June is traditionally the busiest month for weddings, so why not a (metaphorical) marriage of modalities?
To that end, the Society of Nuclear Medicine requests the honor of your presence at next month's wedding of anatomical and functional imaging. You can witness the blessed event at the society's annual meeting in St. Louis, June 4-7, where researchers vow to discuss the latest developments in image fusion.
"Different companies have SPECT cameras with a CT front end," said Dr. Robert Carretta, SNM president and director of nuclear medicine at Sutter Roseville Medical Center in Roseville, CA. "You can do anatomic imaging as well as metabolic imaging ... then fuse the images together so that you can exactly locate abnormal areas."
Used after treatment for cancer, the hybrid modality is unique in its ability to distinguish recurrent tumors from the normal healing process or from changes secondary to surgery, he added.
But image fusion is just the frosting on the cake, so to speak, of this year's conference. Researchers will also serve up the latest nuclear medicine techniques for diagnosing and treating prostate, lung, breast, and colorectal cancer.
In pulmonary imaging, one session looks at V/Q and helical CT in the diagnosis of pulmonary embolism, while another covers lung nodules, and another, lung injuries.
"The sessions on cancer imaging will be very informative, and very leading-edge," Carretta said. "There are certain advantages to looking at metabolic and functional imaging over anatomic imaging, although both modalities are used in a complementary role. With the advent of peptides and monoclonal antibodies and FDG, the fluorine-labeled glucose, we're able to look at cancer patients in a totally different light than we could three or four years ago."
Clinical oncology sessions will survey developments in gastrointestinal and breast cancer imaging. Others will review clinical and technological advances in FDG PET and SPECT imaging, such as coincidence imaging with SPECT, and whole-body FDG PET in cancer patients. The FDG sessions should be well attended as a result of HCFA's recent approval of the agent for reimbursement under Medicare, Carretta said.
"FDG is approved for four specific clinical applications at this time: lung cancer, lymphoma, colorectal cancer with a rising serum tumor marker (CSA test), and metastatic melanoma," Carretta said.
Cardiology is another area where nuclear medicine is gaining ground. The conference will host sessions on, for example, new clinical techniques and applications in cardiology, PET imaging of myocardial metabolism, gated SPECT imaging, and assessing ventricular function and detecting coronary artery disease.
Neuroscientific sessions will build on the modality's recent successes in cerebral imaging, such as the SPECT-based study of patients with attention-deficit hyperactivity disorder that gained wide attention last December (The Lancet, Vol. 354, Number 9196). Nuclear medicine's role in assessing alcohol-related depression, drug abuse, schizophrenia will also be covered, and doctors will present the latest findings in Alzheimer's disease imaging.
As for personal picks, Carretta said that whenever he's not tied up in meetings, luncheons, or a plateful of other duties he must attend to as outgoing president, he'll head for the categorical courses first.
"I think the categorical courses in the first two days of the meeting are the bread and butter for community physicians," he said. "They're the ones that talk about what's available now, what's new in technology, and what's leading-edge -- and it's things you can do in most community hospitals. So I'm looking at the oncology sessions and the cardiology sessions particularly to keep current on what's happening in those areas."
The society has also picked the conference pulpit to unveil what it calls "the next generation of quality assurance phantoms," according to an SNM spokeswoman. "We're really excited about that. Phantoms have been around for awhile, but this represents a real push into the quality assurance area," she said.
More information about the conference is available at the SNM's Web site. Should you be unable to attend, rest assured that AuntMinnie.com will be there to cover the highlights.
Carretta said one of the most interesting parts of his job is educating doctors, particularly referring physicians, about nuclear medicine techniques and when to use them. In prostate cancer, for example, it's known that a monoclonal antibody with a radioactive tracer is far more sensitive for detecting nodes than abdominal CT, he said. Nevertheless, getting doctors to use nuclear medicine "takes education, it takes a changing of habits, it takes a willingness of physicians to look at new diagnostic modalities and algorithms. And that's part of the mission of the society."
He also acknowledged the modality's limitations, urging a broad, outcome-based approach to diagnosis and treatment.
"Not everything that metabolizes glucose is necessarily cancer," he said. "You may see (uptake) in inflammation or infection, so you have to marry it with clinical information and the other modalities, be they ultrasound, CT or MRI.... I think a multidisciplinary approach to cancer is something we need to strive for. We need to work with the radiation therapists, the urologists and the surgeons to come up with the most effective way of diagnosing disease."
By Eric Barnes
AuntMinnie.com staff writer
May 25, 2000
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