CINXE.COM
Green Nuclear Medicine and Radiotheranostics | Journal of Nuclear Medicine
<!DOCTYPE html> <html lang="en" dir="ltr" xmlns="http://www.w3.org/1999/xhtml" xmlns:mml="http://www.w3.org/1998/Math/MathML"> <head prefix="og: http://ogp.me/ns# article: http://ogp.me/ns/article# book: http://ogp.me/ns/book#" > <!--[if IE]><![endif]--> <link rel="dns-prefetch" href="//securepubads.g.doubleclick.net" /> <link rel="dns-prefetch" href="//scholar.google.com" /> <meta http-equiv="Content-Type" content="text/html; charset=utf-8" /> <link rel="shortcut icon" href="https://jnm.snmjournals.org/sites/default/files/images/favicon.ico" type="image/vnd.microsoft.icon" /> <meta name="viewport" content="width=device-width, initial-scale=1" /> <link rel="shortlink" href="/node/125868" /> <meta name="issue_cover_image" content="https://jnm.snmjournals.org/sites/default/files/highwire/jnumed/66/3.cover-source.jpg" /> <meta name="type" content="article" /> <meta name="category" content="research-article" /> <meta name="HW.identifier" content="/jnumed/66/3/340.atom" /> <meta name="HW.pisa" content="jnumed;66/3/340" /> <meta name="DC.Format" content="text/html" /> <meta name="DC.Language" content="en" /> <meta name="DC.Title" content="Green Nuclear Medicine and Radiotheranostics" /> <meta name="DC.Identifier" content="10.2967/jnumed.124.268928" /> <meta name="DC.Date" content="2025-03-01" /> <meta name="DC.Publisher" content="Society of Nuclear Medicine" /> <meta name="DC.Rights" content="© 2025 by the Society of Nuclear Medicine and Molecular Imaging." /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Description" content="There is a significantly growing interest in diagnostic and therapeutic radiopharmaceuticals, and it is foreseeable that an unprecedented number of patients will need to be treated with new nuclear medicine therapies. This predicted increase will have potentially significant environmental impacts. In this discussion, we show different areas of impact, as well as possible measures to reduce such impact. These measures may impact areas from the entire supply chain, starting at the production site of medical isotopes, the energy supply needed for production, transportation, and adaption of the injected amounts of radiopharmaceuticals in clinical use. Furthermore, arguments of local versus centralized production, potentially increasing or decreasing nuclear medicine procedures versus other greenhouse gas–emitting medical imaging tests, as well as radiopharmaceutical waste handling implications, are summarized and weighed against the current status. Overall, this summary hopefully serves as a basis for further discussion in the nuclear medicine community, potentially increases awareness of the environmental impact of this exciting medical field, and may even lead to implementation of measures." /> <meta name="DC.Contributor" content="Patrick Veit-Haibach" /> <meta name="DC.Contributor" content="Ken Herrmann" /> <meta name="DC.Contributor" content="Richard Zimmermann" /> <meta name="DC.Contributor" content="Roland Hustinx" /> <meta name="article:published_time" content="2025-03-01" /> <meta name="article:section" content="The State of the Art" /> <meta name="citation_journal_title" content="Journal of Nuclear Medicine" /> <meta name="citation_publisher" content="Society of Nuclear Medicine" /> <meta name="citation_title" content="Green Nuclear Medicine and Radiotheranostics" /> <meta name="citation_publication_date" content="2025/03/01" /> <meta name="citation_mjid" content="jnumed;66/3/340" /> <meta name="citation_id" content="66/3/340" /> <meta name="citation_public_url" content="https://jnm.snmjournals.org/content/66/3/340" /> <meta name="citation_abstract_html_url" content="https://jnm.snmjournals.org/content/66/3/340.abstract" /> <meta name="citation_full_html_url" content="https://jnm.snmjournals.org/content/66/3/340.full" /> <meta name="citation_pdf_url" content="https://jnm.snmjournals.org/content/jnumed/66/3/340.full.pdf" /> <meta name="citation_issn" content="0161-5505" /> <meta name="citation_issn" content="2159-662X" /> <meta name="citation_doi" content="10.2967/jnumed.124.268928" /> <meta name="citation_pmid" content="39848763" /> <meta name="citation_volume" content="66" /> <meta name="citation_issue" content="3" /> <meta name="citation_num_pages" content="4" /> <meta name="citation_article_type" content="Research Article" /> <meta name="citation_section" content="The State of the Art" /> <meta name="citation_firstpage" content="340" /> <meta name="citation_lastpage" content="343" /> <meta name="citation_author" content="Patrick Veit-Haibach" /> <meta name="citation_author_institution" content="Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada;" /> <meta name="citation_author" content="Ken Herrmann" /> <meta name="citation_author_institution" content="Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany;" /> <meta name="citation_author_institution" content="German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany;" /> <meta name="citation_author" content="Richard Zimmermann" /> <meta name="citation_author_institution" content="Chrysalium Consulting, Lalaye, France; MEDraysintell, Louvain-la-Neuve, Belgium; and Oncidium Foundation, Mont-Saint-Guibert, Belgium; and" /> <meta name="citation_author" content="Roland Hustinx" /> <meta name="citation_author_institution" content="Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liège, Quartier Hôpital, Liège, Belgium" /> <meta name="citation_reference" content="citation_title=MEDraysintell nuclear medicine world market report & directory;citation_author=GP-E. Brechin Vincent;citation_author=M. Nicolas;citation_author=Z. Richard;citation_author=G. Paul-Emmanuel;citation_year=2024" /> <meta name="citation_reference" content="citation_journal_title=J Nucl Med.;citation_author=W. Yang;citation_author=F. Kang;citation_author=Y. Chen;citation_title=Landscape of nuclear medicine in China and its progress on theranostics;citation_pages=29S-37S;citation_volume=65(suppl 1);citation_year=2024" /> <meta name="citation_reference" content="citation_journal_title=J Environ Radioact.;citation_author=J. Wang;citation_author=B. Xu;citation_title=Removal of radionuclide 99Tc from aqueous solution by various adsorbents: a review;citation_pages=107267;citation_volume=270;citation_year=2023;citation_pmid=37598575" /> <meta name="citation_reference" content="citation_journal_title=Phys Chem Earth, Parts A/B/C.;citation_author=RE. Gephart;citation_title=A short history of waste management at the Hanford site;citation_pages=298-306;citation_volume=35;citation_year=2010" /> <meta name="citation_reference" content="citation_journal_title=EJNMMI Phys.;citation_author=G. Sgouros;citation_author=B. He;citation_author=N. Ray;citation_author=DL. Ludwig;citation_author=EC. Frey;citation_title=Dosimetric impact of Ac-227 in accelerator-produced Ac-225 for alpha-emitter radiopharmaceutical therapy of patients with hematological malignancies: a pharmacokinetic modeling analysis;citation_pages=60;citation_volume=8;citation_year=2021;citation_pmid=34406515" /> <meta name="citation_reference" content="citation_title=Environmental Remediation and Restoration of Contaminated Nuclear and Norm Sites.;citation_author=L. van Velzen;citation_pages=132-137;citation_year=2015" /> <meta name="citation_reference" content="citation_journal_title=Environ Res Lett.;citation_author=P-P. Pichler;citation_author=IS. Jaccard;citation_author=U. Weisz;citation_author=H. Weisz;citation_title=International comparison of health care carbon footprints;citation_pages=064004;citation_volume=14;citation_year=2019;citation_doi=10.1088/1748-9326/ab19e1" /> <meta name="citation_reference" content="citation_journal_title=PLoS One.;citation_author=MJ. Eckelman;citation_author=J. Sherman;citation_title=Environmental impacts of the US health care system and effects on public health;citation_pages=e0157014;citation_volume=11;citation_year=2016;citation_pmid=27280706;citation_doi=10.1371/journal.pone.0157014" /> <meta name="citation_reference" content="citation_journal_title=J Clin Med.;citation_author=E. Picano;citation_author=C. Mangia;citation_author=A. D’Andrea;citation_title=Climate change, carbon dioxide emissions, and medical imaging contribution;citation_pages=215;citation_volume=12;citation_year=2022;citation_pmid=36615016" /> <meta name="citation_reference" content="citation_journal_title=Radiology.;citation_author=FX. Doo;citation_author=J. Vosshenrich;citation_author=TS. Cook;citation_title=Environmental sustainability and AI in radiology: a double-edged sword;citation_pages=e232030;citation_volume=310;citation_year=2024;citation_pmid=38411520" /> <meta name="citation_reference" content="citation_journal_title=Can Assoc Radiol J.;citation_title=Canadian Association of Radiologists statement on environmental sustainability in medical imaging;citation_author=K. Hanneman;citation_author=A. Szava-Kovats;citation_author=B. Burbridge;citation_pages=8465371241260013;citation_year=2024" /> <meta name="citation_reference" content="citation_journal_title=Heart.;citation_author=TH. Marwick;citation_author=J. Buonocore;citation_title=Environmental impact of cardiac imaging tests for the diagnosis of coronary artery disease;citation_volume=97;citation_year=2011;citation_pmid=21685481;citation_doi=10.1136/hrt.2011.227884" /> <meta name="citation_reference" content="citation_journal_title=Lancet Reg Health West Pac.;citation_author=S. McAlister;citation_author=F. McGain;citation_author=M. Petersen;citation_title=The carbon footprint of hospital diagnostic imaging in Australia;citation_pages=100459;citation_volume=24;citation_year=2022;citation_pmid=35538935" /> <meta name="citation_reference" content="citation_journal_title=Int J Health Care Qual Assur.;citation_author=A. Esmaeili;citation_author=C. McGuire;citation_author=M. Overcash;citation_author=K. Ali;citation_author=S. Soltani;citation_author=J. Twomey;citation_title=Environmental impact reduction as a new dimension for quality measurement of healthcare services: the case of magnetic resonance imaging;citation_pages=910-922;citation_volume=31;citation_year=2018;citation_pmid=30415627;citation_doi=10.1108/IJHCQA-10-2016-0153" /> <meta name="citation_reference" content="citation_journal_title=Thyroid.;citation_author=BR. Haugen;citation_author=EK. Alexander;citation_author=KC. Bible;citation_title=2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer;citation_pages=1-133;citation_volume=26;citation_year=2016;citation_pmid=26462967;citation_doi=10.1089/thy.2015.0020" /> <meta name="citation_reference" content="citation_journal_title=Eur J Nucl Med Mol Imaging.;citation_author=K. Weyts;citation_author=C. Lasnon;citation_author=R. Ciappuccini;citation_title=Artificial intelligence-based PET denoising could allow a two-fold reduction in [18F] FDG PET acquisition time in digital PET/CT;citation_pages=3750-3760;citation_volume=49;citation_year=2022;citation_pmid=35593925" /> <meta name="citation_reference" content="citation_journal_title=Soc Sci Med.;citation_author=S. Sarkar;citation_author=S. Mateus;citation_title=Doing more with less: how frugal innovations can contribute to improving healthcare systems;citation_pages=115127;citation_volume=306;citation_year=2022;citation_pmid=35750004" /> <meta name="citation_reference" content="citation_journal_title=Technol Soc.;citation_author=M. Hossain;citation_author=H. Simula;citation_author=M. Halme;citation_title=Can frugal go global? Diffusion patterns of frugal innovations;citation_pages=132-139;citation_volume=46;citation_year=2016" /> <meta name="citation_reference" content="Health care’s climate footprint report. Health Care Without Harm website. https://noharm-europe.org/content/global/health-care-climate-footprint-report. Accessed January 9, 2025." /> <meta name="citation_reference" content="citation_journal_title=Acad Radiol.;citation_author=C. Sumner;citation_author=I. Ikuta;citation_author=T. Garg;citation_title=Approaches to greening radiology;citation_pages=528-535;citation_volume=30;citation_year=2023;citation_pmid=36114076" /> <meta name="citation_reference" content="citation_journal_abbrev=J Am Coll Radiol;citation_author=PM. Prasanna;citation_author=E. Siegel;citation_author=A. Kunce;citation_title=Greening radiology.;citation_pages=780-784;citation_volume=8;citation_year=2011;citation_issue=11;citation_pmid=22051462;citation_doi=10.1016/j.jacr.2011.07.017" /> <meta name="citation_reference" content="citation_journal_title=Eur J Radiol Open.;citation_author=L. Büttner;citation_author=H. Posch;citation_author=T. Auer;citation_title=Switching off for future: cost estimate and a simple approach to improving the ecological footprint of radiological departments;citation_pages=100320;citation_volume=8;citation_year=2021;citation_pmid=33457469" /> <meta name="citation_reference" content="World Health Organization from Globocan 2020 data. International Agency for Research on Cancer website. https://gco.iarc.who.int/today/en. Published 2020. Accessed October 31, 2023." /> <meta name="citation_reference" content="citation_title=Cyclotrons used in nuclear medicine report & directory;citation_author=PET. Gothals;citation_author=R. Zimmerman;citation_year=2020" /> <meta name="citation_reference" content="citation_journal_title=Eur J Radiol.;citation_author=D. Yakar;citation_author=TC. Kwee;citation_title=Carbon footprint of the RSNA annual meeting;citation_pages=108869;citation_volume=125;citation_year=2020;citation_pmid=32105915" /> <meta name="citation_reference" content="citation_journal_title=J Nucl Med.;citation_author=B. Saboury;citation_author=T. Bradshaw;citation_author=R. Boellaard;citation_title=Artificial intelligence in nuclear medicine: opportunities, challenges, and responsibilities toward a trustworthy ecosystem;citation_volume=64;citation_year=2023;citation_pmid=36522184;citation_doi=10.2967/jnumed.121.263703" /> <meta name="citation_reference" content="citation_journal_title= Radiography (Lond). 2024;30(suppl 1):119–124.;citation_title=The potential role of artificial intelligence in sustainability of nuclear medicine;citation_author=G. Currie;citation_author=K. Hawk;citation_author=E. Rohren" /> <meta name="twitter:title" content="Green Nuclear Medicine and Radiotheranostics" /> <meta name="twitter:card" content="summary_large_image" /> <meta name="twitter:image" content="https://jnm.snmjournals.org/sites/default/files/highwire/jnumed/66/3.cover-source.jpg" /> <meta name="twitter:description" content="There is a significantly growing interest in diagnostic and therapeutic radiopharmaceuticals, and it is foreseeable that an unprecedented number of patients will need to be treated with new nuclear medicine therapies. This predicted increase will have potentially significant environmental impacts. In this discussion, we show different areas of impact, as well as possible measures to reduce such impact. These measures may impact areas from the entire supply chain, starting at the production site of medical isotopes, the energy supply needed for production, transportation, and adaption of the injected amounts of radiopharmaceuticals in clinical use. Furthermore, arguments of local versus centralized production, potentially increasing or decreasing nuclear medicine procedures versus other greenhouse gas–emitting medical imaging tests, as well as radiopharmaceutical waste handling implications, are summarized and weighed against the current status. Overall, this summary hopefully serves as a basis for further discussion in the nuclear medicine community, potentially increases awareness of the environmental impact of this exciting medical field, and may even lead to implementation of measures." /> <meta name="og-title" property="og:title" content="Green Nuclear Medicine and Radiotheranostics" /> <meta name="og-url" property="og:url" content="https://jnm.snmjournals.org/content/66/3/340" /> <meta name="og-site-name" property="og:site_name" content="Journal of Nuclear Medicine" /> <meta name="og-description" property="og:description" content="There is a significantly growing interest in diagnostic and therapeutic radiopharmaceuticals, and it is foreseeable that an unprecedented number of patients will need to be treated with new nuclear medicine therapies. This predicted increase will have potentially significant environmental impacts. In this discussion, we show different areas of impact, as well as possible measures to reduce such impact. These measures may impact areas from the entire supply chain, starting at the production site of medical isotopes, the energy supply needed for production, transportation, and adaption of the injected amounts of radiopharmaceuticals in clinical use. Furthermore, arguments of local versus centralized production, potentially increasing or decreasing nuclear medicine procedures versus other greenhouse gas–emitting medical imaging tests, as well as radiopharmaceutical waste handling implications, are summarized and weighed against the current status. Overall, this summary hopefully serves as a basis for further discussion in the nuclear medicine community, potentially increases awareness of the environmental impact of this exciting medical field, and may even lead to implementation of measures." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://jnm.snmjournals.org/sites/default/files/highwire/jnumed/66/3.cover-source.jpg" /> <link rel="canonical" href="https://jnm.snmjournals.org/content/66/3/340" /> <meta name="Generator" content="Drupal 7 (http://drupal.org)" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/66/3/340.full.pdf" /> <link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/66/3/340.full.txt" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/66/3/340.ppt" /> <title>Green Nuclear Medicine and Radiotheranostics | Journal of Nuclear Medicine</title> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__QEy_BpbtMcsqv3xURK855GSs2fFjOibU10yA758Mn4c__NucWi_bEk5E3BNVDtTt2nhiPtE1A5I24YwRDQ2fojJ0__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <link type="text/css" rel="stylesheet" href="//cdn.jsdelivr.net/qtip2/2.2.1/jquery.qtip.min.css" media="all" /> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__Db39Kp7uL1Kuiclxk1FnIfde2UirHjyJSD95R3u-xHM__2rNnbNvr3NO99RAKCQ7RQ9CkPZdIl50ojVkDeHrOvSc__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <style type="text/css" media="all"> /* <![CDATA[ */ .user-menu-dropdown-logo>.menubar-nav>.nice-menu>.menuparent a:first-child{background:url('https://jnm.snmjournals.org/sites/default/files/snmmi_2025_logo_white_optimized.png') transparent no-repeat left top;padding-left:136px} /* ]]> */ </style> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__pQSRKzq59W_szcAwGgTnyQi9jkCKNHS2l_sevHfLpsM__mARewvLmCj6W-6nYH7m_CPeEPMG1xcLLH4jl1LbieB4__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <style type="text/css" media="all"> /* <![CDATA[ */ #sliding-popup.sliding-popup-bottom,#sliding-popup.sliding-popup-bottom .eu-cookie-withdraw-banner,.eu-cookie-withdraw-tab{background:#0779bf}#sliding-popup.sliding-popup-bottom.eu-cookie-withdraw-wrapper{background:transparent}#sliding-popup .popup-content #popup-text h1,#sliding-popup .popup-content #popup-text h2,#sliding-popup .popup-content #popup-text h3,#sliding-popup .popup-content #popup-text p,.eu-cookie-compliance-secondary-button,.eu-cookie-withdraw-tab{color:#fff !important}.eu-cookie-withdraw-tab{border-color:#fff}.eu-cookie-compliance-more-button{color:#fff !important} /* ]]> */ </style> <!--[if lte IE 7]> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__ElJr3PIJEvw3qLXc1cnYiLj2G4KgDPSXFOfm6Phf8hw__JdWGm15cDWjsK6KrFlQVXQix9YgNeYysf22XZHj-Y-c__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <![endif]--> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__BuoDuzoWcz2CL9-rYVqiOwZYB0s9mtqPm1bLrGHX4Z4__WNptNuPkTJ2rxI9jvljwIQXeYY9GgnsTxhjOkFT4fEY__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__yIWz8VV-q4ayA01oSETrUtbZ5ewOUfY9uBpz-xrNies__QC4RHo0UkV0hfUwaba8_xu4oeKgJj1ykjJCjtK2i8fM__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <!--[if (lt IE 9)&(!IEMobile)]> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__XH6bpcI0f2dImc-p674DLCZtWBGb-QwxJK1YexVGtno__vUceGprdo5nIhV6DH93X7fI3r8RcTJbChbas9TQXeW4__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <![endif]--> <!--[if gte IE 9]><!--> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__oWyrHF_mmv3c4PPGrsNSmh5Ub_1TfiuNA2i1_MOafWg__1kTjT7uqr7v6BlTbuE-4U2S8EzyEcBTxZhvp1VjA-qo__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <!--<![endif]--> <!--[if gte IE 9]><!--> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__-Kek3KTto4Kje1mJ9bp_-a_lv0D9QS29NgfFBV-inOY__90wksBfd5YlmG0UjedmGQFn8Ano49PMQRwGgVOM50YE__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <!--<![endif]--> <link type="text/css" rel="stylesheet" href="/sites/default/files/advagg_css/css__qhtl8bYJe-p2a_0yeofITZkODFSj95Gf_aDru66nW4Y__j5qyA6qeJVk636TDu5iKSxHyvGoZq90XGKL-H2ruAGQ__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.css" media="all" /> <script type="text/javascript" src="/sites/default/files/advagg_js/js__DdxPgqGimsdUot2QWNz_pGsHzqNGpx6RMCWHpL8YWkg__c6zfK6oHHbLpTal5PdQxeQI3xGoCM8IXWtEHwIZr560__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js"></script> <script type="text/javascript" src="https://securepubads.g.doubleclick.net/tag/js/gpt.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__PdQir_agK1DUA87YM-BJHGIvRUiGIyt3Fx8Ir3qzMbw__mdqIgBq5jfe4fx27BUBZcqxEc7wTCLyKZlhl0gGVsug__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js"></script> <script type="text/javascript" src="//cdn.jsdelivr.net/qtip2/2.2.1/jquery.qtip.min.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__-7E-8-zdkEoIIsW7CcpucOxPpwbOvNz5WwNiUhfCdYY__65qTHBIMb5OryCqFZU9Jt1ZegABy3HNwFebJR29P_TI__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__GM3GJPR36rRIz0TRkjC5OQwrioSyN9aoYRivDhCO_AM__qAl84FcCv2jyN22yFGS5Oc85cjd9zKX6p_cFNLGhe-M__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js" async="async"></script> <script type="text/javascript" defer="defer" async="async" src="//cdn.foxycart.com/snm.ecommerce.highwire.org/loader.js"></script> <script type="text/javascript" async="async" src="https://scholar.google.com/scholar_js/casa.js"></script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- /*! * yepnope1.5.4 * (c) WTFPL, GPLv2 */ (function(a,b,c){function d(a){return"[object Function]"==o.call(a)}function e(a){return"string"==typeof a}function f(){}function g(a){return!a||"loaded"==a||"complete"==a||"uninitialized"==a}function h(){var a=p.shift();q=1,a?a.t?m(function(){("c"==a.t?B.injectCss:B.injectJs)(a.s,0,a.a,a.x,a.e,1)},0):(a(),h()):q=0}function i(a,c,d,e,f,i,j){function k(b){if(!o&&g(l.readyState)&&(u.r=o=1,!q&&h(),l.onload=l.onreadystatechange=null,b)){"img"!=a&&m(function(){t.removeChild(l)},50);for(var d in y[c])y[c].hasOwnProperty(d)&&y[c][d].onload()}}var j=j||B.errorTimeout,l=b.createElement(a),o=0,r=0,u={t:d,s:c,e:f,a:i,x:j};1===y[c]&&(r=1,y[c]=[]),"object"==a?l.data=c:(l.src=c,l.type=a),l.width=l.height="0",l.onerror=l.onload=l.onreadystatechange=function(){k.call(this,r)},p.splice(e,0,u),"img"!=a&&(r||2===y[c]?(t.insertBefore(l,s?null:n),m(k,j)):y[c].push(l))}function j(a,b,c,d,f){return q=0,b=b||"j",e(a)?i("c"==b?v:u,a,b,this.i++,c,d,f):(p.splice(this.i++,0,a),1==p.length&&h()),this}function k(){var a=B;return a.loader={load:j,i:0},a}var l=b.documentElement,m=a.setTimeout,n=b.getElementsByTagName("script")[0],o={}.toString,p=[],q=0,r="MozAppearance"in l.style,s=r&&!!b.createRange().compareNode,t=s?l:n.parentNode,l=a.opera&&"[object Opera]"==o.call(a.opera),l=!!b.attachEvent&&!l,u=r?"object":l?"script":"img",v=l?"script":u,w=Array.isArray||function(a){return"[object Array]"==o.call(a)},x=[],y={},z={timeout:function(a,b){return b.length&&(a.timeout=b[0]),a}},A,B;B=function(a){function b(a){var a=a.split("!"),b=x.length,c=a.pop(),d=a.length,c={url:c,origUrl:c,prefixes:a},e,f,g;for(f=0;f<d;f++)g=a[f].split("="),(e=z[g.shift()])&&(c=e(c,g));for(f=0;f<b;f++)c=x[f](c);return c}function g(a,e,f,g,h){var i=b(a),j=i.autoCallback;i.url.split(".").pop().split("?").shift(),i.bypass||(e&&(e=d(e)?e:e[a]||e[g]||e[a.split("/").pop().split("?")[0]]),i.instead?i.instead(a,e,f,g,h):(y[i.url]?i.noexec=!0:y[i.url]=1,f.load(i.url,i.forceCSS||!i.forceJS&&"css"==i.url.split(".").pop().split("?").shift()?"c":c,i.noexec,i.attrs,i.timeout),(d(e)||d(j))&&f.load(function(){k(),e&&e(i.origUrl,h,g),j&&j(i.origUrl,h,g),y[i.url]=2})))}function h(a,b){function c(a,c){if(a){if(e(a))c||(j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}),g(a,j,b,0,h);else if(Object(a)===a)for(n in m=function(){var b=0,c;for(c in a)a.hasOwnProperty(c)&&b++;return b}(),a)a.hasOwnProperty(n)&&(!c&&!