Molecular Musings

Dirtier than a Toilet?

2008-05-15T16:01:00Z

Have you looked at your keyboard lately? I usually don't, unless I accidentally spill something on it. Then I read in an article on ABC News about a study by a microbiologist in the United Kingdom that showed that the typical office keyboard had contamination by a host of potentially harmful bacteria at levels that were up to five times dirtier that the toilets he also measured.

So I took a look at mine and discovered that months of eating at my desk definitely showed in the crevices of the keyboard. Luckily, I am the only one using my keyboard, so any cold or other virus germs that get on the keys are unlikely to spread. But what about the keyboards in the radiology or nuclear medicine departments, which may be used by several people. Now that computers are ubiquitous in medical imaging departments, what is being done to prevent the spread of germs from keyboards and computer mice to staff and patients?

While medical personnel know to wash their hands between patients, are they also washing after using computer equipment? A few years ago, there were concerns about the spread of germs from phones that were used by multiple users and some places began using wipes to decontaminate the mouthpieces. Should there be a box of wipes next to your computer as well? Will they interfere with the electronics of the system? How do you get at the stuff between the keys?

It turns out that it might be possible to wash the keyboards and mice. Indeed, according to a June 14, 2007 broadcast on National Public Radio, some people have even tried washing their keyboard in a dishwasher. A better solution might be pay a little more for one of the antimicrobial washable keyboards that companies are designing for use in hospitals. For instance, PR Newswire had an article on Feb. 12, 2008 announcing a fully submersible dishwater safe keyboard to help prevent the spread of MRSA in hospitals. A washable computer keyboard even allowed the clean up of a Maalox ® spill, according to a Sept. 25, 2006 article on Business Wire.

There are other manufacturers of washable keyboards and computer mice as well. While I don't think I will need to replace my keyboard, I do think I might recommend my daughter look into a washable keyboard for her computer, because it may be a source of the colds and flu bugs that seem to be passed around between the members of her family. If I was still working in a hospital environment that had multiple users of a single keyboard, however, I think I would be looking into getting a washable keyboard and computer mouse, or at least wearing gloves when using the keyboards.

Is your Hospital Ready for a Disaster?

2008-05-07T20:19:00Z

According to a May 5 report from Reuters news service, a one-day snapshot of emergency room conditions at 34 U.S. hospitals shows they are all overwhelmed and none is prepared to handle a big event like a disaster or attack. The snapshot, which included seven major cities---New York, Los Angeles, Washington, Chicago, Houston, Denver and Minneapolis---was performed in all 34 emergency rooms on Tuesday, March 25 at 4:30 pm local time. Using the information from this report, various news agencies then questioned if the United States was capable of responding to a terror attack similar to the train bombing in Madrid.

What I found most interesting was that just one month later, and before the May 5 report, at least one community hospital showed it was capable of handling such a sudden influx of disaster victims coming in at 4:30 pm. Of course I am talking about Sentara Obici Hospital in Suffolk, Va. As I reported on our website in "Dealing with the Aftermath," a tornado, which just missed the hospital, sent 70 patients to the hospital's ER.

Thanks to disaster preparedness, the hospital was able to provide excellent care to the victims.

When I was working as a NM technologist at a small community hospital, we had a situation where there was a sudden influx of patients to the ER because of a chemical release at a nearby plant. Although we handled the patients well, there was some confusion at first because we had never practiced our emergency preparations.

Do you think your hospital is ready for a disaster? Could it handle a sudden influx of 70 patients as well as the staff of Sentara Obici? Do you know where to look to find your hospital's written procedures for emergencies? Have you had any practice runs?

If you have any suggestions for improving hospital readiness for emergencies, we would love to hear from you.

Heading to the Big Easy?

2008-04-30T20:52:00Z

I just got my airplane reservations to fly down to New Orleans this June 14 for the SNM annual meeting. I am looking forward to the conference which allows me to learn the latest research in nuclear medicine and PET and to connectwith old friends and make new ones.

To tell the truth, I am also curious about how the Big Easy has changed since the last SNM conference, before the hurricane drowned much of the city.

I remember walking the long hallways of the convention center that later became a sort of trap for some of the residents fleeing the flood.

