast.com with the feed to put into iTunes or juice or your favorite podcast software can be found at http://molcast.com/.The cardiac subset of the podcast can be found at http://cardiac.nuccast.com/Please pass on information about this podcast to your colleagues and to your CPD provider.Link to audio file Link to audio fileOr you can subscribe by entering your email address below and you will be informed of new episodesEnter your email address:Delivered by FeedBurnerMost importantly of all please help this podcast by contributing your opinions, Sound files and emailsnucmedpodcast@gmail.comAll contributions welcome, especially as sound files to nucmedpodcast@gmail.com.try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}try{(function() { for(var lastpass_iter=0; lastpass_iter < document.forms.length; lastpass_iter++){ var lastpass_f = document.forms[lastpass_iter]; if(typeof(lastpass_f.lpsubmitorig2)=="undefined"){ lastpass_f.lpsubmitorig2 = lastpass_f.submit; if (typeof(lastpass_f.lpsubmitorig2)=='object'){ continue;}lastpass_f.submit = function(){ var form=this; var customEvent = document.createEvent("Event"); customEvent.initEvent("lpCustomEvent", true, true); var d = document.getElementById("hiddenlpsubmitdiv"); if (d) {for(var i = 0; i < document.forms.length; i++){ if(document.forms[i]==form){ if (typeof(d.innerText) != 'undefined') { d.innerText=i.toString(); } else { d.textContent=i.toString(); } } } d.dispatchEvent(customEvent); }form.lpsubmitorig2(); } } }})()}catch(e){}

Episode Content:​ Amanda's interest in chemistry and her work at a crime lab.   A breakdown of molybdenum 99 and technetium 99m.   Why metastable isotopes are useful for medical applications.   What are ligins?   From a security perspective, why it's in the US' interest to domestically produce molybdenum 99.   The traditional and nontraditional methods of producing molybdenum 99.   Tradeoffs of different production processes.   The Argonne Molybdenum Research Experiment.   Why precipitating uranium creates a hotspot.   How corrosion can be beneficial in producing uranium peroxide precipitate.   What's in store for the future.  

Haven't you ever wanted to hear two completely unqualified people try to explain what a metastable nuclear isomer is? Of course you have. It's the American dream. This week's subjects: Technetium 99m, Noize MC, and Bulbophyllum Agastor. Email the show: Wikiwheelpod@gmail.com Tweet at us @wikiwheel Theme and interstitial music by Apache Tomcat: http://freemusicarchive.org/music/Apache_Tomcat/

TNP delivers a 'explosive' discussion with radioactive pharmacist Dr. Tim Burke. (LOL)  Nuclear pharmacy is a role often talked about in nontraditional pharmacy but rarely discussed in detail. Dr. Tim Burke gives much needed insight into the field, how it fits his personal life, and how he manages to be a Michigan and Arkansas fan?! Transcript:  Interview Summary   Matt: Welcome everyone. Matt Paterini here with The Nontraditional Pharmacist, part of The Pharmacy Podcast Network.  I'm joined today by Dr. Tim Burke. Really excited to have Tim on the show today because Tim is a nuclear pharmacist and I think a lot of times in the nontraditional pharmacy world, we see nuclear pharmacy pop up on the list, yet I don't think a lot of people know what nuclear pharmacy is, what it entails, and what it's all about (myself included). I'm excited to hear Tim's story today. Tim we really appreciate you coming on the show today.   Tim: Yeah thank you very much for having me on here. I hope it's not glistened up too much right now, but I think we'll be able to walk our way through it. I'm happy to be here and talk a little about nuclear pharmacy and let more people know about some of the opportunities that are out there besides the traditional pharmacy roles that we think of.   Matt: Awesome. That's exactly what we're looking for and what I think people listening to the show are looking for. Let's start with kind of a basic question we like to ask all of our nontraditional guests. Give us a little bit of background on your path through pharmacy, how you started, where you've been, and how you've gotten to where you are today.   Tim: Well, when I graduated from high school I didn't really know necessarily when I wanted to do. Like a lot of high school grads, you go off to college and I knew I was into science but didn't really know what direction I wanted to take from there. Went down to Baylor University thinking that I wanted to be a forensic scientist, and it was right when the CSI craze was all the rage. That sounded pretty interesting to me, saw a couple of autopsies and found out that was wasn't for me. I realized that I needed to go into something else.   I had a cousin who was at the University of Texas Pharmacy School at the time, and he told me all about pharmacy and the opportunities that were out there and so I was like well, you know, I've [already] been taking those kinds of classes. I'll try and go that route. While I was there, my parents moved from Michigan down to Arkansas, so I went there for pharmacy school and was fortunate enough to go to a school where we had a Nuclear Pharmacy Program.  