PET/CT for Referring Physician


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  • PET/CT for Referring Physician

    1. 1. PET/CT for Today ELITE IMAGING
    2. 2. PET + CT = More Information CT only PET only PET/ CT
    3. 3. <ul><li>One-Stop-Shop for Anatomical and Functional information. </li></ul><ul><li>Greater Patient Comfort </li></ul><ul><ul><li>One trip to the doctors office for everything </li></ul></ul><ul><ul><li>Shorter overall PET exam time </li></ul></ul><ul><ul><li>Better treatment planning </li></ul></ul><ul><ul><li>More satisfied Patient experience </li></ul></ul>Why PET + CT
    4. 4. <ul><li>Improved Treatment Planning for Therapy </li></ul><ul><li>Anatomical and Functional Cardiac Information </li></ul><ul><li>Higher Confidence with Diagnosis </li></ul><ul><li>Accurate Registration of Patient Images </li></ul><ul><li>Easier to Manage your patient </li></ul>Why PET + CT
    5. 5. Diagnostic Power of PET Source: The Journal of Nuclear Medicine Supplement, Volume 42, 2001 and UCLA.
    6. 6. The Power of Two
    7. 7. Where would you position the treatment port for Radiation Therapy? Would it change now? The Power of Two
    8. 8. <ul><li>Diagnose malignant tumors </li></ul><ul><li>Select and monitor therapy </li></ul><ul><li>Detect recurrent tumors before they can be seen on CT or other imaging modalities </li></ul><ul><li>Find out if the tumor has metastasized (spread) </li></ul>PET is used in oncology to:
    9. 9. <ul><li>HISTORY A 47-year-old male with recurrent colorectal cancer. Patient had a resection of part of his colon 8 months prior to his initial PET scan. </li></ul><ul><li>ORIGINAL DIAGNOSIS CT scans at both 5 and 8 months post-resection were reported as normal. The patient still complained of abdominal pain, and at the patient’s request, a PET scan was ordered. </li></ul><ul><li>PET FINDINGS The whole-body FDG PET scan at 8 months post-resection revealed extensive lesions in both the liver and bowel. </li></ul><ul><li>CHANGE IN TREATMENT Based on the findings of the PET scan, the patient underwent chemotherapy and returned five months after the initial PET scan for a follow-up PET scan. The follow-up scan showed remission in all known tumor sites. </li></ul>PRE-THERAPY POST-THERAPY Colorectal Cancer Courtesy of University of Kansas Medical Center • Kansas City, Kansas
    10. 10. <ul><li>HISTORY </li></ul><ul><li>A 57-year-old female with non-Hodgkin’s lymphoma. </li></ul><ul><li>ORIGINAL DIAGNOSIS CT scan read as negative. </li></ul><ul><li>PET FINDINGS </li></ul><ul><li>Multiple foci of increased activity in the abdomen are noted. There is increased uptake in a retroperitoneal node at the T11-12 level. In addition, focus of abnormal uptake is present superior to the left kidney. Another large focus of abnormal activity is present between the anterior pole of the left kidney in the left lobe of the liver. Small focus of abnormal activity is present just posterior to the superior left lobe of the liver. </li></ul><ul><li>CHANGE IN TREATMENT </li></ul><ul><li>PET enabled the physician to diagnosis the disease and begin treatment immediately. </li></ul>Non-Hodgkin‘s Lymphoma Courtesy of the University of Colorado, Gloria Cook PET Center, Denver, Colorado
    11. 11. <ul><li>Localize seizure focus in patients with seizure disorders </li></ul><ul><li>Differentiate Alzheimer’s disease from multi-infarct dementia or depression </li></ul><ul><li>Analyze Parkinson’s disease </li></ul><ul><li>Evaluate extent of stroke and recovery following therapy </li></ul>PET is used in neurology to:
    12. 12. <ul><li>HISTORY </li></ul><ul><li>A 3-year-old male epilepsy </li></ul><ul><li>ORIGINAL DIAGNOSIS Patient suffered from intractable drop seizures since the age of 18 months. MRI showed no abnormalities. Interictal scalp EEG demonstrated epileptiform activity emanating from the right parietal region . </li></ul><ul><li>PET FINDINGS </li></ul><ul><li>The PET abnormality guided the subdural grid placement with very good correlation. </li></ul><ul><li>CHANGE IN TREATMENT </li></ul><ul><li>The patient was submitted to surgery and is seizure-free . </li></ul><ul><li>Courtesy of Children’s Hospital, Detroit, Michigan </li></ul>Epilepsy
    13. 13. <ul><li>HISTORY </li></ul><ul><li>An 86-year-old male with history of suspected Alzheimer’s . </li></ul><ul><li>PET FINDINGS PET shows hypo-metabolism temporoparietal and reduced glucose uptake in cranial portion of both frontal lobes consistent with Alzheimer’s disease </li></ul><ul><li>CHANGE IN TREATMENT Conventional treatment would be watchful waiting and annual imaging, clinical, and behavior tests for up to five years before diagnosis is confirmed. </li></ul><ul><li>Institut für Medizin Forschungszentrum Jülich, Germany </li></ul>Alzheimer’s Disease
    14. 14. <ul><li>Detect presence of coronary artery disease </li></ul><ul><li>Assess the extent of damage from heart disease (is the patient a bypass candidate?) </li></ul><ul><li>Determine which patients will benefit from cardiac transplantation </li></ul>PET is used in cardiology:
    15. 15. <ul><li>HISTORY A 50-year-old female with history of heart disease waiting for possible cardiac transplant. </li></ul><ul><li>ORIGINAL DIAGNOSIS Thallium scintigraphy found large non-reversible defect; myocardium judged non-viable. </li></ul><ul><li>PET FINDINGS FDG PET scan found good viability throughout the myocardium except for a small part of the apex. </li></ul><ul><li>CHANGE IN TREATMENT Conventional treatment plan based on single photon nuclear medicine study would have been placing the patient on transplant waiting list. After PET, coronary artery bypass graft was performed resulting in improved cardiac function. Patient had significant improvement in quality of life. </li></ul>Myocardial Viability Courtesy of Rush-Presbyterian-St. Luke's Medical Center, Chicago, Illinois SHORT AXIS H LONG AXIS V LONG AXIS
    16. 16. Clinical Cases
    17. 17. Pre-Therapy Fast accurate monitoring for therapy ! Therapy F/U Post-Therapy
    18. 18. Ovarian Cancer <ul><li>46 year old female,143 lbs. </li></ul><ul><li>History: Stage IIIA Ovarian Cancer, evaluate for restaging post-surgery & chemotherapy. </li></ul><ul><li>Two pericaval nodes, one approximately 10 mm and one 4 mm found in the lumbar region, posterior to the right kidney. Findings are consistent with metastatic disease. </li></ul><ul><li>Scan protocol: CT 152 mAs, 120 kV, 0.75 mm acquired slice width, 5 mm reconstruction increment </li></ul><ul><li>PET 11.9 mCi 18 F-FDG 75 min. post-injection, AW-OSEM (4i8s), 7 beds at 4 min/bed </li></ul>4 mm lesion 10 mm lesion Lesion Detectability with HI-REZ Technology HI-REZ Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend
    19. 19. Rectum CA
    20. 20. <ul><li>68 year old male, 80.5 kg (177 lbs.) </li></ul><ul><li>Scan protocol: CT 95 reference mAs CAREDose4D, 130 kV, 5 mm slices, 2.5 reconstruction increment </li></ul><ul><li>PET 12.3 mCi 18 F-FDG, 50 minute uptake, AW-OSEM (4i8s), 6 beds </li></ul>Data Courtesy of Long Beach PET Imaging Center, Long Beach, CA, Dr. Jeff Dobkin 1 min/bed HI-REZ Wholebody Scan
    21. 21. Gallbladder Cancer <ul><li>57 y.o. Female,125 lb. History: Cholangiocarcinoma evaluated for restaging. </li></ul><ul><li>Reccurrence at original site of diagnosis. </li></ul><ul><li>Scan protocol: CT 160 mAs, 120 kV, 3 mm reconstruction increment </li></ul><ul><li>PET 10.5 mCi 18 F-FDG 160 min. post-injection, AW-OSEM (2i8s), 7 beds at 2 min/bed </li></ul>Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend HI-REZ
