Svjetlana Grbac Ivanković

University of Rijeka

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Neva Girotto

University Hospital Centre Zagreb

Tatjana Bogović Crnčić

University of Rijeka

GŠ

Gordan Šarić

University of Osijek

Hrvoje Brkić

University of Osijek

Slaven Jurković

University of Rijeka

Dario Faj

University of Osijek

Ivana Kralik

University Hospital Dubrava

MŠ

Mario Štefanić

University of Osijek

Stanko Težak

University Hospital Centre Zagreb

Koraljka Rajković Molek

University of Rijeka

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University of Rijeka

University Hospital Centre Zagreb

Klinički Bolnički Centar Rijeka

University of Osijek

Klinički bolnički centar Osijek

University of Zagreb

State Clinical Hospital "Clinical Oncology Center No. 1

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Landeskrankenhaus Feldkirch

Opća Bolnica Zadar

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The significance of serum thyroglobulin measurement before and after the treatment of toxic nodular goiter with 131I

Nuclear Medicine Communications (2020)

Boris Bonefačić Tatjana Bogović Crnčić Maja Ilić Tomaš Neva Girotto Svjetlana Grbac Ivanković

Objectives Thyroglobulin is routinely used as a tumor marker in follow up of patients with thyroid carcinoma, but is also elevated in patients with toxic nodular goiter. The aim of this study was to evaluate the role of thyroglobulin measurement prior to and after the radioiodine therapy (RIT) in patients with toxic nodular goiter and to compare the results with the therapy outcome. Patients and methods In 109 patients with toxic nodular goiter (102 females, 7 males, aged 45–85 years), 61 with multinodular toxic goiter and 48 with toxic adenoma, thyroglobulin level was measured before RIT and during the first 12 months after the treatment and compared to therapy outcome, defined as euthyroid, hypothyroid and persistent hyperthyroidism. Results In patients with euthyroid and hypothyroid outcome, a significant fall of thyroglobulin level was noted during the first 12 months after RIT, more prominent in the latter group. In patients with persistent hyperthyroidism, the initial thyroglobulin level was higher than in other two groups and no significant decrease was noted by the end of the first year after therapy, especially in patients with multinodular toxic goiter. Conclusions The significant fall of thyroglobulin after RIT observed in patients in whom euthyroidism and hypothyroidism was achieved indicates that thyroglobulin values can be related to the treatment outcome. In patients with high initial thyroglobulin levels (above 400 ng/l), and possible unfavorable RIT outcome, higher radioiodine activities or other treatment options might be considered. Video abstract: http:/links.lww.com/NMC/A163

Thyroglobulin

10.1097/mnm.0000000000001153

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The estimation of collective dose from medical exposures from diagnostic nuclear medicine examinations in croatia

Ivana Kralik Mario Štefanić Gordan Šarić Stanko Težak Svjetlana Grbac Ivanković

The largest contribution to the man made radiation exposure of population is from medical exposures and it continues growing. In this work, the collective doses from medical exposures from nuclear medicine diagnostic examinations were estimated for year 2010 in Republic of Croatia according to the European Commission DDM2 project methodology. The collective dose was calculated according to the frequencies of the most frequent nuclear medicine examinations and average effective dose per procedure. The frequencies of different examinations were extracted from Croatian Institute for Health Insurance (CIHI) database. Since database is made for reimbursement we investigated usability of database by comparing it with a survey in 7 out of 9 major Croatian nuclear medicine departments. Average administered activities for 28 most frequent nuclear medicine examinations were surveyed and converted to effective doses according to the ICRP dose coefficients. 41.700 nuclear medicine examinations in a year period leaded to 139 manSv collective effective dose. The frequency of nuclear medicine examination was 10.4 examinations annually per 1, 000 members of population with 34.8 μSv effective dose per caput what is comparable to the published values from the DDM2 project. The range and the mean of administered activities are in the range of published values. A lot of uncertainties were revealed if CIHI database is used for population dose survey. If such surveys would be done regularly, the national radiation protection regulatory body and relevant professional societies should work on more straightforward way of data acquisition.