There is Dr Nicki Hilliard, who if you say her name in the nuclear pharmacy world, everybody knows her. Not to mention I think she's actually the APhA President Elect. And so she's obviously made her mark in the pharmacy world. She was the one who got me interested in it. I did an internship with General Electric (GE) healthcare up in Grand Rapids, Michigan between my P2 and P3 year and loved every minute of it. But nuclear pharmacy is kind of a small niche to get into, there's not a whole lot of turnover. So I had to pay my dues, do a little bit of retail work for a year and a half, and then when GE came calling, I decided that that was a good route for me to go and have been there for about seven years now and loved every minute of it.   Matt: Wow. That's that's awesome. So you've spanned some geographic space down from Arkansas up to Michigan. Where does that where does that leave you in terms of sports affiliations?   Tim: Well, you know I nearly planted myself in front of my Michigan flag that says “those who stay will be champions”, because I know you guys obviously are all U of M Grads and you'd probably appreciate that, and that's always been my childhood team. So I'm a big fan of the Wolverines, but I will say I was disappointed when they took Arkansas off the schedule for 2018 and 2019 for the Home and Home, because I was ready to wear my Razorback Red in The Big House.   Matt: Yeah we definitely would have appreciated the Michigan flag. It's good to see that Maize and Blue kind of spreads throughout the country, we like seeing that.   Why don't you give us a little bit of an overview of nuclear pharmacy in general? I think just some general background on what is nuclear pharmacy? I think when other pharmacists think of nuclear pharmacy, we think of radioactive substances and things of that nature. But give us some detail around what exactly it is.   Tim: Sure. The nitty gritty and the easiest way to describe it is, we compound radioactive pharmaceuticals, and the majority of those pharmaceuticals are for diagnostic imaging only. There's not a whole lot of therapeutic application in what we do. But there is some. The main isotope that we use is called Technetium and that is what we use for the majority of our diagnostic imaging, but we also do have some applications like I said that are therapeutic. We can use I-131 and we put that in capsules that a patient can actually swallow, and that can ablate their thyroid, take care of thyroid cancer, things of that nature. There are a couple other drugs out there as well that we can use for therapeutic applications but mostly you're going to be hearing about diagnostic. The biggest one and I would say probably 75% of nuclear pharmacy's compound is some sort of cardiac imaging agents. The particular one that we make at GE is called Myoview, but if you've ever had someone in your family, like a grandparent or someone you might know that has had a stress test done on their heart, Myoview in all likelihood could have been the agent that was used to image their heart. So we compound those radio-pharmaceuticals, send them to the hospitals to where they're going to be administered, and then the nuclear medicine technologist there are actually the ones that inject them into the patient, and perform the scans with the cameras and everything. But we work in a lab, making all of these things and then send them out with a fleet of couriers. It's all over the state really, to deliver these products to the hospitals so they can use it and make their diagnoses.   Matt: Technetium! That sounds something like it's from the future, that sounds crazy.   Tim: It's not that scary. It really isn't. We obtained this activity from generators, is what they're called, and the parent isotope of Technetium is called Molybdenum. We call it Molly. And you also hear me refer to Technetium as just Tech. But we allude these generators and pretty much what happens is we take a saline solution that goes through this generator and all of the Technetium binds onto this aluminum column that you can see that runs through the generator. When we have students at our pharmacy, we've got a cut out of an old generator that doesn't have any activity inside of it. And they can actually see this column, which the saline rinses that technetium off of. What occurs is anion exchange. So we're getting our chemistry back here a little bit. But the chloride ions from the sodium chloride swaps with the Technetium ion. And what you end up with on the other side, in your evacuated vial is pretty much radioactive saline. So there is no color to it, it just looks like a normal, regular old solution. But if you had it unshielded around a Geiger counter, you'd definitely be getting a lot of activity.   Matt: That's so interesting. It sounds a lot more, you mentioned lab work. You mention a lot of the techniques that you're talking about sound to me a lot like research focused almost or kind of more industry focused? Is it more so related to that than a practicing pharmacist? Do you see any comparisons with more of the research side of things?   