    22. 23. Lung Cancer <ul><li>68 year old Female, 116 lbs. History of non small cell lung carcinoma, Referred to restage following therapy. </li></ul><ul><li>Compared to prior exam a large cavitary mass in the right lower lobe continues, exhibiting moderately intense FDG accumulation peripherally, extending medially and posteriorly. Additionally, a slight interval increase in the intensity and the size is noted when compared to prior exam. </li></ul><ul><li>Scan protocol: </li></ul><ul><ul><li>CT 95 reference mAs CAREDose4D, 130 kV, 5 mm slices, 2.5 reconstruction increment </li></ul></ul><ul><ul><li>PET 113.1 mCi 18 F-FDG, 60 min. uptake, AW-OSEM (4i6s), 3 min/bed </li></ul></ul>Data Courtesy of Long Beach PET Imaging Center, Long Beach, CA, Dr. Jeff Dobkin, HI-REZ
    23. 24. 52 yearold male, 62 kg (135 lbs.) Pre- and post-therapy follow-up Squamous cell tonsillar cancer with a 4 cm positive node; pre-surgery chemo; right tonsillectomy and radical neck dissection; removal of positive node and 45 others, all negative. Post-surgical infectious complications; follow-up PET showed diffuse band of activity; PET/CT with LSO, Pico-3D and HI-REZ resolved individual nodes. Patient scheduled for biopsy. Scan protocol: CT: 140 mAs, 120 kV, 5 mm slices at 0.75 mm PET: 11.3 mCi 18 F-FDG, 129 min p.i, 5 min/bed, 7 beds; 4i/8s Tonsillar Cancer Standard PET PRE-THERAPY POST-THERAPY HI-REZ Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend
    24. 25. Wholebody Scan <ul><li>61 y.o. Female, 165 lb. Patient has history of cancer </li></ul><ul><li>Scan protocol: CT 149 mAs, 120 kV </li></ul><ul><li>PET 10 mCi 18 F-FDG, 60 minute uptake, AW-OSEM (4i8s), 3 min/bed </li></ul>Data Courtesy of Alegent Health Bergan Mercy Medical Center, Omaha, NE HI-REZ
    25. 27. Lung Cancer with Liver Metastasis <ul><li>54 year old male, 68.2 kg (150 lbs.) – Recurrent carcinoma of the lung </li></ul><ul><li>There are six separate areas of focal hypermetabolism localized to the left lung, the most medial of these is adjacent to the mediastinum but does not appear to include mediastinal lymph nodes. Also noted are at least three focal hypermetabolic abnormalities localized to the parenchyma of the liver. In addition, there is a focal hypermetabolism localized to a right inguinal lymph node, and in the right ischium and the right ilium. Hypermetabolic abnormalities are consistent with malignancy. </li></ul>Data Courtesy of Alegent Health Bergen Mercy Medical Center, Omaha, NE, Dr. Samual Mehr
    26. 28. Lymphoma <ul><li>58 year old male, 75 kg (165 lbs.) – History of non-Hodgkin’s Lymphoma </li></ul><ul><li>Significant hypermetabolism localized to multiple discrete regions of the left neck; left pharyngeal tonsil is mildly hypermetabolic when compared to right; no additional abnormalities. These findings are consistent with lymphoma. After a round of chemotherapy, the 3 month follow-up exam showed no intense abnormal activity in the left neck. </li></ul>Data Courtesy of Alegent Health Bergen Mercy Medical Center, Omaha, NE, Dr. Samual Mehr
    27. 29. Alzheimer’s Disease <ul><li>54 year old female, 68.2 kg (150 lbs) </li></ul><ul><li>Decreased glucose metabolism in posterior parietal association cortex in patient with memory problems. </li></ul>Data Courtesy of PET Medical Imaging Center, Grand Rapids, MI, Dr. Paul Shreve
    28. 30. Brain Scan <ul><li>41 y.o. Female, 165 lb. – Normal Volunteer </li></ul><ul><li>Scan protocol: CT 426 mAs, 120kV </li></ul><ul><li>PET 15 mCi 18 F-FDG, 98 minute uptake, AW-OSEM (4i8s), 15 minutes </li></ul>Data Courtesy of Alegent Health Bergan Mercy Medical Center, Omaha, NE HI-REZ
    29. 31. Lesion Detection Alzheimer’s Neuro Imaging
