Letter from the editors

Article Outline

• Copyright

SEMINARS IN NUCLEAR MEDICINE has devoted considerable space recently to the exciting new developments that have occurred in areas such as molecular/gene expression imaging and positron emission tomography. Although this “cutting edge” work is of much interest to all of us, it represents a relatively small portion of our daily workload. Therefore, it is important to revisit some of the more routine parts of our practice periodically and examine the progress that has been made in these areas.

This issue deals with the important problems of acute care. Several of the procedures reviewed have been used for many years and are the standard of care in today’s medical world. These techniques include hepatobiliary scintigraphy for acute cholecystitis, gastrointestinal bleeding studies, ventilation/perfusion lung imaging for pulmonary embolism, and radionuclide confirmation of brain death. In each of these diagnostic areas, the authors have stressed recent advances and modifications that have been made to deal with newer radiopharmaceuticals, including lipophilic brain agents that have replaced older “blood brain barrier” agents, the advent of competitive imaging modalities, such as spiral computerized tomograpy for pulmonary embolus diagnosis, and medicolegal considerations involved in interstate differences in the definition of brain death. The authors of these articles have emphasized the most recent developments and the changing roles that are associated with these long used studies.

The use of resting myocardial perfusion studies to help triage patients with acute chest pain has much potential. However, this procedure has been performed in a relatively limited number of medical centers. One of the leading advocates of this acute care technology is Dr. James Tatum at the Medical College of Virginia. Although Drs. Tatum and Kontos make an excellent case for its efficacy, logistic difficulties have limited its usefulness in many centers. Once this commitment has been made, it requires the around-the-clock availability of physicians, nurses, and technologists to ensure its effectiveness.

Finally, optimization of nuclear medicine’s role in acute care has been made possible by the availability of computer-based technology that truly has facilitated remote interpretation of the images. It is not uncommon for a nuclear medicine physician to have responsibilities at multiple sites, with significant geographic separation. Consultation among physicians at different sites also may be needed to interpret a particular study. Dr Tony Parker does a superb job clarifying the various approaches that are available to achieve these goals. The editors hope that this state-of-the-art review and update of some of our established procedures will prove helpful and informative to our readers.