--m&&(d(j)?j=function(){var a=[].slice.call(arguments);k.apply(this,a),l()}:j[n]=function(a){return function(){var b=[].slice.call(arguments);a&&a.apply(this,b),l()}}(k[n])),g(a[n],j,b,n,h))}else!c&&l()}var h=!!a.test,i=a.load||a.both,j=a.callback||f,k=j,l=a.complete||f,m,n;c(h?a.yep:a.nope,!!i),i&&c(i)}var i,j,l=this.yepnope.loader;if(e(a))g(a,0,l,0);else if(w(a))for(i=0;i<a.length;i++)j=a[i],e(j)?g(j,0,l,0):w(j)?B(j):Object(j)===j&&h(j,l);else Object(a)===a&&h(a,l)},B.addPrefix=function(a,b){z[a]=b},B.addFilter=function(a){x.push(a)},B.errorTimeout=1e4,null==b.readyState&&b.addEventListener&&(b.readyState="loading",b.addEventListener("DOMContentLoaded",A=function(){b.removeEventListener("DOMContentLoaded",A,0),b.readyState="complete"},0)),a.yepnope=k(),a.yepnope.executeStack=h,a.yepnope.injectJs=function(a,c,d,e,i,j){var k=b.createElement("script"),l,o,e=e||B.errorTimeout;k.src=a;for(o in d)k.setAttribute(o,d[o]);c=j?h:c||f,k.onreadystatechange=k.onload=function(){!l&&g(k.readyState)&&(l=1,c(),k.onload=k.onreadystatechange=null)},m(function(){l||(l=1,c(1))},e),i?k.onload():n.parentNode.insertBefore(k,n)},a.yepnope.injectCss=function(a,c,d,e,g,i){var e=b.createElement("link"),j,c=i?h:c||f;e.href=a,e.rel="stylesheet",e.type="text/css";for(j in d)e.setAttribute(j,d[j]);g||(n.parentNode.insertBefore(e,n),m(c,0))}})(this,document); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- yepnope({ test: Modernizr.matchmedia, nope: '/sites/all/libraries/media-match/media.match.min.js' }); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- var googletag = googletag || {}; googletag.cmd = googletag.cmd || []; googletag.slots = googletag.slots || {}; //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- googletag.slots["JNM-300x250-right-placement-1"] = googletag.defineSlot("/2724250/JNM-300x250-right-placement-1", [300, 250], "dfp-ad-JNM-300x250-right-placement-1") .addService(googletag.pubads()); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- googletag.slots["JNM-300x600-righttower"] = googletag.defineSlot("/2724250/JNM-300x600-righttower", [300, 600], "dfp-ad-JNM-300x600-righttower") .addService(googletag.pubads()); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- googletag.slots["JNM-300x250-right-placement-2"] = googletag.defineSlot("/2724250/JNM-300x250-right-placement-2", [300, 250], "dfp-ad-JNM-300x250-right-placement-2") .addService(googletag.pubads()); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- googletag.slots["JNM-728x90-Bottom-Leaderboard"] = googletag.defineSlot("/2724250/JNM-728x90-Bottom-Leaderboard", [728, 90], "dfp-ad-JNM-728x90-Bottom-Leaderboard") .addService(googletag.pubads()); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- googletag.slots["jnm_728x90_top_leaderboard"] = googletag.defineSlot("/2724250/JNM-728x90-Top-Leaderboard", [728, 90], "dfp-ad-jnm_728x90_top_leaderboard") .addService(googletag.pubads()); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- document.createElement( "picture" ); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- googletag.cmd.push(function() { googletag.pubads().enableAsyncRendering(); googletag.pubads().enableSingleRequest(); googletag.pubads().collapseEmptyDivs(); googletag.pubads().addEventListener("slotRenderEnded", function (event) { if (event.isEmpty) { var id = event.slot.getSlotElementId(); var x = document.getElementById(id); if (x.parentElement.classList.contains("dfp-tag-wrapper")) { x.parentElement.style.display = "none"; } } }); }); googletag.enableServices(); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- if(typeof window.MathJax === "undefined") window.MathJax = { menuSettings: { zoom: "Click" } }; //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- jQuery(document).ready(function () { if(jQuery("h2").parent().hasClass("issue-toc-section")){ jQuery("li .issue-toc-section").removeClass("issue-toc-section") } }); //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- jQuery.extend(Drupal.settings, {"basePath":"\/","pathPrefix":"","ajaxPageState":{"theme":"jcore_1","theme_token":"0quim9ysB7MMGjshnqRa52QTjfuntpPzxc2KhsSOi8U","jquery_version":"1.8","css":{"modules\/system\/system.base.css":1,"modules\/system\/system.menus.css":1,"modules\/system\/system.messages.css":1,"modules\/system\/system.theme.css":1,"misc\/ui\/jquery.ui.core.css":1,"misc\/ui\/jquery.ui.theme.css":1,"misc\/ui\/jquery.ui.button.css":1,"misc\/ui\/jquery.ui.resizable.css":1,"misc\/ui\/jquery.ui.dialog.css":1,"misc\/ui\/jquery.ui.tooltip.css":1,"misc\/ui\/jquery.ui.accordion.css":1,"sites\/all\/modules\/contrib\/date\/date_api\/date.css":1,"sites\/all\/modules\/contrib\/date\/date_popup\/themes\/datepicker.1.7.css":1,"modules\/field\/theme\/field.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_draw\/css\/highwire-draw.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_folders\/highwire_folders.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_foxycart\/highwire_foxycart.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/css\/highwire-responsive.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_saved_searches\/highwire_saved_searches.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_user\/highwire_user.css":1,"modules\/node\/node.css":1,"sites\/all\/modules\/contrib\/picture\/picture_wysiwyg.css":1,"modules\/search\/search.css":1,"modules\/user\/user.css":1,"sites\/all\/modules\/contrib\/views\/css\/views.css":1,"sites\/all\/modules\/contrib\/ckeditor\/css\/ckeditor.css":1,"sites\/all\/modules\/contrib\/colorbox\/styles\/default\/colorbox_style.css":1,"sites\/all\/modules\/contrib\/ctools\/css\/ctools.css":1,"sites\/all\/modules\/contrib\/foxycart\/foxycart.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire.style.highwire.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/nlm-elements.css":1,"sites\/all\/modules\/contrib\/panels\/css\/panels.css":1,"public:\/\/ctools\/css\/263bfdb18936424f0ade19d6bd885f37.css":1,"sites\/all\/modules\/contrib\/panels_ajax_tab\/css\/panels_ajax_tab.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire.style.markup.css":1,"\/\/cdn.jsdelivr.net\/qtip2\/2.2.1\/jquery.qtip.min.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/layouts\/highwire_2col_stacked\/highwire-2col-stacked.css":1,"sites\/all\/modules\/contrib\/forward\/forward.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_share_link.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_copy_permalink.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_reports_feed.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/highwire-article-citation-list.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_corrections.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/plugins\/styles\/highwire_responsive_toggle\/highwire_responsive_toggle.css.less":1,"sites\/all\/modules\/contrib\/nice_menus\/css\/nice_menus.css":1,"sites\/all\/modules\/contrib\/nice_menus\/css\/nice_menus_default.css":1,"sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css":1,"sites\/all\/modules\/contrib\/eu_cookie_compliance\/css\/eu_cookie_compliance.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/highwire.gtranslate.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/userbar-dropdown-menu.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_theme_tools\/css\/font-hwicons.css":1,"sites\/all\/modules\/highwire\/highwire\/highwire_theme_tools\/css\/font-hwicons-glyphs.css":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/css\/highwire_citing_links.css":1,"sites\/all\/themes\/highwire\/jcore_1\/eu_cookie_compliance.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/font-awesome-ie7.css":1,"sites\/all\/themes\/contrib\/omega\/alpha\/css\/alpha-reset.css":1,"sites\/all\/themes\/contrib\/omega\/alpha\/css\/alpha-mobile.css":1,"sites\/all\/themes\/contrib\/omega\/alpha\/css\/alpha-alpha.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/formalize.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-text.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-branding.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-menu.css":1,"sites\/all\/themes\/contrib\/omega\/omega\/css\/omega-forms.css":1,"sites\/all\/modules\/highwire\/highwire\/css\/highwire-forms.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/mobile-reset.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/font-awesome.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/forms.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/global.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/jquery-ui-elements.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/text.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/eletters.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/colors.css.less":1,"ie::normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"ie::normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-normal.css":1,"ie::normal::sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/normal\/jcore-default-normal-30.css":1,"narrow::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"narrow::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-narrow.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/narrow\/jcore-default-narrow-30.css":1,"normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"normal::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-normal.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/normal\/jcore-default-normal-30.css":1,"wide::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default.css":1,"wide::sites\/all\/themes\/highwire\/jcore_1\/css\/jcore-1-jcore-default-wide.css":1,"sites\/all\/themes\/highwire\/jcore_1\/css\/grid\/jcore_default\/wide\/jcore-default-wide-30.css":1,"sites\/all\/modules\/shared\/jnl_snm_styles\/css\/jnl_snm_styles.css.less":1,"1":1,"0":1},"js":{"sites\/all\/libraries\/enquire.js\/enquire.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_panels_ajax_tab.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_google_scholar_sprinkle.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js":1,"sites\/all\/libraries\/lazysizes\/lazysizes.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_article_trendmd.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_user\/plugins\/content_types\/js\/highwire_user_salutation.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_foxycart\/highwire_foxycart.js":1,"sites\/all\/modules\/contrib\/eu_cookie_compliance\/js\/eu_cookie_compliance.js":1,"sites\/all\/modules\/shared\/jnl_snm_styles\/js\/scripts.js":1,"sites\/all\/libraries\/modernizr\/modernizr.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/jquery\/1.8\/jquery.min.js":1,"misc\/jquery-extend-3.4.0.js":1,"misc\/jquery.once.js":1,"https:\/\/securepubads.g.doubleclick.net\/tag\/js\/gpt.js":1,"misc\/drupal.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.core.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.widget.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/external\/jquery.cookie.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/misc\/jquery.form.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.button.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.mouse.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.draggable.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.position.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.resizable.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.dialog.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.tooltip.min.js":1,"sites\/all\/modules\/contrib\/jquery_update\/replace\/ui\/ui\/minified\/jquery.ui.accordion.min.js":1,"sites\/all\/libraries\/jquery.bgiframe\/jquery.bgiframe.js":1,"sites\/all\/libraries\/jquery.hoverIntent\/jquery.hoverIntent.js":1,"sites\/all\/libraries\/superfish\/superfish.js":1,"sites\/all\/modules\/contrib\/nice_menus\/js\/nice_menus.js":1,"misc\/ajax.js":1,"sites\/all\/modules\/contrib\/jquery_update\/js\/jquery_update.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.equal-heights.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.panels-ajax-tab.js":1,"sites\/all\/libraries\/colorbox\/jquery.colorbox-min.js":1,"sites\/all\/modules\/contrib\/colorbox\/js\/colorbox.js":1,"sites\/all\/modules\/contrib\/colorbox\/styles\/default\/colorbox_style.js":1,"sites\/all\/modules\/contrib\/foxycart\/foxycart.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_log\/highwire_log.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_user\/js\/highwire_user_meta.js":1,"sites\/all\/modules\/contrib\/panels_ajax_tab\/js\/panels_ajax_tab.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_at_symbol.js":1,"\/\/cdn.jsdelivr.net\/qtip2\/2.2.1\/jquery.qtip.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_article_reference_popup.js":1,"misc\/progress.js":1,"misc\/textarea.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_citation\/plugins\/content_types\/js\/highwire_citation_export.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/minipanel_dialog_link.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_share_dialog.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/clipboard.min.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_clipboard.js":1,"sites\/all\/modules\/contrib\/service_links\/js\/twitter_button.js":1,"sites\/all\/modules\/contrib\/service_links\/js\/facebook_like.js":1,"sites\/all\/modules\/contrib\/service_links\/js\/google_plus_one.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_folders\/plugins\/content_types\/js\/highwire_save_to_folders.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_search\/plugins\/content_types\/js\/highwire_search_similar_articles.js":1,"sites\/all\/modules\/contrib\/panels_accordion\/js\/panels_accordion.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/plugins\/styles\/highwire_responsive_toggle\/highwire_responsive_toggle.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.gtranslate.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_article_nav.js":1,"sites\/all\/modules\/highwire\/highwire\/plugins\/content_types\/js\/highwire_nav_float.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.article-citation-access.js":1,"sites\/all\/modules\/highwire\/highwire\/js\/highwire.article-citation-author-tooltip.js":1,"sites\/all\/themes\/highwire\/jcore_1\/js\/theme-scripts.js":1,"sites\/all\/themes\/contrib\/omega\/omega\/js\/jquery.formalize.js":1,"sites\/all\/themes\/contrib\/omega\/omega\/js\/omega-mediaqueries.js":1,"sites\/all\/themes\/contrib\/omega\/omega\/js\/omega-equalheights.js":1,"sites\/all\/modules\/highwire\/highwire\/highwire_responsive\/js\/highwire-mediaqueries.js":1,"sites\/all\/modules\/contrib\/picture\/picturefill2\/picturefill.min.js":1,"sites\/all\/modules\/contrib\/picture\/picture.min.js":1,"\/\/cdn.foxycart.com\/snm.ecommerce.highwire.org\/loader.js":1,"https:\/\/scholar.google.com\/scholar_js\/casa.js":1}},"colorbox":{"opacity":"0.85","current":"{current} of {total}","previous":"\u00ab Prev","next":"Next \u00bb","close":"Close","maxWidth":"98%","maxHeight":"98%","fixed":true,"mobiledetect":true,"mobiledevicewidth":"480px"},"highwire":{"nid":"125868","apath":"\/jnumed\/66\/3\/340.atom","pisa":"jnumed;66\/3\/340","ac":{"\/jnumed\/66\/3\/340.atom":{"access":{"full":true},"pisa_id":"","apath":"\/jnumed\/66\/3\/340.atom","jcode":"jnumed"},"jnumed;66\/3\/340":{"access":{"full":true},"pisa_id":"jnumed;66\/3\/340","apath":"","jcode":"jnumed"}},"processed":["highwire_math"],"markup":[{"requested":"long","variant":"full-text","view":"full","pisa":"jnumed;66\/3\/340"},{"requested":"full-text","variant":"full-text","view":"full","pisa":"jnumed;66\/3\/340"},{"requested":"full-text","variant":"full-text","view":"full","pisa":"jnumed;66\/3\/340"}],"modal_window_width":"560","share_modal_width":"560","share_modal_title":"Share this Article","trendmd":{"trendmd-suggestions":"{\u0022element\u0022:\u0022#trendmd-suggestions\u0022,\u0022track_id\u0022:\u0022null\u0022}"}},"user_uid":0,"customer_email":"","cartstack_siteid":"","foxycart_subdomain":"snm.ecommerce.highwire.org","foxycart_always_show_cart_link":1,"hw_fc_cookie_domain":".snmjournals.org","highwire_panel_tabs":[{"panel_name":"jnl_snm_tab_pdf","panel_ajax_tab":"jnl_snm_tab_pdf"}],"panel_ajax_tab":{"path":"sites\/all\/modules\/contrib\/panels_ajax_tab"},"instances":"{\u0022highwire_abstract_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:20,\u0022height\u0022:20,\u0022border\u0022:1,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-abstract-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-abstract-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022right center\u0022,\u0022my\u0022:\u0022left center\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022shift\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter click \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}},\u0022highwire_author_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:15,\u0022height\u0022:15,\u0022border\u0022:1,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-author-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-author-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022top center\u0022,\u0022my\u0022:\u0022bottom center\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}},\u0022highwire_reflinks_tooltip\u0022:{\u0022content\u0022:{\u0022text\u0022:\u0022\u0022},\u0022style\u0022:{\u0022tip\u0022:{\u0022width\u0022:15,\u0022height\u0022:15,\u0022border\u0022:1,\u0022mimic\u0022:\u0022top center\u0022,\u0022offset\u0022:0,\u0022corner\u0022:true},\u0022classes\u0022:\u0022qtip-custom hw-tooltip hw-ref-link-tooltip qtip-shadow qtip-rounded\u0022,\u0022classes_custom\u0022:\u0022hw-tooltip hw-ref-link-tooltip\u0022},\u0022position\u0022:{\u0022at\u0022:\u0022bottom left\u0022,\u0022my\u0022:\u0022top left\u0022,\u0022viewport\u0022:true,\u0022adjust\u0022:{\u0022method\u0022:\u0022flip\u0022}},\u0022show\u0022:{\u0022event\u0022:\u0022mouseenter \u0022,\u0022solo\u0022:true},\u0022hide\u0022:{\u0022event\u0022:\u0022mouseleave \u0022,\u0022fixed\u0022:1,\u0022delay\u0022:\u0022100\u0022}}}","qtipDebug":"{\u0022leaveElement\u0022:0}","ajax":{"edit-submit--3":{"callback":"highwire_alerts_login_form_submit","wrapper":"alerts-form-wrapper","event":"click","url":"\/system\/ajax","submit":{"_triggering_element_name":"op","_triggering_element_value":"Submit"}},"edit-submit--6":{"callback":"highwire_folder_login_form_submit","wrapper":"folder-form-wrapper","event":"mousedown","keypress":true,"prevent":"click","url":"\/system\/ajax","submit":{"_triggering_element_name":"op","_triggering_element_value":"Submit"}}},"urlIsAjaxTrusted":{"\/system\/ajax":true,"\/content\/66\/3\/340":true},"ws_fl":{"width":100,"height":21},"ws_gpo":{"size":"","annotation":"","lang":"","callback":"","width":300},"highwire_search_similar_articles":{"highwire-search-similar-articles-list-1":{"conf":{"context":"requiredcontext_entity:node_1","override_title":1,"override_title_text":"\u003Ci class=\u0022icon-caret-right\u0022\u003E\u003C\/i\u003E Similar Articles","number_per_page":"5","show_pager":0,"more_link_path":"similar\/articles","more_link":1,"empty_message":"No similar articles are available.","citation_style":"jcore_standard","title_type":"prefer_short","title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","display_original_link":0,"display_access_indicator":0,"display_cme_link":0,"display_access_indicator_text":0,"display_highlight_image":"0","display_variants":0,"display_supplements":0,"display_abstract_tooltip":0,"display_author_tooltip":0,"override_title_heading":"h2","citation_settings_source":"citation_manager","citation_manager_wrapper":{"citation_manager_citation":"jcore_list_title_only"},"corpus_config_wrapper":{"corpus_config_citation_context":[]},"cache_enabled":1,"cache_time":"600","short_title_options":{"char_count":"50","add_ellipsis":0},"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"highlight_image_style":"","featured_image_variant":"large","featured_image_click_image":"colorbox","display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":0,"display_ads_search_tooltip":0,"display_agricola_tooltip":0,"author_site_search_path":"","display_translations":0,"display_translations_text":"","display_translations_text_icon":"","bundle_overrides_checkboxes":{"highwire_book_fragment":{"selector":0},"highwire_news_story":{"selector":0},"highwire_book_edition":{"selector":0},"highwire_article":{"selector":0},"highwire_issue":{"selector":0},"highwire_comment":{"selector":0},"highwire_fragment":{"selector":0},"highwire_book_section":{"selector":0},"highwire_journal":{"selector":0}},"bundle_overrides":{"highwire_book_fragment":{"selector":0,"citation_style":"jcore_title_and_author","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":"0","access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"thumbnail","display_fragment_caption":1,"display_parent_citation":1,"parent_citation_type":"highwire_book_section","parent_citation_settings":{"citation_style":"folio_book_sections_standard","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"author_site_search_path":"search\/"}},"highwire_news_story":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":"0","highlight_image_style":"","featured_image_click_image":"nothing","display_author_tooltip":0,"display_google_scholar_tooltip":0,"display_pubmed_tooltip":0,"display_advanced_search_tooltip":0},"highwire_book_edition":{"selector":0,"citation_style":"folio_books_standard","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":1,"author_site_search_path":"search\/"},"highwire_article":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":0,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":"0","highlight_image_style":"","featured_image_variant":"large","featured_image_click_image":"nothing","display_cme_link":0,"display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":1,"display_ads_search_tooltip":0,"display_agricola_tooltip":0,"author_site_search_path":"search\/","display_translations":0,"display_translations_text":"Translations Available","display_translations_text_icon":"icon-globe"},"highwire_issue":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","featured_image_click_image":"nothing","display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"display_orcid_tooltip":1,"author_site_search_path":"search\/"},"highwire_comment":{"selector":0,"citation_style":"highwire_comment","show_title":0,"title_as_link":0,"title_as_link_type":"tab_view","author_format_type":"fullname","author_format_custom":"","author_list_separator":", ","date_format":"(j F Y)","display_comment_body":1,"display_attachment":1,"display_conflict_of_interest":1},"highwire_fragment":{"selector":0,"citation_style":"jcore_title_and_author","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":"0","access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_fragment_caption":1,"fragment_image_settings":{"fragment_image_variant":"medium","fragment_click_image":"colorbox","show_download_links":1},"display_parent_citation":1,"parent_citation_type":"highwire_article","parent_citation_settings":{"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":0,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":"0","highlight_image_style":"","featured_image_variant":"large","featured_image_click_image":"nothing","display_cme_link":0,"display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":1,"display_orcid_tooltip":1,"display_ads_search_tooltip":0,"display_agricola_tooltip":0,"author_site_search_path":"search\/","display_translations":0,"display_translations_text":"Translations Available","display_translations_text_icon":"icon-globe"}},"highwire_book_section":{"selector":0,"citation_style":"folio_book_sections_standard","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_abstract_tooltip":0,"display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"author_site_search_path":"search\/"},"highwire_journal":{"selector":0,"citation_style":"mla","cache_enabled":1,"cache_time":"600","title_type":"full","short_title_options":{"char_count":"50","add_ellipsis":0},"title_as_link":0,"display_subtitle":0,"choose_pubdate":"ppubdate","display_markup_snippet":"","highlight_image_toggle":0,"display_original_link":0,"display_access_indicator":0,"access_indicator_settings":{"open_access":{"icon":"icon-unlock","title":"Open Access"},"user_access":{"icon":"icon-ok-sign","title":"You have access"},"no_access":{"icon":"icon-lock","title":"Restricted access"}},"display_variants":0,"display_supplements":0,"pdf_download":{"display_pdf_download":0,"pdf_download_icon":"icon-cloud-download","pdf_download_text":"PDF"},"include_on_behalf":1,"cpath_prefix":"\/content","show_mark_citation":0,"display_infotrieve_link":0,"infotrieve_link_settings":{"icon":"icon-usd","link_caption":"Order full text via Infotrieve"},"display_highlight_image":0,"highlight_image_style":"","display_author_tooltip":0,"display_google_scholar_tooltip":1,"display_pubmed_tooltip":1,"display_advanced_search_tooltip":1,"display_author_landing_page_tooltip":0,"display_orcid_tooltip":1,"author_site_search_path":"search\/"}},"cpath_prefix":"\/content","ajax_loading_icon_classes":"icon-spinner icon-spin icon-2x","ajax_loading_text":"","highlight_image_toggle":0,"more_link_label":"See more","url_parameters":{"q":"node\/125868"}},"nid":"125868"}},"panels_accordion":{"highwire_article_accordion_container":{"heightStyle":"content","autoHeight":false,"collapsible":0,"region_accordion_id":"highwire_article_accordion_container","active":0,"animated":"slide"}},"color":{"logo":"https:\/\/jnm.snmjournals.org\/sites\/default\/files\/jnm_256x115_0.png"},"HighWireFoxycart":{"link_text":"Add to Cart (%short-price)","link_icon":""},"nice_menus_options":{"delay":800,"speed":"fast"},"eu_cookie_compliance":{"popup_enabled":true,"popup_agreed_enabled":false,"popup_hide_agreed":false,"popup_clicking_confirmation":true,"popup_scrolling_confirmation":false,"popup_html_info":"\u003Cdiv\u003E\n \u003Cdiv class=\u0022popup-content info\u0022\u003E\n \u003Cdiv id=\u0022popup-text\u0022\u003E\n \u003Ch2\u003EWe use cookies on this site to enhance your user experience\u003C\/h2\u003E\u003Cp\u003EBy clicking any link on this page you are giving your consent for us to set cookies.