Molecular Imaging: A Brave New World

Nuclear medicine, once dismissed as “unclear medicine,” has moved to the cutting-edge of diagnostic healthcare in the past few years with the introduction of fusion molecular imaging modalities such as PET/CT and SPECT/CT, which provide anatomic clarity to the discipline’s functional focus. In addition, groundbreaking research in radiopharmaceuticals holds the promise of new imaging agents for a wider variety of disease as well as therapeutics designed to provide targeted treatments at the molecular level.

Developers are set to introduce new software tools that utilize advanced visualization technologies to further expand the diagnostic capabilities of PET, PET/CT, SPECT and SPECT/CT.

Upgrades and improvements to existing gamma cameras are being displayed and demonstrated at RSNA 2007, as will new devices for breast, thyroid, oncology, and cardiac and multispectral imaging applications.

A host of firms are unveiling offerings for molecular imaging applications and processing this year. Here is a sample of some of the latest products and devices that are being revealed at McCormick Place next month.

 

Capintec (Booth 3117) is showcasing its radiation measurement and protection products for all imaging modalities and featuring molecular imaging products.

The firm designs, manufactures, and sells equipment for medical imaging and radiation oncology. Capintec is displaying a complete line of products for nuclear medicine, PET, brachytherapy and radiation therapy facilities.

Carestream Molecular Imaging (Booth 2513) is unveiling its new Kodak In-Vivo Multispectral system for advanced research applications along with new large Stokes shift dyes.

The new multispectral system incorporates workflow automation and advanced multispectral fluorescence, luminescence, digital x-ray and radioisotopic imaging capabilities for in vivo imaging of small animals for drug development and life science research.

The system delivers improved sensitivity that allows researchers to precisely locate, identify and monitor changes in molecular activity of specific cells or organs within small animals, long before morphological changes can be detected. As a result, users can gain a better understanding of very early disease states which can lead to expedited development of effective therapeutics, according to Carestream.

The organization also is featuring its new large Stokes shift dyes for fluorescent in-vivo imaging applications. These dyes maximize the fluorescent signal while minimizing auto-fluorescence issues during in vivo imaging.

The new dyes, which are characterized by near infrared emission and a large Stokes shift, equip researchers to achieve a higher sensitivity of fluorescent detection deeper into tissue. Having a significantly larger Stokes shift—greater than 80 nanometers in the case of Kodak X-SIGHT Dyes—helps researchers eliminate much of the background that typically obstructs the fluorescent signal while allowing researchers to excite and emit the dyes at their maxima, thus resulting in far greater signal to noise, according to the company. Most commercially available dyes typically have a Stokes shift between 20 to 30 nanometers.

Although the Kodak X-SIGHT Imaging Agents have been optimized for Kodak Image Station and In-Vivo Systems, they also are compatible with other commercially available digital imaging systems, according to Carestream.

Cedara Software (Booth 1316) is debuting its Cedara Clinical Control Center (C4)-enabled works-in-progress Cedara PET/CT module and Cedara I-Response.

The C4 PET/CT application was developed to follow radiology workflow and solve image fusion challenges in a PACS environment, according to the vendor.

The Cedara I-Response is designed to help evaluate, assess and monitor the effect of cancer therapy over time using data from multiple modalities. In addition to providing tools for standard anatomical measurements used for tumor assessment in cancer management and research, Cedara I-Response can analyze both PET/CT and MR-based diffusion-weighted imaging (DWI).

The firm says that by providing the capability to visualize changes in tumors resulting from cellular and metabolic mechanisms during the course of treatment, the product provides clinically relevant information that potentially could be used to make mid-treatment therapy adjustments in an attempt to improve clinical outcome.

Cedara I-Response also features patented functional Diffusion Map (fDM) technology based on work done at the University of Michigan. This functionality enables physicians to analyze DWI studies to visualize and quantify changes over time in the microscopic motion of water in healthy and diseased tissues. University of Michigan investigators have demonstrated that fDM can identify brain tumor patients who are responding to radiation (plus adjuvant chemotherapy in some cases) after only three weeks of treatment, more than two months earlier than conventional methods, according to Cedara.

The results of each analysis are included in automatically generated reports, as well as exporting the results to file for import into a site’s existing data repositories. I-Response is available to original equipment manufacturers (OEMs) as a standalone workstation, and also can be integrated into existing PACS solutions using Cedara’s C4 integration platform.

Gamma Medica-Ideas (Booth 5439) is featuring its dual-headed LumaGEM system for applications such as molecular breast imaging.

