Recently the American Thyroid Association (ATA) released the third version of one of the most cited differentiated thyroid cancer (DTC) guidelines under the title B2015 American Thyroid Association management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer^ [1]. Compared to the earlier versions [2,3], these guidelines are a major departure, as the volume of the text, the number of recommendations and the number of references have increased considerably.We fully understand the effort involving many hours of work that must have been required for the rigorous screening of the literature to produce the evidence tables and the eventual definitions of the recommendations. The document consists of roughly 73,000 words which make up the 101 recommendations and the explanatory text and comments. In the current ATA guidelines, most of the text appears eminently sensible and represents a significant advance from previous DTC-related guidelines published by the ATA as well as other societies, including the 2008 European Association of Nuclear Medicine (EANM) guidelines on 131 I therapy of DTC [4][5][6][7]. For instance, we welcome the clear division of indications for initial 131 I treatment of DTC patients after total thyroidectomy into ablation, adjuvant therapy and therapy. Furthermore, this change in terminology which we strongly support much more clearly delineates the role of 131 I in the care of patients with DTC in other disciplines, especially medical oncology. Considering all the factors that have to be weighed in formulating recommendations this is a huge dedicated effort that has come to fruition.

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Purpose. To systematically review clinical studies examining the effectiveness of nonpharmacological methods to prevent/minimize salivary gland damage due to radioiodine treatment of differentiated thyroid carcinoma (DTC). Methods. Reports on relevant trials were identified by searching the PubMed, CINHAL, Cochrane, and Scopus electronic databases covering the period 01/2000–10/2015. Inclusion/exclusion criteria were prespecified. Search yielded eight studies that were reviewed by four of the present authors. Results. Nonpharmacological methods used in trials may reduce salivary gland damage induced by radioiodine. Sialogogues such as lemon candy, vitamin E, lemon juice, and lemon slice reduced such damage significantly (p < 0.0001, p < 0.05, p < 0.10, and p < 0.05, resp.). Parotid gland massage also reduced the salivary damage significantly (p < 0.001). Additionally, vitamin C had some limited effect (p = 0.37), whereas no effect was present in the case of chewing gum (p = 0.99). Conclusion. The review showed that, among nonpharmacological interventions, sialogogues and parotid gland massage had the greatest impact on reducing salivary damage induced by radioiodine therapy of DTC. However, the studies retrieved were limited in number, sample size, strength of evidence, and generalizability. More randomized controlled trials of these methods with multicenter scope and larger sample sizes will provide more systematic and reliable results allowing more definitive conclusions.

The Nuclear Medicine Global Initiative (NMGI) was formed in 2012 by 13 international organizations to promote human health by advancing the field of nuclear medicine and molecular imaging by supporting the practice and application of nuclear medicine. The first project focused on standardization of administered activities in pediatric nuclear medicine and resulted in two manuscripts. For its second project the NMGI chose to explore issues impacting on access and availability of radiopharmaceuticals around the world. Methods. Information was obtained by survey responses from 35 countries on available radioisotopes, radiopharmaceuticals and kits for diagnostic and therapeutic use.Issues impacting on access and availability of radiopharmaceuticals in individual countries were also identified. Results. Detailed information on radiopharmaceuticals utilized in each country, and sources of supply, was evaluated. Responses highlighted problems in access particularly due to the reliance on a sole provider, regulatory issues and reimbursement, as well as issues of facilities and workforce particularly in low-and middle-income countries. Conclusions. Strategies to address access and availability of radiopharmaceuticals are outlined, to enable timely and equitable patient access to nuclear medicine procedures worldwide. In the face of disruptions to global supply chains by the COVID-19 outbreak, renewed focus on ensuring reliable supply of radiopharmaceuticals is a major priority for nuclear medicine practice globally.