CPC-050 PET/MRI (Part 3) Attenuation and Future Protocols

August 9th, 2013

In this third episode on PET/MRI, we’ll focus on the overall goals for using MRI instead of CT with PET, namely less radiation and more accuracy. These properties have particular benefits in pediatrics and neurology that I’ll discuss. We’ll review the active area of protocol development with PET/MRI, including the issues in attenuation correction. Finally, we’ll look at emerging tracers that could add to some of the excitement over PET/MRI.

CPC-049 PET/MRI (Part 2) TNM Staging and Acquisition

July 26th, 2013

While PET/MRI continues to be a very hot topic in the literature, we’re still not quite sure how to use it. So, to continue the discussion about PET/MRI, we’ll use the transition from PET to PET/CT as a model. We’ll look at the potential benefits PET/MRI may bring to TNM staging and discuss what may be possible for therapy assessment. I’ll also get into some design strategies for combining PET and MRI hardware so that they can be used in one session.

CPC-048 PET/MRI (Part 1) The Promise of Less Dose

July 12th, 2013

In this episode, we’ll dive into the exciting new technology of PET/MRIs. We can learn a lot from our history, and I’ll discuss what image fusion and PET/CT hardware have provided us over the years. But while PET/CT has certainly helped our accuracy in staging, I’ll use a pediatric example to point out how PET/CT can also lead to more dose. Because of the possibility of lower dose and other potential gains, I’ll discuss the reasons PET/MRI scanners hold such promise.

CPC-047 Techniques for Consistent Evaluation

June 28th, 2013

In this episode, I’ll continue to discuss the evaluation of response to therapy using PET. A number of factors affect when to assess therapy response and how to interpret the results, and there are differences between radiation therapy and chemotherapy. Within radiation therapy, it is very important to consider the particular disease, so I’ll discuss specifics for ovarian, cervical, lung, colorectal, and liver cancer. Most of this discussion uses data on the popular FDG tracer, but I will also mention some of what we have to look forward to with newer isotopes.

CPC-046 Therapy Assessment

June 14th, 2013

In this episode we will be looking at PET/CT and the evaluation of different therapeutic interventions. More and more, the interest in PET/CT is not only in the initial evaluation of disease, but also in the subsequent evaluation of therapy response. We will look at the literature to discuss the different recommended standards for defining the disease’s response as complete, partial, stable, or progressive.

CPC-045 Reporting – Combating Ambiguity

May 3rd, 2013

A journal article I read recently had several amusing examples of  “unremarkable” words. This illustrates how easy it is for reports to  contain phrases that only the writer can clearly understand. While some  issues are caused by dictation technology and the tendency of us humans  to occasionally “zone out,” we can still improve the quality of our  reports by following templates and a list of required elements. In this episode, I’ll illustrate this process using a typical report from our site.

CPC-044 Reporting – Language Clarity

April 19th, 2013

In this episode, I’ll discuss the issues of unclear language in written reports. With the growing use of EMR and demands for quick turnaround time, we’re spending less face time with our colleagues. This episode I’ll particularly focus on some studies concerning terminology, and how synonyms can make it difficult to determine to what degree an abnormality is present.

CPC-043 Prostate Cancer

April 7th, 2013

In this episode I’ll discuss prostate cancer and PET. Prostate imaging with PET remains unapproved for reimbursement by CMS, and we’ll examine several reasons why this is the case. One of the major limitations has to do with the tracers available, and along those lines I’ll talk about radiopharmaceuticals currently under investigation.

CPC-042 Head & Neck Malignancies

March 11th, 2013

I’ll continue the discussion of head and neck malignancies and reporting. Every PET/CT report needs to discuss the Tumor (T), the presence of regional lymph nodes, and the presence of metastases. A well-written and organized report will make your clinical and surgery colleagues quite happy with the results.

CPC-041 Head & Neck and PET/CT

February 24th, 2012

Today I’ll continue our discussion of head and neck cancer and PET/CT by going through a number of studies important to both. Several of these studies provide illuminating data by comparing PET/CT to either PET or CT data alone, including data from high-contrast CT. We’ll see how PET/CT can increase the confidence of the radiologist and even find disease in head and neck patients otherwise considered cured.

 

CPC-040 Head & Neck Cancer

January 27th, 2012

In this episode, I’m going to discuss head and neck cancer, including normal variations, clinical indications, and my favorite topic, radiation therapy planning with PET. Head and neck cancer is not as common as other cancers, but the high morbidity and mortality rates make it an important topic. I’ll also discuss the patient preparation and overall procedure used at our site with head and neck cases.

