This letter comments on the practical implementation of the EARL single-syringe phantom filling procedure. While supporting the dilution concept and its quantitative accuracy, we highlight opportunities to better align the workflow with ALARA (as low as reasonable achievable) principles. We advocate retaining the established two-syringe method as an accepted alternative and recommend independent validation comparing accuracy, preparation time, extremity dose, and contamination risk.

Patients with malignant lymphomas are at increased risk for severe COVID-19. In the general population, outcomes of COVID-19 have improved dramatically over time due to increasing immunity through vaccination or infection and due to improved clinical care. It is unclear whether outcomes of COVID-19 in patients with lymphoma have improved similarly over time. We performed a multi-center retrospective study of lymphoma patients with COVID-19 at five tertiary care centers of the Bavarian Cancer Research Center (BZKF) in Germany, evaluating baseline characteristics as well as COVID-19 management and outcomes across different pandemic waves from March 2020 to March 2022. Clinical management of COVID-19 as well as vaccination rates changed significantly over time. In the most recent pandemic wave (cases after December 27th 2021), 88

Artificial intelligence (AI) has vast potential to reshape nuclear medicine. Applications can be found at every step of the processing workflow, including image acquisition, image reconstruction, enhancement, and registration, segmentation, extraction of image-derived biomarkers, and prognostication, both for clinical and preclinical research and routine use. Emerging perspectives include computational nuclear oncology, foundation models, biomorphic AI, and quantum AI - currently exploratory but rapidly evolving. However, clinical translation remains limited. This narrative review summarizes the current literature on the subject and highlights current developments and future research directions. As such, it is not intended as a systematic analysis; instead, it outlines potential future directions, supported by multiple examples. Analysis of literature reveals impressive advances in the application of AI to nuclear medicine, such as improved time resolution, robust denoising, and automated lesion segmentation. Key challenges include the need for high-quality reference data, generalizability across scanners and populations, transparency and uncertainty quantification of model decisions, and compliance with evolving regulatory frameworks. For the future, progress will require broad collaboration between AI developers from research and industry, clinicians, hospital information technology, and regulators, while structured initiatives such as joint symposia should actively include patients to ensure innovations address real needs. Education across disciplines will also be critical for building trust and competence towards fully embracing the potential of AI for better (nuclear) medicine.

Ensuring the reliability and impact of data-driven research requires high-quality data. The more complex the source system and data processing pipelines are, the higher the risk of poor data quality (DQ) during analysis, which in turn compromises the research outcomes. Even for well-structured and standardized data, such as the oncological standardized dataset (oBDS), medical research projects must assess DQ to ensure the reliability of their results. This study assesses the quality of the oncological standardized dataset mapped to FHIR resources across six German university hospitals. Automated DQ checks using Pathling and Great Expectations were implemented on the FHIR resources to evaluate key dimensions of DQ. It demonstrates that DQ varies across data sources, indicating that high DQ cannot be assumed to be uniform even if the dataset is standardized. The results of this assessment will be integrated into the Real World Data Platform of the Bavarian Cancer Research Center (BZKF), enhancing its ability to provide researchers with high-quality oncological data for scientific studies.

BACKGROUND:Septic arthritis (SA), although rare, is a critical joint-threatening emergency. The shoulder, being the third most common site after knee and hip joints, is predominantly affected by hematogenous spread of infection. 2-deoxy-2-[18F]fluoro-D-glucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) has shown promise in identifying infectious foci and modifying treatment plans. This study aims to differentiate the metabolic patterns of septic shoulder arthritis (SSA) from various stages of shoulder osteoarthritis (OA) using F-18-FDG PET/CT and assess its diagnostic performance. METHODS:We retrospectively included subsequent patients diagnosed with SSA between November 2017 and October 2023, who had undergone whole-body F-18-FDG PET/CT scans within 2 weeks before and after diagnosis. The control group included noninfected contralateral shoulder joints and patients who underwent F-18-FDG PET/CT for malignant melanoma staging without evidence of acute infections. Visual and quantitative analyses of F-18-FDG uptake, measured as maximum standardized uptake value (SUVmax), were conducted. OA severity was categorized using the Kellgren and Lawrence system. To establish a cut-off for SSA, a ratio of joint uptake to liver uptake of 18F-FDG was calculated using the SUVmax of the shoulder joint and liver. Intraobserver and interobserver reliability were assessed through repeated measurements. RESULTS:Of 150 shoulders, 149 were included in the study: 13 into the experimental group with confirmed SA and 136 into the control group. One shoulder was excluded from the control group due to metastasis. Thirteen shoulders had confirmed SA. In the control group, F-18-FDG uptake measured by SUVmax increased significantly with OA severity (P = .001). SSA exhibited markedly higher F-18-FDG uptake compared to controls (P < .001). Visual intensity assessments corroborated these findings (P < .001). For a cut-off value of 1 for the joint-liver-ratio, sensitivity, specificity, positive predictive value, and negative predictive value for distinguishing between SSA and OA were 92.3%, 80.9%, 31.6%, and 99.1%, respectively. Interobserver and intraobserver reliability were moderate to high. The intraclass correlation coefficients for standardized uptake value measurements in the total shoulder were 0.994 and 0.996, respectively, while Cohen's kappa coefficients for visual analysis were 0.570 and 0.891. CONCLUSION:F-18-FDG PET/CT effectively differentiates SSA from varying stages of OA. The SUVmax in liver can be used as a cut-off value with high sensitivity and specificity. A negative F-18-FDG PET/CT excludes SSA.

