Livro de Resumos IX Congresso APTMN 2013

IX Congresso da APTMN • Coimbra, 2 de Novembro de 2013 2

Associação Portuguesa de

Técnicos de Medicina Nuclear




Prefácio

A primeira década do Séc. XXI ficou marcada na história mundial por acontecimentos como os Atentados Terroristas

do 11 de Setembro, as Guerras no Afeganistão e no Iraque, o fim do Pontificado do Papa João Paulo II, o início do

Pontificado do Papa Bento XVI, a tomada de posse de Barack Obama, o crescimento económico da China, a entrada

em circulação do Euro, os Jogos Olímpicos de Sidney, de Atenas e de Pequim, bem como a expansão tecnológica,

nomeadamente através do uso crescente de CD e/ou DVD, surgimento do Bluetooth, nascimento das redes sociais

globais (Facebook, LinkedIn, Twitter ou Youtube) ...entre outros. A nível nacional, destaca-se na década a passagem

pelo governo de António Guterres, Durão Barroso, Pedro Santana Lopes e José Sócrates, o acolhimento da Capital

Europeia da Cultura (Porto 2001) e a organização do Campeonato Europeu de Futebol (Euro 2004).

Mas...centrando-nos nos assuntos mais relevantes para as comemorações que este momento compreende, com a

expansão da Medicina Nuclear verificou-se um aumento significativo dos profissionais especializados a trabalhar

nesta área de diagnóstico e terapêutica, nomeadamente os Técnicos de Medicina Nuclear.

E eis que em 2003, dois anos após a formação dos primeiros Licenciados em Medicina Nuclear em Portugal, e

inspirado por esta tendência de crescimento da especialidade e pelo facto de não se reverem em qualquer outra

instância existente nesse momento, surge um movimento de profissionais que criam a APTMN (Associação

Portuguesa de Técnicos de Medicina Nuclear), com o objectivo de representar e contribuir para o desenvolvimento

da Profissão de Técnicos de Medicina Nuclear, na sua especialidade e especificidade, com especial vocação e

interesse pelas vertentes técnico-científicas.

... e passaram 10 anos!! Dez anos de actividade e de que nos podemos todos orgulhar! Assim pelo caminho

percorrido até aqui, que inclui a organização de 9 (nove!) Congressos onde se alinhou a vertente científica à

profissional, como pelo papel activo e a colaboração efectiva na definição estratégica inerente à adaptação ao

Processo de Bolonha e consequente reforma do Sistema Educativo nacional, participação activa - ainda em curso… -

no movimento conducente à criação de uma Ordem Profissional para os Técnicos de Diagnóstico e Terapêutica, bem

como uma extensa série de outras colaborações e co-organizações nos mais diversos eventos científicos, de

divulgação e até mesmo de actividades lúdicas!!! (sim, porque como nem só de pão vive o homem, também nem só

de Medicina Nuclear vivem estes Técnicos! ;-)

E é assim que hoje assumimos com orgulho o nosso passado, congratulando-nos com os Parabéns pelos 10 anos

da APTMN, agradecendo do fundo do coração a todos os muitos que contribuíram, contribuem e vão continuar a

contribuir para o seu funcionamento e o êxito que referimos, mas, acima de tudo, voltamo-nos com coragem e espírito

de Missão para um Futuro que reconhecemos como complexo e difícil, mas que encaramos com confiança, até

porque na expectativa de um envolvimento cada vez mais activo de todas as partes interessadas desta nossa

Associação, que sendo de todos, é sobretudo a Vossa.

Muito Obrigado, …e até daqui a mais 10 anos!!

O Presidente da APTMN.







