Category: Nuclear Medicine

Headlines from SNMMI 2024

Posted on by Brian Casey

SNMMI 2024 wrapped up this week in Toronto, Canada, with the conference once again demonstrating the utility of nuclear medicine and molecular imaging for applications ranging from neurology to oncology to therapeutics. 

An annual SNMMI highlight is always the Image of the Year designation, and this year’s meeting didn’t disappoint. 

  • The honor went to a set of ultra-high-resolution brain PET images acquired with United Imaging’s NeuroEXPLORER (NX) scanner, a PET/CT system that the company developed with Yale and UC Davis and introduced last year for research use (although a clinical introduction could be forthcoming). 

The NX system sports a cylindrical design with a 52.4cm diameter and long axial field-of-view of 49.5cm; in the talk presented at SNMMI, researchers compared it to high-resolution research tomograph images with tracers targeting different dopamine receptors and transporters.

  • Researchers said the NX system had “exceptional” resolution in cortex and subcortical structures, with “low noise and exquisite resolution,” and predicted NX would “dramatically expand the scope of brain PET studies.”

Other important presentations at SNMMI included papers finding … 

  • An AI algorithm developed at Johns Hopkins detected six different types of cancer and automatically quantified tumor burden on whole-body PET/CT scans
  • In a study of 10.5k patients, AI that analyzed SPECT/CT images was able to predict all-cause mortality with an AUC of 0.77 by using CT attenuation correction scans to calculate risk factors like coronary artery calcium
  • Cognitive training is less effective in older adults who have beta-amyloid deposits in the brain on PET scans
  • An ultra-low-dose PET protocol presented by researchers from Bern University Hospital in Switzerland and Siemens Healthineers used deep learning reconstruction for a 50X reduction in PET radiation dose, to 0.15 mSv
  • A gallium-68 FAPI-based PET radiotracer was more accurate than fluorine-18 FDG for systemic staging of newly diagnosed breast cancer
  • A new chelating agent that binds radiometals to the parts of molecules that target cancer reduced off-target toxicity in PSMA radiopharmaceutical therapy
  • A combination of alpha- and beta-radionuclide therapy that combined actinium-225 with lutetium-177 worked well for colorectal cancer in a preclinical study
  • Research sponsored by Novartis on radioligand therapy for prostate cancer with lutetium-177 PSMA-617 (Pluvicto) was chosen as Abstract of the Year

The Takeaway

This year’s SNMMI presentations highlight the exciting advances taking place in nuclear medicine and molecular imaging, with the rise of theranostics giving the field an entirely new wrinkle that places it even closer to the center of precision medicine. Perhaps a new letter – T – will need to be added to the conference before too long.

Nuclear Medicine’s AI Uptake

Posted on by Brian Casey

Nuclear medicine is one of the more venerable medical imaging technologies. Artificial intelligence is one of the newest. How are the two getting on? That question is explored in new point-counterpoint articles in AJR. 

Nuclear medicine was an early adopter of computerized image processing, for tasks like image analysis, quantification, and segmentation, giving rise to a cottage industry of niche software developers.

  • But this early momentum hasn’t carried over into the AI age: on the FDA’s list of 694 cleared AI medical applications through July 2023, 76% of the listed devices are classified as radiology, while just four address nuclear medicine and PET.

In the AJR articles, the position that AI in nuclear medicine is more hype than reality is taken by Eliot Siegel, MD, and Michael Morris, MD, who note that software has already been developed for most of the image analysis tasks that nuclear medicine physicians need. 

  • At the same time, Siegel and Morris say the development of AI-type algorithms like convolutional neural networks and transformers has been “relatively slow” in nuclear medicine. 

Why the slow uptake? One big reason is the lack of publicly available nuclear medicine databases for algorithm training. 

  • Also, nuclear medicine’s emphasis on function rather than anatomical changes means fewer tasks requiring detection of subtle changes.

On the other side of the coin, Babak Saboury, MD, and Munir Ghesani, MD, take a more optimistic view of AI in nuclear medicine, particularly thanks to the booming growth in theranostics. 

  • New commercial AI applications to guide the therapeutic use of radiopharmaceuticals are being developed, and some have received FDA clearance. 

As for the data shortage, groups like SNMMI are collaborating with agencies and institutions to create registries – such as for theranostics – to help train algorithms. 

  • They note that advances are already underway for AI-enhanced applications such as improving image quality, decreasing radiation dose, reducing imaging time, quantifying disease, and aiding radiation therapy planning. 

The Takeaway
The AJR articles offer a fascinating perspective on an area of medical imaging that’s often overlooked. While nuclear medicine may never have the broad impact of anatomical-based modalities like MRI and CT, growth in exciting areas like theranostics suggest that it will attract AI developers to create solutions for delivering better patient care.

Siemens’ Big SPECT/CT Launch

Posted on by Jake Fishman

Siemens Healthineers kicked off SNMMI 2022 with the launch of its Symbia Pro.specta SPECT/CT, marking one of the biggest SPECT/CT rollouts we’ve seen in years.

The FDA and CE-cleared Symbia Pro.specta succeeds Siemens’ longstanding Symbia Intevo SPECT/CT (first launched in 2013) and is built to encourage nuclear medicine departments to finally replace their SPECT-only cameras and first-generation SPECT/CTs. That’s a big goal given SPECT/CT’s history of slow clinical adoption, and the Symbia Pro.specta will rely on a range of new and improved features to try to make it happen:

  • Integrated SPECT/CT – The Symbia Pro.specta boasts a fully integrated SPECT/CT, including an integrated user interface, while allowing providers to also use the system for SPECT or CT-only imaging.
  • myExam Companion – The Symbia Pro.specta adopts Siemens’ high-priority myExam Companion solution, which combines a new UI and automated guidance tools to make SPECT/CT operation far less manual, user dependent, and inconsistent (before and after image acquisition).
  • Diagnostic-Quality CT – Siemens’ new SPECT/CT is now available with 32 or 64-slice CTs (vs. Symbia Intevo’s 32-slice max) and a 70cm bore, while also offering standard Tin Filter and SAFIRE iterative CT reconstruction for low-dose CT imaging.
  • Advanced SPECT – The Symbia Pro.specta ships with standard automatic patient motion correction during SPECT exams (and optional cardiac exam motion correction), while its advanced quantification and energy level versatility allow it to support treatment response evaluations and theranostics usage.
  • Accessibility & Flexibility – Siemens leaned-in on the Symbia Pro.specta’s accessibility strengths, noting that it is sleek enough to fit into most existing SPECT rooms, and can support a range of clinical uses (cardiology, neurology, oncology, orthopedics) and patient types (pediatric, obese, and physically challenged).

The Takeaway

SPECT/CT’s slow path towards becoming a mainstream modality arguably has more to do with its adoption barriers and providers’ acceptance of the status quo than any doubts about its clinical benefits. Even though not all adoption barriers are hardware-dependent, the Symbia Pro.specta lowers enough of them to give nuclear imaging departments a good reason to consider moving up to a modern SPECT/CT.

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