Aim Digitalization in the healthcare sector is becoming increasingly widespread. Yet, the degree of digitalization in nuclear medicine has not been systematically investigated. The "Digitalization and AI" working group of the German Society of Nuclear Medicine conducted a survey to assess the status quo of digitalization of the nuclear medicine health infrastructure in Germany. Methods 100 questions were defined on eleven topics covering the main work processes in nuclear medicine. The survey primarily included single-select multiple-choice questions, yes-no questions on the availability of specific digital structures and processes, and questions assessing the degree of digitalization of certain processes and current satisfaction. The level of satisfaction was measured with an ordinal scale (1, very good to 5, poor). Results In most subject areas, processes relied on a combination of paper-based and electronic procedures for the topics analyzed. Differences in satisfaction regarding the different types of processes for any of the questions were not observed, and the overall level of satisfaction among responding sites was quite high. Conclusion The survey did not reveal a clear need of the responding sites for complete digitalization of clinical processes. Yet, the participants highlighted the lack of proper Wi-Fi (60%) and the desire for a platform for communication between hospitals, registered doctors and patients (74%). Nevertheless, it is important to take a focused and unbiased look at the daily clinical procedures in every institution and place it in the frame of the existing tools or solutions of peer institutions to discover aspects of digitalization that can create added value in terms of time efficiency, integrity and sustainability.

