Discovery alcyone dream (Gil Kovalski) Israel

Discovery ALCYONE at CCN: the dream is alive

Bernard SONGY, David LUSSATO, Mohamed GUERNOU November, 24, 2009

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

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

Nuclear medicine department • • • •

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

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

scintigraphie myocardique et scanner coronaire B.Songy, JL.Sablayrolles et al., CCN, St Denis

Étude rétrospective CCN 2006-2007 160 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.

Medical activity • Nuclear Cardiology: 7000 patients/y 1/3 diagnosis 2/3 assessment of known CAD

• General nuclear Medicine: bone scans : 1600 lung scans: 1200

3000 patients/y

Why thallium 201 ?

• Experience of the department since 1988 • More than 100 000 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

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

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

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

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

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

Low dose protocole: results •

Counts statistic more than 8 M counts is necessary and enough for optimal image quality

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We obtain this result with dose beetween 1.5 and 3 mCi and time beetween 5 and 8 mn

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Vers us 3 to 4 mCi and 10 to 15 mn previously

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So dosimetry is decreased by 30% and time divides by 2

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With this protocol, Alcyone images have less artefact than conventional images

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Diagnosis quality is the same

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Spatial resolution ansd gating quality are better

• Conclusion: feasibility of thallium precedures with decrease of dosimetry by 30% and decreased of time by 50%

1m73, 88 kgs,

3.8 mCi à l’effort, 13 mn acquisition, reinjection de 1 mCi en redistribution, 14 mn acquisition

2.5 mCi, 7 mn pas de rĂŠinjection

1m60, 50 kgs 1.5 mCi, 6 mn

J+2 1 mCi, 6 mn

1m77, 95 kgs 3 mCi, 7 mn

1m75, 70 kgs 2 mCi, 6 mn

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

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

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

Thank you for your visit !