    30. 32. PET/CT 82 Rb Stress/Rest Cardiac Scan <ul><li>43 y.o. Female, 158 lb. Volunteer Patient </li></ul><ul><li>Scan protocol: CT 30 mAs, 120 kV </li></ul><ul><li>PET Rest: 50 mCi RbCl, 2 minute uptake, AW-OSEM (4i8s), 5 min. acq. </li></ul><ul><li>PET Stress: 50 mCi RbCl, 2 minute uptake, AW-OSEM (4i8s), 5 min. acq. </li></ul>Data Courtesy of Alegent Health Bergan Mercy Medical Center, Omaha, NE
    31. 33. 16 Gate 82 Rb Cardiac PET/CT <ul><li>33 year old Male, 175 lbs. </li></ul><ul><li>Cardiac Stress, Rest and Gated PET slices. </li></ul>Data Courtesy of Cleveland Clinic Foundation, Cleveland, OH Stress Rest Gated Stress Rest Gated Stress Rest Gated Stress Rest Gated
    32. 34. Bone Scan <ul><li>42 year old Female, 136 lbs. </li></ul><ul><li>HI-REZ technology demonstrates the finest resolution and exceptional image quality. </li></ul><ul><li>Scan protocol: CT 154 mAs, 120 kV, 1.5 mm acquired slice width, 3 mm reconstruction increment </li></ul><ul><li>PET 11.1 mCi 18 F-NaF 60 min. post-injection, AW-OSEM (4i8s), 4 min/bed </li></ul>Anterior Posterior Saggital HI-REZ Data Courtesy of University of Tennessee, Knoxville, TN, Dr. David Townsend
    33. 35. <ul><li>Lung Cancer </li></ul><ul><ul><li>SPN </li></ul></ul><ul><ul><li>Diagnosis NSCLC & SCLC </li></ul></ul><ul><ul><li>Initial Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><li>Colorectal Cancer </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Initial Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><li>Ovarian Cancer </li></ul>PET/CT Usage
    34. 36. <ul><li>Melanoma </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Initial Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><li>Lymphoma </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Initial Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><li>Pancreatic Cancer </li></ul>PET/CT Usage
    35. 37. <ul><li>Head and Neck Cancer </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Initial Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><li>Esophageal Cancer </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Initial Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><li>Soft tissue sarcoma </li></ul>PET/CT Usage
    36. 38. <ul><li>Breast Cancer </li></ul><ul><ul><li>Diagnosis / Surgical Planning </li></ul></ul><ul><ul><li>Initial Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><ul><li>Evaluation to Response to </li></ul></ul><ul><ul><li>Treatment </li></ul></ul><ul><li>Neurology </li></ul><ul><ul><li>Brain Cancer </li></ul></ul><ul><ul><li>Pre-surgery planning for Seizures </li></ul></ul><ul><ul><li>Alzheimer’s Disease </li></ul></ul>PET/CT Usage
    37. 39. <ul><li>Testicular Cancer </li></ul><ul><li>Thyroid Cancer </li></ul><ul><ul><li>Diagnosis </li></ul></ul><ul><ul><li>Staging </li></ul></ul><ul><ul><li>Restaging </li></ul></ul><ul><li>Cardiology </li></ul><ul><ul><li>Myocardial Perfusion Imaging </li></ul></ul><ul><ul><li>Myocardial Viability Study </li></ul></ul>PET/CT Usage
    38. 40. <ul><li>50% of all PET patients had a CT, or needs a CT </li></ul><ul><li>63% of all positive PET scans need a new CT because of the results. </li></ul><ul><li>It is easier for the patient to have it performed all at once </li></ul><ul><li>The power of the combined unit improves confidence in interpretation </li></ul><ul><li>Over 50% of all cancer treatment is altered as a result of the PET findings on the patient </li></ul>Why PET/CT with use
    39. 41. <ul><li>Medical Journal Articles supporting PET/CT </li></ul><ul><li>Cutting Edge Medical Practice </li></ul><ul><li>Better Patient Management </li></ul><ul><li>Retain Patients by Offering the Best </li></ul><ul><li>Patient Care Solutions for them </li></ul><ul><li>Fast Report Turnaround </li></ul><ul><li>Personal Consultations </li></ul>Why PET/CT with use
    40. 42. ELITE IMAGING CONCORDE CENTRE II 2999 NE 191 ST STREET SUITE 103 AVENTURA, FL 33180 Thank You for your Attention