CAD – leading cause of death
Cardiac SPECT – steady growth in last two decades & played an important role in clinical mangement
Radionuclide ventriculography (MUGA)
First pass studies
PET/CT
CAD – leading cause of death
Cardiac SPECT – steady growth in last two decades & played an important role in clinical mangement
Radionuclide ventriculography (MUGA)
First pass studies
PET/CT
A refresher course on imaging in peripheral arterial disease (PAD). The session also includes talk on clinical exam in PAD, MRA in PAD and interventional radiology treatment of PAD.
Utilidad strain en cardiopatia isquemica; Por: Dr. Ricardo Mora Moreno MAECO (medico en adiestramiento ecocardiografico); IMSS CMN SS XXI Hospital de Cardiologia Servicio de Gabinetes; CDMX, 11 de Octubre del 2019
A refresher course on imaging in peripheral arterial disease (PAD). The session also includes talk on clinical exam in PAD, MRA in PAD and interventional radiology treatment of PAD.
Utilidad strain en cardiopatia isquemica; Por: Dr. Ricardo Mora Moreno MAECO (medico en adiestramiento ecocardiografico); IMSS CMN SS XXI Hospital de Cardiologia Servicio de Gabinetes; CDMX, 11 de Octubre del 2019
L box contemporary non-invasive cardiology testingAlysia Smith
Presentation by Lyndon C. Box, MD, FSCAI for the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.
Role of mdct angio in management of acute chest pain Dr. Muhammad Bin ZulfiqarDr. Muhammad Bin Zulfiqar
In this presentation we will discuss different techniques of MDCT Cardiac imaging to role out different causes of chest pain to help cardiologist in management of the patient.
We shall discuss it case by case.
Advanced Diagnostic Center (radiology): An Introduction.Radiology represents a branch of medicine that deals with radiant energy (energy that travels by waves or particles) in the diagnosis and treatment of diseases.
This field can be divided into two broad areas – DIAGNOSTIC RADIOLOGY & INTERVENTIONAL RADIOLOGY.
A medical doctor who specializes in diagnosing and treating disease and injury through the use of medical imaging techniques such as x-rays, computed tomography (CT), etc.
The most common types of diagnostic radiology exams include :
X-ray Radiography,
Ultrasound,
Computed Tomography (CT),
Nuclear Medicine Including Positron Emission Tomography (PET), And
Magnetic Resonance Imaging (MRI)
x-rays
A detailed description of ct coronary angiography and calcium scoring with various aspects regarding the preparation, procedure, limitations and a short review regarding post CABG imaging.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journey
Spect ct -dan berman
1. SPECT/CT for Atherosclerosis Imaging: The
Future is Clear
Daniel S. Berman, MD
Director, Cardiac Imaging
Cedars-Sinai Medical Center
Professor of Medicine
David Geffen School of Medicine at UCLA
2. DISCLOSURE
Daniel S. Berman, M.D.
declares the following relationships:
Grant Support: BMS Medical Imaging, Astellas,
GE Amersham, Mallinckrodt-Tyco
Speakers Bureau: Astellas
Consultant: Mallinckrodt-Tyco
Spectrum Dynamics
Royalties: Cedars-Sinai Medical Center
Stockholder: Spectrum Dynamics
3. MDCT Technical Parameters 2005
Four major manufacturers with 64 slice CT
• ~.4-.5 mm3
isotropic voxels
• Temporal resolution: 165-210 ms for 180°
(330-420 ms rotation time)
• Cardiac study in 5-10 beats
9. A B C D
Calcification Soft Plaque
D2
Lesion
76 M #3311-1526
10. Limitations of Anatomic Imaging
Little information regarding disease activity
• Two patients: with mild coronary calcium,
score ~100 discovered on screening 1 yr ago
and placed on statin, ASA, and ACE
• Patient A: recently symptomatic
• Patient B: still asymptomatic
• Both undergo CT coronary angiography, and
are found to have 75% mid LAD stenosis by
CT angio AND extensive non-calcified plaque
by IVUS
• Should the treatment be the same?
12. Why not catheterize all suspected CAD patients?
Occulo-stenotic reflex*: unnecessary PCI• Immediate Risk
– Death (rare)
– Clinical MI (uncommon)
– Subclinical MI (more frequent)
– Branch occlusion (frequent)
• Late risk
– Possible higher mortality risk than medical therapy in patients without ischemia
• Costs
• Objective measurements of perfusion and function
• Accurate for assessing risk of cardiac death (CD)
• Relationship of degree of abnormality to risk
• Identifies likely to benefit from revascularization
• Proven as cost effective “gatekeeper” to the cath lab
Limitations
• Cannot detect early atherosclerosis
• May underestimate extent of CAD
*Topol
13. Cardiac CT
Limitations
• Densely calcified plaques: nondiagnostic
• Dependence on low HR and regular rhythm
• Radiation, iodinated contrast
• Overestimation of stenosis
• No information regarding plaque “activity”
14. • No Hx CAD
• Known CAD
• Post-PTCA
• Post-CABG
• Men and Women
• Sx and Asx
• DM
• Elderly
SPECT: Risk Increases as a Function of
Stress Perfusion Abnormality
Extent/Severity of Perfusion Defec
Risk*
*Adjusted or unadjusted
Guidelines for Clinical Use of Cardiac Radionuclide Imaging 2003
Data from over 50,000 patients
15. logHazardRatio
0123456
% Myocardium Ischemic
0 12.5% 25% 32.5% 50%
Medical Rx
Revasc
*
*
*p<0.001
Adjusted†
Risk of Cardiac Death vs MPS ischemia
Revascularization vs Medical Rx
Hachamovitch, et al Circulation 2003
†
Adjusted for predictors
of revascularization as well as
clinical, hx, stress SPECT data
16. VISUAL SSS
STANDARD
TPD
stenosis ≥ 50%
1.00.75.50.250.00
1.00
.75
.50
.25
0.00
1 - Specificity
Sensitivity
Changes in Analytic Software
Automatic Total Perfusion Deficit
**
* P < 0.05
Slomka, et al J Nucl Cardiol 2005;12:66-77
17. When was the last fundamental change in the
detector technology?
