| The first obvious sign of change at the Society of
Nuclear Medicine (SNM of Reston, Va.) is the new logo and tag line advancing
molecular imaging. The art work and slogan are just the tip of the iceberg, as
the organization deals with issues, such as recruiting more nuclear medicine
technologists, educating healthcare providers about positron emission tomography (PET) and
monitoring governmental affairs.
The new logo debuted at SNMs 49th annual meeting in Los Angeles in June. Its
reference to molecular imaging recognizes the role SNM plans in this evolving
field, said Alan Maurer, M.D., outgoing SNM president and director of nuclear
medicine at Temple University (Philadelphia).

SNM leadership did consider new names for the organization, but chose not to make any
changes, preferring to main the status quo as the societys raison dêtre
evolves.
One of the initiatives has been to make the society more inclusive, he
added. SNM initiated an outreach program to radiologists, promoting nuclear medicine as a
potential career option, driven, in part, by the still-burgeoning popularity of positron
emission tomography (PET) into more medical imaging applications.
To help promote PET among healthcare providers, the organization created the SNM
Learning Center for PET in Reston, with educational contributions from more than 20
medical faculty members from around the United States.
The Learning Center has both a physician and technologist section, with intensive,
specialized classes. Enrollment is limited to a maximum of 15 healthcare providers in each
session.
The need to recruit more nuclear medicine technologists comes as the medical imaging
industry continues to face a serious manpower shortage, said Mickey Clarke,
president of SNMs Technologist Section and the division administrator for the
division of nuclear medicine at Mallinckrodt Institute of Radiology (St. Louis). She cited
an American Hospital Association (AHA of Chicago) survey that estimates medical imaging
vacancies at 15 percent, ahead of both pharmacists (12 percent) and nurses (11 percent).
The answer to the shortage is to make the profession more attractive,
Clarke added, with one solution being higher salaries.
Reimbursement success
PET reimbursement will continue to be an issue as long as advocates gather data
to substantiate their claims of PETs worth in more and more medical imaging
applications.
Maurer did express disappointment over the Centers for Medicare & Medicaid Services
(CMS of Baltimore, Md.) decision not to establish a Medicare reimbursement policy for PET
imaging with the radiotracer FDG (fluorodeoxyglucose) as a tool for the detection of
Alzheimers disease.
Maurer cited two indications currently before the CMS, which may receive reimbursement
approval soon thyroid cancer and carcinoma.
Henry D. Royal, M.D. vice president-elect of SNM and professor of radiology at the
Washington University School of Medicine (St. Louis, Mo.), added the society would like to
see broader CMS reimbursement approval for PET with more cancer indications, asserting
that PET already has proven its worth in this area.
At the end of the annual meeting, Maurer turned over the reins to incoming SNM
President Michael Gelfand, M.D. Gelfand also serves as chief of the nuclear medicine
section at Childrens Hospital (Cincinnati).
With PET still on its ascent, Gelfand said SNM will be the place where scientists and
clinicians can get that information and training.
He reiterated the issue of reimbursement by both CMS and private insurers for PET
procedures using FDG, as well as other radiotracers currently under development. Gelfand
advocated the advance and eventual approval of new radiotracers currently in the
pipeline without bureaucratic roadblocks.
Medical advances must get to the public with care, but they must get to the
public, Gelfand said
Research results
The influence of positron emission tomography (PET) continues to grow, as more
research employed the medical imaging technique to uncover more information about the
human body.
In research conducted at the Technische Universitat Munchen (Munich), PET proved an
effective predictor of the success of chemotherapy in patients with stomach (gastric)
cancer.
Researchers used PET imaging on 35 patients in the study. PET accurately predicted the
success of chemotherapy in eight of nine patients who responded to therapy and in 21 of 26
patients who did not respond.
The team concluded that PET promises to provide the first reliable pre-
dictor of preoperative chemotherapy response in patients with gastric cancer, offering
outcomes advantages in treatment options and cost savings for ineffective therapies.
PET also may be a more accurate prognosticator for patients with brain cancer than
traditional pathological grading.
A team of researchers from Wallace-Kettering Neurosciences Institute (Kettering, Ohio)
found that 94 percent of patients with primary gliomas who showed low FDG uptake on PET
lived for more than one year, while 19 percent of the low uptake group survived for more
than five years. The report also found that only 29 percent of patients with high FDG
uptake lived for more than one year, while none survived more than five years.
