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available, the more specialized radiopharmaceuticals described herein are still limited to sites typically possessing a cyclotron and advanced radiochemistry laboratories. In order for patients and physicians alike to benefit from these radiopharmaceuticals, global access has to be provided. The new partnerships growing between big pharma, small radiopharmaceutical companies, and larger companies possessing global radiopharmaceutical distribution networks, as well as the appearance of mobile scanner technology, should greatly facilitate access to nuclear medicine imaging in the next decade.

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**9** 

Ho-Chun Song and Ari Chong

*Republic of Korea* 

 *Chonnam National University Medical School,* 

**Post-Therapeutic I-131 Whole Body Scan in Patients with Differentiated Thyroid Cancer** 

Therapy with radioiodine (I-131) has been used for patients with well-differentiated thyroid cancer such as papillary and follicular thyroid carcinoma to ablate normal thyroid tissue or to treat metastatic lesions. The improvement of survival rates and decrease of recurrence rates after I-131 therapy has been documented by retrospective studies (Mazzaferri & Jhiang, 1994; Samaan et al., 1992). Even those patients categorized as low risk also had significantly lower recurrence and death rates after they received I-131 (Dietlein et al., 2005). Diagnostic I-123 or I-131 whole body scan (DxWBS) can be performed to detect persistent disease before radioiodine therapy. The post-therapeutic I-131 whole body scan (RxWBS)

The purpose of RxWBS is for detection and localization or exclusion of functioning thyroid remnants, persistent or recurrent local disease or distant metastasis in patients receiving I-131 therapy (Luster et al., 2008). There are several reports regarding the higher detection ability of RxWBS than DxWBS. Therefore, the disease stage also can be changed after RxWBS. Fatourechi et al. reported that 13% of 117 patients of thyroid papillary cancer demonstrated abnormal foci on RxWBS, which were not seen on DxWBS (111 MBq (3 mCi), I-131) (Fatourechi et al., 2000). They also reported that RxWBS changed management strategy in 9% of 81 patients. Souza Rosario et al. reported that RxWBS on first ablation changed the disease stage in 8.3% of the patients and therapeutic approach in another 15% among total 106 patients (Souza Rosario et al., 2004). They also reported that RxWBS provided clinically relevant information for 26% of patients with 1 previous ablation. In their report, even when excluding cases whose lesions were known before scanning, the

There are also several reports regarding comparison of I-123 DxWBS and RxWBS. In the retrospective study by Donahue et al., they reported that RxWBS could find more lesions in 18% of 108 patients and clinical upstaging occurred in 10% of patients compared with DxWBS (I-123) (Donahue et al., 2008). In a study by Alzahrani et al., they showed 209 pairs of 238 pairs of RxWBS and DxWBS (I-123) were concordant (87.8% concordance rate) (Alzahrani et al., 2001). They also revealed that there were 29 discordant pairs, 13 RxWBS (5.5%) demonstrated additional foci of uptake at sites that were already positive on DxWBS

can be done after administration of therapeutic dose of I-131.

therapeutic approach was influenced by RxWBS in 15.6% of the patients.

**1. Introduction**

**1.1 Rationale of RxWBS**

