Faculty and Staff of ERA 3

Vanderbilt Nuclear Medicine Faculty and Staff that played a role in ERA 3:

Faculty
David Rollo
: Rollo coordinated staff efforts testing and publishing clinical observations obtained with the planar X-ray fluorescence and longitudinal tomography using the 9-element HPGe multi-detector system. Enhancement of the activity distribution at a selected plane (focal plane tomography) was demonstrated by scanning the detector ensemble with the nine individual collimators focused to a common plane. Price and Pickens developed the reconstruction algorithms used in this application. The major limitations of the 9 detector system remained, namely 1) lower sensitivity than the larger surface area Anger camera, and 2) inability to correct scan data for patient motion, both of which problems discouraged further clinical testing.

A similar longitudinal tomography approach was tested using a digitized PhoCon, with its opposed Anger cameras each with focused collimators, a rectilinear device that could be used for whole or partial body scanning. The commercial analog device used different lenses to image real time events on a CRT that accumulated and automatically displayed images on film from 5 different longitudinal planes. By collecting digital data in a PDP-11 computer, they reconstructed longitudinal and transverse section images from any selected longitudinal plane or cross sectional view. High quality images were demonstrated by imaging phantoms, and heart patients given Tl-201.

Potential uses of NMR were explored for cardiac imaging using early commercial systems in animals and patients. They compared the efficacy of NMR and radionuclide ventriculography to detect and quantitate degrees of myocardial ischemia.
They updated the earlier Cardiac Cath Lab system by adding a hardware module to capture and display video images from both the anterior and lateral image intensifiers as a series of sequential images prior to digitization. The time series of two-dimensional images was an early attempt to improve the accuracy of cardiac-ventricular function studies and to reduce the need for additional views with repeated injections of contrast media. In this way, they demonstrated that such studies could be carried out with commercially available radiographic systems without the need to replace the front end imaging chain.
Leon Partain: came to Vanderbilt in 1979 with Board Certification in Radiology and a PhD in Nuclear Engineering from the University of North Carolina. In 1982 he followed Rollo as Head of the Nuclear Medicine Division. While Chief of the Division he investigated the coupling of NMR, and nuclear medicine procedures. He published reports correlating nuclear medicine, NMR, and X-ray findings particularly those involving myocardial function. Thyroid studies conducted in this period included I-123 and XRF studies in patients with goiters. His studies included the distribution of labeled eosinophils in mice with inflammatory and parasitic infestations. He also evaluated perfusion of different organs with NMR and radioisotope tracers including studies of brain, and blood brain barrier penetration. He became Chair of the Radiology Department following James’ retirement and served in that role from 1992-2000. After returning to clinical practice in the Department he became Editor of the Journal of Medical Resonance Imaging, and took on leadership roles in the Radiological Society of North America. See further information on the Vanderbilt Radiology Website.

Martin Sandler: came to Vanderbilt from South Africa as an Internal Medicine physician. He came as a Fellow in Endocrinology. Following its completion he enrolled in and completed his nuclear medicine residency. In 1992, when Leon Partain became Chair of the Radiology Department, Sandler became Director of the Division of Nuclear Medicine. Sandler’s research included many clinical nuclear medicine publications with emphasis on endocrine systems, and he stimulated several instrumentation developments with industrial collaborators. Close working relationships with El Scint in Israel led to the design and commercialization of a novel PET/SPECT dual-headed Anger camera system. He and Jim Patton evaluated its use for dual isotope single photon Tc-99m, F-18 FDG studies using an ultra high-energy parallel hole collimator. The general consensus after experience with its use as a PET (co-incidence PET) device was that despite its thick crystal its performance in detecting small lesions was not competitive with standard PET devices. In addition, single photon images of Tc-99m were of lower resolution than those obtained with thinner crystal standard Anger cameras. Coincidence PET was not found to be useful, but GE bought the technology and upgraded it as a standard SPECT/CT system. In another collaboration, Sandler worked with a different Israeli company in the design and evaluation of a novel cardiac SPECT system. The system uses multiple small solid state (CZT) cameras arrayed along a 90-degree arc. Each detector rotates at its position on the arc separately so that each points at and samples emissions from the heart region in its restricted field of view. This resulted in both increased sensitivity and resolution, and the D-SPECT system gained in popularity for cardiac imaging. Sandler replaced Partain as Chair of the Radiology Department in 2000 and stimulated research efforts by trainees and Faculty in the Department. A major addition to the research program was the recruitment of John Gore, and his Yale NMR research colleagues in 2002. His recruits were each given faculty appointments in Radiology, some with secondary appointments in Physics, and others in the Engineering School. To support the expanded imaging program, a new Institute, the Vanderbilt Institute of Imaging Science (VUIIS) was created in 2003.

Sandler during his term as Chair of Radiology served also as Editor of the Journal of Nuclear Medicine from 1999-2003. In 2006, he became the Associate Vice Chancellor for Health Affairs at Vanderbilt and served a year as President of the Society of Nuclear Medicine. Jeremy Kay replaced Sandler as Chair of the Department of Radiology. When there was a change in Medical Center leadership in 2009, Sandler returned to the Department as a faculty member doing clinical nuclear medicine, after a sabbatical year getting updated on PET and X-ray CT interpretation. See further information on the Vanderbilt Radiology Website.

