Widely established compared to myocardial perfusion imaging, cardiac autonomous nervous system (CANS) assessment by radiopharmaceutical means is of potential use especially to arrhythmogenic diseases not correlated with anatomic or functional alterations revealed by classical imaging techniques. Molecular imaging of both pre- and postsynaptic functions of the autonomous nervous system is currently feasible, since single photon emission tomography (SPECT) and positron emission tomography (PET) have the ability to reveal the insights of molecular pathophysiology depicting both sympathetic and parasympathetic imbalance in discrete heart pathologies. This review provides not only a brief presentation of radiopharmaceuticals used for non-invasive CANS imaging in the case of ventricular arrhythmias, but also a current update on ventricular tachycardias, cardiomyopathies, Brugada and Long QT syndrome literature.

A plethora of cyclotron options have been developed to fulfil the demands of nuclear medicine industries in PET and SPECT radioisotopes. As a remote site, the difficulties of transporting fluorine 18 radiopharmaceuticals for PET examinations were overcome by the installation of a 7.5 MeV cyclotron for in-house production. The addition of a third-party synthesis module enabled the synthesis of 7 additional radiotracers according to a ''dose on demand'' principle. Radiochemical yield is considered the primary factor in producing sufficient activity for a single patient dose, since low energy cyclotrons can only offer low initial activities. We hereby report the average radiochemical yields, synthesis times and doses per production for [ 18 F]FDG, [ 18 F]PSMA-1007, [ 18 F]DOPA, [ 18 F]FET, [ 18 F]FLT, [ 18 F]FMISO, [ 18 F]Choline and [ 18 F]FES using a BG75 cyclotron and a Neptis Mosaic-RS. Additionally, the presence of radionuclidic impurities in the final product was examined.

The necessity of targeting the prostate-specific membrane antigen (PSMA) with a radiotracer other than the generator-based [68Ga] PSMA compounds, led to the production of the 18F labelled PSMA-1007. The production of [18F]PSMA-1007 was achieved using a 7.5 MeV cyclotron and the NEPTIS mosaic-RS automated synthesis module. After the first 36 batches, the mean percentage yield (decay corrected) was calculated to be 57.0±10.1% and the average activity in the final product vial reached 2.1±0.5 GBq, which can be translated to approximately 3 patients per cassette; using a single PET/CT scanner. The time needed for the synthesis and quality control was 65 minutes. In order to reach an initial activity high enough to produce more than one dose per cassette and therefore for it to become economically viable to produce the radiopharmaceutical, 95 to 100 minutes of bombardment were required at a requested 5.5 μA target current. PET images have shown the expected results according to the literature.

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