PET-MR Project Dr. J. Bomanji Head of Department and Clinical Lead - - PowerPoint PPT Presentation

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PET-MR Project Dr. J. Bomanji Head of Department and Clinical Lead - - PowerPoint PPT Presentation

Apr 25, 2023 207 likes •638 views

PET-MR Project Dr. J. Bomanji Head of Department and Clinical Lead Dept of Nuclear Medicine UCLH NHS Foundation Trust 253 Euston Road London NW1 2BU The Institute of Nuclear Medicine Lead Innovation; Contribute sustainable value for

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PET-MR Project

  • Dr. J. Bomanji

Head of Department and Clinical Lead Dept of Nuclear Medicine UCLH NHS Foundation Trust 253 Euston Road London NW1 2BU

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Patients experience is first priority;

Latest technology

PET-MR

Lead Innovation; Contribute sustainable value for patients and society; Network nationally and internationally

Align services and innovation objectives; Adapt service configuration to market needs; Develop staff to full potential; Maintain financial viability; Support highest standards in service outcomes and audit

Quality service Research Education

To remain the UK’s leading Institute for Nuclear Medicine – in Clinical Service, Research and Education

The Institute

  • f Nuclear Medicine
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PET-MR PROJECT Nuclear Medicine

  • Sept 2009: space in Macmillan Cancer Centre

(PET/CT) no PET-MR machine available

  • Feb 2010: PET-MR machine available from Siemens
  • June 2010: MCC space reconfigured
  • July 2010: Trustees offer to buy and pay for PET/MR

machine installation

  • Sept 2010: Visit to Erlangen, Siemens Factory
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PET-MR PROJECT Business Case (Nov-Dec 2010) Tom Wright & Martin Lerner Assumptions

  • Approximately 8 patients/day
  • Price Tariff similar to a PET/CT/MRI (£ 1500/-)
  • Replace machine in 7yrs (Capital gift)
  • Clinical Indications: unclear

Time: 60% Clinical, 40% Research Seed money of ~ £1.2 million required from CBRC (Research)

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PET-MR PROJECT

  • Approximately a £6 million project
  • Dec 2010, Business case submitted for Board

Approval.

  • Dec 2010, Trustees place order
  • Feb 2011, Board of Directors ratify programme
  • Time-lines:
  • Sept 2011, Machine delivery
  • Jan 2012, Building handover
  • April 2012, Clinical patients
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PET-MR PROJECT Management (Nuc Med)

  • FUNDING: Tom Wright
  • DESIGN: Wendy Waddington
  • INSTALLATION: Wendy Waddington
  • COMPLIANCE: Wendy Waddington
  • RECRUITMENT: TW, WW, JB, S.Punwani
  • CLINICAL WORK FLOW: Caroline Townsend/

Medics

  • RESEARCH: Prof A. Groves, Dr. S. Punwani

(Themes: Oncology, Neurology, Cardiology)

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PET-MR PROJECT PARTNERS

  • Radiology
  • Clinicians
  • Medical Physics
  • The Centre for Advanced Biomedical Imaging
  • The Centre for Medical Image Computing
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PET-MR PROJECT

A Big Thank You to UCLH Trustees Sir Robert Naylor (CEO)

  • Dr. Geoff Bellingham (MD)
  • Prof. Mark Emberton

Martin Lerner All members of Management/ IT SKANSKA

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PET-MR Imaging

CLINICAL and RESEARCH THEMES

  • Oncology
  • Neurology
  • Cardiology
  • Infection/Inflammation
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Biograph mMR

The world’s only simultaneous, whole- body molecular MR

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two is now one. Resulting in… – One exam – One room – One whole-body solution

– For shorter exams – Easier scheduling – And faster results

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PET-MR Project Potential applications, now a reality.

Neurodegenerative disease

Clinicians have proposed a vast range of applications where PET- MR will make a difference. Whole-body oncology Pediatric* oncology Bone metastasis

* MR scanning has not been established as safe for imaging fetuses and infants under two years of age. The responsible physician must evaluate the benefit of the MRI examination in comparison to other imaging procedures.