\u003C\/p\u003E \u003C\/div\u003E\n \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022OK, I agree\u0022\n class=\u0022agree-button eu-cookie-compliance-default-button\u0022\u003EOK, I agree\u003C\/button\u003E\n \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022More info\u0022\n class=\u0022find-more-button eu-cookie-compliance-more-button\u0022\u003EMore info\u003C\/button\u003E\n \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E","use_mobile_message":false,"mobile_popup_html_info":"\u003Cdiv\u003E\n \u003Cdiv class=\u0022popup-content info\u0022\u003E\n \u003Cdiv id=\u0022popup-text\u0022\u003E\n \u003C\/div\u003E\n \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022OK, I agree\u0022\n class=\u0022agree-button eu-cookie-compliance-default-button\u0022\u003EOK, I agree\u003C\/button\u003E\n \u003Cbutton type=\u0022button\u0022 role=\u0022dialog\u0022 aria-labelledby=\u0022More info\u0022\n class=\u0022find-more-button eu-cookie-compliance-more-button\u0022\u003EMore info\u003C\/button\u003E\n \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E","mobile_breakpoint":"768","popup_html_agreed":"\u003Cdiv\u003E\n \u003Cdiv class=\u0022popup-content agreed\u0022\u003E\n \u003Cdiv id=\u0022popup-text\u0022\u003E\n \u003Ch2\u003EThank you for accepting cookies\u003C\/h2\u003E\u003Cp\u003EYou can now hide this message or find out more about cookies.\u003C\/p\u003E \u003C\/div\u003E\n \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n \u003Cbutton type=\u0022button\u0022 class=\u0022hide-popup-button eu-cookie-compliance-hide-button\u0022\u003EHide\u003C\/button\u003E\n \u003Cbutton type=\u0022button\u0022 class=\u0022find-more-button eu-cookie-compliance-more-button-thank-you\u0022 \u003EMore info\u003C\/button\u003E\n \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E","popup_use_bare_css":false,"popup_height":"auto","popup_width":"100%","popup_delay":1000,"popup_link":"\/help\/cookie-policy","popup_link_new_window":1,"popup_position":null,"popup_language":"en","store_consent":false,"better_support_for_screen_readers":0,"reload_page":0,"domain":"","popup_eu_only_js":0,"cookie_lifetime":365,"cookie_session":false,"disagree_do_not_show_popup":0,"method":"default","whitelisted_cookies":"","withdraw_markup":"\u003Cbutton type=\u0022button\u0022 class=\u0022eu-cookie-withdraw-tab\u0022\u003EPrivacy settings\u003C\/button\u003E\n\u003Cdiv class=\u0022eu-cookie-withdraw-banner\u0022\u003E\n \u003Cdiv class=\u0022popup-content info\u0022\u003E\n \u003Cdiv id=\u0022popup-text\u0022\u003E\n \u003Ch2\u003EWe use cookies on this site to enhance your user experience\u003C\/h2\u003E\u003Cp\u003EYou have given your consent for us to set cookies.\u003C\/p\u003E \u003C\/div\u003E\n \u003Cdiv id=\u0022popup-buttons\u0022\u003E\n \u003Cbutton type=\u0022button\u0022 class=\u0022eu-cookie-withdraw-button\u0022\u003EWithdraw consent\u003C\/button\u003E\n \u003C\/div\u003E\n \u003C\/div\u003E\n\u003C\/div\u003E\n","withdraw_enabled":false},"highwireResponsive":{"enquire_enabled":1,"breakpoints_configured":1,"breakpoints":{"zero":"all and (min-width: 0px)","xsmall":"all and (min-width: 380px)","narrow":"all and (min-width: 768px) and (min-device-width: 768px), (max-device-width: 800px) and (min-width: 768px) and (orientation:landscape)","normal":"all and (min-width: 980px) and (min-device-width: 980px), all and (max-device-width: 1024px) and (min-width: 1024px) and (orientation:landscape)","wide":"all and (min-width: 1220px)"}},"omega":{"layouts":{"primary":"normal","order":["narrow","normal","wide"],"queries":{"narrow":"all and (min-width: 768px) and (min-device-width: 768px), (max-device-width: 800px) and (min-width: 768px) and (orientation:landscape)","normal":"all and (min-width: 980px) and (min-device-width: 980px), all and (max-device-width: 1024px) and (min-width: 1024px) and (orientation:landscape)","wide":"all and (min-width: 1220px)"}}}}); //--><!]]> </script> <!--[if lt IE 9]><script src="http://html5shiv.googlecode.com/svn/trunk/html5.js"></script><![endif]--> </head> <body class="html not-front not-logged-in page-node page-node- page-node-125868 node-type-highwire-article context-content hw-default-jcode-jnumed hw-article-type-research-article hw-article-category-the-state-of-the-art"> <div id="skip-link"> <a href="#main-content" class="element-invisible element-focusable">Skip to main content</a> </div> <div class="region region-page-top" id="region-page-top"> <div class="region-inner region-page-top-inner"> </div> </div> <div class="page clearfix footer-borders panels-page panels-layout-jcore_2col" id="page"> <header id="section-header" class="section section-header"> <div id="zone-advertising-top-wrapper" class="zone-wrapper zone-advertising-top-wrapper clearfix"> <div id="zone-advertising-top" class="zone zone-advertising-top clearfix container-30"> <div class="grid-28 suffix-1 prefix-1 region region-ad-top" id="region-ad-top"> <div class="region-inner region-ad-top-inner"> <div class="block block-panels-mini block-dfp-top-leaderboard block-panels-mini-dfp-top-leaderboard odd block-without-title" id="block-panels-mini-dfp-top-leaderboard"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-dfp_top_leaderboard"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-block pane-dfp-jnm-728x90-top-leaderboard text-center pane-dfp" > <div class="pane-content"> <div id="dfp-ad-jnm_728x90_top_leaderboard-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-jnm_728x90_top_leaderboard" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-jnm_728x90_top_leaderboard"); }); </script> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div><div id="zone-superheader-wrapper" class="zone-wrapper zone-superheader-wrapper clearfix mobile-only print-hidden"> <div id="zone-superheader" class="zone zone-superheader clearfix mobile-only print-hidden container-30"> <div class="grid-30 region region-superheader" id="region-superheader"> <div class="region-inner region-superheader-inner"> <div class="block block-panels-mini block-responsive-menu block-panels-mini-responsive-menu odd block-without-title" id="block-panels-mini-responsive-menu"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu"> <div class="panel-panel panel-col"> <div><div id="unique-id3" class="highwire-responsive-toggle-group"><div class="panel-pane pane-panels-mini pane-responsive-menu-main-menu" > <h2 class="pane-title"><span class="icon-reorder"></span><span class="element-invisible">Main menu</span></h2> <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu_main_menu"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-menu-tree pane-main-menu" > <div class="pane-content"> <div class="menu-block-wrapper menu-block-ctools-main-menu-1 menu-name-main-menu parent-mlid-main-menu:0 menu-level-1"> <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-737" role="menuitem"><a href="/" data-hide-link-title="0" class="" data-icon-position="">Home </a></li> <li class="expanded active-trail menu-mlid-738" role="menuitem"><a href="/content/current" class="active-trail link-icon-right link-icon"><span class="title">Content</span> <span class="icon-caret-down mobile-hidden"></span></a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first expanded active-trail menu-mlid-739" role="menuitem"><a href="/content/current" class="active active-trail" data-icon-position="" data-hide-link-title="0">Current</a></li> <li class="leaf menu-mlid-740" role="menuitem"><a href="/content/early/recent" class="" data-icon-position="" data-hide-link-title="0">Ahead of print</a></li> <li class="leaf menu-mlid-741" role="menuitem"><a href="/content/by/volume" data-hide-link-title="0" class="" data-icon-position="">Past Issues</a></li> <li class="leaf menu-mlid-1046" role="menuitem"><a href="https://jnm.snmjournals.org/content/65/Supplement_1" data-hide-link-title="0" title="JNM Supplement" class="" data-icon-position="">JNM Supplement</a></li> <li class="leaf menu-mlid-1045" role="menuitem"><a href="/content/snmmi-annual-meeting-abstracts" data-hide-link-title="0" title="SNMMI Annual Meeting Abstracts" class="" data-icon-position="">SNMMI Annual Meeting Abstracts</a></li> <li class="leaf menu-mlid-974" role="menuitem"><a href="https://www.snmmilearningcenter.org/" data-hide-link-title="0" target="_blank" class="" data-icon-position="">Continuing Education</a></li> <li class="last leaf menu-mlid-1214" role="menuitem"><a href="/page/podcasts" data-hide-link-title="0" class="" data-icon-position="">JNM Podcasts</a></li> </ul></nav></li> <li class="expanded menu-mlid-977" role="menuitem"><a href="/user?current=node/125868" class="link-icon-right link-icon"><span class="title">Subscriptions</span> <span class="icon-caret-down mobile-hidden"></span></a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-745" role="menuitem"><a href="/user?current=node/125868" data-hide-link-title="0" class="" data-icon-position="">Subscribers</a></li> <li class="leaf menu-mlid-1165" role="menuitem"><a href="/page/subscriptions/institutional" data-hide-link-title="0" title="Institutional and Non-member Subscribers" class="" data-icon-position="">Institutional and Non-member</a></li> <li class="leaf menu-mlid-1217" role="menuitem"><a href="https://snmmi.org/Web/Research-Publications/Journals/Subscribe-To-The-Journals.aspx" data-hide-link-title="0" class="" data-icon-position="">Rates</a></li> <li class="leaf menu-mlid-1220" role="menuitem"><a href="/content/claims" data-hide-link-title="0" class="" data-icon-position="">Journal Claims</a></li> <li class="last leaf menu-mlid-973" role="menuitem"><a href="/content/corporate-special-sales" data-hide-link-title="0" title="Corporate & Special Sales" class="" data-icon-position="">Corporate & Special Sales</a></li> </ul></nav></li> <li class="expanded menu-mlid-743" role="menuitem"><a href="/authors" class="link-icon-right link-icon"><span class="title">Authors</span> <span class="icon-caret-down mobile-hidden"></span></a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-985" role="menuitem"><a href="https://submit-jnm.snmjournals.org/#submit" data-hide-link-title="0" title="Submit to JNM" class="" data-icon-position="">Submit to JNM</a></li> <li class="leaf menu-mlid-984" role="menuitem"><a href="/authors" data-hide-link-title="0" title="Information for Authors" class="" data-icon-position="">Information for Authors</a></li> <li class="leaf menu-mlid-1216" role="menuitem"><a href="/copyright" data-hide-link-title="0" class="" data-icon-position="">Assignment of Copyright</a></li> <li class="last leaf menu-mlid-986" role="menuitem"><a href="https://jnm.snmjournals.org/AQARA#aqara" data-hide-link-title="0" title="AQARA requirements" class="" data-icon-position="">AQARA requirements</a></li> </ul></nav></li> <li class="expanded menu-mlid-742" role="menuitem"><a href="/page/permissions" class="link-icon-right link-icon"><span class="title">Info</span> <span class="icon-caret-down mobile-hidden"></span></a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-1215" role="menuitem"><a href="/page/reviewers" data-hide-link-title="0" title="Reviewers" class="" data-icon-position="">Reviewers</a></li> <li class="leaf menu-mlid-972" role="menuitem"><a href="/page/permissions" data-hide-link-title="0" title="Permissions" class="" data-icon-position="">Permissions</a></li> <li class="last leaf menu-mlid-747" role="menuitem"><a href="/content/advertisers" data-hide-link-title="0" class="" data-icon-position="">Advertisers</a></li> </ul></nav></li> <li class="expanded menu-mlid-749" role="menuitem"><a href="/content/about-us" class="link-icon-right link-icon"><span class="title">About</span> <span class="icon-caret-down mobile-hidden"></span></a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-750" role="menuitem"><a href="/content/about-us" class="" data-icon-position="" data-hide-link-title="0">About Us</a></li> <li class="leaf menu-mlid-752" role="menuitem"><a href="/content/journal-nuclear-medicine-jnm-editorial-board" data-hide-link-title="0" class="" data-icon-position="">Editorial Board</a></li> <li class="last leaf menu-mlid-979" role="menuitem"><a href="/content/contact-information" data-hide-link-title="0" class="" data-icon-position="">Contact Information</a></li> </ul></nav></li> <li class="last expanded menu-mlid-753" role="menuitem"><a href="/content/advertising" class="link-icon-right link-icon"><span class="title">More</span> <span class="icon-caret-down mobile-hidden"></span></a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-755" role="menuitem"><a href="/alerts" class="" data-icon-position="" data-hide-link-title="0">Alerts</a></li> <li class="leaf menu-mlid-756" role="menuitem"><a href="/feedback" class="" data-icon-position="" data-hide-link-title="0">Feedback</a></li> <li class="leaf menu-mlid-758" role="menuitem"><a href="/content/help" data-hide-link-title="0" class="" data-icon-position="">Help</a></li> <li class="last leaf menu-mlid-980" role="menuitem"><a href="http://www.snmjournals.org/" data-hide-link-title="0" title="SNMMI Journals" target="_blank" class="" data-icon-position="">SNMMI Journals</a></li> </ul></nav></li> </ul></nav></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-menu-tree pane-umbrella-menu" > <div class="pane-content"> <div class="menu-block-wrapper menu-block-ctools-umbrella-menu-1 menu-name-umbrella-menu parent-mlid-umbrella-menu:0 menu-level-1"> <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first last expanded menu-mlid-731" role="menuitem"><a href="http://www.snmmi.org/" data-hide-link-title="0" class="" data-icon-position="">SNMMI</a><nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-732" role="menuitem"><a href="/" data-hide-link-title="0" class="" data-icon-position="">JNM</a></li> <li class="leaf menu-mlid-981" role="menuitem"><a href="http://tech.snmjournals.org/" data-hide-link-title="0" title="JNMT" class="" data-icon-position="">JNMT</a></li> <li class="leaf menu-mlid-982" role="menuitem"><a href="http://www.snmjournals.org/" data-hide-link-title="0" title="SNMMI Journals" class="" data-icon-position="">SNMMI Journals</a></li> <li class="last leaf menu-mlid-1158" role="menuitem"><a href="http://www.snmmi.org/" data-hide-link-title="0" target="_blank" class="" data-icon-position="">SNMMI</a></li> </ul></nav></li> </ul></nav></div> </div> </div> </div> </div> </div> </div> </div> <div class="panel-pane pane-panels-mini pane-responsive-menu-user-menu" > <h2 class="pane-title"><span class="icon-gear"></span><span class="element-invisible">User menu</span></h2> <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu_user_menu"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-menu-tree pane-user-menu" > <div class="pane-content"> <div class="menu-block-wrapper menu-block-ctools-user-menu-1 menu-name-user-menu parent-mlid-user-menu:0 menu-level-1"> <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf menu-mlid-765" role="menuitem"><a href="http://www.snmmi.org/NewsPublications/content.aspx?ItemNumber=5758&navItemNumber=682" data-hide-link-title="0" title="Subscribe" class="" data-icon-position="">Subscribe</a></li> <li class="leaf menu-mlid-766" role="menuitem"><a href="/alerts" class="" data-icon-position="" data-hide-link-title="0">My alerts</a></li> <li class="leaf menu-mlid-767" role="menuitem"><a href="/user/login?destination=/content/66/3/340" class="" data-icon-position="" data-hide-link-title="0">Log in</a></li> <li class="last leaf menu-mlid-999" role="menuitem"><a href="/cart" class="link-icon-only link-icon"><span class="icon-shopping-cart"></span> <span class="title element-invisible">My Cart</span></a></li> </ul></nav></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-user-identities" > <div class="pane-content"> <div class="highwire-user-message" data-separator="|"><span class="highwire-user-institution" data-id-type="institution" data-identity="a%3A2%3A%7Bs%3A4%3A%22show%22%3Bi%3A1%3Bs%3A7%3A%22message%22%3Bs%3A50%3A%22Institution%3A%20%5Bidentity%3Ainstitutional_display_name%5D%22%3B%7D"></span></div> </div> </div> </div> </div> </div> </div> </div> <div class="panel-pane pane-panels-mini pane-responsive-menu-search" > <h2 class="pane-title"><span class="icon-search"></span><span class="element-invisible">Search</span></h2> <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-responsive_menu_search"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-seach-qsearch-nocontext" > <div class="pane-content"> <form class="highwire-quicksearch button-style-mini button-style-mini" action="/content/66/3/340" method="post" id="highwire-search-qsearch-nocontext-form" accept-charset="UTF-8"><div><div class="form-item form-item-label-invisible form-type-textfield form-item-keywords"> <label class="element-invisible" for="quick_search_header_keywords_1100124946">Search for this keyword </label> <input placeholder="Search..." type="text" id="quick_search_header_keywords_1100124946" name="keywords" value="" size="60" maxlength="128" class="form-text" /> </div> <div class="button-wrapper button-mini"><span class="icon-search"></span><input data-icon-only="1" data-font-icon="icon-search" data-icon-position="after" type="submit" id="quick_search_header_submit_733810377" name="op" value="Search" class="form-submit" /></div><input type="hidden" name="form_build_id" value="form-aTRJSMJCid9bzUqU2ScU-GINGdn_FN-25nU3M9ZPMi8" /> <input type="hidden" name="form_id" value="highwire_search_qsearch_nocontext_form" /> </div></form> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-1 highwire-responsive-advanced-search-link pane-menu-tree" > <div class="pane-content"> <ul class="menu"> <li><a href="/search" title="Advanced search">Advanced search</a></li> </ul> </div> </div> </div> </div> </div> </div> </div> </div></div> </div> </div> </div> </div> </div><div class="block block-panels-mini block-hw-small-logo block-panels-mini-hw-small-logo even block-without-title" id="block-panels-mini-hw-small-logo"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-hw_small_logo"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-small-logo" > <div class="pane-content"> <a href="/" class="" data-icon-position="" data-hide-link-title="0"><img src="https://jnm.snmjournals.org/sites/default/files/jnm_256x115_1.png" alt="Journal of Nuclear Medicine" title="Journal of Nuclear Medicine" /></a> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div><div id="zone-user-wrapper" class="zone-wrapper zone-user-wrapper clearfix mobile-hidden print-hidden"> <div id="zone-user" class="zone zone-user clearfix equal-height-container mobile-hidden print-hidden container-30"> <div class="grid-10 region region-user-first equal-height-element" id="region-user-first"> <div class="region-inner region-user-first-inner"> <div class="block block-nice-menus block-2 block-nice-menus-2 odd block-without-title" id="block-nice-menus-2"> <div class="block-inner clearfix"> <div class="content clearfix user-menu-dropdown user-menu-dropdown-logo user-menu-dropdown-logo-only"> <nav class="menubar-nav"><ul class="nice-menu nice-menu-down nice-menu-umbrella-menu" id="nice-menu-2" role="menu"><li class="menu-731 menuparent menu-path-snmmiorg- first odd last" role="menuitem"><a href="http://www.snmmi.org/" data-hide-link-title="0" class="" data-icon-position="">SNMMI</a><ul role="menu"><li class="menu-732 menu-path-front first odd " role="menuitem"><a href="/" data-hide-link-title="0" class="" data-icon-position="">JNM</a></li> <li class="menu-981 menu-path-techsnmjournalsorg- even " role="menuitem"><a href="http://tech.snmjournals.org/" data-hide-link-title="0" title="JNMT" class="" data-icon-position="">JNMT</a></li> <li class="menu-982 menu-path-snmjournalsorg- odd " role="menuitem"><a href="http://www.snmjournals.org/" data-hide-link-title="0" title="SNMMI Journals" class="" data-icon-position="">SNMMI Journals</a></li> <li class="menu-1158 menu-path-snmmiorg- even last" role="menuitem"><a href="http://www.snmmi.org/" data-hide-link-title="0" target="_blank" class="" data-icon-position="">SNMMI</a></li> </ul></li> </ul></nav> </div> </div> </div> </div> </div><div class="grid-20 region region-user-second equal-height-element" id="region-user-second"> <div class="region-inner region-user-second-inner"> <div class="block block-panels-mini highwire-uid-string block-jnl-snm-uid-strng block-panels-mini-jnl-snm-uid-strng odd block-without-title" id="block-panels-mini-jnl-snm-uid-strng"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_uid_strng"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-user-identities" > <div class="pane-content"> <div class="highwire-user-message" data-separator=" | "><span class="highwire-user-institution" data-id-type="institution" data-identity="a%3A2%3A%7Bs%3A4%3A%22show%22%3Bi%3A1%3Bs%3A7%3A%22message%22%3Bs%3A85%3A%22%3Cspan%20class%3D%22narrow-hidden%22%3EInstitution%3A%20%3C%2Fspan%3E%5Bidentity%3Ainstitutional_display_name%5D%22%3B%7D"></span></div> </div> </div> <div class="panel-pane pane-block pane-system-user-menu links inline pane-system" > <div class="pane-content"> <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf" role="menuitem"><a href="http://www.snmmi.org/NewsPublications/content.aspx?ItemNumber=5758&navItemNumber=682" data-hide-link-title="0" title="Subscribe" class="" data-icon-position="">Subscribe</a></li> <li class="leaf" role="menuitem"><a href="/alerts" class="" data-icon-position="" data-hide-link-title="0">My alerts</a></li> <li class="leaf" role="menuitem"><a href="/user/login?destination=/content/66/3/340" class="" data-icon-position="" data-hide-link-title="0">Log in</a></li> <li class="last leaf" role="menuitem"><a href="/cart" class="link-icon-only link-icon"><span class="icon-shopping-cart"></span> <span class="title element-invisible">My Cart</span></a></li> </ul></nav> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div id="zone-branding" class="zone zone-branding clearfix mobile-hidden print-display-block container-30"> <div class="grid-19 prefix-1 region region-branding print-display-block" id="region-branding"> <div class="region-inner region-branding-inner"> <div class="branding-data clearfix"> <div class="logo-img"> <a href="/" rel="home" class="" data-icon-position="" data-hide-link-title="0"><img alt="Journal of Nuclear Medicine" src="https://jnm.snmjournals.org/sites/default/files/jnm_256x115_0.png" /></a> </div> </div> </div> </div><div class="grid-9 suffix-1 region region-branding-second print-hidden" id="region-branding-second"> <div class="region-inner region-branding-second-inner"> <div class="block block-panels-mini block-jnl-snm-search-box block-panels-mini-jnl-snm-search-box odd block-without-title" id="block-panels-mini-jnl-snm-search-box"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_search_box"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-seach-qsearch-nocontext no-margin-bottom" > <div class="pane-content"> <form class="highwire-quicksearch button-style-mini button-style-mini" action="/content/66/3/340" method="post" id="highwire-search-qsearch-nocontext-form--2" accept-charset="UTF-8"><div><div class="form-item form-item-label-invisible form-type-textfield form-item-keywords"> <label class="element-invisible" for="quick_search_header_keywords_305508002">Search for this keyword </label> <input placeholder="search" type="text" id="quick_search_header_keywords_305508002" name="keywords" value="" size="60" maxlength="128" class="form-text" /> </div> <div class="button-wrapper button-mini"><span class="icon-search"></span><input data-icon-only="1" data-font-icon="icon-search" data-icon-position="after" type="submit" id="quick_search_header_submit_850879422" name="op" value="Search" class="form-submit" /></div><input type="hidden" name="form_build_id" value="form-zhqsZh81iTz5Lvrx7cGUlagwzeqslArHukHict4qu8o" /> <input type="hidden" name="form_id" value="highwire_search_qsearch_nocontext_form" /> </div></form> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-custom pane-2" > <div class="pane-content"> <p><a href="/search">Advanced Search</a></p> </div> </div> </div> </div> </div> </div> </div> </div><div class="block block-gtranslate block-gtranslate block-gtranslate-gtranslate even block-without-title" id="block-gtranslate-gtranslate"> <div class="block-inner clearfix"> <div class="content clearfix"> <script type="text/javascript"> /* <![CDATA[ */ eval(unescape("eval%28function%28p%2Ca%2Cc%2Ck%2Ce%2Cr%29%7Be%3Dfunction%28c%29%7Breturn%28c%3Ca%3F%27%27%3Ae%28parseInt%28c/a%29%29%29+%28%28c%3Dc%25a%29%3E35%3FString.fromCharCode%28c+29%29%3Ac.toString%2836%29%29%7D%3Bif%28%21%27%27.replace%28/%5E/%2CString%29%29%7Bwhile%28c--%29r%5Be%28c%29%5D%3Dk%5Bc%5D%7C%7Ce%28c%29%3Bk%3D%5Bfunction%28e%29%7Breturn%20r%5Be%5D%7D%5D%3Be%3Dfunction%28%29%7Breturn%27%5C%5Cw+%27%7D%3Bc%3D1%7D%3Bwhile%28c--%29if%28k%5Bc%5D%29p%3Dp.replace%28new%20RegExp%28%27%5C%5Cb%27+e%28c%29+%27%5C%5Cb%27%2C%27g%27%29%2Ck%5Bc%5D%29%3Breturn%20p%7D%28%276%207%28a%2Cb%29%7Bn%7B4%282.9%29%7B3%20c%3D2.9%28%22o%22%29%3Bc.p%28b%2Cf%2Cf%29%3Ba.q%28c%29%7Dg%7B3%20c%3D2.r%28%29%3Ba.s%28%5C%27t%5C%27+b%2Cc%29%7D%7Du%28e%29%7B%7D%7D6%20h%28a%29%7B4%28a.8%29a%3Da.8%3B4%28a%3D%3D%5C%27%5C%27%29v%3B3%20b%3Da.w%28%5C%27%7C%5C%27%29%5B1%5D%3B3%20c%3B3%20d%3D2.x%28%5C%27y%5C%27%29%3Bz%283%20i%3D0%3Bi%3Cd.5%3Bi++%294%28d%5Bi%5D.A%3D%3D%5C%27B-C-D%5C%27%29c%3Dd%5Bi%5D%3B4%282.j%28%5C%27k%5C%27%29%3D%3DE%7C%7C2.j%28%5C%27k%5C%27%29.l.5%3D%3D0%7C%7Cc.5%3D%3D0%7C%7Cc.l.5%3D%3D0%29%7BF%286%28%29%7Bh%28a%29%7D%2CG%29%7Dg%7Bc.8%3Db%3B7%28c%2C%5C%27m%5C%27%29%3B7%28c%2C%5C%27m%5C%27%29%7D%7D%27%2C43%2C43%2C%27%7C%7Cdocument%7Cvar%7Cif%7Clength%7Cfunction%7CGTranslateFireEvent%7Cvalue%7CcreateEvent%7C%7C%7C%7C%7C%7Ctrue%7Celse%7CdoGTranslate%7C%7CgetElementById%7Cgoogle_translate_element2%7CinnerHTML%7Cchange%7Ctry%7CHTMLEvents%7CinitEvent%7CdispatchEvent%7CcreateEventObject%7CfireEvent%7Con%7Ccatch%7Creturn%7Csplit%7CgetElementsByTagName%7Cselect%7Cfor%7CclassName%7Cgoog%7Cte%7Ccombo%7Cnull%7CsetTimeout%7C500%27.split%28%27%7C%27%29%2C0%2C%7B%7D%29%29")) /* ]]> */ </script><style type="text/css"> <!