pet/ct scans for dementia

UKAMY00162 February 2017

PET/CT Scans for Dementia patient:

The Patient experience

Roisin Dobbin-Stacey PET/CT Manager, Cobalt, Cheltenham


Cobalt – Who are we?

Charity – Established 1964

A diagnostic imaging provider - 1994

Imaging Centre, Cheltenham - 2006

PET/CT

High-field Open MRI

3.0T MRI

CBCT

Institute of Translational Medicine Imaging Centre – 2017 QE Hospital Birmingham



Mobile MRI

6 mobile MRI Scanners

Only 3.0T mobile MRI service in

Europe



PET/CT

Over 4,000 patientsPopulation 2.2m

NHS patients

Three Counties Bristol

Oncology - 90%Neurology


Dementia

Patient Pathway

2gether NHS Foundation Trust – pathway

Development – First patient

FDG/Amyloid service

Diagnosing dementia

“What’s the point?” “There is no treatment”

What were attitudes to a diagnosis of cancer in the 1960s and HIV in

1980s?


The ReferralAppropriate - RCR Guidelines

FDG

Evaluation of memory loss/neurological sign of dementia and

differentiation of types of dementia in selected patients.

Amyloid

Used in highly selected patients with cognitive impairment where

i) Alzheimer's Dementia is a possible diagnosis but this remains

uncertain after comprehensive

Evaluation by a Dementia expert and conventional imaging work-up

and

ii) where knowledge of the presence or absence of amyloid is

expected to increase diagnostic certainty and influence

patient management.


The Referral

Funding National NHS PET/CT contract or local funding?

Contraindications – Pregnancy, patient compliance

Positron Emission Tomography – Back to basics

FDG Amyloid PET/CT – how does it work


How does it work?

Radiotracers– Back to basics

Before PET scan - a radioactive medicine is produced; tagged to

a natural chemical, glucose, water, or ammonia.

Radiotracer is injected into the patient; go to areas that use the

natural chemical.

FDG (fluorodeoxyglucose) -F18 is tagged to glucose.

Enables measurement of cerebral metabolic rate.

Amyvid is tagged with F18.- travels through the bloodstream and

into the brain, binding to amyloid plaques


How does it work?


Radiotracer production

Difficulty / cost of producing and transporting the radiotracers

Short Half lives

Requires proximity to a cyclotron.

Things to remember:

Consent (radiation dose equivalent)

Isotope order FDG and Amyloid

Risk of failure


How does Positron Emission Tomography work?

PET measures body functions - e.g blood flow, oxygen use, and

sugar (glucose) metabolism

Computed Tomography - demonstrates anatomy

Combined PET/CT images pinpoint the anatomic location of

abnormal metabolic activity

PET detects the energy emitted by positively charged particles

(positrons) being emitted from the patient - converts to 3D image


How does it work?


Normal pattern of uptakeFDG

Amyloid


PET/CT – The referral


What happens once we receive the referral?

Date & Time

Venue

Directions

Eating & drink

Pregnant women & children

Treatment

Diazepam

Need to confirmTelephone contact

Length of visitReferring consultant

Diabetes

Appointment time to suit patient and carers

Referral vetted by consultant/ARSAC


IDD: Normal diet. Normal a.m. insulin

All Other Patients: Fasted (water only) for 3 hours prior to the

appointment time.

Patient Preparation FDG

Patient Preparation Amyvid

All Patients follow their Normal diet

The patient’s ability to lie still for the duration of the acquisition should be assessed prior to booking the appointment/tracer order


Importance of confirmation

Minimise no-shows

Time to allay concerns

Check on patient compliance

Does the patient consent

Importance of patient/Carer contact numbers

Tracer failures

Scanner breakdown

Tracer Order- FDG daily

Amyvid – 5 days


Tracer Delivery/Dispensing FDG

Dose reduction for patients/accuracy

Karl - Weight based delivery

Reduction in handling Radioactive tracers


Tracer Delivery/Dispensing Amyvid


The Patient Experience - Arrival


The Patient Experience


The Patient Experience - FDG


The Patient Experience - Amyvid


The Patient Experience - Injection


Uptake Time

FDG

Inject with 250 mbq FDG/100mls saline

Leave in a quiet darkened room for

30minutes/no stimulus

Amyvid

Inject 370mbq <10ml- 100ml flush

Increased viscosity

30-50 minute resting/TV/reading


The Patient Experience-the scan


The Patient Experience- post scan


The PET/CT Image Interpretation

FDG

Normal

Abnormal


The PET/CT Image Interpretation - Amyloid


How do patients benefit? diagnosis

Access to treatment & supportAccess to treatment & support

Ending of diagnostic uncertainty

Improves quality of life for person with dementia and carers

National Dementia Strategy, 2009/World Alzheimer Report, 2011


What can go wrong?


Scan requests often vague/Lack important information

Often requested by people with minimal PET experience

Referrals need to be for appropriate exam

Education for patients

Problems with referrals

Require good communication between “us” and “them”


Low yields / failure

Afternoon production of Amyvid

Proactive scheduling

Flexibility

Problems with tracer production

Rare but random / Good maintenance


Injection technique

Positioning

Reduce scan time

Patient compliance - every

opportunity to reassure the patient

Radiographic Errors

Nearly always preventable


Good explanation of the procedure

Family or guardian with the patient

Patient comfort

Music for relaxation

Reassure the patient

Patient compliance


Gantry size

Room temp

Noise

Scan time reduced/patient

anxiety

Improving patient experience

Patient satisfaction

Patient experience


Thank you for your attention

Thank you to:

Patients/Colleagues/Staff:

Cobalt Health, Cheltenham

Gloucestershire Hospitals NHS Trust Foundation

2gether NHS Foundation Trust

Acknowledgments


pet/ct scans for dementia

Health & Medicine