August 2003

The SNM leadership outlined many of its achievements and goals at its annual meeting in New Orleans in June, with both eyes on the current and future practice of nuclear medicine.

“Medicine is undergoing a profound transformation from being primarily an anatomically based specialty to one that will be based primarily on biochemistry and physiology,” said Henry Duval Royal, M.D., incoming SNM president. “The promise of the tracer principle has never been greater and there is no specialty in medicine that is in better position to exploit this principle and to benefit patients.”

Royal also serves as professor of radiology at the Washington University School of Medicine (St. Louis, Mo.).

With nuclear medicine playing an increasing role across radiology, Royal added that the Society “has to open its doors so that everyone who is interested in nuclear medicine feels welcome” so nuclear medicine can “meet its promise and grow as it should.”

Outgoing SNM President Michael J. Gelfand, M.D., credited the organization’s PET education center for increasing opportunities and sees SNM’s education and research foundation as playing a greater role in several initiatives. Gelfand also serves as chief of the nuclear medicine section at Cincinnati (Ohio) Children’s Hospital and professor of radiology and pediatrics at the University of Cincinnati.

While it has been in existence for the last 30 years, Gelfand said the foundation would become more involved in philanthropic and educational initiatives, as it raises money from individuals and other sources. The Society would manage the grants and funds the foundation provides.

Education and training also has come to the forefront of the Society’s attention, with the merging of PET and CT technologies — as well as single photon emission computed tomography (SPECT) and CT — to create what is today healthcare’s primary tool in the diagnosis of cancer.

“Unfortunately, 90 percent of the people practicing nuclear medicine have no CT experience and a good 99 percent of the CT people have no nuclear medicine experience,” noted Frances K. Keech, R.T., president of SNM’s Technologist Section. Keech is director of the nuclear medicine program at the Massachusetts College of Pharmacy and Health Sciences (Boston).

Keech emphasized the need for SNM to collaborate with groups, such as the American Society of Radiologic Technologists (ASRT of Albuquerque, N.M.) and American College of Radiology (ACR of Reston), to educate healthcare providers and establish qualifications for the specialties.

SNM has joined ASRT and other groups to lobby for passage of the Consumer Assurance of Radiologic Excellence (CARE) bill (H.R. 1214) now in the U.S. House of Representatives. The proposed legislation would direct the U.S. Department of Health and Human Services (HHS) to establish educational and credentialing standards for personnel who plan and deliver radiation therapy and perform medical imaging procedures.

“At the moment, with all the work we have been able to do on the states side, we only have 22 states in the union that have licensure for nuclear medicine technologists; 38 states have licensure for radiographers; and 32 have licensure for radiation therapists,” said Keech. “We would like the 50 states in the union to offer the same quality care in nuclear medicine for all recipients of a nuclear medicine study.”

With between 17,000 and 18,000 nuclear medicine technicians in the United States, healthcare providers still report vacancies of 15 to 20 percent across the nation.

To help alleviate the situation, the SNM Technologist Section continues to promote the profession among young people and reach into remote areas of the country with the help of schools, such as the University of Arkansas (Fayetteville, Ark.) and the University of Alabama (Tuscaloosa, Ala.).

“The demand for nuclear medicine studies has made it hard to keep pace with education,” said Keech. “A good portion of our education occurs in the clinical areas with nuclear medicine technologists educating the students on procedures. Unfortunately, it is a Catch-22 when you don’t have enough technologists to do the training.”

While the Centers for Medicare & Medicaid Services (CMS of Baltimore, Md.) continues to add PET imaging procedures to its reimbursement lists, SNM still is clearly frustrated over the lack of Medicare coverage in cases of Alzheimer’s disease.

Peter Conti, M.D., SNM director-at-large, said that CMS remains “hung up” on outcomes and treatments regarding Alzheimer’s and PET. The associate professor of radiology at the University of Southern California’s Keck School of Medicine (Los Angeles) said CMS needs to look beyond the issue of outcome and treatment and look at the quality of life for an Alzheimer’s patient and the potential positive effect of early detection.

