14. The cardiac imaging market is transitioning SPECT PET Cardiac catheterization CT angiography
15. SPECT perfusion imaging Low diagnostic accuracy in some patient populations-Balanced ischemia Long Acquisition times Higher radiation exposure Decreasing reimbursement
20. PET perfusion imaging High diagnostic accuracy regardless of patient status-Gate both stress and rest Shorter acquisition times Lower radiation exposure Increasing reimbursement
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22. PET perfusion 2. Nuclear Medicine Self-Study Program III: Nuclear Medicine Cardiology. Botvinik, EH, Ed. 1998: Society of Nuclear Medicine, Reston, VA. Author Sensitivity Specificity # Patients Gould 95% 100% 50 Demer 94% 95% 193 Go 93% 78% 202 Schelbert 97% 100% 45 Yonekura 93% 100% 49 Williams 98% 93% 146 Stewart 84% 88% 319 Weighted Avg. 93% +/- 8 92% +/- 5 766
26. 36 inch separation for patient access GEMINI Open PET/CT Advantage Integrated operation (CT/PET Imaging) Separated operation (Independent CT simulation / diagnostic CT or PET) 195 cm PET coverage in closed position 130 cm PET coverage in open
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30. Dose delivery by Infusion System Infusion pump set to deliver 60 mCi or operate for 25 sec, whichever is reached first. Maximizes bolus of Rb-82. As generator decays, amount of dose delivered may drop. Consistent bolus delivery can improve count statistics near the end of generator life.
31. Sample PET/CT Protocol Protocol courtesy of Marcelo DiCarli, MD Approximately 30 minutes scout CT-trans Rb-82 50-60 mCi 70-90 sec 90-120 sec gated rest pt out Dipy 0.56 mg/kg scout CT-trans 70-90 sec 90-120 sec Rb-82 50-60 mCi gated stress Approx 1 min Approx 7 min Approx 6 min Approx 1 min Approx 7 min
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38. Patient Radiation Dosimetry Copyright Dr. Mark Nathan Isotope Effective Dose Equivalent Per study Total Rb-82 1.6 mrem/mCi 50 mCi 80 mrem Tc-99m mibi 51 mrem/mCi 30 mCi 1500 mrem Th-201 850 mrem/mCi 4 mCi 3200 mrem CT mu-map 440 mR 1 scan 440 mrem
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54. PET perfusion imaging High diagnostic accuracy regardless of patient status Shorter acquisition times Higher insurance reimbursement Lower radiation exposure Value for the patient Value for the practice
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