Coimbra, Portugal

2 de Novembro de 2013

Comissão Científica Presidente

Lídia Cunha

Domingos Vieira

Ana Margarida Abrantes

Sara Ferreira

Marta Oliveira

Elisabete Ferreira




Programa 08:30h – 09:00h – Inscrições & Entrega de Documentação 09:00h – 09:15h – Sessão de Abertura

Presidente da APTMN (Luís F. Metello)

09:15h – 12:45h – Actualidades em Neurologia Nuclear: 09:15h – 09:50h – Imagiologia Multimodal: PET e Ressonância Magnética

Miguel Castelo Branco (ICNAS) 09:50h – 10:25h – Contributo da Medicina Nuclear para o Diagnóstico Clínico

Ana Paula Moreira (Serviço Medicina Nuclear CHUC & ICNAS) 10:25h – 11:05h – Novos Agentes: a Radiofarmácia PET ao Serviço da Neurologia

Antero Abrunhosa (ICNAS) 11:05h – 11:15h – Discussão Aberta 11:15h – 11:45h – Coffee Break e Sessão de Posters 11:45h – 12:45h – Processamento & Quantificação de Imagem em Neurologia Nuclear

Markus Diemling (Nuclear Diagnostics): Demonstração com TelehermesTM por Video-Conferência, directamente de Viena – Áustria

12:45 – 14:30 – Intervalo para Almoço 14:30h – 16:30h – “Utilização das Radiações em Saúde: o Papel da Formação e Treino dos Técnicos de Medicina Nuclear na Qualidade dos Serviços Prestados e na Segurança dos Doentes”

14:00h – 14:30h – J.J. Pedroso de Lima (Prof. Jubilado – Univ. de Coimbra) 14:30h – 16:00 – (Diversos Intervenientes)

A perspectiva dos Doentes A perspectiva do Ambiente A perspectiva dos restantes Profissionais de Saúde A perspectiva das Associações Profissionais O contexto internacional: Passado, Presente e Tendências Futuras

16:00h – 16:30h – Discussão Conjunta 16:30h – 17:00h – Sessão de Encerramento do “IX Congresso Anual da APTMN” e Comemoração 10 Anos da APTMN 17:00h – Assembleia Geral da APTMN







PRÓTESES MAMÁRIAS: ATENUAÇÃO NA CINTIGRAFIA DE PERFUSÃO DO MIOCÁRDIO

Martins A1, Costa P

1, Vieira D

1, Oliveira M

2, Silva A

2, Metello L

1

1 Área Técnico-Científica e Curso de Medicina Nuclear, Escola Superior de Tecnologias da Saúde – Instituto Politécnico do Porto (ESTSP.IPP), VN Gaia. Portugal

2 Departamento de Medicina Nuclear, HGSA, Centro Hospitalar do Porto, Porto. Portugal

Introdução e Objectivos: Os principais artefactos da Cintigrafia de Perfusão do Miocárdio são os artefactos de

atenuação fotónica. As próteses mamárias podem provocar uma atenuação fotónica significativa, diminuindo a

precisão diagnóstica desta Cintigrafia em doentes que realizaram mamoplastia de aumento ou cirurgia de

reconstrução mamária. O objectivo deste estudo é avaliar a influência da atenuação provocada por próteses de gel

de silicone na detecção de defeitos de perfusão, para próteses de diferentes dimensões e em diferentes

localizações.

Material e métodos: Num fantoma de acrílico cardíaco (com uma actividade de 480 ± 8.6 μCi) incorporado num

fantoma cilíndrico (com uma actividade de 48 ± 1.8 μCi) inseriram-se oito defeitos hipocaptantes (com

características e dimensões bem conhecidas e controladas) na parede anterior, inferior, lateral, septal e ápex

cardíaco. As próteses de diferentes dimensões (aqui definidas por A, B e C) foram colocadas sobre o fantoma, em

diferentes posições (unilateral direita, esquerda e bilateral) e efectuaram-se várias aquisições tomográficas de

180º.

Resultados: Em termos qualitativos observou-se uma distorção das imagens obtidas com as próteses bilaterais e

unilaterais esquerdas e verificou-se uma diminuição dos defeitos identificados (quando comparado com as imagens

efectuadas sem próteses). Em termos quantitativos, verificou-se, em média, para a prótese A, uma percentagem de

atenuação de 5,1%, enquanto que este valor se alterou para 6,9% e 9,5% relativamente à prótese B e C (que

corresponde à de maior dimensão). Em relação à posição verificou-se uma percentagem de atenuação de 9,4%,

2,8% e 9,7%, respectivamente para a prótese bilateral, direita e esquerda (valores estes obtidos

independentemente da dimensão das próteses). A atenuação ocasionada pelas próteses foi considerada

estatisticamente significativa (p<0,05) estando, contudo, dependente da abordagem utilizada (análise de cortes

coronais, transversos ou sagitais).