I have talked to some of our editors who have been at meetings in New Orleans during the last couple of years and they say the city is mostly recovered, at least in the tourist areas, and that the conference facilities and restaurants are as good or better than before.

Of course, the main reason to go the annual meeting is to learn more about where nuclear medicine is heading in the next few years. It seems that at every meeting there is some new and exciting advance, from fused systems to new radiopharmaceuticals. This year I expect to see SPECT/MR in the exhibit hall and maybe get a glimpse of a new targeted imaging agent-perhaps a SPECT Alzheimer's plaque imaging agent.

I also look forward to the social events, such as the opening ceremony in the exhibit hall, the technologist party and the traditional technologist game show, which makes learning such fun.

Of course, one of the best things is meeting with our readers and finding new contributors to our magazine.

So, if you are coming on down to the Big Easy, be sure and stop by the ADVANCE booth and leave me a message or stop me in the hall and let me know what you want to see on this blog or in the magazine.

See you there.

My Experience Irradiating Bugs

2008-04-21T21:45:00Z

On Saturday night, I was watching "Myth Busters" with my grandson. This week, they were trying to bust the myth that cockroaches would be the only thing living after a nuclear war. To test this, they put four different bugs, including fruit flies and roaches, into four containers each and had them irradiated with the cobalt source at Pacific Northwest Laboratories. The doses to the cubes were 100 rads, 1000 rads and 10,000 rads (I seem to remember). The final containers were controls with no radiation.

The Myth Busters then checked to see how many insects lived in each situation over a 30 day period. Unfortunately, I was called away before the end so I did not see if the cockroaches beat out other bugs for survival, but it did bring to mind the first time I ever worked with radiation, which was in an after school course in genetics when I was in high school. This was part of an effort to catch up to the Russians, who seemed to be ahead of us in science at the time, having been the first into space with the launch of Sputnik on Oct. 4, 1957.

This was the spring of 1958 and there was a lot less information on the affects of radiation, although it was common knowledge that at certain levels it could cause mutations in offspring.

I don't know how he got it, but our instructor had a cobalt source for us to use in radiating fruit flies so we could see what kinds of mutations it caused. I suppose that the NRC regulations, if that agency even existed then, weren't as strict in those days.

The problem was that genetically pure fruit flies cost money. Since he did not know exactly how much radiation the fruit flies could take without dying, and didn't want to sacrifice the more costly ones, he asked those of us in the class to catch any fruit flies we saw at home and bring them in so we could experiment on them.

I told my mother, Marion MacLeod, and asked her to try to catch any she saw.

Now my mother was the type who would think nothing of handling the bugs and snakes my Dad's boy scout troop was always bringing into the house. But imagine my Dad's bewilderment when he came into the kitchen one day and my mother excitedly exclaimed, "Oh, Jim, there's a fruit fly, there's fruit fly, what am I going to do with it?"

My Dad's response was to take his middle finger and gallantly save her by squashing the offending bug.

Well, that was one less fly for our experiment, which never-the-less was very fascinating.

It wasn't until about 25 years later that I decided to go into training as a nuclear medicine technologist, but I think my fascination with medicine and the uses of radiation started with that class.

Did the Earth Just Move?

2008-04-18T19:27:00Z

I was just trying to get in touch with my sister, who lives in Michigan, to see if the earth had moved under her feet earlier today because of the earthquake in the Midwest. Although the Midwest is not known for earthquakes, one of the biggest faults runs through the middle of the country. This quake was a 5.2 with an epicenter near Evansville, Ind.

The news said that the earthquake could be felt as far as Michigan, but there were no reports of major damage even near the epicenter. Since it happened in early morning, about 5:30am EST, most people probably didn't even notice it.

It reminded me of the only two times I had been anywhere near an earthquake. The first time I was driving and did not find out about it until I got back to work at the hospital where I was a NM tech. Everyone there was saying they felt the earth move a little, but the vibrations of the car must have overwhelmed any small vibration. I was a little disappointed to miss the experience.

The other time, I was attending the Society of Nuclear Medicine Annual Meeting in San Francisco. I think it was in '87 or '88, and I was giving a scientific paper presentation.

