The Clinical Setting

Gamma cameras are key instruments for nuclear medicine, and have been used for diagnostic imaging since the second half of the 20th century.
Today, they are mainly used for diagnostics but some so-called “portable” gamma cameras are also used in the operating theatre.

Here too, technological evolution has brought major benefits to doctors and patients.

1. Dimensions

Challenge

A pressing need for nuclear medicine was to have available an instrument that could provide a scintigraphic image in real time.

While one of the major advantages of scintigraphic systems such as SPECT is the elimination of the problem of overlap of anatomical structures, it is also true that the greater manoeuvrability of an instrument which can be moved around the organ of interest and can rapidly provide a scintigraphic image enables the disease to be localised very quickly. The development of a truly portable gamma camera can offer great benefits to both diagnostics and nuclear surgery.

Solution

A portable gamma camera? To achieve this goal we decided to develop the smallest integrated gamma camera in the world: a gamma camera with an integrated display – but only with the size of a smartphone.

We have developed an instrument that is easy to hold, light, and easy to position along multiple axial planes around the organs of interest. To make a gamma camera truly portable, the solution was the miniaturisation.

2. Use in Radio-guided Surgery

Challenge

The challenge was to make an instrument which could also be used in the operating theatre: to build a easy to use gamma camera enabling fast, easy use and that has an integrated detector and display system.

Sensitivity is one of the great advantages of scintigraphy. This means it can provide functional results with a high clinical value in comparison with other morphological exams, enabling the early identification and treatment of cancer.

The use of a gamma camera in the operating theatre could encourage the more widespread use of new techniques for radio-guided surgery.

Solution

We decided to develop a light, cable-free instrument with an integrated display that was capable of helping physicians to identify the best surgical strategy and easy for them to use without “getting in the way” and without prolonging excision times.

To achieve this goal, the first step was a thorough design phase, implementing the best technologies currently available and developing others ad hoc. This enabled us to produce a highly efficient gamma camera capable of identifying very small lesions and lymph nodes and providing representative imaging even some time after radiopharmaceutical administration.

3. In loco certification

Challenge

The greatest challenge: building an instrument able to certify the complete excision of the lesion or sentinel lymph node objectively, through a high-spatial resolution image, directly in the operating theatre, and in an extremely reduced time (about 30 seconds).

This would enable a reduction in risk, time and costs, leading to a significant improvement in the practice of treating various tumours.

To achieve this objective we decided to follow two routes: increased accuracy in identifying tumours, and increased scanning and display speed, improving the detection efficiency.

Solution
Increased accuracy and detection efficiency
The improved spatial resolution offered by the instrument is the sum of multiple factors whose aim is to provide the medical team with statistically “valid” images as well as the possibility of providing a pre- and postoperative diagnostic picture. It is the device’s portability and user-friendliness which enable a “quick lymphoscintigraphy” to be performed in the operating theatre, in order to locate the point of drainage and identify any positive sentinel lymph nodes. This certifies, through direct preoperative scanning, the presence and number of lymph nodes and/or tumours present prior to the surgical procedure. This “quick lymphoscintigraphy” can also be performed postoperatively to confirm the previously certified excision.

 

Increased image processing speed
The increased detection efficiency greatly facilitates the use of the gamma camera. The availability of a gamma camera providing a fast scintigraphic image expands its application to locations like the operating theatre, where instrument response is fundamental to the surgical strategy. The battery-operated device also avoids the presence of cables, which often hinder the movements of the medical team.

4. Costs

Challenge

Scintigraphy offers many advantages. These include: the ability to perform the exam on subjects who are awake without the need for sedation; the functional response which detects the presence of any lesions; and the high specificity, related to the type of radiopharmaceutical used. The widespread availability of gamma cameras in hospitals enables this diagnostic technique to be extended to various types of clinical exam, despite the not inconsiderable costs related to the acquisition of this instrumentation.
Portable, small-field gamma cameras in particular, while offering a new frontier for imaging in radio-guided surgery, are associated with costs which hinder their rapid take-up by the market.

Solution

Imagensys strove not only to miniaturise all the technology involved but also to design an instrument capable of reducing market prices and healthcare expenditure. In this context, cost reduction went hand in hand with miniaturisation, without causing the instrument to lose its “almost pocket-sized” nature but instead actually boosting its field of detection, to enable its application to be extended to various types of diagnostic imaging and localisation in radio-guided surgical procedures.