-- #goog-gt-tt {display:none !important;} .goog-te-banner-frame {display:none !important;} .goog-te-menu-value:hover {text-decoration:none !important;} body {top:0 !important;} #google_translate_element2 {display:none!important;} --> </style><div id="google_translate_element2"></div> <script type="text/javascript">function googleTranslateElementInit2() {new google.translate.TranslateElement({pageLanguage: 'en', autoDisplay: false}, 'google_translate_element2');}</script> <script type="text/javascript" src="//translate.google.com/translate_a/element.js?cb=googleTranslateElementInit2"></script><select onchange="doGTranslate(this);"><option value="">Select Language</option><option value="en|en" style="font-weight:bold;background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -0px;padding-left:18px;">English</option><option value="en|af" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -688px;padding-left:18px;">Afrikaans</option><option value="en|sq" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -560px;padding-left:18px;">Albanian</option><option value="en|am" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1456px;padding-left:18px;">Amharic</option><option value="en|ar" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -16px;padding-left:18px;">Arabic</option><option value="en|hy" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -832px;padding-left:18px;">Armenian</option><option value="en|az" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -848px;padding-left:18px;">Azerbaijani</option><option value="en|eu" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -864px;padding-left:18px;">Basque</option><option value="en|be" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -768px;padding-left:18px;">Belarusian</option><option value="en|bn" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -928px;padding-left:18px;">Bengali</option><option value="en|bs" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -944px;padding-left:18px;">Bosnian</option><option value="en|bg" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -32px;padding-left:18px;">Bulgarian</option><option value="en|ca" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -384px;padding-left:18px;">Catalan</option><option value="en|ceb" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -960px;padding-left:18px;">Cebuano</option><option value="en|ny" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1312px;padding-left:18px;">Chichewa</option><option value="en|zh-CN" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -48px;padding-left:18px;">Chinese (Simplified)</option><option value="en|zh-TW" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -64px;padding-left:18px;">Chinese (Traditional)</option><option value="en|co" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1472px;padding-left:18px;">Corsican</option><option value="en|hr" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -80px;padding-left:18px;">Croatian</option><option value="en|cs" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -96px;padding-left:18px;">Czech</option><option value="en|da" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -112px;padding-left:18px;">Danish</option><option value="en|nl" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -128px;padding-left:18px;">Dutch</option><option value="en|eo" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -976px;padding-left:18px;">Esperanto</option><option value="en|et" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -576px;padding-left:18px;">Estonian</option><option value="en|tl" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -400px;padding-left:18px;">Filipino</option><option value="en|fi" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -144px;padding-left:18px;">Finnish</option><option value="en|fr" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -160px;padding-left:18px;">French</option><option value="en|fy" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1632px;padding-left:18px;">Frisian</option><option value="en|gl" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -592px;padding-left:18px;">Galician</option><option value="en|ka" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -880px;padding-left:18px;">Georgian</option><option value="en|de" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -176px;padding-left:18px;">German</option><option value="en|el" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -192px;padding-left:18px;">Greek</option><option value="en|gu" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -992px;padding-left:18px;">Gujarati</option><option value="en|ht" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -896px;padding-left:18px;">Haitian Creole</option><option value="en|ha" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1008px;padding-left:18px;">Hausa</option><option value="en|haw" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1488px;padding-left:18px;">Hawaiian</option><option value="en|iw" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -416px;padding-left:18px;">Hebrew</option><option value="en|hi" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -208px;padding-left:18px;">Hindi</option><option value="en|hmn" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1024px;padding-left:18px;">Hmong</option><option value="en|hu" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -608px;padding-left:18px;">Hungarian</option><option value="en|is" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -784px;padding-left:18px;">Icelandic</option><option value="en|ig" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1040px;padding-left:18px;">Igbo</option><option value="en|id" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -432px;padding-left:18px;">Indonesian</option><option value="en|ga" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -736px;padding-left:18px;">Irish</option><option value="en|it" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -224px;padding-left:18px;">Italian</option><option value="en|ja" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -240px;padding-left:18px;">Japanese</option><option value="en|jw" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1056px;padding-left:18px;">Javanese</option><option value="en|kn" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1072px;padding-left:18px;">Kannada</option><option value="en|kk" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1328px;padding-left:18px;">Kazakh</option><option value="en|km" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1088px;padding-left:18px;">Khmer</option><option value="en|ko" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -256px;padding-left:18px;">Korean</option><option value="en|ku" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1504px;padding-left:18px;">Kurdish (Kurmanji)</option><option value="en|ky" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1520px;padding-left:18px;">Kyrgyz</option><option value="en|lo" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1104px;padding-left:18px;">Lao</option><option value="en|la" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1120px;padding-left:18px;">Latin</option><option value="en|lv" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -448px;padding-left:18px;">Latvian</option><option value="en|lt" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -464px;padding-left:18px;">Lithuanian</option><option value="en|lb" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1536px;padding-left:18px;">Luxembourgish</option><option value="en|mk" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -800px;padding-left:18px;">Macedonian</option><option value="en|mg" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1344px;padding-left:18px;">Malagasy</option><option value="en|ms" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -704px;padding-left:18px;">Malay</option><option value="en|ml" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1360px;padding-left:18px;">Malayalam</option><option value="en|mt" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -624px;padding-left:18px;">Maltese</option><option value="en|mi" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1136px;padding-left:18px;">Maori</option><option value="en|mr" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1152px;padding-left:18px;">Marathi</option><option value="en|mn" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1168px;padding-left:18px;">Mongolian</option><option value="en|my" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1296px;padding-left:18px;">Myanmar (Burmese)</option><option value="en|ne" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1184px;padding-left:18px;">Nepali</option><option value="en|no" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -272px;padding-left:18px;">Norwegian</option><option value="en|ps" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1552px;padding-left:18px;">Pashto</option><option value="en|fa" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -672px;padding-left:18px;">Persian</option><option value="en|pl" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -288px;padding-left:18px;">Polish</option><option value="en|pt" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -304px;padding-left:18px;">Portuguese</option><option value="en|pa" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1200px;padding-left:18px;">Punjabi</option><option value="en|ro" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -320px;padding-left:18px;">Romanian</option><option value="en|ru" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -336px;padding-left:18px;">Russian</option><option value="en|sm" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1568px;padding-left:18px;">Samoan</option><option value="en|gd" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1584px;padding-left:18px;">Scottish Gaelic</option><option value="en|sr" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -480px;padding-left:18px;">Serbian</option><option value="en|st" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1392px;padding-left:18px;">Sesotho</option><option value="en|sn" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1600px;padding-left:18px;">Shona</option><option value="en|sd" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1616px;padding-left:18px;">Sindhi</option><option value="en|si" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1376px;padding-left:18px;">Sinhala</option><option value="en|sk" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -496px;padding-left:18px;">Slovak</option><option value="en|sl" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -512px;padding-left:18px;">Slovenian</option><option value="en|so" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1216px;padding-left:18px;">Somali</option><option value="en|es" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -352px;padding-left:18px;">Spanish</option><option value="en|su" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1408px;padding-left:18px;">Sudanese</option><option value="en|sw" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -720px;padding-left:18px;">Swahili</option><option value="en|sv" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -368px;padding-left:18px;">Swedish</option><option value="en|tg" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1424px;padding-left:18px;">Tajik</option><option value="en|ta" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1232px;padding-left:18px;">Tamil</option><option value="en|te" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1248px;padding-left:18px;">Telugu</option><option value="en|th" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -640px;padding-left:18px;">Thai</option><option value="en|tr" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -656px;padding-left:18px;">Turkish</option><option value="en|uk" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -528px;padding-left:18px;">Ukrainian</option><option value="en|ur" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -912px;padding-left:18px;">Urdu</option><option value="en|uz" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1440px;padding-left:18px;">Uzbek</option><option value="en|vi" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -544px;padding-left:18px;">Vietnamese</option><option value="en|cy" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -752px;padding-left:18px;">Welsh</option><option value="en|xh" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1648px;padding-left:18px;">Xhosa</option><option value="en|yi" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -816px;padding-left:18px;">Yiddish</option><option value="en|yo" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1264px;padding-left:18px;">Yoruba</option><option value="en|zu" style="background:url('/sites/all/modules/contrib/gtranslate/gtranslate-files/16l.png') no-repeat scroll 0 -1280px;padding-left:18px;">Zulu</option></select> </div> </div> </div> </div> </div> </div> <div id="zone-menu" class="zone zone-menu clearfix mobile-hidden container-30"> <div class="grid-28 suffix-1 prefix-1 region region-menu region-menu-bg-opaque region-gutters-inner main-menu-active-bg" id="region-menu"> <div class="region-inner region-menu-inner"> <div class="block block-nice-menus block-1 block-nice-menus-1 odd block-without-title" id="block-nice-menus-1"> <div class="block-inner clearfix"> <div class="content clearfix"> <nav class="menubar-nav"><ul class="nice-menu nice-menu-down nice-menu-main-menu" id="nice-menu-1" role="menu"><li class="menu-737 menu-path-front first odd " role="menuitem"><a href="/" data-hide-link-title="0" class="" data-icon-position="">Home </a></li> <li class="menu-738 menuparent menu-path-content-current active-trail even " role="menuitem"><a href="/content/current" class="link-icon-right link-icon"><span class="title">Content</span> <span class="icon-caret-down mobile-hidden"></span></a><ul role="menu"><li class="menu-739 menu-path-content-current active-trail first odd " role="menuitem"><a href="/content/current" class="active" data-icon-position="" data-hide-link-title="0">Current</a></li> <li class="menu-740 menu-path-content-early-recent even " role="menuitem"><a href="/content/early/recent" class="" data-icon-position="" data-hide-link-title="0">Ahead of print</a></li> <li class="menu-741 menu-path-content-by-volume odd " role="menuitem"><a href="/content/by/volume" data-hide-link-title="0" class="" data-icon-position="">Past Issues</a></li> <li class="menu-1046 menu-path-sjnmsnmjournalsorg-content-65-supplement-1 even " role="menuitem"><a href="https://jnm.snmjournals.org/content/65/Supplement_1" data-hide-link-title="0" title="JNM Supplement" class="" data-icon-position="">JNM Supplement</a></li> <li class="menu-1045 menu-path-node-97563 odd " role="menuitem"><a href="/content/snmmi-annual-meeting-abstracts" data-hide-link-title="0" title="SNMMI Annual Meeting Abstracts" class="" data-icon-position="">SNMMI Annual Meeting Abstracts</a></li> <li class="menu-974 menu-path-ssnmmilearningcenterorg- even " role="menuitem"><a href="https://www.snmmilearningcenter.org/" data-hide-link-title="0" target="_blank" class="" data-icon-position="">Continuing Education</a></li> <li class="menu-1214 menu-path-node-110132 odd last" role="menuitem"><a href="/page/podcasts" data-hide-link-title="0" class="" data-icon-position="">JNM Podcasts</a></li> </ul></li> <li class="menu-977 menuparent menu-path-user odd " role="menuitem"><a href="/user?current=node/125868" class="link-icon-right link-icon"><span class="title">Subscriptions</span> <span class="icon-caret-down mobile-hidden"></span></a><ul role="menu"><li class="menu-745 menu-path-user first odd " role="menuitem"><a href="/user?current=node/125868" data-hide-link-title="0" class="" data-icon-position="">Subscribers</a></li> <li class="menu-1165 menu-path-node-99812 even " role="menuitem"><a href="/page/subscriptions/institutional" data-hide-link-title="0" title="Institutional and Non-member Subscribers" class="" data-icon-position="">Institutional and Non-member</a></li> <li class="menu-1217 menu-path-ssnmmiorg-web-research-publications-journals-subscribe-to-the-journalsaspx odd " role="menuitem"><a href="https://snmmi.org/Web/Research-Publications/Journals/Subscribe-To-The-Journals.aspx" data-hide-link-title="0" class="" data-icon-position="">Rates</a></li> <li class="menu-1220 menu-path-node-122193 even " role="menuitem"><a href="/content/claims" data-hide-link-title="0" class="" data-icon-position="">Journal Claims</a></li> <li class="menu-973 menu-path-node-97560 odd last" role="menuitem"><a href="/content/corporate-special-sales" data-hide-link-title="0" title="Corporate & Special Sales" class="" data-icon-position="">Corporate & Special Sales</a></li> </ul></li> <li class="menu-743 menuparent menu-path-node-1 even " role="menuitem"><a href="/authors" class="link-icon-right link-icon"><span class="title">Authors</span> <span class="icon-caret-down mobile-hidden"></span></a><ul role="menu"><li class="menu-985 menu-path-ssubmit-jnmsnmjournalsorg- first odd " role="menuitem"><a href="https://submit-jnm.snmjournals.org/#submit" data-hide-link-title="0" title="Submit to JNM" class="" data-icon-position="">Submit to JNM</a></li> <li class="menu-984 menu-path-node-1 even " role="menuitem"><a href="/authors" data-hide-link-title="0" title="Information for Authors" class="" data-icon-position="">Information for Authors</a></li> <li class="menu-1216 menu-path-node-117062 odd " role="menuitem"><a href="/copyright" data-hide-link-title="0" class="" data-icon-position="">Assignment of Copyright</a></li> <li class="menu-986 menu-path-sjnmsnmjournalsorg-aqara even last" role="menuitem"><a href="https://jnm.snmjournals.org/AQARA#aqara" data-hide-link-title="0" title="AQARA requirements" class="" data-icon-position="">AQARA requirements</a></li> </ul></li> <li class="menu-742 menuparent menu-path-node-97559 odd " role="menuitem"><a href="/page/permissions" class="link-icon-right link-icon"><span class="title">Info</span> <span class="icon-caret-down mobile-hidden"></span></a><ul role="menu"><li class="menu-1215 menu-path-node-115482 first odd " role="menuitem"><a href="/page/reviewers" data-hide-link-title="0" title="Reviewers" class="" data-icon-position="">Reviewers</a></li> <li class="menu-972 menu-path-node-97559 even " role="menuitem"><a href="/page/permissions" data-hide-link-title="0" title="Permissions" class="" data-icon-position="">Permissions</a></li> <li class="menu-747 menu-path-node-5 odd last" role="menuitem"><a href="/content/advertisers" data-hide-link-title="0" class="" data-icon-position="">Advertisers</a></li> </ul></li> <li class="menu-749 menuparent menu-path-node-7 even " role="menuitem"><a href="/content/about-us" class="link-icon-right link-icon"><span class="title">About</span> <span class="icon-caret-down mobile-hidden"></span></a><ul role="menu"><li class="menu-750 menu-path-node-7 first odd " role="menuitem"><a href="/content/about-us" class="" data-icon-position="" data-hide-link-title="0">About Us</a></li> <li class="menu-752 menu-path-node-8 even " role="menuitem"><a href="/content/journal-nuclear-medicine-jnm-editorial-board" data-hide-link-title="0" class="" data-icon-position="">Editorial Board</a></li> <li class="menu-979 menu-path-node-97562 odd last" role="menuitem"><a href="/content/contact-information" data-hide-link-title="0" class="" data-icon-position="">Contact Information</a></li> </ul></li> <li class="menu-753 menuparent menu-path-node-9 odd last" role="menuitem"><a href="/content/advertising" class="link-icon-right link-icon"><span class="title">More</span> <span class="icon-caret-down mobile-hidden"></span></a><ul role="menu"><li class="menu-755 menu-path-alerts first odd " role="menuitem"><a href="/alerts" class="" data-icon-position="" data-hide-link-title="0">Alerts</a></li> <li class="menu-756 menu-path-node-10 even " role="menuitem"><a href="/feedback" class="" data-icon-position="" data-hide-link-title="0">Feedback</a></li> <li class="menu-758 menu-path-node-11 odd " role="menuitem"><a href="/content/help" data-hide-link-title="0" class="" data-icon-position="">Help</a></li> <li class="menu-980 menu-path-snmjournalsorg- even last" role="menuitem"><a href="http://www.snmjournals.org/" data-hide-link-title="0" title="SNMMI Journals" target="_blank" class="" data-icon-position="">SNMMI Journals</a></li> </ul></li> </ul></nav> </div> </div> </div><div class="block block-menu text-right block-menu-social-media block-menu-menu-social-media even block-without-title" id="block-menu-menu-social-media"> <div class="block-inner clearfix"> <div class="content clearfix"> <nav class="menubar-nav"><ul class="menu" role="menu"><li class="first leaf" role="menuitem"><a href="https://jnm.snmjournals.org/page/podcasts" class="link-icon-only link-icon"><span class="icon-microphone icon-2x"></span> <span class="title element-invisible">View or Listen to JNM Podcast</span></a></li> <li class="leaf" role="menuitem"><a href="https://www.facebook.com/JournalofNucMed" target="_blank" class="link-icon-only link-icon"><span class="icon-facebook-sign icon-2x"></span> <span class="title element-invisible">Visit JNM on Facebook</span></a></li> <li class="leaf" role="menuitem"><a href="https://www.linkedin.com/company/79454411/admin/" target="_blank" class="link-icon-only link-icon"><span class="icon-linkedin-sign