SNM Review

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It was the first Society of Nuclear Medicine show for the newly aligned GE Healthcare (formerly GE Medical Systems) after its acquisition of Amersham plc in April 2004. The company was on-board promoting a message of "personalized medicine" and featuring a number of advancements to its nuclear medicine portfolio.

Addressing the growth in nuclear cardiology, GE showcased advanced cardiac applications of its Discovery ST positron emission tomography/computed tomography (PET/CT) system. Designed for cardiac imaging, the system aids in detecting coronary atherosclerosis earlier and define more-effective therapies.

"We are entering a new era in non-invasive cardiology where hybrid imaging will play a major role in managing heart disease," said Karim Benali, MD, MSc, global manager, cardiology PET/CT and nuclear medicine at GE.

Highlighting its new advanced application HeartFusion, the technology aligns the vascular coronary tree created by CT images on the three-dimensional (3D) functional data from PET images. Together, Discovery PET/CT with heart fusion allows physicians to quantify and analyze the impact of atherosclerotic lesions on heart muscle.

GE's Myoview, also on board at the show, is used to diagnose heart disease by visualizing blood flow to heart muscle. In the past year, Myoview received the Food and Drug Administration (FDA) approval for the assessment of left ventricular function in patients with coronary artery disease. GE says that it will continue to expand Myoview on a global basis.

GE also launched its second-generation Infinia nuclear medicine system. The company said it expects to install more than 250 systems by the end of the year.

Enhanced features of the next-generation system include: a 5-mm CT axial resolution with Hawkeye for enhanced single photon emission computed tomography/computed tomography (SPECT/CT) lesion detection; fan beam collimation for brain SPECT scanning efficiency and resolution, and a camera-based positron emission tomography (CBPET) option for extended clinical utility. New detector motions have been added as well to accommodate more patient positions and enhanced productivity, including a camera controlled graphic user interface.

GE introduced at the show a new system that will help produce high capacity and high specific activity PET tracers for use in research and the detection and diagnosis of major diseases.

The new GE cyclotron technology was designed to help produce a high capacity 18F-F2 target. 18F-F2 is a critical starting point in production, by the electrophilic route of F-DOPA, which is showing potential in the diagnosis of Parkinson's disease. Research using F-DOPA is currently underway at major institutions.

The development is the result of a major collaborative effort with Imanet, a joint venture that began with Amersham plc and a number of PET research centers, and now continues with GE.



Siemens Medical Solutions at SNM 2004 unveiled a new SPECT/CT product as well as showcasing its range of nuclear medicine systems.

The company launched the TruePoint SPECT/CT (single photon emission computed tomography/computed tomography (SPECT/CT) system. The system, which integrates Siemens' e.cam SPECT with its CT technology, can be used in the diagnosis and treatment for cancer, cardiac and neurological diseases. In cardiac applications, TruePoint SPECT/CT will provide information about cardiac function and overall health with its ability to measure attenuation correction with diagnostic multi-slice CT.

Siemens also introduced the Symbia platform for its TruePoint SPECT/CT. The Symbia platform enables clinicians to utilize the device in three ways to perform three separate studies - SPECT, multi-slice CT and SPECT/CT. Symbia offers various multi-slice CT configurations with speeds of up to 0.6 seconds per rotation. The integration of syngo, Siemens' software platform, into the Symbia operating system also offers a common, intuitive user interface and enables easy access to patient data.

From its family of nuclear medicine products, Siemens demonstrated its biograph positron emission tomography/computed tomography (PET/CT) system. Key features include HI-REZ, a high resolution PET option that can provide greater than 250 percent improvement in volumetric image resolution; the Pico-3D option which provides ultra-fast detector electronics that substantially improve image quality; and a six-slice CT biograph companion to existing two- and 16-slice configurations.

With more than 3,000 installations worldwide, Siemens continues to improve its e.cam Signature Series flagship gamma camera. The system is equipped with high-definition dynamic digital detectors (HD4), offers cardiac and general Flash 3D, advanced SPECT image reconstruction technology, reduced image noise, and lesion detection.

The e.cam Signature Series also offers Siemens' e.media feature, which is a patient entertainment and comfort system that provides onboard interactive multimedia capability.

Siemens highlighted its six-month old c.cam, a reclining dedicated cardiac gamma camera. The system enhances imaging accuracy in a small footprint design. The c.cam is equipped with myocardial viability and perfusion capabilities and is fully integrated with software that allows clinicians to analyze ejection fraction and wall motion.

Siemens also unveiled a host of new tools to broaden its nuclear medicine system capabilities, and facilitate multi-modality integration. e.soft@LEONARDO integrates the suite of nuclear medicine e.soft functionality in the Leonardo workstation. The syngo-based multi-modality workplace enables efficient post-processing of images from nuclear medicine, CT, MR, and x-ray, as well as images used for radiation therapy planning.

