A Successful Stress Test Beyond Meeting MinimumsPosted on: 05.30.19
The 85% minimum is well known for administering a stress test, but is it really achieving what you need? Are we best serving our patients if we push for that 85% minimum and no more?
There are many reasons for a patient to go through an MPI stress test, with each patient having their own story and set of circumstances. Our view is that the best possible stress tests are planned in collaboration with the patient and take their individual case into consideration.
There are other important factors to look at and some good reasons to go beyond minimums – let’s take a closer look:
The 85% minimum for stress tests
The main part of a stress test is the treadmill exercise portion, where the patient progresses through levels of difficulty. At a minimum, they need to reach 85% of their predicted heart maximum. This maximum is calculated using a formula based on their age and heart rate.
85% is the minimum expected to achieve an adequate test and for the technologist to give the injection of the radioactive isotope. In the field, most technologists tend to follow this 85% rule, give the injection immediately, then terminate the test.
However, there are so many other things besides that 85% that you should be watching. For example, the EKG, how well the patient is doing, their blood pressure and their METS. Also, if you can reach 90% or more instead, why not go for what you can? 85% is just a minimum and you have the potential to learn more and get better data to make better-informed decisions for the patient if you go for more (within reason, of course!)
“The validity of an exercise stress test with and without imaging regarding true sensitivity [negative predictive value] for ischemic heart disease is
1]Not only dependent on THR achieved/and or double product above intermediate hemodynamic response
2] But robust data clearly shows the significance of METS achieved and this must be reported in results so a provider can realize that despite negative imaging…METS <7 decreases sensitivity to rule out IHD, and clinical pre test probability should truly dictate whether invasive strategy is necessary for definitive diagnosis and prognosis”
These are some great points that can support the idea that there is more to it than meeting that minimum.
Here are some aspects that are vital to a successful stress test outside of that 85% minimum:
Communication with the patient
One of the most vital facets outside of that 85% minimum is your communication with the patient. In fact, how well you communicate can aid in achieving better than minimum results. For example, your preparation of the patient ahead of the test can make a big difference.
This includes communicating all of the information that will make them better prepared for the test and more comfortable during it. For example, here are some things you should talk with them about or help them with in preparation for the test:
- The clothing and footwear they should wear. Sometimes people are coming to a stress test straight from work and may not be wearing the most appropriate items. Let them know they will need clothing and footwear suitable for a treadmill.
- The procedure itself and how it will work. Patients are often nervous or feeling stressed over having to be tested. It can help if they feel confident that they know what will happen during the test.
- Set their expectations for what a stress test can and can’t tell them. For example, an abnormal result may point to a risk of CAD, but then again, a normal result doesn’t rule out the risk of a plaque later rupturing.
- How the treadmill works and getting a feel for it. Patients are usually much more comfortable if you give them the chance to spend a little time on the treadmill before actually starting the test. Some people will never have used a treadmill before and this can be a source of anxiety.
- A target heart rate for the test. See if you can get them to go for a stretch target, rather than simply a minimum, otherwise there is often a tendency for people to reach the minimum and decide they are done.
- Give them some level of control to help them feel comfortable. You can talk with them about their part and what they can do to have some control over the situation. For example, point out the emergency stop button and explain that they can hit it any time they feel the need. You can also help them out during the test by letting them know before the transition to each stage.
Communicating with the patient can also help for pushing them that little bit farther to get a good test done. Here’s what Andrea Brumfield, Lead Certified Cardiovascular Technician at Digirad has to say:
“Patients can reach the 85% mark easily within a few minutes if the patient is out of shape, but that doesn’t mean you get a good study by injecting at that point. Most won’t even have symptoms at all, so why not push them a little? Make them feel short of breath and fatigue. See how far they can push themselves (within reason). Personally, I won’t have the patient injected until at least 7.0-10.1 METS and that’s only if they are visibly working hard.
Communication is the key though. Talk with the patient about anything other than what they are doing at that moment and you’ll be surprised to see how much farther they can go.”