icon-2x"></span> <span class="title element-invisible">Join JNM on LinkedIn</span></a></li> <li class="leaf" role="menuitem"><a href="https://twitter.com/JournalofNucMed" target="_blank" class="link-icon-only link-icon"><span class="hw-icon-x-twitter"></span> <span class="title element-invisible">Follow JNM on Twitter</span></a></li> <li class="last leaf" role="menuitem"><a href="https://jnm.snmjournals.org/rss" class="link-icon-only link-icon"><span class="icon-rss icon-2x"></span> <span class="title element-invisible">Subscribe to our RSS feeds</span></a></li> </ul></nav> </div> </div> </div> </div> </div> </div> <div id="zone-header" class="zone zone-header clearfix container-30"> </div> </header> <section id="section-content" class="section section-content"> <div id="zone-content" class="zone zone-content clearfix container-30"> <div class="grid-28 suffix-1 prefix-1 region region-content" id="region-content"> <div class="region-inner region-content-inner"> <a id="main-content"></a> <div class="block block-system block-main block-system-main odd block-without-title" id="block-system-main"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panels-960-layout jcore-2col-layout" > <div class="panel-row-wrapper panel-row-first clearfix"> <div class="top-wrapper"> <div class="panel-panel panel-region-top"> <div class="inside"><div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node125868" data-node-nid="125868" id="top-node-125868--2287027387" data-pisa="jnumed;66/3/340" data-pisa-master="jnumed;jnumed.124.268928" data-apath="/jnumed/66/3/340.atom" data-hw-author-tooltip-instance="highwire_author_tooltip"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-article-title-complete clearfix has-author-tooltip highwire-citation-highwire-article-top-a"> <div class="highwire-cite-overline"><span class="highwire-cite-metadata-article-type highwire-cite-metadata">Research Article</span><span class="separator-pipe"></span><span class="highwire-cite-metadata-art-cat highwire-cite-metadata"><span class="wrapper">The State of the Art</span></span></div> <div class="highwire-cite-access"><span class="highwire-citation-access highwire-citation-access-check" data-pisa-id="jnumed;jnumed.124.268928" data-atom-uri="/jnumed/66/3/340.atom" data-request-view="full"></span></div> <h1 class="highwire-cite-title" id="page-title">Green Nuclear Medicine and Radiotheranostics</h1> <div class="highwire-cite-authors"><span class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">Patrick Veit-Haibach</span>, <span class="highwire-citation-author" data-delta="1">Ken Herrmann</span>, <span class="highwire-citation-author" data-delta="2">Richard Zimmermann</span> and <span class="highwire-citation-author" data-delta="3">Roland Hustinx</span></span></div> <div class="highwire-cite-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">Journal of Nuclear Medicine </span><span class="highwire-cite-metadata-date highwire-cite-metadata">March 2025, </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">66 </span><span class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span class="highwire-cite-metadata-pages highwire-cite-metadata">340-343; </span><span class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.2967/jnumed.124.268928 </span></div> <div class="highwire-cite-extras"><span class="highwire-foxycart-add-to-cart-ahah highwire-foxycart-add-to-cart-ahah" data-text="Add to Cart (%short-price)" data-apath="/jnumed/66/3/340.atom" data-type="link" data-font-icon="" data-parent-id="125787"></span></div> </div> <div id="hw-article-author-popups-top-node-125868--2287027387" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">Patrick Veit-Haibach </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span>Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Mount Sinai Hospital and Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada;</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Patrick%2BVeit-Haibach%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Veit-Haibach%20P&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3APatrick%2BVeit-Haibach%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">Ken Herrmann </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>2</span>Department of Nuclear Medicine, West German Cancer Center, University Hospital Essen, Essen, Germany;</div><div class='author-affiliation'><span class='nlm-sup'>3</span>German Cancer Consortium, Partner Site University Hospital Essen, Essen, Germany;</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Ken%2BHerrmann%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Herrmann%20K&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AKen%2BHerrmann%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">Richard Zimmermann </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>4</span>Chrysalium Consulting, Lalaye, France; MEDraysintell, Louvain-la-Neuve, Belgium; and Oncidium Foundation, Mont-Saint-Guibert, Belgium; and</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Richard%2BZimmermann%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zimmermann%20R&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARichard%2BZimmermann%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">Roland Hustinx </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>5</span>Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liège, Quartier Hôpital, Liège, Belgium</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=Roland%2BHustinx%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hustinx%20R&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ARoland%2BHustinx%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div></div></div> </div> </div> </div> </div> </div> </div> <!-- /.panel-row-wrapper --> <div class="panel-row-wrapper clearfix"> <div class="main-content-wrapper grid-17 suffix-1 alpha"> <div class="panel-panel panel-region-content"> <div class="inside"><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <div class="item-list"><ul class="tabs inline panels-ajax-tab"><li class="first"><a href="/content/66/3/340" class="panels-ajax-tab-tab" data-panel-name="jnl_snm_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:125868" data-trigger="" data-url-enabled="1">Article</a><a href="/panels_ajax_tab/jnl_snm_tab_art/node:125868/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/66/3/340/tab-figures-data" class="panels-ajax-tab-tab" data-panel-name="jnl_snm_tab_data" data-target-id="highwire_article_tabs" data-entity-context="node:125868" data-trigger="tab-figures-data" data-url-enabled="1">Figures & Data</a><a href="/panels_ajax_tab/jnl_snm_tab_data/node:125868/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/66/3/340/tab-article-info" class="panels-ajax-tab-tab" data-panel-name="jnl_snm_tab_info" data-target-id="highwire_article_tabs" data-entity-context="node:125868" data-trigger="tab-article-info" data-url-enabled="1">Info & Metrics</a><a href="/panels_ajax_tab/jnl_snm_tab_info/node:125868/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li class="last"><a href="/content/jnumed/66/3/340.full.pdf" class="panels-ajax-tab-tab" data-panel-name="jnl_snm_tab_pdf" data-target-id="highwire_article_tabs" data-entity-context="node:125868" data-trigger="tab-pdf" data-url-enabled="1"><i class="icon-file-alt"></i> PDF</a><a href="/panels_ajax_tab/jnl_snm_tab_pdf/node:125868/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li></ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs-container" > <div class="pane-content"> <div data-panels-ajax-tab-preloaded="jnl_snm_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://jnm.snmjournals.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-jnl_snm_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article fulltext-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2>Abstract</h2><p id="p-2">There is a significantly growing interest in diagnostic and therapeutic radiopharmaceuticals, and it is foreseeable that an unprecedented number of patients will need to be treated with new nuclear medicine therapies. This predicted increase will have potentially significant environmental impacts. In this discussion, we show different areas of impact, as well as possible measures to reduce such impact. These measures may impact areas from the entire supply chain, starting at the production site of medical isotopes, the energy supply needed for production, transportation, and adaption of the injected amounts of radiopharmaceuticals in clinical use. Furthermore, arguments of local versus centralized production, potentially increasing or decreasing nuclear medicine procedures versus other greenhouse gas–emitting medical imaging tests, as well as radiopharmaceutical waste handling implications, are summarized and weighed against the current status. Overall, this summary hopefully serves as a basis for further discussion in the nuclear medicine community, potentially increases awareness of the environmental impact of this exciting medical field, and may even lead to implementation of measures.</p></div><ul class="kwd-group"><li class="kwd"><a href="/keyword/molecular-imaging" class="hw-term hw-article-keyword hw-article-keyword-molecular-imaging" rel="nofollow">molecular imaging</a></li><li class="kwd"><a href="/keyword/radionuclide-therapy" class="hw-term hw-article-keyword hw-article-keyword-radionuclide-therapy" rel="nofollow">radionuclide therapy</a></li><li class="kwd"><a href="/keyword/radiopharmaceuticals" class="hw-term hw-article-keyword hw-article-keyword-radiopharmaceuticals" rel="nofollow">radiopharmaceuticals</a></li><li class="kwd"><a href="/keyword/green-nuclear-medicine" class="hw-term hw-article-keyword hw-article-keyword-green-nuclear-medicine" rel="nofollow">green nuclear medicine</a></li><li class="kwd"><a href="/keyword/radiotheranostics" class="hw-term hw-article-keyword hw-article-keyword-radiotheranostics" rel="nofollow">radiotheranostics</a></li><li class="kwd"><a href="/keyword/health-economics" class="hw-term hw-article-keyword hw-article-keyword-health-economics" rel="nofollow">health economics</a></li></ul><p id="p-3">The nuclear medicine community and the isotope production sector are currently experiencing an unprecedented increase in interest, investments, and production capacity. Thus, the medical community needs to consider production, supply chain safety, and the environmental impact of this field. In this overview, we debate and provide a basis for discussion about how nuclear medicine could help to support an environmental transition, reduce ecologic impact, and preserve resources in diagnostic and therapeutic nuclear medicine, and we discuss possible (and hopefully controversial) measures to mitigate possible adverse effects.</p><div class="section" id="sec-1"><h2 class="">THE INCREASING RADIOPHARMACEUTICAL MARKET</h2><p id="p-4">Therapeutic radiopharmaceuticals have seen markedly growing interest from the classic pharmaceutical industry, resulting in an increasing number of new molecules under development with blockbuster potential. The nuclear medicine market is anticipated to grow from an annual $9.3 billion in 2023 to at least $42 billion in 2033, with an anticipated yearly growth of 29% over this period for therapeutics alone (<a id="xref-ref-1-1" class="xref-bibr" href="#ref-1">1</a>). This includes new indications for treatment, extension of the application with the same molecules, and the large Chinese market, which potentially will see millions of patients imaged and treated by 2032 (<a id="xref-ref-1-2" class="xref-bibr" href="#ref-1">1</a>,<a id="xref-ref-2-1" class="xref-bibr" href="#ref-2">2</a>). Thus, there is a need for more treatment capacity, experienced staff, and equipment, with consequently increasing logistic needs and more waste.</p></div><div class="section" id="sec-2"><h2 class="">GENERAL ENVIRONMENTAL IMPACT OF DIAGNOSTIC AND THERAPEUTIC MOLECULAR IMAGING PRODUCTION</h2><p id="p-5">Radioactive waste from medical isotopes inevitably arises during production, and their use and the amount of waste generated varies widely among different jurisdictions. Waste has to be stored or treated properly and according to local guidelines, considering the entire sequence of waste management operations.</p><p id="p-6">For example, <sup>99</sup>Mo, the precursor of <sup>99m</sup>Tc, is produced in reactors, mainly in the fission process of <sup>235</sup>U (<a id="xref-ref-3-1" class="xref-bibr" href="#ref-3">3</a>). <sup>99</sup>Tc, the decay product of <sup>99m</sup>Tc, has a long half-life (211,000 y) and strong environmental mobility (highly soluble in the form of pertechnetate). Experiences—that is, from the Hanford Nuclear Plant—have highlighted the importance of environmental policies (<a id="xref-ref-4-1" class="xref-bibr" href="#ref-4">4</a>). On the basis of these experiences, the issue of <sup>177m</sup>Lu was solved using exclusively non–carrier-added <sup>177</sup>Lu, and the use of <sup>225</sup>Ac will soon be based on <sup>225</sup>Ac noncontaminated with <sup>227</sup>Ac. For instance, it is now estimated that at the time of injection, the accelerator-produced <sup>225</sup>Ac would contain 0.7% <sup>227</sup>Ac, which, although it can be considered negligible in the short term, has a long-term bioaccumulation (with a half-life of ∼22 y) that may not be entirely neglectable (<a id="xref-ref-5-1" class="xref-bibr" href="#ref-5">5</a>).</p><p id="p-7">Furthermore, when finding and extracting raw material resources, apart from consumption of significant amounts of energy, less visible effects such as soil erosion and water pollution may occur (<a id="xref-ref-6-1" class="xref-bibr" href="#ref-6">6</a>). The production of radioactive isotopes also involves nuclear reactors or particle accelerators, which can contribute to significant energy consumption. This energy still likely comes mainly from fossil fuels (depending on the location or jurisdiction), contributing to greenhouse gas (GHG) emissions. However, whereas the energy cost of, let us say, <sup>177</sup>Lu at a research reactor might be substantial and also vary on the basis of differing age and design, with the entry of isotope production in power reactors the incremental energy cost for isotope production versus powering the reactor for energy production is now manyfold less.</p><p id="p-8">Energy consumption is not limited to the production stage but also involves further downstream steps, that is, transportation. Thus, efficient on-site or local production can significantly reduce transportation’s carbon footprint. Additionally, there is always a theoretic risk of spills or leaks, which can lead to environmental contamination beyond the estimated nuclear waste.</p><p id="p-9">Lastly, imaging scanners also contribute to energy and resource consumption—during their manufacturing as well as during their actual use in daily clinical routine. Therefore, a modern production (and refurbishment and recycling) process with the least possible energy consumption while using recyclable materials and an environmentally conscious design is desirable.</p></div><div class="section" id="sec-3"><h2 class="">ENVIRONMENTAL IMPACT OF HOSPITAL-BASED MOLECULAR IMAGING DEPARTMENTS</h2><p id="p-10">It is difficult to precisely quantify the contribution of nuclear medicine to the global environmental impact of health care. The overall health care carbon footprint contributes an average of approximately 5% of the national CO<sub>2</sub> footprint (<a id="xref-fig-1-1" class="xref-fig" href="#F1">Fig. 1</a>) (<a id="xref-ref-7-1" class="xref-bibr" href="#ref-7">7</a>). Estimates for 2014 range from 3.5% in India to 7.9% in the United States and 8.1% in The Netherlands (<a id="xref-ref-7-2" class="xref-bibr" href="#ref-7">7</a>). Hospital care is the top contributor, with 36% of GHG emissions. These are U.S. data from 2013, when the relative contribution of health care to GHG emissions was estimated at 9.8% of the national total (<a id="xref-ref-8-1" class="xref-bibr" href="#ref-8">8</a>). The actual contribution of nuclear medicine is not known, but medical imaging (mostly from radiography, CT, and MRI, not including SPECT and PET) might contribute to up to 10% of the health care footprint, accounting for up to 1% of global GHG emissions (<a id="xref-ref-9-1" class="xref-bibr" href="#ref-9">9</a>,<a id="xref-ref-10-1" class="xref-bibr" href="#ref-10">10</a>).</p><div id="F1" class="fig pos-float odd"><div class="highwire-figure"><div class="fig-inline-img-wrapper"><div class="fig-inline-img"><a href="https://jnm.snmjournals.org/content/jnumed/66/3/340/F1.large.jpg?width=800&height=600&carousel=1" title="The healthcare system contributes to approximately 5% of total carbon footprint worldwide. In terms of the most responsible activity for GHG production, “generation and distribution of electricity, gas and heat or cooling” has highest share (∼40%). Regarding the most responsible sector, “hospital care” contributes to more than one third of health care footprint." class="highwire-fragment fragment-images colorbox-load" rel="gallery-fragment-images-997106377" data-figure-caption="<div class="highwire-markup">The healthcare system contributes to approximately 5% of total carbon footprint worldwide. In terms of the most responsible activity for GHG production, “generation and distribution of electricity, gas and heat or cooling” has highest share (∼40%). Regarding the most responsible sector, “hospital care” contributes to more than one third of health care footprint.</div>" data-icon-position="" data-hide-link-title="0"><span class="hw-responsive-img"><img class="highwire-fragment fragment-image lazyload" alt="FIGURE 1." src="data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7" data-src="https://jnm.snmjournals.org/content/jnumed/66/3/340/F1.medium.gif" width="440" height="251"/><noscript><img class="highwire-fragment fragment-image" alt="FIGURE 1." src="https://jnm.snmjournals.org/content/jnumed/66/3/340/F1.medium.gif" width="440" height="251"/></noscript></span></a></div></div><ul class="highwire-figure-links inline"><li class="download-fig first"><a href="https://jnm.snmjournals.org/content/jnumed/66/3/340/F1.large.jpg?download=true" class="highwire-figure-link highwire-figure-link-download" title="Download FIGURE 1." data-icon-position="" data-hide-link-title="0">Download figure</a></li><li class="new-tab"><a href="https://jnm.snmjournals.org/content/jnumed/66/3/340/F1.large.jpg" class="highwire-figure-link highwire-figure-link-newtab" target="_blank" data-icon-position="" data-hide-link-title="0">Open in new tab</a></li><li class="download-ppt last"><a href="/highwire/powerpoint/125945" class="highwire-figure-link highwire-figure-link-ppt" data-icon-position="" data-hide-link-title="0">Download powerpoint</a></li></ul></div><div class="fig-caption" xmlns:xhtml="http://www.w3.org/1999/xhtml"><span class="fig-label">FIGURE 1.</span> <p id="p-11" class="first-child">The healthcare system contributes to approximately 5% of total carbon footprint worldwide. In terms of the most responsible activity for GHG production, “generation and distribution of electricity, gas and heat or cooling” has highest share (∼40%). Regarding the most responsible sector, “hospital care” contributes to more than one third of health care footprint.</p><div class="sb-div caption-clear"></div></div></div><p id="p-12">It was calculated that a single large radiology department could emit GHG emissions equivalent to more than 400 single-family homes annually (<a id="xref-ref-11-1" class="xref-bibr" href="#ref-11">11</a>). In particular, Marwick et al. found certain MRI examinations to be responsible for the highest contribution. SPECT had 4%–11% of the contribution of MRI, and ultrasound had 0.5%–2% (<a id="xref-ref-12-1" class="xref-bibr" href="#ref-12">12</a>). Other estimates trend toward a similar gradient, with, for instance, 0.5 kg/study for ultrasound, 9.2 kg/study for CT, and 17.5–399.8 kg/study for MRI (<a id="xref-ref-13-1" class="xref-bibr" href="#ref-13">13</a>,<a id="xref-ref-14-1" class="xref-bibr" href="#ref-14">14</a>). Unfortunately, no such data are available regarding PET and modern cadmium-zinc-telluride–based SPECT devices.</p><p id="p-13">On the basis of the abovementioned values and being careful not to consider those estimates as undisputed truths but rather as food for thought, one may envision several ways to reduce nuclear medicine’s carbon footprint.</p><div id="sec-4" class="subsection"><h3>Use More Environment-Friendly Techniques to Diagnose Patients</h3><p id="p-14">When acceptable, transitioning to other techniques, that is, non–GHG-emitting examinations such as blood tests (which partly still need to be developed), could potentially enable initiation of treatment. As an example, when a patient with a chronic cardiac ischemic condition is triaged, a complete history and physical examination with an abnormal electrocardiogram and elevated cardiac enzymes can often guide patient management without the need for perfusion imaging. In another currently well-established example, most patients with a history of differentiated thyroid cancer are monitored using serum thyroglobulin without a need for periodic radioiodine scans or CT for their surveillance follow-up (<a id="xref-ref-15-1" class="xref-bibr" href="#ref-15">15</a>).</p><div class="boxed-text" id="boxed-text-1"><div id="sec-5" class="subsection"><h4>NOTEWORTHY</h4><ul class="list-unord " id="list-1"><li id="list-item-1"><p id="p-15">The main overall environmental impact in the future will come from Nuclear Medicine Therapies rather than diagnostic procedures.</p></li><li id="list-item-2"><p id="p-16">Potential negative impacts are, however, uncertain and need future decision tree sensitivity analysis.</p></li><li id="list-item-3"><p id="p-17">Several solutions are presented in this discussion, such as usage of radionuclides with shorter half-lives, increased usage of existing equipment, or balancing production versus transportation, among others.</p></li></ul></div></div></div><div id="sec-6" class="subsection"><h3>Do More Nuclear Medicine Studies</h3><p id="p-18">Increasing the ratio of (adequate) nuclear medicine techniques—for instance, instead of MRI—saves GHG emissions. Obviously, this is a somewhat oversimplistic view since many clinical indications are specific to MRI. Additionally, the generalization of hybrid imaging, that is, SPECT/CT and PET/CT, partly mitigates the benefit due to the higher footprint of CT, especially when underused.</p></div><div id="sec-7" class="subsection"><h3>Increase the Use of PET and SPECT Devices</h3><p id="p-19">Going from 8 to 12 scans per workday could decrease the environmental impact of SPECT by approximately 66% (<a id="xref-ref-12-2" class="xref-bibr" href="#ref-12">12</a>). This stems from the impact generated by assembly, transport, end of life, and, more importantly, stand-by electricity such as that consumed during nonoperational hours. Additionally, technologies such as full-ring cadmium-zinc-telluride (for SPECT) and silicon photomultipliers, and scanners with a long axial field of view (for PET), are much faster, allowing an increased use rate. This also includes artificial intelligence–based methods to denoise the images and provide equivalent diagnostic quality with significantly shorter acquisition times or lower injected doses (<a id="xref-ref-16-1" class="xref-bibr" href="#ref-16">16</a>). This partly allows older systems to be used longer and may have secondary positive consequences in terms of production, transport, and waste management.</p></div><div id="sec-8" class="subsection"><h3>Foster Frugal Innovation (Maybe Even Outside Nuclear Medicine)</h3><p id="p-20">Essential health care services are available to a maximum of half the world’s population (<a id="xref-ref-17-1" class="xref-bibr" href="#ref-17">17</a>). Frugal innovation fosters the development of “low-cost and efficacious, new or adapted products (or services), mostly emerging from contexts of institutional voids and resource constraints, involving the creative use of existing resources” (<a id="xref-ref-17-2" class="xref-bibr" href="#ref-17">17</a>). The main benefit is the trickling-up effect, or reverse innovation—that is, innovations initially developed toward low- and moderate-income countries felt efficient enough to be used in high-income countries at a lower cost. Examples exist in radiology, notably in the development of U.S. devices (<a id="xref-ref-18-1" class="xref-bibr" href="#ref-18">18</a>).