Key steps to implementing a successful PET program
There are several essential components required to run a successful positron emission tomography (PET) cardiac imaging program. Cardiovascular Business spoke with Erin R. Stevens, CNMT, NCT, director of nuclear medicine at Oregon Heart Center, to learn more about this topic; she spoke on this topic at the American Society of Nuclear Cardiology (ASNC) 2024 meeting.
Stevens shared insights from her experience and provided practical advice for institutions looking to implement or improve PET programs.
There is an increasing number in hospitals now adding PET to either use as dedicated systems for cardiac nuclear imaging, or dual use with oncology.
Stevens emphasized the importance of a collaborative team, noting that involvement from technologists, physicians and administrators is crucial for any program's success.
"Being a technologist and doing the meat of the procedure, it's important to have a technologist champion alongside a physician champion," she said, highlighting the need for multidisciplinary input to ensure a smooth workflow and effective patient care.
She said the biggest takeaway from her presentation was the need to get technologists involved and having both a technologist and physician champion for the program will go a long way for getting buy in to start a new PET program.
For centers considering launching a PET program, Stevens recommended careful research, collaboration and conducting site visits.
"Doing site visits is a big thing," she said, recommending that institutions see firsthand how different PET systems function and learn best practices from existing programs. She also stressed the value of consulting with both physicians and technologists who have already implemented PET to avoid common pitfalls.
Unique PET workflow using rubidium-82
Stevens' center uses a rubidium-82 (Rb-82) generator for its perfusion imaging radiotracer, which comes with specific challenges. Unlike technetium used in single-photon emission computed tomography (SPECT) that has a longer half life so is more forgiving in cases of patient movement or breathing, rubidium decays rapidly and requires strict attention to timing. Rb-82 has a half life of only 75 seconds.
"If you're not paying attention to what you're doing, or if your patient moves, it's not just a re-scan, it's a re-injection," she said. "It’s very compartmentalized, and having everything ready to go when you're imaging is going to save you from making errors."
To manage this, technologists need to focus closely on their patients and the process, ensuring that both the rubidium infusion system and camera are ready to go.
Rubidium's short half life means that the entire workflow must be tightly coordinated. Stevens explained that having everything prepared and ready to go before initiating imaging is essential to avoid delays or errors.
Where a SPECT procedure may take three to four hours for same-day rest and stress imaging, combined Rb-82 PET are compressed into about 25 minutes she said.
One of the significant benefits of rubidium is the convenience of having a generator on-site, reducing reliance on daily shipments. However, the generator's decay over six weeks presents unique scheduling considerations. Stevens noted that, as the generator ages, it becomes harder to obtain the required doses used for larger patients, necessitating adjustments to the imaging schedule.
"The last week and a half, you're not going to get the amount you need, so you won’t scan heavier patients that week," she explained.
She has an older PET system and she bases dose calculations based on patient weight. She uses a window of 30 millicuries to a maximum of 60.
"When I have a very fresh generator and I have a patient that's got a very large BMI, they're going to get 60 millicuries and that gives me a better quality image. But as the generator ages and you're getting towards the end of life, you're not going to be able to get that minimum amount that you want."
She said newer PET systems enable the use of lower doses.
Training and transitioning from SPECT to PET
Centers converting from SPECT to PET, or those where technologists switch between the two modalities, face additional challenges. Stevens emphasized the importance of thorough training, particularly given the current shortage of nuclear medicine technologists. She advised advocating for sufficient training time, both from application specialists and through peer-to-peer learning, to ensure technologists are confident in both PET and SPECT imaging.
Starting a PET program requires careful planning for radiation safety, staffing and workflow changes. Stevens highlighted the need for a shielding plan, updates to the facility’s radioactive materials (RAM) license, and new quality control protocols for the rubidium infusion system. Additionally, successful PET programs must involve everyone who touches a PET order, from technologists to schedulers, billing staff and insurance representatives.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com