Give the patient something to focus on
It can help the patient to go further if they have something they can focus on while they do their test. Too many clinics have blank walls for patients to stare at with nothing to keep them occupied.
If you don’t have the option of facing equipment toward a window, put something engaging on the wall. We recommend interesting posters with scenery that might hold their attention, such as the one shown below.
Want a poster for your office? We are happy to send you a print of our posters if you don’t have any. Contact us here to request your poster.
There is more to MPI stress tests than simply meeting that 85% minimum. In fact, you may have a better test if you’re able to push above minimums, as well as monitor important aspects such as METs and EKG readings.
Communication with the patient is the key ingredient for a successful stress test. You can do a lot to prepare the patient ahead and ease any fears they may have about doing the test. You can also keep them informed during the test so that they are as comfortable as possible.
Often you can achieve much better than the 85% minimum just by communicating with the patient and giving them something else to focus on during the test other than their current situation.
Should you push past the 85% minimum? If you can do so safely, yes, absolutely.
How is patient obesity affecting cardiac imaging?Posted on: 05.16.19
Obesity rates in the United States are the highest in the world and a growing health concern. In fact, according to data published by the Centers for Disease Control, 67% of men and 62% of women are overweight. Thirty-four percent of women and 28% of men could be further classified as obese. It’s a contributing factor in numerous diseases like Type 2 diabetes, cancer, stroke, and coronary artery disease.
Because obesity puts patients at greater risk for a host of other medical conditions, they’ll ultimately require more tests and scans during their lifetime in comparison to leaner patients. When it comes to nuclear imaging, obese patients and the unique challenges their weight presents can further hinder an accurate diagnosis and an optimal treatment plan.
Imaging and obesity-related challenges
Consider something as simple as diagnostic testing. Most nuclear cameras are designed to accommodate the standard, ideal-weighted patient. With obesity rates climbing at an alarming rate, physicians need to think about whether their equipment can adequately serve this growing population.
Many of today’s SPECT cameras still have a maximum weight capacity of 250-300 pounds. This standard feature can make imaging impossible for larger patients and can put both the patient and the technologist at risk.
For example, an obese patient will have difficulty getting up on, positioning and balancing themselves, and remaining still as they lay on a standard imaging table. They’ll also have to turn over or step down from the table, which could be equally as dangerous. Obese patients have a different center of gravity, which is a significant safety concern that needs to be addressed.
Some SPECT cameras, like the Digirad X-ACT+, utilize the more patient-friendly, seated position, which all but eliminates the patient’s risk of injury from climbing up on, balancing, turning, and stepping down from a supine-positioned table. It also has a maximum weight allowance of 500 pounds, a larger gantry for ingress and egress, and handrails for support.
Orbital space, girth, and field of view
Another issue is reduced orbital space. If the distance between the patient and the detectors is not sufficient, the detectors may not be able to rotate properly. Especially when imaging larger patients, the risk of truncation occurs if the detectors are not able to clear the distance, or cover the girth.
Many of today’s SPECT cameras also have a fixed detector design, which challenges the ability to position the heart of an obese patient in the “sweet spot.” A leaner patient’s heart is more likely to be ideally positioned because today’s cameras are designed for their average body type.
With any size patient, a technician should be able to center the heart in the field of view with relative ease, like with the Digirad X-ACT+ camera. Once the patient is seated, the chair can be moved forward and backward and from left to right in order to optimally position the heart inside the field of view and with enough distance from the detectors.
Attenuation, radiation, and scan time
Images with excessive attenuation and scatter are also more prevalent with obese patients. Dense breast tissue, for example, in both male and female patients, makes it more difficult to acquire accurate quantitative information. Attenuation correction has significant diagnostic value for all patients, but especially obese patients. With it, image clarity and quality are improved, which can result in fewer false positives and fewer unnecessary cardiac catheterizations.
