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This is the second article of a two-part series on patient education. This article builds on the first one by discussing some of the unique considerations in providing patient education in the nuclear medicine department. Concrete strategies for nuclear medicine technology practice are discussed here. After reading this article, the technologist should be able to: (a) describe the affective and technical aspects of the nuclear medicine technologist's role as a patient educator; (b) identify some strategies that nuclear medicine technologists can use to become better teachers; and (c) describe factors that affect patient learning in the nuclear medicine department and some approaches to overcome or minimize learning barriers.

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UNLABELLED: Critical thinking is cited as one of the essential skills for clinical practice. Educators need to be aware of barriers that may hinder the development of this skill in students and cultivate strategies to encourage it. This article describes one strategy to develop critical thinking. METHODS: Students participated in a critical thinking exercise by imaging the American College of Nuclear Physicians (ACNP) Renal Imaging Proficiency Test Phantom, critiquing their results, and comparing their results to results collected nationally in other nuclear medicine facilities and the true values reported by the ACNP. Students were instructed to review pertinent imaging principles before discussing the imaging results. They also were supplied with a list of questions pertinent to the review. RESULTS: Students experienced the complexity of designing a SPECT imaging protocol and how the final results are affected by the choices made by the technologist. They learned the importance of and method for proper matrix selection, determination of pixel size and the necessity for quality control. CONCLUSION: The imaging exercise was a successful means of helping students connect clinical practice with theory through the use of critical thinking.

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This is the third article of a four-part series on gerontology and its applications to the care of elderly patients in nuclear medicine. This article reviews some of the ethical issues that arise in caring for the elderly. Upon completion of this article, the reader should be able to: (a) discuss the relationship between autonomy and competence; (b) differentiate between competence and decision-making capacity; (c) identify guidelines for determining decision-making capacity; (d) define ageism and provide examples of it; (e) describe the way American society views death and the issues this view raises for health care professionals; and (f) describe the grieving process.

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Changes in gene expression occurring during skeletal muscle differentiation are exemplified by downregulation of brain creatine kinase (BCK) and induction of muscle creatine kinase (MCK). Although both are transcriptionally regulated, there appears to be no transcription factor-element overlap, suggesting that their coordinate expression results from culture medium-related influences. Basic fibroblast growth factor (bFGF) prevents myogenesis and represses MCK expression by inhibiting transcriptional activation. It was hypothesized that bFGF similarly influenced BCK by inducing its expression. Accordingly, BCK promoter constructs were transiently transfected into C2C12 cells and, after a switch to differentiation medium, were treated with bFGF, bFGF plus herbimycin, adenosine 3',5'-cyclic monophosphate (cAMP), or phorbol 12-myristate 13-acetate (PMA). Analyses demonstrated that bFGF responsiveness was contained within a 33-base pair element. Electromobility shift assays showed that bFGF induction increased the abundance of the nuclear factor binding the element. Both effects were prevented by herbimycin. Neither cAMP nor PMA specifically induced the construct containing the bFGF-responsive element. The induced factor required phosphorylation to bind, implying that bFGF-mediated increases in binding may be due to transcription factor phosphorylation.

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This is the second article of a four-part series on gerontology and its applications to the care of elderly patients in nuclear medicine. This article reviews anatomic and physiologic changes and pathology associated with aging. It also discusses tailoring nuclear medicine procedures according to patients' needs and conditions, as well as adopting changes within the nuclear medicine department to better serve older patients. Upon completion of this article, the reader should be able to: (a) describe normal age-related anatomic and physiologic changes that are observed in older patients; (b) identify common age-related disorders; (c) discuss considerations in tailoring nuclear medicine procedures for older patients; and (d) identify changes in the nuclear medicine facility that would better accommodate older patients.

