Two main types of cardiac amyloidosis (CA) exist, as a result of either aberrant plasma cell production of misfolded monoclonal light chains, known as immunoglobulin light chain amyloidosis (AL), or production of disintegrated and misfolded transthyretin (TTR) proteins by the liver, also called transthyretin amyloidosis (ATTR). Non-invasive diagnostics (cardiac uptake on diphosphonate scintigraphy, Perugini score 2 or 3) have gained prominence in modern cardiology in correlation with the negative findings of free light chains in serum and the results of negative immunofixation in serum and urine. Additionally, criteria related to echocardiography or cardiac magnetic resonance are necessary for establishing a diagnosis. A total of 3.063 99mTc-MDP bone scintigrams were analyzed between August 2018 and March 2023, of which Perugini score 1 was validated in 13 patients, Perugini score 2 in 10 patients and Perugini score 3 in 1 patient. From our experience, we could observe that cardiac uptake can be verified in daily clinical practice and that is meaningful for monitoring patients with ATTR-cardiomyopathy (ATTR-CM). Although the sample size is not large, the importance of the study lies in the fact that it involves patients whose findings have been incidentally verified. If patients are selected according to clinical characteristics, the number of positive findings may potentially increase. Our study aimes to raise awareness among physicians of various specialties about the significance of the diagnostic algorithm for infiltrative cardiomyopathies. This is to ensure early diagnosis of this problem and initiation of treatment in the earliest stages when the therapeutic effect is most optimal. Such an approach would yield benefits for both patients and the entire healthcare system. A meticulous diagnostic and therapeutic approach is therefore fundamental for improving clinical outcomes in patients with ATTR-CM, including careful attention to specific TTR genetic variants and long-term follow-up.

Contouring, planning and dose calculation in treatment planning systems (TPS) are based on computedtomography (CT) images. Therefore, it is important to have developed, optimized and adapted scanning protocolsfor specific anatomic regions and special radiotherapy modalities such as stereotactic radiosurgery (SRS). The aimof this study was to determine influence of tube voltage, field of view size (FOV) and reconstruction kernels on CTnumbers and the resulting radiotherapy (RT) dose calculation.This study was performed at Clinic of Oncology, Clinical Center University of Sarajevo. Verification electrondensity and CT number values was performed using CIRS Thorax 002LFC phantom, while anthropomorphic CIRS038 phantom for stereotactic end-to-end verification was used for the purpose of dose plan calculation analysis withlarge bore CT simulator Canon Aquillion LB.The significant correlation between the tube voltage and the measuredvalues of CT numbers is significant for all materials (p < 0.05), except for water (p = 0.310). No significantcorrelation between FOV and obtained values of CT numbers was found in any of the evaluated tissue equivalentmaterials. Evaluating the impact of reconstruction kernels on Hounsfield units (HU), significant deviations werefound for the FC62, FC68 and FC07 reconstruction kernels. Also, analyzing the influence of reconstruction kernelson the RT dose calculation, the extreme values are associated with Dmin/D in PTV for kernels FC41 and FC68, wheredeviations from the values obtained using the baseline scanning parameters were -1.3% and -1.9%. For deviation of1 HU in muscle tissue of CIRS 002LFC, the calculated Dmin/D in PTV of CIRS STEEV phantom will reduce by0.79%. Similarly, the reduction of D₉₈ and D₂ would be 6.8 cGy and 3.03 cGy for 1 HU, respectively. Change of thereconstruction kernels caused differences of 0.4% in Dmin/D calculation in clinical target volume (CTV).CT scanning and reconstruction parameters may affect Hounsfield units, which could have an impact on dosecalculations in RT plan. Hence, it is recommended to standardize the scanning protocol used in calibration curvegeneration for TPS. One should avoid use of different tube voltages and kernels, while according to this study, thechange of FOV will have no impact on dose calculations

Background: The use of resolution recovery (RR) in bone and myocardial perfusion imaging is becoming increasingly popular in nuclear medicine departments. RR produces reconstructed images that show improved spatial resolution and signal-to-noise ratio compared with conventional single-photon emission computed tomography (SPECT) images. Objective: To evaluate the impact of the ordered subset expectation maximization (OSEM) RR modality on preserving noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) for short SPECT acquisition. Methods: This prospective study was conducted on 80 patients. Full SPECT acquisition was performed as a standardized protocol, while reduced acquisition was achieved with the Poisson resampling method. Noise, SNR, and CNR were measured for different reconstruction parameters for the same image levels. The impact of surface area and body mass index was also measured for the same reconstruction parameters. Results: The results show significantly higher SNR and CNR for the Evolution for Bone protocol compared to the other two reconstruction protocols for full and reduced SPECT acquisition. With the shortening of the SPECT acquisition, an increase in the value of noise was recorded. SNR and CNR decreased with the reduction in SPECT acquisition. Conclusion: The Evolution for Bone protocol for all three analyzed acquisition protocols had the lowest noise values. The highest SNR and CNR were recorded in the Evolution for Bone protocol for the three acquisition protocols and SPECT acquisition time can be reduced from 20 to 10 min for bone SPECT.

