Radioiodine Scintigraphy with SPECT/CT: Thyroid Cancer

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Magnetic Resonance Imaging: 0.75
Patient Care: 0.75
Patient Interactions and Management: 0.75

Nuclear Medicine Technology: 3.00
Procedures: 3.00
Endocrine and Oncology Procedures: 3.00

Radiography: 0.75
Patient Care: 0.75
Patient Interactions and Management: 0.75

Registered Radiologist Assistant: 3.00
Procedures: 3.00
Musculoskeletal and Endocrine Sections: 3.00

Sonography: 0.75
Patient Care: 0.75
Patient Interactions and Management: 0.75

Radiation Therapy: 3.00
Patient Care: 1.50
Patient and Medical Record Management: 1.50
Procedures: 1.50
Treatment Sites and Tumors: 1.50

Outline

1. Introduction
2. Advantages, Disadvantages, and Limitations of SPECT/CT
3. Utility of Post-therapy Radioiodine SPECT/CT
4. Utility of SPECT/CT for Problem Solving (Evaluation of Unusual Radioactivity Distributions
5. Utility of Diagnostic Preablation Radioiodine SPECT/CT
6. Utility of Radioiodine SPECT/CT for Lesional Dosimetry
7. When to use SPECT/CT for Best Impact in Thyroid Cancer Management
8. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the most characterized thyroid cancer based on histology
2. know the histological subtypes of papillary thyroid cancer
3. understand the most commonly used staging system for thyroid cancer
4. be familiar with how thyroid cancer patients are staged by TNM classifications
5. understand how thyroid cancer patients are scored by TNM classifications
6. be able to use the provided table to understand how patients are staged for thyroid cancer
7. be familiar with ATA guidelines for recommendation of ¹³¹I ablation therapy
8. be familiar with ATA guidelines for those not recommended for ¹³¹I ablation therapy
9. be familiar with the overall trend for thyroid cancer in the United States and Western Europe
10. be familiar with the percentage of deaths from thyroid malignancy
11. understand the advantages and disadvantages of SPECT/CT over planar scintigraphy
12. understand the limitations of detecting micrometastatic lesions with SPECT/CT
13. be familiar with the percentage of differentiated thyroid cancer that remains undetected on SPECT/CT
14. be familiar with the histopathological and biochemical data necessary for accurate interpretation of findings on planar and SPECT/CT scintigraphy
15. understand the effects of spatial degradation on a SPECT/CT scans
16. be familiar with SPECT/CT’s ability to reduce equivocal foci on scans
17. understand that ¹³¹I SPECT/CT performed at first ablation can predict the occurrence or persistence of iodine-avid cervical nodal metastases
18. understand that CT data from SPECT/CT can reduce the need for additional imaging studies and increase in the detection of non-iodine-avid metastases
19. know that postablation scintigraphy has prognostic value for predicting outcomes of thyroid cancer patients
20. understand that planar WBS and SPECT/CT radioiodine scintigraphy can increase sensitivity and specificity in predicting recurrent or persistent disease in thyroid cancer patients
21. identify what the range of acceptable diagnostic dosing is for SPECT/CT radioiodine scintigraphy
22. be familiar with the areas of incremental value of SPECT/CT as compared with WBS
23. be familiar with the incremental value SPECT/CT radioiodine scintigraphy has over planar scintigraphy imaging
24. be familiar with the SPECT/CT advantages for rapid exclusion of physiologic activity or contamination during interpretation
25. identify which diagnostic tests changed the prescribed therapeutic dose for thyroid cancer patients
26. be able to define remnant radioiodine therapy
27. be able to define adjuvant radioiodine therapy
28. be familiar with the photopeak energy for ¹³¹I
29. identify the appropriate collimator for imaging with ¹³¹I
30. understand the value of the CT component of SPECT/CT for lesion-specific dosimetry
31. be familiar with the advantages of diagnostic ¹³¹I scintigraphy in detecting metastases in normal-sized lymph nodes on a postoperative neck
32. understand the earlier detection of bone metastases due to the use of SPECT/CT radioiodine scintigraphy
33. identify which nuclear medicine imaging tests may not portray the full extent of skeletal metastatic disease
34. know how preablation radioiodine scans alter the management plans of thyroid cancer patients
35. understand when the dosimetry calculations based on percentage whole-body retention should be conducted
36. be familiar with the improvement of tumor characterization by using SPECT/CT radioiodine scintigraphy
37. identify the therapeutic properties of ¹³¹I
38. understand the pregnancy precautions for patients undergoing ¹³¹I therapy
39. be familiar with the proper dose range for postoperative ablation ¹³¹I therapy for thyroid bed remnants
40. be familiar with who is qualified to administer ¹³¹I therapeutic doses