Ideas in Hospital-Based Imaging

U of Pittsburgh Researchers Shine New Light on Alzheimer’s
IBM and Siemens Partner on Cost-Effective IT Solution

U of Pittsburgh Researchers Shine New Light on Alzheimer’s

Researchers and clinicians at hospitals across the country received groundbreaking news from their colleagues at the University of Pittsburgh during the Society of Nuclear Medicine meeting in New Orleans in June.

Results of a recent brain imaging study at the university may have a significant impact on the early detection of Alzheimer’s disease (AD), which traditionally has been monitored through careful assessment of clinical histories.

While some studies have proposed that the symptoms of AD occur up to a decade before dementia sets in, clinicians have found it difficult to search inside a living person’s brain for deposits of plaque. This abnormal accumulation of insoluble fibrous beta-amyloid protein aggregates has been thought to be responsible for the disease’s onset.

Past approaches encompassed the watchful examination of the subtle changes associated with cognitive decline over a number of years. The latest research suggests that molecular imaging can help in the management of the neurodegenerative disease, allowing researchers to monitor its progression, identify individuals at risk, and assess the effectiveness of new therapies. Using PET technology and the Pittsburgh Compound-B (PiB) radiotracer, which has the ability to bind to plaques found in the brains of AD patients, a research team at the University of Pittsburgh has found that beta-amyloid imaging may enable early detection of AD and more accurate differential diagnosis of other dementias.

In the current longitudinal study, participants have been monitored for more than 4 years, during which patients with AD were compared to elderly control individuals as well as subjects with mild cognitive impairment (MCI). This comparison aids doctors in determining control subjects at risk of developing cognitive impairment, and it assists clinicians in figuring out those MCI subjects most likely to progress to a clinical diagnosis of AD. A total of 35 people—four with mild to moderate AD, 10 with MCI, and 21 elderly controls—were scanned at yearly intervals over 4 years.

“The research literature shows that 30% to 40% of people with MCI do not progress to AD during 5 to 10 years of follow-up testing,” said Chester Mathis, PhD, professor of radiology at the University of Pittsburgh. “Our hypothesis was that MCI subjects with brain plaque would develop AD and MCI subjects without plaque would not advance to AD. We found that about 60% of the MCI subjects had plaque loads comparable to AD subjects, while about 35% of MCI subjects had no detectable plaque.”

Mathis said only those MCI participants with plaque progressed to the clinical diagnosis of AD. Also, AD subjects exhibit a ceiling to plaque deposition, and plaque concentration does not increase as the disease progresses from mild to advanced stages of AD.

“We had also assumed that the elderly control group would have little PiB retention, indicating no amyloid deposits, but the results were otherwise,” Mathis said. “We found that about 25% of participants between 65 and 80 years of age had significant deposits of amyloid plaque in their brains. We hypothesize that these control subjects are in a presymptomatic, at-risk state that will eventually lead to AD.”

More than 5 million people in the United States have AD, and according to the Alzheimer’s Association, that number could triple by 2050. It is the seventh leading cause of death in the country.

MCI patients show a decline of cognitive performance that is more pronounced than expected from age, but is not severe enough to meet the criteria for the clinical diagnosis of dementia. Patients’ clinical prognoses are difficult to forecast on the basis of clinical measures alone.

—Elaine Sanchez

IBM and Siemens Partner on Cost-Effective IT Solution

A new collaboration between IBM Corp, Armonk, NY, and Siemens Medical Solutions USA Inc, Malvern, Pa, could result in significant cost savings for community hospitals looking to reduce operating overhead and energy consumption while expanding their information technology capabilities.

The two companies have partnered to provide a bundled solution that combines Siemens MedSeries4, a health information system (HIS) designed specifically for community hospitals, with BladeCenter server technology from IBM. This technology works by consolidating servers to reduce data center space requirements, streamline data center management, and lower energy costs.

“The new configuration takes advantage of BladeCenter technology to provide a level of consolidation that simplifies the community hospital’s computing environment and lowers cost of ownership,” said Ruth Bowen, product marketing manager for MedSeries4 at Siemens.

Bowen also emphasized that BladeCenter is a “green” technology, demanding both less energy and less cooling power than alternative server configurations. “The potential for the technology to lower energy costs is why it would be important to community hospitals,” she said. “I think it’s very likely that this kind of consolidation is going to be a requirement at some point in this market space.”

Scott Serafin, a client executive at IBM, added, “One of the things we’ve looked at is that the power savings alone could actually equal your initial cost of hardware over time.”

Consolidation also reduces overall hardware and software costs by as much as 25%, according to initial analyses conducted by the two companies. “When the solution was initially delivered, it would span across three racks with traditional rack-mounted servers,” said Serafin. “We saw that by consolidating multiple servers into a BladeCenter, we were able to reduce the overall costs associated with the configuration. It’s more efficient, reduces cabling points of failure, and is less expensive to package this way.”

In addition, there are cost savings associated with improved storage efficiency. “When the configuration spanned across three racks, each solution had its own backup and internal storage strategy,” said Serafin. “By going to a BladeCenter, each application is now sharing a common storage area network [SAN], which means you’re more effectively using the latest technology solution by IBM to support the MedSeries4 solution.” Serafin also notes that high availability and disaster recovery options, capabilities community hospitals have historically been unable to afford, are optimized when the two solutions are bundled together. “If one of their servers were to fail, they can reload its software personality from the SAN to the Blade Server and they’re up and running again in minutes,” he said. “They will also have less downtime at the hospital site if there’s a system outage, meaning less manual processes would have to be used. When everything is automated through the BladeCenter, you’re utilizing the intelligence of the system to fail over to a hot spare Blade.”

Bowen emphasizes the challenges community hospitals often face when deploying IT solutions. “This solution has the promise of lowering overall cost of ownership, whether it be in the hardware itself, energy, server space, or just in terms of freeing up resources to make further investments in IT,” she said. IBM’s Tivoli Storage Manager will be included in the package, automating data protection and coordinating access to all data coming from applications residing in BladeCenter; the system will be backed up by IBM’s Linear Tape system. “We will provide complete HIS functionality in a single, integrated system,” said Bowen.

The bundled solution will be commercially available this summer.

—C. Vasko