Conclusões: A atenuação das próteses foi superior com o aumento da dimensão das próteses e mais evidente para

próteses bilaterais e unilaterais esquerdas, apesar da prótese unilateral direita provocar igualmente atenuação.

Embora seja um estudo feito num fantoma, pode-se supor, perante os resultados obtidos, que as próteses de gel

de silicone podem contribuir como um factor relevante para diminuir a precisão diagnóstica da Cintigrafia de

Perfusão do Miocárdio.




RADIOLABELED POLYETHYLENEIMINOMETHYL PHOSPHONIC ACID AS A MOLECULE WITH POTENTIAL FOR

DIAGNOSIS AND THERAPY. COMPARATIVE STUDY ON MODELS OF BLADDER CANCER AND OSTEOSSARCOMA.

Ferreira S1,2,3

, Abrantes AM1,4

, Brito A1, Laranjo M

1,4, Gonçalves AC

4,5, Sarmento-Ribeiro AB

4,5, Metello L

3, Zeevart J

6, Louw W

6, Dormehl I

7,

Botelho MF1,4

1Biophysics Unit, Institute for Biomedical Research on Light and Image, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

2School of Sciences, University of Minho, Braga, Portugal

3Nuclear Medicine Course, High Institute of Allied Health Technologies of Porto’s Polytechnic Institute, Porto, Portugal

4Centre of Investigation on Environment, Genetics and Oncobiology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal

5Applied Molecular Biology and Hematology Group, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

6Radiochemistry Department, NECSA, Pretoria, South Africa

7Department of Internal Medicine, University of Pretoria, South Africa

Introduction and Aim: The polymer PEI-MP (polyethyleneiminomethyl phosphonic acid) that might be labeled with

99mTc and 188Re, have a potential for diagnosis and therapy, respectively. The aim of this study was to evaluate the

efficacy of 99mTc-PEI-MP for diagnosis and 188Re-PEI-MP therapy, in a comparative study using models of bladder

cancer and osteossarcoma.

Material and Methods: In vitro studies were performed using the cell lines of bladder cancer (HT-1376) and of

osteossarcoma (MNNG-HOS). Cytotoxicity of PEI-MP was investigated using the MTT test and flow cytometry.

Radiochemical purity of 188Re-PEI-MP and 99mTc-PEI-MP was achieved using ascending microchromatography.

Celular uptake studies were performed using the complexes 188Re-PEI-MP, 99mTc-PEI-MP, Na188ReO4 and Na99mTcO4.

Cell samples were collected during four hours, centrifuged to separate supernatant and pellet, and radioactivity of

each portion was counted to determine percentage of uptake. The in vivo studies were performed using twelve

groups of Balb/c nu/nu mice: four normal groups injected with Na188ReO4, 188Re-PEI-MP, Na99mTcO4 and

99mTc-PEI-

MP, four with bladder carcinoma xenotransplants and four with osteosarcoma xenotransplants injected with the

same complexes. After injection of the radiopharmaceuticals, were acquired dynamic and static images for 2 and 4

hours. For biodistribution proposes, mice were euthanized 2 and 4 hours after injection and organ samples where

weighted and counted in a well-counter to obtain percentage injected activity per gram of organ (%ID/g).

Results: The MTT assay and flow cytometry tests showed that PEI-MP is not cytotoxic. The radiochemical purity

was 85%. The uptake studies demonstrated that the uptake was higher for 188Re-PEI-MP and 99mTc-PEI-MP in

relation to their controls, and higher for 188Re-PEI-MP in relation to 99mTc-PEI-MP. The biodistribution with 188Re-

PEI-MP and 99mTc-PEI-MP showed that the excretion of these complexes occurs primarily through the renal system,

with a small fraction being eliminated by the hepatobiliary system. Tumor/muscle ratio for 188Re-PEI-MP was >1 for

the xenotransplants of osteosarcoma and >1.5 to xenotransplants of bladder cancer.

