Cardiovascular Business - October/November 2007 - (Page 26) iN praCtiCe › by JonatHan batCHelor Cardiac PET/CT Steps into the Clinical Mainstream According to the Centers for Disease Control and Prevention (CDC), heart disease has been the leading cause of death in the United States for the past 80 years and is a major cause of disability. The CDC estimates that approximately 61 million people in the United States have heart disease, and approximately 950,000 people die from the condition each year. Overall, heart disease contributes to approximately 40 percent of all deaths. F or women, heart disease statistics paint an even grimmer picture. According to the American Heart Association, cardiovascular disease accounts for more deaths in women per year in the United States than the next six causes of death combined. Myocardial perfusion imaging (MPI), particularly quantitative MPI, with PET/CT has demonstrated superior sensitivity, specificity, and efficiency compared with SPECT studies. However, until recently, cardiac PET/CT imaging has largely been the purview of academic or research-based medical centers. The primary reason for this situation lies in the Centers for Medicare & Medicaid (CMS) reimbursement-approved radiotracers utilized in the PET portion of a cardiac study. Nitrogen13 (N-13) ammonia requires an on-site cyclotron, radiochemistry synthesis capabilities, and has an approximate 10-minute half-life. Although N-13 ammonia has enjoyed widespread use in scientific investigations, its production parameters have limited its clinical utilization. The other CMS-approved cardiac PET radiotracer, rubidium-82 chloride (Rb-82), is a monovalent cationic analogue of potassium with a half-life of approximately 75 seconds. However, unlike N-13 ammonia, this radiotracer is produced in a commercially available generator (CardioGen-82 by Bracco Diagnostics) that can be delivered to a PET/CT practice via distribution channels throughout the United States. The generator contains strontium-82 (Sr-82) in a lead-shielded elution column. The Sr-82 has a half-life of 25 days, which allows for the generator to be on-site for nearly four weeks before it needs replacing. The Rb-82 is eluted with saline by a computercontrolled infusion pump, connected via an intravenous tube to the patient. The generator is replenished every 10 minutes, allowing for Rb-82 to be utilized in a routine clinical setting for gated rest/pharmacological stress PET/CT MPI studies. 26 Cardiovascular Business October/November 2007
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