My daughter (19 or 20 at the time) had come along with me and I took one afternoon off to take her to the Great America Amusement Park in San Jose, which was a bit of a way from San Francisco.

We had just gotten off the rollercoaster and were looking for souvenirs near the base of the coaster when there was a tremendous roaring noise. The building started shaking and stuff started to fall off the shelves. I thought, "Gee, that rollercoaster comes awfully close to this shop." It took a minute and a look at the panic on the shop assistant's face to realize that what I took to be a coaster was really an earthquake. It turned out to be a 6.2 quake located fairly close to the park. Luckily, it was in a rural area, and there was only some property damage and no casualties. I was glad I had already gotten off a ride, because many of the people were stuck on them for nearly an hour until it was determined that they were not damaged.

When I got back to San Francisco, I was expecting to see some damage but everyone I talked to there said they had barely felt it.

So, I suppose that an amusement park is probably the only place where you can be in a earthquake and not know it, because everything seems to be shaking and roaring all the time.

What Did I Want in the Refrigerator?

2008-04-16T21:30:00Z

Next Monday will be my 66^th birthday and while I think my mind is as sharp as it used to be when I was a spring chicken of 55, I sometimes find myself forgetting where I put my keys or why I went over to the refrigerator. These small lapses are not new. I have been searching for my keys and sometimes trying to remember why I went to the refrigerator most of my life, but as I get older, I wonder if it is happening more and if it might mark some beginning of "oldtimer's disease."

Now contrary to what some young people believe, I know that anyone can have moments of forgetfulness, especially when they are busy, and that even 90 year-olds can sometimes be sharper than those half their age.

For instance, at the funeral of my great aunt Nora, who lived to 95, the minister told about a spelling contest that he had conducted at the senior center just a few months before. He had thought that Nora spelled one word wrong, but she said, "I was a teacher most of my life and I know how it is spelled." When he looked it up in the dictionary, she was right and he was wrong. Yes, Nora, along with most of my other older relatives, remained sharp as a tack, even into her 90s.

I also have had experience with seeing some older friends of the family cope with the ravages of Alzheimer's in their 80s and 90s, so I am following with interest research in creating radiopharmaceuticals to image the amyloid plaques that are associated with, and may be the cause of, Alzheimer's disease.

That is why I was attracted to a press release today from the University of Pittsburgh noting that William E. Klunk, MD, PhD, and Chester A. Mathis PhD, were awarded the 2008 Potamkin Prize at today's annual meeting of the American Academy of Neurology in Chicago. Considered by some as the "Nobel Prize of Neurology," the award is given to researchers who have made outstanding contributions to the study of Alzheimer's disease and related dementias. Dr. Klunk and Dr. Mathis won for their work on the Pittsburgh compound, an targeted Alzheimer's plaque imaging agent.

The $100,000 prize, which will be shared between the Pittsburgh researchers and Clifford R. Jack Jr. MD of the Mayo Clinic in Rochester, will be used toward continuing Alzheimer's research, according to the press release.

It makes me proud as a nuclear medicine technologist that nuclear medicine and PET is leading the way in helping to diagnose Alzheimer's, hopefully at an earlier stage, where it might be controlled or even cured. I am also optimistic that by having imaging agents that can quantify changes in plaque deposits, researchers will soon be able to find treatments to delay, or even block, the formation of these plaques.

It gives me hope that, when I reach my 90s, there will be treatments available that will help me keep my mind as sharp as my Aunt Nora's was.

Canadians Protest PET Restrictions

2008-04-11T18:52:00Z

When you look at some of the arguments for a national health care, our system is often compared unfavorably with the national health system in Canada. Generally, this is done by people who have never had to deal with that system first hand. Now it is true that many people benefit from their system, but a look at how many Canadians come over to the U.S. for healthcare they cannot get in Canada shows the other side of the story.

Take, for example, the ability to have a PET scan to stage oncology patients, so that the most appropriate treatment can be given. Although not every PET scan for cancer is covered here, the major cancers are covered and others can be covered if they are part of a study protocol.