Conclusions: Considering the results, 188Re-PEI-MP seems to be promising in the treatment of both types of cancer,

but with a greater potential for bladder cancer. 99mTc-PEI-MP seems to be optimal for diagnosis of both types of

cancer.




ASSESSING RADIOBIOLOGICAL EFFECTS OF LOW DOSES OF IONIZING RADIATION ON ZEBRAFISH BY

BIDIMENSIONAL GEL ELECTROPHORESIS

Lemos J1, Costa P

1, Cunha L

1,4, Campos A

3, Carvalho AP

2,3, Vasconcelos V

2,3, Genésio P

5, Ponte F

5, Costa PS

5, Crespo P

6, Metello LF

1,4

1 Nuclear Medicine Dept, High Institute for Allied Health Technology of Polytechnic Institute of Porto (ESTSP.IPP), 4400-330 Vila Nova de Gaia, Portugal;

2 Biology Dept, Sciences Faculty,

3 CIIMAR, Univ. of Porto, 4050-123 Porto, Portugal;

4 IsoPor SA, 4445-526 Ermesinde, Portugal;

5 Julio Teixeira SA, 4460-188 Porto, Portugal;

6 LIP, Physics Dept, Univ of Coimbra, 3004-516 Coimbra, Portugal;

Aim: This paper relates with a specific task from a larger research project oriented to the development and

application of the Zebrafish – Danio rerio – to the study of radiobiological effects of medical diagnostic level – low

doses – of ionizing radiation.

Introduction: Studies on biological effects of ionizing radiation using animal models are considered of extreme

importance when trying to overcome limitations founded when trying to extrapolate results obtained from in vitro

cell cultures studies to in vivo processes. In recent years, the use of Zebrafish has grown considerably, pointing

more and more as a very interesting model in biomedical research, essentially because of the full knowledge of its

genome and the level of homology that it shares with the human genome, all this complemented by a very easy

and affordable practical side. Based on these advantageous properties, its potential for radiobiology studies

deserves each day more attention from researchers worldwide.

On other hand, proteomic analysis is a powerful tool to investigate the cellular response to injuries, such as those

caused by ionizing radiation. The bidimensional gel electrophoresis (2DE) is a method used for the analysis of

complex protein mixtures from biological samples. This method allows the detection of differences in protein

expression under different conditions, so allowing creating relations between those differences and the irradiations

that were in their basis and has been elected for this fact.

Material and Methods: This work used a population of circa 300 animals, divided in four groups and externally

irradiated with three distinct protocols, with the acute biological effects of doses ranging around 100 mGy being

studied using two-dimensional gel electrophoresis (2DE).

Results and Conclusion: These preliminary results appear promising, seeming to point to differences in protein

expression dependent of the absorbed dose. The remaining samples will be processed soon, allowing more robust

statistical analysis.




MODERN RADIOBIOLOGY: STUDY OF IONIZING RADIATION BIOLOGICAL EFFECTS USING THREE-DIMENSIONAL

CELL CULTURES

Costa P1, Lemos J

1, Cunha L

1,3, Carvalho AP

2, Vasconcelos V

2, Genésio P

4, Ponte F

4, Costa PS

4, Crespo P

5, Metello LF

1,3

1 Nuclear Medicine Dept, High Institute for Allied Health Technology of Polytechnic Institute of Porto (ESTSP.IPP), 4400-330 Vila Nova de Gaia, Portugal; 2 Biology Dept, Sciences Faculty, CIIMAR, Univ. of Porto, 4050-123 Porto, Portugal; 3 IsoPor SA, 4445-526 Ermesinde, Portugal; 4 Julio Teixeira SA, 4460-188 Porto, Portugal; 5 LIP, Physics Dept, Univ of Coimbra, 3004-516 Coimbra, Portugal;

Introduction: Biological effects of high doses of ionizing radiation are reasonably well studied and documented.

Nevertheless, there is a clear lack of information and/or evidence concerning biological effects of Low Doses,

namely at medical imaging levels, as those characterizing Nuclear Medicine and Radiology typical environments.

