Advances in Cardiac SPECT and PET Imaging E. Gordon DePuey, M.D. Director of Nuclear Medicine Mt. Sinai St. Luke’s and Mt. Sinai West Hospitals Clinical Professor of Radiology Icahn School of Medicine ant Mt. Sinai New York, NY 2

Disclosures E. Gordon DePuey, M.D.

• Target Audience: Nuclear Pharmacists

Disclosures:

• ACPE#: 0202-0000-16-062-L01-P

Grant Support: Michael J. Fox Foundation Consultant: Adenosine Therapeutics

• Activity Type: Knowledge-based

*This activity is approved for Board Certified Nuclear Pharmacist (BCNP) recertification credit.

The American Pharmacists Association is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

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Learning Objectives

Self-Assessment Question 1

• Describe advancements in imaging techniques and

• • •

• Which of the following is NOT an effective advancement to

software for single photon emission computed tomography (SPECT) and positron emission tomography (PET) cardiovascular procedures. Discuss recent advances in the fields of cardiac molecular and vascular biology. Discuss developments in SPECT and PET targets for cardiovascular imaging. Compare SPECT and PET in terms of combined indices for patient care.

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© 2016 by the American Pharmacists Association. All rights reserved.

decrease patient radiation dose? A. B. C. D. E.

Regadenoson vasodilator stress Focused collimation Solid state detectors Stress only SPECT imaging PET perfusion radiopharmaceuticals

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Advances in Cardiac SPECT and PET Imaging

Self-Assessment Question 2 • Which of the following radiopharmaceuticals hold promise in the early detection of atherosclerotic plaque? A. B. C. D. E.

Tc-99m tetrofosmin I-123 BMIPP I-123 MIBG F-18 NaF F-18 flurpiridaz

E. Gordon DePuey, M.D. Director of Nuclear Medicine Mt. Sinai St. Luke’s and Mt. Sinai West Hospitals Clinical Professor of Radiology Icahn School of Medicine ant Mt. Sinai New York, NY

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Patient-Centered Imaging

Patient-Centered Imaging

• Combines aspects of: – Safety • Risk of additional inappropriate testing and or therapies if imaging sub-optimally performed • Limitation of radiation exposure in younger/female patients – Clinical utility • Choosing the correct technique and/or protocol to answer the clinical question – Cost – Convenience – Patient Satisfaction

• The goal of the ASNC Preferred Practice Statement is to help providers choose the proper imaging procedure for the individual patient

• One MPI test DOES NOT fit all

DePuey EG, Miller TD, Mahmarian JJ et al, JNC 2012 9

ASNC Initiatives to Decrease Patient Radiation Exposure •Promote awareness of radiation exposure associated with various MPI imaging protocols •Encourage adherence to MPI Appropriate Use Criteria and Image Wisely Recommendations

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Recommendations for Reducing Radiation Exposure in Myocardial Perfusion Imaging: ASNC Information Statement • Decrease MPI radiation dose to