Parametric Imaging History and Theory Online Training USA

Welcome to the Parametric Imaging: History and Theory Online training. This course will cover the history and theory behind Parametric Imaging.  FlowMotion Multiparametric PET is an optional feature and it is not available on all Biograph scanners. Upon successful completion of this training, you will be able to: Summarize a brief history of Parametric Imaging Explain the theory behind Parametric Imaging Identify the advantages of Parametric Imaging Recognize the limitations of SUV's Congratulations. You have completed the Parametric Imaging History and Theory Online Training course. Listed below are the key points that have been presented. Take time to review the material before you proceed to the final quiz. Summarize a brief history of Parametric Imaging In 1977, Sokoloff and Patlak used autoradiography with 14[C]deoxyglucose to understand cerebral glucose utilization In 1978, the first commercial PET scanner was designed and delivered to UCLA In 1980s, FDG became available In 1990s, SUV was introduced Explain the theory behind Parametric Imaging Factors affecting SUV in FDG* imaging include uptake time, patient habitus, and blood glucose levels FDG is distributed in the body through the following steps: FDG is injected and made available in the blood pool FDG is then transported to the cell in the same manner as glucose FDG is then transported in and out of the cell until it is fully metabolized and becomes trapped in the cell Patlak modeling uses the dynamic nature of PET to estimate dynamic physiological processes It assumes that there is a single input function and that the tracer of interest can enter and leave any number of compartments but there must be at least one compartment where it remains trapped May not be optimal for all PET tracers or all anatomical regions Examples of complexities involved with the conventional methods of parametric imaging includes: A lot of time is required from the staff to acquire data, acquire the input function, and reconstruct the images Manual arterial blood samples required Limited to single bed dynamic imaging Requires 3rd party processing software Identify the advantages of Parametric Imaging Provides additional images and parameters for more clinical information including: Activity Concentration (SUV) Metabolic Rate (MRFDG) Distribution Volume (DV) Recognize the limitations of SUVs The SUV is limited by the following factors: Subject size and composition Uptake time of F18 FDG  Accurate calibration of the dose calibrator Type of SUV measured Injection infiltration Dependence on the reconstruction algorithm Dependence on the plasma glucose level Physical activity of the subject during uptake time   1970s 1977 - Sokoloff and Patlak used autoradiography with [14C]deoxyglucose to understand cerebral glucose utilization 1978 - The first commercial PET Scanner was designed at EG&G ORTEC and delivered to UCLA 1980s Fludeoxyglucose F18 injection (18F FDG)*  became available 1990s SUV was introduced  *Please see accompanying full prescribing information at the end of the course Limitations of SUV include: Subject size and body composition​ Uptake time of F18 FDG* Accurate calibration of the dose calibrator Type of SUV measured Injection Infiltration Reconstruction algorithm dependency Plasma glucose level dependency Physical activity of subject during uptake *Please see accompanying full prescribing information at the end of the course   Please note that the learning material is for training purposes only!   For the proper use of the software or hardware, please always use the Operator Manual or Instructions for Use (hereinafter collectively “Operator Manual”) issued by Siemens Healthineers. This material is to be used as training material only and shall by no means substitute the Operator Manual. Any material used in this training will not be updated on a regular basis and does not necessarily reflect the latest version of the software and hardware available at the time of the training.   The Operator's Manual shall be used as your main reference, in particular for relevant safety information like warnings and cautions.   Note:  Some functions shown in this material are optional and might not be part of your system.   Certain products, product related claims or functionalities (hereinafter collectively “Functionality”) may not (yet) be commercially available in your country.  Due to regulatory requirements, the future availability of said Functionalities in any specific country is not guaranteed. Please contact your local Siemens Healthineers sales representative for the most current information.   The reproduction, transmission or distribution of this training or its contents is not permitted without express written authority. Offenders will be liable for damages.   All names and data of patients, parameters and configuration dependent designations are fictional and examples only.   All rights, including rights created by patent grant or registration of a utility model or design, are reserved.   