PET/MR. Are You Ready?? Derek Lee, BS, CNMT, PET

Transcription

1 PET/MR Are You Ready?? Derek Lee, BS, CNMT, PET

2 Allow Myself to Introduce Myself I ve been around a while: 23+ years in Nuclear Medicine and counting PET & PET/CT for 13 years and counting Currently working on PET/MR installation

3 Disclosures

4 Overview The Current Market Planning Training Who s Going to Run This Thing? What s It Good For? Where Do We Go From Here?

5 The Story So Far Currently there are 3 systems commercially available for clinical use: Siemens Phillips GE

6 Siemens mmr Simultaneous PET/MR

7 Philips Ingenuity TF PET/MR Sequential PET/MR

8 GE Signa PET/MR Simultaneous PET/MR

9 Quick Comparison Siemens Philips GE Acquisition Simultaneous Sequential Simultaneous TOF No Yes Yes Bore Size Max Patient Weight 60cm PET 70cm/MR 60cm 60cm 500lbs 440lbs 500lbs Axial FOV 258mm 180mm 250mm Sensitivity 13.2cps/kBq 17.7cps/kBq 21cps/kBq 4.4mm 4.9mm 4.1mm

10 Other Details Available Space vs. Equipment Footprint Exam Room Control Room Equipment Room Uptake Room(s)

11 Sample Safety Zone Layout From ACR White-paper on MRI Safety 2013

12 MRI Safety Zones Zone 1: Free Access Zone 2: Interface between Free Access Zones and Restricted Zones Zone 3: For screened individuals under supervision of MRI personnel Zone 4: MRI Scanner Room clearly marked with Magnet is On signage

13 MRI Safety Zones magmedix.com

14 Details HVAC Exam Room Equipment Room

15 Details System Cooling Chiller Placement Routing for Plumbing Quench Plumbing

16 Details Power Lots of Power! 400 or 480 volts 9-50kW

17 Details MR Compatible Ancillary Equipment Injectors Gurneys Code Cart Anesthesia Cart Syringe Shields

18 Breast MR Spine MR Body MR MSK MR Neuro MR

19 Details Shielding: Gamma RF! Gauss

20 Training Check With Your State Requirements Vary Check With Your Employer Written Policy

21 Training MRI Personnel Ionizing Radiation ALARA Time, Distance, Shielding Functional/Metabolic Imaging

22 Training PET Personnel MRI Safety Training Level I/Level II

23 Bad Things Can Happen

24 Training ARRT Primary Pathway Post-Primary Pathway - Open to NMTs Resonance-Imaging

25 Training ARRT Post-Primary Requirements Must be registered ARRT(N) or CNMT Beginning 1/1/2016 must have 16 hours of structured education Must complete MRI Clinical Experience Requirements

26 Training Beginning January 1, 2016, candidates for postprimary certification and registration will also be required to complete 16 hours of structured education related to the content outlines for that exam. Acceptable forms of structured education include: 1 Academic courses from an institution accredited by a mechanism recognized by the ARRT for an academic degree, 2 CE opportunities approved by a RCEEM or RCEEM +, or 3 A combination of the two options.

27 Training Minimum 25 different procedures 3-5 repetitions of chosen procedures Complete 125 repetitions across all procedures No more than 1 procedure documented per patient Must be documented through ARRT website

28 Who s Going To Run This Thing? Turf War Do Your Homework ACR Requirements = 2 People Collaborate Research

29 By the Way Who s Gonna Read These Things?"

30 What is PET/MR Good For? Lower Radiation Dose Can Provide Functional Information Shorter Acquisition Times (Compared to Separate Exams) Better Characterization of Soft Tissues

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32 Potential PET/MR Indications Most Musculoskeletal Tumors Tumors of Head & Neck Intracranial Tumors Tumors of Breast Tumors of Liver

33 Philips Medical Systems

34 Quantitative Tools... MR Elastography Cortex Activity Variances Cardiac Viability Multi-Nuclear Spectroscopy Fat Content Perfusion Arterial Spin Labeling 22%

35 Limitations Long MRI Sequences Increased Likelihood of Sedation Needed Metallic Implants Characterization of Cortical Bone and Lung Nodules Reduced Cost $$$

36 Osseous Sarcoma Eur J Nucl Med Mol Imaging 2009

37 Sarcoma Eur J Nucl Med Mol Imaging 2009

38 Sarcoma Philips Medical Systems

39 Melanoma Eur J Nucl Med Mol Imaging 2009

40 Pediatric Neurology Courtesy of Dr. Stephen Jones; Cleveland Clinic s Department of Radiology, the Mellen Center for Multiple Sclerosis and the Epilepsy Center.

41 Neurology Philps Healthcare USA

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43 Philips Healthcare USA Prostate Ca

44 Gynecological Ca Cancer of the cervix Philips Healthcare USA

45 Siemens Healthcare Liver Lesions

46 Breast Ca Eur J Nucl Med Mol Imaging 2009

47 Where Do We Go From Excellent Question Here? Very Expensive Machine Unknown Indications Unknown Reimbursement Staffing Unknown Unknowns

48 Thank You! Images Courtesy of: Eur J Nucl Med Mol Imaging 2009 Siemens Healthcare USA Philips Healthcare USA GE Healthcare USA Dr. Stephen Jones; Cleveland Clinic s Department of Radiology, the Mellen Center for Multiple Sclerosis and the Epilepsy Center

49 Thank You! Carl Linsz; GE Healthcare Dr. Edwin Goldstein; Phoenix VA Healthcare System Douglas Boyd; Phoenix VA Healthcare System