Collective dose

Croatian

Medical radiation

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Nuclear medicine diagnostics of cardiac amyloidosis

Medicina Fluminensis (2022)

Dorian Tokmadžić Tatjana Bogović Crnčić Svjetlana Grbac Ivanković Sanja Klobučar Majanović Teodora Zaninović Jurjević

Amiloidoza srca nastaje uslijed nakupljanja nepravilno savijenih ili polimeriziranih bjelančevina, najčešće transtiretina ili lakih lanaca imunoglobulina u intersticiju miokarda. Bolest se još uvijek teško otkriva jer se na nju kao mogući uzrok zatajivanja srca rijetko pomišlja. Dijagnoza se postavlja na temelju kliničke slike, anamnestičkih podataka, nalaza srčanih biomarkera, promjena u elektrokardiogramu, ehokardiografskom nalazu i/ili magnetskoj rezonanciji, koji zajedno mogu upućivati na dijagnozu. Donedavno je biopsija miokarda bila jedina pouzdana dijagnostička metoda za dokaz ove bolesti. Nuklearna medicina nudi mogućnost neinvazivnog postavljanja dijagnoze, no samo u pacijenata koji zadovoljavaju određene kliničke kriterije. Koriste se radiofarmaci obilježeni gama i pozitronskim emiterima namijenjeni prikazu skeleta ili direktnoj vizualizaciji amiloidnih plakova koji se nakupljaju u miokardu zahvaćenom amiloidozom. Dijagnostička vrijednost scintigrafije ovisi o korištenju te metode u ispravnom kliničkom kontekstu te o poznavanju i postupanju prema dijagnostičkom algoritmu. Posljednjih se godina transtiretinska amiloidoza sve više prepoznaje kao uzrok zatajivanja srca, a razvijaju se i nove terapijske mogućnosti. Stoga je interes za dijagnostiku, posebno nuklearno-medicinske metode povećan, a provode se i brojna istraživanja, naročito u području PET/CT dijagnostike.

10.21860/medflum2022_280996

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Effects of background substraction on differential kidney function measured by static scintigraphy with DMSA and dynamic scintigraphy with MAG 3

Nuklearmedizin - NuclearMedicine (2007)

Neva Girotto Aleksandar Smokvina Svjetlana Grbac Ivanković Vanja Licul

The aim of this study was to assess the influence of background subtraction (BS) on estimation of differential kidney function (DF) on the static scintigraphy with (99m)Tc dimercaptosuccinic acid (DMSA) and dynamic scintigraphy with (99m)Tc mercaptoacetyltriglicine (MAG3) and to establish possible differences between DF values estimated with these methods.Patients (n=106) were selected among those scheduled to static and dynamic scintigraphies within 3 months, with no interim clinical and laboratory changes, regardless the kidney pathology. DF was estimated according to the uptake ratio method. Four background regions of interest (ROIs) were applied, identical for both studies, and DF values were recalculated after BS. The corrected values were compared to the values before correction, separately for DMSA and MAG3, and between the studies. The results showed that ROIs used introduce variable results for the same patients, predominantly when noncorrected DF values were <45%. There were no significant differences between DF values (corrected and noncorrected) obtained from static and dynamic scintigraphy in all groups of patients. Since numerous reasons can bring to the errors in DF estimation when BS is used, the conclusions are that it would probably be more accurate to avoid BS, particularly when DF values are compared in a patient follow-up, and when kidney function is normal. BS should be used, but always in the same way, only when there is a significant difference in kidney size, or when DF is <25%, since background activity is then considerable. MAG3 and DMSA can be equally used for DF estimation and their results compared in patient follow-up.

Subtraction

10.3413/nukmed-0056

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Estimated collective effective dose to the population from nuclear medicine diagnostic procedures in Croatia: A comparison of 2010 and 2015

PLoS ONE (2017)

