Nuclear Imaging traditionally has been based on measuring variation in tissue concentrations of radioactive biomarkers, providing data which can be correlated to specific states of organ function and pathophysiology. The resulting functional images are then used to complement the structural imaging obtained by radiographic or MR studies. The past decade, however, has seen a fundamental shift in nuclear imaging technology with the advent of hybrid systems which combine functional and structural imaging. Our department has been on the cutting edge of these innovations, adding two SPECT-CT scanners—one of which, added in 2009, includes full ring diagnostic CT—and an on-site fixed PET-CT system which was the first in northern New England and remains the only fixed PET-CT scanner in the state.
The Division of Nuclear Imaging provides a full range of diagnostic imaging and therapeutic procedures. To the diverse selection of studies offered, the division has added, within the past several years, cardiac PET imaging for myocardial viability, Zevalin® studies (imaging and therapy for lymphoma, performed in conjunction with the Section of Radiation Oncology), Therasphere® studies (for liver malignancy, performed in conjunction with the Division of Interventional Radiology and the Section of Radiation Oncology.)
The Nuclear Cardiac Stress Lab, under the direction of Dr. Foote (board certified in Internal Medicine and Nuclear Cardiology) is a regional referral center for noninvasive assessment of all types of cardiac pathologies. Exercise and pharmacologic stress and rest imaging studies are performed to assess a variety of diagnostic and prognostic parameters and to measure ventricular size and function. Research focus in the lab has been on measures of exercise capacity, new myocardial imaging agents, and novel biomarkers of myocardial ischemia. The Dartmouth group was the first in the world to publish evidence clarifying the sensitivity of cardiac stress testing, as well as the first to demonstrate elevation of certain neurohormones in the blood of patients with transient myocardial ischemia.
The division continues to play a key role in PET and PET-CT education on a national level. Under the direction of Dr. Seltzer, who serves as director of our PET-CT program, we conduct regular sessions of the teaching seminar, Frontline of PET-CT. This course is given several times per year and has been attended by radiologists and nuclear medicine physicians from across the United States and from as far away as Asia and South America. The division hosts a highly regarded annual symposium The Role of PET-CT in Cancer Management. And in partnership with the American College of Radiology, division faculty led by Dr. Seltzer conducts "ACR-Dartmouth PET/CT," a three-day course offered each June, September and December in Reston, Virginia.
The division pursues a variety of research interests, is active in quality improvement initiatives, and has participated in several recently concluded or ongoing clinical trials. These include: a multicenter study on the role of dopamine receptors in the diagnosis of Parkinson's disease; the use of fatty acid tracers for the imaging of myocardial ischemia; FDG in the diagnosis of Alzheimer's disease; and is currently participating in a multi-center trial testing the value of F-18 sodium fluoride for defining skeletal metastases. Drs. Foote and Herr, in the Cardiac Stress Lab, have conducted extensive work on the use of brain natriuretic peptide (BNP) in the diagnosis of heart disease.
Division Director Dr. Siegel also serves on the D-H Information Systems Steering Committee, is chair of its subcommittee on Medical Imaging, and is a member of the institution's Clinical Informatics Committee and is Director of Radiology Informatics. He was recently awarded a DMS Learning Technology Venture Fund grant to develop a web-based teaching file application that facilitates image-uploads from any workstation, providing an easily accessible repository of cases and educational material.
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