Considering that three-dimensional cell culture techniques provide a more realistic approach to the in vivo cellular

microenvironment, with significant differences in cellular differentiation and protein expression, we hypothesize

that these kind of techniques might constitute an interesting approach and a step further to study modern

radiobiology.

Material and Methods: To perform this study, due to the complexity of the effects aimed to be studied, and

recognizing several known limitations and difficulties of the current monolayer cellular models, as well as the

increasing difficulties to translate in vitro obtained data to in vivo biological behavior, advanced biological

alternative cellular models, namely three-dimensional cell cultures, have been developed. HepG2 cells were then

cultured using three different techniques: two-dimensional cell cultures (monolayer), with 1,5% Agarose coating

(3D Agarose) and with 1% Alginate encapsulation (3D Alginate).

Results and Conclusion: Our results suggest that cultivation methodologies indeed have an impact in experimental

outcomes. Specifically, our data summarizes a possible relationship between clastogenic factors released by the

cells immediately after low dose irradiation and the decrease of cellular proliferation rate, showing also that cells

tend to recover their proliferation rate/viability 72 hours post-irradiation.




NUCLEAR MEDICINE TECHNOLOGISTS EDUCATION AND TRAINING AMONG EUROPE

Metello LF, Costa P, Lemos L, Ferreira S, Vieira D, Neves D, Oliveira M, Cunha L

Nuclear Medicine Department, High Institute for Allied Health Technologies, Polytechnic Institute of Porto, ESTSP.IPP, Portugal

This work aims to promote critical thinking and to sustain discussion about distinct methods and options for

Education and Training of Nuclear Medicine Technologists.

Data and experience from several European countries distinct approaches is presented and compared in order to

allow evaluating its potential impact in the theoretical knowledge and practical competences acquired, so as well in

the responsibility, autonomy and technical level of performance expectable.

Nuclear Medicine is an independent medical specialty for almost fifty years. Its distinct origin, evolution and

dynamic of development are clear justification for specialization between the distinct health professionals involved.

Nevertheless, in some countries there is one exception: the Technologists. Their education differs from country to

country and it might vary from strictly Professional to a Superior Degree level within the European Union, as well as

between a Multispecialty approach (which received a “wide band” education and training, the same used for

Radiology and Radiotherapy Technologists) and a Dedicated Specialty approach.

According with those facts, concepts as “Basic” and “Advanced” Practice becomes entirely meaningless, while

some “Post-Graduated” Courses in some countries present a level clearly inferior to some “Undergraduate”

Courses from other countries, causing that some Graduates are more competent and

best performers than some Post-Graduates. Also, nationally, specialties that should be parallel are benefiting from

much higher attention during the Education and Training process than others, resulting that Health Professionals

theoretically – and legally! – equivalent are in fact very different and perform with very distinct levels of

competences, autonomy and responsibility.

We are convicts that those facts needs to be clarified and highlighted adequately, to be clearly assumed

…or not! – for the Society and the remaining Health Professionals with whom we share our daily activities.




PRACTICES IN RADIOPHARMACY: IS THE USE OF A BREATHING NEEDLE A CONCERN ON THE RADIOCHEMICAL

PURITY OF 99MTC-RADIOPHARMACEUTICALS?

Oliveira M1, Oliveira T

2, Rebelo A

2, Sousa C

1, Silva A

1, Nery J

1, Amorim I

1, Castro R

1

1Santo António General Hospital, Oporto Hospital Center, Porto, PORTUGAL

2High Institute for Allied Health Technologies, Polytechnic Institute of Porto, ESTSP.IPP, Gaia, PORTUGAL.

Aim: The action of collecting the patient’s individual doses isn’t subjected to any followed protocol, unlike most

practices in the Nuclear Medicine department. In certain departments, the individual doses are withdrawn by

perforating the rubber septum at every dose while others choose to keep a needle in the kit to avoid multiple

perforations. Radiochemical purity is typically the primary concern for 99mTc-radiopharmaceuticals so the potential

presence of impurities will affect the radiochemical stability of the radiopharmaceutical and, after being injected to

a patient, result in an altered biodistribution and poor image quality. Therefore, it’s important to verify every

practice used on the product, which results in a need to learn if the needle kept in the kit at some departments is

affecting the radiopharmaceutical’s stability. It is aimed to disseminate the results obtained on a large study

performed to evaluate whether there is any correlation between keeping the needle in the kit, during the clinical

practice and during the stability period of two different radiopharmaceuticals.