Copyright © Siemens Healthcare GmbH 2019 Please proceed to the final assessment. Uptake Time SUV values vary over time because the tracer distribution is changing until it reaches a plateau. Different tissues will plateau at different times. Patient Habitus SUV normalizes for body weight. Fat has a much lower uptake of FDG* than other tissues.  Blood Glucose Levels FDG* competes with glucose because they are both processed in a similar fashion. If a cell does not take up as much FDG* because of competition with glucose, the SUV will be reduced. *Please see accompanying full prescribing information at the end of the course FDG* is injected and becomes available in the blood pool FDG* is transported to the cell through the same process as glucose transport FDG* is transported in and out of cells until it is metabolized When FDG* is metabolized or phosphorylated, it becomes trapped in the cell Artery Tissue Blood Plasma Exchangeable Trapped Tissue CT(t) [18F] *Please see accompanying full prescribing information at the end of the course Process requires a lot of time and effort from the staff to acquire data, acquire the input function, and reconstruct images Manual arterial blood samples Limited to single bed dynamic imaging Requires 3rd party processing software     Introduces an end-to-end clinical solution to provide multiparametric PET images outside the research setting Completely integrated into the PET/CT workflow Allows users to obtain: Activity Concentration (Bq/mL, SUV) Metabolic FDG Rate (MRFDG) Distribution Volume (DV) Image courtesy of Siemens Healthineers. Physiological Meaning of MR and DV of FDG Learn about physiological meaning of MRFDG and DV. Tab TitleTextActivity Concentration (SUV) Represents the F18 distribution at a single point in the time interval Includes both non-metabolized and metabolized or trapped F18 Image Courtesy of Yale University. Metabolic Rate (MR) Represents the metabolized FDG6P distribution in an area It only represents the trapped FDG Image Courtesy of Yale University. Distribution Volume (DV) Represents the volume of blood that contains the same non-metabolized FDG in 1 mL of tissue Only the free flowing FDG that is not trapped is being represented by this volume Image Courtesy of Yale University. Activity Concentration Obtained from a standard clinical image (SUV Image) Each voxel represents the amount of FDG* (metabolized and non-metabolized) in a tissue at a certain point Metabolic Rate (MRFDG) Each voxel represents the rate of metabolized FDG* in a volume of tissue Measured in mg/min/100 mL Distribution Volume (DV) Correlates to the amount of non-metabolized FDG* in tissue Units are measured in percentage A value of 200% means the tissue concentration is 2x that of blood * Please see accompanying full prescribing information at the end of the course.   Images courtesy of Siemens Healthineers. Patlak is a graphical modeling technique that can be applied to dynamic data May not be optimal for all PET tracers or all anatomical regions Uses the dynamic nature of PET to estimate physiological processes Patient is injected at the bed when the acquisition is started - or -  The initial bolus concentration in the blood is estimated using non-imaging techniques Blood Plasma                     Exchangeable                          Trapped Tissue *Please see accompanying full prescribing information at the end of the course Indications and Usage Fludeoxyglucose F 18 Injection (18F FDG) is indicated for positron emission tomography (PET) imaging in the following settings: Oncology: For assessment of abnormal glucose metabolism to assist in the evaluation of malignancy in patients with known or suspected abnormalities found by other testing modalities, or in patient with an existing diagnosis of cancer Cardiology: For the identification of left ventricular myocardium with residual glucose metabolism and reversible loss of systolic function in patients with coronary artery disease and left ventricular dysfunction, when used together with myocardial perfusion imaging Neurology: For the identification of regions of abnormal glucose metabolism associated with foci of epileptic seizures Important Safety Information Radiation Risk: Radiation-emitting products, including 18F FDG, may increase the risk for cancer, especially in pediatric patients. Use the smallest dose necessary for imaging and ensure safe handling to protect the patient and health care worker Blood Glucose Abnormalities: In the oncology and neurology setting, suboptimal imaging may occur in patients with inadequately regulated blood glucose levels. In these patients, consider medical therapy and laboratory testing to assure at least two days of normoglycemia prior to 18F FDG Adverse Reactions: Hypersensitivity reactions with pruritus, edema and rash have been reported; have emergency resuscitation equipment and personnel immediately available ​Dosage Forms and Strengths Multiple-dose 30 mL and 50 mL glass vial containing 0.74 to 7.40 GBq/mL (20 to 200 mCi/mL) of Fludeoxyglucose F 18 Injection and 4.5 mg of sodium chloride with 0.1 to 0.5% w/w ethanol as a stabilizer (approximately 15 to 50 mL volume) for intravenous administration. Select this link to view the full prescribing information.