Optimal parathyroid scintigraphy requires an understanding of (a) the embryologic, anatomic, and physiologic features of the parathyroid glands and (b) the properties of the two common imaging agents, technetium-99m sestamibi and Tc-99m tetrofosmin. Normal parathyroid glands are too small to be visualized, but parathyroid disease often produces visibly enlarged glands. Enlarged parathyroid glands may be found near the thyroid gland or outside their expected locations. Characteristic abnormal scintigraphic patterns may be described as focal or multifocal, usual or ectopic in location, and associated with a normal or abnormal thyroid gland. Patients who are referred for parathyroid imaging should have an abnormal biochemical profile. The first step in evaluating images of a patient suspected to have parathyroid disease is correlating the normal or abnormal scintigraphic patterns with the clinical and surgical history. By integrating the interpretative and technical pearls and pitfalls of parathyroid scintigraphy, the radiologist can be more confident in establishing a correct diagnosis and can precisely guide the surgeon to a single parathyroid adenoma, multiple parathyroid adenomas, or multigland hyperplasia.

Context: Recombinant human TSH (rhTSH) is used to evaluate thyroid carcinoma patients and off-label for 131 I thyroid ablation and nontoxic goiter therapy.Objective: Our objective was to determine the optimal time for 131 I administration after rhTSH.Participants: Twenty-five euthyroid nongoitrous volunteers participated in the study.Design: Baseline 24-h thyroid 123 I uptake (RAIU) was measured, and then 0.1 mg rhTSH was administered.123 I was administered 24, 48, or 72 h after rhTSH, and a repeat 24-h RAIU was obtained. Setting:The study was conducted at an academic research center. Main Outcome Measures:Thyroid function tests, thyroid ultrasounds, and electrocardiograms were measured before rhTSH, then daily for 4 d, and finally 7 d after rhTSH.Results: Serum TSH concentrations 24 h after rhTSH increased from 1.7 Ϯ 0.5 U/ml (mean Ϯ SD) to 13.3 Ϯ 4. The 24-h RAIUs rose from 25 Ϯ 5 to 47 Ϯ 8% (88% increase) when the 123 I was given at 24 h after rhTSH and from 29.8 Ϯ 7 to 40.5 Ϯ 13% (36% increase) when the 123 I was given at 48 h and were unchanged when the 123 I was given at 72 h. The post-rhTSH RAIU increase was greater at 24 than at 72 h (P Ͻ 0.005) and marginally greater than at 48 h (P ϭ 0.057). Thyroid volumes significantly increased 48 h after rhTSH (10 Ϯ 3.8 vs. 11.1 Ϯ 3.7 ml; P Ͻ 0.009). Electrocardiograms were normal. Conclusions

Women are, and have always been, underrepresented in radiology. This gender disparity must be addressed. Women bring a different perspective to the workplace; and their collaborative, empathetic, and compassionate approach to patient care and education is an asset that the radiology community should embrace and leverage. Radiologic organizations should focus on removing barriers to the entry of women physicians into radiology as a specialty and to their career advancement. Organizations should address bias, promote physician well-being, and cultivate a safe and positive work environment. Radiology leaders committed to increasing gender diversity and fostering an inclusive workplace have the opportunity to strengthen their organizations. This article outlines the key steps that practice leaders can take to address the needs of women in radiology: (a) marketing radiology to talented women medical students, (b) addressing recruitment and bias, (c) understanding and accommodating the provisions of the Family and Medical Leave Act of 1993 and the Fair Labor Standards Act for both trainees and radiologists in practice, (d) preventing burnout and promoting well-being, (e) offering flexible work opportunities, (f) providing mentorship and career advancement opportunities, and (g) ensuring equity. ©

In patients with newly diagnosed differentiated thyroid cancer who had undergone thyroidectomy and ( 131)I ablation, posttherapy ( 131)I whole-body scintigraphy revealed new IAFs in 18% and clinical upstaging occurred in 10% of patients compared with pretherapy ( 123)I whole-body scintigraphy. Therefore, posttherapy ( 131)I whole-body scintigraphy provides incremental clinically relevant information as it helps to establish the true extent of IAFs and may contribute to altering of staging.

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