In Canada, not only are PET machines very limited but, in some provinces, PET is limited to research, so only a handful of Canadians can take advantage of this technology, unless they want to come to the U. S. and pay for this service.

According to a story in yesterday's Globe and Mail:

Ontario's Ombudsman is investigating the provincial government over complaints that restricted access to PET scans is unjust--and even compromising the care of cancer patients.

At issue is Ontario's restricted access to positron emission tomography scans. The province says it is studying how best to use them. But doctors say the issue has already been well studied, the scans are widely available in other provinces - and many Ontario patients are being denied access to a crucial test.

According to the article, Quebec, which is next door to Ontario, provides the best PET coverage. Some other provinces also cover PET but have few installed systems. Ontario, however, which is the home of the Canadian capital city of Ottawa, only provides access to the 11 PET scanners in the province through clinical trials or special access. The limitation of this policy is shown in the next statement from a health ministry spokesperson that "2,575 cancer patients have obtained PET scans since May, 2004." Less than 2,600 in all this time in Canada's most populated province?

Now as an older American looking to retirement, a free national healthcare system seems like a blessing. Then I look at some of the pitfalls in national health and I am glad that if I need it, my access to medical care is limited only by my insurance coverage and my ability to pay, not by my proposed value to society, as happens in rationed systems.

Dealing with Questions

2008-04-04T18:09:00Z

Over on our March 14th Mammography Matters blog, Wanda Francisco discussed dealing with the questions of patients who wanted to know what they were seeing on the screens of the new digital mammogram machines .

It seems that some of the digital mammography systems allow the monitors to face the patients and she wanted to know how mammographers dealt with patients questions.

While CT, MR and even PET systems have the monitors in separate rooms, nuclear medicine SPECT cameras often put the processing systems, including the monitors, in the same room as the patients.

Many years ago, when I was working in nuclear medicine, my SPECT system had processing and imaging monitors facing out into the imaging room where they were visible to anyone accompanying the patient and even to some of the patients, for instance the renal patients sitting with their back to the camera for a dynamic study.

The problems came when someone accompanied a patient for a bone scan and the images on the monitor showed a lot of intense uptake in multiple metastases. Even those with little knowledge of anatomy or nuclear medicine could get an idea that there was definitely something wrong. Because there was no way to turn these monitors in another direction, I would usually darken the monitor during any scans where the images might cause concerns if seen by others in the room.

When asked what I saw, I would say that the images needed processing before the doctor could interpret them.

Other times, I would get a patient in for a thyroid scan because a lump or enlargement in the thyroid caused concerns of possible thyroid cancer. They would also ask what I saw. I hated to send them home worried, when it was pretty obvious from the image that the nodule was something benign. Since I could not answer their question, I instead explained there are a lot of different reasons for a thyroid to be enlarged and most of the time it was not cancer but something else that could be easily treated, so they should try to not to worry too much while they waited to hear the results from their physician.

Of course, it was not nearly as easy when a physician came by and wanted to know what I had seen on a scan they had ordered. I would say "Dr XXX has not read the study yet", but they knew that I had the knowledge to read most scans. I know that many technologists have had this problem, as a few years ago the SNMTS did a survey in which most technologists replied that they had indeed been asked to give opinions on scans.

Are your imaging monitors visible to patients at your hospital? Have you even been asked by a physician to give an opinion on a scan? If so, how do you handle the questions from patients and physicians at your facility?

This Time It's Cell Phones

2008-03-31T20:39:00Z

In this weeks top story Calming Fears, I discussed the difficulty that most people have in accurately assessing risks, sometimes fearing small risks, such as that of being near someone who has had radioiodine therapy, while dismissing larger risks, such as those of smoking. I also discussed the role media plays in sensationalizing stories about certain risks.

Today, press stories are fanning fears about cell phone use, based on a the unpublished work of a single English physician that contradicts the findings of the American Cancer Society, which are based on peer-reviewed published studies. Indeed, the press (including Fox News.Com and New York's Daily News) even go as far as quoting the doctor, Vini Khurana, as saying that "It is anticipated that this danger has far broader public health ramifications than asbestos and smoking." To make this assumption he noted that 3 billion people worldwide use cell phones, while only 1 billion smoke.