Radiation dosage and scan times for obese patients can be an issue too. While there are standard imaging protocols, they were created for an average weighted patient. Dosage calculations are higher and scan times are longer for obese patients, but those estimated amounts can miss the mark. A low estimate compromises the quality of the images and a high estimate unnecessarily increases the radiation burden to the patient.
The Digirad X-ACT+ camera not only performs attenuation correction with a radiation dose of less than five microsieverts, it also uses TruACQ Count Based Imaging™ software to calculate dosing and scan times. Without the guesswork, technologists can proceed with confidence and ultimately work to deliver higher quality images.
Many of the imaging problems that accompany obese patients can be overcome with the right equipment and software. In reality, though, technicians and cardiologists will simply work with the equipment they have to do the best job they can. At Digirad, we believe that every patient deserves the highest quality of care, regardless of their weight.
Digirad can help
The fact that an imaging system can easily accommodate obese patients may not be the sole reason you choose a camera. However, when that benefit is paired with state-of-the-art technology that can help deliver a higher level of quality of care for a broader group of patients, it’s hard to ignore.
Are all SPECT MPI cameras the same?Posted on: 05.13.19
It’s safe to say that SPECT is a well-established and widely used modality in diagnostic cardiac imaging. While some cameras may be younger than others or have more bells and whistles, is it also safe to say that they’re generally the same?
With rapidly advancing technology, the real question comes down to how; How much more convenience and comfort does a particular model provide? How much higher is the image clarity and quality? How much faster is the scan time and how does that affect the radiation exposure to the patient? Overall, how much difference do these answers make in the quality care you provide?
Anger vs. solid-state technology
The biggest distinction between a SPECT camera is its base technology, which can be either Anger or solid-state. Anger technology gamma cameras use vacuum tube photomultipliers (PMTs) and hygroscopic sodium iodide (NaI) crystals. These cameras were designed by Hal Anger more than 50 years ago. Although the technology is antiquated, there are a surprising number of Anger-based imaging systems still in operation today.
Solid state, on the other hand, is the more advanced technology that uses a pixilated detector. It provides benefits over Anger-based systems including, its compact and lightweight design, higher quality images, enhanced patient experience, and the ability to be employed in both fixed and mobile configurations.
For example, one of the most noticeable differences between solid-state and Anger is the size of the detector heads. Anger’s PMTs and NaL crystals require a significant amount of space. The solid-state detectors, however, are a fraction of Anger’s size and contribute to its more ideal, compact feature. The weight of a solid-state detector is also over 600% lighter than that of an Anger head too.
There are two types of solid-state nuclear imaging technology, direct and indirect conversion. Direct conversion uses cadmium zinc telluride (CZT). When the crystal absorbs a photon, it creates an electric charge directly, hence the term direct conversion. Direct conversion is effective but the manufacturing cost of CZT can be expensive.
Indirect conversion uses cesium iodide (CsI) with a photodiode. When a photon comes in contact with the crystal it produces light, which is converted to an electronic signal. This process is faster and the manufacturing cost of CsI detectors is significantly less than that of CZT.
With Digirad’s technology, each solid-state gamma detector is comprised of thousands of individual detector elements, or pixels. Each pixel is isolated from the other. When a scintillation event occurs on a particular crystal, its exact location can be quickly and accurately identified, making the detector substantially faster and more accurate.
Solid-state technology allows for lower levels of radiation to be used in imaging. And, attenuation correction can be performed using the same detectors for both the transmission and emission in a single sitting, thereby reducing scan time.
On the surface, many solid-state SPECT camera systems may look similar. But, if you compare their individual design, functionality, and features more closely, you’ll see that they can differ significantly.
For example, the Digirad X-Act+ camera uses CsI photodiode and employs triple head cardio-centric imaging. The Spectrum Dynamics D-SPECT camera uses CZT and relies on high efficiency moving column detectors. Both CsI and CZT crystals are effective, and both acquisition methods are fast imaging.
The distinguishing features are those that are absent. Although both types of detector geometries mentioned are efficient, moving columns have a higher potential for truncation.
