Molecular Imaging Merges Care & Cure

A partnership works best when it enhances and rewards its partners. That is the case with the partnership between University Hospitals (UH) Case Medical Center and Case Western Reserve University in Cleveland and Philips Healthcare that is focused on developing, advancing and enhancing medical and molecular imaging technology. It also benefits another very important group—patients.

Since its founding in 1866, University Hospitals Case Medical Center has remained on the forefront of innovation and care. It continues to live its mission—To Heal. To Teach. To Discover.—every day. UH includes an expansive network of physicians, hospitals, health centers, outpatient surgery centers, urgent care centers, cancer and pediatric specialty centers, rehabilitation facilities and mental health services in Northeast Ohio. The focus is personalized care close to home.

A year and a half ago, the cancer program at UH embarked on a new era of patient care with the opening of UH Seidman Cancer Center. This 120-bed, 375,000-square-foot hospital consolidated all of the UH Seidman Cancer Center’s services under one roof in a new $260 million cancer hospital. “We are high tech and high touch,” says Linda Mangosh, VP of operations of the Cancer Center.

Billboard signs along the freeway similarly tout care at the UH Seidman Cancer Center that opened in June 2011: Curing Cancer Every Day. Much of that care, and even cure, is enabled by leading-edge imaging technology and techniques that are at the root of the partnership between UH and Philips.

The project began in June 2010 with a $5 million Ohio Third Frontier grant from the state of Ohio. The grant program seeks to develop healthcare and biomedical device technology organizations in Cleveland and Northeast Ohio, spurring commercialization collaborations among industry, research institutions and clinical systems.
Philips Healthcare is investing more than $33.5 million in the first phase of a medical imaging research and development center at UH to test and evaluate new imaging technologies. The center also is developing and testing imaging agents, developing new imaging technologies and providing researchers with access to prototype and early generation technologies.

Together, the grants are helping to fund the Philips Healthcare Global Advanced Imaging Innovation Center in renovated space at University Hospitals as well as at newly constructed space in the Cancer Center. With Philips global computed tomography and nuclear medicine businesses located about 20 minutes down the road from UH, face-to-face collaboration is a daily reality.

Defining cancer care

University Hospitals’ cancer patient volume has grown steadily in recent years, namely due to the area’s aging population and its industrial past. Over the last dozen or so years, the system has seen a fourfold increase in the total number of cancer patient visits and now sees about 8,000 annually. Also, between 2005 and 2010, UH Case Medical Center’s cancer-related hospital discharges increased to 6,500 a year from about 5,200.

The state-of-the-art UH Seidman Cancer Center, located next to the main hospital, was created with much contemplation and planning from clinicians, patients and families, according to Mangosh. Early on in the planning stage, focus groups with patients and families grew into a Patient and Family Advisory Council that helped formulate the needs and wants for the facility. “We took those ideas to our meetings with the architects and designers,” she says. “We designed open spaces with natural light, glass, sloping terraces and a healing garden to help reduce the stresses of illness and being in the hospital. Our art curator wanted things to be lively and whimsical and a distraction to patients and families so 325 works of art were incorporated, too. We also thought about the health of patients’ family members in creating areas for them to stay and have amenities such as wireless internet connections, computer workstations, refrigerators, washers and dryers. We work to care for the body and the mind.”

What grew from all the planning and careful construction is a 10-story, glass-front hospital with four floors dedicated to inpatient care, while the others offer clinics and exam rooms, surgery, bone marrow transplant, IV therapy and a survivorship center. Open-bay IV therapy enables patients receiving chemotherapy or outpatient infusion services to sit in heated chairs overlooking the Schneider Healing Garden, or escape there to take a walk surrounded by nature. Activity lounges offer distraction as do exercise rooms with treadmills, recumbent bikes, ergometers and Wii games. Patient care is carefully coordinated by multidisciplinary teams of physicians and nurse navigators who facilitate appointments and care for inpatients and outpatients.

Inside UH

The scope of University Hospitals is vast, with seven fully owned hospitals and two partially owned hospitals. The Department of Radiology at Case Western Reserve University School of Medicine and University Hospitals Case Medical Center, led by Pablo Ros, MD, MPH, PhD, professor and chairman, performs radiology services performed at 23 sites, with 100 radiologists. Together, the facilities perform a million radiology exams per year. The department houses the latest generation of Philips imaging modalities, including one of the world’s first PET/MR systems installed last fall, five PET/CT scanners, some 20 gamma cameras, an Ingenia 3T MR and numerous other MR and CT systems. The facility was the first to get an Ingenuity CT scanner. “Philips has innovation and engineers and scientists. All of these things together with the clinical and research expertise here is a very effective combination for advancing medicine and treating patients,” Ros says.

Imaging is a core strength for UH. “Technology is important—for finding the source of disease and monitoring its progress—but also for research activities and bettering the science. Being high tech also has helped in [physician and staff] recruiting,” Mangosh offers.

Ros points to the importance of cutting-edge technology for research. “As an alpha site, we have development equipment which means we have minimal overhead to conduct research.” As a research site, they’ve watched key developments emerge—such as being the first to test time-of-flight imaging.  

