HCFA decision on Medicare PET payment level gives lift to SNM attendees
The remarkable comeback of the nuclear medicine industry continues unabated. Attendees at this months Society of Nuclear Medicine meeting in Toronto found that the modality is well into the second year of a growth spurt characterized by new equipment purchasing. The markets resurgence shows no signs of slowing, and the renewed growth is sparking new optimism among nuclear medicine practitioners and manufacturers about the modalitys future.
Some vendors at the SNM conference reported that the U.S. nuclear medicine market is demonstrating year-to-date growth of 20% in dollar volume and 10% in unit volume. Industry observers estimate that the U.S. market could be valued at between $400 million and $450 million by the end of the year.
Much of the credit for the revival goes to PET, nuclear medicines costly sister modality, whose long-term future was in doubt just a few years ago. Clinical studies are beginning to demonstrate the utility of PET imaging in providing metabolic information unavailable with anatomical imaging modalities, particularly for oncology applications.
Manufacturers are pursuing PET imaging with dedicated PET cameras, as well as with gamma cameras upgraded with coincidence detection electronics. Many companies began shipping coincidence detection packages this year, adding to the markets momentum. In fact, some industry experts believe that another major factor in the markets resurgence is the number of coincidence-ready variable-angle dual-head gamma cameras that have begun shipping in the past year from major manufacturers like Siemens, Elscint, and Picker.
The biggest news at the SNM meeting concerned the Health Care Financing Administrations announcement of Medicare reimbursement levels for PET and coincidence detection studies with fluorodeoxyglucose (FDG) (SCAN 6/10/98). Although HCFA in January announced that Medicare would pay for FDG lung studies, it did not release a payment level, creating uncertainty in the market as to whether PET imaging would be economically feasible.
HCFA released a payment level of $1980 for the technical elements of PET imaging, an amount that was greeted with enthusiasm by market observers. The rate ensures that clinical PET sites will be able to break even on PET imaging with fewer than six scans a day. PETproponents are working with HCFA to gain Medicare reimbursement for other applications.
Other highlights at the SNM conference included ADACs introduction of CPET, a dedicated PET scanner manufactured by UGM Medical Systems that ADAC began selling on June 1. Picker also raised eyebrows with its introduction of Beacon, a work-in-progress attenuation correction device that works in both SPECT and coincidence detection modes, and gPET, a new coincidence detection protocol that the company is developing.
Among new vendors making their debuts at the meeting was IS2 Research, a company founded by former Park Medical founder Iain Stark to manufacture and sell a new line of single-head digital gamma cameras.
- This Pleasanton, CA, company develops linear accelerators, which it believes can be a cost-effective alternative to cyclotrons for producing FDG. AccSys is building its first dedicated FDG linear accelerator for Imatron Japan, which plans to sell the accelerators to Japanese customers as a package with Positron PET cameras (SCAN 5/13/98). Work on Imatron Japans accelerator should be completed by early 1999, according to AccSys executives.
- ADAC used the SNM meeting to introduce CPET, ADACs trade name for the PET camera it co-developed with UGM Medical Systems of Philadelphia. ADAC made several modifications to the UGM product, the most important being the addition of curved sodium iodide detectors developed by scintillation crystal firm Bicron of Newbury, OH. The curved detectors give CPET better efficiency and improve the systems spatial resolution from 5 mm to 4 mm.
- CPET comes in two configurations: CPET 125 has a 12.8-cm field-of-view and carries a list price of $1.2 million, while CPET 250 has a 25-cm field-of-view and lists at $1.5 million. The Milpitas, CA, company sold the first CPET this month to a facility in Germany.
- In other areas of its booth, ADAC demonstrated ongoing work on its Molecular Coincidence Detection with Attenuation Correction (MCD/AC) technique, which reduces attenuation artifacts in coincidence detection images. MCD/AC shipments began in May.
- Panels demonstrated InSync, ADACs term for a simultaneous dual-isotope imaging technique with thallium and technetium. Research on the work-in-progress protocol is under way at the University of Utrecht in the Netherlands and at Cedars-Sinai Medical Center in Los Angeles.
- This Los Angeles-based company made its SNM conference debut exhibiting SeeMor, a remote-viewing software package that runs on PCs or Macintosh computers. SeeMor supports native formats from major nuclear medicine vendors, as well as DICOM 3.0 and Interfile formats. Areeda sells SeeMor directly, although most sales go through OEMs, which bundle the software with their nuclear medicine workstations.
