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THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO IBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO.

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Presentation on theme: "THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO IBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO."— Presentation transcript:

1 THE FRONTIERS OF MEDICAL IMAGING FERRUCCIO FAZIO IBFM CNR, UNIVERSITY OF MILANO BICOCCA, H S. RAFFAELE, MILANO

2 X RAYS ULTRASOUND X RAYS COMPUTED TOMOGRAPHY CT MAGNETIC RESONANCE MR POSITRON EMISSION TOMOGRAPHY PET IN VIVO MEDICAL IMAGING

3 - Improved Temporal Resolution - Wider Anatomical Coverage - Improved Axial Resolution HELICAL MULTI-SLICE CT Solid State Detectors Ultra Fast Ceramics

4 SINGLE-SLICE CT 1 sec/revolution

5 HELICAL MULTI-SLICE CT 16 SLICES 0.4 sec/revolution 1.25 slice thickness 1000 images/whole body study

6 HELICAL MULTI-SLICE CT CARDIAC IMAGING

7 MORPHOLOGY FUNCTION FLOW CHEMICAL CONTENT MR BOLD Gd PERFUSION DIFFUSION/ PERFUSION MR ANGIOGRAPHY MR SPECTROSCOPY in vivo

8 MAGNETIC RESONANCE ANGIOGRAPHY FAST GRADIENT ECHO MR ANGIOGRAPHY DIGITAL ANGIOGRAPHY Acute pulmonary embolism

9 MAGNETIC RESONANCE DIFFUSION/PERFUSION IMAGING ECHO PLANAR SEQUENCES Acute trombosis of the left carotid artery. T2 weighted image DIFFUSION weighted image PERFUSION weighted image

10 DIFFUSION TENSOR IMAGING - FIBER TRACKING

11 DIFFUSION TENSOR IMAGING – FIBER TRACKING

12 POSITRON EMISSION TOMOGRAPHY PET

13 CLINICAL PET IN ITALY TOTAL EXAMS/YEAR Nr. exams Year ESTIMATED PET - PET/CT SCANNER UNITS WW

14 18 F-FDG WHOLE BODY PET  DIAGNOSIS  STAGING  RE-STAGING AND FOLLOW-UP  RADIOTHERAPY

15 RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 

16 RADIOTRACERS PREPARED AT HSR [18F]FDG Glucose metabolism [18F]FESP D2 and 5-HT 2 receptor antagonist [15O]H2O Cerebral flow, Studi attivazione funzionale [13N]AMMONIAMyocardial flow m-[11C]hydroxyefedrine Adrenergic antagonist [11C]FLUMAZENILBenzodiazepine receptor antagonist [11C]RACLOPRIDEDopamine D2 receptor antagonist [11C]FE-  -CITDopamine reuptake inhibitor [11C]SCH23390 Dopamine D1 receptor antagonist [11C]CARAZOLOL Adrenergic  1/  2 receptor antagonist [11C]MCN5652Serotonin reuptake inhibitor [11C]MDL100907Serotonin 5-HT2A receptor antagonist [11C]methylcolineProstate Cancer [11C]FLUVOXAMINESerotonin reuptake inhibitor [11C]CGP62349 GABAB antagonist [11C]isovaleroil-L-carnitineCerebral metabolism [ 11 C]PNU167760Serotonin 5-HT 1A receptor antagonist [ 11 C] BISOPROLOL Adrenergic  1 antagonist [ 11 C] ICI Adrenergic  2 receptor antagonista [ 11 C] OLANZAPINEAtypical Antipsychotic [ 11 C] SB235753Dopamine D4 receptor antagonist [ 11 C] E2020Muscarinic M 2 receptor antagonist [ 11 C] SCH442416Adenosine A 2A receptor antagonist [ 11 C] PALMITATEFatty acids metabolism [ 11 C] A 84543Nicotine  2  4 antagonist [ 11 C] VC195Peripheral Benzodiazepine [ 11 C] VC193MPeripheral Benzodiazepine [ 11 C] VC198MPeripheral Benzodiazepine [ 11 C] WAY100635Serotonin 5-HT1A receptor antagonist [ 11 C]RN5Adrenergic  1 receptor antagonist [ 11 C] VA100Opioid K1 receptor antagonist [ 11 C] CARFENTANILOpioid  receptor agonist [ 11 C] ZOFENOPRILACE inhibitor [ 18 F]FLUORO CAPTOPRILACE inhibitor [ 11 C] CNR1  1 adrenergic antagonist [ 11 C] PK Peripheral Benzodiazepine [ 11 C] F167  2 receptor antagonist [ 11 C] PD60dopamine D 3 antagonist [ 11 C] PD78dopamine D 3 antagonist