CPC-039 Lung Cancer, Radiation Therapy & PET

January 13th, 2012

As we continue our discussion of lung cancer, I want to cover how radiation therapy and PET are becoming linked. I’ll discuss the three key volumes used for any plan, the most important of which is the Gross Tumor Volume (GTV) that the therapist delineates using imaging. In lung cancer, PET can have a particular influence on the size of the GTV, either by increasing or decreasing this volume. For example, PET can detect regional lymph nodes in non-small cell lung cancer patients.

CPC-038 Lung Cancer Staging

December 9th, 2011

Today I’m going to continue my discussion of PET and lung cancer by going through a number of interesting studies. I’ve spoken before about the pitfalls of SUV, but there is research that shows that the SUV combined with Hounsfield units can be very helpful when studying adrenal lesions. Due to a lack of standardized criteria, it is difficult to completely quantify PET’s ability to help categorize patient response, yet the data shows that PET is very useful in therapy response and predicting patient survival.

 

CPC-037 Lung Cancer and SUV Pitfalls

December 3rd, 2011

Today I’ll continue my discussion of PET and lung cancer. The SUV can be a valuable tool to use as a baseline and for follow-up, but essentially an SUV measurement on its own isn’t really better than visual analysis. I’ll discuss the various pitfalls of SUV, as well as tips for examining both solitary pulmonary nodules and the mediastinum.

CPC-036 Lung Cancer and PET

November 11th, 2011

In this episode, I will discuss the history of approved reimbursements from CMS, from the 1998 approval for solitary pulmonary nodules to more recent changes in terminology that affect our billing.  Lung cancer has a high mortality rate in both men and women, and the current statistics on the subject are striking.  I will also go into detail about how our site uses PET with lung cancer cases.

CPC-035 Pediatric PET, Disease States

October 28th, 2011

In this follow-up to Pediatric PET, I’ll move to discussing specific applications and disease states. In pediatrics, it is particularly important to minimize dose, since the patient will hopefully have many more years to live. I’ll talk about how standalone PET, and the new developments in PET/MR, can potentially help reduce the frequency of using diagnostic CT.

CPC-034 Pediatric PET, Patient Considerations

October 14th, 2011

Today I want to talk about pediatric PET, and the issues we encounter before any images even get to the radiologist.  It may sound simplistic, but children are not little adults, and often patient sedation is required.  Because of this, it’s best to coordinate exams close to each other in time, and in the same room if possible.  Overall, we want to minimize sedation time, dose, delays between scans, and patient discomfort.  And of course, don’t forget about the parents!

CPC-033 Fusion, SPECT/CT and the Future

October 7th, 2011

In this third look at fusing anatomic and physiological data, I want to examine why SPECT/CT has not enjoyed the popularity of PET/CT.  SPECT/CT can offer many of the same benefits as PET/CT, such as improved image quality, and it has some interesting brachytherapy applications,  Later in this podcast, I will also examine the future of PET/MR.

CPC-032 Fusion, the PET/CT Advancement

August 15th, 2011

In this episode, I continue my discussion of the advancements made by hardware fusion. The adoption of the combined PET/CT instrument gave us dramatic decreases in imaging time, reduced dose, and most importantly, gains in image quality. Even with these advancements, software fusion remains important for the future, since it allows comparison of images from different time points.

CPC-031 Fusion, Essential to Patient Care

July 1st, 2011

We’ve already benefited a great deal from fusion thanks to the clinical context it provides for surgery and radiation therapy.  In this episode, I’m going to discuss both software and hardware fusion and the advancements made by these techniques.  Software techniques have improved with deformable registration, and the combined instrument in hardware is really very useful for improving image quality.

CPC-030 Technologists

June 16th, 2011

A good technologist can really be an important asset in a PET/CT department like ours.  A great technologist should first and foremost reduce patient anxiety, but in this episode I’ll also talk about how a careful and educated technologist is needed to get both complete and accurate images.

CPC-029 The Radiologist in Radiotherapy Planning

May 26th, 2011

During radiotherapy treatment planning, communication between imaging experts and radiation therapists proves to be essential.  We as radiologists can help with the displayed image contrast and the different algorithms for segmentation.  The radiation therapy experts can tell us about when and how to measure the success of radiation therapy.  It turns out that therapeutic response can be measured a number of ways.

