Poised for NaF PET Procedures
MEDRAD?s Intego? PET Infusion System is the only FDA-approved multi-PET agent infusion system.
The MEDRAD® Intego™ PET Infusion System is the only automated infusion system currently cleared by the FDA for positron emission tomography (PET) imaging. Having received FDA clearance for F18 fluoro-deoxy-glucose (F18-FDG) administration in 2008 and recently for F18-sodium fluoride (F18-NaF) administration in July 2010, Intego is also the only multi-PET agent infusion system cleared by the FDA. With the recent announcement of expanded coverage for PET scans using the NaF radiotracer, Intego is prepared to help bring sodium fluoride into mainstream clinical use.
As of February 7, 2011, the Centers for Medicare and Medicaid Services has been reimbursing sites participating in the National Oncologic PET Registry (NOPR) for NaF PET scans. F18-NaF PET is most frequently used in oncology to find and assess bone metastases. Now, physicians treating Medicare patients with known or suspected cancer metastatic to bone can much more widely order PET scans using the NaF radiotracer.
As clinics increase their procedure volumes, repeated manual dosing, increased radiation exposure, and managing a constantly changing patient schedule can become problematic. Intego attempts to minimize these challenges with the use of an integrated dose calibrator, real-time automated dose preparation, and infusion directly from a multidose vial. This helps improve the precision, flexibility, safety, and efficiency of high-volume PET imaging.
When asked to compare the precision of manual versus automatic dosing, Dennis Wright, product manager-Americas for MEDRAD, stated, “With manual dosing ? there’s a significant margin of error factored into the process. The Society of Nuclear Medicine guidelines say acceptable dose variance is +/- 10% of the prescribed dose, and often sites will struggle to get within that range. So one of the great parts of our system is that we have a calibrated dose indicator so that Intego can prepare, measure, and infuse the precise dose that you are looking for within +/- 2% on demand, exactly when the clinician needs it.”
This delivery method also offers a number of safety benefits. By drawing from a multidose vial that is entirely lead shielded, staff in a busy clinic is not exposed to increased amounts of radiation with greater numbers of PET procedures. Intego has been FDA approved for at least 20% radiation exposure reduction, according to Wright. “They are able to pull, extract, measure, and infuse those doses on demand through a touch screen. It’s a completely hands off operation for the technologist.”
In addition, there is a drastic reduction in the number of steps required with Intego’s automatic infusion as compared to manual infusion, which normally requires a lot of back and forth to the hot lab before and after each procedure. “You don’t have to pull the dose until you actually need it and want to deliver it to the patient.? It’s simply a matter of preparing the dose automatically on the system and pressing the infuse button and everything gets automated? you get a label that prints out that says exactly what was delivered to the patient. You can put that right on the patient record and you’re done,” said Wright.
“There is excitement in the market right now. They [our customers] are really looking forward to using our system to see the same benefits [with NaF] that they have been able to recognize with FDG,” said Wright. “With the recent reimbursement news for NaF and the recent coverage, I think that we are going to see procedures increase.”
All PET facilities currently participating in the NOPR are eligible to participate in the expanded program, and new facilities are encouraged to join. For more information regarding NOPR, visit the NOPR Web site: www.cancerPETregistry.org.
Philips’ Ingenious Solution
The Ingenuity TF PET/CT from Philips made its debut at RSNA.
The new Philips Ingenuity TF PET/CT is a premium hybrid imaging system for conducting oncology imaging, cardiac perfusion, and diagnostic CT studies. This system was introduced in November 2010 at the Radiological Society of North America (RSNA) meeting. Its unique features are designed to optimize low-dose imaging without the need to make compromises in patient care.
A number of new and exclusive features come together in the Ingenuity platform to make such innovation possible. Satrajit Misra, senior director, head of global product marketing Nuclear Medicine, PET CT, SPECT CT & Workstations at Philips Healthcare, was asked to describe these redefining features of the system. “At the heart of the Ingenuity TF PET/CT is a new level of clinical integration and a wide variety of applications such as iDose4, Philips’ newest generation of its DoseWise radiation management program. iDose4 provides up to 80% reduction of dose while maintaining image quality, fast reconstruction times, and improved spatial resolution. The Ingenuity TF PET/CT also offers the power of Astonish TF, the next evolution in time-of-flight (TOF) technology. Astonish TF has up to 30% improved contrast over non-TOF and offers exceptional speed and imaging purity, allowing for faster scans, lower dose, and excellent image quality for patients of virtually any size. Another exclusive to the Ingenuity TF PET/CT is SyncRight, a tool that provides seamless integration between the injector console and scanner that ultimately eliminates the need for extra equipment and repeat exams for patients, results in enhanced image quality with up to 15% less injected contrast, and offers a more efficient process for clinicians.”