</p><p id="p-21">Another hospital-based aspect again relates to waste management. It is estimated to be responsible for approximately 3% of the total health care carbon footprint (<a id="xref-ref-19-1" class="xref-bibr" href="#ref-19">19</a>). Therapeutic radioisotopes such as <sup>131</sup>I, <sup>177</sup>Lu, and <sup>90</sup>Y have longer half-lives, and subsequently, waste management becomes complex. Nuclear medicine departments that are treating inpatients have to deal with contaminated body fluids, the injection material, disposable clothing, plastic films that cover part of the hospital room, etc., and possibly even food. This waste may require storage for extended periods, often in low-temperature rooms, and hence, radiation protection requirements may contradict sustainability efforts. Countries that allow outpatient therapies with the current or upcoming modern radiotheranostic agents (i.e., <sup>177</sup>Lu-PSMA) are therefore balancing radiation protection and cost with the secondary benefit (probably beyond the original goal) of promoting sustainability in the practice of nuclear medicine. Also, the next generation of radiotheranostics may be partly geared more toward <sup>212</sup>Pb or <sup>211</sup>At, which have short half-lives.</p><p id="p-22">Hospital heating, ventilation, and air conditioning systems generate the highest consumption of energy and CO<sub>2</sub> emissions (<a id="xref-ref-20-1" class="xref-bibr" href="#ref-20">20</a>). Considering that SPECT and PET devices, as well as the abovementioned waste storage rooms, are required to be maintained at specific cool temperatures, smart heating and cooling systems (available already for home use) can support the sustainability efforts. Vendors will need to develop energy-saving states in which the imaging system can remain when not in use without impacting the required temperature.</p><p id="p-23">Also, turning off workstations after core working hours could reduce total energy consumption by approximately one third, resulting in an extrapolated saving of more than 22 tons in CO<sub>2</sub> emissions per year in a single-center experience (<a id="xref-ref-21-1" class="xref-bibr" href="#ref-21">21</a>,<a id="xref-ref-22-1" class="xref-bibr" href="#ref-22">22</a>). Lastly, using highly efficient lighting and energy-friendly bulbs (e.g., motion-detector lights) in the department can create significant annual energy savings.</p></div></div><div class="section" id="sec-9"><h2 class="">WHAT ARE THE OUT-OF-HOSPITAL SOLUTIONS?</h2><div id="sec-10" class="subsection"><h3>Reducing the Environmental Impact of the Increasing Use</h3><p id="p-24">It is expected that the large number of patients on whom radiopharmaceuticals are used will grow. If addressing only 5% of cancer patients (global prevalence of 44 million (<a id="xref-ref-23-1" class="xref-bibr" href="#ref-23">23</a>)), this would mean that more than 8 million doses of radiopharmaceuticals will have to be produced yearly. Thus, increased radioactive waste will have to be taken care of, but additionally, the amount of radioactivity to be released in water 10 y from now, without protective measures, will be substantial. With long-half-life radionuclides such as <sup>177</sup>Lu (6.7 d) and <sup>225</sup>Ac (9.9 d), the water contamination may reach a level that raises serious concerns. In some U.S. centers, patients are requested to wear diapers during the first days at home and to keep them in a safe container until full decay (respectively, 2 and 3 mo). Thus again, shorter-half-life radionuclides without long-half-life contaminants may have a competitive advantage in this scenario.</p><p id="p-25"><sup>225</sup>Ac- and <sup>177</sup>Lu-labeled drugs appear to be on their way to becoming the future blockbusters of nuclear medicine and possibly will generate significant revenues for the industry during the next 15 y. Although currently in development with somewhat uncertain market and distribution uptake, an equivalent efficient drug labeled with a shorter-half-life radionuclide, such as <sup>211</sup>At or <sup>212</sup>Pb, has, however, a great chance to claim a significant market share over the long term, if showing at least equal efficacy.</p></div><div id="sec-11" class="subsection"><h3>Reducing the Impact of Transport and Travel</h3><p id="p-26">When considering radionuclides with shorter half-lives, the number of production sites needs to be increased, and the balance between investment in new sites and transportation costs must be evaluated carefully. However, the example of the production of <sup>18</sup>F (900 cyclotrons among the 1,500 operating cyclotrons in the world in good-manufacturing-practice condition (<a id="xref-ref-24-1" class="xref-bibr" href="#ref-24">24</a>)) shows that the industry is actually able to develop large networks of production tools. Although this corresponded to over 25 y and a $4 billion investment, a network of about 30 <sup>211</sup>At production units that could easily cover the 3 major markets would correspond to not more than a $600 million investment, less than what is now spent to develop the <sup>225</sup>Ac production network and far above what will be required to achieve worldwide access to <sup>212</sup>Pb.</p><p id="p-27">Lastly, providing remote access, such as through telereporting, can help reduce the carbon footprint by decreasing pollution and energy use related to transportation. This is also implied in research programs and scientific events. If open-access cloud-based databases become available for radiopharmaceutical purposes, they will obviously decrease the need for the same research studies to be initiated in other jurisdictions. International scientific events can have a significant carbon footprint, which should be considered. It was calculated that attending the Radiological Society of North American annual meeting generates a carbon footprint equal to the average annual footprint of 3,689 people living in high-income countries, 10,560 people living in middle-income countries, or 123,072 people living in low-income countries (<a id="xref-ref-25-1" class="xref-bibr" href="#ref-25">25</a>).</p></div><div id="sec-12" class="subsection"><h3>Using the Current Long-Half-Life Therapeutics Equitably</h3><p id="p-28">Although long-half-life therapeutics can be more impactful on the environment, some measures can be taken to limit their adverse effects. For example, adapted radionuclide therapy, instead of a fixed-dosing approach, will help to optimize dosage and radiopharmaceutical waste. Dosimetry can maximize the benefit-to-risk ratio for patients by calculating the maximum tolerated activity in a personalized manner. SPECT serves as the primary posttreatment quantification modality for dosimetry, and with current cadmium-zinc-telluride technology and artificial intelligence–based image reconstruction techniques, scanning time can be reduced and multiple sessions of dosimetry after therapy can be omitted (<a id="xref-ref-26-1" class="xref-bibr" href="#ref-26">26</a>). Also, there are novel artificial intelligence–based methods, such as digital twins, that can provide a precise virtual analog of each individual patient before administration of radiopharmaceutical therapy (<a id="xref-ref-27-1" class="xref-bibr" href="#ref-27">27</a>).</p></div></div><div class="section conclusion" id="sec-13"><h2 class="">CONCLUSION</h2><p id="p-29">The growth in diagnostic and therapeutic radiopharmaceuticals is based on an increasing number of new molecules and new indications and an expansion of clinical applications. We have discussed the impact of this growth on various levels, such as in terms of life expectancy (which such new therapies are actually trying to increase), social issues such as ambulatory (with impact on home care) versus inpatient care. However, it is only with a true decision tree sensitivity analysis that these potential negative effects can be evaluated. Only then can solid outcomes be generated from what-if scenarios. We cannot currently say what the environmental impact would be if survival were shortened by doing suboptimal or fewer tests, if earlier interventions were not possible because of testing restrictions, and if there were downstream effects from a significant rise in health care costs.</p><p id="p-30">Although potentially controversial, we have shown scenarios in which nuclear medicine procedures can provide alternatives for other, potentially more detrimental, imaging modalities. We hope that the points we have raised and the demonstrated scenarios may serve as a basis for further discussion about the little-known environmental impact of nuclear medicine and radiotheranostics.</p></div><div class="section" id="sec-14"><h2 class="">DISCLOSURE</h2><p id="p-31">No potential conflict of interest relevant to this article was reported.</p></div><div class="section fn-group" id="fn-group-1"><h2>Footnotes</h2><ul><li class="fn" id="fn-1"><p id="p-1">Published online Jan. 23, 2025.</p></li></ul></div><ul class="copyright-statement"><li class="fn" id="copyright-statement-1">© 2025 by the Society of Nuclear Medicine and Molecular Imaging.</li></ul><div class="section ref-list" id="ref-list-1"><h2 class="">REFERENCES</h2><ol class="cit-list ref-use-labels"><li><span class="ref-label">1.</span><a class="rev-xref-ref" href="#xref-ref-1-1" title="View reference 1. in text" id="ref-1">↵</a><div class="cit ref-cit ref-other" id="cit-66.3.340.1"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Brechin Vincent</span> <span class="cit-name-given-names">GP-E</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Nicolas</span> <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Richard</span> <span class="cit-name-given-names">Z</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Paul-Emmanuel</span> <span class="cit-name-given-names">G</span></span></li></ol><cite>. <span class="cit-article-title">MEDraysintell nuclear medicine world market report & directory</span>. MEDraysintell website. <a href="http://www.medraysintell.com">www.medraysintell.com</a>. Published September <span class="cit-pub-date">2024</span>. Accessed October 18, 2024.</cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">2.</span><a class="rev-xref-ref" href="#xref-ref-2-1" title="View reference 2. in text" id="ref-2">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.2"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Yang</span> <span class="cit-name-given-names">W</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kang</span> <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Chen</span> <span class="cit-name-given-names">Y</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Landscape of nuclear medicine in China and its progress on theranostics</span>. <abbr class="cit-jnl-abbrev">J Nucl Med.</abbr> <span class="cit-pub-date">2024</span>;<span class="cit-vol">65(suppl 1)</span>:<span class="cit-fpage">29S</span>–<span class="cit-lpage">37S</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BNucl%2BMed.%26rft.volume%253D651%26rft.spage%253D29S%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><span class="ref-label">3.</span><a class="rev-xref-ref" href="#xref-ref-3-1" title="View reference 3. in text" id="ref-3">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.3"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Wang</span> <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Xu</span> <span class="cit-name-given-names">B</span></span></li></ol><cite>. <span class="cit-article-title">Removal of radionuclide <sup>99</sup>Tc from aqueous solution by various adsorbents: a review</span>. <abbr class="cit-jnl-abbrev">J Environ Radioact.</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">270</span>:<span class="cit-fpage">107267</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BEnviron%2BRadioact.%26rft.volume%253D270%26rft.spage%253D107267%26rft_id%253Dinfo%253Apmid%252F37598575%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=37598575&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">4.</span><a class="rev-xref-ref" href="#xref-ref-4-1" title="View reference 4. in text" id="ref-4">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.4"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Gephart</span> <span class="cit-name-given-names">RE</span></span></li></ol><cite>. <span class="cit-article-title">A short history of waste management at the Hanford site</span>. <abbr class="cit-jnl-abbrev">Phys Chem Earth, Parts A/B/C.</abbr> <span class="cit-pub-date">2010</span>;<span class="cit-vol">35</span>:<span class="cit-fpage">298</span>–<span class="cit-lpage">306</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DPhys%2BChem%2BEarth%252C%2BParts%2BA%252FB%252FC.%26rft.volume%253D35%26rft.spage%253D298%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><span class="ref-label">5.</span><a class="rev-xref-ref" href="#xref-ref-5-1" title="View reference 5. in text" id="ref-5">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.5"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Sgouros</span> <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">He</span> <span class="cit-name-given-names">B</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ray</span> <span class="cit-name-given-names">N</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ludwig</span> <span class="cit-name-given-names">DL</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Frey</span> <span class="cit-name-given-names">EC</span></span></li></ol><cite>. <span class="cit-article-title">Dosimetric impact of Ac-227 in accelerator-produced Ac-225 for alpha-emitter radiopharmaceutical therapy of patients with hematological malignancies: a pharmacokinetic modeling analysis</span>. <abbr class="cit-jnl-abbrev">EJNMMI Phys.</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">8</span>:<span class="cit-fpage">60</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEJNMMI%2BPhys.%26rft.volume%253D8%26rft.spage%253D60%26rft_id%253Dinfo%253Apmid%252F34406515%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=34406515&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">6.</span><a class="rev-xref-ref" href="#xref-ref-6-1" title="View reference 6. in text" id="ref-6">↵</a><div class="cit ref-cit ref-book" id="cit-66.3.340.6"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">van Velzen</span> <span class="cit-name-given-names">L</span></span></li></ol><cite>. <span class="cit-source">Environmental Remediation and Restoration of Contaminated Nuclear and Norm Sites.</span> <span class="cit-publ-name">Elsevier</span>; <span class="cit-pub-date">2015</span>:<span class="cit-fpage">132</span>–<span class="cit-lpage">137</span>.</cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">7.</span><a class="rev-xref-ref" href="#xref-ref-7-1" title="View reference 7. in text" id="ref-7">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.7" data-doi="10.1088/1748-9326/ab19e1"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Pichler</span> <span class="cit-name-given-names">P-P</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Jaccard</span> <span class="cit-name-given-names">IS</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Weisz</span> <span class="cit-name-given-names">U</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Weisz</span> <span class="cit-name-given-names">H</span></span></li></ol><cite>. <span class="cit-article-title">International comparison of health care carbon footprints</span>. <abbr class="cit-jnl-abbrev">Environ Res Lett.</abbr> <span class="cit-pub-date">2019</span>;<span class="cit-vol">14</span>:<span class="cit-fpage">064004</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEnviron%2BRes%2BLett.%26rft.volume%253D14%26rft.spage%253D064004%26rft_id%253Dinfo%253Adoi%252F10.1088%252F1748-9326%252Fab19e1%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1088/1748-9326/ab19e1&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a></div></div></li><li><span class="ref-label">8.</span><a class="rev-xref-ref" href="#xref-ref-8-1" title="View reference 8. in text" id="ref-8">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.8" data-doi="10.1371/journal.pone.0157014"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Eckelman</span> <span class="cit-name-given-names">MJ</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Sherman</span> <span class="cit-name-given-names">J</span></span></li></ol><cite>. <span class="cit-article-title">Environmental impacts of the US health care system and effects on public health</span>. <abbr class="cit-jnl-abbrev">PLoS One.</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">11</span>:<span class="cit-fpage">e0157014</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DPLoS%2BOne.%26rft.volume%253D11%26rft.spage%253De0157014%26rft_id%253Dinfo%253Adoi%252F10.1371%252Fjournal.pone.0157014%26rft_id%253Dinfo%253Apmid%252F27280706%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1371/journal.pone.0157014&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=27280706&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">9.</span><a class="rev-xref-ref" href="#xref-ref-9-1" title="View reference 9. in text" id="ref-9">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.9"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Picano</span> <span class="cit-name-given-names">E</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mangia</span> <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">D’Andrea</span> <span class="cit-name-given-names">A</span></span></li></ol><cite>. <span class="cit-article-title">Climate change, carbon dioxide emissions, and medical imaging contribution</span>. <abbr class="cit-jnl-abbrev">J Clin Med.</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">12</span>:<span class="cit-fpage">215</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BClin%2BMed.%26rft.volume%253D12%26rft.spage%253D215%26rft_id%253Dinfo%253Apmid%252F36615016%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=36615016&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">10.</span><a class="rev-xref-ref" href="#xref-ref-10-1" title="View reference 10. in text" id="ref-10">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.10"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Doo</span> <span class="cit-name-given-names">FX</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Vosshenrich</span> <span class="cit-name-given-names">J</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Cook</span> <span class="cit-name-given-names">TS</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Environmental sustainability and AI in radiology: a double-edged sword</span>. <abbr class="cit-jnl-abbrev">Radiology.</abbr> <span class="cit-pub-date">2024</span>;<span class="cit-vol">310</span>:<span class="cit-fpage">e232030</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DRadiology.%26rft.volume%253D310%26rft.spage%253De232030%26rft_id%253Dinfo%253Apmid%252F38411520%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=38411520&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">11.</span><a class="rev-xref-ref" href="#xref-ref-11-1" title="View reference 11. in text" id="ref-11">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.11"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Hanneman</span> <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Szava-Kovats</span> <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Burbridge</span> <span class="cit-name-given-names">B</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Canadian Association of Radiologists statement on environmental sustainability in medical imaging</span>. <abbr class="cit-jnl-abbrev">Can Assoc Radiol J.</abbr> <span class="cit-pub-date">2024</span>:<span class="cit-fpage">8465371241260013</span>.</cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">12.</span><a class="rev-xref-ref" href="#xref-ref-12-1" title="View reference 12. in text" id="ref-12">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.12" data-doi="10.1136/hrt.2011.227884"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Marwick</span> <span class="cit-name-given-names">TH</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Buonocore</span> <span class="cit-name-given-names">J</span></span></li></ol><cite>. <span class="cit-article-title">Environmental impact of cardiac imaging tests for the diagnosis of coronary artery disease</span>. <abbr class="cit-jnl-abbrev">Heart.</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">97</span>:<span class="cit-fpage">1128</span>–<span class="cit-lpage">1131</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DHeart.%26rft_id%253Dinfo%253Adoi%252F10.1136%252Fhrt.2011.227884%26rft_id%253Dinfo%253Apmid%252F21685481%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6ODoiaGVhcnRqbmwiO3M6NToicmVzaWQiO3M6MTA6Ijk3LzE0LzExMjgiO3M6NDoiYXRvbSI7czoyMToiL2pudW1lZC82Ni8zLzM0MC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=/YTozOntzOjQ6InBhdGgiO3M6Mjk1OiIvbG9va3VwL2lqbGluay9ZVG96T250ek9qUTZJbkJoZEdnaU8zTTZNVFE2SWk5c2IyOXJkWEF2YVdwc2FXNXJJanR6T2pVNkluRjFaWEo1SWp0aE9qUTZlM002T0RvaWJHbHVhMVI1Y0dVaU8zTTZORG9pUVVKVFZDSTdjem94TVRvaWFtOTFjbTVoYkVOdlpHVWlPM002T0RvaWFHVmhjblJxYm13aU8zTTZOVG9pY21WemFXUWlPM002TVRBNklqazNMekUwTHpFeE1qZ2lPM002TkRvaVlYUnZiU0k3Y3pveU1Ub2lMMnB1ZFcxbFpDODJOaTh6THpNME1DNWhkRzl0SWp0OWN6bzRPaUptY21GbmJXVnVkQ0k3Y3pvd09pSWlPMzA9IjtzOjU6InF1ZXJ5IjthOjA6e31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">13.</span><a class="rev-xref-ref" href="#xref-ref-13-1" title="View reference 13. in text" id="ref-13">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.13"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">McAlister</span> <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">McGain</span> <span class="cit-name-given-names">F</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Petersen</span> <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">The carbon footprint of hospital diagnostic imaging in Australia</span>. <abbr class="cit-jnl-abbrev">Lancet Reg Health West Pac.</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">24</span>:<span class="cit-fpage">100459</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DLancet%2BReg%2BHealth%2BWest%2BPac.%26rft.volume%253D24%26rft.spage%253D100459%26rft_id%253Dinfo%253Apmid%252F35538935%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=35538935&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">14.</span><a class="rev-xref-ref" href="#xref-ref-14-1" title="View reference 14. in text" id="ref-14">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.14" data-doi="10.1108/IJHCQA-10-2016-0153"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Esmaeili</span> <span class="cit-name-given-names">A</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">McGuire</span> <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Overcash</span> <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ali</span> <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Soltani</span> <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Twomey</span> <span class="cit-name-given-names">J</span></span></li></ol><cite>. <span class="cit-article-title">Environmental impact reduction as a new dimension for quality measurement of healthcare services: the case of magnetic resonance imaging</span>. <abbr class="cit-jnl-abbrev">Int J Health Care Qual Assur.</abbr> <span class="cit-pub-date">2018</span>;<span class="cit-vol">31</span>:<span class="cit-fpage">910</span>–<span class="cit-lpage">922</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DInt%2BJ%2BHealth%2BCare%2BQual%2BAssur.%26rft.volume%253D31%26rft.spage%253D910%26rft_id%253Dinfo%253Adoi%252F10.1108%252FIJHCQA-10-2016-0153%26rft_id%253Dinfo%253Apmid%252F30415627%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1108/IJHCQA-10-2016-0153&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=30415627&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">15.</span><a class="rev-xref-ref" href="#xref-ref-15-1" title="View reference 15. in text" id="ref-15">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.15" data-doi="10.1089/thy.2015.0020"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Haugen</span> <span class="cit-name-given-names">BR</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Alexander</span> <span class="cit-name-given-names">EK</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Bible</span> <span class="cit-name-given-names">KC</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">2015 American Thyroid Association Management guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the American Thyroid Association guidelines task force on thyroid nodules and differentiated thyroid cancer</span>. <abbr class="cit-jnl-abbrev">Thyroid.