“We need to make [reimbursement] available to these people, because they need the test and there will be drugs used for treatment,” Conti said. “The biggest problem I have is the lack of access because of quality of life issues that are not being addressed with current methods.”

He added that drug companies and physician investigators design protocols and the current accuracy with diagnosing patients with the disease leads to many patients being incorporated into these trials who don’t have Alzheimer’s disease. Subsequently, the trials “can be heavily biased” and the treatment drug may be discarded unjustly.

The images were acquired at the Ahmanson Biological Imaging Clinic at the University of California-Los Angeles (UCLA) Medical Center. Researchers Johannes Czernin, M.D., and Benjamin Halpern, M.D., produced the images as part of their study examining the impact of acquisition time on image quality.

Researchers at the UCLA School of Medicine acquired this PET image in three minutes using a CPS Innovations PET-CT system.

The researchers used a PET-CT scanner from CPS Innovations (Knoxville, Tenn.), a division of CTI Molecular Imaging Inc. (Knoxville). CPS’ PET-CT scanner uses lutetium oxyorthosilicate (LSO) detector material to shorten the length of PET scan time. The CT scan also serves the function of attenuation correction in the image acquisition.

SNM’s Image of the Year is selected annually by former SNM President Henry N. Wagner Jr., who chose the UCLA image because the process was able to shorten scan time and provide adequate sensitivity to detect the cancer without sacrificing image quality.

On average, a whole-body PET scan can take approximately 90 minutes from the time a patient enters the nuclear medicine department until the time the patient leaves. Image acquisition time alone can take 30 to 45 minutes.

In the UCLA case, a diagnostic quality whole-body scan was obtained in less than 10 minutes.

“This is a somewhat controversial issue, because some people — who I think are somewhat conservative — say ‘We are only doing four [PET] scans a day now. Why do we want to have a higher throughput?’,” said Wagner. “We are looking forward to a time when [PET] studies will be so valuable that we will want to do large number of studies.”

Czernin said the faster PET protocols allow the scanning of patients in as few as seven minutes, without compromising the diagnostic information. The less time that a patient has to lie immobile, he added, the better the image quality due to reduced motion artifacts.

“The patient leaves the clinic about 40 minutes earlier than with a conventional PET scanner,” Czernin said. “What you are doing is utilizing the equipment much better.”

Czernin is director of nuclear medicine at the UCLA Medical Center. Halpern serves in the department of molecular and medical pharmacology and division of nuclear medicine at the UCLA David Geffen School of Medicine.

SNM evaluated some 2,000 submissions for this year’s annual meeting before accepting approximately 1,400 for oral or poster presentations.

Researchers at the University of Frankfurt (Germany) used PET and SPECT to monitor the success of progenitor cell transplants in heart attack victims.

Prognosis for survivors of acute myocardial infarction (AMI) is greatly dependant on the amount of damage to the myocardium, or the middle layer of the wall of the heart, which consists of cardiac muscle fibers that allow the heart to contract.

The scientists used mean signal intensity (MSI) to measure the viability of the implanted cells, taking baseline scans after implantation and then repeating the scans four months later. In 11 of 14 patients, the MSI in areas with AMI damage increased significantly, according to both PET and SPECT scans, with no discernible difference due to the type of progenitor cells used.

A study from Washington University School of Medicine’s Mallinckrodt Institute of Radiology, under the direction of Farrokh Dehdashti, M.D., found that FDHT-PET scanning of androgen receptors (AR) is successful in imaging patients with prostate cancer.

The study observed 15 men between the ages of 56 and 79 with advanced metastatic prostate. PET scans were performed using the radiopharmaceutical fluorodihydrotestosterone (FDHT), which is designed for AR imaging. FDHT-PET revealed numerous lesions in two patients; one patient had multiple osseous lesions, indicating the cancer had spread to the bones, while the other had extensive lymph node lesions (confirmed by CT).

In the remaining eight patients, FDHT-PET detected 10 of 16 lesions identified by bone scintigraphy. FDHT-PET also found seven additional lymph node lesions in two patients and unsuspected lymph node lesions in one patient.