The syngo FusedVision3D is a set of three-dimensional (3D) visualization tools for evaluating multimodality studies. This application offers special image layout for viewing of PET, CT and fused PET/CT images in one display. syngo FusedVision3D also features a volume rendering technique (VRT) with a broad range of image settings.



Toshiba America Medical Systems Inc. (TAMS) featured at SNM 2004 upgrades to its e.soft software now available on the company's t.cam Signature Series variable angle, dual-detector gamma camera system. The new versions include e.soft version 3.5 and e.soft express version 2.0.

e.soft version 3.5 improves t.cam's clinical applications by enabling the use of the quality-control activity to motion correct data acquired through "profile attenuation correction." TAMS says the feature allows for greater diagnostic accuracy during cardiac examinations, as well as imaging organs surrounding the heart.

Version 3.5 offers broker activity, which is designed to simplify the integration of third-party applications into the e.soft workflow environment, and the new capability of capturing print areas in JPEG, BMP or EMF formats or any cine in an AVI format.

Additionally, the upgrade includes flexible display changes such as interactive region of interest and split function, enhanced dual-monitor support, interactive print and save functions, three-slice and multi-modality slice display capabilities, and Segami Corp.'s NeuroGam optional software for 3D comparisons of SPECT and PET brain scans.

The (optional) e.soft express version 2.0 is remote viewing software designed for cardiac data and general nuclear medicine and PET/CT data. The e.soft express Cardiac has been optimized for remote viewing of cardiac quantification analysis data. Also available is e.soft express viewing for general nuclear medicine, and PET/CT data with complete workflow functionality, print and save screens, and DICOM support for third-party data viewing.



Philips Medical Systems used SNM 2004 to springboard its new single photon emission computed tomography/computed tomography (SPECT/CT) system. The company also displayed new nuclear medicine and molecular imaging products.

Philips' new Precedence SPECT/CT is one of the first hybrid SPECT that combines diagnostic CT. It is available in both 16-slice and 6-slice configurations. Approved by the Food and Drug Administration, Philips says the system will be installed at its first beta site at Johns Hopkins in a few months. It will be commercially available in 2005. Philips says the 16-slice system will cost approximately $1.4 million.

SPECT/CT imaging has the potential to change the way disease is diagnosed and treated. Industry experts believe that the images can potentially assist with identifying tumors, analyzing appropriate treatment, delivering targeted therapy to precisely destroy target cells and assessing treatment effectiveness. In addition, therapeutic agents for SPECT are currently widely available and cost effective.

According to Philips, the company designed Precedence as a platform to accelerate the adoption of molecular imaging into the mainstream of care. Philips emphasized at SNM its commitment to partner with luminary academic medical centers and pharmaceutical companies to develop new molecular imaging agents and extend the application of molecular imaging in the pre-clinical and clinical settings.

New and expanded collaborations for the discovery and validation of new molecular imaging therapeutics include Kereos, CellPoint, Theses and Cytogen.

Philips' also highlighted its comprehensive nuclear medicine portfolio. JETStream Workspace is a nuclear medicine workstation that integrates display, processing, review, reporting and image archiving technologies. Astonish is Philips' software that is designed to sharpen resolution in total body and other planar procedures as well as provide diagnostic quality images in clinically practical processing times. Philips' PET/CT scanner Gemini, integrated in the company's Brilliance 16 Power CT system, is now available in a mobile setting to facilitate patient imaging at multiple customer locations. As the latest addition to the Gemini cardiovascular applications portfolio, Gemini CV PET incorporates gated acquisition with Emory Toolbox PETtools for quantitative analysis in PET myocardial perfusion and viability imaging.

Additionally, Philips announced several product upgrades, including the Forte Gamma Camera with JETStream, CardioMD with Vantage PRO and various features to its SKYLight 3.0 gamma camera system.



On the exhibit floor at SNM 2004, Hitachi Medical Systems America Inc. (HMSA) introduced a new PET/CT hybrid imaging system called Sceptre P3.

The system combines three technologies in one: Lutetium oxyorthosilicate (LSO) PET technology, HMSA's fast quad-slice CT and the connectivity of AVIA PACS, Hitachi's "advanced visualization and image analysis" workstation

AVIA PACS architecture was designed to meet the increasing demands of multi-modality imaging. Offering DICOM connectivity, AVIA provides the framework necessary to connect various modalities and to utilize multifunctionalities, says Hitachi.

In addition, HMSA revealed its "Evolve" program which allows a field upgrade path from the Sceptre dedicated PET system to the Sceptre P3 PET/CT. The Evolve upgrade will be available to all existing Sceptre installations as well as forward production Sceptre systems.

