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Ingenuity TF PET/CT - The experience at University Hospital Salzburg

Best Practice
Philips NM Clinical Science Philips Healthcare • USA

To help manage Austria’s growing rate of non-small-cell lung cancer cases, University Hospital Salzburg runs a fast-track lung biopsy program. The clinical pathway begins with imaging, such as PET/CT, and includes a findings report and discussion by clinicians in pneumology, thoracic surgery, oncology, radiology, radiotherapy, nuclear medicine and pathology. PET/CT imaging is performed on the Ingenuity TF PET/CT, and the images acquired in the nuclear medicine department are used by radiotherapy specialists for treatment planning. Facilitated by one system for diagnostic and simulation imaging, University Hospital Austria leverages an interdisciplinary approach to deliver outstanding care and keep pace with the evolving role of molecular imaging.


Maintaining one high standard of care

“If I were a patient,” reflects Dr. Datz, “this is the way I’d want to be cared for.” She’s referring to the interdisciplinary collaboration that goes into each patient report. It contains diagnoses from both radiology and nuclear medicine.


“In treatment planning,” Dr. Datz continues, “we [radiologists, radiotherapy and nuclear medicine specialists] review images based on the same dataset. This teamwork is superb, and it’s grown stronger ever since PET was integrated with CT at this facility.” University Hospital Austria radiologists access CT images reconstructed with iDoseā“, while radiotherapy specialists review PET images along with dimensional CT images, both acquired on the same system.


Deepening the value of PET – together

Dr. Zehentmayr also appreciates the clinical benefit of working so closely with colleagues in nuclear medicine. “The value of PET imaging,” he explains, “is going beyond the purposes of diagnosis. This modality provides additional information on the activity. Is it, say, in the middle of the tumor? If you combine this with CT images, you know where to apply what dose for this specific patient.” Dose escalation in ungated [18]-FDG cases is already practiced at the site, and Dr. Zehentmayr is excited about the possibilities this represents for adaptive therapy.


PET/CT-driven treatment planning has increased, says Prof. Dr. Pirich, since studies have revealed PET/CT’s impact on the course of treatment. For Prof. Dr. Pirich, quantification capabilities inherent in PET play a key role. “Therapy monitoring is where quantification becomes even more important than it is for initial assessments,” he says. “Lymphoma is a good example. The measurement rate allows you to differentiate patients on a semi-quantitative basis, and based on that you can plan the treatment.”


"Planning without PET/CT is out of the question for me." - Dr. Franz Zehentmayr, Radiotherapy specialist


Supporting clinically relevant decisions

Advanced technology, such as Astonish TF, can push back boundaries of clinical feasibility. The Ingenuity TF PET/CT 540 ps timing resolution enhances the detectability of very small lesions, “which is very important,” Prof. Dr. Pirich points out, “when the hilar lymph nodes are examined. But every tumor is unique,” he continues, elaborating on the different needs for diagnostic and simulation imaging. “If you’ve already discovered peritoneal or retroperitoneal metastases in a neuroendocrine tumor, for instance, you need to consider how to proceed.”


Clinicians also have the tools they need to concentrate time and resources on cases which will benefit most from gating. Designed for phase gating, the Pulmonary Toolkit acquires data in one of three modes to accommodate different clinical needs. Patients first admitted to the fast-track program receive an ungated PET/CT scan; based on the results, a select number are scheduled for a follow-up gated PET/CT. “Gated PET/CT does provide us with metabolic information on the tumor. This helps define and, whenever possible, reduce the target volume,” says Dr. Zehentmayr. “But at the moment, gating makes the most clinical sense in locally advanced non-small cell lung cancer and esophageal cancer. This approach could be useful in about 10-15% of patients – and in the coming year, we’d like to expand our collaboration with nuclear medicine to make this possible.”


"This gating technology is instrumental in helping us see individual lung tumors to characterize and quantify them with confidence." - Prof. Dr. Christian Pirich, Head of Nuclear Medicine and Endocrinology department


* Results at this facility are not predictive of results at other facilities, results in other facilities may vary

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May 31, 2017

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Best Practice
Ingenuity TF PET/CT
Astonish TF, biopsy, Body, esophageal cancer, FDG-PET/CT, follow up, iDose4, lesion, lung cancer, lungs, lymph nodes, lymphoma, Oncology, Pulmonary Toolkit, treatment planning, tumor

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