CPC-028 Collaboration in Radiotherapy Planning

May 13th, 2011

A recent talk I presented had me further examining how clinicians, radiologists, and radiation therapists interact during the treatment planning process.  I’ll illustrate with a prostate treatment example and later touch on the importance of image quality as it relates to SPECT and PET.  A healthy collaboration is essential to maximizing treatment dose, sparing normal tissues, and increasing the chances of a positive outcome.

CPC-027 SNM 2010 – Radiopharmaceuticals

October 8th, 2010

Dr. Faulhaber continues his thoughts on SNM 2010 with a review of radiopharmaceuticals. He then discusses trends in scanning instruments towards minimum dose, maximum speed, and increased image quality. Dr. Faulhaber also explores the improvements in imaging software and the exciting trend of server-based imaging using cloud technology.

CPC-026 SNM 2010 – Cyclotrons

September 17th, 2010

Dr. Faulhaber reflects on his trip to SNM 2010 with some thoughts on the history and improvements in cyclotrons, noting that the current trend will help spread PET technology into smaller hospitals, especially in third world nations.

Society of Nuclear Medicine 2010

May 22nd, 2010

The annual SNM meeting on June 5th in Salt Lake City is fast approaching.  My preparations for the meeting will keep me busy for the next few weeks, but I will return to podcasting later in June.

Look for my SNM 2010 Review podcast to hear my reflections on the important news from this year’s event.

Thanks for listening.

-Peter

CPC-025 Brain Imaging, Seizures

May 14th, 2010

Dr. Faulhaber concludes his three-part series on non-oncologic brain imaging by discussing refractory seizures. He covers the techniques for evaluating intractable epilepsy, including the role of PET in brain surgery guidance. Dr. Faulhaber also discusses why interictal PET combined with ictal and interictal SPECT will have a better chance of finding an epileptogenic focus. He then discusses the importance of co-registering these scans with software and using subtraction techniques.

CPC-024 Brain Imaging, Dementia

May 7th, 2010

Dr. Faulhaber continues his three-part series on non-oncologic brain imaging by covering a wide range of dementia. He examines the challenge of diagnosing from a broad spectrum of symptomatic criteria and looks at the dangers of treating one type of dementia as if it were another. Dr. Faulhaber concludes by examining the promising new agents being used for dementia PET imaging, which offer hope for more accurate diagnoses.

CPC-023 Brain Imaging, Alzheimer’s

April 30th, 2010

Dr. Faulhaber begins a three-part series on non-oncologic brain imaging. He summarizes the CMS approval process, which has led to the evaluation of Alzheimer’s Dementia (AD) with PET. He also examines how imaging can help aid in the early diagnosis and in distinguishing between AD and mild cognitive impairment. Early detection and treatment to delay the onset of AD could potentially have a significant impact on the cost of care, which is currently estimated at 150 billion dollars.

CPC-022 PET for Clinical Staff, Radiation Therapy

April 23rd, 2010

Dr. Faulhaber concludes his four-part series for clinical staff by looking at the challenges of radiation therapy. He emphasizes the extreme importance of clear communication among the various clinical teams in understanding the plan and possible treatment protocols. For example, using a flat versus a curved table can have a significant impact on the success of the radiation therapy. Dr. Faulhaber also examines the various methods of drawing PET tumor volumes, including constant threshold edge detection and the more accurate gradient edge detection.

CPC-021 PET for Clinical Staff, Physiologic Parameters

April 16th, 2010

Dr. Faulhaber continues his four-part series for the nurses, technologists, and physicians directly taking care of the patient. He describes the patient’s physiologic parameters that affect what lesions and tumors can and cannot be seen. He also discusses the value of respiratory gating to overcome blurring and the difficulties of minimizing errors when evaluating SUVs.

CPC-020 PET for Clinical Staff, Hardware & Exposure

April 9th, 2010

Dr. Faulhaber continues his four-part series for the nurses, technologists, and physicians directly taking care of the patient. He describes many of the terms, mechanical functions, and time requirements involved in using a PET/CT scanner. Dr. Faulhaber also covers the potential exposure of patients and clinical staff to radiological dose.

CPC-019 PET for Clinical Staff, Positron Emitters

April 2nd, 2010

Dr. Faulhaber begins a four-part series for the entire clinical staff–the nurses, technologists, and physicians directly taking care of the patient. Having some PET background is important, because the patient today is likely to be more sophisticated and educated about treatment and terminology. Dr. Faulhaber begins with an explanation of PET scanners and positron emitters.