PET imaging also was the basis for a study using FDG and FLT (fluoro-L-thymidine) to forecast the long-term success of breast cancer chemotherapy regimens. While FDG PET has previously been shown to be an effective diagnostic and treatment monitoring tool for breast cancer, the elevated uptake of FDG by treated tumors can persist, especially in the early stages of chemotherapy.

Research was conducted by the departments of molecular and medical pharmacology and hematology-oncology at David Geffen School of Medicine at the University of California-Los Angeles (UCLA).

Morning Star Molecular Imaging (Sarasota, Fla.) made its public debut in June at the annual meeting of the Society of Nuclear Medicine (SNM of Reston, Va.) in New Orleans.

The Morning Star lineup includes former CTI alumni Fred Stuvek Jr. as president, Guy Messer as vice president of business development and Ken Manning as vice president of marketing.

Robert L. Buckannon, a chiropractor by medical trade and operator of medical imaging and surgery centers for the last 18 years, serves as Morning Star’s chairman and CEO. John Hall, a hospital administrator since 1982 and more recently administrative director and director of new business at medical imaging center operator U.S. Imaging, serves as COO.

With more than $100 million in funding to support its initial growth and future expansion, the privately held company is poised to open state-of-the-art PET-CT centers across the United States. Morning Star opened with three PET-CT centers in Atlanta. The business plan is to expand into Florida, Texas and Colorado.

“Over the next 12 months, we will have 10 centers up and operational. Then we’re looking at doing 10 to 12 [facilities] per year,” said Messer. “We’ll look at some acquisition … and doing starts-ups as well.”

The company will consider a variety of business models, including agreements with hospitals to set up shop nearby to handle the facility’s PET-CT volume.

“We are going into major metropolitan areas so we can get our economies of scale and supplies, such as FDG (fluorodeoxyglucose),” said Buckannon.   

Though it is still early in the company’s development, the PET-CT of choice is the scanner with LSO-based (lutetium oxyorthosilicate) crystal detector technology, which has greatly reduced PET scanning time to less than 10 minutes. Coincidentally, the LSO-based PET-CT scanner is a product of CTI’s CPS Innovations (Knoxville) division.

“Right now, we think LSO systems are the best. We have a bias and the industry is on notice that we do [have some bias],” said Manning. “We will look at [PET-CT systems] that give us the best image quality and, because we are an entrepreneurial organization, we also will look at throughput.”

One of Morning Star’s three Atlanta facilities already uses a GE Medical Systems (GEMS of Waukesha, Wis.) PET-CT system with BGO-based (bismuth germanate) crystal detector technology.

“We’ll have a relationship with every vendor out there,” noted Buckannon. “Every vendor is making changes and improvements to their equipment all the time. We will buy from the vendor that has the best technology.”   

Morning Star also plans to have dedicated personnel at its medical imaging centers to handle scheduling and insurance claims processing.

RIS Logic, founded in 1997, has 64 medical imaging center customers, representing approximately 200 medical imaging facilities. In May, RIS Logic noted that it booked eight new clients in the fourth quarter of 2002, bringing the number of installations at medical imaging center sites to 182 at that time.

The company’s RIS Logic CS is designed to integrate information and automate workflow for scheduling, report turnaround, billing, claims processing, and other operational functions in a practice. The company recently introduced RIS Logic CS Version 2.0, which includes optional modules for mammography and embedded digital dictation.

The PET-CT system also made its first appearance at the Society of Nuclear Medicine (SNM of Reston, Va.) annual meeting in June in New Orleans.

The system consists of Siemens’ 16-slice CT scanner — the Somatom Sensation 16 — and its ECAT Accel PET scanner with lutetium oxyorthosilicate (LSO) as the PET scintillator. With the LSO detector technology, the biograph Sensation 16 can perform a whole body scan in 12 to 15 minutes.

Siemens said the system also is designed for more precise lesion registration, improved accuracy in diagnosis and more targeted patient treatment, such as radiation therapy planning (RTP).

Siemens installed its first biograph Sensation 16 at University of Tennessee Medical Center.

