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Making the most of big bore PET/CT

Best Practice
Scibelli, Anthony, B.Eng. Philips Healthcare • USA

Philips GEMINI TF Big Bore PET/CT at Fletcher Allen

Who/where

Fletcher Allen in Burlington, VT, is a 550-bed licensed hospital, affiliated with the University of Vermont College of Medicine, and the only teaching hospital in the state of Vermont. The University of Vermont College of Medicine at Fletcher Allen serves as a national model for the delivery of high-quality academic health care for a rural region. The radiology department performs approximately 300,000 examinations each year.


Challenge

Maximizing use of the Philips GEMINI TF Big Bore PET/CT to optimize return on investment and enhance patient care.


Solution

Fletcher Allen is seeing advances in patient care using the GEMINI TF Big Bore PET/CT system in radiation oncology for PET and CT simulation, as well as for routine diagnostic PET work and cardiac imaging.


PET/CT as part of an effective care strategy

Dr. Steven Braff, Chair, Radiology Department, University of Vermont Medical Group at Fletcher Allen explains that the Fletcher Allen approach to high-quality medicine and use of technology is also cost effective. “Our per capita costs are among the lowest in the state and the lowest of any teaching hospital in the country per admission,” he states. With regard to the GEMINI TF Big Bore PET/CT, “Its use in oncology is obvious…the value of PET/CT is obvious.”


Tripling the use of a PET scanner
Dr. George Ebert, Chief, Imaging Technology, University of Vermont Medical Group at Fletcher Allen states, “What Philips has done with the GEMINI TF Big Bore PET/CT system is to incorporate all the best features of a PET scanner. They now have one of the fastest crystals available, the shortest coincidence time, and Time-of-Flight technology (third-generation technology with 495 pico-second timing resolution). Time-of-Flight technology eliminated the need for the septa and shielding used in early PET scanners. Without the shielding, the bore has been opened to 85 cm, allowing almost any sized patient to be scanned. These changes now allow a triple use of this machine for routine oncology, PET and CT simulation for radiation therapy, and cardiac PET for very large patients.”

Ebert continues, “The cardiac applications of this machine are particularly useful. There are very few patients who can’t fit inside an 85 cm bore. Not every hospital can justify the purchase of a PET/CT scanner based on oncology volume alone. Eliminating the need for an additional CT simulation machine with an option for PET/CT simulation or an additional SPECT machine for cardiac stress testing makes this machine more attractive. The additional benefit in cardiac imaging is that the cardiac exam can be completed in less than one hour, accelerating clinical decisions with a fraction of the radiation dose and higher specificity and sensitivity compared with traditional SPECT MPI. The clever use of Time-of-Flight technology to eliminate the shielding and septa is the key feature of this particular product. Time-of-Flight imaging has been the holy grail of PET for as long as I can remember.”

“With the GEMINI TF Big Bore PET/CT you’re able to triple the use of a PET scanner. That’s a cost-effective way to look at this type of equipment.” - Dr. George Ebert, Chief, Imaging Technology, University of Vermont Medical Group at Fletcher Allen.

“The system nicely marries the need for oncology and cardiac imaging and gives you the flexibility you need.” - Dr. Janusz Kikut, Director of Nuclear Medicine and PET, University of Vermont Medical Group at Fletcher Allen.
Steven Braff, M.D. Chair, Radiology Department, University of Vermont Medical Group at Fletcher AllenGeorge Ebert, M.D., Ph.D. Chief, Imaging Technology, University of Vermont Medical Group at Fletcher AllenJanusz Kikut, M.D. Director of Nuclear Medicine and PET, University of Vermont Medical Group at Fletcher Allen
Steven Braff, M.D.
George Ebert, M.D., Ph.D.
Janusz Kikut, M.D.
Chair, Radiology Department, University of Vermont Medical Group at Fletcher Allen
Chief, Imaging Technology, University of Vermont Medical Group at Fletcher Allen
Director of Nuclear Medicine and PET, University of Vermont Medical Group at Fletcher Allen

Providing clinical flexibility
Dr. Janusz Kikut, Director of Nuclear Medicine and PET at the University of Vermont Medical Group at Fletcher Allen agrees, “A key for us about the GEMINI TF Big Bore PET/CT system is the flexibility. We don’t have enough oncology volume to fill all the spots for one day, and being able to move into cardiac imaging was a big jump for us. I can’t overemphasize how important it is to have the large bore for patients for cardiac imaging. Many of those patients are obese and if you are applying an attenuation correction CT you need to have a true attenuation map, which is paramount for PET imaging. The system nicely marries the need for cardiac imaging and oncology and gives you the flexibility you need.”

The value of a hybrid image in radiation therapy planning
“I think there is no good medical or scientific reason not to do PET simulation. CT simulation or PET simulation is now essential to all radiation therapy planning. We have advocated PET simulation for years. Targeting the metabolically active tumor is often more effective than targeting the anatomy, as demonstrated by CT alone. Fusing the anatomy with the metabolic activity is where PET/CT simulation shows its advantages. PET/CT hybrid simulation and radiation planning give you the best of both worlds,” says Ebert.

The importance of Time-of-Flight technology
In Ebert’s opinion, “Our oncology scans benefit substantially from Time-of-Flight technology. We use Time-of-Flight reconstruction on 100% of our oncology patients because this improves our spatial resolution and diagnostic accuracy. Time is resolution. Less time, more resolution.”

Opportunities in cardiac imaging
Kikut estimates the facility does close to 900 oncology and 500 cardiac PET exams a year. “Imaging large patients is not an issue with co-registration of CT and PET,” he says. Ebert affirms, “It was our intention to combine cardiac and oncology imaging on the same machine from the start. Cardiac PET is cost-effective and ideal for patients. While SPECT exercise stress tests are still the gold standard, rubidium-82 PET scanning is most likely the best way to do pharmacologic stress testing of the heart,” he says.

High count rates allow low-dose scanning
Ebert states, “Using 3D Time-of-Flight technology we’re able to take advantage of significantly higher count rates than are allowed by 2D non-Time-of-Flight technology. Time-of-Flight technology reduces what would otherwise be unacceptable random and scatter events typically seen in early 3D imaging. In addition, the increased sensitivity of 3D imaging with Time-of-Flight technology has allowed us to significantly reduce our rubidium doses from the traditional 60 mCi. Because of Time-of-Flight technology, our scans are of much higher quality.”

“Time is resolution. Less time, more resolution.” - Dr. George Ebert, Chief, Imaging Technology, University of Vermont Medical Group at Fletcher Allen.

“The people of Philips have shown themselves uniquely very willing to listen. They focus on getting it right….” - Dr. Steven Braff, Chair, Radiology Department, University of Vermont Medical Group at Fletcher Allen.

Allowing for patient comfort
Kikut also notes the opportunity for patient comfort while maintaining excellent diagnostic image quality. “The system is open. No one likes long tunnels. And it’s easier to get equipment such as IVs in there. If you take large bore images and regular bore images side by side you couldn’t tell the difference.”

Working together
Braff states, “Increasingly it’s obvious that we have to work together to provide solutions that are cost-effective, efficient, and high quality. We work closely and collaboratively with Philips.”

“The people of Philips have shown themselves uniquely very willing to listen. They focus on getting it right, listening to the customer’s voice, making things consistently better, and making things more patient-centric and radiologist-centric in terms of workflow, efficiencies, and patient care,” he summarizes.


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Apr 25, 2011

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Best Practice
Gemini TF Big Bore
bariatric, CT simulation, Cardiac, Oncology, radiation therapy
 

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