The Sceptre P3 PET/CT imaging system is pending Food and Drug Administration clearance and is not currently available for sale in the U.S.



PETNET Solutions, a subsidiary of CTI Molecular Imaging, introduced at SNM 2004 a new training resource for interpreting physicians, referring physicians and technologists called "PET/CT University."

PET/CT U is available through PETNET's Reveal Network Solutions (RNS) and is a wed-based, interactive educational resource. PETNET customers purchasing their Success offering, including FDG and provider marketing tools, will have access to the online resource.

With this tool, a PET provider has access to over 180 PET/CT cases. When viewing one of the case studies, users will find the patient's history, the previous imaging studies, the PET scan and interpretation, pathology reports, treatment and follow-up options, and reference articles that support the use of PET for each specific procedure and/or disease state.

PETNET says the educational tool will be available at the end of July.

The company also highlighted its training seminar geared toward the PET practice's marketing personnel called "Taking it to the Streets: Marketing PET to Oncologists." The seminar has been held four times.

"In order to be a successful PET provider, marketing must reach referring physicians," said Joan Washburn, vice president of sales and marketing for the company. "You have to gain access to the referring physicians and know about patient management specific to oncology. There is a specific message about PET to each physician type (medical oncology, ObGyn, thoracic surgeons). This program is designed to teach marketing persons PET and oncology applications, as well as selling skills, in order to deliver the PET message and improve referrals."



Codonics was at SNM 2004 showcasing its mature product line and printer technology. The Middleburg, Ohio-based company exhibited side by side its Horizon Ci and Horizon SF medical imagers for nuclear medicine and multimodality imaging.

The Horizon Ci is a desktop dry film imager that produces diagnostic quality medical films in three sizes: 8-inch by 10-inch, 11-inch by 14-inch and 14-inch by 17-inch. The unit is designed for the PET/CT and SPECT market since it prints large format CT. The Horizon SF multimedia dry imager is a small format coloring/grayscale machine intended for nuclear medicine departments and clinics.

Codonics recently announced a software upgrade for its medical imager, version 1.8.0. In addition, the company unveiled an exclusive agreement with Philips Medical Solutions to market and bundle its EP-1200 medical imager with Philips' nuclear medicine modalities.



Syntermed Inc. unveiled at SNM 2004 its FDA approved NeuroQ, a software platform consisting of quantitative tools to assist radiologists, nuclear medicine physicians and other professional interpreters of PET images with interpretation of brain scans. The unveiling of NeuroQ was made on the heels of the announcement by the Centers for Medicare & Medicaid Services (CMS) that it will expand Medicare coverage of PET to include some Medicare beneficiaries with suspected Alzheimer's disease.

The Atlanta-based company, in affiliation with Daniel Silverman, MD, PhD, head of the neuronuclear imaging section at UCLA's medical center, developed NeuroQ. The scalable software generates quantified analysis of regional cerebral activity.

According to Syntermed, NeuroQ works by providing automated quantification of more than 200 standardized regions of interest and comparison of the activity of brain regions in an individual scan to regional activity values derived from a database of normal scans, through quantitative and statistical assessments.

"The next significant modification to the NeuroQ platform will be a diagnostic and prognostic tool that differentiates Alzehimer's disease from other forms of dementia, which has been developed by Silvermen," said Kenneth Van Train, president of Syntermed.



Cardinal Health showcased at SNM 2004 offerings from both its radiation management services division and nuclear cardiology division.

From its radiation management services division, Cardinal highlighted ASM-993, an advanced survey meter. Improving regulatory compliance, the device is equipped with bar code, data log and infra-red features to minimize errors, save time and reduce paperwork. Cardinal's dose calibrator, Mark VI, is equipped with a touchscreen interface combined with Windows XP and an automated dose-drawing that calculates the correct future dose. For training and research, Cardinal featured its lineup of anthropomorphic phantoms (heart/thorax, striatal and thyroid). The phantoms test reconstruction techniques, non-uniform attenuation, and scatter correction methods using different radionuclides under realistic conditions.

Cardinal's Cardiology Solutions provides a complete package of services and resources for starting, owning and operating a nuclear cardiology imaging facility. Providers are offered a range of consulting services including nuclear pharmacy services, staffing, health physics, ICANL accreditation and department management.

In IT, Cardinal demoed SYNtrac, a department management system and CardioWriter, an ASNC-compliant cardiology report writer. SYNtrac includes applications for patient demographic, management of patient scheduling, patient dosing, regulatory reporting, inventor and waste tracking, health physics and remote order entry. CardioWriter incorporates features that help run a cardiology department more efficiently and effectively.



Gamma Medica at SNM 2004 highlighted a new cardiac gating subsystem for its pre-clinical imaging system, X-SPECT.