Wait a minute, later in the full article, as published in the UK paper the Independent, it notes that some 5 million people worldwide die of cancer each year. Now since the ACR reports that 4 times as many people get malignant brain cancer from metastases as get any sort of primary brain cancer (benign or malignant), Dr. Khurana's statement seems a little off, especially since the primary cause of metastatic brain cancer is from lung and breast cancer.

Furthermore, the National Cancer Institute (NCI) Cancer Statistics Review puts a lifetime risk of developing cancer of the brain or other nervous system at 0.6 percent. Based on statistics for the same time frame (2002-2004), the NCI puts the lifetime risk of developing cancer of the lung (for the entire population, not just current smokers) at 6.98 percent.

Indeed the American Cancer Society has this to say about cell phone use:

"This has been the subject of a huge number of studies, most of which find no connection with brain tumors. A few studies, mostly from Sweden, suggested that people who used cellular phones extensively for many years did have a higher risk for brain tumors. Some studies also suggest there may be some increased risk of brain tumors from long-term use of analog phones, an older kind of cellular phones that have been replaced by newer digital phones. Most experts feel that more studies are needed before coming to any conclusions."

Indeed, results from a multi-national study did find one Danish study, which suggested a increased risk of a benign acoustic neuroma in long-term cell phone users, it did not see any increase in short-term users. Furthermore, other studies showed no increased risk from cell phones of more malignant cancers such as meningioma or glioma.

Although all the cancer groups say that there needs to be further studies to accurately define if there is a risk from using cell phones, the debate is certainly not helped by sensationalizing a single study that has not yet met peer-reviewed scrutiny. Indeed, in my opinion, the public is not well served by this story or by any other press reports, such as CT radiation concerns or radiotherapy concerns, that are based more on conjecture and sound-bites than on facts.

Thoughts from the Other Side of the CE Table

2008-03-26T17:12:00Z

As you are aware, ADVANCE News Magazines holds job fairs and career events in venues all over the country. Free continuing education courses are offered as a part of the event and the company likes to have some of the editorial staff participate in these events, generally hosting the various speakers and acting as a room monitor to validate CE participation. This gives us a way to have personal contact with those of our readers who are attending the event. It also fulfills the requirements of the certifying agencies that the participants did attend the entire lecture.

At the end of the session, it is our duty to stamp forms to verify this attendance. For popular sessions, the line for the stamping can sometimes get rather long as people rush to get to the exhibit hall or to the next session.

Yesterday, I worked the CE table at the King of Prussia Job Fair. At the end of the day it was my duty to hand out certificates for each of the sessions that participants had attended. At the end of the day, it seemed to me like there were a dozens of hands simultaneously presenting their stamped forms and requesting their certificates. Luckily, I had help, and things went smoothly. It got me to thinking, however, about all the times that I, as a technologist, was on the other side of the table when attending CT events, such as local SNM meetings. Sometimes, when you are hurrying to the next event, it can seem like it is taking forever to get your attendance sheet stamped or to have your card scanned.

Now that I am on the other side, performing the accreditation tasks, I appreciate the work of my fellow technologists who have generously volunteered their time to perform these monitoring duties during SNM local and regional educational sessions.

For many years, the NMTCB did not require CE credits, and the ASRT accepted self-reported attendance at some of the SNM meetings. Now, both certifying agencies require monitoring and attendance verification of all CE activities.

If it were not for volunteers helping with this attendance verification, CE education at local or national society meetings would certainly cost more, and fewer sessions might be available.

With the SNM annual meeting coming up this June, have you considered offering your services to help with introducing speakers or monitoring sessions? You might not have the time to work on a committee or to take an office in your local or national society, but there are always opportunities to help.

The next time you attend a local, regional or national meeting, consider letting the organizers know that you will be willing to help for a few hours, if needed. For instance, there is always a need for people to judge the posters or papers at the SNM annual meeting. Of course, the officers of the societies do many of these jobs; however, they also have sessions to direct and other duties to perform.

If it seems to you that the same people are always doing all the work in the organization, consider helping them out. Who knows, you might just find you enjoy the opportunity.