Siemens also offered up its e.cam Signature Series gamma camera at SNM 2003. The system’s high-definition dynamic digital detectors (HD4) are designed to enhance image quality and reliability. The single-photon emission computed tomography (SPECT) camera also features cardiac and general Flash 3D, advanced SPECT image reconstruction technology for improved outcomes for the clinician, including increased image contrast, reduced image noise, superior lesion detection, and enhanced diagnostic confidence.

Siemens’ e.soft workstation and software are based on Siemens’ syngo multimodality software platform. With a range of standard and optional features for SPECT and PET, e.soft is intended to streamline the nuclear medicine imaging process, providing a single integrated clinical solution for acquisition, processing, review and information sharing between users and healthcare facilities.

The company debuted its new Infinia Hawkeye SPECT-CT system at the annual meeting of the Society of Nuclear Medicine (SNM of Reston, Va.). Infinia Hawkeye’s SPECT images focus on the metabolic information, as CT gathers the anatomical images for the combined scan.

GE Medical Systems’ Infinia Hawkeye debuted in June at SNM 2003.

The system features a single-head gamma camera designed for all scanning positions. GEMS added that its all-digital Elite BGO (bismuth germanate) detector technology and advanced attenuation correction enhance SPECT reconstruction and image resolution.

GEMS anticipates as many as 100 installations of the system before the end of the year.

GEMS also launched a mobile configuration of its Discovery ST PET-CT system. The first buyers are Shared Medical Services Inc. (Madison, Wis.) and Alliance Imaging Inc. (Anaheim, Calif.). The company expects to deliver approximately 20 mobile Discovery ST units by the end of this year.

GEMS also introduced its new Xeleris functional imaging workstation, designed to serve as the productivity hub of nuclear medicine and positron emission tomography (PET) imaging departments. Xeleris features Ignite, which automates most clinical procedures, such as patient selection and image processing on selected GEMS’ systems.

GEMS rounded out its SNM 2003 exhibit by broadening the capabilities and capacities of its Minitrace and PETtrace cyclotrons. The next-generation Minitrace will be able to produce more of the fluorine-18 radioisotope and more than 2.5 curies of F-18 in two hours with minimal enriched water usage. PETtrace will be able to make more than 3.5 curies of F-18 in one hour and as much as six curies in two hours.

Montefiore Medical Center (Bronx, N.Y.) took delivery and installation in May and imaged more than 50 patients in the first month of operation.

The announcement of the inaugural installation came at the annual meeting of the Society of Nuclear Medicine (SNM of Reston, Va.) in June.

Philips will release version 2.0 of its SkyLight gantry-free gamma camera in August.

“We expect to ship another 14 systems worldwide by the end of the third quarter,” noted Deepak Malhotra, Philips’ senior director of PET marketing.

Philips created Gemini by combining its Allegro dedicated PET system with its Mx8000 multislice CT scanner. The open design of the Gemini allows healthcare facilities to use the Gemini as a PET-CT system or to perform separate PET and CT scans. The two systems can separate by 100 centimeters. The open configuration is designed to allow clinicians to access the patient between the two scanners and enhance patient comfort.

Philips also showcased its Syntegra multi-modality software, designed to improve workflow between diagnostic and radiation oncology applications for more accurate tumor identification and treatment. Syntegra currently is available on Philips’ Pinnacle3 3D radiation therapy planning (RTP) system and Philips’ PET systems — Gemini, Allegro and CPET Plus.

“Syntegra allows two clinicians — the radiation oncologist and the radiologist or nuclear medicine physician — to consult while they are sitting at their own workstations,” added Malhotra.

Syntegra software was released for Philips’s Allegro and CPET dedicated PET scanners in March, while an enhanced version of Syntegra (version 1.1) is set for availability on the Gemini this summer. An additional upgrade to Syntegra — version 2.0 — will be available in August on the Allegro and Gemini.

Speaking of Allegro, Philips displayed version 8.1/8.1.2 at SNM 2003. The enhancements include software and hardware to lessen scanning time and a new patient table. Whole-body scanning time has been reduced by 12 to 15 minutes.