</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">26</span>:<span class="cit-fpage">1</span>–<span class="cit-lpage">133</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DThyroid.%26rft.volume%253D26%26rft.spage%253D1%26rft_id%253Dinfo%253Adoi%252F10.1089%252Fthy.2015.0020%26rft_id%253Dinfo%253Apmid%252F26462967%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1089/thy.2015.0020&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=26462967&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">16.</span><a class="rev-xref-ref" href="#xref-ref-16-1" title="View reference 16. in text" id="ref-16">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.16"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Weyts</span> <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Lasnon</span> <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ciappuccini</span> <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Artificial intelligence-based PET denoising could allow a two-fold reduction in [<sup>18</sup>F] FDG PET acquisition time in digital PET/CT</span>. <abbr class="cit-jnl-abbrev">Eur J Nucl Med Mol Imaging.</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">49</span>:<span class="cit-fpage">3750</span>–<span class="cit-lpage">3760</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEur%2BJ%2BNucl%2BMed%2BMol%2BImaging.%26rft.volume%253D49%26rft.spage%253D3750%26rft_id%253Dinfo%253Apmid%252F35593925%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=35593925&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">17.</span><a class="rev-xref-ref" href="#xref-ref-17-1" title="View reference 17. in text" id="ref-17">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.17"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Sarkar</span> <span class="cit-name-given-names">S</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Mateus</span> <span class="cit-name-given-names">S</span></span></li></ol><cite>. <span class="cit-article-title">Doing more with less: how frugal innovations can contribute to improving healthcare systems</span>. <abbr class="cit-jnl-abbrev">Soc Sci Med.</abbr> <span class="cit-pub-date">2022</span>;<span class="cit-vol">306</span>:<span class="cit-fpage">115127</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DSoc%2BSci%2BMed.%26rft.volume%253D306%26rft.spage%253D115127%26rft_id%253Dinfo%253Apmid%252F35750004%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=35750004&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">18.</span><a class="rev-xref-ref" href="#xref-ref-18-1" title="View reference 18. in text" id="ref-18">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.18"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Hossain</span> <span class="cit-name-given-names">M</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Simula</span> <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Halme</span> <span class="cit-name-given-names">M</span></span></li></ol><cite>. <span class="cit-article-title">Can frugal go global? Diffusion patterns of frugal innovations</span>. <abbr class="cit-jnl-abbrev">Technol Soc.</abbr> <span class="cit-pub-date">2016</span>;<span class="cit-vol">46</span>:<span class="cit-fpage">132</span>–<span class="cit-lpage">139</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DTechnol%2BSoc.%26rft.volume%253D46%26rft.spage%253D132%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a></div></div></li><li><span class="ref-label">19.</span><a class="rev-xref-ref" href="#xref-ref-19-1" title="View reference 19. in text" id="ref-19">↵</a><div class="cit ref-cit ref-other" id="cit-66.3.340.19"><div class="cit-metadata"><cite><span class="cit-auth cit-collab">Health care’s climate footprint report. Health Care Without Harm website</span>. <a href="https://noharm-europe.org/content/global/health-care-climate-footprint-report">https://noharm-europe.org/content/global/health-care-climate-footprint-report</a>. Accessed January 9, 2025.</cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">20.</span><a class="rev-xref-ref" href="#xref-ref-20-1" title="View reference 20. in text" id="ref-20">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.20"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Sumner</span> <span class="cit-name-given-names">C</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Ikuta</span> <span class="cit-name-given-names">I</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Garg</span> <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Approaches to greening radiology</span>. <abbr class="cit-jnl-abbrev">Acad Radiol.</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">30</span>:<span class="cit-fpage">528</span>–<span class="cit-lpage">535</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DAcad%2BRadiol.%26rft.volume%253D30%26rft.spage%253D528%26rft_id%253Dinfo%253Apmid%252F36114076%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=36114076&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">21.</span><a class="rev-xref-ref" href="#xref-ref-21-1" title="View reference 21. in text" id="ref-21">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.21" data-doi="10.1016/j.jacr.2011.07.017"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Prasanna</span> <span class="cit-name-given-names">PM</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Siegel</span> <span class="cit-name-given-names">E</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kunce</span> <span class="cit-name-given-names">A</span></span></li></ol><cite>. <span class="cit-article-title">Greening radiology</span>. <abbr class="cit-jnl-abbrev">J Am Coll Radiol.</abbr> <span class="cit-pub-date">2011</span>;<span class="cit-vol">8</span>:<span class="cit-fpage">780</span>–<span class="cit-lpage">784</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.stitle%253DJ%2BAm%2BColl%2BRadiol%26rft.aulast%253DPrasanna%26rft.auinit1%253DP.%2BM.%26rft.volume%253D8%26rft.issue%253D11%26rft.spage%253D780%26rft.epage%253D784%26rft.atitle%253DGreening%2Bradiology.%26rft_id%253Dinfo%253Adoi%252F10.1016%252Fj.jacr.2011.07.017%26rft_id%253Dinfo%253Apmid%252F22051462%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=10.1016/j.jacr.2011.07.017&link_type=DOI" class="cit-ref-sprinkles cit-ref-sprinkles-doi cit-ref-sprinkles-crossref"><span>CrossRef</span></a><a href="/lookup/external-ref?access_num=22051462&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">22.</span><a class="rev-xref-ref" href="#xref-ref-22-1" title="View reference 22. in text" id="ref-22">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.22"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Büttner</span> <span class="cit-name-given-names">L</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Posch</span> <span class="cit-name-given-names">H</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Auer</span> <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Switching off for future: cost estimate and a simple approach to improving the ecological footprint of radiological departments</span>. <abbr class="cit-jnl-abbrev">Eur J Radiol Open.</abbr> <span class="cit-pub-date">2021</span>;<span class="cit-vol">8</span>:<span class="cit-fpage">100320</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEur%2BJ%2BRadiol%2BOpen.%26rft.volume%253D8%26rft.spage%253D100320%26rft_id%253Dinfo%253Apmid%252F33457469%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=33457469&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">23.</span><a class="rev-xref-ref" href="#xref-ref-23-1" title="View reference 23. in text" id="ref-23">↵</a><div class="cit ref-cit ref-other" id="cit-66.3.340.23"><div class="cit-metadata"><cite><span class="cit-article-title">World Health Organization from Globocan 2020 data</span>. International Agency for Research on Cancer website. <a href="https://gco.iarc.who.int/today/en">https://gco.iarc.who.int/today/en</a>. Published <span class="cit-pub-date">2020</span>. Accessed October 31, 2023.</cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">24.</span><a class="rev-xref-ref" href="#xref-ref-24-1" title="View reference 24. in text" id="ref-24">↵</a><div class="cit ref-cit ref-other" id="cit-66.3.340.24"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Gothals</span> <span class="cit-name-given-names">PET</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Zimmerman</span> <span class="cit-name-given-names">R</span></span></li></ol><cite>. <span class="cit-article-title">Cyclotrons used in nuclear medicine report & directory</span>. MEDraysintell website. <a href="http://www.medraysintell.com">www.medraysintell.com</a>. Published <span class="cit-pub-date">2020</span>. Accessed October 18, 2024.</cite></div><div class="cit-extra"></div></div></li><li><span class="ref-label">25.</span><a class="rev-xref-ref" href="#xref-ref-25-1" title="View reference 25. in text" id="ref-25">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.25"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Yakar</span> <span class="cit-name-given-names">D</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Kwee</span> <span class="cit-name-given-names">TC</span></span></li></ol><cite>. <span class="cit-article-title">Carbon footprint of the RSNA annual meeting</span>. <abbr class="cit-jnl-abbrev">Eur J Radiol.</abbr> <span class="cit-pub-date">2020</span>;<span class="cit-vol">125</span>:<span class="cit-fpage">108869</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DEur%2BJ%2BRadiol.%26rft.volume%253D125%26rft.spage%253D108869%26rft_id%253Dinfo%253Apmid%252F32105915%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="/lookup/external-ref?access_num=32105915&link_type=MED&atom=%2Fjnumed%2F66%2F3%2F340.atom" class="cit-ref-sprinkles cit-ref-sprinkles-medline"><span>PubMed</span></a></div></div></li><li><span class="ref-label">26.</span><a class="rev-xref-ref" href="#xref-ref-26-1" title="View reference 26. in text" id="ref-26">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.26" data-doi="10.2967/jnumed.121.263703"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Saboury</span> <span class="cit-name-given-names">B</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Bradshaw</span> <span class="cit-name-given-names">T</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Boellaard</span> <span class="cit-name-given-names">R</span></span>, </li><li><span class="cit-etal">et al</span></li></ol><cite>. <span class="cit-article-title">Artificial intelligence in nuclear medicine: opportunities, challenges, and responsibilities toward a trustworthy ecosystem</span>. <abbr class="cit-jnl-abbrev">J Nucl Med.</abbr> <span class="cit-pub-date">2023</span>;<span class="cit-vol">64</span>:<span class="cit-fpage">188</span>–<span class="cit-lpage">196</span>.</cite></div><div class="cit-extra"><a href="{openurl}?query=rft.jtitle%253DJ%2BNucl%2BMed.%26rft_id%253Dinfo%253Adoi%252F10.2967%252Fjnumed.121.263703%26rft_id%253Dinfo%253Apmid%252F36522184%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx" class="cit-ref-sprinkles cit-ref-sprinkles-openurl cit-ref-sprinkles-open-url"><span>OpenUrl</span></a><a href="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" class="cit-ref-sprinkles cit-ref-sprinkles-ijlink"><span><span class="cit-reflinks-abstract">Abstract</span><span class="cit-sep cit-reflinks-variant-name-sep">/</span><span class="cit-reflinks-full-text"><span class="free-full-text">FREE </span>Full Text</span></span></a></div></div></li><li><span class="ref-label">27.</span><a class="rev-xref-ref" href="#xref-ref-27-1" title="View reference 27. in text" id="ref-27">↵</a><div class="cit ref-cit ref-journal" id="cit-66.3.340.27"><div class="cit-metadata"><ol class="cit-auth-list"><li><span class="cit-auth"><span class="cit-name-surname">Currie</span> <span class="cit-name-given-names">G</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Hawk</span> <span class="cit-name-given-names">K</span></span>, </li><li><span class="cit-auth"><span class="cit-name-surname">Rohren</span> <span class="cit-name-given-names">E</span></span></li></ol><cite>. <span class="cit-article-title">The potential role of artificial intelligence in sustainability of nuclear medicine</span>. <abbr class="cit-jnl-abbrev"> Radiography (Lond). 2024;30(suppl 1):119–124.</abbr> </cite></div><div class="cit-extra"></div></div></li></ol></div><ul class="history-list"><li xmlns:hwp="http://schema.highwire.org/Journal" class="received" hwp:start="2024-10-07"><span class="received-label">Received for publication </span>October 7, 2024.</li><li xmlns:hwp="http://schema.highwire.org/Journal" class="accepted" hwp:start="2024-12-19"><span class="accepted-label">Accepted for publication </span>December 19, 2024.</li></ul><span class="highwire-journal-article-marker-end"></span></div><span class="related-urls"></span></div></div> </div> </div> </div> </div> </div> </div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-node-pager" > <div class="pane-content"> <div class="pager highwire-pager pager-mini clearfix highwire-node-pager highwire-article-pager"><span class="pager-prev"><a href="/content/66/3/337" title="Advancing Tomorrow’s Cancer Medicines" rel="prev" class="pager-link-prev link-icon"><span class="icon-circle-arrow-left"></span> <span class="title">Previous</span></a></span><span class="pager-next"><a href="/content/66/3/344" title="Molecular Imaging in Cancer Chemoresistance: What’s Brewing?" rel="next" class="pager-link-next link-icon-right link-icon"><span class="title">Next</span> <span class="icon-circle-arrow-right"></span></a></span></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-back-to-top" > <div class="pane-content"> <a href="#page" class="back-to-top" data-icon-position="" data-hide-link-title="0"><span class="icon-chevron-up"></span> Back to top</a> </div> </div> </div> </div> </div> <div class="sidebar-right-wrapper grid-10 omega"> <div class="panel-panel panel-region-sidebar-right"> <div class="inside"><div class="panel-pane pane-panels-mini pane-jnl-snm-art-issue pane-style-alt-content" > <h2 class="pane-title">In this issue</h2> <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_art_issue"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-article-citation" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-issue node125787" data-node-nid="125787" id="node-125787--289659660" data-pisa="jnumed;66/3" data-pisa-master="jnumed;66/3" data-apath="/jnumed/66/3.atom"><div class="highwire-cite highwire-cite-highwire-issue highwire-citation-jcore-issue-widget clearfix"> <div class="highwire-cite-highlight"><a href="/content/66/3" class="highlight-image-linked"><img class="highlight-image" src="https://jnm.snmjournals.org/sites/default/files/styles/medium/public/highwire/jnumed/66/3.cover-source.jpg?itok=mbx699u7" alt="Journal of Nuclear Medicine: 66 (3)" /></a></div> <div class="highwire-cite-col"> <a href="/content/66/3" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">Journal of Nuclear Medicine</span></a> <div class="highwire-cite-metadata"><span class="highwire-cite-metadata-volume highwire-cite-metadata">Vol. 66</span>, <span class="highwire-cite-metadata-issue highwire-cite-metadata">Issue 3 </span><div class="highwire-cite-metadata-pubdate highwire-cite-metadata">March 1, 2025 </div></div> <div class="highwire-cite-extras"><div class='highwire-article-citation-variant-list'><ul class="links variants-list"><li class="toc first"><a href="/content/66/3.toc" class="highwire-variant-link variant-toc " title="Table of Contents" rel="alternate" type="text/html" data-icon-position="" data-hide-link-title="0">Table of Contents</a></li><li class="tocpdf"><a href="/content/66/3.toc.pdf" class="highwire-variant-link variant-tocpdf " title="Table of Contents (PDF)" rel="alternate" type="application/pdf" data-icon-position="" data-hide-link-title="0">Table of Contents (PDF)</a></li><li class="cover-expansion"><a href="/content/66/3.cover-expansion" class="highwire-variant-link variant-cover-expansion " title="About the Cover" rel="alternate" data-icon-position="" data-hide-link-title="0">About the Cover</a></li><li class="index-by-author"><a href="/content/66/3.index-by-author" class="highwire-variant-link variant-index-by-author " title="Index by author" rel="alternate" data-icon-position="" data-hide-link-title="0">Index by author</a></li><li class="enclosure-complete-issue last"><a href="/content/jnumed/66/3/local/complete-issue.pdf" class="highwire-variant-link variant-enclosure" title="Complete Issue (PDF)" rel="alternative" data-icon-position="" data-hide-link-title="0">Complete Issue (PDF)</a></li></ul></div></div> </div> </div></div> </div> </div> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-dfp-right-placement-1" > <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-dfp_right_placement_1"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-block pane-dfp-jnm-300x250-right-placement-1 text-center pane-dfp" > <div class="pane-content"> <div id="dfp-ad-JNM-300x250-right-placement-1-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-JNM-300x250-right-placement-1" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-JNM-300x250-right-placement-1"); }); </script> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-snm-art-tools" > <div class="pane-content"> <div id="mini-panel-jnl_snm_art_tools" class="highwire-2col-stacked panel-display"> <div class="panel-row-wrapper clearfix"> <div class="content-left-wrapper content-column"> <div class="panel-panel panel-region-content-left"> <div class="inside"><div class="panel-pane pane-highwire-variant-link" > <div class="pane-content"> <a href="/content/jnumed/66/3/340.full-text.print" target="_blank" rel="nofollow" class="link-icon"><span class="icon-print"></span> <span class="title">Print</span></a> </div> </div> <div class="panel-pane pane-highwire-variant-link text-no-wrap" > <div class="pane-content"> <a href="/content/jnumed/66/3/340.full-text.pdf" target="_blank" class="link-icon"><span class="icon-download-alt"></span> <span class="title">Download PDF</span></a> </div> </div> <div class="panel-pane pane-minipanel-dialog-link pane-jnl-snm-art-alert" > <div class="pane-content"> <div class='minipanel-dialog-wrapper'><div class='minipanel-dialog-link-link'><a href="/" oncontextmenu="javascript: return false;" class="minipanel-dialog-link-trigger link-icon" title="Alerts for this Article"><span class="icon-exclamation-sign"></span> <span class="title">Article Alerts</span></a></div><div class='minipanel-dialog-link-mini' style='display:none'><div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_art_alert"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-article-add-form" > <div class="pane-content"> <div id = "alerts-form-wrapper"><form action="/content/66/3/340" method="post" id="highwire-user-opportunity-login" accept-charset="UTF-8"><div><div class="form-item form-item-label-before form-type-textfield form-item-name"> <label for="edit-name">User Name <span class="form-required" title="This field is required.">*</span></label> <input type="text" id="edit-name" name="name" value="" size="60" maxlength="128" class="form-text required" /> </div> <div class="form-item form-item-label-before form-type-password form-item-pass"> <label for="edit-pass">Password <span class="form-required" title="This field is required.">*</span></label> <input type="password" id="edit-pass" name="pass" size="60" maxlength="128" class="form-text required" /> </div> <div id="alerts_email">Sign In to Email Alerts with your Email Address</div><div class="form-item form-item-label-before form-type-textfield form-item-highwire-alerts-email"> <label for="edit-highwire-alerts-email">Email <span class="form-required" title="This field is required.">*</span></label> <input type="text" id="edit-highwire-alerts-email" name="highwire_alerts_email" value="" size="60" maxlength="128" class="form-text required" /> </div> <input type="submit" id="edit-submit--3" name="op" value="Submit" class="form-submit" /><input type="hidden" name="form_build_id" value="form-wINo7-YFIokYGczDR90NbOf5CBTH1DJQNDwccLtszPc" /> <input type="hidden" name="form_id" value="highwire_alerts_article_sign_up_form" /> <input type="hidden" name="current_path" value="content/66/3/340" /> </div></form></div> </div> </div> </div> </div> </div> </div></div> </div> </div> <div class="panel-pane pane-minipanel-dialog-link pane-jnl-snm-art-email" > <div class="pane-content"> <div class='minipanel-dialog-wrapper'><div class='minipanel-dialog-link-link'><a href="/" oncontextmenu="javascript: return false;" class="minipanel-dialog-link-trigger link-icon" title="Email this Article"><span class="icon-envelope"></span> <span class="title">Email Article</span></a></div><div class='minipanel-dialog-link-mini' style='display:none'><div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_art_email"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-block pane-forward-form pane-forward" > <div class="pane-content"> <form action="/content/66/3/340" method="post" id="forward-form" accept-charset="UTF-8"><div><div id="edit-instructions" class="form-item form-item-label-before form-type-item"> <p>Thank you for your interest in spreading the word on Journal of Nuclear Medicine.</p><p>NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.</p> </div> <div class="form-item form-item-label-before form-type-textfield form-item-email"> <label for="edit-email">Your Email <span class="form-required" title="This field is required.">*</span></label> <input type="text" id="edit-email" name="email" value="" size="58" maxlength="256" class="form-text required" /> </div> <div class="form-item form-item-label-before form-type-textfield form-item-name"> <label for="edit-name--2">Your Name <span class="form-required" title="This field is required.">*</span></label> <input type="text" id="edit-name--2" name="name" value="" size="58" maxlength="256" class="form-text required" /> </div> <div class="form-item form-item-label-before form-type-textarea form-item-recipients"> <label for="edit-recipients">Send To <span class="form-required" title="This field is required.">*</span></label> <div class="form-textarea-wrapper resizable"><textarea id="edit-recipients" name="recipients" cols="50" rows="5" class="form-textarea required"></textarea></div> <div class="description">Enter multiple addresses on separate lines or separate them with commas.</div> </div> <div id="edit-page" class="form-item form-item-label-before form-type-item"> <label for="edit-page">You are going to email the following </label> <a href="/content/66/3/340" class="active" data-icon-position="" data-hide-link-title="0">Green Nuclear Medicine and Radiotheranostics</a> </div> <div id="edit-subject" class="form-item form-item-label-before form-type-item"> <label for="edit-subject">Message Subject </label> (Your Name) has sent you a message from Journal of Nuclear Medicine </div> <div id="edit-body" class="form-item form-item-label-before form-type-item"> <label for="edit-body">Message Body </label> (Your Name) thought you would like to see the Journal of Nuclear Medicine web site. </div> <div class="form-item form-item-label-before form-type-textarea form-item-message"> <label for="edit-message--2">Your Personal Message </label> <div class="form-textarea-wrapper resizable"><textarea id="edit-message--2" name="message" cols="50" rows="10" class="form-textarea"></textarea></div> </div> <input type="hidden" name="path" value="node/125868" /> <input type="hidden" name="path_cid" value="" /> <input type="hidden" name="forward_footer" value="" /> <input type="hidden" name="form_build_id" value="form-8PW28ZiBcSB3dInU_G12K8oFep5Hvg5lQefAqK77j5E" /> <input type="hidden" name="form_id" value="forward_form" /> <div class="form-actions form-wrapper" id="edit-actions"><input type="submit" id="edit-submit--4" name="op" value="Send Message" class="form-submit" /></div></div></form> </div> </div> </div> </div> </div> </div></div> </div> </div> <div class="panel-pane pane-minipanel-dialog-link pane-jnl-snm-cite-tool" > <div class="pane-content"> <div class='minipanel-dialog-wrapper'><div class='minipanel-dialog-link-link'><a href="/highwire/citation/125868/download" oncontextmenu="javascript: return false;" class="minipanel-dialog-link-trigger link-icon" title="Citation Tools"><span class="icon-globe"></span> <span class="title">Citation Tools</span></a></div><div class='minipanel-dialog-link-mini' style='display:none'><div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_cite_tool"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-citation-export" > <div class="pane-content"> <div class="highwire-citation-export"> <div class="highwire-citation-info"> <div class="highwire-article-citation highwire-citation-type-highwire-article cite-tool-node125868" data-node-nid="125868" id="citation-node-125868--21995387654" data-pisa="jnumed;66/3/340" data-pisa-master="jnumed;jnumed.124.268928" data-apath="/jnumed/66/3/340.