Molecular Imaging - Fully integrated SPECT/CT modernizes facilities to maximize abilities

Fully integrated SPECT/CT modernizes facilities to maximize abilities

By Linda Brookes


Nuclear medicine experts on two continents describe how the new fully integrated SPECT/CT serves more patients and signals the beginning of a new era in nuclear imaging.

Photography by Jonathan Browning and Scott van Osdol

Watch highlights of how the Baylor Scott & White team transitions from SPECT to SPECT/CT.

Single-photon emission computed tomography (SPECT) combined with computed tomography (CT) was introduced as a hybrid SPECT/CT imaging modality almost two decades ago. Soon after the first commercially available diagnostic SPECT/CT system, Siemens’ Symbia TruePoint™ system, was launched in 2004, researchers recognized the potential for improving image quality and incorporating quantitative image acquisition and reconstruction.

Alexander Hans Vija, PhD, who has been working in the field for more than 25 years and is currently head of SPECT research at Siemens Healthineers Molecular Imaging in Hoffman Estates, Illinois, USA, recalls that collaborative research led to Symbia Intevo™, which featured standardized quantification and the high-resolution xSPECT Bone™ reconstruction algorithm. “But from here, we wanted to have a more integrated solution and ultimately enable many more imaging departments to install a SPECT/CT system.” This would allow more patients to access a wider range of services. 

<p>Alexander Hans Vija, PhD</p>
Symbia Pro.specta™ “brings closure to the era of the original Symbia TruePoint SPECT/CT,” Vija says. For 20 years the aim has been to amalgamate the data and construct a system that is in reality “one system under the hood.” Symbia Pro.specta is that system, he asserts. “It would be very exciting if it would motivate people who were holding on to their 15-year-old or older systems to upgrade. I believe this system moves the bar to a level where everybody can enter the SPECT/CT world,” Vija says.

Vija’s hopes for Symbia Pro.specta have been realized at Baylor Scott & White (BSW) Medical Center-Temple in central Texas (USA), a part of the BSW Health, one of the largest not-for-profit healthcare systems in the US. “We had been wanting a SPECT/CT camera for many years,” admits Michael L. Middleton, MD, director of the nuclear radiology division which employs three nuclear physicians and six technologists. Obtaining approval for purchase of a SPECT/CT system was challenging, however, due to reimbursement issues. “Approval of parathyroid SPECT/CT opened the door,” he recalls, but even then, installation of a SPECT/CT system was delayed for years. “We were left with just two Symbia™ SPECT-only cameras. We desperately needed a third nuclear medicine camera just to keep up with demand. So, Symbia Pro.specta was a godsend,” he says. The center has now been working with the new system for one year, and it has been providing more capabilities to a much wider variety of patients.

“The Symbia Pro.specta system has been most useful for parathyroid imaging, which we do once or twice a day,” Middleton notes. “We also schedule our larger (BMI >35) cardiac patients on the camera because it improves attenuation correction on the myocardial perfusion scans in these patients who have issues due to soft tissue, large breasts, and fat.” Women with breast cancer who have had axillary breast surgery and cannot raise their arms, causing attenuation, are also being moved to the Symbia Pro.specta system. Additionally, it is being used for octreotide scans where patients do not have access to PET, for MIBG scans, and imaging of 99mTc MAA particles and bremsstrahlung SPECT/CT for post-therapy imaging of 90Y microsphere selective internal radiation therapy (SIRT) of liver cancer. Another advantage of the new camera and software is the improved visualization of lesions compared with planar imaging or SPECT alone, the BSW professionals add. “With Symbia Pro.specta, we have been able to start using the xSPECT Bone reconstruction algorithm, which helps us better localize and characterize bone disease,” Middleton says.

Another noticeable effect after upgrading to SPECT/CT was the intelligent imaging experience that fully integrates SPECT and CT. Middleton noticed how the staff appreciates the automation of the workflow. “It reduces the time going from the control room to the camera room. They can basically run it from the control room.” For lead nuclear medicine technologist Stephen Stoner, a big advantage of Symbia Pro.specta is streamlined design. “We don’t have all the big computers that we used to have. That gives us more space within the control room itself,” he says. “You just have the monitors and the keyboard on top of the table, with no big computer box underneath.”

Michael L. Middleton, MD

Middleton adds, “Any site acquiring one of these SPECT/CT cameras needs to schedule extra training time for the technologists to learn the new SPECT syngo® software platform. But then I think they will be happy with it.” Middleton’s team switched the software they used to read the scans to syngo.via. “It wasn’t a hard transition, and it’s been an improvement, especially on the cardiac reading,” he comments. “Overall, it’s been a positive learning curve.”

The USA medical facilities are looking forward to expanding their services with Symbia Pro.specta. “Our dream would be to get up and running with contrast-enhanced CT, for follow-up prostate or bone scans, and be able to go one-stop shop with that. That is our aim for next year,” Ross says.

The positive experience of the US hospitals with the new Symbia Pro.specta reflects the culmination of Vija’s vision of wider availability and easier use, but also demonstrates the potential for both nuclear medicine departments to expand their patient services even beyond those they envisaged when they first started using the Symbia Pro.specta.

Linda Brookes is a freelance medical writer and editor. She divides her time between London and New York, working for a variety of clients in the healthcare and pharmaceutical fields.