Consider the fully integrated micro-low dose fluorescence attenuation correction feature of the X-ACT+. The D-SPECT imaging system does not offer any built-in process that identifies and corrects for soft tissue artifacts in their SPECT images. Given the fact that attenuation correction results in higher reading confidence, improved diagnostic accuracy, and a lower incidence of false positive studies, Digirad’s methodology is able to offer a significant improvement from a reliability, exposure, and cost standpoint.
In the end
All SPECT cameras are not the same. Whether it’s the number of detectors, technology, maximum weight supported, or the additional features provided – your best decision will be made by weighing the advantages and disadvantages of each model and manufacturer.
How does the Digirad Cardius X-ACT+ compare to the GE NM 530cPosted on: 04.18.19
On the surface, many solid-state SPECT camera systems may look similar. But, if you compare their individual design, functionality, and features more closely, you’ll see that they can differ significantly.
Whether it’s the number of detectors, the method by which they image patients, the maximum weight they can support, or the size of the imaging sweet spot, your best decision will be made by weighing the advantages and disadvantages of each model and manufacturer.
SPECT Imager Comparison: Digirad X-ACT+ vs. GE NM 530c
Comparison between the Digirad X-ACT+ and the GE NM 530c SPECT imagers
UPMC Launches First Mobile Xe-133 Lung Ventilation Scan System in the United StatesPosted on: 01.24.19
In a recent issue of Pediatric Insights, Michael R. Czachowski, MBA, CNMT, NCT, PET, ASCP(N), R.T.(N)(BD) (ARRT), discussed the idea and the execution of the first portable Xenon-133 lung ventilation exam performed in the United States on a patient in a pediatric cardiac intensive care unit.
Czachowski is the supervisor of the Nuclear Medicine and Molecular Imaging Departments at UPMC Children’s Hospital, where the groundbreaking procedure was performed. The process, which was implemented to allow technicians to perform portable ventilation lung exams in the CICU and to alleviate the need to move medically fragile patients to the nuclear medicine department, was made possible with the use of the Digirad Ergo™ portable nuclear camera.
Ventilation lung exams the CICU were previously prohibited because of the inability to safely deliver the Tc-99m DTPA (diethylenetriamine pentaacetic acid) aerosol and the risk of radiation contamination.
Collaboration overcomes obstacles
During a previous portable perfusion lung exam in the CICU, Czachowski’s team was questioned about the possibility of performing a portable ventilation lung exam. The challenge sparked some thought–and a lot of innovation among his team. Through much discussion, brainstorming, option searching, and evaluation, Czachowski and his collaborators agreed that the use of Xenon-133 gas in conjunction with the patient’s ventilator and the Pulmonex system was the most highly viable solution.
The Pulmonex system, which when used in the nuclear medicine department, safely captures exhaled radioactive Xenon-133 through a lead-lined trap. The hurdle was finding a way to capture the gas from the patient, contain it, and maintain the patient’s ventilator dependency, all while remaining in the CICU.
Leveraging the expertise of Alvin Saville, RRT, Respiratory Education Coordinator at UPMC Children’s Hospital, a tubing adaptor placed between the patient’s ventilator circuit and the endotracheal tube was added. It successfully trapped the patient’s exhaled radioactive Xenon-133 inside the Pulmonex system, which ensured a safe environment for the patient, staff, and family.
Innovation pays off in the CICU
In April 2018, after months of development and testing, the successfully modified system was used for the first time on a patient in the CICU. Although they continue to refine the protocol, “to do the lung ventilation exam with no interruption of the patient’s physiological and physical environment in the CICU or elsewhere is quite an accomplishment,” said Czachowski. It has created a seamless process that is both safe and efficient.
You can find the original announcement about the First Mobile Xe-133 Lung Ventilation Scan System in the United States here.
How to Reduce Gut Activity with Myocardial Perfusion ImagingPosted on: 11.15.18
We’re all familiar with the obstacles that radiotracers and subsequent gut activity presents during Myocardial Prefusion Imaging. When the radioisotope expands beyond the coronary arteries, it’s difficult to obtain quality SPECT MPI imaging of the heart. It’s a common problem that plagues many patients and physicians. So what do we do?
