Storyboard

Garran Medical Imaging Centre

ESHI Story No. 3

Garran Medical Imaging
(Canberra, Australia)

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DTZ-Berlin-Arzt-Berlin-MVZ-Diagnostik-Nuklear1_PET

ESHI Story No. 2

Diagnostic Therapeutic Centre Berlin
(Berlin, Germany)

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Pic1

ESHI Story No.1

Radiology Center
(Vienna, Austria)

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ESHI Storyboard

On our storyboard, we put a spotlight on medical centers in Europe that use hybrid imaging scanners and modalities in their daily work. The stories of those centers are compiled here, proving that there is a very active hybrid imaging network in Europe that is operating highly successful.

Do you also want to share your story with our community? Contact the ESHI Office: office@eshi-society.org

 

ESHI Story No. 3

GMI Logo TRANSPARENT

Garran Medical Imaging

Canberra, Australia

 

 

Our Story

Garran Medical Imaging is a state of the art medical imaging centre in Canberra, Australia. The centre was established in 2015. This centre was an idea that grew from a desire to make a difference. Its founders (Iain Duncan, Kevin Osborn, and Nick Ingold) were not prepared to be complacent, to accept the status quo, or to keep doing things the same way. Over years in medical imaging they all developed a desire, an idea, a hunger to do things better. The entire team at Garran Medical Imaging share this passion.

We are a small team that really tries to make a difference. Garran Medical Imaging aims to be an integral part of the healthcare solution for both patients and their doctors.

The patient journey, from referral through booking, check–in, the scanning procedure, the analysis and reporting, and the delivery of results, is carefully mapped to ensure a comfortable, productive and stress-free experience. Our equipment and staff are able to provide state of the art imaging by adopting the best techniques available and adapting them for the specific needs of our referral patterns.

Our hybrid imaging is done without compromise – see this 1-minute video on xSPECT molecular imaging.

Websites: garranmedicalimaging.com.au
driainduncan.com.au

5 Questions to
Dr. Iain Duncan

Dr Iain DuncanHow does the centre work with hybrid imaging?
Our centre has a strong musculoskeletal bias and the hybrid imaging is used mostly in the context of assessing complex musculoskeletal cases. We use xSPECT/CT and direct quantification often in combination with either MRI or ultrasound. I started my career as a rheumatologist, so I often combine imaging and clinical evaluation to optimise the use of imaging to assess difficult diagnostic and management problems. We have established a large database of xSPECT/CT and xSPECT Quant cases and are currently developing the use of direct quantification in musculoskeletal and oncology diagnosis. In 2017 we have added Tc-PSMA imaging to our stable (tracer from Tecnology University of Munich). Currently we are the only site in Australia offering this service and our experience to date is very positive.

What is the newest instrument in your program? Why did you choose that one in particular?
When we opened the centre in 2015 we acquired an Intevo xSPECT/CT from Siemens and in addition opted to use the new xSPECT/CT bone reconstruction. Later we added direct quantification. We believe this is currently the best hybrid gamma camera solution. Both our onsite technical testing and our subsequent experience support this choice. We undertook a prospective evaluation after installing the equipment -that is currently in press (European Journal of Hybrid Imaging). The addition of quantification has added a whole new level of accuracy to serial assessment of oncology cases –both for Bone and PSMA studies. The higher resolution of xSPECT is particularly important with Tc-PSMA, where the SPECT resolution becomes much closer to gallium PET PSMA. It then becomes improtant to consider the resolution of the CT scan, as in soft tissue hybrid imaging it is the lower resolution CT that can limit the system sensitivity (eg size of lymph nodes in Tc-PSMA scans).

Quantification is also proving useful in Tc-pyrophosphate scans for cardiac amyloid.

How do the benefits outweigh the costs?
This is a difficult question to be objective about. Unquestionably we believe our hybrid imaging has provided much better patient assessment. I report hybrid imaging scans from a number of other centres and it is clear that older and cheaper systems cannot provide the level of anatomic sensitivity and specificity of our system. We do not charge any more for these more expensive solutions, so ultimately the stand-alone business case for better quality is not strong -we rely on being able to attract more referrals to our centre. Ultimately, we do it because we care about our patients.

How do Radiologists and Nuclear Medicine Physicians collaborate at your medical center?
I work closely with Dr Kevin Osborn our radiologist. We share a reporting office which is literally at the centre of our practice. This allows us to have frequent dialogue on an hour to hour basis. Kevin specialises in MRI but we both do ultrasound and I have a strong understanding of bone CT as a result of many years in hybrid imaging. We can discuss patients who have had both hybrid imaging and MRI for example. If required we can do software fusion of MRI and SPECT/CT, though in practice this is rarely required. We also understand the strengths and weakness of all of the available imaging modalities. For example we can immediately discuss the appropriateness of an MRI versus a bone scan in a patient that we are having diagnostic difficulty with using ultrasound. Having previously spent some time in a facility that did only ultrasound and hybrid imaging I can highly recommend the benefits of radiology and nuclear physicians working side by side.