This proprietary technology has been independently evaluated by clinics. In February, the Journal of Nuclear Medicine (JNM) published a study by El Fakhri et al1 that discussed the benefit of TOF technology with respect to lesion detection. The authors concluded, “Over all contrasts and body mass indexes, oncologic TOF PET [compared to non-TOF PET] yielded a significant improvement in lesion detection that was greater for lower lesion contrasts. This improvement was achieved without compromising other aspects of PET imaging.”
With so much technology behind it, the Ingenuity TF PET/CT makes personal customization of scans possible within a busy clinic setting. Clinicians can optimize the balance between required dose and image quality on a case-by-case basis. “In the past, the combination of great image quality, low dose, and fast reconstruction times has been a challenge,” said Misra. “The Philips Ingenuity TF PET/CT is the next step toward fully optimizing low-dose imaging, and we are working with clinicians who seek an economically sound system without compromising the well-being of their patients in both the short and long term.”
The Ingenuity platform also provides tools to improve clinical efficiency such as RapidView IR and a new, easy to use operator console designed to increase throughput by up to 25% and reduce decision points by up to 50%. However, clinical efficiency is not just a matter of faster scans. It is also measured by how well the entire process is streamlined. To address this, Philips Ingenuity TF PET/CT also integrates the IntelliSpace Portal and extended Brilliance Workspace, across hospital information systems (HIS), radiology information systems (RIS), and picture archiving and communication systems (PACS).
According to Misra, in the 3 months since its commercial launch, the Philips Ingenuity TF PET/CT has evoked tremendous interest in the clinical community. “We are currently in dialogues with a number of clinicians and imaging facilities interested in installing an Ingenuity TF PET/CT.”
- El Fakhri G, Surti S, Trott CM, Scheuermann J, Karp JS. Improvement in lesion detection with whole-body oncologic time-of-flight PET [published online ahead of print February 14, 2011]. J Nucl Med. 2011;52:347-353. 10.2967/jnumed.110.080382.
Siemens IQ-SPECT Gets Frost and Sullivan Award
Symbia systems, using SPECT, upgradeable SPECT, and SPECT*CT imaging, can perform a complete range of studies such as heart and brain imaging, renal exams, and bone scans.
The 2011 North American Nuclear Cardiology Product Differentiation Excellence of the Year Award by Frost and Sullivan was recently awarded to Siemens Healthcare for its IQ-SPECT technology. This distinction speaks to the technology’s ability to address the dynamic clinical and economic environment faced by most cardiology services. IQ-SPECT provides a simpler, more cost-effective tool for meeting today’s cardiology imaging demands.
Siemens IQ-SPECT was developed to help increase the speed and potentially reduce the dose delivered to patients with SPECT cardiac perfusion imaging. This technology works with Siemens Symbia S and Symbia T SPECT systems. Although it is sold with new systems, it also can be sold as an upgrade. If a facility is starting to see an increase in cardiac volume, rather than having to purchase another camera, they can simply upgrade their existing Symbia system with IQ-SPECT and essentially add another camera. There are currently over 500 Symbia systems in US centers that are upgradeable to IQ-SPECT.
One of the key features of IQ-SPECT is its SMARTZOOM collimators that are placed in a cardio-centric orbit and collect up to four times more counts than conventional parallel hole collimators. When asked to describe IQ-SPECT, Chad DeGraaf, product manager SPECT-CT at Siemens Healthcare, explained, “It’s simply an add-on using SMARTZOOM collimators and a specialized software. It allows us to achieve two things: First, doubling the throughput of cardiac patients, so rather than having imaging times of 16 to 20 minutes per study, we are able to do that in as little as 4 minutes. This [technology] also gives us an added benefit because of the sensitivity and power of acquiring information with IQ-SPECT, it allows our customers to also reduce the dose to their patients.”
It’s not just a matter of speed, but also of quality. As DeGraaf stated, “Essentially, cardiac perfusion imaging with SPECT is the gold standard with respect to imaging for coronary artery disease. So to take things to the next step, our major concern was to keep that image quality the same. It was already the gold standard…. What we can do is offer a decrease in time without decreasing the number of counts or the collection of counts.”
IQ-SPECT was first introduced at the Society of Nuclear Medicine meeting in 2008 and generally released worldwide in the fall of 2010. Since then, there have been 140 purchases and 50 installations globally, of which only 20 have been purchased in the United States. DeGraaf explained that the United States is the only country in the world that has stand-alone cardiology centers, or cardiology outpatient centers. In the rest of the world, the cardiologists typically send their patients to hospitals, where there has been a greater need for something like IQ-SPECT, which is an add-on to a multipurpose SPECT camera.