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After five months of exposure to repeated blast events, the majority of nine otherwise healthy military instructors had significantly increased amyloid deposition in the brain, according to positron emission tomography (PET) findings from a new study.

Brain PET Study Suggests Link Between Early Amyloid Accumulation and Repetitive Subconcussive Trauma

A recent prospective study found that progression-free survival (PFS) and disease-specific survival (DSS) were significantly associated with breast cancer tumor treatment response on 2-(18F)FDG-PET/CT imaging in comparison to contrast-enhanced computed tomography (CT), which showed no evidence of a significant association with tumor response.

Is PET/CT Better than CT for Monitoring Metastatic Breast Cancer Treatment?

There are several ongoing clinical trials looking at the use of alpha-emitting, prostate-specific membrane antigen (PSMA)-targeting therapy for patients with prostate cancer (PCa), according to Jeremie Calais, M.D., Ph.D. During a 

, Dr. Calais suggested the potential of this modality’s efficacy and reduced side effects could eventually lead to a significant role in this patient population.

“Maybe in 10 years, I think Pluvicto will be replaced by alpha-emitting agents targeting PSMA. That may be something that I foresee,” posited Dr. Calais, the director of the clinical research program with the Ahmanson Translational Theranostics Division at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

While cautioning that the research is in the “very early days on alpha emitters,” Robert Flavell, M.D., Ph.D., said preliminary data has shown encouraging efficacy and noted other potential attributes.

“The side effect profile is a little different with the alpha emitters. They seem to have a much more pronounced xerostomia or a dry mouth, but perhaps less toxicity in other areas like the bone marrow. So we'll see how that all plays out. Another potential advantage for alpha emitters is relatively simplified radiation handling because you're typically giving much lower administered activities, and they have lower gamma fractions, so the patients are emitting a lot less radiation to the environment and to family members,” pointed out Dr. Flavell, the chief of molecular imaging and the Therapeutics Clinical Section in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF).

(Editor’s note: For related content, see “

The Reading Room Podcast: Emerging Trends with Theranostics in Prostate Cancer, Part 1

PSMA PET/CT Facilitates Better Long-Term Survival Rates After Salvage Radiotherapy for Recurrent PCa

SNMMI: Can Multimodal Monitoring Bolster Outcomes with Pluvicto in Treating mCRPC?

For more insights from Dr. Calais and Dr. Flavell, listen below or 

In the second of a two-part podcast episode, Jeremie Calais, M.D., and Robert Flavell, M.D., discuss current and emerging alpha-emitting therapies, possible roles for artificial intelligence (AI), and what the future may hold for theranostic applications in patients with prostate cancer.

The Reading Room Podcast: Emerging Trends with Theranostics in Prostate Cancer, Part 2

More and more urologists and medical oncologists are incorporating findings from prostate-specific membrane antigen positron emission tomography (PSMA PET) into restaging decisions for patients being treated for prostate cancer (PCa), noted Jeremie Calais, M.D., Ph.D., during a 

Dr. Calais said PSMA PET agents help provide rapid and significant insight into the impact of treatment on prostate tumor volume changes.

“(It provides) major information you can monitor for the appearance of new lesions expressing PSMA or not, with the CT information, and combining that with PSA (prostate-specific antigen) and ctDNA (circulating tumor DNA) can really give you refined tumor response assessment after, you know, two cycles. I think everybody should get at least two cycles and then see if you want to continue or not, and maybe you can expect to have to change your management based on that,” asserted Dr. Calais, the director of the theranostics program with the Ahmanson Translational Theranostics Division at the David Geffen School of Medicine at the University of California, Los Angeles (UCLA).

Robert Flavell, M.D., Ph.D., added that single-photon emission computed tomography (SPECT) offers significant utility for evaluating the effectiveness of lutetium Lu 177 vipivotide tetraxetan (Pluvicto), particularly among patients who have low PSA secretion.

“One thing to remember with the lutetium PSMA therapy is that you can use the radiation from the therapy to generate an image. It does, in fact, admit a lower fraction of gammas. So if you perform SPECT imaging with every cycle, you essentially get a free PET scan every cycle without administrating additional radiopharmaceutical. We've definitely found this is pretty useful for following response to therapy,” pointed out Dr. Flavell, the chief of molecular imaging and the therapeutics clinical section in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco (UCSF).