What will the future hold for hybrid imaging?
I am optimistic, as it is clear that over the last 10 years in general nuclear medicine the resolution of systems has improved enormously, both following the introduction of hybrid imaging and with the improvement of those systems. It is clear that hybrid imaging can provide a more accurate and useful assessment than pure anatomic imaging. PSMA and bone imaging are both great examples of this. As more tracers are developed the clinical utility of hybrid imaging can only improve. Direct Quantification will also become a more integral part of SPECT hybrid imaging, most particularly in oncology.


Dr. Iain Duncan

Dr Iain Duncan is a founder of Garran Medical Imaging (GMI) and has been working in Canberra ultrasound and nuclear medicine for more than 15 years. This followed 10 years in rheumatology at The Canberra Hospital, the last five as Director. His passion to improve patient outcomes through proactive response to clinical problems and direct relationships with clinicians, underpins his practice. He manages to keep busy introducing new technology, providing clinical care, and participating in academic advancement while running a private medical imaging practice.
Iain also has his own website which show cases educational material and recent updates for clinicians, patients, and fellow healthcare professionals.

 


Dr. Duncan’s

Case to Remeber

Fig.2b-GMI-C3

xSPECT/CT of the lumbar spine and pelvis 

 

Click here to see the full case!

 

Would you like to publish your centre on our website and share your story with our community?

Contact: office@eshi-societ.org

ESHI Story No. 2

About the centre

DTZ Berlin has been actively employing PET/CT technology since 2003, which has enabled the centre to offer reliable and precise cancer diagnoses. In 2012, SPECT/CT and MRI (magnetic resonance imaging) were integrated into the hybrid medical imaging program, along with the addition of a modern radiotherapy facility.

Every patient benefits from a highly personalized radiopharmaceutical program using in-house radiochemistry together with a ring accelerator (cyclotron), tested for the highest levels of proven quality.

In 2016, DTZ Berlin added a state-of-the-art PET/MR device to its palette. The program has been designed to unite powerful diagnostic technology with high-performance therapy for comprehensive care tailored to the needs of the individual patient.

Website: www.berlin-dtz.de/en

5 Questions to
Prof. Dr. Wolfgang Mohnike

Prof_Mohnike_Friedrichshain_Nuklearmedizin_Diagnostik_Strahlentherapie_Krebs_Tumor_BerlinHow does the centre work with hybrid imaging?
Our hybrid imaging data flows directly into the process of planning a radiotherapy program, resulting in the best possible treatment. We also work very closely with physicians of various specialties – not only in our own facilities, but also with transferring physicians. Our diagnostics team, comprised of radiologists and nuclear medicine physicians, has collected precise results data using comprehensive state-of-the-art devices, which are used to offer patients more progressive options for continuing therapy.

What is the newest instrument in your program? Why did you choose that one in particular?
Our newest device is a PET/MR system (Biograph mMR). For many different illnesses, the combination of metabolic and anatomical information offers powerful added diagnostic value, which can also play a pivotal role in planning and managing the course of therapy. Moreover, MRI offers a very high soft tissue contrast and a reduction in patient exposure to radiation as compared with CT. This second point is particularly advantageous when it comes to children.

How do the benefits outweigh the costs?
The DTZ has relied on hybrid imaging since 2003 because we are convinced of its diagnostic advantages. We have developed our own in-house certified radiochemistry, which employs its own cyclotron and enables us to cost-effectively create the tracers required for hybrid imaging without sacrificing time or quality. In order to be able to care for our patients in the most flexible way, unlimited by the health politics of the day, we have coordinated specific care provision contracts with several different health insurance companies and participate in numerous studies. Beyond this, we are active in the politics involved in health care in order to promote methods for addressing important issues and the long-term reimbursement of costs for our patients.

How do Radiologists and Nuclear Medicine Physicians collaborate at your medical center?
DTZ Berlin has dedicated itself to being an easy-access medical care centre. Our team of radiologists, nuclear medicine physicians and radiologists work together as a single unit under one roof and benefit from each others’ expertise when reviewing patients. This results in the best possible diagnosis and therapy. A communal data pool supports this effective collaboration in that the diagnostic data can be directly applied to therapy planning. Furthermore, many of the physicians possess a dual specialty or are training in a related discipline in order to intensify their knowledge of hybrid imaging.