We’ve heard of everything from half & half, cold water, and even a certain type of soda post injection to reduce the dreaded gut activity. Since we weren’t aware of any tried and true solution, we polled our fellow nuclear specialists on LinkedIn to see if they could provide some tips, tricks and home remedies.
Wait Time is always going to be your best practice to assist with clearance but if that or your go-to response doesn’t always work, check out these suggestions and add them to your list:
If it is a bowel loop, we give them another cup of cold water and have them walk the hallway if they can. If they have a hiatal hernia or liver disease, we give them a longer wait time prior to scan to try to avoid the need for rescan. And we ask them all not to lay down, but to sit up instead when possible when waiting.
In my experience, the most effective method for reducing gut uptake and obtaining separation from the inferior margin is the combination of walking and ice cold water consumption. I have also heard of technologist giving patient’s Boost/Ensure after rest dosing and obtaining great images. This is done at the discretion of exercise stress, however.
Additional cold water – approximately 8 ounces. Drink fast. Walk around for 5-10 minutes, then have the patient lay on their right side to see if the loop will pull away from the bottom half of the heart. I had a tech that worked for me that came from Ohio State, and they would try this. Sometimes it would work and sometimes it wouldn’t. Always feed them. That, of course, helps for most.
We find that waiting is the best remedy but not always practical. Cold water gulped down for resting scan. Snack and a drink for the stress scan. Sometimes, particularly with hot livers, lying the patient on 2 pillows behind the shoulders, raising them will drop the activity away from the heart.
I have used carbonated sodas if walking and drinking water didn’t help. I used to use Diet Sprite, but I guess ginger ale is an option too. For stress images, fatty foods, ice cream, coffee, anything that helps bowel movement.
I’ve often placed a broad strip of pliable soft lead shielding over the patient’s abdomen at an angle, and this has often helped mitigate proximal intestinal activity. Otherwise, if you have the time, waiting 45-60 minutes post-injection to perform resting MPI has been fairly beneficial.
I like for my patients to have a drink of their choice (soda, water, coffee, etc.) and some crackers or small snack before their stress images. Some water only before rest images. Extra wait time for Cardiolite vs. Myoview, especially for liver clearance.
Practical pre-authorization tips for nuclear imagingPosted on: 10.25.18
In today’s economy, everyone is looking to save money and reduce costs, including insurance companies. This has translated into an increasing level of scrutiny when it comes to ordering nuclear imaging studies.
Pre-authorization is now an accepted part of the process, but the requirements and rules are getting more and more complex. In this post, we’ll take a look at ways to better navigate the process.
The pre-approval process
The pre-approval process is used by health insurance companies to verify that certain drugs, procedures, and services are medically necessary before they’re completed.
The quickest way to gain approval is through strict adherence to appropriate use criteria, but it also requires detailed, clear, and complete documentation in the patient’s clinical record.
Documented records should include the patient’s chief complaints, diagnosis, and the results of prior testing that are consistent with a particular treatment plan.
Major roadblocks and how to avoid them
One of the major hurdles is the amount of time that pre-approvals consume and thus detract from other patient-centered tasks in the office. It’s important for staff to have all the information handy before they start the process. The insurance company will have detailed questions, and the staff will need to provide the appropriate answers in a timely manner.
If an insurance company representative senses any lack of confidence, disorganization, or hesitation on the part of the office staff, they can use that to their advantage, which can quickly slow down the approval process.
It’s expected for insurers to require additional information, and sometimes a peer-to-peer review, when the conversation offers up the opportunity to ask for more. You need to be prepared for the possible roadblocks ahead of time.
If your organization is large enough, staff members tasked with managing pre-authorization can work at developing relationships with insurance representatives from particular companies. Leveraging that relationship and specific payer protocol is a smart idea. Chances are they’ll have a higher rate of success because they’ll know what the insurer is looking for and how to manage it.