- Scintillation crystal developer Bicron has found a home for its CurvePlate detector technology, thanks to a relationship with UGM Medical Systems. UGM has incorporated CurvePlate into its PET camera, which is being sold by ADAC as CPET.
- Bicron originally hoped to sell CurvePlate into the SPECT market, but the difficulties in designing curved collimators led the Newbury, OH, company to pursue PET instead (SCAN 4/29/98). CurvePlate detectors conform more closely to patient anatomy, limiting light spread in the detector and reducing noise, according to Mike Lopez, product manager. UGM has sold the first CurvePlate PET camera to the University of Pennsylvania, and more orders should come in as ADAC ramps up its sales effort for CPET.
- CurvePlate could also be used on dedicated coincidence detection gamma cameras, although such systems could not be used for SPECT imaging. Bicron is interested in securing more OEM partners for CurvePlate, because the companys agreement with UGM is nonexclusive, Lopez said.
- Bicron also displayed models of cadmium zinc telluride solid-state digital detectors, which are under development at the company. Bicron is working on reducing the cost of CZT enough to make such a product commercially viable.
Boston Life Sciences
- Exhibiting at its second SNM meeting, this Boston-based company displayed panels on its Altropane iodine-123-labeled radiopharmaceutical for the detection of Parkinsons disease. Altropane, which is in phase II clinical trials, can confirm the diagnosis of early-stage Parkinsons and can differentiate the disease from other CNS disorders. Boston Life Sciences is also developing therapeutic radiopharmaceuticals.
- Braccos offering at the conference was its CardioGen-82 rubidium-based agent for cardiac PET studies. The Plainsboro, NJ, company also featured Choletec, for detection of hepatobiliary disease; Iodotope, for treatment of thyroid cancer; MDP Bracco, for detection of bone cancer; and Rubratope, for detection of pernicious anemia.
- Bracco continues clinical trials for Cardiotec, a technetium-based myocardial perfusion agent approved by the Food and Drug Administration in 1991, but voluntarily withdrawn by the company in 1993. The trials are Braccos effort to reestablish the product as appropriate for myocardial perfusion.
- Bracco last month entered into an agreement with International Isotopes in which International Isotopes will manufacture certain finished radiopharmaceuticals for Braccos nuclear medicine division. Bracco claims the number-four slot in the U.S. radiopharmaceutical market, according to company executives.
Care Wise Medical Products
- CareWise of Morgan Hill, CA, displayed its C-Trak gamma-detecting surgical probe, which has also been displayed at previous SNM meetings.
- CTI of Knoxville, TN, featured its R&D work with Siemens Medical Systems on hybrid PET/SPECT systems using detectors based on crystals made from lutetium oxyortho-silicate and sodium iodide. Siemens hopes to incorporate the crystals into an E.Cam gantry to offer a product capable of imaging a full range of radioisotopes at different energy levels. Prominent nuclear medicine physician Dr. Henry Wagner of Johns Hopkins named an LSO/NaI image as Image of the Year in his wrap-up presentation at the end of the SNM conference.
- Cytogen featured ProstaScint, its monoclonal antibody-based agent for detecting prostate cancer. The company has increased promotion of the agent through its Partners in Excellence (PIE) program, which teaches physicians and technicians how to image and interpret ProstaScint scans correctly. The Princeton, NJ, company began shipping ProstaScint in February 1997.
- After flirting with litigation last month, Cytogen and Du Pont Merck settled differences over Quadramet, Cytogens bone cancer pain relief agent. Du Pont will continue to manufacture and distribute Quadramet, as well as provide basic service, but will search for a new partner to promote the product. Sales of Quadramet have not been affected by the conflict, but overall sales during the past year were well below Cytogens expectations, according to company executives. Cytogen is investigating additional applications for Quadramet, including its use with refractory rheumatoid arthritis patients.
- Cytogen also highlighted OncoScint, a colorectal and ovarian cancer agent and the companys first product on the market.
- The peptide-based product line manufactured by radiopharmaceutical firm Diatide is coming to commercial fruition. At its SNM booth, the Londonderry, NH, company featured AcuTect, its newly trademarked P280 deep-vein thrombosis imaging agent, as well as a number of other diagnostic and therapeutic products. The company applied for a new drug application (NDA) for AcuTect last August, has submitted drafts of phase IV protocols, and is now waiting for final clearance for the product, which it expects by September.
- Diatide has completed phase III trials for P829, a lung cancer imaging agent, and announced this week that the Food and Drug Administration has given the products NDA priority classification. The firm expects clearance within six months, and plans to release P829 commercially in the second half of 1999.
- Diatides agents in phase II trials are P748, for the detection of pulmonary embolism, and P483H, for the detection of white-cell infection. P773, for the detection of unstable atherosclerotic plaque, is in phase I trials.
- Diatide is also developing therapeutic agents, such as Sn-117m DTPA, for palliation of bone cancer, as well as agents for tumor therapy. The companys goal is to file an NDA every year, according to vice president and CFO Daniel Harrington.
- A highlight of this San Diego companys booth was a rotating chair, displayed as a work-in-progress, that enables the firms Digirad 2020 TC Imager to conduct SPECT studies. Digirad plans to offer the rotating chair as part of a package with 2020 TC Imager, which is based on solid-state CZT detectors.
- Digirad also displayed investigational images collected with a diverging collimator, which gives 2020 TC Imager a larger field-of-view than the parallel-hole collimators currently used on the camera. Diverging collimators expand the cameras field-of-view from 8 x 8 in to 14 x 14 in, expanding its versatility, according to Karen Klause, president and CEO of the company.
- Digital Scintigraphics tested the waters for a wide range of possible new PET and SPECT systems by displaying models of cameras it is thinking about developing. The systems could include a camera capable of conducting brain PET and SPECT studies, a dedicated PET breast imaging system, a whole-body PET camera using sodium iodide detectors, and a next-generation brain SPECT camera. The Waltham, MA, company used the SNM meeting to gauge market interest in the systems before proceeding with additional R&D, according to Sebastian Genna, president and CEO.
- The company continues to monitor the development of clinical protocols for using brain SPECT in the emergency treatment of stroke, Genna said. Brain SPECT could be used in conjunction with CT to improve treatment of emergency-room patients with the clot-dissolving drug tissue plasminogen activator (tPA). If interest in such protocols increases, Digital Scintigraphics may move forward with a portable, easy-to-use brain SPECT camera that can be wheeled into ER departments, Genna said.
Du Pont Merck Pharmaceuticals
- In its conference booth, Du Pont Merck of North Billerica, MA, emphasized Cardiolite for cardiac imaging and Miraluma for breast imaging. It also featured work-in-progress developments on DMP-444, a thrombus imaging agent.
- After negotiations, Du Pont and Cytogen have resolved their conflict over Quadramet, Cytogens bone cancer pain relief agent. Although DuPont will proceed with the manufacture, distribution, and technical service of Quadramet, it will find another marketer for the agent and will divert its promotion dollars to other products.
- This Richmond, British Columbia, company featured its range of high-current, variable-energy cyclotrons, including the TR series.
- Elscint placed a major emphasis on MagiCam, a new variable-angle dual-head gamma camera that makes the Israeli company more competitive in the mid-range variable-angle segment. MagiCams compact size and small footprint make it ideal for budget-minded nuclear medicine departments, according to the company. MagiCam carries a list price of around $450,000.
- The company displayed connectivity features for its nuclear medicine systems using InnerView, a Java-based image management package developed by Algotec Systems of Raanana, Israel.
- Elscint is now able to remotely diagnose and service gamma cameras, thanks to an expansion of its TeleService program, a remote diagnostics package that is already in use on the companys CT and MRI scanners.
- Poster panels in the companys booth described the development of cadmium zinc telluride solid-state digital detectors by the ELGEMS joint venture that supplies Elscint and GE with nuclear medicine equipment. ELGEMS has merged the solid-state R&D programs of Elscint and GE, which had been working independently with two Israeli companies, eV Products and Isorad.
- Another panel discussed investigational work on attenuation correction for CoDe, Elscints coincidence detection protocol.
- This generic pharmaceutical company has begun selling dipyridamole injection, the generic equivalent to Du Pont Mercks I.V. Persantine pharmacological stress agent. The product is indicated as an alternative to exercise in thallium myocardial perfusion imaging for evaluating coronary artery disease in patients who cannot exercise.
- This San Francisco company showcased additions to CardioMatch, its cardiac analysis and quantification software package. Focus is adding risk stratification and prognostics functions to the software to enable physicians to calculate a patients prognosis based on various treatment options. The package uses a database of cardiac outcomes developed by Dr. George Diamond of UCLA. The database should enable physicians to fine-tune diagnosis and therapy to each patients profile and cardiac history.
- Focus plans to incorporate the Diamond database into CardioMatch to develop a product called CardioRisk, which will be sold to clinical cardiologists for patient management and therapeutic guidance. CardioRisk should be available in the next six months. CardioMatch will be targeted to nuclear cardiologists and nuclear medicine physicians, with sales beginning in the next several months.
Panels in this Deerfield, IL, pharmaceutical companys booth emphasized its
- Adenoscan cardiac stress agent, which Fujisawa claims has captured one-third of the cardiac stress market. Adenoscan competes with I.V. Persantine from Du Pont Merck, as well as another stress agent, dobutamine.
GE Medical Systems
- The Milwaukee company emphasized the broad range of its gamma camera line, which was bolstered by the ELGEMS agreement with Elscint last year. In addition to GE-developed systems, the company also featured Millennium VG, its product name for the VariCam system developed by Elscint.
- Investigational work on attenuation correction protocols for both SPECT and coincidence detection was a highlight in the GE booth. Panels described work under way at St. Lukes Roosevelt Hospital in New York City on algorithms designed to correct for artifact problems caused by attenuation correction. GE is still awaiting 510(k) clearance on SPECT and coincidence detection versions of attenuation correction.
- The vendor also plans to migrate the attenuation correction used on Millennium VG to the mid-range Millennium MG camera. GE began international deliveries earlier this year of attenuation correction for the Optima NX 90° dual-head camera. U.S. deliveries should begin shortly.
- GE has also finished developing a version of its Genie workstation designed for legacy StarCam gamma cameras, which were GEs first SPECT cameras. The melding of Genie with StarCam systems will give users of the legacy systems a modern workstation, according to David Hollnagel, Americas marketing manager for nuclear medicine/PET.
- As did Elscint, GE described ongoing work in solid-state digital gamma cameras by ELGEMS.
- Like Boston Life Sciences, Guilford is developing an iodine-123-based radiopharmaceutical for diagnosing Parkinsons disease. Guilfords product, called Dopascan, is in phase III clinical trials and is the Baltimore companys only diagnostic agent.
Hitachi Medical Corporation of America
- Hitachi has begun placing production units of its variable-angle dual-head digital gamma cameras in the U.S., according to Gary Enos, general manager of the companys nuclear medicine division in Twinsburg, OH. The company showed results on its coincidence detection reconstruction (CDR) technique, and is finishing investigation of attenuation correction for CDR using offset fanbeam collimators.
- Hitachi should be in full production mode on CDR by the end of 1997, when it will also begin shipping its nonuniform attenuation correction (NUA) technique, Enos said.
- Immunomedics came to the meeting with a new distributor for CEA-Scan and a new president and CEO. In April, Immunomedics terminated its distribution deal with Mallinckrodt and switched to Bergen Brunswig; new chief executive Robert DeLuccia began work earlier this month.
- At its booth, the company highlighted CEA-Scans use as a preoperative and intraoperative imaging agent. The products revenues are at least 30% higher than they were at this point last year, according to company executives. CEA-Scan is entering phase III trials for breast cancer imaging. The Morris Plains, NJ, firm also featured its therapeutic agent, CEA-Cide, which is in phase I/II dose-ranging trials.
- Immunomedics is awaiting FDA approval of LeukoScan, an imaging agent which differentiates soft-tissue infection from osteomyelitis. The company continues research on a work-in-progress immunoangioplasty agent.
Institute for Clinical PET
- The Institute for Clinical PET arrived at the SNM meeting bolstered by the news of HCFAs $1980 payment rate for PET studies of lung cancer. The announcement means victory for the ICP, whose task force provided HCFA with clinical data to support a fair reimbursement policy, according to Jennifer Keppler, ICPs executive director.
- International Isotopes featured a full list of the radioisotopes it expects to begin producing by the fall, including cobalt-57, fluorine-18, iodine-125, and yttrium-90. The company also discussed its plans for products such as iodine-125 seeds and finished radiopharmaceuticals.
- The Denton, TX-based firm has access to a number of facilities, including a nuclear reactor operated by MAC Isotopes, one of International Isotopes new acquisitions; its own linear accelerator, purchased from the U.S. governments Superconducting Super Collider project; and a cyclotron owned by the University of North Texas. The company expects the linear accelerator to be online by fall, and the cyclotron to be operational by the end of June. In the pipeline are international radioisotope sites and a gamma camera with higher resolution than current cameras on the market.
- This recently formed New York City company displayed several miniature gamma- and beta-detecting probes and cameras as works-in-progress. The firms mini gamma camera is controlled by a laptop computer and consists of a tin-can-sized detector with a single photomultiplier tube inside. IntraMedicals beta camera features submillimeter resolution and could be used for intraoperative imaging of tumors that have spread superficially.
- The companys products were developed by Farhad Daghighian, a scientist at Memorial Sloan-Kettering Cancer Center in New York City who is leaving the hospital to form IntraMedical. IntraMedical is awaiting 510(k) clearance for the probes and cameras.
Ion Beam Applications
- IBA showcased its Cyclone line of cyclotrons for the production of PET radioisotopes. The Belgian company is examining options for selling its cyclotrons in the U.S. and is looking for sales and marketing partners, according to Rudi Verbruggen, area sales manager. IBA had a North American sales and marketing deal with Park Medical, but the agreement died when Park filed for bankruptcy last year (SCAN 8/6/97).
- Making its trade show debut was IS2 Research, which was started by Park Medical founder Iain Stark. The Nepean, Ontario, company is bringing to market its NuCamma line of digital single-head gamma cameras, designed by Stark, that incorporate all of the systems electronics into the detector head. IS2 claims that the approach makes the systems easier to service.
- NuCamma C+ is a circular-head camera, while NuCamma Rx is a rectangular system. A major selling point of the cameras is their low price, in the $155,000 (U.S.) range, and IS2 plans to position the systems against refurbished single-head models rather than against new offerings from major gamma camera OEMs. The company reduced costs by relying on commercially available parts, such as the slip rings used in the NuCamma line, rather than in-house-developed components, according to Steve Thomas, chief electronics technician for service and production.
- The company hopes to begin shipments of the NuCamma systems in September, once they receive 510(k) clearance.
- This Sunnyvale, CA, film digitizer and PACS developer displayed a line of nuclear medicine image management products initially developed by Medical Technology Associates (MITA). MITA had been acquired by CompuRad, which in turn was purchased by Lumisys last year (SCAN 10/1/97).
- The MITA-developed products include GammaView, for image viewing; GammaCon, for data translation between gamma cameras from different vendors; and GammaServe, a router to send images over hospital networks. All three products are shipping.
- St. Louis-based Mallinckrodt presented its imaging agent portfolio, including OctreoScan and Myoview. The company also discussed the radiopharmaceutical contract it launched last July with hospitals in the Premier group purchasing organization.
- In April, Immunomedics terminated its agreement with Mallinckrodt to market CEA-Scan, Immunomedics colorectal cancer imaging agent, although Mallinckrodt continues to fill orders for CEA-Scan through its pharmacies.
- Mallinckrodt is working on a new generation of peptide-based imaging agents, for breast and prostate cancer diagnosis and therapy, that it expects to roll out over the next several years. Company executives declined to comment further on the new products.
- This Canadian companys parent firm, MDS Inc., acquired radiation therapy developer Theratronics International just two weeks prior to the SNM meeting. Theratronics is well known for cobalt-60 radiotherapy equipment, as well as sources used to treat cancer. It also develops radiation treatment planning software. Theratronics will become a division of MDS Nordion.
- A panel in MDS Nordions booth described the companys ongoing effort to build two new nuclear reactors to produce molybdenum, the technetium raw material whose supply has been interrupted twice in the last year due to labor problems (SCAN 6/10/98).
- Medasys highlighted its DX Win PC-based image viewing software, which was released at last years Radiological Society of North America meeting. The software enables users to send and retrieve images from a DICOM-based server, according to Larry Ware, vice president of sales for the Miami company.
- Medasys also introduced a Web-based product at the RSNA meeting and has begun shipping the product, Ware said.
- On the nuclear medicine workstation side, Medasys has made enhancements in SPECT reconstruction to its DX Pinnacle image processing workstation. Medasys supplies the DX Pinnacle software to Hitachi, which is using it as the basis for its own nuclear medicine workstation.
- The Delta Manager workstation was a highlight in the booth of this Ann Arbor, MI, company. MedImage also displayed its Galen teleradiology software.
Mediso Medical Equipment
- New single-head gamma cameras from this Hungarian company were on display. The firms Nucline systems ranged from large field-of-view circular-head systems to rectangular-head units and small field-of-view cameras for organ imaging.
- Mediso also touted its ability to upgrade the electronics of legacy gamma cameras.
- Neoprobe highlighted its Neoprobe 1500 gamma ray-detecting probe, which was released last year. The probe is optimized for the detection of lesions that have spread to sentinel lymph nodes, the first nodes that drain from malignant lesions. The probe is particularly useful for intraoperative use in breast and melanoma surgeries.
- Neoprobe 1500 differs from older probes offered by the company in its range and count rate, according to executives with the Dublin, OH, company. It also has an audible signal that reflects the detection of gamma rays.
- Neoprobes new marketing partner is Johnson & Johnsons Ethicon Endo-Surgery division, with which Neoprobe signed on after its previous relationship with U.S. Surgical expired. Neoprobe began training Ethicon Endo-Surgery personnel this month, according to the company.
- This company made its SNM conference debut to show Hermes, a newly updated software suite for the acquisition, reconstruction, and Web-based viewing of nuclear medicine images. Hermes uses Java-based applets to enable remotely located physicians to view images stored on a central server. Such a configuration enables nuclear medicine departments to provide image access to referring physicians at a fraction of the cost of a dedicated teleradiology system, according to Jan Bertling, president of the Hagersten, Sweden-based company. Nuclear Diagnostics is looking for strategic partners to sell Hermes in the U.S., according to Bertling.
- Numa won rights to distribute the GammaView product developed by Lumisys under an agreement signed between the companies in April. The Toronto SNM meeting was the first conference at which Numa has displayed the Lumisys products, according to executives with the Amherst, NH, company.
- A new nuclear medicine acquisition station, NumaStation, received 510(k) clearance in February. NumaStation is designed to replace older workstations on legacy gamma cameras, giving users of the systems modern image processing features and capabilities. Six NumaStations had been installed as of the SNM meeting. Most of them were sales to owners of Siemens cameras.
- Nycomed Amersham of Princeton, NJ, exhibited at its first SNM show as an integrated company since the merger of Nycomed and Amersham International last year (SCAN 7/9/97). Emphasized at the companys booth was its Myoview technetium-based agent for cardiac imaging and Ceretec agent for brain imaging.
P.E.T.Net Pharmaceutical Services
- P.E.T.Net rode into the conference on the momentum of HCFAs announcement of a payment scale of $1980 for PET lung cancer studies (SCAN 6/10/98). Company executives were optimistic about the effect the announcement would have on FDG demand and reported increased interest both nationally and internationally.
- The Norcross, GA-based firm introduced its FDG offering under a new trade name, MetaTrace FDG, in an effort to establish its products consistency with protocols set by the Peoria Methodist Hospitals new drug application (NDA). The Peoria NDA was the first application approved by the FDA for FDG.
- P.E.T.Net expects to initiate five to 10 new cyclotron sites in the next year. Its 12-site network serves more than 100 coincidence imaging and dedicated PET cameras, according to Jim Monaco, president and CEO.
- P.E.T.Net is researching additional positron drugs that can be labeled with FDG and targeted to other indications. One such pharmaceutical is fluoradopa, a brain imaging agent.
- New advances and enhancements for its Irix triple-head and Axis dual-head gamma cameras were at the top of the agenda for this Cleveland company. Picker has shipped a total of 60 Irix and Axis cameras since they were introduced at last years SNM meeting, and the company has more than 100 orders in its backlog, according to Josh Gurewitz, marketing manager for Pickers nuclear medicine division.
- New work-in-progress developments for the systems include gPET (gamma PET), a new coincidence detection protocol displayed as a work-in-progress, and Beacon, a new nonuniform attenuation correction technique that works in both PET and SPECT modes.
- gPET consists of Pickers next-generation PET electronics and software that can be installed on Irix or Axis cameras, resulting in a major boost in sensitivity over Pickers previous version of coincidence, Positron Coincidence Detection (PCD). Picker believes gPET is 2.3 times as sensitive on the Irix camera in triple-head mode than other coincidence detection dual-head techniques on the market, while Axis is 60% more sensitive.
- Picker used gPET the week before the SNM meeting to acquire what the company believes is the worlds first clinical triple-head coincidence detection image, according to Gurewitz. An Irix system in gPET mode collected the image in 18 minutes, which compares with 30- to 40-minute acquisition times typically used by other coincidence detection techniques, Gurewitz said. Picker hopes that by employing Irix in triple-head coincidence mode, users will be able to conduct coincidence detection studies much more quickly than on dual-head cameras, and the technique will help the company bring the performance of Irix close to that of a low-end PET system. gPET is still under development; Picker hopes to be in clinical testing by the end of summer, with a commercial release to follow.
- PCD will remain in Pickers product line as the coincidence detection option for Prism gamma cameras. The company continues to sell all the cameras in the older Prism line, with the exception of the triple-head Prism 3000. gPET does not work on Prism cameras.
- Picker continues to investigate whole-body coincidence detection techniques, such as its PT 511 survey mode, which it believes could be useful as a screening mode to identify occult tumors or metastases.
- Pickers new nonuniform attenuation correction protocol, Beacon, uses two scanning point sources of barium, which has a 10-year half-life and thus never needs to be changed over the life of the gamma camera. The sources are contained in a shielded housing that parks itself next to the detectors when not in use. When employed during a study, Beacon can be positioned with the detectors in multiple configurations, rather than the standard 90° geometry for cardiac SPECT studies or 180° configuration for coincidence detection. Like gPET, Beacon works with both Irix and Axis, and in either PET or SPECT modes. Picker hopes to begin deliveries of Beacon in the next nine to 12 months.
- Picker also rolled out a new version of its Odyssey FX computer workstation, the 800 series. The new series, based on the latest version of Digital Equipments Alpha chip, offers two to five times the performance of the Picker computer displayed at the San Antonio SNM meeting a year ago.
Siemens Medical Systems
- Siemens featured its ongoing work with CTI on hybrid PET/SPECT detectors made from lutetium oxyortho-silicate and sodium iodide (LSO/NaI). The company has fitted the detectors on an E.Cam gantry, resulting in a system capable of imaging both high- and low-energy ranges of isotopes, according to Barbara Franciose, group vice president of the division. An image collected with the hybrid system won Image of the Year honors in Dr. Henry Wagners wrap-up talk at the end of the conference.
- The hybrid system uses pixellated scintillation crystals, rather than a single slab of crystal, as is used on other gamma cameras, according to Franciose. The pixellated crystal matches with the modular structure of LSO, giving the system a higher count rate. Siemens hopes to have clinical hybrid cameras ready this year, and the company has already submitted a 510(k) application for a system. Production shipments will probably occur in 1999, with the system carrying a list price between that of a PET camera and a SPECT system.
- While work on the LSO/NaI hybrid progresses, Siemens continues to pursue more conventional coincidence detection imaging using sodium iodide crystals with an E.Cam gantry. Siemens coincidence detection camera, E.Cam+, is in beta testing, with production shipments scheduled to begin in August.
- The attention PET has been receiving has improved Siemens PET sales in the U.S., according to the company. Siemens believes it will sell more than 10 PET cameras this year in the U.S., compared with two last year. Siemens believes that customers will gravitate to different PET imaging options in its product line based on patient volume, with busy sites acquiring dedicated PET cameras while less busy departments use gamma camera-based systems.
- A panel in the Siemens booth described the companys development of CZT solid-state detectors. The company has made a major investment in R&D resources in the technology, and that investment is beginning to pay off, Franciose said. Siemens plans to release more information on the system at this years RSNA show.
- Another project in the works is a hybrid CT/PET scanner that consists of a ring of PET crystals installed inside a Siemens Somatom Plus CT gantry. A prototype system is installed at the University of Pittsburgh, where it began producing images this month. A hybrid system could allow clinicians to collect both anatomical and metabolic information in one scan session. It would obviate some of the difficulties encountered with software-based image registration techniques, according to Franciose.
- Siemens also showed some of the first clinical results of its Profile attenuation correction protocol. Profile uses a multiple line array of 28 sources, and the results showed the ability of the technique to work effectively with patients over 200 lb, according to Siemens. Commercial Profile shipments are scheduled to start in August.
- Finally, Siemens has upgraded its Icon nuclear medicine workstation to the G3 Power Macintosh computer, increasing its speed by 30%.
- SMV presented two gamma cameras at the meeting: the new DSXi, a single-head camera that is upgradable to a dual-head, and DST-XLi, a modified version of the variable-angle, dual-head DST-XL camera that supports coincidence imaging. Both cameras have extra-large fields-of-view, open-gantry configurations, and long-access SPECT.