Tim: A little bit. There's definitely a little bit of crossover there, but this is very patient specific. You're drawing up a dose for a patient, at a particular time, and it's intended for that one person. There might be some crossover between research, but this is patient oriented, it's just that you don't get that patient-pharmacist interaction. We are on our own site, where we compound all of these things. It's not a hospital or anything like that. So from that aspect, I guess you could say that we're in a lab, and it's kind of for chemistry nerds, we enjoy it, we love it, but it is for a particular patient. A lot of the times there is a patient name actually associated with the dose that you're dispensing. So it's kind of a hybrid. It's a little bit of both worlds there.   Matt: Okay, that makes a lot of sense. Walk us through a little bit of your day-to-day responsibilities. You said it's kind of a hybrid of lab work but it's patient focused, so what do your day-to-day responsibilities look like? Take us through a typical day as a nuclear pharmacist.   Tim: Part of that has to do with what shift you're working. This is one of the big things that turns people off to nuclear pharmacy, is you do have to work some night shifts. So kind of that that third-shift work that a lot of people don't necessarily want to work. For some people, they find a lot of benefit in it, and other people think that it's not the greatest. But for us, it works out really well because say there's a hospital that needs a dose at seven o'clock in the morning. Well, that dose has to be made, compounded, packaged up, shipped out with one of our drivers, and get to the hospital before 7:00 a.m. So obviously we have to make that well before the dose is going to be administered. And that's usually going to be in the middle of the night. A lot of people ask me you know, why don't you just make the day before? The problem with that is, we've got sterile compounding restrictions, where a lot of these drugs are only good for say 6 to 12 hours. And so if they're only good for 6 to 12 hours, we can't make it that far in advance. The other problem is we're working with radioactive substances that decay over time, and because they decay over time, Technetium has a six hour half-life. If we want to make a dose for a patient that's going to be 12 hours later, we need four times the activity to prepare that dose at the time and we're preparing it, versus when it's actually going to be administered to the patient. And so it's not very cost effective for us to make something that far in advance because we're using so much more activity for a dose, because it's so far into the future.   Matt: So it sounds like some later shifts and the schedule can vary. How does that affect work life balance? Do the shifts change from week to week? And how does that fit in with your personal life?   Tim: Well like I said, some people look at it in a positive way, other people look at it in a negative way. That third shift is actually probably our most active shift. That's when we're compounding the most, it's when we're making the most doses, you're staying very involved while you're there. And so it's not like a third shift that you might think of where the store is dead and you're just struggling to stay awake. It's nothing like that. It's when we probably do 80% of our compounding and dose drawing. So because of that, you're staying active, you're doing other things, and so you don't even really think about what time it is, short of when you have to drive in. Obviously nobody likes driving in at midnight.   But the other shift that we have is kind of a typical first shift, it's from about 8:00 am to 4:00 pm. Now of course this is going to vary from pharmacy to pharmacy. You have some pharmacies that might be open from 3:00 am until 3:00 pm. Some pharmacies that might be open from midnight until 5:00 p.m. the next day. So it really can vary from site to site. But because of that, there are going to be two shifts that you could be working, depending on if you've got lots of pharmacists because you're busy, there might be two or three different types of shifts that you could work. But for myself, I feel like it works out very well for my work-life balance. I've got two kids at home, a wife, and dogs and to know that even if I'm working third shift, I can be home for supper. You can have all that family time. But if you're working first shift, you're getting out at 4:00 pm or 5:00 pm and you can do those same things. When kids grow up, I'm not going to have to worry about whether or not I can make a soccer game or a band concert or something like that. So from that perspective, I do think it provides a little bit more family-friendly shift than say you're 9-7 or 9-9 that you might be working in the retail world.   Matt: Yeah, work-life balance is so important. I think going through pharmacy school and even post-graduate pharmacy practice, it's not emphasized a lot. So it's good to hear that you keep that in consideration. And it's really a big part of how you work in your professional and your personal responsibilities. So on that note, for your personal and professional goals moving forward, how does the role that you're in right now help you to achieve those? Are you where you want to be? And what's next or in the future for you?   