September 2016 - Cardiac Stress Leaders in training: our course
in collaboration with the University of Salford
Senior Nuclear MedicineTechnologist Caroline Hurley
discusses the key features of the electrocradiogram (ECG) trace
with students on the Stress Leaders Course in the seminar room at
Central Manchester Nuclear Medicine Centre
Many of our "heart scans" are actually two scans in one. Before
the first scan, the tracer is injected when the heart rate is
higher, or 'under stress'. Before the second scan, the tracer is
injected when the heart rate is slower and 'at rest'. By taking
pictures after each injection, we can compare how well the heart is
working under 'stress' and 'rest' conditions.
Before injecting the tracer 'under stress', the heart rate is
raised using exercise or a slow injection of adrenaline or
dobutamine. The heart contractions are monitored carefully
throughout using wires connected to the surface of the chest to
generate a electrocardiogram (ECG). It's important that those
leading the process of putting the heart under stress (a 'stress
test'), have a good understanding of the effects of exercise,
adrenaline and dobutamine, what any changes in the ECG mean, and
how to respond to these.
We are collaborating with the University of Salford on the
Stress Leaders Course for Technicians, Radiographers and Nurses who
want to learn how to lead a stress test. The students have already
covered cardiac physiology and pharmacology in sessions at the
University of Salford. On Thursday 15th September, they attended
the department to observe stress testing in practice and learn how
to interpret ECGs obtained during stress tests. The students then
return to their departments and perform 100 supervised stress
tests, which they need to reflect on in a log book, before being
assessed through a viva examination at the end. Some are very
experienced and looking to extend their role, others have very new
to their professions.
Senior Nuclear Medicine Technologist Caroline Hurley, who
oversaw the training, says: "I am involved in teaching and in the
viva at the end. There was good interaction through the day. My
motivation is that it keeps my understanding fresh if I have to
explain it to someone else."
If you'd like to know more about heart scans, we've made a short
video showing how these are done, which you can view
July 2016 - Congratulations Jen! Another of our technologists
achieves their MSc
We have a long-standing collaboration with the University of
Salford in delivering their
Nuclear Medicine Imaging PGDip/MSc course, with several of our
technologists and clinical scientists giving lectures and running
practical sessions. Many of our more senior technologists have also
studied for the PGDip or MSc over the years alongside working in
the department. The latest to graduate is Jennifer Emmott, pictured
here with colleagues from the course (on the far right) at their
graduation at The Lowry Theatre in Salford Quays. Many
congratulations to her, and all our other technologists who have
completed this course, on your achievement.
April 2016 - Success at 50th Annual Meeting of the
British Nuclear Medicine Society
Mr Matthew Memmott collects his first and third place poster
prizes (left) and Dr Mary Prescott collects the third place oral
presentation prize on behalf of Dr Ibrahim Niematallah (right) at
The department was well-represented at the
50th meeting of our national Nuclear Medicine society by Mr
Andy Bradley (Consultant Medical Physicist), Mrs Annika Boloz (STP
Trainee: clinical radiopharmaceutical science), Dr Beverley Ellis
(Consultant Radiopharmacist), Ms Christine Tonge (Consultant
Medical Physicist and Directorate Manager), Mr Ian Armstrong
(Principal Medical Physicist), Dr Ibrahim Niematallah (Radiologist
in training), Dr Mary Prescott (honorary Consultant Nuclear
Medicine Physician and former Clinical Director), Mr Matthew
Memmott (Senior Medical Physicist), Mr Michael Gornall (STP
Trainee: medical physics), Mrs Natalie Fyfe (Nuclear Medicine
Technologist), Dr Nidhal Ali (Nuclear Medicine Physician), Dr
Parthi Arumugram (Consultant Nuclear Medicine Physician and
Clinical Director), and Prof Richard Lawson (former Consultant
Medical Physicist). This meeting always provides a great
opportunity to network with and learn from our colleagues
throughout the UK and beyond, and this year there was a
particularly celebratory air to proceedings as the BNMS marked it's
50th anniversary with a special dinner and limited-edition
Annika presented her recent research into blood caffeine levels
in patients attending for myocardial perfusion PET in the
radiopharmacy session, Beverley spoke about career options for
radiopharmacists, Ian gave a talk at the technicians' bootcamp
on best practice in Cardiac SPECT, and Ibrahim presented his study
of renography following renal transplant at Central Manchester
Nuclear Medicine Centre. Matthew also presented two posters,
describing the considerable improvements he has made to the way we
do lung SPECT. You can view Matthew's posters by clicking the links
noise estimation for maintaining VQ SPECT image quality
novel two-sample approach for clinical SPECT noise
We're very proud to announce that Matthew's posters won
both 1st and 3rd prizes, and Ibrahim's presentation won 3rd
prize. Well done to you both!
To find out more about our department, click here. To contact one of the
BNMS delegates, please use the form here.
February 2016 - Refinements to heart perfusion scanning
promise lower radiation doses to patients and staff
Christine Tonge, Parthiban Arumugam, Ian Armstrong and Kim
Saint, who are leading the heart scan project team
Coronary artery disease (CAD) is the UK's largest killer and
those living in the North West are more likely to die from the
condition than anywhere else in England. In patients with
CAD, the arteries that supply the heart muscle with oxygen-rich
blood become narrowed by a gradual build-up of fatty deposits.
Eventually this may block the delivery of oxygen to the heart
causing permanent damage to the heart, known as a heart attack.
A myocardial perfusion scan is a non-invasive scan that gives
doctors information about the blood supply to the heart muscle. It
is one of the tests that have an important role in the management
of patients with CAD, with thousands of scans performed across the
UK every year. We provide scanning for patients with heart
conditions across the North West region and currently perform
approximately 2300 scans a year.
