4. Stress testing

8. Stress echo

9. Stress Echo

11. Stress Echo

13. Stress Echo

14. The cardiac imaging market is transitioning SPECT PET Cardiac catheterization CT angiography

15. SPECT perfusion imaging Low diagnostic accuracy in some patient populations-Balanced ischemia Long Acquisition times Higher radiation exposure Decreasing reimbursement

18. SPECT PET

20. PET perfusion imaging High diagnostic accuracy regardless of patient status-Gate both stress and rest Shorter acquisition times Lower radiation exposure Increasing reimbursement

22. PET perfusion 2. Nuclear Medicine Self-Study Program III: Nuclear Medicine Cardiology. Botvinik, EH, Ed. 1998: Society of Nuclear Medicine, Reston, VA. Author Sensitivity Specificity # Patients Gould 95% 100% 50 Demer 94% 95% 193 Go 93% 78% 202 Schelbert 97% 100% 45 Yonekura 93% 100% 49 Williams 98% 93% 146 Stewart 84% 88% 319 Weighted Avg. 93% +/- 8 92% +/- 5 766

25. The Myth of Rb-82

26. 36 inch separation for patient access GEMINI Open PET/CT Advantage Integrated operation (CT/PET Imaging) Separated operation (Independent CT simulation / diagnostic CT or PET) 195 cm PET coverage in closed position 130 cm PET coverage in open

30. Dose delivery by Infusion System Infusion pump set to deliver 60 mCi or operate for 25 sec, whichever is reached first. Maximizes bolus of Rb-82. As generator decays, amount of dose delivered may drop. Consistent bolus delivery can improve count statistics near the end of generator life.

31. Sample PET/CT Protocol Protocol courtesy of Marcelo DiCarli, MD Approximately 30 minutes scout CT-trans Rb-82 50-60 mCi 70-90 sec 90-120 sec gated rest pt out Dipy 0.56 mg/kg scout CT-trans 70-90 sec 90-120 sec Rb-82 50-60 mCi gated stress Approx 1 min Approx 7 min Approx 6 min Approx 1 min Approx 7 min

38. Patient Radiation Dosimetry Copyright Dr. Mark Nathan Isotope Effective Dose Equivalent Per study Total Rb-82 1.6 mrem/mCi 50 mCi 80 mrem Tc-99m mibi 51 mrem/mCi 30 mCi 1500 mrem Th-201 850 mrem/mCi 4 mCi 3200 mrem CT mu-map 440 mR 1 scan 440 mrem

54. PET perfusion imaging High diagnostic accuracy regardless of patient status Shorter acquisition times Higher insurance reimbursement Lower radiation exposure Value for the patient Value for the practice