Tim: Right now, I'm very happy with where I'm at. I work with two other pharmacists that are great. I couldn't have two better partners out there, one of which is my pharmacy manager. The other one is the pharmacist that I switch shifts with every couple of weeks, working third or working first shift. So I'm very happy where I'm at right now. Works great for my family life like I say. But there are ways that you can kind of climb the ladder in nuclear pharmacy, just like you could in any other area of pharmacy. One of the things that my partner does, is he what's called our radiation safety officer. He is the one who keeps track of all of our equipment, making sure that things are reading efficiently, are constantly the way they should be. He has all the responsibilities with limits on how much activity we can be releasing into the public, things of that nature. So there's more responsibilities that I could gain over time. There's also management possibilities out there, too. You've got pharmacy managers just at a particular site like you would at a retail pharmacy. You've also got district managers who might be over 5 to 10 to 15 pharmacies, depending on the size of your district and figuring out all sorts of things associated with that. There's so many factors in nuclear pharmacy that just don't even show their face in any other type of pharmacy setting, whether it be, do you guys have been big enough generators to have the activity you need to get your runs out? Do you have enough drivers to supply to all the different areas of the state that you're driving to? There's quite a bit to think about that you never really would have thought of as being a pharmacy role, it's almost more of a business-type role than it is pharmacy.   Matt: Interesting. Yeah. I think a lot of a lot of roles are like that, and you know on the surface you can say what nuclear pharmacy is, but there's so much behind the scenes that people don't know. And different facets of the business really, the practice side of things, the operations, the business and everything that goes along with it. So it sounds like there's a lot of different roles within nuclear pharmacy. What's the landscape look like currently, in terms of the job market? Are there opportunities available? And what does it look like moving forward?   Tim: Right now, I would say there are job opportunities out there. But if you're someone who might want to stay exactly where you grew up and things of that nature, it's going to be a little bit tougher to find because this is a pretty specialized niche. There's also training that has to be done on top of it, too. So you have to make yourself marketable to be able to be a nuclear pharmacist. If someone out there has training versus someone that does not, obviously a pharmacy is going to be more interested in hiring that person who is what they call an “authorized user” with the Nuclear Regulatory Commission (NRC), which is a regulatory body we have to deal with. But I would say there is plenty of opportunity out there if you're willing to relocate. That's a huge factor I would say, just because the state of Michigan, at least with GE, we only have two pharmacies in the whole state. And then if you include all of the other companies, you know independents, etc., there might be six to eight pharmacies. There's just not nearly as many as you know your CVS or Walgreens that are on most of the street corners that you can find a job at.   So, from that standpoint it is a little bit tougher to get into. But like I say, you can make yourself more marketable. I think there's a lot of advancements that are going on with nuclear pharmacy and there's even some other roles besides the pharmacy setting that I've told you about, that you can use your nuclear pharmacy education as well. And that would be more of your what they call PET aspects. What we do is SPECT. PET involves using a cyclotron and typically is going to be inside of a hospital. I think U of M might even have one, and so you can use your nuclear pharmacy degree there as well. There is a little extra training involved with that. There's a lot of opportunity out there, but there's going to have to be a little bit of give and take with where you're willing to work and what kind of role you'd like to have.   Matt: Where would people go, pharmacy students and pharmacists, go to do some more research and learn more?   Tim: Well, the three big universities that have nuclear pharmacy programs are Purdue (probably the number one for proximity for us), but also University of Arkansas, and New Mexico is another big pharmacy school. All three of those are probably your top three for finding information about nuclear pharmacy. There's also a website called Nuclear Education Online (www.nuclearonline.org) and that is a collaboration between the University of Arkansas as well as New Mexico, and they've got a whole program that you can actually do most of your didactic training to become an authorized user online. So you don't actually have to go to a class and do all these things, because beyond that, you do have to get more training hours on-site at a nuclear pharmacy. So that's how you get all of that hands-on training as well. But there is that website and you can do all of it online, do it at your own pace. It was actually a resource that I used while I was at the University of Arkansas. And I did a lot of those classes while I was doing rotations during my last year of pharmacy school. So you kind of knock everything out all at once.   