Gamma Medica-Ideas’ LumaGEM is a dedicated gamma camera used for diagnostic imaging. It has been marketed up to this point as a single-head system, and such systems are installed in North America and Europe where they are being used to provide patients with the benefits of functional breast imaging. A prototype dual-head LumaGEM for molecular breast imaging has been in use at the Mayo Clinic in Rochester, Minn., for the past two years, according to the firm.

The rationale behind a dual-head system lies in achieving closest proximity to potential lesions in the breast and cutting the imaging time significantly. In single-head systems, the fall-off of spatial resolution with distance can cause low-contrast lesions located opposite a single detector to be missed, whereas a second detector can find otherwise missed lesions due to its proximity, the company says.

The LumaGEM system features solid-state digital detection technology utilizing eV Products cadmium zinc telluride (CZT) to provide better resolution compared with the conventional scintillation camera technology traditionally used in gamma cameras, Gamma Medica-Ideas says. It also allows minimal dead space at the edges of the image, permitting the closest access to the chest wall.

The new dual-headed LumaGEM camera features a gantry that allows for greater versatility in positioning a patient, with a full range of motion. Gamma Medica-Ideas’ patented mounting mechanism, allowing the use of light breast compression, ensures that the radiologist can obtain images using any standard mammography view. LumaGEM is designed for optimal use with molecular imaging pharmaceuticals such as Sestamibi and similar agents that localize in neovascular structures for breast cancer detection.

GE Healthcare (Booth 1729) is demonstrating two new technologies for its Discovery Dimension PET/CT systems, motion free PET/CT and VUE Point.

GE is providing exclusive technologies on its Discovery Dimension—high-definition PET image processing, patient motion management and clinical productivity features—that together address motion, which is one of the most significant factors in lesion characterization that degrade PET/CT image quality. The newest version of Discovery Dimension helps clinicians advance toward the goal of motion free PET/CT imaging by allowing the clinician to address imaging mismatches related to respiratory and cardiac motion.  These include motion correction techniques that effectively improve clinical results and minimize blur caused by motion.

Also on display is a new application for PET image generation, VUE Point. VUE Point helps improve small lesion detectability, clinical confidence and exam productivity, according to the developer. VUE Point incorporates advanced proprietary image reconstruction algorithms; including volume scatter correction and a patented image projection technique developed at GE’s Global Research facility, and is enabled by the Volume CT reconstruction technology development. VUE Point is applicable to both 2D and 3D PET acquisition modes, static, dynamic and motion imaging.

The VUE Point technology is available on the Discovery Dimension with new installations, or by Continuum field upgrades for installed base Discovery ST systems, the company says.

MEDX (Booth 8300) is introducing its T-Quest small field-of-view gamma camera. The device was designed specifically for optimized thyroid imaging and uptake calculations, but has the flexibility to perform any small organ imaging, the company says. 

The portable T-Quest features a small footprint, requiring only 8 square feet of space; lightweight collimators that can easily be changed by hand; and a flexible, DICOM-compatible user interface, according to MEDX.

The vendor also has been a provider of new, remanufactured and refurbished equipment, service, and parts for more than 30 years. It has delivered more than 3,000 nuclear imaging systems and accessories to facilities worldwide.

The firm offers complete nuclear medicine coverage including: ICANL/ACR accreditation; radiation physics support; field service support; professional on-site applications training; certified parts; and 24/7 personal support with a 24-hour response time.

Merge Healthcare (Booth 1122) is highlighting its Merge PET/CT Workstation software, a vendor-neutral solution for digital reading that features easy-to-use controls for advanced imaging and streamlined reporting.

Merge PET/CT is designed to overcome the clinical challenges of fusion imaging to easily accommodate the standard methods that radiologists use to read CT datasets, the company says. Following the norm found in PACS, the PET/CT Workstation shows the images by providing layouts split across dual monitors in panoramic mode. For efficient study comparison, this method of review allows simultaneous comparison of CT images, PET corrected, PET uncorrected, PET/CT fused and maximum intensity projection (MIP) images, among others. Rigid registration between images allows simultaneous navigation through all data sets.

For premium clinical effectiveness, Merge PET/CT has incorporated reading tools such as 3D volume rendering and hot-spot scout, and comprehensive reporting tools such as standardized uptake value (SUV) calculations and configurable color maps. The software also allows for DICOM connectivity to PACS applications for easier image receiving and storage, the company says

Naviscan PET Systems (Booth 6920) is announcing its collaboration with advanced visualization technology developer MIMvista and unveiling the firms’ work at creating MIMviewer PEM, an application for Naviscan’s PEM Flex Solo II PET scanner.