Dominique Delbeke came to the United States from Belgium with her MD, PhD in Physiology, and specialty training in Pathology from the Free University of Brussels. After a post-doctoral fellowship training at Yale University, she completed her residency training in both in Pathology and in Nuclear Medicine at Vanderbilt University. She was a faculty member in Nuclear Medicine until Martin Sandler became the Chair of the Radiology Department in 2000 when she became director of the Nuclear Medicine Division. Delbeke increased the range of clinical studies using PET to include cardiac applications in addition to neurology, along with other diagnostic uses of nuclear medicine procedures. She was one of the pioneers to investigate the oncological applications of FDG PET in the mid 1990, then PET/CT in early 2000. With the sponsorship of GE Healthcare through the Society of Nuclear Medicine, she was one of the leaders in international education about clinical FDG PET/CT. She followed the footprints of Martin Sandler’s becoming President of the Society of Nuclear Medicine and Molecular Imaging, as the organization had changed its name in 2010. Molecular Imaging was added to name of the organization in response to the growing importance of targeting molecular, cell-based receptor families for diagnosis and therapy. At the completion of her term as President, she became Editor of the Journal of Nuclear Medicine in 2012 for a 5-year term ending in 2016. The clinical faculty includes important physician/scientists. William Martin practiced as an Endocrinologist prior to coming to Vanderbilt in 1993 where he completed the residency program, and stayed on the faculty rising rapidly to the rank of Professor. Ron Walker is a radiologist and nuclear medicine physician who came to Vanderbilt in 2006 from the University of Arkansas. Gary Smith was trained in Engineering, and Nuclear Medicine and came to Vanderbilt and the VA in 2009 from Knoxville where he was Head of the UT Memorial Hospital Nuclear Medicine program. Chiraya Shah is a Vanderbilt trained radiologist with Nuclear Medicine certification. During his training he spent a year working in VUIIS getting additional research experience.

 

NUCLEAR MEDICINE / PET

The Vanderbilt University Hospital has five state-of-the-art gamma cameras, all of which are dual-head single photon emission computed tomography (SPECT) systems; one of them is a state-of-the-art large field of view gamma camera with an integrated 16-slice CT and one of these possesses a 4-slice integrated X-ray CT system for SPECT attenuation correction and fusion for anatomical localization. tAnother is an integrated cardiac SPECT/CT combining a dual-head SPECT gamma camera and a state-of-the-art 64-slice CT unit allowing the performance of CT angiography. In addition, there are three dual-head SPECT gamma cameras at the Vanderbilt Heart and Vascular Institute and one at The Vanderbilt Children’s Hospital.

The Nuclear Medicine Division also includes positron emission tomography (PET). PET is an imaging modality which allows direct evaluation of the metabolic rate of organs in the normal and various pathological states. PET has become an established procedure for the evaluation of neurologic, cardiovascular, and oncologic disorders. The PET center is equipped with state-of-the-art cyclotron and a state-of-the art integrated PET/CT system combining a dedicated full ring PET tomograph and a multi-detector CT unit. The cyclotron has been operated commercially for distribution of 18F-fluorodeoxyglucose (FDG) since the mid-1990s. Combined PET/CT and SPECT/CT devices provide both the metabolic information from PET or SPECT and the anatomic information from CT in a single examination; the information obtained by SPECT/CT and PET/CT has been shown to be more accurate than either imaging method alone.

The facilities include a well-equipped radiopharmacy and in vitro laboratory, a PET radiopharmacy and radiochemistry laboratories. The radiochemistry laboratories have recently expanded facilities and staff for the development of new SPECT and PET radiopharmaceuticals. MicroPET and microSPECT are available at the Vanderbilt Univeristy Institute for Imaging Sciences for animal research studies.

The Radiology Department has a comprehensive integrated computer network with an electronic health record (EHR) and PACS system with numerous viewing stations.

The affiliated Veterans Administration Medical Center is located on the University campus, directly adjacent to Vanderbilt University Medical Center, and includes seven gamma cameras, four with SPECT/CT capability and three with dual head, variable angle capability. There is also at the VA a state-of-the art integrated PET/CT system combining a dedicated full ring PET tomograph and a multi-detector CT unit.

All nuclear medicine faculty members are leaders in their field with extensive publications in multiple areas including but not limited to PET and PET/CT and SPECT and SPECT/CT in the evaluation of neurologic, cardiovascular and oncologic disorders. Numerous research programs are ongoing in the Division of Nuclear Medicine, as well as collaborations with other Divisions in the Vanderbilt Department of Radiology and the Vanderbilt University Institute of Imaging Sciences.

In addition to the Nuclear Medicine faculty, the Nuclear Medicine Program is supported by:

The Nuclear Medicine Residency Program offers four residency positions. (Nuclear Medicine Residents and Fellows- 1974-2014) .  A Nuclear Medicine Technology Program has been in continued existence  since 1969. There are more than fifteen nuclear medicine clinical conferences monthly as well as numerous collaborative clinical and research conferences complemented by an extensive nuclear medicine library with teaching files and computerized instruction.

 

Scientific Staff: Many physicists, engineers, and chemists on the Radiology faculty made major contributions to the clinical and research activities in the Department.
These included many Vanderbilt PhD graduates: Ron Price, Jim Patton, Jon Erickson, Jerry Jones, Norman Dyer;
Engineers: David Pickens, Bill Riddle, and Ed Lagan;
Chemists: Jeff Clanton, and Charles Manning (VUIIS PET tracer chemist);
Health Physicist: Mike Stabin. (Dosimetry); Todd Peterson (PET/SPECT VUIIS scientist), and Randy Brill.

Many other members of the Radiology faculty and VUIIS made major contributions.

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