X-SPECT is used by medical researchers and drug companies that perform in-vivo imaging techniques and molecular markers on animals to study disease progression and therapy. The new cardiac gating tool will allow users to accelerate their studies aimed at understanding diseases and finding a cure.

Cardiac gating is critical to imaging accuracy in the heart, as it freezes the movement of the heart during its expansion and contraction phases.

Together with Siemens Medical Solutions, its U.S. marketing partner, Gamma Medica sells its MicroSPECT products to bio-pharmaceutical companies, research hospitals and universities. The pair recently announced an expansion to their agreement. Siemens now holds exclusive rights to market and distribute Gamma Medica's X-SPECT pre-clinical imaging system worldwide.



At SNM 2004, Unfors featured its nuclear educational dosimeter (NED), an instrument that measures finger dose preparation and injection of radiopharmaceuticals.

NED is an alternative to TLDs for reliably measuring finger dose. The device consists of a small sensor on a cable connected to a display unit. The sensor can measure the dose and dose rate as well as total exposure time. In addition, Unfors' NED gives users an immediate audible warning when the preset dose rates are exceeded.



InSight Health Services Corp. set up at SNM 2004 to showcase its diagnostic imaging, treatment and management services related to nuclear medicine. A provider of services in imaging diagnostics ranging from MRI to lithotripsy, the Lake Forest, Calif.-based company says 12 percent of its business is dedicated to mobile and fixed-site PET (positron emission tomography) and PET/CT scan services.

InSight offers medical providers the necessities they need for starting, sustaining and/or growing its PET imaging service. Fifty percent of its customer base uses mobile PET coaches, while 50 percent are actually fixed imaging sites, says Cardinal.

Commencing its PET venture in late 2000, Cardinal helps customers cope with the large amount of risk, as well as capital expenditure, involved in using PET. Many customers start by using mobile services and eventually transition of fixed PET and PET/CT imaging centers, says Cardinal.



MedImage highlighted at SNM 2004 future enhancements that are in the works for its MedView nuclear medicine/PET display software. MedView is an interactive display program for medical imaging departments and clinics and it is part of MedImage's display and reporting package called DELTAmanager.

The Ann Arbor, Mich.-based company said that a DICOM CD printing feature is one of the enhancements that it hopes to release within a couple of months. The feature allows users to transport images to radiation therapy systems or a central archive, replace film when a patient needs to take images to another radiologist, and accompany the written report sent to the referring physician.

Additional upgrades to the software that will be released later this year include new layouts for its Flex Tomo window and volume registration and image fusion. The volume registration tool will allow users to register, in three dimensions, two sets of transaxial or oblique data via: scaling, rotation and translation. Therefore, users can display registered images in a large format with the FlexTomo window, show maximum intensity projection and manipulate images.

MedView reads data originating from multiple nuclear/PET vendors in native or DICOM file format. File classes include static, dynamic, SPECT (single photon emission computed tomography), gated SPECT, results screens and whole body images. The software is equipped with a variety of image manipulation tools, image storage ands management capabilities and image output functions.



Segami Corp. featured StereoVue on the SNM 2004 show floor. The work-in-progress is a stereo projection system that allows multiple users to simultaneously view 3D data wearing polarized glasses under normal room light conditions.

The projector system, marketed by VizEverywhere of Glen Allen, Va., is compatible with most stereo-enabled graphic cards and together with Segami application software provides for in-depth viewing perspectives of medical image data. The company says that stereo imaging allows for better localization of tumors, treatment planning and cath lab procedures.

Segami's flagship product, the Mirage workstation, also made center stage at the show. The workstation is compatible with virtually all vendors' DICOM compliant medical imaging equipment



Numa Inc. was at SNM 2004 to showcase its recently introduced NumaStore DVD Image Management System.

The medical image management device meets the specific needs of nuclear medicine, nuclear cardiology, positron emission tomography (PET) and PET/CT (computed tomography) departments. It provides secure, long-term storage while managing the flow of images throughout the nuclear medicine department and beyond.

Numa also highlighted its NumaLink 3.0 which offers DICOM connectivity between OEM workstations, between legacy non-DICOM capable systems, and support for processed/reconstructed data and screen saves. NumaLink 3.0 allows nuclear medicine facilities to make their existing legacy equipment DICOM 3.0 compatible. The company says this will facilitate the connectivity to new DICOM capable workstations, viewers, and hospital-wide PACS (picture archiving and communications systems).

In addition, the company featured NumaList, which adds or corrects DICOM modality worklist information in DICOM image files. This enables the correct patient demographic information to be added to the DICOM images with little or no user input. The correct information is automatically disseminated, thus reducing errors and improving efficiency throughout the imaging department and healthcare facility.