The variable of uptake in FDG is key, because when FDG is injected into a
patient, it is absorbed more rapidly by a tumor than healthy tissue. The uptake helps
physicians to determine the extent of the tumor and often with functional relationships
with surrounding vessels, structures and tissues.
In cases of osteosarcoma a form of bone cancer that often affects children
PET could predict outcomes and potentially change the course of therapy. Again,
researchers relied on FDG uptake as the key indicator.
The study, conducted at the University of Munster (Germany), surveyed 29 osteosarcoma
patients, who ranged in age from five to 41 years. The patients also had received
chemotherapy and surgery of their primary tumor sites. During the median 28-month
follow-up, researchers found that the higher the initial uptake of FDG in the tumor, the
poorer was the prognosis.
Exhibitor review
The positron emission tomography (PET) bandwagon is picking up momentum and more
vendors are hopping aboard to offer more services to help healthcare providers and
potential entrepreneurs enter the nuclear medicine market.
CTI Inc. (Knoxville, Tenn.) is now CTI Molecular Imaging Inc. The company unveiled its
new name and logo at SNM 2002, as the company transforms itself from the silent PET
equipment supplier it was two years ago to a more visible market presence.
CTI launched its new ECAT Emerge PET scanner with the faster-scanning LSO (lutetium
oxyortho-silicate) detector technology. CTI is positioning the Emerge to sell at a lower
price point less than $1 million than its higher-end ECAT Exact PET scanner,
which also features LSO technology.
Emerge will be part of CTIs new QuickStart program, which will offer a variety of
products and services to healthcare providers looking to initiate PET service at their
respective facilities. QuickStart offerings will include radiopharmaceuticals,
technologist training, service, site planning and financing.
A main component of the QuickStart program is a fee-per-scan financing
option, added Ken Manning, CTIs director of marketing. All the products
and services are bundled into that fee.
ECAT Emerge also will be available through Siemens Medical Solutions Inc. (Iselin,
N.J.) and Hitachi Medical Systems America Inc. (Twinsburg, Ohio). Siemens will keep the
Emerge brand name, while Hitachi will market the system as the Sceptre.
Only CTI will offer the QuickStart program.
CTI also showcased its PET-CT scanner the ECAT Reveal-RT (rapid throughput) with LSO
technology. Reveal-RT allows for routine whole-body studies in 16 minutes and has a
selling point of approximately $2.4 million.
CTI in June completed its first installation of the ECAT Reveal-RT at the University of
California at Los Angeles (UCLA) Medical Center.
CTIs PET-CT portfolio includes the Reveal-HD (high definition) with BGO (bismuth
germanate) detector crystals.
Even with the early success of LSO technology to reduce scanning time, CTI has no plans
to phase out BGO-based detectors.
As the non-hospital market continues to evolve and becomes more interested in
PET, they will be looking for lower price points, Manning said. Typically,
those sites might not need to do 15 exams per day.
Hitachi returns to the PET market with the Sceptre, designed and manufactured by
CTIs CPS Innovations (Knoxville) business unit.
The Sceptre includes a new Avia PET imaging workstation with Fusion 7D software from
Mirada Solutions Ltd. (Oxford, United Kingdom) for image fusion and temporal imaging
assessment of PET, CT and/or MRI images. Fusion 7D recently received FDA 510(k) clearance.
GE Medical Systems (GEMS of Waukesha, Wis.) introduced a new turnkey radiopharmacy
program for both research and FDG (fluorodeoxyglucose) distributors.
TRACERcenter will offer products, such as GEMS PETtrace and MINItrace cyclotrons;
TRACERLab series of chemistry synthesis products; quality control, dispensing, radiation
protection and monitoring equipment; education and training programs; and laboratory
accessories and supplies.
The foundation of TRACERcenter is GEMS February acquisition of Nuclear Interface
(Munster, Germany).
The first participants of the TRACERcenter program will come from United Pharmacy
Partners Inc. (UPPI of Wilmette, Ill.). GEMS inked a three-year pact to become UPPIs
primary provider of PET and associated PET radiopharmacy technologies and services. UPPI
has 52 independent radiopharmacies across the United States.
I think what you are seeing today is PET becoming more of a commercial
market, said Eric Roman, GEMS general manager of global radiopharmacy.
It is maturing; it is growing. You have financial type people coming into play who
want to sell FDG. Why? Because they can get a financial return.
GEMS also is continuing its collaboration with Amersham Health (Princeton, N.J.) to
develop new PET-based molecular medical imaging technologies and systems. The first
project involves the development of a PET synthesis system that will produce a new
generation of targeted molecular radiopharmaceuticals.