Colorectal cancers Head/Neck cancers Cardiac evaluation Liver metastasis Bone and soft tissue lesions Prostate cancer

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ONCOLOGY

Lung cancer PET/MRI fusion images show vascular invasion.

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Breast

  • Breast imaging at 3T represent the ultimate

potential of MR imaging (4mm lesion size).

  • Imagine the potential of looking at glucose

metabolism (PET), receptor status of tumour (PET) and the tumour oxygenation levels (MRI).

  • PET--MRI: The potential in breast cancer ?
  • Not for primary diagnosis,
  • monitor response to conventional and novel therapies.
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SUPRAGLOTTIC PARAGANGLIOMA

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SUPRAGLOTTIC PARAGANGLIOMA

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VAGINAL paraganglioma

T2 fat suppressed

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Short axis Cardiac MR, Rb-82 and contrast MR (using an IR-FLASH pulse sequence)

CARDIOLOGY

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? ? ? ?

Non-Tumourumor

Tumor

Brain abscess

Demyelinating lesion Protoplasmatic astrocytoma WHO II

  • Dept. of Nuclear Medicine • University of Munich

Demyelinating lesion

Glioblastoma WHO IV

NEUROLOGY

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PET-MR with Gallium-68- DOTATATE For Meningioma

Radiotherapy Planning

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Malignant Meningiomas

  • Combining PET Ga-DOTATATE (SS2)

receptor imaging with MRS in meningiomas to monitor response to therapy

  • Note elevated Alanine at 1.48ppm is a

signature of meningiomas

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MR Spectroscopy

  • Proton MRS can be performed in 10-15

min & can be added to conventional MR protocols.

  • PET--MRS indications:
  • Epilepsy
  • Tumours (serial monitoring of response to

relevant therapies)

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PET--MRS EPILEPSY

  • Blood oxygenation level dependent

(BOLD) Dynamic MR imaging technique that acquires images of the brain during stimulus and also rest.

  • Complemented by reduced metabolic

(FDG) activity in epilepticogenic focus.

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EPILEPSY

LESSON: The area of hypometabolism is far greater than the area

  • f seizure onset, possibly reflection propagation of seizure activity

as well as the functional deficit area. Aim of surgery:

  • To resect focus without causing functional deficits.

To do

  • Strategies that tailor resection extent to regional

hypometabolism may warrant further evaluation

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PET Tracers F-18-fluorodeoxyglucose (FDG) Amyloid tracers

  • florbetapir, (previously known as AV-45)
  • flutemetamol ,
  • florbetaben (previously known as AV-1)
  • Alzheimers Disease
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73 year old female; MMSE 28. 73 year old female; MMSE 28. Subject and spouse concerned but memory tests normal. Subject and spouse concerned but memory tests normal. 18 months later 18 months later – – amnestic amnestic MCI MCI

AD AD Asymptomatic Asymptomatic

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[18F]-AV1/ZK

Alzheimer’s Disease

80 year old male MMSE 26

Healthy Elderly Control

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Von Hippel Lindau Syndrome

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Orthopedic applications

  • The new 3T scanner can pick up minute
  • rthopaedic detail and subtle signs of injury.
  • Combine this strength with a F-18 PET which

reflects an increase in osteoblastic activity secondary to bone injury, bruising and repeated biomechanical stress.

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MALIGNANT PIGMENTED VILLONODULAR SYNOVITIS

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PET-MR Project

Questions: What is the big deal about PET-MR

Radical new hybrid technology First in UK Apart from Germany 1st in Europe (worldwide 7machines) UK Clinical and Diagnostic service on map UK Translational Research on map

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PET-MR Project

Does it improve outcome and quality?

  • To early to give an answer

Does it improves safety?

  • Yes! Reduced radiation dose

Does it improves patience experience?

  • Yes! reduce patient journey, one stop shop
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PET-MR Project

Does it improves cost efficiency?

  • To early to answer.
  • A decade ago we were in the same place with PET/CT

which is now established

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THANK YOU