When I was talking to David Gilmore, MS, CNMT, NCT, RT(R)(N) the current president of the SNMTS, he told me that he got his start by helping with at local meetings, doing whatever was needed. This eventually led to advancements within his professional life, as well as within the society. You too may find friendships and opportunities by volunteering to help your societies. Why not contact a local representative and volunteer today?

CMS Strikes Out FDG for Infection Imaging

2008-03-21T15:53:00Z

In the battle to get CMS to understand the value of diagnostic imaging, this month saw one gain, the decision not to limit CTA imaging, and one loss, a decision to continue national non-coverage of FDG PET for infection and inflammation imaging.

Explaining this decision, the CMS cited lack of interest in the FDG PET imaging by both orthopedic surgeons and infectious disease specialists as part of their determining factor.

Summing this up the CMS wrote: "This leads us to reasonably determine that the interest in the use of PET for these indications is narrow and does not apparently include the physicians who routinely manage the care of beneficiaries who have these conditions. Thus, we have determined that FDG PET is not reasonable and necessary for these indications."

In addition, the CMS still seems does not seem to understand the role of diagnostic imaging as they are still focusing on improved health outcomes as the deciding factor, stating:

"Based upon our review CMS has determined that the evidence is inadequate to conclude that FDG PET for chronic osteomyelitis, infection of hip arthroplasty and fever of unknown origin improves health outcomes in the Medicare populations and therefore has determined that FDG PET for chronic osteomyelitis, infection of hip arthroplasty and fever of unknown origin is not reasonable and necessary under Section 1862(a)(1)(A) of the Social Security Act ."

Although some FDG-PET studies for non-covered cancer applications are being reimbursed, when they are performed under certain study requirements, the CMS further determined that: "CMS has also determined that the request for coverage is not appropriate for the Coverage with Evidence Development (CED) paradigm."

This is a double blow to those working on imaging infection and inflammation with PET, because it will now be more difficult to collect the evidence needed to reverse the CMS non-coverage decision for this indication.

CTA Victory Also Helps Fusion Imaging

2008-03-18T19:47:00Z

At first glance, the furor over reimbursement for CT angiography (CTA) may not seem to be something that concerns nuclear medicine technologists. After all, the CT experts often predict that CTA could replace some of the current myocardial perfusion scans that are the bread and butter of most nuclear medicine departments. With fusion imaging moving to PET/CT and SPECT/CT systems capable of doing CTA, the March 12 decision by the CMS not to enact binding restrictions the use of this technology for coronary artery disease is cause for celebration, because it means that the growth of these fusion systems will not be constrained.

The old adage, "we must all hang together or we will certainly hang separately," holds true for other reasons as well. Reimbursement determinations restricting one application of medical imaging can lead to even more obstacles in getting new imaging techniques or radioisotopes approved for nuclear medicine imaging. Indeed, the argument the CMS used for restricting CTA echoed the "prove that this procedure improves medical outcomes" that were used to restrict reimbursement for PET imaging.

The CMS still does not seem to understand that diagnostic imaging is a step removed from the outcomes measurement. Although it can supply the information needed to make a diagnosis or evaluate therapy response, there is no way for the diagnostic imaging personnel to control how physicians use the information from the scans in treatment decisions. Because of this, it is very difficult and expensive to design outcomes studies for diagnostic imaging.

A CMS emphasis on using outcomes data as the single measurement when deciding reimbursement is bound affect all of medical imaging.

In addition, having the information from the CT as part of the overall PET/CT cardiac workup has resulted in a renewed interest in cardiac PET imaging. Both PET/CT and SPECT/CT growth, particularly in the cardiac arena, might have been significantly restricted if the CMS had decided to go with their original intentions for a National Coverage Decision.

For more information on the CMS decision go to "CTA Roadblock Lifted" on our website.

Too Many Tests?

2008-03-12T16:41:00Z

Yesterday the New York Times ran an essay called "Many Doctors, Many Tests, No Rhyme or Reason" by Sandeep Jauhar M.D. that outlined a specific case, where the author felt that the expert consultations and tests spiraled out of control. Because the article did not give the final diagnosis or any reason that all the specialists were consulted or tests performed. It was a little hard to know if indeed some of the care was excessive.