We realize there is a future beyond FDG, said Roman. We are actively
involved with those people involved in developing new tracers, new drugs and the
combination of those that will be done in research and ultimately in clinical
applications.
Mallinckrodt (St. Louis) launched its new Monoject safety syringe, a system designed to
improve protection for nuclear medicine technologists against needlesticks, without
increasing the risks of radiological exposure.
The Monoject fits into standard injection and syringe shields and prohibits radiation
leakage. It also does not require the technologist to remove the syringe from the
injection shield. The majority of needlesticks occur from the point of injection to the
point of disposal; 20 percent occur going into the container.
Monoject has received FDA 510(k) clearance and conforms with all standards of the
Needlestick Protection Act. Mallinckrodt plans to have the safety syringe on the market by
this fall.
Research Systems Inc. (RSI of Boulder, Colo.), a wholly owned subsidiary of Eastman
Kodak Co. (Rochester, N.Y.), released its new Watsyn medical imaging software at SNM 2002.
The fully integrated implementation platform for medical application development and
deployment targets the mainstream medical industry. Watsyn software is designed to allow
developers to reduce the time-to-market for medical applications, extend the value of
existing clinical workstations, and integrate users applications into a common
platform.
Siemens Medical Solutions (Iselin, N.J.) unveiled its new e.cam Signature Series for
enhanced SPECT (single photon emission computed tomography) imaging in June at the annual
meeting.
Signature Series features include new HD4 High-Performance digital detectors for
enhanced count rate performance and image quality. An integrated audio-visual screen,
similar to a TV monitor, is mounted for the patient to view for information on his or her
procedure or general viewing. Dubbed e.media, the feature also targets pediatric patients.
People are nervous about their procedures and nuclear medicine is about lack of
movement, said Barbara D. Franciose, president of Siemens Nuclear Medicine
group (Hoffman Estates, Ill.). We have some 30- or 40-minute studies. If we can keep
patients entertained and relaxed, it will make a difference.
Siemens also displayed Flash 3D technology on the Signature Series as a
works-in-progress. The 3D beam modeling and iterative reconstruction technology is
designed to improve image quality, contrast resolution and lesion detection.
There are six different configurations within the Signature series, including dual-head
to single-head models.
Siemens also provided updates on its biograph PET-CT system with LSO-based (lutetium
oxyorthosilicate) detector technology to reduce whole-body scanning time. The system is
FDA-cleared and has performed whole-body scans in as little as 15 minutes in procedures at
Hong Kong Baptist Hospital. The hospital also has reported scanning times of 12 minutes
after additional protocol optimization.
Siemens also offers the biograph PET-CT system with bismuth germanate (BSO) detector
technology. Scanning times with BGO average 30 minutes.
Depending on configuration, the selling price of the LSO-based biograph ranges between
$1.9 and $2.2 million.
Siemens also offers LSO detector technology in its Accel PET scanner. The system is
installed in approximately 60 locations.
On the PET-CT side, Philips Medical Systems (Bothell, Wash.) is progressing with its
Gemini open-design system. The company expects to have its first prototype installed
before the end of this year into a site in the United States. Because the Allegro PET
scanner and Mx8000 CT scanner separately, Philips says the design opens the door for
interventional procedures and offers patients the improved comfort of an open design.
Deliveries of the Gemini are anticipated for the first half of 2003.
Philips also is upgrading its SkyLight, the gantry-free gamma camera, which allows for
a multitude of patient imaging positions. The company showed SmartStep, a new software
which combines multiple manual processes into one automated step for the operator.
Several functions such as the exchange of collimators can be handled
automatically according to upcoming exams. The DualPlanar option on SkyLight would allow
users to scan two patients at the same time. Philips anticipates DualPlanars release
in the second quarter of 2003.
Philips unveiled its new ENsphere workflow environment. Physicians and nuclear medicine
technologists have their own workstation portals where patient information and data are
managed. The physicians workstation called PDT (Physicians Diagnostic Toolset) can review
patient mulitimodality data and generate reports and then transmit it to the next
destination. The PDT also is available in a wireless laptop configuration. An electronic
data card slips into the side of the laptop, allowing for over-the-air network connection
to the server.
At SNM 2002, Philips gave customers a glimpse of its early investments in the area of
molecular imaging across its medical imaging lines. Philips is working with several
companies to design the appropriate medical imaging equipment to deal with new oncology
and cardiology drugs. |