The benefits of outsourcing pre-authorization
Frustration and the time investment are some of the most common reasons a practice gives up pursuing in-house pre-approval. To combat those hurdles, many practices outsource the approval process to a third-party, like MDBoss for instance, who specializes in pre-certification.
For a practice that lacks the manpower, does not have experienced staff, or the time to spend on the phone with insurers, it can be a cost-effective solution. Many outsourced providers charge based on a per-study basis so even small clinics can leverage the service without worrying about minimums or expensive retainers.
The insurance landscape is continually changing. Many insurers are hiring third-parties themselves to manage their approval process. There is also a push from some insurers, like Humana, BCBS, and Cigna, for locations to become approved test sites. It requires a lengthy summary that includes camera serial numbers, staff credentials, certifications, and other key information, that can easily overload small practices.
The pre-certification or pre-authorization process is an essential part of the services that a physician’s office provides to their patients. There are ways to make the process run smoother, but it takes time, dedicated staff, and a lot of patience.
If your in-house attempts are not producing the desired results, determine the most common hurdles and work quickly to overcome them. It’s in the best interest of your business, your patient’s health, and their financial well-being.
A Closer Look at the Digirad Ergo (Infographic)Posted on: 08.23.18
Seven mistakes to avoid when choosing between a new and refurbished nuclear cameraPosted on: 04.26.18
With the continual advancements in healthcare technology and service, investing in your cardiac practice, upgrading equipment, and improving efficiency is an ongoing process. One of the most significant considerations is not only when to replace a camera, but also if refurbished, or new equipment might be a better decision.
It’s important to take the time to look beyond your immediate imaging needs and consider the long-term goals of your practice. Both refurbished and new camera systems come with advantages, but be sure to consider these factors before signing on the dotted line:
1. Focusing only on purchase price vs. the long-term cost of ownership
A nuclear gamma camera is a significant investment for any practice, so it’s natural to focus on the cost. There are times when prioritizing price is a smart idea, but only when the product still retains an acceptable level of value. There are many refurbished cameras that have a considerable amount of life left and could be a wise investment.
When you evaluate new versus used equipment, consider how much image quality has improved in recent years, the availability of new software programs, and the viability of the camera’s current operating system. When the camera is in need of repair, will parts be readily available and will the manufacturer agree to service it? Some manufacturers include a firm end-of-service date on their equipment, which leaves you at the mercy of third-party service providers and replacement parts. Some service companies may even decline service because of age, limited part availability, and the associated risk.
2. Overlooking the ability to maintain image quality
Older, refurbished cameras may undoubtedly be in working order, but their boards and analog methodologies could be less effective. With age, the camera’s light pipe, which includes crystals that eventually yellow and crack, will no longer respond, sometimes without warning. Replacement crystals for older cameras may not be available. Even with newer refurbished cameras, the crystals have already aged, may be hydrated, and are potentially unfixable. Be sure to inquire about and examine the crystals if you’ve considering a refurbished camera.
3. Putting your HIPAA compliance at risk
Another important factor to consider is HIPAA compliance. Many refurbished cameras cannot be upgraded to current software versions, and, because they’re no longer supported by the manufacturer, they can’t they be patched securely. Consequently, the camera cannot be connected to a network because internet access imposes new risks. You also may not be able to add additional processing programs and, in the end, may be forced to purchase an entirely new software package, which will be costly.
4. Not factoring in the credit rating of the practice
While many physicians may have excellent credit, they may not be willing to put their personal credit history on the line when purchasing capital equipment such as a nuclear gamma camera. Instead, they opt to leverage the business credit, and this can have a direct impact on the approval process and interest rate.
If the practice does not have an extensive credit history, it’s more challenging to secure a loan, and interest rates are likely higher on pre-owned equipment. Additionally, if a financial institution feels that you may have issues with part availability on refurbished systems, they may be hesitant to approve a loan for older medical equipment. Be sure to discuss the details and get loan pre-approval before the sales process begins.