Enhancements also are on the way for Philips’ SkyLight, the company’s gantry-free gamma camera. Philips is scheduled to release SkyLight version 2.0 in August, which will add the DualPlanar feature to image two patients at the same time using different acquisition parameters.

Version 2.0 also will have concurrent imaging to acquire multiple images and data sets simultaneously to optimize image quality and reduce acquisition steps.

Philips also is entering the pre-clinical research imaging market with the introduction of Mosaic, an advanced, small bore animal PET imaging system. Mosaic is based on Allegro PET scanner architecture and design.

“Some of the components and the crystal are the same or similar” to the Allegro, said Michael Licata, Philips’ general manager of small bore imaging systems and vice president of PET customer support.

Philips will target universities and research centers and pharmaceutical companies for the animal scanner. First deliveries of Mosaic are set for December.

Cytogen will partner with Siemens and University Hospitals of Cleveland (Ohio) for one initiative.

Bruce Sodee, M.D., professor of radiology and nuclear medicine at Case Western Reserve University (Cleveland), said one goal is to identify prostate cancer earlier, locate it more accurately and improve long-term prognosis for patients.

Physicians will use Siemens’ e.cam gamma camera with Flash 3D iterative reconstruction and CT attenuation correction technology, along with Cytogen’s monoclonal antibody agent ProstaScint. Sodee said that combination already is producing images and enhancing the diagnosis and staging of metastatic prostate cancer.

Sodee and his colleagues image the prostate prior to surgery and confirm their diagnosis through examination of the specimen following the procedure. He added that they average an accuracy of approximately 90 percent in the identification of the tumor location through the imaging procedure, as verified by pathology.

With GEMS, Cytogen will combine the company’s Infinia Hawkeye imaging system with its ProstaScint imaging agent to help evaluate the extent and spread of prostate cancer.

The Infinia Hawkeye combines the anatomic detail of CT with molecular imaging data provided by nuclear medicine cameras, as well as ProstaScint’s imaging capabilities. Infinia Hawkeye also provides CT-based attenuation correction and localization for single-photon emission computed tomography (SPECT) studies that can help address the inherent limitations of SPECT imaging.

The GEMS-Cytogen pact also allows both companies to advance patient and physician awareness of fusion imaging. GEMS will maintain installation and customer service activities, while Cytogen will provide technical support for ProstaScint fusion imaging.

A supplier to several major radiopharmaceutical companies in the United States, Draximage now is looking to make its name more known among nuclear medicine’s rank-and-file. The company’s presence at the annual meeting of the Society of Nuclear Medicine (SNM of Reston, Va.) in June was Draximage’s first appearance at the yearly forum.

Draximage dates back to 1955, when the company was founded as Merck Frosst Canada & Co. Draximage was acquired by its current parent company, Draxis Health Inc. (Mississauga, Ontario, Canada), in 1997.

Draximage achieved sales of $10.2 million in 2002, a gain of 45 percent over $7 million in 2001, and up from $6 million in 2000. Draximage’s 2002 sales numbers represent 26 percent of Draxis Health’s total sales of $38.6 million last year. (All dollar amounts are in U.S. currency.)

Draximage exports approximately 80 percent of its products to the United States and Europe. The company also markets its products to Central and South America, as well as the Far and Middle East and Korea.

Draximage’s U.S. customers include Amersham Health (Princeton, N.J.), Bracco Diagnostics Inc. (Princeton), Bristol-Myers Squibb Co. (New York City), Cardinal Health Inc. (Dublin, Ohio) and Tyco Healthcare (St. Louis, Mo.).

“Most of what we sold [in the United States], until very recently, was non-radioactive and easy to transport,” said Draximage President Richard J. Flanagan, Ph.D. “In the last two years, we started exporting radioactive products. We started selling sodium iodide-131 capsules in the U.S. We launched two radiotherapy brachytherapy products — BrachySeed Iodine-125 and BrachySeed Palladium 103.”

In April, Draximage launched its therapeutic kit for the preparation of sodium iodide I-131 capsules. The kit is indicated for the treatment of thyroid cancer and hyperthyroidism. U.S customers for the I-131 capsules include Bracco and Cardinal Health.