Later in the article, the author speculated that the growth in medical imaging has been influenced not only by the ability to get better diagnostic information and the fears of litigation but to a large extent by financial incentives.

To make his case, he gave an example of a cardiologist he visited who offered nuclear medicine gamma imaging in his office. The quotes from the physician seemed to show that he ordered un-necessary nuclear medicine tests when needed to make sure that he was able to break even on the costs of the machine rental, the technologist salary and other expenses. The article quoted him: "Now say I get an average $850 per nuclear stress test...Then I have to do at least 10 stress tests a month just to cover the costs, no profit going into my pocket."

My first response to the article is "why did he have to pick on nuclear medicine as the example, considering that all the other diagnostic tests have also increased greatly, with some people questioning whether they are needed."

Then I began to wonder if there might be some truth to the claim, especially as outpatient cardiology clinics have added nuclear medicine studies to their in-office cardiac offerings.

I know that there were a couple of times that I performed lung scans on ICU patients who were so sick, and on so many machines, that I wondered whether it would have been kinder to just let them alone, since they were so obviously close to death. As a technologist, however, I was not privy to whether the information from the scan really did aid in prolonging their life or reducing their pain. Indeed, during the time I worked in nuclear medicine, I never felt that any imaging tests were ordered for reasons other than to gain additional diagnostic information that might improve that patient's potential care. Have you seen any indication in outpatient facilities or in the hospital that there is a move toward ordering nuclear medicine scans for questionable reasons, such as litigation worries or financial gain?

4,600 Karats of Garnet—That’s Some Bling

2008-03-07T19:34:00Z

Nuclear medicine technologists are used to working with crystals, such as BGO, LSO, NaI and GSO, as scintillation materials to catch gamma and positron emissions. Soon, however, they might be working beside 4,600 karats of semi-precious garnets too.

This is the new scintillation material that is being used to create GE Healthcare's high-definition CT scanner.

"It is a real garnet that our engineers have molecularly altered to improve its imaging capabilities," said a GE spokesperson. It is 99 percent garnet and 1 percent of an additive that turns the garnet from its natural red to yellow.

The spokesperson went on to tell me that garnets have unique imaging qualities and are already used for Lasix or laser eye surgery to increase preciseness. GE has a patent on modifying the gem for use in imaging and has stockpiled quantities of these jewels, which will be fused together to form the scintillation matrix for a new 64-slice CT system.

This new system is still in process of research and will be submitted for 510 K approval in the first half of this year. Knowing how fast new CT systems get incorporated into the PET/CT and SPECT/CT systems, however, it might not be long before nuclear medicine technologists are working with gems from GE Healthcare.

*photo courtesy: GE Healthcare

Will Nuclear Medicine be Next on Your Grocery List?

2008-03-04T22:38:00Z

Yesterday the Wall Street Journal, along with other news outlets, published an article about the first retail medical clinic opening in one of Britain's largest supermarket chains. The article notes that patients would have to be registered with the supermarket clinic to get their care covered by the National Health System.

Of course, we already have clinics that are open in some of our retail outlets here in the U.S. The idea is to make it more convenient for patients who need immediate but not urgent emergency room care when their physician's office is closed. For instance, someone might go to these clinics rather than the ER to determine if an ankle injury is just a severe strain or a break that needs emergency care. This may help ease the load on emergency rooms, especially for patients without a primary care doctor who sometimes clog waiting rooms with the flu and aches. It might also cut the cost of care, since a flu shot or an ankle wrap at this type of facility is less expensive than a couple of hours in an ER bed.

For anyone who has had an experience sitting for hours in a waiting room at the doctor office, the ability to get your shopping done while you wait may be more attactive than reading old issues of magazines.

With national attention focusing on healthcare availability and costs, maybe having medical care available right where the patients are is a good idea. If this trend continues, however, how far will it go? Will there be mammography and gamma/specific breast imaging exams available in the mall? Could you get a cardiac scan on one of the small cardiac-specific gamma cameras and then go shopping for low-cholesterol foods? Will imaging technologists eventually find themselves listening to the blue light specials?