SNMMI: 18F-Piflufolastat PSMA PET/CT Offers High PPV for Local PCa Recurrence Regardless of PSA Level

SNMMI: Can 18F-Fluciclovine PET/CT Bolster detection of PCa Recurrence in the Prostate Bed?

SNMMI: What a New Meta-Analysis Reveals About Radiotracers for PET/CT Detection of PCa

In the first of a two-part podcast episode, Jeremie Calais, M.D., and Robert Flavell, M.D., discuss recent advances with PSMA-targeted radiotracers in the treatment of metastatic castration-resistant prostate cancer (mCRPC), and the role of imaging criteria in monitoring patients treated with PSMA-targeted radionuclide therapy.

For Satoshi Minoshima, M.D., Ph.D., the approval of new anti-amyloid treatments and emerging research on the use of blood-based biomarkers were key developments that fueled the 

recently updated appropriate use criteria (AUC)

 for brain positron emission tomography (PET) in patients with mild cognitive impairment (MCI)

, Dr. Minoshima noted that amyloid PET wasn’t recommended 10 years ago for patients who had an established diagnosis of Alzheimer’s disease. However, with the approvals of the anti-amyloid therapies lecanemab (Leqembi, Eisai/Biogen) and donanemab (Kisunia, Eli Lilly), Dr. Minoshima said amyoid PET enables clinicians to confirm target expression within the brain in these patients prior to treatment.

Additionally, in light of emerging evidence on the use of blood-based biomarkers, Dr. Minoshima notes the utility of amyloid PET imaging if cerebrospinal fluid (CSF) or other fluid biomarker results are uncertain or incongruent with the clinical diagnosis.

“I think maybe that’s a great opportunity to do amyloid PET imaging,” posited Dr. Minoshima, a past president and current chair of value initiative at the Society of Nuclear Medicine and Molecular Imaging (SNMMI).

The updated AUC also incorporated the use of tau PET imaging, which could enhance assessment of neuronal injury and possibly assist in differentiating Alzheimer’s disease and other neurodegenerative conditions, according to Dr. Minoshima.

“This clinical distinction between progressive supranuclear palsy (PSP) and Alzheimer’s disease is actually quite difficult, so hopefully the availability of tau pet in the future is going to give us a better differential diagnosis so combining (tau PET) with amyloid PET, we can guide the patient to the right treatment,” noted Dr. Minoshima, the Anne G. Osborn Chair and professor in the Department of Radiology and Imaging Sciences at the University of Utah.

In the podcast, James Williams, the chief executive officer for Siemens Healthcare Molecular Imaging, also noted that the availability of low-cost, easily to perform blood tests in the future may lead to a broader population of patients being tested for neurodegenerative diseases due to family history or genetic predisposition.

“In those cases, I think the imaging gets even more critical because certainly you wouldn't want to … subject someone to the therapy until you're very sure what's going to happen, but they're going to be a different patient population too. (These are) not the images we've seen in the clinical trials or for a large part of the research up to (now),” added Williams.

SNMMI Issues New Appropriate Use Criteria for Amyloid PET and Tau PET Imaging

A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, MD, Part 1

A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, Part 2

For more insights from Dr. Minoshima and Dr. Williams, listen below or 

In a new podcast, Satoshi Minoshima, M.D., Ph.D., and James Williams, Ph.D., share their insights on the recently updated appropriate use criteria for amyloid PET and tau PET in patients with mild cognitive impairment.

The Reading Room Podcast: Current Perspectives on the Updated Appropriate Use Criteria for Brain PET

Preliminary research findings have shown that the investigational anti-microtubule binding region (MTBR) tau antibody etalanetug may help reduce a biomarker for brain tau pathophysiology and tau signals on positron emission tomography (PET).

Emerging Tau-Targeting Antibody for Alzheimer’s Disease Gets FDA Fast Track Designation

The latest edition of the Hermia software reportedly facilitates standard evaluation of amyloid PET quantification across a variety of tracers and protocols.

