Discovery ALCYONE. the dream is alive. Bernard SONGY, David LUSSATO, Mohamed GUERNOU November, 24, 2009

Transcription

1 Discovery ALCYONE at CCN: the dream is alive Bernard SONGY, David LUSSATO, Mohamed GUERNOU November, 24, 2009

2 Nuclear Medicine at CCN Department created in 1988 by Antoine BLASCO and Florence VIGONI 3 ( and soon 4) nuclear physicians full time, 5 cardiologists, one fellow in nuclear cardiology, one partial time physicist, 8 technologists 3 gamma-cameras in function 1 PET will be installed at the begining of 2010

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4 The physicians Bernard SONGY, cardiologist, nuclear physician, american board of nuclear cardiology David LUSSATO, nuclear physician, nuclear oncologist Mohamed GUERNOU, nuclear physician, trained both in nuclear cardiology and nuclear oncology

5 Nuclear medicine department Independant society Independant from CCN Independant from radiology department 2 owners: Bernard Songy and David Lussato

6 Nuclear medicine department closed collaboration with : Clinical cardiology: daily staff for all patients Coronarography and angioplasty department ( Dr Guyon) Radiology, especially CTCA unit ( Dr Sablayrolles) PET unit of St Louis University Hospital ( Pr Moretti, Dr Lussato) future collaboration with: Cardiac PET unit of Bichat University Hospital ( Pr Le Guludec, Dr Songy ) La Roseraie private hospital whom physicians will come 2days/ week to use the PET camera in CCN St Denis general hospital for nuclear medecine

7 scintigraphie myocardique et scanner coronaire B.Songy, JL.Sablayrolles et al., CCN, St Denis Étude rétrospective CCN patients sans antécédent, 2 examens à visée diagnostique à moins de 30 jours Quand le scanner est normal, la scintigraphie est normale. 30% des patients ayant des sténoses non serrées au scanner ont une ischémie scintigraphique. 60% des patients ayant des sténoses serrées au scanner ont une ischémie scintigraphique. Un scanner anormal, quelque soit le degré de la sténose, doit donc être complété par un test d'ischémie myocardique.

8 Medical activity Nuclear Cardiology: 7000 patients/y 1/3 diagnosis 2/3 assessment of known CAD General nuclear Medicine: bone scans : 1600 lung scans: patients/y

9 Why thallium 201? Experience of the department since 1988 More than patients explored with thallium Quality of thallium, especially in very severe coronary diseases Lack of molybdene-technetium from 2008 until 2015? Good opportunity of using our thallium experience with alcyone technology

10 cameras 2 Discovery Alcyone NM 530 c validation from june to july clinical use since august 2000 patients explored with these cameras with 201-thallium prone ( +/- supine ) 1 Discovery Hawkeye 4 HD clinical use since september

11 GE relationship Biweekly phone conference with Haifa engeeners ( Aharon Peretz, Reuven Brenner, Gil Kovalski) and french support Frequent mail exchange, especially with Gil Kovalski ( Haifa) and Sarah Roy ( Buc), with transmission of data, technical questions and answer Very good relationship and confidence with the technical french support

12 Validation of Discovery Alcyone NM 530c with 201-thallium: method Validation of camera with thallium 201 by comparison with conventionnal camera 156 consecutive patients explored with regular dose of 201-thallium ( 3 to 4 mci ) have 15 mn conventional camera acquisition then 5 mn alcyone acquisitions, prone then supine Blinded analysis was made by 2 experimented specialists

13 Validation of Discovery Alcyone NM 530c with 201-thallium: results Positionning of patients is ok for 155 on 156 patients Diagnosis is the same with both cameras Quality, especially spatial resolution and gated analysis is better with discovery alcyone Supine imaging shows more beautiful images, but more artefacts, especially in inferior wall Conclusion: with regular 201-thallium doses, GE Discovery Alcyone can be used with 5 mn prone acquisitions with high diagnosis and imaging quality

14 Low dose protocole: method One major advantage of thallium 201 is its better myocardial extraction by comparison with other myocardial agents Its major disadvantage is its higher dosimetry So we are worked about decreasing dose by using low dose of thallium 201, ie 2 mci in place of 3 mci, with an acquisition time beetween 5 and 8 mn (instead 15 mn previously) We include prospectivly 130 patients who had a previous myocardial scan with regular dose previous month or year and compare diagnosis and image quality We compared counts statistic, quality of images, pathologic defects and artefacts

15 Low dose protocole: results Counts statistic more than 8 M counts is necessary and enough for optimal image quality We obtain this result with dose beetween 1.5 and 3 mci and time beetween 5 and 8 mn Vers us 3 to 4 mci and 10 to 15 mn previously So dosimetry is decreased by 30% and time divides by 2 With this protocol, Alcyone images have less artefact than conventional images Diagnosis quality is the same Spatial resolution ansd gating quality are better Conclusion: feasibility of thallium precedures with decrease of dosimetry by 30% and decreased of time by 50%

16 1m73, 88 kgs, 3.8 mci à l effort, 13 mn acquisition, reinjection de 1 mci en redistribution, 14 mn acquisition

17 2.5 mci, 7 mn pas de réinjection

18 1m60, 50 kgs 1.5 mci, 6 mn

19 J+2 1 mci, 6 mn

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21 1m77, 95 kgs 3 mci, 7 mn

22 1m75, 70 kgs 2 mci, 6 mn

23 Future (next months) Scientific communications of our results (french society, SNM): Validation of the use of Discovery Alcyone with 201-thallium Validation of the low dose protocol and the reduction of dosimetry with discovery Alcyone Fusion of myocardial perfusion scan acquired with Alcyone in NM department and CTA acquired separatl with 64 slices CT in radiology department

24 Future ( next years) Quantitation with high rate and list mode acquisition of coronary flow and coronary reserve by compartment analysis cf Pisa - Thallium is the best agent for that Alcyone technology should allow that It will be a functionnal approach complementar with the anatomic approach made by CTA

25 Conclusions Complementarity of nuclear cardiology and radiologic cardiology Alcyone technology is very efficient Ultrafast acquisition, low dosimetry, high quality and in the future quantitation Dream is becoming reality Partnership beetween radiology, nuclear cardiology and GE is a exciting challenge for high quality care for cardiac patients

26 Thank you for your visit!