Background Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive lymphoma in adults, predominantly affecting older patients with a median age of 65 years at diagnosis. State-of-the-art treatment involves anthracycline-based chemo-immune therapy (R-CHOP/Pola-R-CHP), which achieves high cure rates in fit patients. Elderly/frail and medically unfit patients require attenuated regimens that compromise efficacy, highlighting the unmet need for exploring effective therapies that avoid classical chemotherapeutic agents. For this reason, we developed R-Pola-Glo, comprising the CD20 antibody rituximab (R), the antibody-drug conjugate polatuzumab vedotin (anti-CD79B; Pola), and the bispecific antibody glofitamab (CD20×CD3; Glo). Here, we report the first time the planned primary analysis of efficacy and toxicity of R-Pola-Glo.Methods This prospective, multicenter, one-arm phase II trial (AGMT-NHL-16/GLA2022-10/IKF062; EUCT#: 2024-513949-37) enrolled 80 previously untreated elderly/frail or otherwise medically unfit DLBCL patients ineligible for full-dose R-CHOP. Treatment consisted of a steroid pre-phase followed by 12 q3w cycles. Cycle 1 included obinutuzumab, Pola, and step-up Glo (2.5/10 mg); cycles 2-6 combined R, Pola, and Glo at 30 mg; cycles 7-12 consisted of Glo consolidation (30 mg). The first six cycles were administered inpatient; supportive care included G-CSF and anti-infective prophylaxis. Response was assessed by PET/CT per Lugano after cycles 2, 6, and end of treatment (EOT); toxicities were graded per CTCAE/ASTCT. The data cut was on July 2, 2025. The primary endpoint is 1-year progression-free survival (PFS); secondary endpoints include event-free survival (EFS), overall survival (OS), response rates, and duration of responses, along with toxicity analyses.Results The median age was 80 years (range: 66–92), with 19% (15/80) of patients (pts) over 85 years. Most pts had advanced-stage disease (64% [51/80]), elevated LDH (63% [50/80]), and ECOG 2 (28% [22/80]); 64% (51/80) had intermediate/high-risk IPI (IPI 3–5). According to the simplified geriatric assessment (sGA), 91% of patients were classified as unfit or frail; among 6 “fit” pts, 1 had already received anthracyclines for a different cancer, and 5 had relevant cardiovascular comorbidities not captured by the sGA. Overall, the patient profile aligns with the expected real-world profile of medical unfit/frail DLBCL patients with high treatment complexity. Therapy adherence was high, with 80% (64/80) of patients completing treatment as planned. Treatment was generally well tolerated, with 34% (27/80) of patients experiencing no grade 3-5 adverse effects (AE) in any cycle. Common toxicities included infections, grade 3-5 in 22% of pts (grade 3: 15 pts; grade 5: 3 pts), including 3 fatal infections (COVID: 1; COVID+RSV: 1; unknown focus: 1). Cytokine release syndrome occurred in 31% of pts (grade 3: 1 pts; no grade 4/5), and ICANS in 4% of pts (grade 2: 2 pts; grade 3: 1 pts). Notably, CRS usually occurred at early cycles and low grade, and all resolved completely. The overall response rates at cycles 2, 6, and EOT were 96% (95% CI: 89–99), 94% (95% CI: 86-98), and 90% (95% CI: 81–96); corresponding complete metabolic response (CMR) rates were 58%, 75%, and 81%, respectively. Late CMR conversions were frequent, with 52% of early partial responses converting to CMR by cycle 6 and an additional 40% converting during consolidation, highlighting the importance of extended Glo exposure. At data cut, 89% (71/80) were alive. Notably, with a median follow-up time of 15 months, these responses were durable and the one-year PFS, EFS, and OS rates were 85% (95% CI: 77-93), 82% (95% CI: 74-91), and 90% (95% CI: 83-97), respectively. Exploratory subgroup analysis suggested that R-Pola-Glo efficacy was consistent across all sGA risk groups and mitigated the adverse prognostic impact of classical IPI factors, including LDH.Conclusions R-Pola-Glo achieved high and durable CMR rates with an expected and manageable safety profile, translating into favorable 1-year survival rates in elderly/frail and medically unfit patients with aggressive B-cell lymphoma. Compared with other regimens for this population, R-Pola-Glo demonstrated higher response rates and improved survival outcomes at 1 year, strongly supporting its further clinical evaluation as a frontline option for this vulnerable patient population.

Immune-related adverse events (irAEs) in cancer patients receiving immune checkpoint inhibitors (ICIs) cause morbidity and necessitate cessation of treatment. Comparing irAE treatments, we find that anti-tumor immunity is preserved in mice after extracorporeal photopheresis (ECP) but reduced with glucocorticosteroids, TNFα blockade, and α4β7-integrin inhibition. Local adiponectin production elicits a tissue-specific effect by reducing pro-inflammatory T cell frequencies in the colon while sparing tumor-specific T cell development. A prospective phase-1b/2 trial (EudraCT-No.2021-002073-26) with 14 patients reveals low ECP-related toxicity. Overall response rate for all irAEs is 92% (95% confidence interval [CI]: 63.97%-99.81%); colitis-specific complete remission rate is 100% (95% CI: 63.06%-100%). Glucocorticosteroid dosages could be reduced for all patients after ECP therapy. The ECP-adiponectin axis reduces intestinal tissue-resident memory T cell activation and CD4+IFN-γ+ T cells in patients with ICI-induced colitis without evidence of loss of anti-tumor immunity. In conclusion, we identify adiponectin as an immunomodulatory molecule that controls ICI-induced irAEs without blocking anti-tumor immunity.

Bacterial infections and antimicrobial resistance constitute significant threats to global human health, resulting in millions of fatalities annually. The development of innovative diagnostic agents is essential to facilitate precision medicine approaches in the battle against infectious diseases. Infection imaging using radiolabeled antimicrobial peptides (AMP) has emerged as a promising approach to detect bacterial infections. UBI(29–41), an AMP fragment, exhibits binding to bacterial cell membranes. Conjugated to chelators, UBI(29–41) has been labeled with radiometals such as 99mTc or 68Ga, and proven its ability to differentiate between sterile inflammation and infection with S. aureus by imaging. Due to its physical properties, 18F is more favorable for PET/CT imaging. As peptide labeling with 18F is challenging, we here implemented the Al18F labeling approach. This study aims to develop an optimized, fully automated, GMP-compliant process for radiolabeling of NOTA-conjugated UBI(29–41) with Al18F for PET/CT imaging of infections. Optimized reaction conditions led to the establishment of a robust Al18Fcomplexation protocol, which was implemented on a SynChrom R D module. The labeling reaction was carried out in an acidic medium (pH 4.0) at 105 °C for 15 min, followed by a two-step HPLC purification for 20 min. Optimization of reagent concentrations enabled an activity yield up to 10 ± 1 GBq, with a radiochemical yield of 24.2 ± 0.6