Updated Molecular Imaging Software with Centiloid Scale Quantification Gets FDA Nod

New research shows that over 94 percent of patients who had a PSA level of < 0.2 ng/mL and low-volume disease assessment six months after initiation of apalutamide and androgen deprivation therapy (ADT) for metastatic hormone-sensitive prostate cancer had radiographic progression-free survival at 24 months.

Study Emphasizes PSA and PSMA PET Tumor Volume Assessment for Predicting mHSPC Progression After Apalutamide and ADT 

Featuring advanced detector technology, the Pharos PET scanner reportedly enhances detection of subtle anomalies across brain, breast and extremity imaging.



FDA Clears Emerging High-Resolution PET Scanner

Patient with biochemical recurrence of prostate cancer who had PSMA PET/CT prior to salvage radiotherapy had better survival rates at one, two and five years, according to newly published research.

Welcome to Diagnostic Imaging’s Weekly Scan, which offers an opportunity to catch up on the most well-viewed radiology content of the past week.

 published research revealed that having PSMA PET/CT scans before salvage radiotherapy resulted 

in higher rates of survival and biomechanical recurrence-free survival at one, three and five years

neuroradiologist Tammie Benzinger discussed the utility of low-field MRI

 in facilitating appropriate triage and health equity for patients with suspected Alzheimer’s disease.

In a new digital breast tomosynthesis (DBT) study published in the 

78 percent malignancy rate when DBT images showed a combination of architectural distortion with highly suspicious m

Reading Room Podcast on emerging trends in theranostics for prostate cancer

, Jeremie Calais, M.D., Ph.D., discussed the potential of alpha-emitting therapies. Here is a clip from the podcast.

510(k) clearance for the NeedleVue LC1 ultrasound system

. While traditional ultrasound guidance for interventional procedures can be thwarted by complex calibration and reduced sensitivity, the multidirectional design with the NeedleVue LC1 Ultrasound System reportedly allows high-fidelity tracking from a variety of orientations.

Diagnostic Imaging's Weekly Scan is your chance to catch up on the latest radiology content, from new research and device news to the latest interviews with key opinion leaders in the field of radiology.

Diagnostic Imaging's Weekly Scan: August 11 — August 17 (Video Version)

Catch up on the latest news, research and insights in radiology with our Weekly Scan.

Emphasizing the ongoing treatment challenge of metastatic breast cancer, Matt Covington, M.D., said radioligand therapy has “revolutionary” potential for women with breast cancer. However, in a recent interview, Dr. Covington noted a lag in the development of radioligand therapies for breast cancer.

“I think the targets for prostate cancer and neuroendocrine tumors were a little bit more obvious than for breast cancer, and that is one reason why there is some lag that we’ve seen and continue to experience with radioligand therapy for breast cancer,” posited Dr. Covington, a nuclear and breast imaging radiologist at Summit Physician Specialists in Salt Lake City, Utah. “I also wonder if there's some potential that there needs to be increased investment in women's health, in research in general, and this could be one manifestation where women are potentially falling a little bit behind in terms of therapies and advances that are very possible and could exist but currently don't.”

Noting that some radioligand therapies are being evaluated in early phase clinical trials for breast cancer, Dr. Covington pointed out that many breast cancers express prostate-specific membrane antigen (PSMA) on positron emission tomography (PET). He added that a subgroup of breast cancers “are likely to” express somatostatin receptors that are typically involved in the detection and staging of neuroendocrine tumors.

“ … (These agents are) already FDA approved. Clinics are already using these. They know how to (use) them. We just would need to expand that FDA approval toward breast cancer, and trials are undergoing right now, especially to test, for example, PSMA expression in triple-negative breast cancer, which is a subtype of breast cancer that really needs new therapeutic options. So that one especially has my interest,” added Dr. Covington.

“I don't expect that most triple-negative breast cancers will be able to be targeted this way, but some proportion of them, I believe, likely, will be able to be targeted, and this could be a great advance for those patients.”

Researchers Show Higher Breast Cancer Upstaging Rate with 18F-FAPI PET/CT

Positron Emission Tomography and De-Escalation of Breast Cancer Treatment: What Emerging Research Reveals

Emerging Insights on the Use of FES PET for Women with Lobular Breast Cancer

For more insights from Dr. Covington, watch the video below.