With those products in the market, Draximage is focusing on the next generation of its portfolio.

Draximage’s Fibrimage for the detection of deep vein thrombosis currently is in Phase Three development. Infecton, which is on its way to Phase Two clinical trials, is designed to detect infection in extremities, such as a diabetic’s foot, and fever of unknown origin.

Draximage plans to submit Fibrimage in a new drug approval (NDA) application to the FDA early next year. An NDA submission for Infecton could come in early 2005.

Draximage also is developing products for the prompt detection of myocardial infarction and for cancer detection.

Amiscan is an imaging agent designed for acute myocardial infarction (MI). The goal is to determine if there has been a true MI in as fast as 30 minutes after an Amiscan injection.

Also in development is Somatoscan for cancer diagnosis and therapy. The imaging agent would be used primarily for neuroendocrin tumors with some overlap into lymphoma and some types of lung cancer.

The new entity will be known as Evolved Digital Systems Inc. and will have its headquarters in Laval. The combined company would offer an integrated suite of digital imaging products and services to hospitals, outpatient centers and physician offices in North America and Europe.

Electromed develops high-definition imaging acquisition products combined with application software for the management, manipulation, communication and results reporting of cardiac images and information securely on an intranet, as well as internet technologies for healthcare facilities worldwide. Inphact provides web-based radiology services serving healthcare facilities throughout the United States.

“We have spent the last seven months streamlining our operations and strengthening our management team across all divisions,” said Electromed Chairman Dennis Wood. “We also have implemented strong internal controls and accelerated the pace of new product introductions. Having established a strong foundation, we believe we are well-positioned to take advantage of the market opportunities.”

The proposed transaction remains subject to shareholder and regulatory approval, as well as an eight-to-one Electromed reverse stock split. Evolved Digital Systems would continue to trade under the Electromed ticker symbol MED on the Toronto Stock Exchange.

The holders of Inphact securities would own 70 percent of Electromed shares. As a condition of the transaction, Electromed also will obtain financing of approximately $20 million to fund working capital, acquisitions and general corporate purposes.

The companies expect to complete the transaction in the third quarter.

As Evolved Digital Systems, the new company will have more than 120 facilities in the United States, Canada and Europe with either Electromed or Inphact technology. Evolved Digital Systems also will have a backlog of 55 sites scheduled for installation.

The companies’ combined customer list includes HCA Inc. (Nashville, Tenn.), Tenet Healthcare Corp. (Santa Barbara, Calif.), Triad Hospitals Inc. (Dallas) and Quorum Health Group Inc. (Brentwood, Tenn.).

“The combination [of Electromed and Inphact] effectively doubles the market coverage of our individual companies,” said Inphact CEO Jon Lehman. “We will also have a sales team of 16 representatives in North America. The teams will be cross-trained in both product offerings and will work to cross-sell to each company’s existing customer base.”

Electromed and Inphact already have collaborated on one project to bring a radiology and cardiology image management configuration to a healthcare facility.

Wood noted that approximately 40 percent of the new company’s target customers plan to convert to digital imaging in their radiology and cardiology departments over the next two to three years.

The company emphasized in its announcement that the results are unaudited and may change as Fischer Imaging’s accountants, Ernst & Young LLP (Denver), complete their review, which still is in progress.

During its review of its financial results, the company said in its release that Fischer Imaging “determined that certain historical accounting practices and procedures should be reviewed and, where required, changed. In the course of the company’s reviews, other accounting inaccuracies, questionable accounting practices and internal control failures were also discovered, which in total could be viewed as problematic.”

As a result, Fischer chose to conduct its re-audit of its results since 2000, as well as what it described as “significant transactions” over the last four years with the assistance of outside legal counsel, Hogan & Hartson (Denver) and Ernst & Young.

“We believe that we have captured and reviewed all significant and discoverable questionable prior practices and that these restatements present properly and fairly, in all material respects, the results of operations and the financial position of Fischer Imaging Corp. during the relevant periods,” said Fischer Imaging President and CEO Harris Ravine in a prepared statement.