Matt: So a lot of resources available and we'll be sure to share those with our viewers so that they know where to go to learn more information. But what advice would you give students or pharmacists that are looking to make a career transition? What advice would you give to them if they're looking to pursue nuclear pharmacy?   Tim: Well for students I feel like it's a lot easier. You're out, you're young, you've got a little bit more flexibility, you might not be somebody who's already got a family and established in a job and everything. But for students, I would definitely recommend checking out Nuclear Education Online, I think that's a great place to start because there's just not that many pharmacy schools out there that offer this kind of information. So to go to a resource like that would be really beneficial. They get to see a lot of pictures of what we use, the shielding that we use, how we compound things. It's very informative there. There's also links off of the University of Arkansas, that might even go over to Purdue University's website, of more pharmacists like myself that have been interviewed and talked about what they do, and probably more extensively than what I've gotten into. We certainly could get a lot more in-depth if we wanted to. But that would be a great starting point for students, and I would say if you if you're interested in it, get it done, get yourself marketable, because that way if you realize that retail or the hospital or a clinical pharmacy setting isn't necessarily for you, you've already taken the steps to be able to do this kind of role.   As for pharmacists that are already established in a job, I've had a few inquire already about this job and what all is required of you in order to become a nuclear pharmacist and that tends to be the biggest roadblock is that you've got to do all this didactic work, and then on top of that you have to have 500 hours of actual work at a nuclear pharmacy before you can even apply to the Nuclear Regulatory Commission (NRC) to become an authorized user. And so when they hear that, and know that they also need to hold down their other job, because obviously a lot of people can't just stop working, that makes it a little bit tougher. So I will admit there can be some roadblocks, but no more difficult than going back to school to change what you wanted to do to begin with and how many people are doing that these days. So it's certainly a manageable thing, but I understand it's a little bit more difficult for them.   Matt: Very true. very true. Well thanks for the insight into nuclear pharmacy Tim. We like to talk a little bit with our nontraditional guests about their take on the pharmacy profession in general, because we think you have a unique perspective on the field of pharmacy, doing something different than a lot of other pharmacists. So what are your thoughts on the field of pharmacy in general and the future of the profession?   Tim: You know, really I feel like the possibilities could be endless. It seems like even since I'm graduated, and I've only been out since 2009, I think we were able to do flu shots, but beyond that, I don't really think there was much going on in the way of immunizations. Now we're doing Zostavax, DTap, we're doing all these different things. And then also many states are allowing us to use our clinical judgment. We're able to make therapeutic substitutions if we get an error from an insurance company, we can substitute with the product that they'd prefer, just like they would at a hospital with their formulary. I think the more that we're allowed to use our clinical knowledge, the more ways that pharmacists could be used. We're a great resource to the public. We're a lot more accessible than doctors are a lot of the time. So I feel like really, we could do anything and then now too, they've got residencies that are going up to three years. You're talking about a lot of higher education right there. And so I think it's just a matter of State Board of Pharmacies and things of that nature allowing us to use that knowledge, and then really we could go anywhere.   Matt: Well there you have it. Scientific, specialized, and radioactive is Dr. Tim Burke. Tim, we certainly appreciate you joining us on The Nontraditional Pharmacist. We'll be sure to share the resources that you've shared with us with our viewers. Everyone please connect with Tim at The Pharmacy Network on The Nontraditional Pharmacist. Tim thanks again, we appreciate it. And we will talk to everyone next time on The Nontraditional Pharmacist.   Tim: Absolutely. Thank you very much Matt, I appreciate you having me on   See omnystudio.com/listener for privacy information.

Technetium is essential for medical imaging, yet supplies of this short-lived radioactive manmade element are far from guaranteed. Justin Rowlatt heads to University College London Hospital to see a technetium scan in progress, to view the clean rooms where technetium cows are milked, and to speak to nuclear medicine researcher Dr Kerstin Sander about a possible solution to cancer.Professor Andrea Sella explains why this element sparked a 70-year wild goose chase by chemists in the 19th Century. And, we dispatch Matt Wells to Winnipeg in Canada to meet the team hoping to come up with an alternative source of technetium, when the biggest current source - the Chalk River reactor in Ontario - shuts down in 2016.