In a recent interview, Matt Covington, M.D., discussed challenges with the development of radioligand therapies for breast cancer and the potential of emerging radioligand agents to augment current treatment options in this patient population.

Can Radioligand Therapy Have an Impact for Women with Breast Cancer?

For patients with estrogen receptor-positive (ER+) lobular breast cancer, the updated National Comprehensive Cancer Network (NCCN) Guidelines recommendation of fluoroestradiol positron emission tomography (FES PET) for staging of recurrent or metastatic disease represents a significant advance in this patient population, according to Sherry Shen, M.D., a breast medical oncologist at the Memorial Sloan Kettering Cancer Center.

“This most recent inclusion in the NCCN guidelines of considering FES PET, particularly for patients with lobular histology in the staging of the disease, is a huge step forward for our field in terms of research,” emphasized Dr. Shen in a recent interview.

“This is the first time there has been a histology specific guideline, and I think it’s based on so much research work showing that FES PET really can image lobular breast cancer particularly well. It’s going to help clinicians utilize this scan more (and) help with insurance coverage for our patients. Ultimately, it's going to help us change our treatment decisions and improve outcomes for patients with lobular breast cancer.”

While fluorodeoxyglucose PET (FDG PET) is commonly utilized for cancer imaging at her facility, Dr. Shen said lower proliferation rates with lobular breast cancer cells can lead to false negatives with FDG PET. In contrast, Dr. Shen noted the estrogen receptor targeted FES PET scan (Cerianna, GE HealthCare) is particularly beneficial for imaging in women with lobular breast cancer.

“ … Over 90 percent of lobular breast cancers over express the estrogen receptor. For ER-positive lobular breast cancers, this FES PET scan does not depend on proliferation rates but kind of hones in on areas where that estrogen receptor is over expressed and can essentially better detect lobular breast cancer throughout the body, which is why it's a really important imaging modality for this disease,” pointed out Dr. Shen, co-lead of the Lobular Breast Cancer Program at Memorial Sloan Kettering Cancer Center.

Moving Beyond Mammography for Screening and Staging of Invasive Lobular Carcinoma

What New Interventional Radiology Research Reveals About Treatment for Breast Cancer Liver Metastases

For more insights from Dr. Shen, watch the video below.

In a recent interview, Sherry Shen, M.D., discussed the potential impact of FES PET recently being recommended by the National Comprehensive Cancer Network (NCCN) Guidelines for the staging of recurrent or metastatic estrogen receptor-positive (ER+) lobular breast cancer.

While single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is well validated for the detection of coronary artery disease (CAD) and other cardiovascular abnormalities, there is a degrading effect with attenuation that requires an additional computed tomography (CT) scan to address attenuation compensation.

However, in a recent interview, Abhinav Kumar Jha, Ph.D, noted there are a large number of SPECT scanners that do not have the CT component and this issue is particularly prevalent in community hospitals and rural facilities. Dr. Jha says this problem is compounded as studies have demonstrated a higher prevalence of heart disease in rural health-care settings.

Dr. Jha pointed out that 75 percent of SPECT MPI exams are performed without attenuation compensation and cites a survey of nuclear cardiology providers that found only 5.6 percent provided CT-based attenuation correction.

“Therefore, you can imagine there's a very important need for a large segment of the patient population to have access to this technology of attenuation correction without being able to take a CT scan,” noted Dr. Jha, an associate professor of biomedical engineering and radiology at the Washington University School of Medicine in St. Louis.

However, in recently published research, Dr. Jha and other researchers developed a deep learning technique that provides CT-less (dubbed CTLESS) attenuation compensation. With this research and other studies, Dr. Jha said the CTLESS approach has provided consistent performance across scanner models and patients with different degrees of heart disease.

While acknowledging that more studies are needed to validate the technology, Dr. Jha noted the CTLESS approach has potential to bolster access to SPECT MPI.

“I'm excited about the CTLESS technology (and) making the process of attenuation compensation more accessible, affordable as well as safe,” emphasized Dr. Jha.

Assessing MACE Risk in Women: Can an Emerging Model with SPECT MPI Imaging Have an Impact?

