The aim of the present study was to measure airway, oropharyngeal and gastrointestinal deposition of 99m Tc-labelled hydrofluoroalkane-beclomethasone dipropionate after inhalation via a pressurised metered-dose inhaler and spacer (Aerochamber Plus TM ) in asthmatic children.A group of 24 children (aged 5-17 yrs) with mild asthma inhaled the labelled drug. A total of 12 children took five tidal breaths after each actuation (tidal group). The other 12 children used a slow maximal inhalation followed by a 5-10-s breath-hold (breath-hold group). Simultaneous anterior and posterior planar c-scintigraphic scans (120-s acquisition) were recorded.For the tidal group, mean¡SD lung deposition (% ex-actuator, attenuation corrected) was 35.4¡18.3, 47.5¡13.0 and 54.9¡11.2 in patients aged 5-7 (n54), 8-10 (n54) and 11-17 yrs (n54), respectively. Oropharyngeal and gastrointestinal deposition was 24.0¡10.5, 10.3¡4.4 and 10.1¡6.2. With the breath-hold technique, lung deposition was 58.1¡6.7, 56.6¡5.2 and 58.4¡9.2. Oropharyngeal and gastrointestinal deposition was 12.9¡3.2, 20.1¡9.5 and 20.8¡8.8.Inhalation of the extrafine formulation with the breath-hold technique showed significantly improved lung deposition compared with tidal breathing across all ages. Oropharyngeal and gastrointestinal deposition was markedly decreased, regardless of which inhalation technique was applied, compared with a previous paediatric study using the same formulation delivered via a breath-actuated metered-dose inhaler.

QVAR TM , an extrafine hydrofluoroalkane/beclomethasone dipropionate formulation, has been shown to double lung deposition in adults. The aim of the present study was to assess the total body deposition and distribution of technetium99m-labelled ( 99m Tc) QVAR TM in children after inhalation via an Autohaler TM . Sixteen male asthmatic children (5-14 yrs) inhaled labelled drug (v4 MBq 99m Tc; 100 mg beclomethasone dipropionate) via an Autohaler within 30 min after salbutamol (200 mg) administration. Simultaneous anterior and posterior planar scintigraphic scans (120 s acquisition time) were collected after inhalation of labelled drug.Mean¡SD lung deposition of labelled drug (attenuation-corrected; percentage of ex-actuator dose) was 36.9¡9.2, 46.5¡11.6 and 54.1¡10.7% in children aged 5-7, 8-10 and 11-14 yrs, respectively. Combined oropharyngeal and gastrointestinal deposition was 59.7¡8.2, 48.9¡12.3 and 40.3¡11.8%. Lung deposition positively correlated with the forced expiratory volume in one second (FEV1) and forced vital capacity (FVC). Gastrointestinal dose negatively correlated with the FEV1, FVC, height and age.In older children (11-14 yrs), lung deposition was almost identical to that reported in adults using QVAR TM . In children aged 5-10 yrs, lung deposition using QVAR TM was greater than the levels measured using other commercial aerosol delivery systems. Oropharygeal and gastrointestinal deposition was inversely related to age.

IntroductionPreoperative wire-guided localisation (WGL) of impalpable breast lesions is widely used but can be technically difficult. Risks include wire migration, inaccurate placement, and inadequate surgical margins. Research shows that radioguided occult lesion localisation (ROLL) is quicker, easier, and can improve surgical and cosmetic outcomes. An audited introduction of ROLL was conducted to validate the technique as a feasible alternative to WGL.MethodsFifty patients with single impalpable lesions and biopsy proven malignancy or indeterminate histology underwent WGL followed by intralesional radiopharmaceutical injection of 99m-Technetium macroaggregated albumin. Postprocedural mammography was performed to demonstrate wire position, and scintigraphy to evaluate radiopharmaceutical migration. Lymphoscintigraphy and intraoperative sentinel node biopsy were performed if indicated, followed by lesion localisation and excision using a gamma probe. Specimen imaging was performed, with immediate reexcision for visibly inadequate margins.ResultsAccurate localisation was achieved in 86% of patients with ROLL compared to 72% with WGL. All lesions were successfully removed, with clear margins in 71.8% of malignant lesions. Reexcision and intraoperative sentinel node localisation rates were equivalent to preaudit figures for WGL. ROLL was easy to perform and problems were infrequent. Inaccurate radiopharmaceutical placement necessitating WGL occurred in four patients. Minor radiopharmaceutical migration was common, but precluded using ROLL in only two cases.ConclusionsROLL is effective, simple, inexpensive, and easily learnt; however, preoperative confirmation of correct radiopharmaceutical placement using mammography and the gamma probe is important to help ensure successful lesion removal. Insertion of a backup hookwire is recommended during the initial introduction of ROLL.

Osseous metastasis from ILC can have a characteristic imaging pattern on CT and SS. The pattern of USSL on CT scan with negative SS is highly suggestive of osseous metastasis from ILC.