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.

Background: Patients infected by coronavirus disease (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), display various symptoms and severity of the clinical picture. Thus, the therapy and pathophysiology of this disease are a dilemma for health professionals and scientists. Objective: This paper aims to evaluate the effectiveness of therapeutic protocols (the use of anticoagulants) in the treatment of COVID-19 patients of various severity of the clinical picture by monitoring coagulation markers (PT, INR, aPTT and D-dimer), as well as the impact of the type and number of comorbidities patients had on these markers. Methods: A total of 200 patients with a mild (n=76), moderate (n=70) or severe (n=54) clinical picture was included. Coagulation markers [PT (prothrombin time), INR (international normalized ratio), aPTT (activated partial thromboplastin time), D-dimer] were examined on three occasions: twice during hospitalization and once after hospital discharge. Anticoagulants used intrahospital were fraxiparine, rivaroxaban or unfractionated heparin. Posthospital, patients were taking either rivaroxaban or did not use any anticoagulants. For statistical analysis, SPSS 26.0 and Microsoft Excel 2019 were used, with a level of significance of α=0.05. Nonparametric tests (Kruskal-Wallis, Wilcoxon Signed-Rank and Bonferroni) were applied and effect size (ES) was calculated. Results: Three anticoagulants used intrahospital caused a significant decrease in PT, INR and D-dimer and a significant increase in aPTT, especially in patients with a severe clinical picture, but the ES was the biggest with fraxiparine, then rivaroxaban, and lastly unfractionated heparin. Posthospital, rivaroxaban caused a significant decrease in PT, INR and D-dimer and a significant increase in aPTT, especially in patients with a severe clinical picture. Hypertension was the most common comorbidity in all patients, as well as in patients with a severe clinical picture. There was a statistically significant impact of the number of comorbidities patients had on D-dimer, and none on PT, INR and aPTT, but the highest number of comorbidities was in patients with a severe clinical picture. Conclusion: The use of anticoagulants, especially fraxiparine intrahospital and rivaroxaban posthospital, is justified in most COVID-19 cases as there is a significant correlation between this disease’s pathophysiology and the coagulation process. There is also a positive correlation between the severity of the clinical picture and the number of comorbidities patients have.

Background: The pathophysiology and therapy of coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), are a dilemma for scientists and health professionals, and the fact that patients show different symptoms and severity of the clinical picture also contributes to that. Objective: This paper aims to evaluate the effectiveness of therapeutic protocols (the use of immunomodulators) in the treatment of COVID-19 patients of various severity of the clinical picture by monitoring inflammatory markers (ESR and CRP), as well as the impact of the type and number of comorbidities patients had on these markers. Methods: A total of 200 patients with a mild (n=76), moderate (n=70) or severe (n=54) clinical picture was included. Inflammatory markers [ESR (erythrocyte sedimentation rate), CRP (C-reactive protein)] were examined on three occasions: twice during hospitalization and once after hospital discharge. Immunomodulators used intrahospital were corticosteroids (methylprednisolone, dexamethasone, methylprednisolone + dexamethasone), tocilizumab or metenkefalin/tridecactide. Posthospital, patients were taking either methylprednisolone or did not use any immunomodulators. For statistical analysis, SPSS 26.0 and Microsoft Excel 2019 were used, with a level of significance of α=0.05. Nonparametric tests (Kruskal-Wallis and Wilcoxon Signed-Rank) were applied and effect size (ES) was calculated. Results: Three corticosteroid therapies used intrahospital caused a significant decrease in both inflammatory markers, especially in patients with a severe clinical picture, but the ES was the biggest with methylprednisolone + dexamethasone, then dexamethasone, and lastly methylprednisolone. Posthospital, methylprednisolone caused a significant decrease in both inflammatory markers, especially in patients with a severe clinical picture. The most common comorbidity in all patients, as well as in patients with a severe clinical picture, was hypertension. There was no statistically significant impact of the number of comorbidities patients had on ESR and CRP, but the highest number of comorbidities was in patients with a severe clinical picture. Conclusion: The use of immunomodulators, especially methylprednisolone + dexamethasone intrahospital and methylprednisolone posthospital, is justified in most COVID-19 cases as there is a significant correlation between this disease’s pathophysiology and the immune response. There is also a positive correlation between the number of comorbidities patients have and the severity of the clinical picture.

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: Radiation therapy has long played an integral role in the manage¬ment of locally advanced head and neck cancer (HNC), both for organ preservation and to improve tumor control in the postoperative setting. The aim of this research is to investigate the effects of adaptive radiotherapy on dosimetric, clinical, and toxicity outcomes for patients with head and neck cancer undergoing radiation therapy treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an interesting treatment paradigm that has been developed to directly adjust to these changes.Material and methods: This research contains the results of 15 studies, including clinical trials, randomized prospective and retrospective studies. The researches analyze the impact of radiation therapy on changes in tumor volume and the relationship with planned radiation dose delivery, as well as the possibility of using adaptive radiotherapy in response to identified changes. Also, medical articles and abstracts that are closely related to the title of adaptive radiotherapy were researched.Results: The application of ART significantly improved the quality of life of patients with head and neck cancer, as well as two-year locoregional control of the disease. The average time to apply ART is the middle of the treatment course approximately 17 to 20 fractions of the treatment.Conclusion: Based on systematic review of the literature, evidence based changes in target volumes and dose reduction at OAR, adaptive radiotherapy is recommended treatment for most of the patients with head and neck cancer with the support of image-guided radiotherapy.

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.