Material and Methods: Two commonly used 99mTc-radiopharmaceuticals, 99mTc-Tetrofosmin (n=20) and 99mTc-HDP

(n=20), were included. The radiopharmaceuticals were prepared strictly according to manufacturer’s instructions.

All preparations were stored at room temperature. To assess the radiochemical stability, the reference sample was

withdrawn directly from the vial, immediately after radiolabelling, and subsequent aliquots were tested for each

time-point predefined (1h, 3h and 6h after radiolabelling). Radiochemical purity was assessed by thin-layer

chromatography, according to manufacturer’s or EU Pharmacopeia instructions. Student’s t-Test was used to

evaluate differences between means for each hour.

Results: At 0h, the results were identical since the labeling was performed similarly in both situations. However, at

6h, a variation of 1,32% and 0,61% is seen on the radiochemical purity, for 99mTc-HDP and 99mTc-Tetrofosmin,

respectively, with the smaller values obtained when a needle is kept in the kit. Still at 6h, the free pertecnetate

values differ 0,20% and 0,20% and the 99mTc-colloid impurities values present variations of 1,12% and 0,42%, for

99mTc-HDP and 99mTc-Tetrofosmin, respectively, being higher when the needle is kept in the kit.

Conclusion: Results demonstrate that a higher percentage of 99mTc-radiopharmaceuticals is obtained when the

needle isn’t kept in the kit. This can have a positive impact on subsequent clinical images, due to a highest

concentration of radioactivity in the target organs.




THE ROAD TO TELEMEDICINE: MOBILE SOLUTIONS FOR NUCLEAR MEDICINE

Vieira D, Costa P, Cunha L, Metello LF

Nuclear Medicine Department, High Institute for Allied Health Technologies of Porto - Polytechnic Institute of Porto, Porto, PORTUGAL

Aim: The present dimension of the concept “Telemedicine” includes the application of mobile communication

technologies and information systems to provide Health Care at distance. In the medical imaging field, and

particularly in Nuclear Medicine, this concept is broader, involving the application of a variety of software and

mobile applications at several steps of the process: digital imaging display and processing, data transfer and

storage, but also decay calculations and inherent corrections, often in real-time and automatically performed, as

well as the exchange of theoretical information. This paper aims to review the current status concerning available

software and applications, with a clear accent on those with a close relation to cloud computing and interfacing

with smart phones and/or tablets.

Materials and Methods: This paper presents a literature review in this field, complemented by a general

description of the solutions available in the market. A small introduction based on the relevance and justification of

Telemedicine will be presented, followed by the proof-of-concept using several independent solutions. Finally, our

vision about this each-day increasingly important issue will be pointed and justified, including the enumeration of

the correspondent limitations and predictable difficulties for its wide implementation.

Results and Conclusion: Main applications found were related with support guidelines, learning games, DICOM

viewers, scientific and education articles access, portal news, technical remote support/equipment assessment and

augmented reality. It is widely recognized that this is a complex process, since it ideally requires a change of the

mind setting, at different levels, of the distinct players, with some of them more able - and willing to do so - than

others. Nevertheless, the added value of these sorts of applications seems to win more and more acceptation,

clearly tending to become quite consensual ⋯and so the need and overall interest to adapt the daily practice of

medicine to the commonly available technological tools, assumedly with an extra-urgency created by the present

socio-economic reality.




Com o apoio de:

Comissão Organizadora

Presidente: Joana Lemos

Carla Morais Cátia Alves Cátia Neto

Diana Neves Francisca Rocha

Graça Paixão Joana Teixeira

Mariana Teixeira Marlene Costa Nuno Arantes Pedro Costa

Raquel Martins Sara Cunha Sara Silva

Susana Cunha

Livro de Resumos IX Congresso APTMN 2013

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