What will the future hold for hybrid imaging?
In our view, the future of hybrid imaging for nuclear medicine will be determined by the development of new specific tracers under the rubric of “theranostics”, which are suitable for diagnostic and therapeutic application. Highly specific tracers enable not only the confident confirmation or ruling out of illnesses that are difficult to diagnose, (such as F-18-amyloid for Alzheimer’s dementia) or to precisely localize tumours and metastasis that are difficult to detect, but also to treat the corresponding illness (such as Ga-68-PSMA as diagnostic, Lu-177-PSMA as therapeutic tracer for prostate cancer).


Prof. Dr. Wolfgang Mohnike

Following a residency in internal medicine and research in cardiology, Prof. Mohnike added a nuclear medicine residency and a professorship in this field. Persuaded by the future prospects of nuclear medicine, he founded the Diagnostic Therapeutic Centre (DTZ) together with his colleague Prof. Dr. Jürgen Schmidt after the fall of the Berlin wall. He applied his expertise to a concept of interdisciplinary collaboration within a single practice under one roof. Constantly aware of the latest research, he continues to work tirelessly to keep the practice equipped with state-of-the-art devices and to supplement these when necessary, as well as refining methods. To promote the acceptance of hybrid imaging in nuclear medicine, he has been active since 2003 in the association for the promotion and propagation of positron emission tomography (PET e.V.) and is the initiator of the scientific PET/CT symposium series in Berlin, which celebrated its 15th anniversary in 2017.


Prof. Dr. Mohnike’s

Case to Remeber

68GA_PSMA-PET-MR_combined_pics

 

Lymph node metastasis in a prostate carcinoma: Ga-68-PSMA-PET/MR
Click here to see the full case!

Would you like to publish your centre on our website and share your story with our community?

Contact: office@eshi-societ.org

ESHI Story No.1

LogoRadCenterViennaRadiology Center

Vienna, Austria

 

 

For over 110 years, our radiology center has combined the advantages of a small private practice with those of a large, modern clinic. We offer personal engagement and individual care by our highly qualified team of doctors, technologists and administrative staff. We operate state-of-the-art imaging equipment in radiology (X-ray, mammography, ultrasound, CT, MRI and angiography) and nuclear medicine (laboratory, scintigraphy, positron emission tomography, SPECT/CT, PET/CT). All examinations and therapies are availale for both out- and in-patients. For us, radiation protection has top priority and, therefore, for the good of our patients, we will always choose the method with the lowest radiation possible.

Website: www.radiology-center.com
Facebook: facebook.com/radiologycentervienna

5 Questions to
Martha Hoffmann, MD and Philipp Peloschek, MD

What is your involvement with hybrid imaging?RC_ProfDr_Martha_Hoffmann
Our place of engagement is along the diagnostic pathway. Referring doctors expect us to make precise recommendations, and by combining our nuclear medicine expertise with radiological expertise, we can give very straightforward recommendations.

What was the latest instrument you have acquired? Why did you choose this instrument?
A Siemens Biograph PET/CT and a Siemens Symbia Intevo SPECT/CT, both offer the full range of radiological and nuclear medicine capabilities we need for modern molecular and morphological imaging.

How do the benefits outweigh the costs?RC_PrivDozDr_Philipp_Peloschek2
We opened a completely new range of diagnostic options for our referring physicians. When looking at our internal costs, we are happy to say that with either hybrid imaging system (SPECT/CT, PET/CT) we cover also standalone CT indications, and, therefore, do not require a separate CT system anymore. We do all our routine CTs on either the SPECT/CT or the PET/CT. This saves space and obviates the need for another set of expensive radiation shielding.

How do Radiologists and Nuclear Medicine Physicians collaborate at your medical center?
Extremely well. We cannot imagine operating either SPECT/CT or PET/CT without the joint efforts of radiology and nuclear medicine specialists. Our imaging workstations stand side-by-side right in the middle of the Radiology Center. Referring specialists come over to us to discuss the cases with us and to provide us with feedback on our diagnoses as well as on their choice of treatment, together with feedback on its efficacy.

What will the future hold for hybrid imaging?
More SPECT tracers for oncology imaging.


Martha Hoffmann, MD and Philipp Peloschek, MD

When radiologist Philipp Peloschek, MD, used the chance to spend some time at the nuclear medicine department of Vienna University Hospital in Austria, and he realized that many pathologies are invisible for radiological (i.e. morphological) imaging. That’s why he teamed up with nuclear medicine specialist Martha Hoffmann MD to found the Radiology Center right next door to the Medical University in 2014.


Dr. Hoffmann and Dr. Peloschek’s

Case to Remeber   

Case-Teaser

Avascular necrosis of the knee: 99mTc-HDP bone SPECT/CT and MRI

 

Click here to see the full case!