Digitalization in the healthcare sector is becoming increasingly widespread. Yet, the degree of digitalization in nuclear medicine has not been systematically investigated. The "Digitalization and AI" working group of the German Society of Nuclear Medicine conducted a survey to assess the status quo of digitalization of the nuclear medicine health infrastructure in Germany.100 questions were defined on eleven topics covering the main work processes in nuclear medicine. The survey primarily included single-select multiple-choice questions, yes-no questions on the availability of specific digital structures and processes, and questions assessing the degree of digitalization of certain processes and current satisfaction. The level of satisfaction was measured with an ordinal scale (1, very good to 5, poor).In most subject areas, processes relied on a combination of paper-based and electronic procedures for the topics analyzed. Differences in satisfaction regarding the different types of processes for any of the questions were not observed, and the overall level of satisfaction among responding sites was quite high.The survey did not reveal a clear need of the responding sites for complete digitalization of clinical processes. Yet, the participants highlighted the lack of proper Wi-Fi (60%) and the desire for a platform for communication between hospitals, registered doctors and patients (74%). Nevertheless, it is important to take a focused and unbiased look at the daily clinical procedures in every institution and place it in the frame of the existing tools or solutions of peer institutions to discover aspects of digitalization that can create added value in terms of time efficiency, integrity and sustainability.

BACKGROUND:Despite revolutionary efficacy of CD19-CAR-T cell therapy (CAR-T) in aggressive B cell lymphoma, many patients still relapse mostly early. In early failure, distinct drugs support CAR-T which makes reliable and early prediction of imminent relapse/refractoriness critical. A complete metabolic remission (CR) on Fluor-18-Deoxyglucose (FDG) Positron-Emission-Computed Tomography (PET) 30 days after CAR-T (PET30) strongly predicts progression-free survival (PFS), but still fails in a relevant proportion of patients. We aimed to identify additional routine parameters in PET evaluation to enhance CAR-T response prediction. RESULTS:Thirty patients with aggressive B cell lymphoma treated with CAR-T were retrospectively analyzed. Pre-CAR-T, LDH was the strongest PFS-predictor also by multivariate analysis. Post-CAR-T, 10 out of 14 patients (71.4%) with PET30-CR remained in disease remission, while 12 out of 16 patients (75%) with incomplete metabolic remission (PET30-nCR) relapsed after CAR-T. 28.6% of patients with PET30-CR ultimately progressed. Change of liver FDG-uptake from baseline to day30 (Delta-Liver-SUVmean) was identified as an independent biomarker for response. PET30-nCR and a decrease of Delta-Liver-SUVmean were associated with a high risk of tumor progression (HR 4.79 and 3.99, respectively). The combination of PET30 and Delta-Liver-SUVmean identified patients at very low, at intermediate and at very high risk of relapse (PFS not reached, 7.5 months, 1.5 months, respectively). CONCLUSION:Additionally to PET30 metabolic remission, longitudinal metabolic changes in Delta-Liver-SUVmean predicted CAR-T efficiency. Our results may guide early intervention studies aiming to enhance CAR-T particularly in the very high-risk patients.

Introduction PET imaging is a key diagnostic procedure in clinical routine worldwide. While public figures on PET volume are available in many countries, until now these numbers were not publicly known for Germany. Methods On behalf of the PET committee of the German Society of Nuclear Medicine, we conducted a comprehensive survey among PET centers in Germany to collect data on PET imaging, including the total PET volume and indication groups. Results National total PET volume in 2021 was 154,400 scans (94% PET/CT, 6% PET/MRI). PET volume in 2021 normalized to total population was lower in Germany (1,857 scans per 1 million inhabitants) when compared to public figures from France (10,182 scans), Belgium (9,866 scans), or Italy (4,312 scans). PET volume in Germany demonstrated significant growth 2017 to 2021 (+ 48%). Top three indication fields were oncological (re)staging (76%), theranostic (13%), and neurology (4%). The top three indications were lung cancer (31%), prostate cancer (16%), and lymphoma/leukemia (12%). The top three radiotracers used were [ 18 F]FDG (75%), PSMA radioligands (17%), and somatostatin-receptor radioligands (8%). Conclusions Clinical adoption of PET imaging in Germany is behind compared to Italy, France, and Belgium. However, newly established outpatient reimbursement seems to contribute to recent growth in PET volume. We observe considerable shift towards theranostic applications.