5. Failing to consider the true patient volume
Volume is another important factor to evaluate when deciding between used or new equipment-or even whether to outsource your imaging services completely. Not all cardiac practices need a camera on site five days a week. If you’re imaging one, two, or even three days a week, you might consider partnering with a mobile imaging company.
Your volume should factor into your financial investment. Without it, the lack of revenue wouldn’t warrant spending dollars on maintenance costs and might eventually lead to a decline in the integrity of the equipment.
6. Purchasing camera that offers limited use
Any new or used camera that you plan to purchase should be able to expand and grow with your practice. A camera should be able to fill your current imaging needs, but also serve your practice in other ways. Would it lend itself to increased productivity, improved efficiency, and greater patient satisfaction? Sometimes it may be worth the extra investment if it allows you to move forward on another strategy that has the potential to increase revenue or to reach other goals.
7. Not performing your own due diligence
Lastly, knowing from whom you’re purchasing your equipment is of critical importance. An investment of this size should only be made through a reputable company with a proven track record, especially if it’s a refurbished camera. Prepare a due diligence checklist and take the time to get better acquainted with the camera, just as you would with a home, used car, or any other purchase in the second-hand market. Ask to see it, or have it inspected by an independent service company, and ask for the repair and maintenance records.
It’s well within your rights to investigate the camera’s history, current value, and the likelihood of any future issues before making a final commitment. If you don’t, you’re exponentially increasing your chance of winding up with a lemon and having no recourse.
Cost shouldn’t be the only consideration when buying a camera. It may be high on your list, but the value it brings to your practice should be well worth the money you spend.
Intraoperative benefits of Ergo touted in the Journal of Pediatric SurgeryPosted on: 03.15.18
The portability of the Digirad Ergo Imaging System is making a significant impact in the pediatric oncology world. The Journal of Pediatric Surgery recently published an article on its intraoperative use. Most notably, it reported on how nuclear imaging with the Ergo effectively reduces the time under anesthesia and offers real-time confirmation of lesion removal. Digirad recently spoke with Dr. Marcus M. Malek of Children’s Hospital of Pittsburgh of UPMC, to further elaborate on the study.
Single environment reduces time under anesthesia
In order to guide lymph node biopsy, pre-surgery lymphatic mapping is done via lymphoscintigraphy. Adults and teens are generally able to tolerate the procedure while awake. It does, however, involve an injection and the need to remain still, which can often be difficult for a child. For that reason, young pediatric patients, and some adults for that matter, are sedated and mapped in the nuclear medicine suite and then transported to the operating room. The additional step takes a considerable amount of time and coordination, which leads to downtime in the OR.
The portability of the Digirad Ergo allows the patient to be anesthetized while they’re in the operating room. Prior to the start of the surgery, the nuclear medicine technologist or physician injects the radiotracer in standard fashion. After the tracer has moved to the area of interest, the Ergo acquires the images needed for the lymphoscintgraphy. Once the sentinel nodes are marked and the area is prepped, the surgery can begin without delay. When the procedure and the surgery are done in one environment, it’s safer for the patient, spares them additional time under anesthesia, and alleviates the need for transport.
Visual confirmation in real-time
Beyond reduced anesthesia time, a camera in the operating room allows the surgeon to confirm the lesion of interest has been removed in real time. Certainly, a preoperative lymphoscintigraphy can help with mapping, but it cannot visually confirm the lesion’s removal. The Ergo allows confirmation of lesion removal or, in some cases, identification of lesions that were thought to be removed or hidden behind another. Visual representation is a fail-safe that ultimately improves surgical outcome.
In the past, some have equated portability with lower quality images, but the Digirad Ergo doesn’t trade one benefit for another. It delivers high-quality images that technologists say rival any static nuclear camera and its compact, portable design offers maximum clinical versatility.
Read the full article, Use of intraoperative nuclear imaging leads to decreased anesthesia time and real-time confirmation of lesion removal , at the Journal of Pediatric Surgery.