CLINICAL | CENTRES OF EXCELLENCE
Making nuclear medicine patient friendly
TheraMed Nuclear is a general Nuclear Medicine/PET-CT facility based in Midstream, Gauteng and deals with scanning for various cancers and diseases.
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S DR GEORGE BENNIE, nuclear physician states, “If you’re at nuclear medicine, you’re usually pretty sick.” Surrounded by nature-themed murals and light wooden furniture the atmosphere is calm and soothing. In patients newly diagnosed with cancer, this is imperative according to Dr Bennie. This theme is evident throughout the practice from reception to the imaging rooms. The practice is unique in that it has the only three-in-one PET-CT-SPECT camera in Africa. This allows the facility to perform both PET-CT (positron emission tomography) and SPECT-CT (single phone emission computed tomography) making it one of only three private facilities in South
Africa, and the only one in Gauteng with single-sitting whole-body co-registered SPECT-CT hybrid imaging capabilities with diagnostic quality CT scanning to boot. The two datasets, namely the 3D SPECT images are automatically fused to conventional CT allowing for better image processing and accurate localisation of lesions that is otherwise difficult in most studies (without some anatomical reference points). This obviates the need for a separate CT to be performed at additional cost and does not require the use of costly co-registration software to achieve similar results. TheraMed Nuclear is an example of a practice embracing hybrid (or dual-modality) molecular imaging, which until recently was
30 SEPTEMBER 2019 | MEDICAL CHRONICLE
limited to PET-CT. SPECT-CT allows for a cheaper and yet still competitive alternative to PET-CT in cancer diagnosis and treatment decisions. It is especially popular amongst referring oncologists because the cost of the scan allows for more funds to be retained for treatment purposes, especially where scheme oncology benefits are limited. SPECT-CT Where SPECT-CT has proved useful of late is with Technetium-99m iPSMA wholebody scans for prostate cancer skeletal and soft-tissue staging and follow-up. A third of the cost of the PET-CT alternative, the benefits outweigh the marginally lower sensitivity – a margin their referring
doctors are happy with, providing the CT scan is included. Without the CT the iPSMA scan is difficult to interpret as the radiopharmaceutical doesn’t distribute to fixed anatomical reference points as it does with a bone scan for example – limited to only skeletal staging. Other indications for SPECT-CT include pre-surgical localisation of excisable lesions eg sentinel lymph nodes for melanoma and breast cancer, and parathyroid adenoma in primary hyperparathyroidism. In addition to surface markings and gamma probe use, the addition of CT into the mix allows the surgeon to better strategise. The practice has largely abandoned its conventional ventilation-perfusion