A dedicated team of passionate technology professionals describe their vision for the next generation of PET/CT.
Photos: Steve Belkowitz
Yanic Bercier captures Biograph Vision´s performance measurements.
William Curtis Howe, MD, remembers when he was an intern at the Albert B. Chandler Medical Center in Lexington, Kentucky, USA, and he met a cancer patient who also happened to be a radiologist. “He performed his own CT scan and diagnosed himself,” says Howe, product manager for Biograph Vision™: the next generation PET/CT scanner from Siemens Healthineers. “He did this so matter of factly. I can’t imagine how difficult it must have been for him. His commitment to finding answers despite the personal challenges really moved me. I followed him for the rest of his clinical course until he passed away. I have always thought that if I can live up to his example of how to deal with something so potentially devastating as the diagnosis of cancer and still maintain enough presence of mind to be rational and fight 100 percent of the way, then I can do something that really matters. I will remember this guy for the rest of my life. What he did. What he taught me."
At Siemens Healthineers, Howe is part of a team that, in many ways, lives up to the example of this patient. They are a diverse team of passionate technology professionals who work to bring Biograph Vision from concept to reality. “What we are working to achieve has been challenging, professionally and personally, but everyone just knows this is something we need to do. It’s an incredible time,” shares Howe. Featuring a completely redesigned detector, Optiso UDR, Biograph Vision aims to bring a new world of precision to PET/CT. Optiso UDR‘s silicon photomultiplier (SiPM) design achieves 100 percent coverage1 of the crystal area, thereby allowing the system to capture almost all of the light from the scintillation. Such a design enables a time-of-flight performance at 249 ps1, which helps improve image quality and aides in the reduction of scan times and injected dose when compared to existing products. Employing significantly more and smaller crystals, the system generates a high spatial resolution that enables physicians to see small lesions and provides information to help make more informed treatment determinations. Biograph Vision also features a large 78 cm bore that enhances patient comfort and supports the study of a broad patient population.
“With time-of-flight, patients can have a shorter time on the table, which we hope means more comfort and a better experience.”
“From the patient’s perspective, you don’t want to spend a lot of time on the scanner. You want the experience to be easy, and you don’t want to be injected with a lot of radiotracer,” says Howe. “This scanner addresses these points…it’s designed to be a more sensitive scanner.”1 Biograph Vision aims to hit that proverbial “sweet spot” between spatial resolution, scan speed, and injected dose. Reaching such a remarkable combination is now a possibility thanks to the time-of-flight performance. “This new technology gives us the potential to better differentiate areas of concern,” states project manager Greg Gray, MEM, PMP. “And, with time-of-flight, patients can have a shorter time on the table, which we hope means more comfort and a better experience.” "From a patient perspective, having answers is what you really want,” stresses Michael E. Casey, PhD, principal expert in research and clinical collaborations. He speaks from personal experience, having undergone a PET/CT scan to determine if the cancer he had in his prostate had spread. “I know the feeling. It’s being scared because of the uncertainty, and thinking you have recurring cancer. There is relief in seeing the scan and knowing the result. For me, fortunately, there was nothing there,” Casey reveals.
Casey saw PET/CT technology move from what he called a “laboratory curiosity” to a value-added tool in clinics. “It’s a complex tool from the point that it requires a scanner capable of making precise measurements and the chemistry to produce the radiotracers that are used. With Biograph Vision, we are working hard to make PET/CT an even more valuable tool.” The approach to Biograph Vision came about by careful examination of existing technology, identifying a path to improvements, and utilizing input from physicians, clinical administrators, academic institutions, non-academic institutions, and patients. “The idea that you can turn a gamma ray into a flash of light, and then into an electronic pulse inside where it comes from and make an image is pretty fascinating,” says Michael Loope, a senior electrical engineer at Siemens Healthineers’ Rockford, Tennessee, USA, Detector Center. “Now there‘s an opportunity to push PET‘s capabilities even further.“
Jamie Spence and Nate Thurm review the image quality achieved with Biograph Vision.
But Biograph Vision is not technology for the sake of technology. Everyone who works on the project knows there is a time and place for leading-edge technological advances. For example, increasing the number of crystals in the scanner seems like a logical step, so why has this not yet happened? According to Gray: “We felt the raw technology available to date was a little too immature, and it’d be premature to try to build a product around it. But our Detector Center continued to research, kept their finger on the pulse of the technology, really understood its capabilities, and developed a center of excellence, a real deep technical knowledge. Once they knew that the technology itself was ready, they told us matter-of-factly‚ ‛Now is the time.‘ We said‚ OK, then let‘s do it,“ he smiles.
