Fusion Imaging : What to do Now

Fusion Imaging: What to do Now?

Mary Ann Spohrer

Illinois Emergency Management Agency

Chairperson for the Task Force on Emerging Issues

The Task Force on Emerging Issues (H-24) is a fairly new task force that was created last summer under the emerging issues program that CRCPD initiated. As a result of funding from the American College of Radiology a suggestion was proposed to conduct a training session during 2004. At the same time, one of the issues identified under the emerging issues umbrella was PET/CT imaging. After discussions with CRCPD, members of ACR, as well as the AAPM it was decided to plan a National Symposium on Fusion Imaging and Multimodalities. With that the Task Force was created, given a list of charges and a specific life expectancy. Committee members include: Cass Kaufman, Cindy Cardwell, Jack Ferruolo and the presenter of this information. Throughout last fall several conference calls with committee members as well as representatives from ACR, AAPM, ASRT, FDA, SNMTS, and NEMA were held and the symposium began to take shape.

The symposium was officially called the National Symposium on Fusion Imaging and Multimodalities: Technical Features and Regulatory Considerations and was held February 18-20, 2004 in Kansas City, Missouri. 126 people representing state radiation control programs, physicists, physicians, technologists, industry representatives and federal regulators attended the symposium. The speakers for the symposium were physicians, physicists, both state and federal regulators, nuclear medicine and x-ray technologists, and industry manufacturers. These individuals represented the American College of Radiology, American Association of Physicists in Medicine, FDA, NRC, State Radiation Control Programs, Society of Nuclear Medicine Technologist Section, American Society of Radiological Technologists, Conference of Radiation Control Program Directors, CTI/PET NET, RadCal, and Siemens.

The symposium presented technical and clinical information relative to computed tomography (CT), positron emission tomography (PET), the fusion of these two technologies (PET/CT), as well as various training and cross training considerations. Also presented was information relative to the radiation therapy treatments of GliaSite, Theraspheres/SIRSpheres and monoclonal antibodies such as Zevalin and Bexxar. Physicists, physicians, representatives from the clinical setting, manufacturers and both federal and state regulators presented their perspectives on these issues.

The final session of the symposium consisted of a discussion of the future tasks and issues that should be addressed relative to the issues presented throughout the program. Discussion was open to any attendee and a list of actions was developed. The intent of this symposium was not necessarily to solve the problems, but to identify what problems may exist and consider ways to address them. In many ways this was just the beginning of the work that should be done. The attendees for the symposium were presented with the opportunity to evaluate the program and provide comments and feedback. The vast majority of the evaluations reflected that the attendees were satisfied with the content of the program. Many written comments addressed future actions as well as suggestions for future symposium topics.

In an effort to prioritize the list of “Actions to be Taken” the attendees were sent an email from CRCPD asking them to choose what they believed are the five most important action items from the lengthy list of suggestions. This ranking was intended to help the CRCPD Board choose and prioritize the actions to be taken first.

It has been recognized that the National Symposium on Fusion Imaging was an effective launching pad for the future, as evidenced by the rather extensive list of proposed actions to be taken. After reviewing the list, the actions can basically be narrowed down into two categories, one directly related to the issues of fusion imaging and the second encompassing everything else. In order to effectively answer the question “What to do now?” responses need to be considered on both fronts. The issues directly related to Fusion Imaging dictate that the first task that should be accomplished is a gap analysis focusing specifically on the topic of “where additional regulation/inspection guidance may be needed”. Alternative consideration is needed to add special modules to address specific issues relative to existing SSRCRs. After completion of the gap analysis then new SSRCRs or special modules should be formulated, as needed. In concert with the SSRCR initiative, another CRCPD group could develop some type of inspection guidance with special consideration given to performance-based inspections blended with objective inspections. It was requested that these tasks be completed in a timely manner with professional input from AAPM, HPS, ACR, ASRT, SNMTS, etc. In addition it was also suggested that participating parties should also consider consulting with industry representatives for technical expertise concerning specific equipment issues.

The second category where action needs to be directed is pretty encompassing and involves various committees and/or task forces that would best be directed by the OED of CRCPD. The primary task, as directed by the attendees of this symposium, is “continued training efforts for state personnel/technical staff”. Other tasks include nurturing and/or establishing relationships with tech societies, Committee on Radiological Technology Education and Licensure, AAPM, ACR, HPS, etc., and the Alliance.

In summary, a CD of the symposium was made and a complimentary copy was provided to each state program as well as other attendees not representing state programs. The complete list of “Actions to be Taken” can be found within the proceedings. In reviewing the selection of the top five items it was noted that almost all of the action items were selected. The following list of action items was provided to the CRCPD Board of Directors for further direction. Again the actions that should be undertaken need to be considered in conjunction with the suggestions for additional players and considerations:

Fusion Imaging Issues

1. Gap Analysis with regard to fusion imaging and training, certification and inspection issues.

2. Development of any needed SSRCRs/special modules.

3. Development of inspection guidance.

Additional Issues

1. Continue offering training for state personnel/technical staff.

2. Nurture/Develop relationships with tech societies, AAPM, ACR, HPS, Committee on Radiological Technology Education and Licensure, and the Alliance.

Finally, it should be noted that the success of this program would not have been possible without the assistance of many people as well as the financial support of a number of organizations. Financial assistance was provided by the American College of Radiology, the American Association of Physicists in Medicine, the American Society of Radiological Technologists, the Food and Drug Administration, the Society of Nuclear Medicine Technologist Section and the Conference of Radiation Control Program Directors.