Nuclear Cardiology: Single Photon Imaging
18. When was the last fundamental change in the
detector technology?
1958: Hal Anger patented the current NaI
(Tl) detector/photomultiplier array
configuration (#3011057)
Nuclear Cardiology: Single Photon Imaging
19. Resolution & Contrast - a Comparison
Total counts: 2,500K Total counts: 2,500K
Spectrum-Dynamics
Coronal
Sagittal
Transverse
Net acquisition time: 9 minutes
Frame angle: 3°, positions:60, 9sec per position
Net acquisition time: 1 minute
positions:40, 1.5sec per position
Millennium VG a
Spectrum Dynamics Measured Contrast
Target A: 1.6
Target B: 2.2
Millenium Measured Contrast
Target A: unseen
3:1
2:1
20. Cardiac Phantom
Conventional
• No AC
• Acquisition time 12.5
m
Spectrum Dynamics
• No AC
• Acquisition time 1.25 m
•Tc99m
•Heart : .5mCi
•Background : 2mCi (.19mCi/l)
•Liver : .23mCi
(.19mCi/liter)
21. Cardiac SPECT Improvements
Implications for CHD and Atherosclerosis Testing
• Increased sensitivity: reduced acquisition time
– Dynamic cardiac SPECT:
• time-activity curves for blood and myocardium
• Compartment modeling results in:
– Absolute blood flow (voxel)
– Coronary Flow Reserve: a region compared to itself
– Coronary endothelial function (CPT)
• Increased resolution:
– Potential to directly image plaque
• quantify “activity” of atherosclerosis
23. Dynamic SPECT for
Molecular Imaging
• Noninvasive biopsy
• Specific diagnosis
CT for Structure
DynaQ™ hybrid scanner
24. Who needs PET/CT or SPECT/CT
• Equivocal nuclear
• Follow-up studies after initial CT (or
nuclear)
• Why simultaneous: molecular imaging
25. Comparative Spatial Resolution and
Tracer Concentration
SPECT PET ECHO MRI CT
Resolution
(mm)
7-15 3-10 < 1 < 1 < 1
Tracer
Concentration
pM-nM* pM-nM* 10-100
μM
10-100
μM
10-100
μM
*picomolar-nanomolar concentrations employed are
key advantage of the radionuclide methods
26. translocase
death domains
mediated signaling
activation of the
executioner of apoptosis
scramblase
floppase
?
binding followed by
2D-crystallization
Annexin V
Detection of the
apoptotic cell
TNF or
Fas Ligand
TNFR or
CD95
+ +-
Courtesy Chris Reutlingsperger, Maastricht University
Tc-99m Annexin V: Probe for Vulnerable Plaque
27. Old TIA Recent TIA
A B
C D
Transverse
Coronal
ANT
L
Annexin
IHC in
Endarterectomy
Keitselaar, Hofstra, Narula; NEJM 2004
Annexin-V Imaging For ApoptosisAnnexin-V Imaging For Apoptosis
29. 99m
Tc-Annexin V SPECT for In Vivo Detection of
Atherosclerotic Lesions in Porcine Coronary Arteries
Johnson et al. J Nucl Med 2005;46:1186-93
Scan positive
Scan negative
30. Imaging of Atherosclerotic Plaques Using a Human
Antibody Against the Extra-Domain B of Fibronectin
Matter et al. Circ Res 2004;95:1225-33
125
I-labeled L19 to
atherosclerotic
plaques in ApoE-/-
mice.
32. IL2 SPECT in 2 pts with bi-lateral carotid plaques
A Annovazzi e A Signore ACC 2005
33. IL2 SPECT: Carotid T/B ratios in patients from
LS before and after 3 month treatment
1
1,5
2
2,5
3
3,5
Before therapy After therapy
99mTc-IL2uptake(C/Bratios)
Atorvastatin
1
1,5
2
2,5
3
3,5
Before diet After diet
Hypocholesterolemic
diet
35. Molecular Imaging
Needed Developments
• Discovery in molecular biology
• New probes (with FDA approval)
• Multimodality technology
– Structure/function
Post-processing software
• Reimbursement
36. SPECT/CT for Atherosclerosis Imaging
• CT: quantify plaque volume
• SPECT or PET:
– quantify plaque activity
– Potential to quantify rest/stress blood flow
Advantage of SPECT
• Multiple tracers simlutaneously
• Possible wider availability of tracers and cameras
• Potential of SPECT
• Increased sensitivity and resolution need to be realized