CPC-018 Breast Cancer, Metastases

March 26th, 2010

Dr. Faulhaber concludes his two part series on breast cancer. He continues beyond using PET to see the primary, to evaluating axillary lymph node metastases and prognosis.

CPC-017 Breast Cancer, Changes in Therapy

March 19th, 2010

Dr. Faulhaber begins a two part series on PET/CT and breast cancer. PET can have a significant impact on the changes in therapy in conjunction with the availability of multiple chemo therapy regiments.

CPC-016 Uterine Malignancies

March 12th, 2010

Dr. Faulhaber concludes his three-part session on gynecologic oncology by examining various uterine malignancies and the disturbing fact that the incidence of cancer is increasing but is tempered by a high cure rate.

CPC-015 Cervical Cancer

March 5th, 2010

Dr. Faulhaber continues his three-part session on PET/CT and gynecologic oncology, specifically cervical cancer. The keys to cure include prevention with a vaccine, early detection, and accurate staging.

CPC-014 CMS and Gynecologic Oncology

February 26th, 2010

Dr. Faulhaber begins his three part series on PET/CT and gynecologic oncology by examining Medicare and Medicare Services and their recent decisions impacting gynecologic malignancies.

CPC-013 Respiratory Gating Impact

February 19th, 2010

Dr. Faulhaber continues his two-part session by examining the impact of respiratory gating on localization, quantification, correlation, and therapy planning.

CPC-012 Respiratory Gating Techniques

February 12th, 2010

Dr. Faulhaber begins a two-part session by exploring, “Why bother doing respiratory gating?” and the refinements in PET in “stopping” the motion and seeing the lesion better.  He also discusses FDG and how imaging techniques have changed with improvements in hardware, software, and fusion.

CPC-011 Reporting

February 5th, 2010

Dr. Faulhaber explores what information (such as malignancy, grade, or previous treatment/surgery) should be specified when a clinician orders a PET, and what information (such as dose, glucose level, and type of scan) should be returned in the final PET report.

CPC-010 Imaging of Gastrointestinal Malignancies Pt3

January 29th, 2010

Dr. Faulhaber concludes his three part series on clinical indications by looking at diseases specific to the liver and gastrointestinal stromo tumors.

CPC-009 Imaging of Gastrointestinal Malignancies Pt2

January 22nd, 2010

Dr. Faulhaber continues his three-part series on clinical indications by looking at PET imaging of the abdomen and comparing treatment planning pre- and post-PET.

CPC-008 Imaging of Gastrointestinal Malignancies Pt1

January 15th, 2010

Dr. Faulhaber begins his three part series on clinical indications by looking at diseases of the abdomen and pelvis, specifically colorectal cancer.

CPC-007 From Prognosis to Treatment Planning

January 8th, 2010

Dr. Faulhaber looks at the many advantages that image fusion, or PET/CT, has brought to PET, such as increased accuracy in the pinpointing of tumors.

CPC-006 Moving Beyond Staging & Restaging

December 18th, 2009

Dr. Faulhaber continues with his discussion of the clinical use of PET. He discusses the usefulness of PET in determining the prognosis of a patient.

CPC-005 Clinical Indication for PET Approved by CMS

December 11th, 2009

Dr. Faulhaber examines how PET has developed clinically as the approval process of CMS has increased.  He begins with a brief review of the value of PET over time and the impact of Fluorine-18 tagged with Glucose as a very powerful imaging agent.

Welcome to my Podcast

December 8th, 2009

The initial episodes of Clinical PET Cast have been well received.  Upcoming programs will cover such wide-ranging topics as:

  • Approval Process of CMS
  • Staging & Restaging
  • Treatment Planning
  • Gastrointestinal Malignancies
  • Respiratory Gating

In the future, I am hoping to expand CPC to include a video podcast companion.  Your feedback will help me direct these plans and to guide the current podcast into areas most relevant to our practices.  Either leave a voicemail at 216-455-0777 or email clinicalpetcast@gmail.com.

-Thanks for listening, Peter

CPC-004 Intro to Quantitation

December 4th, 2009

Dr. Faulhaber discusses the concept of quantitation and in particular the Standard Uptake Value or SUV.  Clinical PET relies on semi-quantitative methods which are based on the data acquired from the patient, and how that data is corrected for attenuation.

CPC-003 Pitfalls & Artifacts of PET Imaging Part 2

November 25th, 2009

Dr. Faulhaber continues this two-part session by examining specific regions of the body that can be quite confounding in the anatomic and physiologic variation. He begins with the head & neck, a very difficult area to interpret.