Faster, better, safer: The latest in PET and SPECT

June 06, 2022
by Lisa Chamoff, Contributing Reporter
Manufacturers in the PET and SPECT space are focusing on decreasing scan times, improving image quality to see smaller irregularities and lowering radiation dose.

In nuclear medicine, product development has also focused on researching new radiotracers. There are also several preclinical devices in the research stages.

Here’s a look at what's new and what's to come in the future.

Cubresa's BrainPET, the world’s first commercial PET insert system, is designed for use in a 3T MR scanner and provides simultaneous PET/MR imaging capacity. The company recently announced that two prominent brain research centers — Barrow Neurological Institute in Phoenix, Arizona, and Lawson Health Research Institute in Ontario, Canada — have joined the company’s Foundational Client Program. This program is designed to engage global leaders at brain research institutions who are seeking to enhance their research activities with the addition of a BrainPET system.

“The BrainPET is designed for brain research centers that are conducting leading-edge research and are looking to add simultaneous PET/MR capability to their imaging suite,” said Lisa Bako, vice president of sales and strategic partnerships for Cubresa. “We are speaking with numerous institutions in North America, the U.K. and beyond who are very interested in acquiring this novel system.”

The BrainPET is currently under development with the aim of providing a higher PET spatial resolution and sensitivity than commercially-available whole-body hybrid systems. Potential future clinical applications include Alzheimer's dementia screening and diagnosis, brain tumor assessment and management, epilepsy assessment and treatment and the study of amyotrophic lateral sclerosis.

DOSIsoft has been marketing its PLANET Onco Dose software for molecular imaging and molecular radiotherapy to provide patient-specific dosimetry, personalization of treatment and disease follow-up.

The company has approval to use the software for SIRT/Yttrium-90 in the U.S., and is adding Lutetium-177 and Iodine-131 support in both the U.S. and Europe.

The software is unique in that it’s multi-radionuclides and vendor-neutral, said Sébastien Vauclin, product manager at DOSIsoft.

“We wanted to have a complete solution that is independent of imaging manufacturers,” Vauclin said.

GE Healthcare
GE Healthcare recently introduced a new feature for neurological imaging for its SIGNA PET MR system. Called MotionFree Brain, it removes any patient motion using raw images.

“Literally any movement of the patient or the subject is recovered as if the patient didn't move,” said Almos Elekes, global product marketing manager for GE Healthcare.

The feature reconstructs the images faster than the PET scanner acquires them, Elekes said. It’s ideal for imaging pediatric patients as well as those with neurogenerative diseases, including Parkinson’s, where very often patients present with a tremor.

Last year, GE Healthcare introduced MyoSPECT, a nuclear medicine cardiology system, which the company calls the next generation of cardiac-dedicated nuclear medicine.

The system was designed with a faster scan and workflow, providing a better patient experience and the ability to accommodate more patients, said Sonia Sahney, chief marketing officer for molecular imaging and CT at GE Healthcare.

“It really helps clinicians determine the right course of treatment for the patient, while the patient is having a much more comfortable experience,” Sahney said.

The system comes with a wider table and a wider field of view, as well as smart positioning technology to allow for optimal patient positioning. A smaller footprint allows the system to be used in a hospital or clinical setting.

Hermes Medical Solutions
Hermes Medical Solutions recently launched its Hermia molecular imaging software.

The all-in-one software platform uses artificial intelligence and automation, together with the latest computing technology, to accelerate workflow and reporting, said Rene Rebeaud, chief business officer for North America and Latin America for Hermes Medical Solutions. Some examples are AI-driven foci segmentation, AI-driven lesion tracking and automatic local registration.

Hermia also includes the Voxel Dosimetry application, which can predict and quantify, for each patient, how much radiation a tumor and surrounding cells will receive. Patients now only need to be imaged a single time for treatment follow-up, making it easier to implement in clinical practice, Rebeaud said. The application is CE marked, FDA and Health Canada cleared for a wide range of imaging isotopes.