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard clearfix"> <div class="highwire-cite-title">Green Nuclear Medicine and Radiotheranostics</div> <div class="highwire-cite-authors"><span class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Patrick</span> <span class="nlm-surname">Veit-Haibach</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Ken</span> <span class="nlm-surname">Herrmann</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Richard</span> <span class="nlm-surname">Zimmermann</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Roland</span> <span class="nlm-surname">Hustinx</span></span></span></div> <div class="highwire-cite-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">Journal of Nuclear Medicine </span><span class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2025, </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">66 </span><span class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span class="highwire-cite-metadata-pages highwire-cite-metadata">340-343; </span><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.2967/jnumed.124.268928 </span></div> </div> </div> </div> <div class="highwire-citation-formats"> <h2>Citation Manager Formats</h2> <div class="highwire-citation-formats-links"> <span class="Z3988" title="ctx_ver=Z39.88-2004&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.spage=340&rft.epage=343&rft.atitle=Green%20Nuclear%20Medicine%20and%20Radiotheranostics&rft.volume=66&rft.issue=3&rft.date=2025-03-01%2000%3A00%3A00&rft.stitle&rft.jtitle=Journal%20of%20Nuclear%20Medicine&rft.au=Veit-Haibach%2C+Patrick&rft.au=Herrmann%2C+Ken&rft.au=Zimmermann%2C+Richard&rft.au=Hustinx%2C+Roland"></span><ul class="hw-citation-links inline button button-alt button-grid clearfix"><li class="bibtext first"><a href="/highwire/citation/125868/bibtext" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">BibTeX</a></li><li class="bookends"><a href="/highwire/citation/125868/bookends" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Bookends</a></li><li class="easybib"><a href="/highwire/citation/125868/easybib" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EasyBib</a></li><li class="endnote-tagged"><a href="/highwire/citation/125868/endnote-tagged" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EndNote (tagged)</a></li><li class="endnote-8-xml"><a href="/highwire/citation/125868/endnote-8-xml" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">EndNote 8 (xml)</a></li><li class="medlars"><a href="/highwire/citation/125868/medlars" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Medlars</a></li><li class="mendeley"><a href="/highwire/citation/125868/mendeley" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Mendeley</a></li><li class="papers"><a href="/highwire/citation/125868/papers" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Papers</a></li><li class="refworks-tagged"><a href="/highwire/citation/125868/refworks-tagged" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">RefWorks Tagged</a></li><li class="reference-manager"><a href="/highwire/citation/125868/reference-manager" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Ref Manager</a></li><li class="ris"><a href="/highwire/citation/125868/ris" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">RIS</a></li><li class="zotero last"><a href="/highwire/citation/125868/zotero" class="hw-download-citation-link" data-icon-position="" data-hide-link-title="0">Zotero</a></li></ul> </div> </div> </div> </div> </div> </div> </div> </div> </div></div> </div> </div> </div> </div> </div> <div class="content-right-wrapper content-column"> <div class="panel-panel panel-region-content-right"> <div class="inside"><div class="panel-pane pane-highwire-share-link highwire_clipboard_link_ajax" id="shareit"> <div class="pane-content"> <a href="/" class="link-icon"><span class="icon-share-alt"></span> <span class="title">Share</span></a> </div> </div> <div class="panel-pane pane-panels-mini pane-jnl-snm-share highwire_clipboard_form_ajax_shareit" > <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_share"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-article-citation large-margin-bottom" > <div class="pane-content"> <div class="highwire-article-citation highwire-citation-type-highwire-article node125868--3" data-node-nid="125868" id="share-node-125868--41359418046" data-pisa="jnumed;66/3/340" data-pisa-master="jnumed;jnumed.124.268928" data-apath="/jnumed/66/3/340.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard clearfix"> <div class="highwire-cite-title">Green Nuclear Medicine and Radiotheranostics</div> <div class="highwire-cite-authors"><span class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">Patrick</span> <span class="nlm-surname">Veit-Haibach</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">Ken</span> <span class="nlm-surname">Herrmann</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">Richard</span> <span class="nlm-surname">Zimmermann</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">Roland</span> <span class="nlm-surname">Hustinx</span></span></span></div> <div class="highwire-cite-metadata"><span class="highwire-cite-metadata-journal highwire-cite-metadata">Journal of Nuclear Medicine </span><span class="highwire-cite-metadata-date highwire-cite-metadata">Mar 2025, </span><span class="highwire-cite-metadata-volume highwire-cite-metadata">66 </span><span class="highwire-cite-metadata-issue highwire-cite-metadata">(3) </span><span class="highwire-cite-metadata-pages highwire-cite-metadata">340-343; </span><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.2967/jnumed.124.268928 </span></div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-clipboard-copy large-margin-bottom" > <div class="pane-content"> <div class = "clipboard-copy"> <span class="label-url"> <label for="dynamic">Share This Article:</label> </span> <span class="input-text-url"> <input type="text" id="dynamic" value="https://jnm.snmjournals.org/content/66/3/340" size="50"/> </span> <span class="copy-button button"> <button id="copy-dynamic" class="clipboardjs-button" data-clipboard-target="#dynamic" data-clipboard-alert-style="tooltip" data-clipboard-alert-text="Copied!">Copy</button> </span> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-service-links" > <div class="pane-content"> <div class="service-links"><a href="http://twitter.com/share?url=https%3A//jnm.snmjournals.org/content/66/3/340&text=Green%20Nuclear%20Medicine%20and%20Radiotheranostics" id="twitter" title="Share this on Twitter" class="service-links-twitter" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="https://jnm.snmjournals.org/sites/all/modules/highwire/highwire/images/twitter.png" alt="Twitter logo" /></a> <a href="http://www.facebook.com/sharer.php?u=https%3A//jnm.snmjournals.org/content/66/3/340&t=Green%20Nuclear%20Medicine%20and%20Radiotheranostics" id="facebook" title="Share on Facebook" class="service-links-facebook" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="https://jnm.snmjournals.org/sites/all/modules/highwire/highwire/images/fb-blue.png" alt="Facebook logo" /></a> <a href="http://www.linkedin.com/shareArticle?mini=true&url=https%3A//jnm.snmjournals.org/content/66/3/340&title=Green%20Nuclear%20Medicine%20and%20Radiotheranostics&summary=&source=Journal%20of%20Nuclear%20Medicine" id="linkedin" title="Publish this post to LinkedIn" class="service-links-linkedin" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="https://jnm.snmjournals.org/sites/all/modules/highwire/highwire/images/linkedin-32px.png" alt="LinkedIn logo" /></a> <a href="http://www.mendeley.com/import/?url=https%3A//jnm.snmjournals.org/content/66/3/340&title=Green%20Nuclear%20Medicine%20and%20Radiotheranostics" id="mendeley" title="Share on Mendeley" class="service-links-mendeley" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><img src="https://jnm.snmjournals.org/sites/all/modules/highwire/highwire/images/mendeley.png" alt="Mendeley logo" /></a></div> </div> </div> </div> </div> </div> </div> </div> <div class="panel-pane pane-service-links" > <div class="pane-content"> <div class="service-links"><div class="item-list"><ul><li class="first"><a href="http://twitter.com/share?url=https%3A//jnm.snmjournals.org/content/66/3/340&count=horizontal&via=&text=Green%20Nuclear%20Medicine%20and%20Radiotheranostics&counturl=https%3A//jnm.snmjournals.org/content/66/3/340" class="twitter-share-button service-links-twitter-widget" id="twitter_widget" title="Tweet This" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><span class="element-invisible">Tweet Widget</span></a></li><li><a href="http://www.facebook.com/plugins/like.php?href=https%3A//jnm.snmjournals.org/content/66/3/340&layout=button_count&show_faces=false&action=like&colorscheme=light&width=100&height=21&font=&locale=" id="facebook_like" title="I Like it" class="service-links-facebook-like" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><span class="element-invisible">Facebook Like</span></a></li><li class="last"><a href="https://jnm.snmjournals.org/content/66/3/340" id="google_plus_one" title="Plus it" class="service-links-google-plus-one" rel="nofollow" target="_blank" data-icon-position="" data-hide-link-title="0"><span class="element-invisible">Google Plus One</span></a></li></ul></div></div> </div> </div> <div class="panel-pane pane-add-member" > <div class="pane-content"> <a href="/highwire/folders/save_to_folders/atom%3A/jnumed/66/3/340.atom?destination=content/66/3/340" id="atom-jnumed-66-3-340atom" class="highwire-save-to-folders highwire_saved_search_link_ajax link-icon"><span class="icon-bookmark-empty"></span> <span class="title">Bookmark this article</span></a><div style="display:none" id="atom-jnumed-66-3-340atom" class="highwire_saved_folder_form_ajax_atom-jnumed-66-3-340atom"><div id="folder-form-wrapper"><form action="/content/66/3/340" method="post" id="highwire-user-opportunity-login--2" accept-charset="UTF-8"><div><div class="form-item form-item-label-before form-type-textfield form-item-name"> <label for="edit-name--3">User Name <span class="form-required" title="This field is required.">*</span></label> <input type="text" id="edit-name--3" name="name" value="" size="60" maxlength="128" class="form-text required" /> </div> <div class="form-item form-item-label-before form-type-password form-item-pass"> <label for="edit-pass--2">Password <span class="form-required" title="This field is required.">*</span></label> <input type="password" id="edit-pass--2" name="pass" size="60" maxlength="128" class="form-text required" /> </div> <div class="form-item form-item-label-after form-type-checkbox form-item-remember"> <input type="checkbox" id="edit-remember--2" name="remember" value="1" class="form-checkbox" /> <label class="option" for="edit-remember--2">Remember my user name & password. </label> </div> <input type="submit" id="edit-submit--6" name="op" value="Submit" class="form-submit" /><input type="hidden" name="form_build_id" value="form-zM9cnTGBH79lINTiPwxRev2mKlPTsJdk85P6F--_2ao" /> <input type="hidden" name="form_id" value="highwire_folders_select_folder_form" /> <input type="hidden" name="current_path" value="content/66/3/340" /> </div></form></div></div> </div> </div> </div> </div> </div> </div> <!-- /.panel-row-wrapper --> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-nav mobile-hidden pane-style-alt-content" > <h2 class="pane-title">Jump to section</h2> <div class="pane-content"> <div class="highwire-list-wrapper highwire-article-nav highwire-nav-float"><div class="highwire-list"><ul data-highwire-float="1" data-highwire-float-class="grid-10 alpha omega"><li class="parent first odd"><a href="/content/66/3/340" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">Article</a><div class="highwire-list"><ul><li class="first odd"><a href="#abstract-1" class="highwire-article-nav-jumplink first" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">Abstract</a></li><li class="even"><a href="#sec-1" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">THE INCREASING RADIOPHARMACEUTICAL MARKET</a></li><li class="odd"><a href="#sec-2" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">GENERAL ENVIRONMENTAL IMPACT OF DIAGNOSTIC AND THERAPEUTIC MOLECULAR IMAGING PRODUCTION</a></li><li class="even"><a href="#sec-3" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">ENVIRONMENTAL IMPACT OF HOSPITAL-BASED MOLECULAR IMAGING DEPARTMENTS</a></li><li class="odd"><a href="#sec-9" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">WHAT ARE THE OUT-OF-HOSPITAL SOLUTIONS?</a></li><li class="even"><a href="#sec-13" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">CONCLUSION</a></li><li class="odd"><a href="#sec-14" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">DISCLOSURE</a></li><li class="even"><a href="#fn-group-1" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">Footnotes</a></li><li class="last odd"><a href="#ref-list-1" class="highwire-article-nav-jumplink last" data-panel-ajax-tab="jnl_snm_tab_art" data-icon-position="" data-hide-link-title="0">REFERENCES</a></li></ul></div></li><li class="even"><a href="/content/66/3/340/tab-figures-data" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_data" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">Figures & Data</a></li><li class="odd"><a href="/content/66/3/340/tab-article-info" class="highwire-article-nav-jumplink" data-panel-ajax-tab="jnl_snm_tab_info" data-is-tab-link="true" data-icon-position="" data-hide-link-title="0">Info & Metrics</a></li><li class="last even"><a href="/content/66/3/340.full.pdf" class="highwire-article-nav-jumplink" data-icon-position="" data-hide-link-title="0"><i class="icon-file-alt"></i> PDF</a></li></ul></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-dfp-right-tower" > <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-dfp_right_tower"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-block pane-dfp-jnm-300x600-righttower text-center pane-dfp" > <div class="pane-content"> <div id="dfp-ad-JNM-300x600-righttower-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-JNM-300x600-righttower" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-JNM-300x600-righttower"); }); </script> </div> </div> </div> </div> </div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-jnl-snm-accordion" > <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_accordion"> <div class="panel-panel panel-col"> <div><div id="highwire_article_accordion_container"><h3 ><i class="icon-caret-right"></i> Related Articles</h3><div><div class="highwire-list highwire-related-articles highwire-article-citation-list"><ul class="highwire-related-articles-list"><li class="first last odd"><div class="no-results">No related articles found.</div></li></ul></div><div class='highwire-list-footer'><div class="highwire-related-articles-footer"><ul class="links inline"><li class="related-pubmed first"><a href="/lookup/external-ref?link_type=MED_NBRS&access_num=39848763" target="_blank" class="" data-icon-position="" data-hide-link-title="0">PubMed</a></li><li class="related-google-scholar last"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=related&author%5B0%5D=Patrick%2BVeit-Haibach&author%5B1%5D=Ken%2BHerrmann&author%5B2%5D=Richard%2BZimmermann&author%5B3%5D=Roland%2BHustinx&title=Green%2BNuclear%2BMedicine%2Band%2BRadiotheranostics&publication_year=2025&path=content/66/3/340" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Google Scholar</a></li></ul></div></div></div><h3 ><i class="icon-caret-right"></i> Cited By...</h3><div><div class="highwire-list highwire-cited-by"><ul><li class="first last odd"><div class="no-results">No citing articles found.</div></li></ul></div><div class='highwire-list-footer'><ul class="links inline"><li class="citing-google-scholar first last"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=citedby&path=content/66/3/340" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Google Scholar</a></li></ul></div></div><h3 ><i class="icon-caret-right"></i> More in this TOC Section</h3><div><div class="highwire-list highwire-article-citation-list"><ul><li class="first odd"><div class="highwire-article-citation highwire-citation-type-highwire-article node125715" data-node-nid="125715" id="node-125715--2704418936" data-pisa="jnumed;jnumed.124.268522v1" data-pisa-master="jnumed;jnumed.124.268522" data-apath="/jnumed/early/2025/02/27/jnumed.124.268522.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard-title-only clearfix"> <a href="/content/early/2025/02/27/jnumed.124.268522" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">Navigating Radiation Safety After Radiopharmaceutical Therapies: Proposed Workflow and Essential Guidelines for Nonspecialists</span></a> </div> </div></li><li class="last even"><div class="highwire-article-citation highwire-citation-type-highwire-article node125725" data-node-nid="125725" id="node-125725--22011056056" data-pisa="jnumed;jnumed.124.268818v1" data-pisa-master="jnumed;jnumed.124.268818" data-apath="/jnumed/early/2025/02/27/jnumed.124.268818.atom"><div class="highwire-cite highwire-cite-highwire-article highwire-citation-jcore-standard-title-only clearfix"> <a href="/content/early/2025/02/27/jnumed.124.268818" class="highwire-cite-linked-title" data-icon-position="" data-hide-link-title="0"><span class="highwire-cite-title">The Role of PSMA PET Parameters as Biomarkers for Response to PSMA-Targeted Radiopharmaceutical Therapy</span></a> </div> </div></li></ul></div><div class='highwire-list-footer'><a href="/content/by/section/The%20State%20of%20the%20Art" class="" data-icon-position="" data-hide-link-title="0">Show more <span class="wrapper">The State of the Art</span></a></div></div><h3 ><i class="icon-caret-right"></i> Similar Articles</h3><div><div class="highwire-search-similar-ajax-wrapper" id="highwire-search-similar-articles-list-1"><div class="highwire-ajax-loading"><span class="icon-spinner icon-spin icon-2x"></span></div></div></div></div></div> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-term-full-title" > <h2 class="pane-title">Keywords</h2> <div class="pane-content"> <div class="highwire-list highwire-a-full-title"><ul class="field-items inline comma-separated"><li class="first odd"><a href="/keyword/molecular-imaging" class="" data-icon-position="" data-hide-link-title="0"><span class="wrapper">molecular imaging</span></a></li><li class="even"><a href="/keyword/radionuclide-therapy" class="" data-icon-position="" data-hide-link-title="0"><span class="wrapper">radionuclide therapy</span></a></li><li class="odd"><a href="/keyword/radiopharmaceuticals" class="" data-icon-position="" data-hide-link-title="0"><span class="wrapper">radiopharmaceuticals</span></a></li><li class="even"><a href="/keyword/green-nuclear-medicine" class="" data-icon-position="" data-hide-link-title="0"><span class="wrapper">green nuclear medicine</span></a></li><li class="odd"><a href="/keyword/radiotheranostics" class="" data-icon-position="" data-hide-link-title="0"><span class="wrapper">radiotheranostics</span></a></li><li class="last even"><a href="/keyword/health-economics" class="" data-icon-position="" data-hide-link-title="0"><span class="wrapper">health economics</span></a></li></ul></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-article-trendmd" > <div class="pane-content"> <div id="trendmd-suggestions"></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-panels-mini pane-dfp-right-placement-2" > <div class="pane-content"> <div class="panel-display panel-1col clearfix" id="mini-panel-dfp_right_placement_2"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-block pane-dfp-jnm-300x250-right-placement-2 text-center pane-dfp" > <div class="pane-content"> <div id="dfp-ad-JNM-300x250-right-placement-2-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-JNM-300x250-right-placement-2" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-JNM-300x250-right-placement-2"); }); </script> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> <!-- /.panel-row-wrapper --> </div> </div> </div> </div><div class="block block-panels-mini block-dfp-bottom-leaderboard block-panels-mini-dfp-bottom-leaderboard even block-without-title" id="block-panels-mini-dfp-bottom-leaderboard"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-dfp_bottom_leaderboard"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-block pane-dfp-jnm-728x90-bottom-leaderboard text-center pane-dfp" > <div class="pane-content"> <div id="dfp-ad-JNM-728x90-Bottom-Leaderboard-wrapper" class="dfp-tag-wrapper"> <div id="dfp-ad-JNM-728x90-Bottom-Leaderboard" class="dfp-tag-wrapper"> <script type="text/javascript"> googletag.cmd.push(function() { googletag.display("dfp-ad-JNM-728x90-Bottom-Leaderboard"); }); </script> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </section> <footer id="section-footer" class="section section-footer"> <div id="zone-footer" class="zone zone-footer clearfix container-30"> <div class="grid-28 suffix-1 prefix-1 region region-footer-first" id="region-footer-first"> <div class="region-inner region-footer-first-inner"> <div class="block block-panels-mini block-jnl-snm-foot-info block-panels-mini-jnl-snm-foot-info odd block-without-title" id="block-panels-mini-jnl-snm-foot-info"> <div class="block-inner clearfix"> <div class="content clearfix"> <div class="panel-display panel-1col clearfix" id="mini-panel-jnl_snm_foot_info"> <div class="panel-panel panel-col"> <div><div class="panel-pane pane-page-logo-footer" > <div class="pane-content"> <a href="https://www.snmmi.org/" class="linked-footer-logo" data-icon-position="" data-hide-link-title="0"><img class="footer-logo" src="https://jnm.snmjournals.org/sites/default/files/snmmi_2025_logo_white_optimized.png" width="136" height="27" alt="SNMMI" /></a> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-snippet pane-footer-copyright-text" > <div class="pane-content"> <div class="snippet footer-copyright-text" id="footer-copyright-text"> <div class="snippet-content"> <p>© 2025 <span style="font-family: Arial, sans-serif; font-size: 14px;">SNMMI</span></p> </div> </div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-branding" > <div class="pane-content"> <a href="http://home.highwire.org" target="_blank" class="highwire-branding-link" data-icon-position="" data-hide-link-title="0"><img class="logo-highwire" src="https://jnm.snmjournals.org/sites/all/modules/highwire/highwire/plugins/content_types/images/logo_small_hw_white.png" width="190" height="31" alt="Powered by HighWire" /></a> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </div> </footer> </div> <div class="region region-page-bottom" id="region-page-bottom"> <div class="region-inner region-page-bottom-inner"> </div> </div><script type="text/javascript" src="/sites/default/files/advagg_js/js__IJuO2zTBevR9UaeFd_maXXn3NHFQrDb_xzKCcbFnGYo__-vovmN1y_fWj5zBzIJmQpOeve1aT7OKOuvKs0lJqP1Y__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__2WRbxlwOW0MEUc_hSWU5MBepQg6Lch6O5SZwefpJ6IE__HCL0YQJqLkOhrLPZZYGqosGvtFsEHMGghHIkSx4y9vA__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js" defer="defer"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__7wIZ-Fggxuz1XBq4W-gV9zVqSKOKMJ9F8HRNs4UfDbQ__LYpq6x97AHkV6nczZd2iqB4USQvZg7peOb7zH4R__4U__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__Jd5dsvNznZMdglFu8sSni1wCsUfzvQbApHPAZwt5TY4__65Mqa1DMRwcSvPxjJEn6BXgMm-ckF3oOvkUTG9HRADI__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js" defer="defer"></script> <script type="text/javascript" src="/sites/default/files/advagg_js/js__vdfcxOCd0gKaJofqm73Qz2ruRXzGRjhQN_NOA6ZZiLw__HB2OIhI08QR42dOpX7zF5XQnrt9xKy76eo0qPpwoXC8__niUiAMAtktBhlJjRjRWAoYa3mPLdBp-Rl0_PwMhDwvs.js"></script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- function euCookieComplianceLoadScripts() {} //--><!]]> </script> <script type="text/javascript"> <!--//--><![CDATA[//><!-- var eu_cookie_compliance_cookie_name = ""; //--><!]]> </script> </body> </html>