Software’s toolbox increases access  to care and operational agility

Software’s toolbox increases access 
to care and operational agility

By Reinaldo Lopes


In many countries, the best clinical expertise is often concentrated in and around capitals. Dr. Horacio Amaral, from Santiago, Chile’s capital city, not only has the latest molecular imaging equipment but highly educated users as well. Across this large country, it is important for clinicians to share their expertise, reach more patients, and enable easier access to care in remote parts of Chile. 
How can they achieve that?

The Covid-19 pandemic was challenging for doctors everywhere, and the scenario was no different for Dr. Amaral’s team at PositronMed, a leading medical imaging and theranostics center in Santiago, Chile. After relying heavily on
syngo.via software for PET/CT and SPECT/CT imaging during the pandemic, the software continues to benefit the medical center’s patients and nuclear medicine staff.

In Chile, Horacio Amaral, MD, PositronMed’s medical director, and his team are utilizing syngo.via molecular imaging software and consider it one of the most important platforms for their work with PET/CT and SPECT/CT imaging. The Covid-19 pandemic compounded travel issues for both geographically dispersed patients to tend to their healthcare and for medical teams to treat patients. It became quite apparent that syngo.via was able to help address many pandemic-related challenges.

PositronMed and its sister company, PositronPharma (with its own dedicated cyclotron, where PositronMed’s radiopharmaceuticals are produced), were among the first South American institutions to have their own PET/CT and SPECT/CT systems, says Amaral. Their medical team currently has eight nuclear medicine physicians, four radiologists, and a dozen nuclear medicine technologists. PositronMed sees about 30 patients per day. Amaral estimates about 90% of their patients are oncological. They also see patients with neurological conditions like Alzheimer’s or Parkinson’s disease. 

“It was difficult to have the staff together in the workplace,” recalls Amaral, reflecting on the effects of the pandemic. The extra precautions that the center initially adopted presented staffing challenges, however Amaral and his colleagues were able to keep their high standards of diagnostics while working at home using the molecular imaging software. All team members managed to be “on the same page” remotely just by using a standard VPN connection. “It was a very important solution, a huge aid. It would have been very difficult to keep working as we did without it.” 

The flexibility of working remotely that was first implemented during the pandemic continues to be an integral part of PositronMed’s organizational culture. “My home, for example, is 600 km away from Santiago—I live in Concepción, in southern Chile,” explains René Fernández, MD, a nuclear medicine physician at PositronMed. “I’m in Santiago only three days each week, but I can always take a good look at exams using syngo.via. You can move with the software whenever you need.”

Horacio Amaral, MD 

Because of the software’s ability to ease operations, the center is now able to tend to patients from both the private health system as well as referrals from the Chilean public health system. This efficiency allows private companies to work through the process of licitaciones—that is, competitive contractors that offer the best cost-benefit conditions in order to be approved by the Ministry of Health.

The ease with which syngo.via can be applied to remote collaborations is helping PositronMed’s medical staff to train newly fledged Chilean doctors in the use of imaging and to make it available for patients all over the country, including those in the care of the public health system.

While the majority of patients at PositronMed are oncology patients, the center is expanding into the neurology clinical pathway. “When we are dealing with neurological data, syngo.via has very unique tools to offer,” Fernández explains. “There is, for example, the ability to clearly quantify what you are seeing in your patient by comparing it with a reference database, taking into account the standard deviation from a normal subject. That, in neurology, really increases the value of your report.”

Among the software’s features with a significant impact on precision and improved workflow, Fernández mentions the possibility of customizing the display of scans and the ease of comparison between different exams. “It’s very easy to do. For example, suppose your patient has a lung lesion. After a new scan, the software is able to show the exact same location of the lesion from the scan that you did three months before that.” Amaral adds that particularly for neurological patients, syngo.via is also able to seamlessly integrate MRI data and PET/CT and SPECT/CT scans.

According to Fernández, syngo.via has been “such an important tool for our work with PET/CT, and it’s extremely intuitive to use,” he says. “A new colleague of ours, a physician who joined us about a month ago, learned how to use the main tools in syngo.via in just two days.” Fernandez adds that the IT infrastructure needed to incorporate it was also relatively straightforward to arrange and easy to integrate.

PositronMed’s team is also excited about a relatively new tool in syngo.via that allows users to evaluate metabolic tumor volume. “We’ve only been using it for the last three weeks or so, and it takes some time to finesse it—we are still in training at the moment, although it’s easy to use, as intuitive as the other tools. But it’s something very useful to evaluate response after therapy, taking into account the volume of each lesion before and after each treatment session,” says Fernández.

“An interesting aspect is that it allows you to exclude the healthy tissues when you are calculating the total volume of the tumor,” explains Ana Hurtado, a nuclear medicine technologist and medical physicist at PositronMed. “There’s no denying it’s a new kind of information about what’s happening inside the different lesions,” adds Fernández. “Of course, the report based on that data is always a combination of the medical interpretation of what is there, something more qualitative, and of the more quantitative aspects. Both contribute to an improved report. We’re still working on it, but we think it will be a very useful tool—not only for routine clinical applications but also for clinical studies.”

Today Amaral and his colleagues provide a platform for training Chilean physicians and nuclear medicine technologists from universities, hospitals, and private practices in the use of the imaging software for multi-modality reading. “Two universities in Chile offer training for nuclear medicine physicians, and many of them come to our center to complete this training,” Amaral states. Syngo.via is part of the reason that the center can foster research collaborations with Chilean institutions and with universities and companies in Europe and the United States.

Reinaldo Jose´ Lopes is a science and health writer at Folha de S. Paulo, Brazil’s leading daily newspaper, and is the author of several books. Lopes is also the author of another Nuclear Medicine News & Stories/Imaging Life article: