Issuu Medical Chronicle September 2019 :www.issuu.com/newmediab2b/docs/mc_september_2019_issuu/30
TheraMed Nuclear is a general Nuclear Medicine/PET-CT facility based in Midstream, Gauteng and deals with scanning for various cancers and diseases. As Dr Bennie states, “If you’re at Nuclear Medicine you’re usually pretty sick.”
Surrounded by nature-themed murals and light wooden furniture the atmosphere is calm and soothing. In patients newly diagnosed with cancer this is imperative according to Dr Bennie. This theme is evident throughout the practice from reception to the imaging rooms.
The practice is unique in that it has the only three-in-one PET-CT-SPECT camera in Africa. This allows the facility to perform both PET-CT (positron emission tomography) and SPECT-CT (single phone emission computed tomography) making it one of only three private facilities in South Africa, and the only one in Gauteng with single-sitting whole-body co-registered SPECT-CT hybrid imaging capabilities with diagnostic quality CT scanning to boot. The two datasets, namely the 3D SPECT images are automatically fused to conventional CT allowing for better image processing and accurate localization of lesions that is otherwise difficult in most studies (without some anatomical reference point). This obviates the need for a separate CT to be performed at an additional cost and does not require the use of costly co-registration software to achieve similar results.
As such, TheraMed Nuclear is an example of a practice embracing hybrid (or dual-modality) molecular imaging, which until recently was limited to PET-CT. SPECT-CT allows for a cheaper and yet still competitive alternative to PET-CT in cancer diagnosis and treatment decisions. It is especially popular amongst referring oncologists because the cost of the scan allows for more funds to be retained for treatment purposes, especially where scheme oncology benefits are limited.
Where SPECT-CT has proved useful of late is with Technetium-99m iPSMA whole-body scans for prostate cancer skeletal and soft-tissue staging and follow-up. At a third of the cost of the PET-CT alternative, the benefits outweigh the marginally lower sensitivity – a margin their referring doctors are happy with, providing the CT scan is included. Without the CT the iPSMA scan is difficult to interpret as the radiopharmaceutical doesn’t distribute to fixed anatomical reference points as it does with a bone scan for example – limited to only skeletal staging.
Other indications for SPECT-CT includes pre-surgical localization of excisable lesions e.g. sentinel lymph nodes for melanoma and breast cancer and parathyroid adenoma in primary hyperparathyroidism. In addition to skin surface markings and gamma probe use, the addition of CT into the mix allows the surgeon to better strategize.
The practice has largely abandoned its conventional ventilation-perfusion (VQ) scans for pulmonary embolism diagnosis in favour of hybrid perfusion-only SPECT-CT scan as it yields more information regarding other lung pathology and is cheaper (compared to traditional VQ scan or CTPA – the ubiquitous standard) making it very cost-effective. Literature shows that SPECT-CT, while not yet universally available, is the best-performing investigation for acute pulmonary embolism diagnosis and has been well received by the hospital’s specialists due to the additional information it provides.
PET-CT has largely become the de-facto method of staging various malignancies and the service provided at TheraMed Nuclear is no different to any of the world’s leading oncology centres. The multi-slice CT provides diagnostic quality images and allows for accurate staging and follow-up of patients.
PET-CT is also indicated in the diagnosis/prognostication of various other conditions e.g. cardiac viability, dementia and epilepsy, infection localization, sarcoidosis and large-vessel vasculitis – all of which are performed at TheraMed Nuclear – a one-stop-shop for all your Nuclear Medicine needs.
Atmosphere and facilities:
The friendly yet utterly professional staff guide you seamlessly through what would be described as an otherwise intimidating disposition (including the scan pre-authorization hassles with the medical schemes etc.). This is not the case at TheraMed Nuclear where you are taken care of from referral-to-report.
The decor and large spaces are welcoming and reassuring. This extends to the camera rooms which have scenic murals and large windows allowing the technologist to monitor and communicate with the patient – all small considerations that help settle the nerves.
Each PET-CT patient has a private waiting cubicle that is kept dimly lit to limit unwanted brain activity that may affect scan interpretation – but each with a comfortable lazy-boy chair the patients often drift-away, which is ‘first-prize’ according to the technologists.
The procedure room is stocked with all the examination-room essentials as well as a treadmill for myocardial perfusion testing, which the doctor performs personally. In case of emergency, the unit is also has a fully-stocked resuscitation trolley and ample space for performing emergency measures. Fortunately this has not been required yet.
Other considerations include an onsite ablution facility for injected patient use while waiting and an all-you-can -drink coffee counter to rejuvenate the spirit (and blood sugar levels) after a long night of fasting.
TheraMed Nuclear truly believes in their promise of being ‘Patient-centred and doctor-tailored.”
Nuclear Medicine & PET-CT in a nutshell:
“Conventional nuclear medicine (incl. SPECT – the 3D-version), and PET are two sides of the same coin. Effectively you are injecting a pharmaceutical that has known chemical properties that determine its pharmacokinetic and pharmacodynamic processes. By adding a low dose radioactive isotope – lower than most x-rays – you can detect these pharmaceuticals and the process each one undergoes in the body. Essentially we are imaging the functional or physiological state of body, its organs, disease processes or malignancies as opposed to just its anatomy, as is the case in conventional radiology. Since these pharmaceuticals interact with their targets at a molecular level, Nuclear Medicine forms part of the broader field of molecular-imaging. Of all the molecular imaging methods currently available Nuclear Medicine has proven the most sensitive, with the most literature to support this, and depending on the specificity of the radiopharmaceutical, is also very specific. The only real difference between SPECT and PET is the type of radiation emitted and the detection method – requiring two different cameras.”Dr George Bennie
While all the services provided are beyond the scope of this article, information can be found at www.theramednuclear.co.za