Radiology ‘Game-Changer’: FDA Approves PET Agent for Enhanced Detection of Coronary Artery Disease

Study Shows Merits of CTA-Derived Quantitative Flow Ratio in Predicting MACE

For more insights from Dr. Jha, watch the video below.

Abhinav K. Jha, Ph.D., discusses emerging research for a deep learning CT-less alternative for providing attenuation compensation for SPECT MPI.

Can Deep Learning Provide a CT-Less Alternative for Attenuation Compensation with SPECT MPI?

In a recent interview, Abhinav K. Jha, Ph.D., discussed key challenges with the use of SPECT MRI and how an emerging deep learning model may facilitate attenuation compensation without the need for an additional computed tomography (CT) scan.

“I like to say that amyloid (PET) is necessary for the diagnosis of Alzheimer’s disease but not sufficient,” noted Phillip Kuo, M.D., during a recent interview to discuss the recently released appropriate use criteria for amyloid and tau positron emission tomography (PET) in patients with mild cognitive impairment (MCI).

Dr. Kuo offered insights on the use of amyloid and tau PET in three cases involving a man in his 80s who veered back and forth in testing between early amnestic mild cognitive impairment (MCI) and normal results over the course of a year; a 74-year-old with MCI, suspected vascular contribution and a history of stroke; and a 60-year-old patient who had recent progression from early Alzheimer’s disease to frank dementia.

As Dr. Kuo conveyed with these cases in the interview, these patients had very different stages of disease, yet their amyloid PET scans appeared to be similar.

“The amyloid is the first half, but it doesn't give us the entire second half, like those cases I showed you, (with) that insight into that neuropathology. You can be amyloid PET positive and still not have your symptoms be due to Alzheimer's disease. … The tau PET is more specific that your symptoms are really due to Alzheimer's disease,” explained Dr. Kuo, a professor and division chief of nuclear medicine in the Department of Diagnostic Radiology at the City of Hope Cancer Center in Duarte, Calif.

(Editor’s note: The images and cases discussed in the video are courtesy of Gene Alexander, M.D.,

the Banner Alzheimer’s Institute in Tucson, Az., and the Radiological Society of North America (RSNA).)

While emphasizing that brain PET imaging is among a variety of factors that clinicians use in determining whether anti-amyloid antibody therapy is appropriate for patients, Dr. Kuo emphasized that the combination of amyloid PET and tau PET offers a complementary diagnostic picture in cases of uncertain presentations.

“ … To get that complete picture, we need to know the biomarkers. We can get that non-invasively with both amyloid PET now as well as tau (PET). Hopefully, these 

 will make help clinicians out there to really make sure that we bring value to patient care using these non-invasive, very important and powerful tools for assessing biomarker positivity and also biomarker spatial distribution in the brain,” added Dr. Kuo.

FDA Grants Fast Track Designation to Emerging Tau PET Imaging Agent

For more insights from Dr. Kuo, watch the video below.

Phillip Kuo, MD discusses appropriate use criteria and clinical cases incorporating the use of amyloid and tau PET in patients with mild cognitive impairment.

A Closer Look at the New Appropriate Use Criteria for Brain PET: An Interview with Phillip Kuo, MD, Part 2

In the second part of a two-part interview on the recently published appropriate use criteria for brain positron emission tomography (PET) for patients with mild cognitive impairment (MCI), Phillip Kuo, M.D. discusses clinical cases involving the use of amyloid and tau PET imaging.

Discussing the evolution of updating appropriate use criteria (AUC) for amyloid positron emission tomography (PET) from the originally issued AUC in 2013, Phillip Kuo, M.D., recalls vociferous debates, addressing new clinical scenarios and rescoring of recommendations.

In a recent interview, Dr. Kuo said the normally arduous undertaking of updating an AUC with a multidisciplinary panel was a dynamic four-year process marked by the challenges of incorporating tau PET into the 

 and reflecting the emergence of the newly FDA-approved anti-amyloid antibody therapies lecanemab (Leqembi, Eisai/Biogen) and donanemab (Kisunla, Eli Lilly) upon updates for amyloid PET.