Introduction: Prostate cancer has been the leading type of cancer to affect male population, and as such, it is a subject to efforts to furthermore diagnostic tools already in existence as well as development of new ones which will Aid early diagnostic, treatments as well as a follow up procedures and clinical trials. Bone scan index is a useful and objective biomarker used as a valuable tool for determination as to precise bone involvement in advanced cases, as well as a tool to predict the outcome in prostate cancer patients in clinical trials.Methods: This paper is a non-experimental (qualitative) research, that is, a scientific review of the literature.Results: The results we analyzed in this paper were collected from published academic journals.Conclusion: As a new imaging biomarker, bone scan index has potential to predict therapeutic effects and survival of patients with prostate cancer. Using measurable diagnostic image parameters, the bone scan index is important for determining metastatic bone changes in prostate cancer patients.

Introduction: Glioblastoma in children (pGBM) occurs somewhat less frequently than in adults. Pediatric pGBMs have a different molecular profile than GBM for adults. The aim of the presentation of this case is the possibility of the effectiveness of the GBM radiation method and the evaluation of magnetic resonance imaging, and the monitoring of the treatment outcome of the patient.Material and methods: The case study is of the retrospective-prospective type. Medical documentation, magnetic resonance imaging, and chronologically monitored evaluation of the findings from November 2018 to August 2021 were used to present the study. The postoperative course was analyzed, as well as the effect of concurrent chemoradiotherapy, VMAT radiotherapy and adjuvant chemotherapy with Temozolomide in a patient aged 4 years and 6 months, comparing treatment outcome with median and overall survival in glioblastoma.Results: The pediatric patient after being diagnosed with high-grade glioma in 2018 is so far in very good general condition, without signs of physical and psycho-social defects, which compared to the scientifically proven median of survival indicates a good therapeutic effect. Volumetrically modulated arc radiotherapy with the use of modern IGRT verification techniques and with the use of chemotherapy with Temozoloimod, has proven to be a still effective oncological method treatment of GBM. For the final outcome of the disease and the effect of therapeutic modalities, the patient's condition and evaluation of magnetic resonance imaging will be monitored. The result supports further research into this therapeutic regimen.Conclusion: Glioblastoma is a very aggressive tumor, which occurs somewhat less frequently in the pediatric population than in adults, but is a very fatal disease. Surgical resection followed by concurrent chemoradiotherapy, with adjuvant Temozolomide is still the method of choice in the treatment of glioblastoma.

18F-FDG PET/CT is the most widely used diagnostic modality for detection of malignant disease. Beside the visual insight of FDG pathways into the human body, PET/CT can give valuable information based on the SUV values. The SUV is a quantitative parameter of metabolic activity. FDG application has 2 major impacts on PET/CT: qualitative aspect (visual insight of FDG in the body) and quantitative aspect (degradation of the SUV values). Based on the literature, FDG extravasation incidence is 31% for all PET/CT studies and in 8% of all cases extravasation has been visually confirmed since the application place has been in the field of view. By constantly developing the technique, work methodology and increasing the quality control of the staff in the PET/CT department, the incidence of extravasation can be significantly reduced based on the results from the literature. In the case when paravenous injection is present on PET/CT images we can use certain software procedures to improve image quality and SUV quanitification.

Introduction: Among the female population, breast cancer is the most commonly diagnosed cancer in the world, and nearly half of women population with breast cancer develop metastatic disease during their lifetime. Breast cancer most often metastazises to the lungs, liver, bones, brain and lymph nodes. 18F-FDG PET/CT can detect metastases that are not visible in other imaging modalities, and with the newly discovered lesions, decision about adequate treatment option can be evaluated. Material and methods: The examination was conducted as a retrospective descriptive study in May and June of 2019 at the Clinic for Nuclear Medicine and Endocrinology of the University Clinical Center in Sarajevo. It included 100 female patients with the age structure of 33-79 years. The patient's reference diagnosis is breast cancer, with a suspected finding of metastatic activity. A comparison of the sensitivity and specificity of the breast imaging between PET/CT, CT and bone scintigraphy was performed. Results: PET/CT revealed significantly more positive findings on metastatic activity than other diagnostic imaging modalities, with Mann-Whitney test value of p = 0.01014. In the diagnosis of lungs and liver lesions, PET/CT sensitivity and specificity are 92.59% and 85.37%, respectively, while the statistical parameters for CT are 77.78% for sensitivity and 90.24% for specificity. The PET/CT sensitivity and specificity for bone lesions are 93.55% and 88.89%, respectively, compared to 78.57% and 100% for bone scintigraphy. Conclusion: Hybrid imaging technique, which integrates PET and CT imaging methods, has considerable advantages over other diagnostic methods in the detection of distant metastases, and based on obtained results, PET/CT may be method of choice in evaluation of metastatic activity in breast cancer.