The desire to advance and drive the development of imaging technology grew out of the University Hospitals’ Vision 2010 strategic plan that sought to position the health system for continued leadership into the future, offers Himanshu Pandya, VP of radiology at UH Case Medical Center. With an investment of more than $1 billion over five years, the Vision 2010 initiative at UH has resulted in several new state-of-the-art facilities as well as expansions of several programs. Since 2009, the Cancer Center, a new hospital and three health centers have been built as well as a new ER and NICU created. The Cancer Center brought the opportunity to reexamine radiology capabilities.

To get ready for the expansion, Pandya and his team worked with Philips staffers to inventory and evaluate the systems installed across the UH facilities and defined a path to acquire leading-edge technology. They moved systems among facilities to optimize productivity and put out bids on new technology. Molecular imaging was a priority in terms of PET/CT and with an eye toward PET/MR.

“We worked on extensive bids and RFPs,” Pandya says. “We cast a wide net to see what was out there in terms of technology. The Philips bids presented the best technologies available and good prices, but where they won out was in support and service. They offered a dedicated project manager and service people to assist us in bringing in the new technology. They also offered building assistance which we needed in several instances to modify departments and facilities for the new systems.”
But what solidified the deal to move forward with a majority of best-of-breed Philips systems were discussions about and the creation of the research collaborative. “We saw testing and beta testing of imaging devices as a positive for us to move into the future as a leader and innovator, contributing to better care for our patients,” Pandya says.

Path to progress

UH is now starting to see some fruits of that partnership. Some 30 to 40 projects are now underway with help from a senior scientist and five research fellows from UH. Current projects focus on CT, PET/MR, digital PET and 7 Tesla MRI. UH is working on time-of-flight in CT and PET/MR and beginning to scan cartilage degeneration with 7T. Investigations into gynecological cancers also are underway with PET/MR. They are seeking ways to beef up attenuation correction and speed up exam times.
“PET/MR is the ultimate imaging modality with a very high contrast resolution and sensitivity,” Ros says. “It is a very robust technology. But it still has issues, such as a long scan time. That will shorten with time. But we are still seeking out its strengths and place in imaging disease.”

He sees the next wave of investigation looking at comparing the findings of PET/MR and PET/CT in patients with breast cancer, notably in secondary findings and lymph nodes. Prostate cancer is another area of research. But Ros is a firm believer in the power of the leading hybrid molecular imaging technology, PET/CT, pointing out that two-thirds of radiology is CT. “In diseases such as lung cancer, PET/CT will never be substituted,” he notes. “Whatever CT does well, CT will continue to do well with PET/CT and vice versa with MR [and PET/MR]. This is not an either-or, but both. If you don’t see what you seek with CT, then do MR. And also in cases where there is concern over radiation dose, such as pediatrics or patients under 50, we favor MR. We bring these technologies in to serve our patients better—to enable more accurate diagnosis, guidance and therapy.”

Improved accuracy comes from advanced technology and doctors helping doctors, says James K. O’Donnell, MD, director of nuclear medicine at UH Case Medical Center. “I see myself as the doctor’s doctor to give appropriate and intricate information to specialists treating our patients. The photons never lie, sometimes we don’t know what they mean or misinterpret them, but they never lie. Our scanners now have incredible image quality, quicker scan times and expanding clinical applications. We analyze function and physiology and anatomy before, during and after treatment. Cancer is often a lifetime disease, we monitor it all along.

“PET/CT hybrid imaging has taken imaging by storm over the last 10 years,” O’Donnell says. “It is ‘the’ modality for staging [cancer]—where is the cancer, where else is it located in the body, is it still active or have we gotten it all? We are more accurate in identifying lesions and we give that information to oncologists, radiation oncologists and surgeons to carry out more focused therapies and surgeries.”

Like Ros, O’Donnell sees PET/MR emerging in areas where CT is weaker, such as in the pelvis and more specifically in prostate, gynecological and colorectal cancers. “PET/MR [in these areas] gives several order of magnitude better images. It is a step forward that will not replace, but complement, PET/CT.”
O’Donnell also touts PET/CT’s merits in neurology, specifically Parkinson’s disease, dementia and Alzheimer’s disease detection via new tracers that detect the presence of amyloid plaque. “Now that we can assess plaque burden, the world needs to look at drugs that will help these problems and stop them from progressing. I am confident pharmaceutical companies have drugs in the pipeline. And we see this as a large area of growth for imaging patients. I even wonder if we are prepared to image the volumes of people who could seek out these exams.”

Other areas for future growth come in imaging addictions such as overeating, obsessive compulsive disorders and marijuana and alcohol abuse. “The sky is the limit with functional imaging,” he says. “And with all disease, this enables us as physicians and teams of physicians in collaboration via tumor boards and [similar groups] to treat better, treat earlier, more effectively and more efficiently.”

It is this physician partnership in care that enhances patient care. And the partnership between University Hospitals and Philips that is enhancing and rewarding patients, physicians and even people who will someday benefit from the lessons learned from this innovative imaging-based research. Stay tuned.