Background: While MRI is the primary diagnostic tool for the diagnosis of spondylodiscitis, the role of [18F]-fluorodeoxyglucose ([18F]FDG) PET/CT is gaining prominence. This study aimed to determine the frequency of [18F]FDG PET/CT usage and its impact on the in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric population. Methods: We conducted a Germany-wide cross-sectional study from 2019 to 2021 using an open-access, Germany-wide database, analyzing cases with ICD-10 codes M46.2-, M46.3-, and M46.4- (‘Osteomyelitis of vertebrae’, ‘Infection of intervertebral disc (pyogenic)’, and ‘Discitis unspecified’). Diagnostic modalities were compared for their association with in-hospital mortality, with a focus on [18F]FDG PET/CT. Results: In total, 29,362 hospital admissions from 2019 to 2021 were analyzed. Of these, 60.1% were male and 39.9% were female, and 71.8% of the patients were aged 65 years and above. The overall in-hospital mortality rate was 6.5% for the entire cohort and 8.2% for the geriatric subgroup (p < 0.001). Contrast-enhanced (ce) MRI (48.1%) and native CT (39.4%) of the spine were the most frequently conducted diagnostic modalities. [18F]FDG PET/CT was performed in 2.7% of cases. CeCT was associated with increased in-hospital mortality (OR = 2.03, 95% CI: 1.90–2.17, p < 0.001). Cases with documented [18F]FDG PET/CT showed a lower frequency of in-hospital deaths (OR = 0.58, 95% CI: 0.18–0.50; p = 0.002). This finding was more pronounced in patients aged 65 and above (OR = 0.42, 95% CI: 0.27–0.65, p = 0.001). Conclusions: Despite its infrequent use, [18F]FDG PET/CT was associated with a lower in-hospital mortality rate in patients with spondylodiscitis, particularly in the geriatric cohort. This study is limited by only considering data on hospitalized patients and relying on the assumption of error-free coding. Further research is needed to optimize diagnostic approaches for spondylodiscitis.

PURPOSE:The higher detection efficacy of PSMA PET for oligometastatic recurrence of prostate cancer has promoted new loco-regional treatment options. PSMA-targeted radioguided surgery (PSMA-RGS) was introduced to facilitate salvage surgery of small tumor deposits. The objectives of this retrospective analysis are to describe an independent single-center consecutive cohort of patients undergoing PSMA-RGS and to evaluate its clinical and oncological outcomes. METHOD:Between 2018 and 2022, 53 patients were treated with PSMA-RGS and 50 patients were available for final analyses. All patients were initially treated with radical prostatectomy (RP) and presented with biochemical recurrence (BCR) with at least one positive lesion on PSMA-PET imaging. After preparation of 99mTc-PSMA-I&S and intravenous injection, surgery was performed by using a gamma-probe intraoperatively. RESULTS:Median age was 70 years (IQR 65-73) and the median PSA at salvage surgery was 1.2 ng/mL (IQR 0.6-3.0). In all patients pathologically positive lesions could be removed during PSMA-RGS. 29 (58%) patients had one pathologically positive lesion, 14 (28%) had two and 7 (14%) had three or more, respectively. The overall complication rate was 26% with 4 (8%), 1 (2%), and 8 (16%) having Clavien-Dindo (CD) type I, II, and IIIb complications, respectively. During the follow-up period 31 (62%) patients experienced BCR and 29 (58%) received further therapy. CONCLUSIONS:PSMA-RGS is a promising treatment option to enhance salvage surgery in early biochemical recurrence. However, only 42% of the patients treated with PSMA RGS remain without a biochemical recurrence. Further research is mandatory to identify patients, who profit from PSMA-RGS.