Introduction: This study aims to explore clinical values and possibilities of heart artifact elimination for patients who underwent SPECT myocardial perfusion scintigraphy. The main focus is on nuclear medicine technologists and their knowlodge of the new technologies developed in nuclear cardiology. Methods: A qualitative descriptive study, review article has been performed for this research. Pubmed, Web of Science, and Embase were searched using a predefined electronic search strategy. Eighteen studies were deemed eligible for this systematic review. Results: Based on the literature we found average age for the patients with coronary artery disease is 59.69 years for women and 57.39 yeras for men. False positive findings, blurred images, respiratory artifacts and sinogram and linogram interruption is very often, especially with patients with irregular breathing cycles, fear of the reasults, anxiety and patients with high BMI. Many studies performed on phantoms or on patients suggest image artifacts can be reduced or even eliminated with the new scanning methodology, software application upgrade, and with right nuclear medicine technologist education. Conclusion: Coronary artery disease can affect men and women equally so the best diagnostic modality is essential for adequate treatment. Interruption of sinogram or linogram, truncation of the heart and blurred image is the first sign artifact of the image. Essential and the first step of every cardiac proccesing software is sinogram and linogram inspection combined with motion correction evaluation of the raw images. New technologies can improve image quality which can increase sensitivity and specificy of myocardial perfusion scintigraphy in all patients.

INTRODUCTION: Cardiac single photon emission computed tomography (SPECT) is one such technique that has a potential to overcome the limitations of conventional myocardial SPECT including the absolute quantification. Despite the progress in the field of medical technology, soft tissue attenuation is still a hindrance in the path of the diagnostic accuracy of myocardial perfusion imaging. Soft tissue attenuation artefacts are more likely to occur in patients with high body mass index (BMI) undergoing myocardial perfusion imaging (MPI) and therefore it is routine practice to perform attenuation correction in this group of patients. However, that attenuation artefacts may also occur in patients with normal BMI. Soft tissue photon attenuation produces inhomogeneous defects that decrease the specificity of the test, thereby making it difficult to distinguish between coronary artery disease and the attenuation artifact. AIM: The aim is to demonstrate the benifit of the use of CT and the attenuation correction in MPI. MATERIALS AND METHODS: This paper is a non-experimental (qualitative) research, that is, a scientific review of the literature. Upon creating their professional work, different databases were used, including Pub Med, Medline. RESULTS: The results we analyzed in this paper were collected from published academic journals. CONCLUSION: Conclusions are concerning the aim of the research.

Introduction: The introduction of hybrid imaging systems such as single photon emission computed tomography/computed tomography (SPECT/CT) has completely changed the scanning procedure of conventional diagnostic nuclear medicine protocols. Modern bone scintigraphy protocols include standardized uptake value quantification and whole body (WB) SPECT/CT scanning modality. The major limitation of these new technologies is the relatively long scanning time. New detector systems with modern reconstruction software have been developed for fast scanning SPECT protocols. These new technologies can produce images of reduced acquisition with the same quality as full scanning acquisition. As a result, new studies suggest that planar WB scintigraphy should be replaced with WB SPECT/CT. Methods: One hundred oncology patients performed SPECT/CT as a part of their clinical follow-up. Three different scanning and three reconstruction protocols have been evaluated. Two nuclear medicine physicians evaluated with Likert scale image sharpness, lesion visibility, and lesion background detectability. The overall image quality was determined as the sum of these three parameters. Results: In terms of scan duration reduction on image quality, Volumetrix Evolution for Bone performed during ultra-fast SPECT acquisition achieved the highest score, which is superior compared to the standard SPECT acquisition protocol. The overall image quality was the best with the Volumetrix MI Evolution for Bone protocol for ultra-fast acquisition. Conclusion: The Evolution for Bone protocol for ultra-fast acquisition showed the best results compared to other protocols. The adoption of the new acquisition SPECT protocol may offer more comfortable examinations, resulting in higher patient satisfaction. The implementation of this new protocol can lead to an improvement in SPECT sensitivity, primarily due to the reduction of SPECT motion artifacts: SPECT has significantly improved nuclear medicine diagnostics. The disadvantage of SPECT methods is the relatively low signal-to-noise ratio and contrast-to-noise ratio. The low number of image photons is a major problem with SPECT imaging, as the signal decreases as the noise (image background) increases.