WBR incorporates all the available 3D, statistical, physical, and geometrical information produced by the scan and reconstructs the image.In a world where 3D creatures rise from the green slime to star in their own movies, it makes little sense for physicians to continue to look at two-dimensional images of something as three-dimensional as the human body.
If Israeli startup UltraSPECT’s home page was a work of modern art, it might be titled ‘Dance of the Halloween Pelvises’. What greets you are two synchronized identical revolving x-ray images of the lower torso. But even to the untrained eye the pelvis, vertebrae, femurs and ribs are much more distinct in the image created by the company’s Xact.bone product. Imagine how much more information they reveal to radiologists and other physicians who use today’s Nuclear Medicine imaging technology.
The problem in Nuclear Medicine (NM) imaging is one that many of us, holding our first – or third – digital camera, face today: resolution vs. noise. As the resolution, or quality of the image, is increased, so does the noise, or unwanted or irrelevant elements. As filtering is applied to reduce the noise, some of the image information is lost as well.
An added complication is that while visible light travels in a single direction, the gamma-waves which provide the illumination source in NM are emitted in all directions and a special device called a collimator that orients the waves must be applied to correct for this phenomenon. At best there is a tradeoff, and more often than not the image is dependent on the skill and experience of the gamma camera operator, of whom there are too few.
The Wide Beam Reconstruction (WBR) technology of UltraSPECT creates a stack of images that are transferred to a workstation where physicians can review the 3D model. This means more accurate diagnoses by the doctors, more efficient treatment for the patient, and a major change in the quality of Nuclear Medicine imaging in American hospitals.
The 12,000 NM scanners in the U.S. aren’t sitting there gathering dust. The number of cardiac scans performed in the US annually is tremendous, about 7.5 million procedures a year, or 1 for every 40 Americans, and that number is growing 7-10% per year. Typically cardiac scans are used to evaluate coronary artery diseases such as ischemia, while planar (bone) scans have applications in oncology, orthopedic, inflammatory and metastatic diseases.
The potential for UltraSPECT to have a behind-the-scenes impact on the quality of NM and healthcare in the U.S. is immense. At an average cost of $600 per procedure, this is a $4.5 billion dollar annual market, not including the hundreds of millions of dollars spent on capital equipment acquisition.
The gamma cameras scan in two different modes: planar, where the patient lies absolutely still on a very uncomfortable bed for the better part of 30 minutes – a real problem for the elderly and ill – as the camera slowly passes down the length of their body making transverse images, or ‘salami slices’, as Schwartz calls them; or SPECT (Single Photon Emission Computerized Tomography), where the camera revolves 180° around a specific part of the body, snapping up to 128 pictures along the way. Prior to each scan a radiopharmaceutical is injected into the body; different compounds are used depending on the type of scan and procedure.
Radiopharmaceuticals are expensive and, as they are radioactive, carry a certain risk so it is in the patients’ interest to receive as low a dose as possible.
This is difficult enough for hard-tissue images, but what of imaging soft-tissue, such as a beating heart? In cardiology, the patient must undergo two scans: a rest-scan and a stress-scan, not always done on the same day. This is where the WBR method comes in. WBR incorporates all the available 3D, statistical, physical, and geometrical information produced by the scan and reconstructs the image, estimating missing parameters if necessary.
Established in 1999, the Haifa-based company, which operates in the U.S. out of Brookfield, Wisconsin, recently announced 15 installations of its systems in top-tier U.S. and Israeli hospitals. Duke University Medical Center and Vanderbilt University Medical Center were both beta sites for the UltraSPECT’s products, and some of the members of the company’s medical advisory board have prominent posts at these institutions.
In addition, UltraSPECT’s technology is already working at thirteen other sites including NY Presbyterian Hospital, the Mayo Clinic, and two Israeli hospitals, Jerusalem’s Hadassah Ein Kerem and Haifa Carmel. The company is presently in preliminary talks regarding alliances with leading medical imaging companies such as GE Medical, Philips, and Siemens.
Its products, Xact.bone and Xpress.bone – both launched in June after receiving United States Food and Drug Administration clearance – truncate the duration of the imaging process which is a convenience for the patient and a cost-saving measure that improves the efficiency and turnover of the highly expensive imaging devices.
According to Shuli Schwartz, UltraSPECT’s CEO and co-founder, “we can reduce acquisition time by half, and reconstruct as good an image or better. This leads to better patient care and comfort, and better accuracy for physicians.”
And for those who look at the balance side of the ledger, UltraSPECT’s technology and products promise “better capital equipment utilization, by shorter acquisition time and 50% more patient throughput.”
In other words, hospitals and other facilities can make better use of all those very expensive machines they own.
“The results lead to improved health care for the patient and more efficient use of limited resources. Image resolution is a well known problem, and it was difficult to solve it,” Schwartz told ISRAEL21c.
Schwartz should know. She previously worked on image processing in Nuclear Medicine at Israeli company Elscint as did co-founder Israel Ohana. She’s a mathematician and he’s a physicist, and together they created the solution at the heart of UltraSPECT’s products.
They have managed to capture the attention of some of Israel’s best Venture Capital funds and Jonathan Adereth, private investor and former CEO of Elscint who, not coincidentally, was Ohana’s boss when Ohana was VP of the Nuclear Medicine division of Elscint (and later ELGEMS, a joint venture between Elscint and General Electric).
“I invested my own money in the company because I believe in the people, their unique knowledge, the technology and their market understanding. This dilemma (optimizing resolution, scan time, and dose) has been around for 40 years. This is a classic example of how a small company with an entrepreneurial spirit can bring about a radical change in thinking, something that large companies, who have many different directions, can not do,” said Schwartz.
Already UltraSPECT is looking to the future. They are collaborating on molecular imaging for oncology applications, looking for radiopharmaceuticals that will directly target the different lesions. But Schwartz is cautious.
“I don’t want to use the term ‘early detection’, she said while speaking of this new direction, “but there is a potential due to better localization of lesions, better diagnostic confidence.”