SPECT Suits Up with Speed and Sensitivity

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Siemens TruePoint SPECT/CT from the Symbia product family includes multidetector CT configurations with speeds of up to 0.6 seconds per rotation.

Single photon emission computed tomography (SPECT) has proven itself over time in imaging patients with suspected or confirmed coronary artery disease. Not only has it stood up to several new technologies, the list of indications for SPECT is growing. Greater speed and relatively low costs are just what the healthcare industry needs.

‘Better at a better price’

Since SPECT first came on the scene in the 1970s, there have been dramatic changes. Originally, SPECT scanning did not involve rotating around the heart, speeds have been cut by about one quarter and, even with vast technological improvements, the costs have gone down. “We also added ventricular function,” says Gary Heller, MD, PhD, director of Nuclear Cardiology at Hartford Hospital in Hartford, Conn., and director of the Cardiovascular Fellowship Program and professor of Medicine and Nuclear Medicine at the University of Connecticut School of Medicine. Heller’s facility uses CardioMD and Cardio 60 from Philips Medical Systems.

“The technology continues to evolve,” he says. “The cameras are more sophisticated, but cheaper. We’re better at a better price. Even though the technology is older, it still provides considerable benefit to patients.” Heller does about 6,000 SPECT studies a year.

From time to time, something else is touted as the next best thing that will replace cardiac SPECT scanning. “I’ve been hearing that since I started in the late 1990s,” says Chad Timisen, nuclear medicine manager for North Phoenix Heart Center in Arizona. “It never happens. When all is said and done, it’s usually still SPECT standing.” Timisen’s department uses a Ventri dual-head dedicated cardiac SPECT camera from GE Healthcare.

Heller agrees that SPECT has been a “mainstay of noninvasive imaging for patients with suspected coronary artery disease [CAD] or with [confirmed] CAD.”

Standing up to competition

SPECT continues to rate well when compared with other, newer technologies, Heller says. For example, “stress echo tells you function at peak stress, but doesn’t tell you anything about perfusion.”

Cardiac catheterization generally requires an overnight hospital stay or same-day admission. SPECT can be performed in a physician’s office and costs much less. A good SPECT camera costs about $250,000, compared with a $1.5 million price tag for a CT scanner, Heller says.

When you consider the cost of SPECT equipment, a physician practice can actually acquire the equipment and run a lab at a much lower financial risk, says Timisen. Plus, reimbursement for some PET/CT exams are still up for debate among payers, including Medicare. “I think that makes [SPECT] enticing for cardiologists, and for imaging centers,” he says. “You’d be hard-pressed to get people to pay out of pocket for testing that they could have covered through insurance.”

The use of SPECT eventually will decrease the overall cost of diagnosing and treating CAD, says Harry Lessig, MD, FACNP, FACNM, co-director of nuclear medicine at Deborah Heart and Lung Center in Brown Mills, N.J. He already has used single and dual-head SPECT equipment from Siemens Medical Solutions. The Symbia T, a TruePoint SPECT/CT system that combines a dual-detector variable angle gamma camera with a CT scanner, will be installed in September. Eighty percent of the SPECT work done at Deborah is within nuclear cardiology.

“SPECT will determine those patients who do not need cardiac catheterization,” he says. Some believe magnetic resonance imaging “is the wave of the future. The problem with that is it is extraordinarily expensive and will probably overdiagnose certain things,” he says. Cardiologists are in the process of working out when and how SPECT should be used. “We need to collaborate on the best procedures for conditions in the next two to five years. When we learn what modalities to use for what, we’ll have savings.”

SPECT’s surprising sensitivity

Aside from cost savings, SPECT offers unique levels of sensitivity and specificity. Timisen points out that the physiological aspect of nuclear medicine can show problems other modalities cannot. He says a lot of his patients have normal stress test results and no chest pain or other symptoms, but “when we do the images, the [patient has] a blockage. The patient doesn’t feel it at all.”

Cardiospecialists Group Ltd., with three clinics in the Chicago