The software is available for the PEM Flex Solo II, a high-resolution PET scanner designed to image small body parts such as the breast and hand. The Solo II utilizes PET technology for positron emission mammography (PEM) breast applications, which allows physicians to visualize and characterize lesions as small as 2 millimeters in size.

Key features of the MIMviewer software include: 3D measurement capabilities; an embedded PEM lexicon; and improved region of interest (ROI) support. In early 2008, the MIMviewer PEM will integrate the capability to display images from other modalities with enhanced SUV quantification, and a comprehensive reporting tool, according to the companies.

Philips Medical Systems (Booths 4048, 4165, and 4129) is spotlighting its BrightView SPECT, which features new technologies that allow clinicians to get the device closer to patients for superior image resolution, according to the developer.

Proprietary integrated technologies move detectors closer to each patient for superior image resolution, acquiring information with precision and efficiency, then reconstructing faster without typical increases in noise, Philips says.

The BrightView SPECT features the firm’s CloseUp technologies, which enable higher resolution through software, new electronics, and minimal distance between detector and patient. Philips’ BodyGuard automated contouring moves the detectors closer to patients, even when imaging infants or small regions of the body.

The device features a wide-open gantry that can support a wide range of patient sizes, and a thin (0.1 inch, 2.5 mm) imaging pallet and very small cardiac dead space help improve image quality in bone and cardiac studies, according to the company. The modality features new PET-based digital detectors with the vendor’s PinPoint technologies to provide single-uniformity correction for multiple-energy imaging.

In addition, Philips says that its reconstruction technologies offer PET-like resolution of less than 5 mm through a proprietary measured-resolution recovery algorithm. The BrightView SPECT is designed to be easily upgradeable to future configurations, and its compact footprint enables system installation in rooms as small as 15 feet, 6 inches by 12 feet (4.72 x 3.66 meters).

Siemens Medical Solutions Molecular Imaging Division (Booth 7713) is showcasing its high definition positron emission tomography technology, HD•PET. The clarity achieved by HD•PET is the result of a unique and proprietary technology that optimizes the elements of image uniformity, resolution and contrast. The improved 2 mm resolution enables physicians to clearly visualize the smallest of lesions from the center to the edges. Adding high definition to PET systems enhances contrast. The improvement in signal to noise, which effectively doubles, reveals sharper images, allowing clinicians to better differentiate between healthy and suspicious tissue.

HD•PET improves the delineation of small abdominal lesions as well as small retroperitoneal lymph node metastases including testicular tumors, and cervical and uterine malignancies. HD•PET can also improve the accuracy of radiotherapy planning by providing better detection of the true extent of the lesion.

HD•PET is based on Siemens’ TruePoint technologies — a combination of technological features and workflow solutions for PET/CT imaging. HD is an option on all new Biograph TruePoint systems and an upgrade option for current Biograph TruePoint users.

Also being showcased is the 3D-application, syngo TrueD, which provides advanced image analysis and comparison, supporting physicians in diagnosis and decision-making. syngo TrueD enhances clinical workflow by enabling efficient reading of multi-modality patient scans from multiple time points, including PET/CT, SPECT/CT as well as the fusion of CT or MR with PET or SPECT images.

Thinking Systems (Booth 4583) is demonstrating the firm’s recently released new cardiac imaging and reporting functions, as well as enhanced support for PET/CT fusion in the latest iteration of its ThinkingPACS product.

The new cardiac imaging and reporting features include template driven, structured reporting for nuclear cardiology and echocardiography; MUGA processing; phase analysis for SPECT and MUGA nuclear cardiac studies; simultaneous processing and display of attenuation corrected and uncorrected nuclear cardiac studies; and simultaneous processing and display of motion corrected and uncorrected nuclear cardiac studies.

The new features are not only available on the Thinking Systems PACS workstation, but are also available on the firm’s ThinkingWeb web server, which allows clinicians to view, process, analyze and report cardiac studies anywhere in the world.

The enhanced PET/CT features include optimized radiology-centric or nuclear medicine-centric views to satisfy the needs of differently trained physicians; simultaneous display of CT, PET and fused images with multiple window/level settings; shortcut keys for window/level preset adjustment; shortcut key to turn fusion on and off; and side-by-side comparison between PET/CT and contrasted diagnostic CT. The PET/CT features are available on both the Thinking Systems PACS workstation and the ThinkingWeb web server, according to the developer.