0:00

And that brings us to the end

0:02

of the PSMA PET Mastery Series.

0:05

I hope you've enjoyed getting to know a bit of the cases

0:08

and it is a bit of an introduction

0:09

and hopefully it has inspired you to read more studies

0:14

to start to learn more about PSMA PET

0:16

and given you some pearls

0:17

that will hopefully help you in your practice.

0:19

So if you take home messages

0:21

before we finish up, I encourage you to adjust your settings

0:24

and continue to adjust your settings

0:26

as you read the PSMA pets.

0:28

And I always start with a mip.

0:30

I think it's a great way to get an overview of the patient

0:33

and really set the tone for your reporting.

0:37

Recognize normal structures with physiological uptake

0:40

and here are again, our, our ganglia

0:43

and also that case of the diverticulum.

0:45

And you can use tools such as intravenous contrast

0:47

and that anatomical correlation to be more confident

0:50

that something is normal

0:51

and anatomical rather than representing disease.

0:55

I encourage you to work systematically.

0:57

I start with prostate and seminal vesicles

0:59

or the prostatectomy bed if the prostate has been removed,

1:02

then nodes, metastases and other findings.

1:04

And I integrate that search pattern

1:06

with my organized template and structured reporting.

1:09

Also, remember that patients are 3D structures.

1:11

It's important to look not only at the axials,

1:15

not only at the fused, look at all the images available.

1:17

Um, so this is a great little example

1:19

with some retroperitoneal nodes

1:21

and some uptake in the vertebra.

1:23

And then if you look on the sagittal reconstruction, yes,

1:26

those nodes are intensely PSMA expressing,

1:28

but there's also a superior nplate compression fracture

1:30

just hiding behind.

1:34

Remember to correlate clinically

1:36

and look for the causes of the patient's symptoms, which is

1:38

where that clinical assessment,

1:39

that brief clinical assessment at the beginning can come in

1:42

really handy and correlation

1:43

with the clinical question from your referring doctor,

1:46

determining what can be targeted to help.

1:48

This patient may have had really severe right hip pain

1:51

and has quite a large acetabular metastasis.

1:56

Remember that not all lesions

1:57

that are P smma AVID are prostate cancer

2:00

and there are benign and malignant mimics.

2:02

So this is our lung cancer case

2:04

and this was the OMA with quite intense uptake in the rib,

2:08

but a classic lesion on low dose ct.

2:12

Also important to check your local protocols.

2:15

Um, see what trace you use,

2:16

whether it's gallium 68 PSAF 18 PSR,

2:18

or another tracer, um, which is A-P-S-M-A ligand.

2:22

And the last little bit of advice I give you is to practice,

2:25

um, looking at lots of scans,

2:27

getting a really good handle on what is normal

2:30

and then what is abnormal will improve your sensitivity,

2:33

specificity, and accuracy of your reporting.

2:36

I wish you all the best and good luck with your journey

2:38

with PSMA pet.

2:39

I'd like to thank my colleagues at Royal North Shore

2:41

Hospital for the support in developing the program.

2:43

In particular, Dr. Edward Shaw, Dr. Ashvin Raghavan, and Dr.

2:46

Jeff Sheri. I'd like

2:48

to thank the Royal North Shore Radiation Oncology Department

2:51

who have given me so much knowledge

2:53

and the opportunity to develop my PSMA PET skills,

2:56

the University of Sydney and the National Imaging

2:58

Facility, which, um, they share our pet suite.

3:02

Um, so we're very grateful for their ongoing support

3:04

of us at Royal North Shore Hospital.

3:05

And finally to modality

3:07

of the invitation to develop this program.

3:09

Um, it's been a lot of fun

3:10

and I hope that you've found it useful.

3:11

Thanks so much.