“Even within this short period of time, relatively speaking, (there were a lot) of changes in the therapeutic landscape that obviously would affect the AUC criteria,” explained Dr. Kuo, a professor and division chief of nuclear medicine in the Department of Diagnostic Radiology at the City of Hope Cancer Center in Duarte, Calif.

“Those scenarios were added and then had to be rescored to reflect the fact that we now know that these anti-amyloid antibodies can have a statistically significant slowing of cognitive decline in patients who are amyloid positive and have (mild cognitive impairment) or early dementia due to Alzheimer's disease.”

While the multidisciplinary panel was originally charged with updates to the AUC for amyloid PET, Dr. Kuo said there was fairly strong consensus that tau PET recommendations needed to be included in the new AUC as well.

“ … While (amyloid PET) is a very sensitive and accurate marker for amyloid deposition in your brain, it doesn’t necessarily track very well with the clinical symptoms or the functional decline. That is where tau (PET) really has its strength,” emphasized Dr. Kuo. “It is a much more dynamic biomarker and is far more reflective, generally speaking, … of clinical symptoms.”

New PET and MRI Research Suggests that Visceral Fat Reduction May Prevent or Delay Alzheimer’s Disease

FDA Clears New Centiloid Scoring and Tau PET Quantification Tools

Phillip Kuo, MD discusses the new appropriate use criteria for amyloid positron emission tomography (PET) and tau PET for patients with mild cognitive impairment (MCI).

In a recent interview, Phillip Kuo, M.D., discussed the impact of newer anti-amyloid antibody therapies for Alzheimer’s disease upon recently issued appropriate use criteria (AUC) for amyloid positron emission tomography (PET) imaging as well as the incorporation of tau PET into the AUC for patients with mild cognitive impairment.

New research shows that non-physician practitioner (NPP) image interpretation in office settings grew by more than nine percent annually over the course of a decade for ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) and increased by more than seven percent annually for nuclear medicine interpretation.

In a recent interview, study co-author Richard Duszak, MD, shared his perspective on the increases in NPP image interpretation reported in the study, which was recently published in the 

Journal of the American College of Radiology

“The compound growth rate here is pretty staggering: 9 percent per year for X-ray, ultrasound, CT, and MR with (nuclear medicine) not far behind at 7 percent. They’re all growing at a relatively similar rate,” noted Dr. Duszak, a professor and chair of the Department of Radiology, at the University of Mississippi Medical Center.

“It's only about 5.5 percent of all the nurse practitioners and (physician assistants) that we were able to identify (via) Medicare claims (data) that are doing this, but they are empowered, perhaps emboldened, to say, ‘I can look at an ankle X ray, therefore, I'm going to look at a brain CT scan.’ From somebody who spent an extensive amount of time in medical school, in residency, going through board certification, to have folks come out of nurse practitioner school with essentially no training in imaging — which is what the data from nurse practitioner training program literature says — (and attempt to interpret images) is a bit scary.”

The Rise of NPP Image Interpretation: What New Radiology Research Reveals

Current Perspectives on Radiology Workforce Issues and Potential Solutions

Emergency Department Radiology: Study Shows Higher Imaging Orders by NPPs

Dr. Duszak said there was considerable state by state variation with the NPP image interpretation rates. For example, Dr. Duszak explained that the probability of having an office-based NPP interpret imaging in Alaska is approximately 20 percent and noted this would have been closer to zero percent when he was in residency training. He noted the importance of identifying causes behind these trends in outlier states and emphasizing targeted advocacy and education.

“This is an exponential curve. It really is a potential game changer with regard to what's happening in the workforce and in the marketplace. I think (this) really requires a lot more attention, not just from researchers, but from policy makers as well,” emphasizes Dr. Duszak, a member of the Board of Chancellors for the American College of Radiology.

For more insights from Dr. Duszak, watch the video below.

Richard Duszak, MD discusses new study findings that show significant annual increases in CT, MRI and ultrasound interpretation by office-based non-physician practitioners.

Radiology Study Finds Increasing Rates of Non-Physician Practitioner Image Interpretation in Office Settings

In a recent interview, Richard Duszak, MD, discussed new study findings that showed over nine percent annual increases in ultrasound, CT and MRI interpretation by office-based non-physician practitioners (NPPs) between 2013 and 2022.

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