“This is a game-changer because, historically, you had to acquire images for four or five time points to be able to perform the treatment follow-up, and now our software can achieve literally the same result with a single time point,” Rebeaud said.

The software can also perform a standardized uptake value calculation with any vendor’s SPECT camera.

“This is ideal when a department is equipped with scanners from different manufacturers, [and] staff can perform the acquisition on the camera that is best suited for the study or available when needed,” Rebeaud said. “Now, with quantitative SPECT reconstruction, you can really assess and track lesions over time with the standardized uptake value. This considerably simplifies the workflow of the department and allows for harmonized results and new assessment possibilities. “

The new software comes with a technology called Deep Fusion that allows users to fuse any number of image layers, from any modality, including PET-MR, PET-CT and SPECT in any combination. For the first time, 3D data from any modality, including volumes of interest (VOI), can be visualized in real time, and are fully interoperable in radiotherapy structure format, facilitating collaboration within oncology departments.

In the fall of last year, MILabs released its seventh generation of preclinical imaging systems. The new Series 7 platform is made up of five integrated scanners that can be delivered in any combination and facilitate many synergistic imaging protocols.

The system’s optical imaging can perform high-throughput imaging with high sensitivity, said Frederik Beekman, chief executive officer of MILabs.

“The new SPECT and PET supercluster technology provides random-free sensitivity of up to 15%,” Beekman said. “This enables [users] to see tiny radioactive lesions. This is a breakthrough, since other scanners cannot see those isotopes at a high resolution.”

The company will present its latest PET and SPECT technology at the SNMMI annual meeting this month.

MILabs’ G-SPECT clinical imaging system, which is still in development, now also has the capability to image high-energy isotopes and PET and SPECT tracers simultaneously.

“It is very difficult to see them with traditional SPECT,” Beekman said. “But with the G-SPECT, you will be able to see theragnostic agents go into the tumor. It is expected that this will allow [users] to calculate if there's enough to kill the tumor and that other organs are spared, so one will be able to personalize the treatment to make it optimal for the patient.”

Positron is planning to introduce a new PET-CT scanner. The company anticipates a 2022 release upon FDA certification later this year.

“Positron has been at the forefront of the dedicated PET only and SPECT cardiac market for decades,” said Aaron Hargrave, vice president and head of clinical applications at Positron. “The company’s expansion to offering a PET/CT system is an important step for Positron’s future. PET is the superior technology that is the key driver of the significant new demand in all areas of nuclear imaging diagnostics. Positron’s system will provide better-quality patient scans in a shorter period of time, with less discomfort to the patients, with better resolution and better sensitivity.”

Positron’s combination PET-CT will also allow them to enter the oncology and neurology markets, Hargrave said.

Hargrave said the scanner will include the company’s respiratory gating technology, a new quantitative analysis tool and new AI-based image reconstruction technology.

Prescient Imaging
The Centers for Medicare and Medicaid Services recently finalized its Medicare coverage policy for treatment of Alzheimer’s with monoclonal antibodies directed against amyloid plaques in approved clinical trials.

As a result, Prescient Imaging has been receiving interest in its BBX PET
portable PET scanner, which was FDA cleared in March of 2021.

“There are up to a million and a half people who are covered by the CMS announcement and each of those patients needs at least one PET scan,” said David Haar, vice president of marketing for Prescient Imaging. “If you take a million and a half patients and you say, well, that'll take about 45 minutes a patient, you're talking about 1,125,000 hours of scanning that need to be done. And no one that we've spoken to believes there's that kind of excess capacity in the PET imaging delivery system. … I think the point of care in a neurologist’s office is going to be the best place for that.”

Haar believes PET imaging will follow the trend of X-ray imaging and ultrasound that’s delivered at the point of care.

