Newly developed Cardiovascular Non-invasive Imaging Program – led by Marcelo F. Di Carli, Chief of Nuclear Medicine – brings together all non-invasive cardiovascular imaging technologies to deliver the latest in diagnostic services to referring physicians and their patients.
Physicians at the Division of Cardiovascular Medicine and Depart-ment of Radiology at Brigham and Women’s Hospital are leading the way in the integration and management of existing and emerging technologies that will improve diagnosis and treatment of cardiovascular care.
With the completion of the new Carl J. and Ruth Shapiro Cardiovascular Center and the appointment of Marcelo F. Di Carli, MD, Chief of Nuclear Medicine, as Director of the Non-invasive Cardiovascular Imaging Program, all non-invasive cardiovascular imaging technology and expertise will be brought together in one location and under one organizational aegis.
Peter Libby, MD, Chief of Cardiovascular Medicine, who along with Steven Seltzer, MD, Chief of Radiology, conceptualized the Cardiovascular Non-invasive Imaging Program, says, “This program is the expression of our shared commitment to change the face of cardiovascular medicine, and I believe the level of integration we have achieved is unprecedented.”
Dr. Seltzer adds, “Our collaborative model will allow us to take full advantage of the explosive growth in imaging technology to enhance patient-centered care, multidisciplinary education for tomorrow’s cardiovascular physicians, and pioneering research.”
Groundbreaking clinical research
Dr. Di Carli is national principal investigator for a large prospective, multi-center observational study designed to elucidate the clinical value of four prominent diagnostic imaging modalities – SPECT, PET, PET/CT, and CT angiography (CTA) – in the evaluation of coronary artery disease. The SPARC trial (Study of Myocardial Perfusion and Coronary Anatomy Imaging Roles in CAD) will investigate the value of these modalities with respect to post-test resource utilization and patient outcomes.
Dr. Di Carli says, “SPARC’s large national data base will have sufficient power to allow us to examine the effects of geography on the utilization and effectiveness of different imaging modalities and the effectiveness of different techniques in diverse patient populations and sub-groups. We anticipate that it will provide important information about the benefits of each modality to help physicians make informed clinical decisions and payers make appropriate reimbursement decisions.”
Training tomorrow’s imaging specialists
One of Dr. Di Carli’s primary objectives for the Cardiovascular Non-invasive Imaging Program will be the development of a multimodality advanced training program. The program will require all trainees to have a broad spectrum of basic skills that enables them to recognize the strengths and limitations of different imaging tools, and will provide opportunities to achieve proficiency in more than one imaging modality.
He notes, “Cross-training will enable our physicians to design the right imaging strategies to answer the right clinical question, and to integrate data from different imaging modalities and translate it into more appropriate clinical recommendations.”
Pioneering imaging research advances future of cardiovascular care
Molecular imaging will be a major research initiative of the Cardiovascular Non-invasive Imaging Program. Dr. Libby says, “Molecular imaging has the potential to change the standard of cardiovascular care. Whereas traditional cardiovascular imaging has been bound to anatomy, molecular imaging will allow us to target biomarkers of disease, information that will be valuable in diagnosis of and risk assessment for cardiovascular disease, as well as in monitoring therapy and assessing the efficacy of investigational agents.”
“The potential is there,” says Dr. Di Carli, “to detect disease earlier in a more individualized way. If you intervene earlier, you are going to save lives.”
The challenges of bringing molecular imaging to the bedside include identifying biomarkers of disease, constructing probes to target biologic processes, developing imaging technology to visualize those processes, and validating the probes in clinical practice. In the cardiovascular arena, the small caliber of coronary vessels and the constant motion of the beating heart are further obstacles to overcome.
The Cardiovascular Center also has been home to pioneering research of Dr. Libby and his colleagues demonstrating that inflammation is a pivotal factor in atherosclerosis. “Inflammation cannot be imaged by any traditional modality,” he says, “We are hopeful that within a few years, our molecular imaging research will enable us to visualize inflammation in vivo, which may in turn lead to the development of a clinical tool that can identify inflammation and plaques particularly at risk of causing a heart attack or stroke before they occur. Such modalities would help us target populations who may require more aggressive therapy for atherosclerotic disease.”
Dr. Libby notes, “Our comprehensive program brings together the strength of a robust basic laboratory research program as well as access to large imaging tools, and places us in an advantageous position to advance molecular imaging and design the cardiovascular care of the future.”
New Center supports multidisciplinary care
When it opens in spring 2008, the Carl J. and Ruth Shapiro Cardiovascular Center will house a multimodality interpretation area staffed by cardiologists and radiologists to optimize services to patients and to provide a single source for consultation and imaging reports for referring physicians. An advanced post-processing, visualization, quantification, and image-management system will allow interpreters to access all current and previous studies, from any imaging modality, to assist them in making the most informed patient care decisions.
The Shapiro Center will house advanced imaging technology including:
- Advanced multi-slice CT
- A hybrid 64-slice PET/CT
- A 3 Tesla MRI with high performance gradients for dedicated cardiovascular imaging
- Advanced echocardiography, including contrast and 3-D echo
- Access to a cyclotron for production of advanced radiopharmaceuticals for PET and SPECT imaging.
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