To be sure, members of the Biograph Vision team are passionate about technology. But they approach technology with an eye towards continuous improvement. “I came into the project trying to understand how far we could push the performance of the components and how that performance fit in to the overall system,” says Ziad Burbar, MS, principal systems engineer on the project. “A while back we realized what this new technology is potentially capable of.” Burbar describes how the team of Siemens Healthineers examined over 2,500 system permutations to reach the ultimate configuration of Biograph Vision. “We took all these permutations, educated the stakeholders about them, identified what was needed to condense it down to the system we have currently.”
John Keller and Ziad Burbar survey Biograph Vision´s next-generation technology.
It almost goes without saying that narrowing the permutations down from 2,500 was a tremendous undertaking, but Burbar draws inspiration for this task from his family. He talks of his young son, who often walks around his home wearing a self-made badge identifying himself as a PhD. “I asked him why he wears that. He said, ‘I want to be like you, Dad.’ That’s all the inspiration I need.” Having a hero is all good, but Burbar himself doesn’t look for heroes. “I believe in a team.” He describes himself as an enabler. “I look at our team and look to exploit their strengths. [Every day] I can’t wait to get to work. This is a once-in-a-lifetime opportunity to be here and work on a next-generation system that’s poised to offer outstanding performance in many aspects. A clear stand-out from earlier systems.”1 Burbar has no direct reports, but speaks with deep appreciation about how the team follows the plan set forward for the new product. “People just truly believe in what we are doing. I cannot even begin to tell you how much of themselves has gone into Biograph Vision."
When he first saw the images Biograph Vision produces, Burbar admits to being a bit scared, and laughs, “I knew the work we still had to do. I was worried that people were going to say, ‘Look! We have beautiful images. We’re almost done!’ But our work was not done. This was just a great sign that the high bar we set for ourselves was potentially possible.” “You always want to do better than yesterday,” admits Melika Roknsharifi, PhD, a senior scientist on the Siemens Healthineers team. “That’s where we set the bar. Today we want to be slightly better than yesterday. And we do whatever we can. I don’t mind scratching what I have done so far in favor of something better.” She says it isn’t simply throwing away what you did yesterday, but rather building on what you develop, saving what works, and seeing how it can evolve into an even better product. For example, one of the initial Biograph Vision prototypes she worked on produced images that were stunning. “But that was just the first prototype,” she says. “And, we felt the final version could be even better. That is what we are striving for.
Members of the Biograph Vision team meet to discuss the future of PET/ CT.
“With higher resolution, you have to process a lot more data. That means more processors in the system. We developed chips that sit at the front end of the system that stream out one signal containing all the data,” says Roknsharifi. “It’s why I wanted to be an electrical engineer.” Gray emphasizes that managing a team of highly educated, highly motivated individuals is both a challenge and a reward of his job. “It’s really humbling for me to realize the brilliance of the people that I work with. The key is getting everyone to really listen to the other person. Understand the merits of an alternate idea. We have to [sometimes] put our egos aside when brainstorming because there are a lot of really good ideas coming from the team.” As professionally and technically diverse as the team is, everyone shares a desire to make a difference. Back when he was in college, Gray broke a leg while skiing. He vividly remembers the professionalism and expertise of the emergency response team that retrieved him from the ski slope. “Those guys worked together to get me off the hill and take care of me…somehow I want to do something similar to really help people.”
“When I look back at the end of my life, I don’t want to say that I developed a better internet chat line,” says Robert Mintzer, a staff scientist at Siemens Healthineers’ Detector Center. “My goal is to design technology that helps medicine progress.” When he was in college at the University of Southern California, Sanghee Cho, PhD, a staff scientist at the Detector Center, remembers how discouraged his professor was upon seeing droves of students flock to the computer gaming lab. “He’d tell us ‘Those guys [in the computer gaming lab] are doing work for fun, but you guys … you guys are doing work for human beings. You need to be proud of what you are doing.’ I still remember that to this day.” When he was in college, Loope recalls his fascination with photo sensors and optics. “In looking for a job [after college] I saw there were a lot of opportunities in missile systems. But I wanted to be a part of a medical team. It felt right then, and it feels right now.”
There was a moment when Howe felt Biograph Vision could be a knock-it-out-of-the-park success, and it didn’t happen in a test, nor did it happen when the product was previewed at a trade show. “We were conducting an IRB [Investigational Research Board] for Biograph Vision, and one woman, a breast cancer patient, came for a test and she just charmed everybody. When she was going back to the scanner she mentioned she felt cold. One of our team members, Jamie Spence, offered her a blanket—which was heated with a new blanket warmer—to wrap herself in before the scan. And I thought at that time that I had never been prouder to work for this company. Everyone appreciated the trouble she was going through to help us. That’s when I knew this is going to work. The team we have in place really cares about patients and creating a new PET/CT scanner that is unlike any other.”