17 B.P. 65 yrs PSA: 1,9 ng/ml PROSTATE CANCER [ 11 C]Choline-PET[ 18 F]FDG-PET [ 99m Tc]MDP

18 TRACERS for TUMOR CHARACTERIZATION Glucose metabolism [ 18 F]FDG Membrane function [ 11 C]Choline Proliferation [ 18 F]FLT [ 18 F]FMISO Hypoxia [ 18 F]FAZA [ 64 Cu]ATSM Apoptosis [ 18 F]Annexin V Angiogenesis [ 18 F]NGR-peptide Neuroendocrine tumors [ 110 In]Octreotate 

19 RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 

20 SANDWICH OF DETECTORS FASTER DETECTORS for HIGH COUNT RATE CAPABILITY TIME OF FLIGHT INFORMATION NEW DETECTORS with: SMALLER SIZE (2-3 mm) GOOD ENERGY RESOLUTION DEPTH OF INTERACTION INFORMATION FUTURE DEVELOPMENTS IN PET CURRENT DETECTORS: BGO, GSO, LSO

21 RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 

22 PET PET – [ 18 F]FDG LACK OF ANATOMICAL INFORMATION

23 PET CT PET/CT PET – [ 18 F]FDG ANATOMICAL INFORMATION

24 PETCT PET/CT

25 HSR MILANO 18 F-FDG PET/CT

26 PET/CT - APPLICATIONS ANATOMICAL LOCALIZATION OF PET FUNCTIONAL IMAGES PET/CT GUIDED RADIOTHERAPY TREATMENT PLANNING

27 METABOLICALLY AIMED RADIOTHERAPY (MART) CTPET CT BASEDPET/CT BASED TREATMENT PLAN

28 OPTIMIZED TREATMENT PET/CT VOLUME DEFINITION PET/CT GUIDED RADIOTHERAPY PLANNING METABOLLICALLY AIMED RADIOTHERAPY MART

29 LUNG SIMULATION TOMOTHERAPY MD Anderson Houston

30 4D PET/CT Respiration control during PET/CT Target volume with precise motion information TREATMENT UNDER RESPIRATION CONTROL

31 HYPO-FRACTIONATION  5-10 fractions PET GUIDED IMRT/TOMOTHERAPY IMPROVED TUMOR/NON TUMOR RADIATION DOSE METABOLLICALLY AIMED RADIOTHERAPY MART

32 RADIOCHEMISTRY INSTRUMENTATION HW/SW PET + PROTEOMICS/FUNCTIONAL GENOMICS ADVANCES IN PET IMAGING NEW SCINTILLATION CRYSTALS PET/CT NEW TRACERS PET 

33 THE PROTEOMICS OF PET: IDENTIFICATION OF NEW TUMOR MARKERS At present, tumor markers (CEA, PSA....) are inadequate for early diagnosis and restaging Functional proteomics (on human tumor specimens) may identify new markers The new markers identified can be validated for assessemnt of early diagnosis or follow-up (re-staging) Patients selection criteria for PET and current tracers (FDG, Choline) Development of new radiotracers for PET imaging


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