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The future looks bright for combined modalities.

Hybrid imaging technology and molecular probes are irrevocably changing the workplace for nuclear medicine technologists as radioisotopes, aided by computed tomography and magnetic resonance, light the way for tracking disease at a cellular level.

As these combined modalities work their way into general practice, the need for technologists who are skilled in both nuclear medicine and CT or MR grows.

In combining CT or MR with positron emission tomography and single photon emission computed tomography, manufacturers have achieved greater detail in imaging tumors and surrounding structures compared with the 2-D gamma camera and conventional radioisotopes. Additionally, molecular imaging reagents can provide information on biochemical and physiological abnormalities that underlie disease.

PET, combined with molecular imaging, is credited with revitalizing nuclear medicine imaging in clinical practice. This resurgence is due to the ability of PET to provide information about body chemistry and function, as well as metabolic activity--something other imaging studies can't provide.

Another factor contributing to PET's increased use is expanded reimbursement for various types of cancers. Medicare has broadened its coverage of PET studies to include lung cancer, melanoma, colorectal cancer and lymphoma.

"I think that the primary reason for the popularity, or expansion, of PET-CT lies in its proven clinical benefits," said Piotr J. Maniawski, M.S., senior manager for clinical sites for Philips Medical Systems. "Even at low CT doses, characterization and localization of a tumor is more effective with the hybrid PET-CT than with PET or CT alone."

A recent study illustrates the effectiveness of PET in targeting tumor type, which is one factor driving its wider acceptance. Using the radiolabeled monoclonal antibody G250 and PET, researchers at Memorial Sloan-Kettering Cancer Center in New York were able to identify clear cell renal carcinoma with 96 percent sensitivity. G250 targets and binds to clear cell carcinoma and reacts against an enzyme present in 94 percent of cases. In a study published in the April issue of The Lancet Oncology, 15 of 16 carcinomas were correctly identified. One hundred percent of the nonclear cell renal masses in nine patients also were identified correctly.

The Philips GEMINI, GE Healthcare Discovery and Siemens Medical Solutions Biograph PET-CT imaging systems are the leading molecular imaging hybrids in today's market. Mr. Maniawski emphasized that acceptance of this technology in general practice depends on reimbursement. For now he anticipates a future role in treatment planning and higher patient volumes in facilities that have purchased the hybrids.

"About 40 percent of radiation oncology sites already use PET data to help them design radiation therapy plans," said Mr. Maniawski.

Although the future looks bright for the hybrid technology, a shortage of nuclear medicine technologists could sharply affect the total number of procedures that can be performed.

"We are seeing an increase in molecular imaging procedures with the hybrid technology," said David Gilmore, M.S., R.T.(R)(N), CNMT, nuclear medicine technology program director at Beth Israel Deaconess Medical Center in Boston. "This increased utilization is expanding our department, and we are seeing the need for additional technologists."

As president-elect of the SNM Technologist Section and an ASRT nuclear medicine chapter delegate, Mr. Gilmore thinks that molecular imaging is changing the profession nationally.

"I do believe that using PET-CT for radiation therapy treatment planning is on the very near horizon," he said. "However, I also think that PET-MR, SPECT-CT, PET-mammography and many other molecular imaging techniques will be a reality. We need to be ready."

In 2004 the ASRT and the SNMTS collaborated on a PET-CT curriculum, which can be accessed at > Educators > Curriculum. It recognizes the need to close any educational gaps R.T.s have in skills and knowledge when it comes to hybrid technologies. At that time, fewer than 5,000 technologists were certified in both radiography and nuclear medicine and fewer than 200 were certified in CT and nuclear medicine.

Dual certifications are important in states that require R.T.s to have both nuclear medicine and CT credentials and experience to perform nuclear medicine procedures on hybrid equipment. "There are still licensure issues in some states, but we have to be forward thinking and realize that those 'hurdles' will be reduced one day," said Mr. Gilmore.

Mr. Gilmore is confident that nuclear medicine technologists can and will meet higher expectations. "We are moving to lifelong learning, meaning we need to continue to learn more to expand our jobs, such as CT education. MR education is next on the list," he said. "So yes, there are many new avenues for technologists."

By Robin L. Anderson, Contributing Writer
COPYRIGHT 2007 American Society of Radiologic Technologists
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

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Title Annotation:technology update
Author:Anderson, Robin L.
Publication:ASRT Scanner
Geographic Code:1USA
Date:Jul 1, 2007
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