Medical imaging is crucial in a variety of medical settings and at all levels of health care. In public health and preventive medicine as well as in both curative and palliative care, effective decisions depend on correct diagnoses. This edition addresses the most current needs and offers guidance on clinical practice, radiation safety and patient protection, human resource development and training required for the overall practice of nuclear medicine.

Multi-modality imaging has become increasingly prevalent in nuclear medicine and diagnostic radiology. To accurately interpret single photon emission computed tomography/computed tomography (SPECT/CT) images in addition to understanding the principles of image formation and the biological distribution of the radiopharmaceutical, it is important to understand the image artefacts that can arise from these imaging systems. This atlas presents an overview of quality control procedures in SPECT and SPECT/CT and guides the reader through pitfalls and image artefacts that can be faced using these imaging modalities. In addition to examples of artefacts themselves, descriptions are given on their causes, and the steps that can be taken to avoid their recurrence. The atlas is intended to be used as a guide for nuclear medicine and diagnostic radiology professionals (medical physicists, nuclear medicine physicians, radiologists, medical radiation technologists and service engineers) on how to take appropriate quality control measures, and to assist with problem analyses and prevention.

This publication is part of the lAEA's continuing efforts to transfer technology and to contribute to capacity building by providing information on the theoretical background and practical application of state of the art methodologies for assessing human zinc metabolism to better understand absorption, dietary bioavailability and nutritional requirements. It reviews the role of zinc in human nutrition and the application of stable isotope techniques to evaluate nutritional interventions. Information is given on planning a study, administering isotopes, preparing and analysing samples, and calculating physiological end points. The publication was developed with input from international experts and is intended for nutritionists, analytical chemists and other professionals interested in the application of stable isotope techniques to evaluate human zinc nutrition and metabolism.

Accuracy requirements in radiation oncology have been defined in multiple publications; however, these have been based on differing radiation technologies. In the meantime, the uncertainties in radiation dosimetry reference standards have been reduced and more detailed patient outcome data are available. No comprehensive literature on accuracy and uncertainties in radiotherapy has been published so far. The IAEA has therefore developed a new international consensus document on accuracy requirements and uncertainties in radiotherapy, to promote safer and more effective patient treatments. This publication addresses accuracy and uncertainty issues related to the vast majority of radiotherapy departments including both external beam radiotherapy and brachytherapy. It covers clinical, radiobiological, dosimetric, technical and physical aspects.

Nuclear cardiology is one of the most widely used non-invasive techniques for the assessment of coronary artery disease and other cardiovascular conditions. It has proved to be a cost effective tool for the evaluation and management of cardiac patients and usually has a decisive role for diagnosis, prognosis and risk stratification. In particular, radionuclide myocardial perfusion imaging (MPI) is used extensively worldwide for the evaluation of known or suspected coronary artery disease, with an estimated 15–20 million procedures performed annually. This publication provides a detailed analysis of all the steps involved in the delivery of nuclear cardiology services, from referrals to reporting, and is intended to serve as guidance for the implementation, homogenization and enhancement of MPI practice in those Member States where the technique is under development.

The atlas focuses specifically on single photon emission computed tomography/computed tomography (SPECT/CT) in musculoskeletal imaging, and thus illustrates the inherent advantages of the combination of the metabolic and anatomical components in a single procedure. In addition, the atlas provides information on the usefulness of several sets of specific indications. The publication, which serves more as a training tool than a textbook, will help to further integrate the SPECT and CT experience in clinical practice by presenting a series of typical cases with many different patterns of SPECT/CT seen in bone scintigraphy.

Quality management systems are essential and should be maintained with the intent to continuously improve effectiveness and efficiency, enabling nuclear medicine to achieve the expectations of its quality policy, satisfy its customers and improve professionalism. The quality management (QM) audit methodology in nuclear medicine practice, introduced in this publication, is designed to be applied to a variety of economic circumstances. A key outcome is a culture of reviewing all processes of the clinical service for continuous improvement in nuclear medicine practice. Regular quality audits and assessments are vital for modern nuclear medicine services. More importantly, the entire QM and audit process has to be systematic, patient oriented and outcome based. The management of services should also take into account the diversity of nuclear medicine services around the world and multidisciplinary contributions. The latter include clinical, technical, radiopharmaceutical, medical physics and radiation safety procedures.

Providing a basic introduction to digital technology and digital networks, the publication also gives an overview of the issues to consider when implementing such technology in diagnostic radiology. In an area that is under rapid development, it provides a careful analysis of the principles and advice on implementation and sustainability of digital imaging and teleradiology. The transition from film to digitally based medical imaging is complex and requires knowledge and planning to be successful. This comprehensive resource guide contains information on the needs and implications of a transition to digital imaging with case studies for different facilities requiring different levels of communication connectivity. It is aimed at hospital administrators and managers, radiologists and radiographers/technologists, medical physicists and clinical engineers as well as information technology staff.

Integrated positron emission tomography/computed tomography (PET/CT) has evolved since its introduction into the commercial market more than a decade ago. It is now a key procedure, particularly in oncological imaging. Over the last years in routine clinical service, PET/CT has had a significant impact on diagnosis, treatment planning, staging, therapy, and monitoring of treatment response and has therefore played an important role in the care of cancer patients. The high sensitivity from the PET component and the specificity of the CT component give this hybrid imaging modality the unique characteristics that make PET/CT, even after over 10 years of clinical use, one of the fastest growing imaging modalities worldwide. This publication combines over 90 comprehensive cases covering all major indications of fluorodeoxyglucose (18F-FDG)-PET/CT as well as some cases of clinically relevant special tracers. The cases provide an overview of what the specific disease can look like in PET/CT, the typical pattern of the disease’s spread as well as likely pitfalls and teaching points. This PET/CT Atlas will allow professionals interested in PET/CT imaging to embrace the variety of oncological imaging by providing clinically relevant teaching files on the effectiveness and diagnostic quality of FDG-PET/CT imaging in routine applications.

Brachytherapy is an essential component of the curative treatment of cervical cancer, a disease with high incidence in many developing countries. The IAEA supports the use of high dose rate (HDR) brachytherapy for centres with a large number of patients with this disease. HDR brachytherapy is also used in other common cancers such as breast, lung, oesophagus and prostate cancer. This publication provides guidance to radiation oncologists, medical physicists and planners on establishing and operating an HDR brachytherapy unit with modern standards, and presents the main issues to be addressed for its effective and safe operation.

This publication serves as a useful resource for nuclear medicine physicians, radiologists, radiopharmacists, pharmacologists and other researchers engaged with radiolabelling of autologous products for clinical application. It provides practical guidelines towards clinical work with radiolabelled autologous products and aims to streamline the variety of strategies that have evolved, for example, in the handling of radiolabelled red and white blood cells. The publication highlights the importance of the quality of radiolabelling services, provides advice on safety issues, and also addresses the use of other radiolabelled autologous products and their translation into the clinical environment.

This publication provides an updated source for professionals involved in employing guided intraoperative scintigraphic tumour targeting (GOSTT). Its content contributes to supporting both the clinical decision making process and the implementation of minimally invasive surgical procedures. The publication provides an update on innovations in the use of radiopharmaceuticals for sentinel lymph node mapping and sentinel lymph node biopsy. In addition, it provides an update on advances in the implementation of hybrid imaging technologies for the surgical management of patients with cancer in conjunction with intraoperative regional lymph node mapping. The experience with the use of small field scintigraphic imaging devices in the operating theatre is also presented.