Technetium is essential for medical imaging, yet supplies of this short-lived manmade element are far from guaranteed. We see a technetium scan in progress and a cow being milked, and hear the yarn of the 70-year chemistry wild goose chase sparked by this mysterious radioactive metal.

Technetium podcast from Chemistry World - the magazine of the Royal Society of Chemistry.

1 - Young Punx - You've Got To (Fembot Funk Remix) - PMN - MYS 2 - Future Daze - Random Robotic Dancing - PMN - MYS 3 - amb26 - Suffering Fools - PMN - MYS 4 - Technetium - Tantric Energy - PMN - MYS 5 - Electromagnetic Impulses - Hercules - PMN - MYS 6 - Milo Firewater - My High - PMN - MYS 7 - Pulse - Miracle - PMN - MYS 8 - Ibrahim Reevy - Made In Dirtica - PMN 9 - DJ Noa - Brain Silence - PMN - MYS 10 - Ultra Deep Field - Creamy Kittens - PMN - MYS All the music was provided by the Podsafe Music Network Many thanks to all the Podsafe artists for their permission to play their music. Download the show here Subscribe via RSS Email me at thestartledbunny@gmail.com Dig, add, or befriend me on MySpace , Podshow , Twitter , Facebook , and Pownce . Check out my Tumblr blog Please Vote For Me every month at Podcast Alley

The Show Notes:IntroParsec NominationsAcoustic duo vs. PFAOccasional Songs for the Periodic TableCobalt, Nickel, Copper, Zinc, Gallium, Germanium, Arsenic, Selenium, Bromine, Krypton, Rubidium, Strontium, Yttrium, Zirconium, Niobium, Molybdendum, Technetium, Ruthenium, Rhodium, Palladium, SilverA Super Magumba Ask George - Matt Frewer? Marty Gordon- Tom Cruise and Germany? Mike Lee- Ukrainian? Steven Novak- Accents and the other e-mail? Terence Praet - Real piano vs. fake piano? Mat from London- Prime Number? Light Twinkie? Clair High- The J. Foster Interrogatories of DOOMMinoishe Interroberg's To Make with the Good English- Meteoric Rise Paul Minturn- Oriented vs. Orientated V. Ross- For the longest time Jill Arroway- Sketchy vs. Shady, not gonna lie Terence, again- I could care less, For all intensive purposes Jay Parlar- The EX factor Paul MakiShow Close......................................Mentioned in the show: Skepticality, the Philadelphia Funk Authority.And as always: George's blog, website, flickr, and myspace page. Have a comment on the show, a topic for Minoishe Interroberg, or a question for Ask George? Drop George a line at geo@geologicrecords.net or through his blog.Have any comments?

Following the current hypothesis that acute schizophrenic psychotic illness is associated with a triatal ‘hyperdopaminergic state’, presynaptic integrity and dopamine transporter (DAT) density in first-episode, neuroleptic-naive schizophrenic patients was measured by single-photonemission- tomography (SPECT) and compared with that in healthy control subjects. A new SPECT-ligand for assessment of the striatal DAT, the Technetium-99m-labelled tropane TRODAT-1 ([99mTc]TRODAT-1), was used. Ten inpatients suffering from a first acute schizophrenic episode and 10 age- and sex-matched healthy control subjects underwent SPECT with [99mTc]TRODAT-1. On the day of SPECT, psychopathological ratings were performed with the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS) and Schedule for Assessment of Negative Symptoms (SANS). Patients had not previously received any neuroleptic or antidepressant medication. Mean specific TRODAT-1 binding in the striatum did not differ significantly between the patient and the age- and sex-matched control group (1.25 vs. 1.28). Variance was significantly higher in the patient group. The data obtained with the new ligand in first-episode, drug-naive schizophrenic patients are in line with the PET results from the group of Laakso et al. in a comparable patient sample. [99mTc]TRODAT-1 seems to be a valuable new SPECTligand in the evaluation of the presynaptic site of the striatal dopaminergic synapse in schizophrenia.

Thu, 12 Feb 2004 12:00:00 +0100 https://edoc.ub.uni-muenchen.de/1874/ https://edoc.ub.uni-muenchen.de/1874/1/pachmayr_florian.pdf Pachmayr, Florian