“X-ray used to be a very advanced technology and you had to go to the hospital to get it,” Haar said. “Now there's an X-ray machine in every NFL stadium around the country. Ultrasound used to be advanced. Now, most OB/GYN practices do it in house, and we certainly think that trend will continue. We have a small lightweight portable PET camera that's affordable for a neurology practice, and we think it will follow that same trend to the point of care.”

The BBX PET will make it practical for neurology practices with multiple locations to own their own PET scanner and be able to move it between their office locations.

“If you've got five office locations, which a lot of large practices do, you don't you don't need to buy a PET scanner for each location,” Haar said.

Siemens Healthineers
At the beginning of this year, Siemens Healthineers released the Biograph Vision Mobile Edition, a PET/CT system available on wheels.

The system, with the company’s SiPM-based detector technology and fast Time-of-Flight performance, is aimed at health systems that need to service regional areas in oncology, neurology, cardiology and orthopedics.

“Patients don’t have to travel long distances to have a PET/CT scan, enabling access to quality patient care no matter where they live,” said Katherina Swystun, global marketing manager for molecular imaging at Siemens Healthineers.

A recent study published in EJNMMI Research looked at the clinical impact of OncoFreeze AI, Siemens Healthineers' deviceless AI-enabled motion management feature, showing that the standard uptake volume and metabolic volume is more accurate using the feature, which could impact metabolic tumor volume assessment.

Spectrum Dynamics
In 2022, Spectrum Dynamics released the latest version of D-SPECT cardiac scanner software, providing current and new users with additional features and capabilities, such as TruCorr and TruPlanar.

D-SPECT TruCorr is a software application that generates attenuation-corrected myocardial perfusion images without requiring additional scanning sessions for the patient. The emission-based attenuation correction, based on deep learning using the patient's own myocardial perfusion SPECT data, is commercially available, with users in the U.S., Europe, and Asia. The technology averts the need for the patient to incur radiation exposure from an additional CTAC transmission scan or to endure longer or multiple appointments, said Jim Haisler, vice president of Global Commercial Operations at Spectrum Dynamics.

“We get improved image quality, efficiency, and accuracy,” Haisler said. “I would, in a way, call it a kind of revolution. This has never been released in a commercial forum before. It's been more in research than on the commercial [side].”

The company's VERITON-CT digital SPECT/CT features the same detector technology introduced with the D-SPECT, which allows for dynamic imaging. VERITON-CT's temporal resolution and sensitivity allow TruFlow imaging: one scanning session captures the dynamic flow plus the functional and anatomical information in SPECT and CT tomographic fashion. This is clinically relevant in many nuclear medicine routine applications such as three-phase bone scans, renal scans and, more recently, myocardial flow reserve (MFR) quantitation using SPECT/CT.

The scanner's new capabilities include a workflow feature that allows personalization of the SPECT scan based on the patient's body contour, as defined by the CT. The system will recommend parameters to optimize scan time and image quality when performing a total body SPECT/CT scan. Within seconds of scan completion, the final result is an attenuation-corrected total body scan ready for review and quantitative analysis.

United Imaging
United Imaging has added new features to its uMI 550 PET/CT scanners. Among those is uCare.iQC, an automated quality control program that helps with workflow, providing time and dose savings.

“It runs the QC program overnight, so that technologists don’t have to use a radioactive source to run a QC program at the beginning of each day,” said Jeffrey Bundy, chief executive officer of United Imaging Healthcare Solutions.

The company also released its uAI HYPER DPR Deep Progressive Reconstruction technology, which uses AI to improve PET image quality. The algorithm is trained on the uEXPLORER ultrahigh-resolution digital PET/CT.

“That high-quality data, which comes from highest-resolution scanner on the market, and iterative approach allows us to create a higher signal-to-noise reconstruction, but at the same time the neural network increases the contrast of the images,” Bundy said.

Both applications are available on both new and all installed systems through United Imaging’s Software Upgrades for Life program.