With more than 30 years experience, the Nuclear Medicine Unit (NMU) of Ospedale San Raffaele provides conventional Nuclear Medicine and PET investigations for referred patients at a local, national and international level. The NMU has been one of the first PET-Cyclotron Centres in Italy contributing to the development and diffusion of the technique all over the Country. The NMU is recognized as a Centre of excellence with a national and international reputation in Molecular Imaging for its high quality clinical, research and training activities.
NMU mission is to offer the most accurate diagnosis helping the assessment and management of treatment strategy, and to contribute, with a high quality translational/clinical research in oncology, neurology and cardiology, to the understanding of the mechanisms of disease and the development of new diagnostic techniques to be translated into clinical practice. To achieve these goals, NMU is always up to date both technologically as well as in the clinical and scientific education of the staff. One of the major strengths of the Unit consists in the multidisciplinary expertise, including Nuclear Medicine physicians, radiochemists, physicists and engineers, all having a common objective which has its center in the patient care. NMU activity over the years is characterized by constant qualitative and quantitative developments and improvements. Currently, approximately 18.000 studies are performed every year, including SPECT, SPECT/CT, PET and contrast-enhanced CT (ce-CT) scans.
Clinical investigations performed
The clinical activity of the NMU includes all the standard Nuclear Medicine and PET investigations. Here below are listed the principal PET/CT and Conventional Nuclear Medicine investigations performed:
Principal PET/CT Investigations:
Principal Conventional Nuclear Medicine Investigations:
In general, the main clinical interests are focused on oncology, neurology and cardiology with some specificities:
In addition to the conventional PET/CT procedures for staging, restaging, monitoring and patient follow-up, at our Unit an integrated service of PET and contrast enhanced CT, performed in the same session, is also offered. Currently this opportunity, being available for both [18F]FDG and [11C]Choline studies, allows significant clinical and logistic advantages for patients who may have a complete staging of their disease in a single session examination.
Moreover, in the NMU a strong support to radiation oncology procedures is also present by providing PET functional information for radiation planning, patient monitoring and patient selection for personalized radiation treatment. These achievements are possible thanks to the strong collaboration of Nuclear Medicine and Radiation Oncology physicians and physicists. In particular, PET/CT procedures may also be performed in 4D modality (respiratory gated). The 4D PET/CT images provide information not only about the targets but also on its motion due to patient breathing. These information are used by Radiation Oncology physicians for a more accurate and personalized design of the treatment plan, avoiding under-irradiation of the target as well as over-irradiation of healthy surrounding normal tissues.
The staff is able to apply and integrate advanced nuclear medicine neuroimaging to neurological patients with a tight network of experts. The Nuclear Medicine Unit Neurology Section at Ospedale San Raffaele is considered a Centre of Excellence in Italy, Europe and abroad and it is one of the leading centre for molecular and functional brain imaging in neurological diseases. Here, validation and optimization procedures for [18F]FDG PET assessment of brain metabolic functions in cognitive decline and dementias have been obtained with high sensitivity and specificity for accurate early and differential diagnosis. Such procedures are routinely applied for clinical diagnosis and prognosis at single subject level. [18F]FDG PET scans are routinely performed in subjects with cognitive decline and early dementia for diagnosis and prognosis by using these advanced and validated analysis methods. Amyloid PET scans can be also performed using [11C]PIB a validated tracer for measures of amyloid burden (the Nuclear Medicine Unit was part of a multicentre European study for the validation of the amyloid PET methods in AD and early cognitive decline. In Parkinson’s diseases and parkinsonism we use DAT SPECT scan for presynaptic dopaminergic assessment for diagnosis and differential diagnosis.
Our strongest clinical application in cardiological field is represented by SPECT myocardial perfusion studies performed by an innovative gamma camera specifically dedicated to cardiac studies. This system permits a reduction of imaging times and a reduction (more than 50%) of the ionizing radiation exposure of the patient compared to traditional protocols, while maintaining a high image quality and diagnostic accuracy.
Although PET/CT cardiac applications represent a small percentage of NMU PET/CT clinical activity, a full procedure of analysis which allows the absolute quantitative estimation of the MBF (Myocardial Blood Flow) with [13NH]PET and kinetic modelling was implemented. The absolute quantification of MBF with PET allows to perform an objective and accurate evaluation of the whole coronary tree, providing a more complete assessment of the heart functionality than that obtained by visual analysis that can only provide relative information amongst different territories.
The Unit performs translational and applied clinical research in oncology and neurology, being also involved in clinical trials. In addition, a strong methodological research activity is aimed to support both clinical and research applications (in oncological, neurological and cardiological fields) to provide high quality images as well as accurate quantitative data.
Specific researches currently ongoing are:
The group, in the last five years (2009-2013), has published more than 200 papers on peer reviewed journals with a total Impact Factor 1.116,82 (Mean I.F= 3,97). The NMU has several collaborations at local national and international level for research purpose and academic training programs including Medical School, Specialty School in Nuclear Medicine and Radiology and Radiochemical Radiology Technicians for University Milano-Bicocca and Vita-Salute San Raffaele University.
The NMU extends over a 1.500 m2 area including two cyclotrons (18MeV e 11MeV), radiochemistry laboratories dedicated to the synthesis of radiopharmaceuticals and equipped with shielded cells (20) and automated systems for the production of labelled radiopharmaceuticals (i.e. 18F, 11C). PET laboratories are able to ensure the quality and safety of radiopharmaceuticals production for diagnostic use complying with national and European regulations. Furthermore, current procedures are undergoing to obtain full GMP accreditation (Good Manufacturing Production) in order to develop drugs for experimental use. The GMP accreditation in laboratories within a clinical setting will represent an unique scenery at national level. The facility of the Unit also includes 4 Positron Emission Tomography/Computed Tomography (PET/CT), 2 Single Photon Computed Tomography (SPECT), 1 SPECT/CT scanners and a dedicated system for myocardial perfusion SPECT studies. A preclinical SPECT/PET system is also available.