Previewing ASNC 2023: Why nuclear cardiology needs to evolve
A key focus of American Society of Nuclear Cardiology (ASNC) President Mouaz Al-Mallah, MD, MSc, is the need to update very old imaging equipment across nuclear cardiology. While many imaging systems are updated every eight to 10 years at most hospitals, nuclear imaging systems can often be 15-25 years old. He said the need to modernize is one of his key messages at ASNC 2023, scheduled for Sept. 29 - Oct. 1 in Toronto.
"At the annual meeting, we want to give a lot of emphasis to this topic, because there is a need for this as our members talk to their administrators in the current economic environment. There is a business aspect to nuclear imaging and overall cardiac imaging that we are not usually taught in academic settings and we have to learn it on the job. At ASNC 2023, we want to walk the cardiologists through the steps for how they can better modernize their labs. That can be with adding cardiac PET, newer cameras with CZT detectors or a SPECT-CT system, or new software to allow them to better process these images. There are also AI tools to improve image quality," explained Al-Mallah, the Beverly B. and Daniel C. Arnold Distinguished Chair, director of cardiovascular PET and associate director of nuclear cardiology for the department of cardiology at Houston Methodist DeBakey Heart and Vascular Center. He is also a professor of cardiology at the Houston Methodist Academic Institute Center.
While echo, CT and MRI systems being used for front-line imaging tend to be updated regularly so they can improve image quality, offer better analysis tools and lower radiation dose, the same has not been true in nuclear imaging. Part of the reason these systems have not seen widespread replacement is the drop in cardiac nuclear imaging exams over the past decade. Another reason is that the technology had not progressed significantly for several years, but that has been changing over the past decade.
Recent advances in this field include digital detector technology that can cut exam times in half because they are much more sensitive than the older photo-multiplier tubes. Alternatively, these same digital detector systems can be used cut the radioisotope dose in half, lowering radiation dose to the patient.
Al-Mallah also noted that positron emission tomography (PET) technology has really started to grow because there are several technology advantages. These include better image quality and added prognostic value with coronary flow reserve analysis.
The addition of CT in the system for built-in attenuation correction on hybrid single photon emission computed tomography (SPECT)-CT and PET-CT systems also adds CT anatomical imaging on every scan to enable coronary calcium scoring. Artificial intelligence (AI) technology also has been developed to enable software-based attenuation correction on older scanners without the need for CT. He said these advances are needed to ensure nuclear cardiology can be as accurate as possible, to reduce image artifacts and enable better patient care.
"ASNC has a patient-first approach to use the right test at the right time, but you have to be able to perform the exam correctly so you need to have the latest technology," Al-Mallah explained. "In the past several years, nuclear cardiology has developed newer tools, from hardware, to software, to artificial intelligence. I think these will help our clinicians do their jobs better."
The need for better image quality and to get more diagnostic information from imaging is a trend across cardiac imaging modalities, but has not seen widespread implementation in nuclear imaging. As other modalities have added value to their diagnostic ability with more information to help make clinical decisions, nuclear imaging largely has not, but there are technologies out there that can add additional value.
"We need better tools that will allow up to measure myocardial blood flow reserve, CT technology that will allow us to assess atherosclerosis, these things will allow us to better do our job. We have to incorporate these newer technologies in our labs. It is not an option at this stage," Al-Mallah said.
He added that it is more important now to upgrade as the patient volumes increase and there is a need for better efficiency. Also, more and more of these patients are obese, which makes it harder to image them with the older technologies. These newer technologies, he said, will help provide better service to patients with more accurate clinical information.
"The field has progressed, it has not been stagnant, and there are newer tools available. I think it is extremely important to adopt these new tools into clinical practice," Al-Mallah said.
Newer technology also can help provide new applications for nuclear cardiology beyond perfusion that just started to be performed in the past five years. He said as perfusion studies decrease, there has been an uptick of new exams for cardiac amyloidosis, cardiac sarcoidosis and other types of inflammation, and imaging for infection of cardiac devices. In his lab, Al-Mallah said there are now between two to five sarcoid exams per day.
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