As a result, the company said that it has established “stronger internal controls as well as a more appropriate revenue recognition policy, a more conservative policy of accounting for inventory, and improved supervision and review procedures,” said CFO Stephen G. Burke.

The level of product sales to its marketing partners had both positive and negative results for Advanced Magnetics Inc. (Cambridge, Mass.) in the company’s third fiscal quarter, ending June 30. Revenues advanced to $1.4 million, compared with $1.1 million in the third quarter of FY02. Net income totaled $664,432, compared with a net loss of $125,554 in the year-ago quarter. For the nine-month period, revenues decreased to $4 million, compared with $4.7 million in the same period of FY02. The company also posted a net loss of $348,607, compared with net income of $671,375 in the year-ago period.

Sonus Pharmaceuticals Inc. (Bothell, Wash.) posted a net loss of $3.1 million in its second-quarter financial report. The net loss compares with a net loss of $3.5 million in the second quarter of 2002. The company reported a net loss of $5.4 million in the first six months of 2003, compared with a net loss of $6 million in the same period of 2002. The financial results reflect Sonus’ investment in the Phase 2 clinical program for its lead cancer product, Tocosol Paclitaxel, and new product development activities. The development company has had no revenues to date in 2003.

RITA Medical Systems Inc. (Mountain View, Calif.) says its second-quarter revenues will be $4 million to $4.1 million less than previous estimates. The cancer treatment products company also expects a net loss of between $3.3 million and $3.7 million in the three-month period, ending June 30. RITA blames a “longer selling cycle” for lower revenues in the three months, ending June 30. International sales also declined. The company planned to release its results in July 22.

HealthSouth Corp. (Birmingham, Ala.) is expecting net revenue of $4.1 billion and free cash flow of $328 million over the next 12 months. So says Bryan Marsal, a partner at turnaround specialist Alvarez & Marsal (New York City). Marsal added that the healthcare provider also could generate earnings before taxes and other expenses (EBITDA) of $650 million. HealthSouth is working to avoid bankruptcy and recover from federal allegations of massive accounting fraud. Eleven former executives have entered guilty pleas on fraud charges related to the federal government’s investigation.

Imagin Diagnostic Centres Inc. (Toronto, Ontario, Canada) is alleging that a New York City stock research analyst is attempting to extort money from the company’s newly appointed managing director of corporate development, Patrick Rooney. Imagin asserts that the unnamed analyst is threatening to expose a 1983 tax evasion charge against Rooney by contacting local news media in Toronto. The company said Rooney was acquitted of the charge that same year. Rooney — an underwriter of initial public stock offerings (IPOs) in the United States in the 1980s — also had civil disputes with the Securities and Exchange Commission (SEC), all of which were settled without denying or admitting any wrongdoing. Rooney’s background information has been disclosed in prior company press releases. Imagin is a developmental stage company with medical imaging centers to bring positron emission tomography (PET) and PET-CT to Canada.

Fischer Imaging Corp. (Denver) on July 7 lost its listing on the Nasdaq national market. The stock exchange delisted the company after Fischer delayed filing its annual financial report for 2002 and its results for the first quarter of 2003. Nasdaq requires that public companies file their statements within 90 days of the close of the fiscal year and 45 days after the end of each company’s quarter. Fischer’s shares are available for trading on the Pink Sheets. In 2002, Fischer Imaging’s revenues increased 6 percent to $45 million, compared with $42.5 million in 2001. The company credited sales of its SenoScan digital mammography system for its growth. Net income increased to $10 million, compared with a net loss of $200,000 in 2001.

The failure to meet minimum requirements has prompted the Nasdaq stock exchange to drop Cedara Software Corp. (Mississauga, Ontario, Canada) from its listings. The company’s shares still will be available on the Toronto Stock Exchange and the U.S. Over-the-Counter (OTC) bulletin board. Cedara will trade under the ticket symbol CDSW on the OTC.

Vital Images Inc. (Minneapolis) has joined the Russell 3000 Index. The Frank Russell Co. reconstitutes its indexes annually in order to accurately rank the 3,000 largest companies in the U.S. stock market by market capitalization. Vital Images’ market capitalization is approximately $150 million.