PET/MR Are You Ready?? Derek Lee, BS, CNMT, PET
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
Disclosures
Overview The Current Market Planning Training Who s Going to Run This Thing? What s It Good For? Where Do We Go From Here?
The Story So Far Currently there are 3 systems commercially available for clinical use: Siemens Phillips GE
Siemens mmr Simultaneous PET/MR
Philips Ingenuity TF PET/MR Sequential PET/MR
GE Signa PET/MR Simultaneous PET/MR
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 Resolution @1cm 4.4mm 4.9mm 4.1mm
Other Details Available Space vs. Equipment Footprint Exam Room Control Room Equipment Room Uptake Room(s)
Sample Safety Zone Layout From ACR White-paper on MRI Safety 2013
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
MRI Safety Zones magmedix.com
Details HVAC Exam Room Equipment Room
Details System Cooling Chiller Placement Routing for Plumbing Quench Plumbing
Details Power Lots of Power! 400 or 480 volts 9-50kW
Details MR Compatible Ancillary Equipment Injectors Gurneys Code Cart Anesthesia Cart Syringe Shields
Breast MR Spine MR Body MR MSK MR Neuro MR
Details Shielding: Gamma RF! Gauss
Training Check With Your State Requirements Vary Check With Your Employer Written Policy
Training MRI Personnel Ionizing Radiation ALARA Time, Distance, Shielding Functional/Metabolic Imaging
Training PET Personnel MRI Safety Training Level I/Level II
Bad Things Can Happen
Training ARRT Primary Pathway Post-Primary Pathway - Open to NMTs https://www.arrt.org/certification/magnetic- Resonance-Imaging
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
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.
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
Who s Going To Run This Thing? Turf War Do Your Homework ACR Requirements = 2 People Collaborate Research
By the Way Who s Gonna Read These Things?"
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
Potential PET/MR Indications Most Musculoskeletal Tumors Tumors of Head & Neck Intracranial Tumors Tumors of Breast Tumors of Liver
Philips Medical Systems
Quantitative Tools... MR Elastography Cortex Activity Variances Cardiac Viability Multi-Nuclear Spectroscopy Fat Content Perfusion Arterial Spin Labeling 22%
Limitations Long MRI Sequences Increased Likelihood of Sedation Needed Metallic Implants Characterization of Cortical Bone and Lung Nodules Reduced Cost $$$
Osseous Sarcoma Eur J Nucl Med Mol Imaging 2009
Sarcoma Eur J Nucl Med Mol Imaging 2009
Sarcoma Philips Medical Systems
Melanoma Eur J Nucl Med Mol Imaging 2009
Pediatric Neurology Courtesy of Dr. Stephen Jones; Cleveland Clinic s Department of Radiology, the Mellen Center for Multiple Sclerosis and the Epilepsy Center.
Neurology Philps Healthcare USA
Philips Healthcare USA Prostate Ca
Gynecological Ca Cancer of the cervix Philips Healthcare USA
Siemens Healthcare Liver Lesions
Breast Ca Eur J Nucl Med Mol Imaging 2009
Where Do We Go From Excellent Question Here? Very Expensive Machine Unknown Indications Unknown Reimbursement Staffing Unknown Unknowns
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
Thank You! Carl Linsz; GE Healthcare Dr. Edwin Goldstein; Phoenix VA Healthcare System Douglas Boyd; Phoenix VA Healthcare System