PET/CT Scans for Dementia
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Presented at the Dementias 2017 conference which was held in the Royal College of General Practitioners in London on 9th and 10th February 2017.
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PET/CT Scans for Dementia
- 2. PET/CT Scans for Dementia patient: The Patient experience Roisin Dobbin-Stacey PET/CT Manager, Cobalt, Cheltenham UKAMY00162 February 2017
- 3. Cobalt – Who are we? Charity – Established 1964 A diagnostic imaging provider - 1994 Imaging Centre, Cheltenham - 2006 PET/CT High-field Open MRI 3.0T MRI CBCT Institute of Translational Medicine Imaging Centre – 2017 QE Hospital Birmingham UKAMY00162 February 2017
- 4. Cobalt – Who are we? Mobile MRI 6 mobile MRI Scanners Only 3.0T mobile MRI service in Europe UKAMY00162 February 2017
- 5. Cobalt – Who are we? PET/CT Over 4,000 patients Population 2.2m NHS patients Three Counties Bristol Oncology - 90% Neurology UKAMY00162 February 2017
- 6. Dementia Patient Pathway 2gether NHS Foundation Trust – pathway Development – First patient FDG/Amyloid service Diagnosing dementia “What’s the point?” “There is no treatment” What were attitudes to a diagnosis of cancer in the 1960s and HIV in 1980s? UKAMY00162 February 2017
- 7. The Referral Appropriate - RCR Guidelines FDG Evaluation of memory loss/neurological sign of dementia and differentiation of types of dementia in selected patients. Amyloid Used in highly selected patients with cognitive impairment where i) Alzheimer's Dementia is a possible diagnosis but this remains uncertain after comprehensive Evaluation by a Dementia expert and conventional imaging work-up and ii) where knowledge of the presence or absence of amyloid is expected to increase diagnostic certainty and influence patient management. UKAMY00162 February 2017
- 8. The Referral Funding National NHS PET/CT contract or local funding? Contraindications – Pregnancy, patient compliance Positron Emission Tomography – Back to basics FDG Amyloid PET/CT – how does it work UKAMY00162 February 2017
- 9. How does it work? Radiotracers– Back to basics Before PET scan - a radioactive medicine is produced; tagged to a natural chemical, glucose, water, or ammonia. Radiotracer is injected into the patient; go to areas that use the natural chemical. FDG (fluorodeoxyglucose) -F18 is tagged to glucose. Enables measurement of cerebral metabolic rate. Amyvid is tagged with F18.- travels through the bloodstream and into the brain, binding to amyloid plaques UKAMY00162 February 2017
- 10. How does it work? UKAMY00162 February 2017
- 11. Radiotracer production Difficulty / cost of producing and transporting the radiotracers Short Half lives Requires proximity to a cyclotron. Things to remember: Consent (radiation dose equivalent) Isotope order FDG and Amyloid Risk of failure UKAMY00162 February 2017
- 12. How does Positron Emission Tomography work? PET measures body functions - e.g blood flow, oxygen use, and sugar (glucose) metabolism Computed Tomography - demonstrates anatomy Combined PET/CT images pinpoint the anatomic location of abnormal metabolic activity PET detects the energy emitted by positively charged particles (positrons) being emitted from the patient - converts to 3D image UKAMY00162 February 2017
- 13. How does it work? UKAMY00162 February 2017
- 15. Normal pattern of uptake FDG Amyloid UKAMY00162 February 2017
- 16. PET/CT – The referral UKAMY00162 February 2017
- 17. What happens once we receive the referral? Date & Time Venue Directions Eating & drink Pregnant women & children Treatment Diazepam Need to confirm Telephone contact Length of visit Referring consultant Diabetes Appointment time to suit patient and carers Referral vetted by consultant/ARSAC UKAMY00162 February 2017
- 18. IDD: Normal diet. Normal a.m. insulin All Other Patients: Fasted (water only) for 3 hours prior to the appointment time. Patient Preparation FDG Patient Preparation Amyvid All Patients follow their Normal diet The patient’s ability to lie still for the duration of the acquisition should be assessed prior to booking the appointment/tracer order UKAMY00162 February 2017
- 19. Importance of confirmation Minimise no-shows Time to allay concerns Check on patient compliance Does the patient consent Importance of patient/Carer contact numbers Tracer failures Scanner breakdown Tracer Order- FDG daily Amyvid – 5 days UKAMY00162 February 2017
- 20. Tracer Delivery/Dispensing FDG Dose reduction for patients/accuracy Karl - Weight based delivery Reduction in handling Radioactive tracers UKAMY00162 February 2017
- 21. Tracer Delivery/Dispensing Amyvid UKAMY00162 February 2017
- 22. The Patient Experience - Arrival UKAMY00162 February 2017
- 23. The Patient Experience UKAMY00162 February 2017
- 24. The Patient Experience - FDG UKAMY00162 February 2017
- 25. The Patient Experience - Amyvid UKAMY00162 February 2017
- 26. The Patient Experience - Injection UKAMY00162 February 2017
- 27. Uptake Time FDG Inject with 250 mbq FDG/100mls saline Leave in a quiet darkened room for 30minutes/no stimulus Amyvid Inject 370mbq <10ml- 100ml flush Increased viscosity 30-50 minute resting/TV/reading UKAMY00162 February 2017
- 28. The Patient Experience-the scan UKAMY00162 February 2017
- 29. The Patient Experience-the scan UKAMY00162 February 2017
- 30. The Patient Experience- post scan UKAMY00162 February 2017
- 31. The PET/CT Image Interpretation FDG Normal Abnormal UKAMY00162 February 2017
- 32. The PET/CT Image Interpretation - Amyloid UKAMY00162 February 2017
- 33. How do patients benefit? diagnosis Access to treatment & support Access to treatment & support Ending of diagnostic uncertainty Improves quality of life for person with dementia and carers National Dementia Strategy, 2009/World Alzheimer Report, 2011 UKAMY00162 February 2017
- 34. What can go wrong? UKAMY00162 February 2017
- 35. Scan requests often vague/Lack important information Often requested by people with minimal PET experience Referrals need to be for appropriate exam Education for patients Problems with referrals Require good communication between “us” and “them” UKAMY00162 February 2017
- 36. Low yields / failure Afternoon production of Amyvid Proactive scheduling Flexibility Problems with tracer production Rare but random / Good maintenance UKAMY00162 February 2017
- 37. Injection technique Positioning Reduce scan time Patient compliance - every opportunity to reassure the patient Radiographic Errors Nearly always preventable UKAMY00162 February 2017
- 38. Good explanation of the procedure Family or guardian with the patient Patient comfort Music for relaxation Reassure the patient Patient compliance UKAMY00162 February 2017
- 39. Gantry size Room temp Noise Scan time reduced/patient anxiety Improving patient experience Patient satisfaction Patient experience UKAMY00162 February 2017
- 41. Thank you for your attention
- 42. Thank you to: Patients/Colleagues/Staff: Cobalt Health, Cheltenham Gloucestershire Hospitals NHS Trust Foundation 2gether NHS Foundation Trust Acknowledgments UKAMY00162 February 2017