- The Twinsburg, OH-based company featured its Transmission Attenuation Correction (TAC) technology, which includes its motion correction program (Stasis) and its resolution recovery and scatter compensation program (Restore). SMV began shipping the TAC option in April and currently has it installed at roughly 25 sites throughout North America and Europe, with the expectation that it will install at least another 40 packages in the next few months. TAC can be added to any of SMVs variable-angle cameras, including the DST-XLi.
- The company also featured its Volumetric Coincidence Reconstruction (VCR) program and emphasized the programs accelerated iterative reconstruction method and randoms correction capability. According to company executives, VCR is five to 10 times faster than other coincidence reconstruction programs on the market, completing coincidence processing in less than a minute.
- Like other vendors, SMV is developing attenuation correction technology for coincidence detection imaging. It plans to apply for 510(k) clearance by next month. The company will use a segmented software approach that will access CT scans for the transmission data rather than an externally mounted source. Data will be sent to an SMV workstation through DICOM or digitized CT film, then applied to coincidence data with a segmented reconstruction software program. At the conference, the firm presented initial, work-in-progress studies to support this approach. SMV expects the technology to hit the market by the first quarter of next year.
- The firm estimates its overall market share in both Europe and the U.S. to be roughly 15%, based on National Electrical Manufacturers Association shipment numbers from the last six months. SMV reported that its first-quarter shipments are up 42% in the U.S from the first quarter of 1997.
- This Chatsworth, CA, company is moving into a role as a teleradiology provider through NukeNet, a service that Syncor is setting up to provide primary and secondary image reading to nuclear medicine departments. Syncor is working with Dr. Hirsch Handmaker of Healthcare Technology Group in Phoenix to assemble a group of physicians who can provide image reading services to its clients. NukeNet uses Autocytes Amicus software for image transmission.
- NukeNet is currently in a pilot phase, and will probably be rolled out to international sites this fall, with a U.S. program coming online in 1999. Syncor believes that NukeNet could help many hospitals cope with the growing shortage of nuclear medicine physicians in the U.S.
- Syncor also discussed SynTrac, an HIS offering designed to track equipment usage and scheduling. Syncor released SynTrac in October, and the program has been installed at 170 sites.
Toshiba America Medical Systems
- Toshiba America Medical Systems introduced work-in-progress Transview software at the SNM conference. With the GCA-7200 fixed-angle dual-head camera, the software will use Toshibas transmission correction and triple energy window (TEW) programs to remove scatter from images. The Tustin, CA-based company is compiling material to submit a 510(k) application for Transview.
- The company also featured Profile nonuniform attenuation correction and developments in coincidence detection imaging for its Toshiba E.Cam, which the company buys from Siemens for resale. Toshiba will ship coincidence-ready cameras in July and will install coincidence imaging software by first quarter 1999. Also by July, E.Cam will carry programs that provide motion correction, lung quantification, the merging of spot images into whole body images, and DICOM 3.0 software as part of its standard configuration.
- Toshiba America purchased 13 E.Cams from Siemens in the last year and expects to have 20 installed by September. The company claims a 6% nuclear medicine market share in the U.S.
Trionix Research Laboratory
- Although Trionix has scaled down its sales effort for new gamma cameras, the company continues to exhibit at SNM meetings. The Twinsburg, OH, vendor displayed clinical validation images of its Quasar SPECT quantitation package. Quasar addresses the problems found in SPECT quantitation, including photon scatter elimination, attenuation correction, and geometric collimator response recovery.
U.S. Department of Energy
- The DOE continues work on its Sandia Laboratories reactor in New Mexico and expects to be capable of producing 70% of North American demand for molybdenum-99 by the end of the year. However, the DOE will still be required to submit sample doses of molybdenum, as well as documentation of its production methods, to the FDA for clearance. The DOEhopes the Sandia reactor will be a viable alternative to a reactor operated by the Canadian government that produces most of the worlds molybdenum supply.
- In January of next year, the Department of Energy will supply certain pharmaceutical firms with molybdenum from Sandia, from which technetium will be processed for FDA approval. The DOE expects the product and facility clearance process to take about six months and anticipates cleared molybdenum production by mid-1999.
- U.S. Surgical of Norwalk, CT, displayed Navigator, a gamma-detecting probe for lymphatic mapping.
Web Link Medical
- Web Link was formed in 1997 to commercialize a Java-based software package that provides a low-cost method of image viewing for remotely located physicians with Web browsers. The Oakville, Ontario, company plans to sell its software primarily through OEMs. The company is an arm of nuclear medicine connectivity firm Link Medical of the U.K.