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This is the first article of a four-part series on gerontology and its applications to the care of elderly patients in nuclear medicine. The series includes discussions about the theories of aging, approaches to meeting the special needs of the elderly and ethical dilemmas in caring for the elderly. It also reviews anatomical and physiological changes associated with aging and the role of nuclear medicine studies in caring for the elderly. Upon completion of this article, the reader should be able to: (a) describe the aging U.S. population by citing demographic data; (b) identify the theories of aging and distinguish their major characteristics; (c) differentiate a gerontologic approach from a geriatric approach in caring for the elderly; and (d) recognize factors important to the delivery of effective care for the elderly.

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This is the last article of a four-part series on gerontology and its applications to the care of elderly patients in nuclear medicine. This article reviews selected nuclear medicine procedures that are more commonly performed on older patients. On completion of this article, the reader should be able to: (a) identify nuclear medicine procedures commonly performed on older patients; (b) give examples of how normal age-related anatomic and physiologic changes may affect various nuclear medicine procedures and findings; and (c) identify new or developing nuclear medicine techniques that may have future applications in the elderly population.

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This article describes the imaging of aortic dissection from the perspective of a multidisciplinary imaging team. The relative merits of radiography, aortography, computed tomography, magnetic resonance imaging, ultrasound and nuclear medicine are described. Each technique has unique advantages for initial diagnosis, confirmation and follow-up. In recent years, ultrasound, computed tomography and magnetic resonance imaging have seen increased use for diagnosis of the condition.

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Previous studies in animals and humans have shown that technetium-99m mercaptoacetyltriglycine (MAG3) purified by high-performance liquid chromatography is a renal tubular agent with characteristics similar to those of iodine-131 orthoiodohippurate (OIH). A kit formulation for Tc-99m MAG3 has been developed and compared with I-131 OIH in 17 patients with suspected renal dysfunction and three potential kidney donors. There were no adverse reactions. Tc-99m MAG3 images were of good quality and consistently better than I-131 OIH images. There was no significant difference in the relative renal uptake of Tc-99m MAG3 and I-131 OIH. The 30-minute urinary excretion of Tc-99m MAG3 was 36.4%, versus 40.4% for I-131 OIH. The average plasma clearance of Tc-99m MAG3 (138 mL/min +/- 117) was less than that of I-131 OIH (272 mL/min +/- 205) (P less than .001); however, there was good correlation between the Tc-99m MAG3 and I-131 OIH clearances (r = .87). The volume of distribution of Tc-99m MAG3 (5.96 L +/- 1.94) was less than that of I-131 OIH (9.41 L +/- 3.73) (P less than .001). These characteristics and the advantages of a simple kit formulation should lead to widespread clinical use.

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In conjunction with single photon emission computed tomography (SPECT), iodine-123 (123I)-labeled N,N,N'-trimethyl-[2-hydroxy-3-methyl-5-iodobenzyl]-1,3-propanediamine (HIPDM) has been used clinically as a regional cerebral perfusion imaging agent. The [123I]HIPDM can be prepared by a simple aqueous exchange reaction in a kit form. We synthesized unlabeled HIPDM by condensation of 2-hydroxy-3-methyl-5-iodobezaldehyde and N,N,N'-trimethyl-1,3-propanediamine, followed by a sodium borohydride reduction reaction. The kinetics of the radioactive iodine exchange reaction for the preparation of [123I]HIDM is controlled by the pH, the temperature, and the presence of reductant (sodium bisulfite), and oxidant (sodium iodate). The reaction is a second order iodine-iodine exchange with an activation energy of 30.6 kcal/mole. The mechanism of this reaction probably involves the formation of an active 1+ or iodine free radical, which is sensitive to the presence of a reductant, such as sodium bisulfite.

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Frequently allied health faculty are unprepared to assume the role of professional academician. Instituting a professional development program can assist faculty in enhancing their effectiveness in that role. As the first step, a faculty group in the School of Health Related Professions, State University of New York at Buffalo, designed a questionnaire to obtain information on faculty members' judgments about their own skills in various activities--teaching, research, writing, service, and administration--and the importance of these activities. The goal of this survey was to identify those activities for which there was the greatest need for faculty development. Research and writing were identified as areas having the greatest overall potential for professional development. The survey also provided groundwork for implementing an on-going professional development program that could be systematically evaluated.

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