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September 2017 - Manchester is the top recruiter for national heart disease research study

PREFFIR LogoThe Central Manchester Nuclear Medicine Centre recruited and scanned our first patient in the PRE18FFIR trial in February 2016, and have since recruited another 139 patients, of which 95 have already had their scans. To date, Central Manchester University Hospitals have recruited and scanned more patients than any of the other four hospitals involved in the trial.

Patients who have had a recent heart attack are invited to take part by the research nurses at  Manchester Heart Centre, led by Thabitha Charles. They are then interviewed to see if they are suitable for the trial before coming to the department for scans.

The scans for this study are quite complex, involving a PET scan of the chest and a CT scan of the blood flow to the heart. Patients also return for another of these CT scans after two years.

Nuclear Medicine Technologists Gareth Pawson and Jennifer Emmott have had specialist training to be able to perform these scans, and are now passing that expertise on to their colleagues. We have also had expert advice and support from Consultant Radiologists Devinda Karunaratne and Mani Motwani, together with technical support from Senior Medical Physicist Heather Williams. The study is overseen by Clinical Director and lead for Nuclear Cardiology, Parthiban Arumugam.

The PET scan done as part of the PRE18FFIR trial is different to the other PET scans we do in the department. This scan provides information about how radioactive fluoride, seen on the PET scan, is taken up in the walls of arteries supplying blood to the heart muscle. Doing a CT scan of the blood flow to the heart muscle at the same time means we can compare the fluoride map from PET with how much blood is getting through to the same bits of the heart. The blood flow to the heart muscle is then tested again two years later using the same sort of CT scan. The purpose of this research is to see whether the radioactive fluoride in the walls of the blood vessels helps us predict how well patients will recover after a heart attack.

You can read more information about the trial  here. The initial research which lead to the PRE18FFIR trial can be found  here.

July 2017 - Another new gamma camera

intevoWe have continued to upgrade our facilities with another new gamma camera, replacing our Siemens Symbia T6 with a Siemens Symbia Intevo. Upgrading to the latest models on a regular basis enables us to stay abreast of developments in imaging technology and make use of these developments to improve our service to patients.

The new Siemens Symbia Intevo camera installation went smoothly, and we were able to carry on with patient imaging throughout, even in adjoining rooms. The physicists in the department tested the system before it was used with patients (as shown in the picture above), and the technologists have undergone further training so they are aware of the differences between this Siemens gamma camera and its predecessor.

Senior Medical Physicist for Nuclear Medicine Dr Heather Williams says: "The Siemens Symbia Intevo provides us with updated facilities and improved performance which will allow us to perform a wide variety of patient scans, and improve on these images in the future".

March 2017 - Nuclear Medicine team makes the final of the 'We're Proud of You' awards

WPOYAEvery year, our hospital celebrates teams and individuals who best embody our values of respect, dignity, compassion, pride, empathy and consideration in the "We're Proud of You" awards. This year we were nominated for Support Team of the Year 2016, for the exceptional standard of care we provide to our patients and particularly for our work on reducing the dose of radiation needed for several types of scans.

We were very honoured to make the finals, and Nuclear Medicine Technologist Natalie Fyfe, Medical Physicist Kimberley Saint, and Senior Nuclear Medicine Technologist Carl Grimsditch (pictured left) represented us at the award ceremony. The award went to the Therapeutic and Specialised Play Service for giving a positive experience to young patients, but we were extremely proud to be the runners-up. As Medical Physicist Kimberley Saint says: "It was a wonderful opportunity to raise the profile of what we do in Nuclear Medicine across the Trust, and make more people aware of the high quality service we offer our patients."

If you visit us, you will see our certificate on display at reception, alongside another certificate commending us all for outstanding achievement in outpatient services.

 

January 2017 - New gamma camera and image viewing and processing computers

discovery_correctJust in time for Christmas 2016, we were happy to welcome not only a new gamma camera to the department, but also a new network of image viewing and processing computers. Both are upgrades to our previous facilities, ensuring we stay abreast of developments in imaging technology.

The new GE Discovery 630 gamma camera, pictured left, replaces our GE Infinia, and our network of GE Xeleris workstations was replaced with an innovative mix of GE Xeleris image-processing workstations running the latest software and remote links to these workstations from standard office computers. The installation of the camera went very smoothly with minimal disruption to patient imaging, and the roll-out of the new image viewing and analysis facilities followed according to plan, being completed over the following two months.

Principal Medical Physicist for Nuclear Medicine Dr Ian Armstrong, who oversaw the installation, says: "The GE Discovery 630 provides us with a modern, flexible, cost-effective imaging facility which can accommodate a wide variety of patient scans. Our novel implementation of the latest GE Xeleris image viewing and analysis systems streamlines how we currently process patient images, as well as providing new software which we hope will allow us to extract more information from our lung and brain scans in future".

September 2016 - Cardiac Stress Leaders in training: our course in collaboration with the University of Salford

ECG course

Left: 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  here.

July 2016 - Congratulations Jen! Another of our technologists achieves their MSc

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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

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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 BNMS 2016

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 book.

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 below:

A-priori noise estimation for maintaining VQ SPECT image quality

A novel two-sample approach for clinical SPECT noise estimation

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

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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 detail.

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 of time.

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 in Hamburg

EANM team

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:

EANM MATTA Novel Method for Krypton-81m Intrinsic Uniformity Measurements

Comparing 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 camera

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

Evaluating 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 and months.

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.