A myocardial perfusion scan uses a short-lived radioactive
tracer that is injected into a vein in a patient's arm and
accumulates in the heart muscle. The radioactive tracer emits
gamma rays and the position of these is detected using a gamma
camera. The gamma camera has a lead filter (collimator)
attached to the front of the camera to control the amount of
radioactivity it detects.
We have recently published some research in which a perspex
model filled with water was used to mimic the distribution of
radioactive tracer from a patient heart scan. This approach allows
researchers to evaluate alternative techniques without unnecessary
radiation risk for patients.
We compared the quality of images using alternative collimators,
that allow more radioactivity through to the camera, against
standard collimators. The benefit of the alternative collimators is
that less radioactive tracer can be used and the images can be
acquired in less time. However the images produced have less fine
We found that by using an advanced image processing technique
called "resolution recovery" they were able to create images using
the alternative collimator, which were of similar or better quality
than the standard procedure. This new approach reduces the amount
of radioactive tracer required and will lead to a reduction of
patient radiation dose by 35-40%.
Ian Armstrong, Principal Physicist in Nuclear Medicine, said:
"We undertake considerable research into optimising nuclear
medicine techniques for the benefit of our patients and to also
help our staff work more efficiently. As physicists, we have
a responsibility to drive efficiencies in the way our departments
work. As well as reducing the radiation risk, we hope that
this new approach will enable us to provide the same high-quality
scans using less radioactive tracer. The next step is to undertake
a clinical trial to compare the effectiveness of the new procedure
against standard practice in patients. We will start recruiting
patients to participate in this trial in spring 2016".
For those with access to academic journals, the original paper
describing this research can be found
here. The editor of the journal wrote this positive response to
the work in the editorial for that issue, which is free for all to
access and can be found here.
November 2015 - Improved PETCT imaging means faster scanning
and lower radiation doses to patients and staff
PETCT imaging is widely used in the management of cancer
patients. Most commonly, an FDG PET scan is carried out to identify
areas with high glucose metabolism, such as tumours. These images
are useful for diagnosis, staging and monitoring treatment.
Such a scan requires the injection of a radioactive tracer -
which is taken up by the tumour tissue - and therefore the
procedure has an associated radiation dose for the patient and for
staff at the imaging facility.
Recent work by scientists in this department and at The
University of Manchester investigated whether technological
developments in scanner equipment over the last decade could allow
a reduction in the amount of radioactive tracer used.
Ian Armstrong, a nuclear medicine physicist who led the
study, said: "Despite improvements in PET technology, we haven't
seen any change in the guidance regarding the amount of injected
radiotracer we should use for FDG PET."
PET imaging relies on the detection of simultaneous pairs of
gamma rays produced when positron particles emitted by the injected
tracer interact inside the body. The team looked at an analysis
approach using time-of-flight (TOF) information, which utilises the
faster detectors present in modern PET systems to more accurately
locate the source of each pair of rays.
We found that by making use of TOF information, they could
reduce the number of 'counts', or individual gamma ray pairs, we
measured. This means that for the same quality of image, we could
reduce the injected radioactive dose, or scan for a shorter period
Ian says: "Here in Manchester we've decided to use this
improvement to do both - reduce the administered activity and the
scan time. As a result we have managed to lower the radiation dose
for cancer patients and our staff and also increase the numbers of
scans we are able to carry out."
This work attracted considerable media attention, including an
interview with BBC Radio Manchester. For those with access to
academic journals, the original paper can be found here: "The assessment
of time-of-flight on image quality and quantification with reduced
administered activity and scan times in 18F-FDG PET" Armstrong
et al. (2015) Nuclear Medicine Communications 36:728-37.
October 2015 - Our team at EANM 2015
On Friday 9th October, members of our team flew out to Hamburg
to join the European Association
of Nuclear Medicine Annual Congress. The Nuclear Medicine
Centre at Central Manchester University Hospitals was represented
by Dr Heather Williams and Mr Matthew Memmott (Senior Medical
Physicists), Mr Carl Grimsditch (Senior Nuclear Medicine
Technologist), and Ms Cordelia Onwukwe (Specialist Nurse
Practitioner) - show left to right in the picture above.
We also presented a considerable volume of research and
development work in the poster sessions - eight posters! The work
attracted keen interest from a number of conference delegates,
the picture below shows Matthew Memmott discussing our poster
regarding measures of gamma camera uniformity on a Siemens Symbia
gamma camera, during one of the poster sessions.
The posters are listed below, you can access and download them
in .pdf format for free by clicking on the links:
A Novel Method for Krypton-81m Intrinsic
123I-Ioflupane (DatScan) SPECT using LEHR and Fan-Beam (FB)
collimators - an Initial Investigation into Clinical Impact
Conflicting measures of uniformity on a Siemens Symbia gamma
Continued validation of metallic artefact reduction (MAR)
algorithms for reducing the likelihood of false positive cardiac
implantable device infection (CIED) investigations
Development of a cell labelling technique using 89Zr for
Inflammation Imaging with PET
carotid plaque inflammation in patients with active rheumatoid
arthritis (RA) using 3T magnetic resonance imaging (MRI) and
Fludeoxyglucose (18F) PET (18FDG PET) : a pilot study
Optimisation of Ventilation/Perfusion (V/Q) SPECT reconstruction
using advanced reconstruction methods : a phantom study
Splenic switch-off in 82Rb myocardial perfusion imaging : an
indication of adequate vasodilation?
To find out more about our department, click here. To contact one of the
EANM delegates, please use the form here.
August 2015 - new website goes live!
Our new website is now live.
Further updates and refinements will be made in the coming weeks
Check back here for the latest
departmental news, we intend to use this page as a "mini-blog" to
announce and celebrate our developments and successes.