Ivana Kralik Mario Štefanić Hrvoje Brkić Gordan Šarić Stanko Težak

Objective This study presents national surveys of patient exposure from nuclear medicine (NM) diagnostic procedures in 2010 and 2015 in the Republic of Croatia. Methods The survey was performed according to the European Commission Dose DataMed (DDM) project methodology. 28 most frequent NM diagnostic procedures were identified. Data about frequencies of procedures and average administered activities of radioisotopes used in those procedures were collected. Average administered activities were converted to effective doses according to the dose conversion coefficients. Then the collective effective dose to the population and an effective dose per capita were calculated based on the number of the most frequent NM diagnostic procedures and the average effective dose per procedure. Results In 2010, 41200 NM diagnostic procedures led to 146.7 manSv collective effective dose to the population and in 2015, 42000 NM diagnostic procedures led to 146.8 manSv collective effective dose to the population. The frequencies of NM diagnostic procedures were 9.7 and 9.8 annually per 1000 population with 34.1 μSv and 34.2 μSv effective dose per capita for 2010 and 2015, respectively. The main contributors to the annual collective dose from NM in Croatia are examinations of the bone, heart, thyroid and PET/CT tumour diagnostic. Average administered activities have not changed considerably from 2010 to 2015. Nevertheless, within the frequency of some of the procedures, significant changes were found in five-year period. Conclusions Frequencies, average administered activities and collective effective dose to the population from NM diagnostic procedures in Croatia are comparable to the values reported by other European surveys. Changes were found between 2010 and 2015 and we intend to perform this study periodically to identify possible trends, but also to raise awareness about the potential dose optimization.

Collective dose

European commission

10.1371/journal.pone.0180057

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[Analysis of sentinel lymph node in early breast cancer patient - Clinical Hospital Center Rijeka].

PubMed (2013)

Nives Jonjić Elvira Mustać Irena Seili‐Bekafigo Koraljka Rajković Molek Franjo Lovasić

Sentinel lymph node (SLN) biopsy is an accurate method for the detection of axillary metastases in early breast cancer patients and is of value as a replacement for axillary dissection. However, variations in the methods and protocols used for the pathological evaluation of SLN exist in everyday practice. Therefore, standardization how to detect, dissect, process, stain, assess and report SNL is required in order to stratify patients into adequate prognostic groups. The aim of this study was to present our experience in SLN analysis in patients with early breast cancer and clinical stage T1-2 and N0. In the period between 2003 and 2011, 1071 consecutive patients or 1915 SLN were analyzed. The protocol included intraoperative analysis of histological frozen sections and cytological imprint, followed by analysis of paraffin sections according to the protocol that included sections of whole SLN with the interval of 250 prm. According to the accepted protocol 75% of SLN were negative. The obtained results were correlated with literature data.

Axillary Dissection

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Thyroid hormones and antithyroid antibodies influence infertility treatment, reproductive outcome and indications for assisted reproduction

Medicina : glasilo Hrvatskoga liječničkoga zbora, Podružnica Rijeka (2016)

Silvana Petretić Majnarić Neda Smiljan Severinski Svjetlana Grbac Ivanković Ines Mrakovčić-Šutić Maja Burić

Cilj: Cilj istraživanja bio je utvrditi vrijednost rutinskog određivanja hormona stitnjace, autoprotutijela (antiperoksidazna – A-TPO, antitireoglobilinska A-Tg) u serumu te ultrazvucnog (UZ) pregleda stitnjace u procjeni ishoda lijecenja neplodnih parova postupcima medicinski pomognute oplodnje. Ispitanice i metode: U istraživanje su ukljucene pacijentice (n = 222) s dijagnozom neplodnosti lijecene u razdoblju od 2009. do 2015. godine postupcima medicinski pomognute oplodnje na Zavodu za humanu reprodukciju i Klinickom zavodu za nuklearnu medicinu Klinickog bolnickog centra u Rijeci. Pacijenticama je uzeta anamneza, ucinjen je klinicki i ultrazvucni pregled stitnjace, a određene su i koncentracije hormona i protutijela u serumu. Rezultati: Udio spontanih pobacaja bio je 29 % kod pacijentica s urednom funkcijom stitnjace, a 52 % kod pacijentica s autoimunom ili supklinickom bolesti stitnjace. Zakljucak: Povisene vrijednosti serumskih mikrosomalnih protutijela povezane su s cescim spontanim pobacajima nakon postupka medicinski pomognute oplodnje i u pacijentica koje imaju normalne serumske vrijednosti hormona stitnjace. Rutinsko određivanje hormona stitnjace i antitireoidnih antitijela u serumu te UZ pregled stitnjace može pomoci u utvrđivanju uzroka neplodnosti, probiru pacijentica s rizikom za spontani pobacaj te pracenju i lijecenju neplodnosti.

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