While cell‐free liquid biopsy (cfLB) approaches provide simple and inexpensive disease monitoring, cell‐based liquid biopsy (cLB) may enable additional molecular genetic assessment of systemic disease heterogeneity and preclinical model development. We investigated 71 blood samples of 62 patients with various advanced cancer types and subjected enriched circulating tumor cells (CTCs) to organoid culture conditions. CTC‐derived tumoroid models were characterized by DNA/RNA sequencing and immunohistochemistry, as well as functional drug testing. Results were linked to molecular features of primary tumors, metastases, and CTCs; CTC enumeration was linked to disease progression. Of 52 samples with positive CTC counts (≥1) from eight different cancer types, only CTCs from two salivary gland cancer (SGC) patients formed tumoroid cultures (P = 0.0005). Longitudinal CTC enumeration of one SGC patient closely reflected disease progression during treatment and revealed metastatic relapse earlier than clinical imaging. Multiomics analysis and functional in vitro drug testing identified potential resistance mechanisms and drug vulnerabilities. We conclude that cLB might add a functional dimension (to the genetic approaches) in the personalized management of rare, difficult‐to‐treat cancers such as SGC.

BACKGROUND:Periprosthetic joint infection (PJI) with sepsis is a life-threatening condition and identification of synchronous foci of infection is challenging. Positron emission tomography using 18F-fluorodeoxyglucose combined with computed tomography (18F-FDG-PET/CT) is useful to detect PJI in elective, nonseptic patients. We hypothesized that in patients who have PJI and concomitant sepsis requiring intensive care, 18F-FDG-PET/CT could accurately identify synchronous foci of infection. We addressed the following questions: (1) How often were synchronous foci of infection detected?; (2) What were the confirmation rates of these infection foci by other complementary state-of-the-art methods?; (3) Did 18F-FDG-PET/CT findings result in surgical treatment?; and (4) What is the risk of synchronous PJI in patients who have PJI and concomitant sepsis who have another indwelling arthroplasty? METHODS:We retrospectively analyzed mechanically ventilated septic PJI patients who underwent 18F-FDG-PET/CT between January 1, 2017 and December 21, 2022. The identified synchronous foci of infection were categorized into musculoskeletal, cardiovascular, pulmonary, or other infections and compared to results from tissue culture, histopathology, magnetic resonance imaging, or transesophageal echocardiography. RESULTS:We identified 17 eligible patients. The 18F-FDG-PET/CT revealed at least one additional infection focus in 15 patients with the following distribution: musculoskeletal (n = 12), cardiovascular (n = 3), pulmonary (n = 13), and other infections (n = 6). Synchronous foci of infection identified with 18F-FDG-PET/CT were confirmed by another state-of-the-art method in 1 all 15 patients. Diagnoses with 18F-FDG-PET/CT led to additional surgery in 11 patients. Of the patients, 10 of 17 had another arthroplasty with a risk in three of synchronous PJI. CONCLUSIONS:We highlight the value of 18F-FDG-PET/CT in patients who have PJI and sepsis, emphasizing its role in the comprehensive evaluation of these patients for subsequent therapeutic decision-making.

AbstractPrecision medicine has a substantial basis in nuclear medicine and found its way into diagnosis and treatment of major and rare diseases. Apart from their scientific basis, further aspects are important for new medical procedures to be introduced into broad clinical care. In this matter, we in Germany have special experiences with PET which is still not fully recognized by statutory health insurances as the standard procedure of choice for many important indications despite its recommendation in international guidelines. This chapter describes the long way of PET and PET/CT into German guidelines and reimbursement for the example of lung cancer, to which the jubilarian made crucial contributions.

AIM:To update the subject-specific, competence-based catalog of learning objectives for medical studies in Germany published by the German Society of Nuclear Medicine (DGN) in 2018, prioritizing relevant learning objectives. METHODS:Based on the previous catalog, the writing group compiled nuclear medicine topics and formulated competence-based learning objectives, including medical developments, device innovations and new radiopharmaceutical approvals. These were presented for prioritization to the 180 habilitated DGN members as an expert group in a Delphi process. The first round of voting assessed firstly the topics in terms of necessity or dispensability, and secondly the detailed learning objectives of the topics were assessed for their relevance to academic teaching in nuclear medicine. The results of the first survey were used to draft a catalog of learning objectives with final approval by the expert group in a second survey. The time available for teaching nuclear medicine was also recorded. RESULTS:The writing group developed 240 competence-based learning objectives from 41 topics. After a first Delphi round, 73 detailed competence-based learning objectives from 15 topics were compiled. The mean teaching time was 8.4 h for lectures, 3.7 h for seminars and 3.6 h for practical courses. In a second Delphi round, the agreement of the expert group was at least 95% for the selected topics and at least 90% for the detailed learning objectives. SUMMARY:The catalog of subject-specific learning objectives, updated by expert consensus, provides basic knowledge, skills and competences related to the most relevant diagnostic and therapeutic procedures in nuclear medicine, taking into account both long-established topics and recently introduced innovations.