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FMTVDM-TFM©℗: True quantification requires standardization of the tool being used to measure, with a known, unchanging standard to produce accurate, consistent and reproducible quantified measurements

  • Richard M. FlemingEmail author
  • Matthew R. Fleming
  • Andrew McKusick
  • Tapan Chaudhuri
Letter to the Editor
  • 137 Downloads

Everyone is beginning to understand the importance of quantification for use in Medicine, particularly Molecular Imaging. With the recent introduction of mandates by CMS, ASNC and the SNMMI for Quantification, it is not surprising that papers are being published on the topic. One recent publication by Zhao et al1 demonstrates that there may be misunderstandings regarding modern molecular imaging.

The Misunderstanding of Quantification

Quantification is not asking whether a tool can count, but rather whether the tool can count accurately. The Zhao paper presents several methods using phantoms and display “counts” of isotope scintillation activity, reporting on the ability of the cameras to count. Concluding that there is a camera calibration factor, which must be applied, there is an example regarding the counts obtained using a point source with a SPECT camera. When the SPECT camera was asked to count over time2,3using a 128 × 128 matrix setting, there was a 14.6% reduction in...

References

  1. 1.
    Zhao W, Esquinas PL, Hou X, et al. Determination of gamma camera calibration factors for quantification of therapeutic radioisotopes. EJNMMI Phys 2018;5:8.CrossRefGoogle Scholar
  2. 2.
    Fleming RM, Fleming MR, McKusick A, Chaudhuri T, Dooley WC. The B.E.S.T. protocol for early breast cancer detection. In: 47th Annual Meeting Florida Nuclear Medicine Technologists (FNMT), Tampa, FL, USA, 6 May 2018.Google Scholar
  3. 3.
    Fleming RM, Fleming MR, Chaudhuri T, McKusick A, Dooley WC, Glover C. Both percent diameter stenosis (%DS) and coronary flow reserve can be derived directly from myocardial perfusion imaging using FMTVDM and measurement of isotope redistribution. J Nucl Med Radiat Ther 2018;9:1000353.  https://doi.org/10.4172/2155-9619.1000353.Google Scholar
  4. 4.
    The Fleming method for tissue and vascular differentiation and metabolism (FMTVDM) using same state single or sequential quantification comparisons. Patent Number 9566037. Issued 02/14/2017.Google Scholar
  5. 5.
    Breast enhanced scintigraphy testing (BEST); BEST imaging. 1-655833872. Started 9-1-2011. Effective 9-16-2011, TX 7-451-243.Google Scholar
  6. 6.
    Fleming RM, Harrington GM, Baqir R, Jay S, Challapalli S, Avery K, Green J. The evolution of nuclear cardiology takes us back to the beginning to develop today’s “new standard of care” for cardiac imaging: How quantifying regional radioactive counts at 5 and 60 minutes post-stress unmasks hidden ischemia. Methodist DeBakey Cardiovasc J 2009;5:42-8.CrossRefGoogle Scholar
  7. 7.
    Fleming RM, Harrington GM, Baqir R, Jay S, Challapalli S, Avery K, Green J. Renewed application of an old method improves detection of coronary ischemia. A higher standard of care. Fed Pract 2010;27:22-31.Google Scholar
  8. 8.
    Fleming RM, Fleming MR, Chaudhuri T, McKusick A, Dooley WC, Glover C. Both percent diameter stenosis (%DS) and coronary flow reserve can be derived directly from myocardial perfusion imaging using FMTVDM and measurement of isotope redistribution. J Nucl Med Radiat Ther 2018;9:1000353.  https://doi.org/10.4172/2155-9619.1000353.Google Scholar
  9. 9.
    Fleming RM, Harrington GM, Baqir R. Heart disease in men. Chapter 3. Using multiple images post-stress to enhance diagnostic accuracy of myocardial perfusion imaging: The clinical importance of determining washin and washout indicates a parabolic function between coronary perfusion (blood flow) and cellular (“uptake/release”) function. Alice B. Todd and Margo H. Mosley editors, Nova Publishers 2009, pp. 75-100. (https://www.novapublishers.com/catalog/product_info.php?products_id=8409).
  10. 10.
    Fleming RM, Harrington GM. Chapter 13. Fleming Harrington redistribution wash-in washout (FHRWW): The platinum standard for nuclear cardiology. Establishing better standards of care in doppler echocardiography, computed tomography and nuclear cardiology. Richard M. Fleming editor, Intech Publishing 2011. ISBN: 978-953-307-366-8.Google Scholar
  11. 11.
    Dorbala S, Ananthasubramaniam K, Armstrong IS, et al. Single photon emission computed tomography (SPECT) myocardial perfusion imaging guidelines: Instrumentation, acquisition, processing, and interpretation. J Nucl Cardiol 2018.  https://doi.org/10.1007/s12350-018-1283-y.Google Scholar
  12. 12.
    Franceschi M, Guimond J, Zimmerman RE, Picard MV, English RJ, et al. Myocardial clearance of Tc-99m hexakis-2-methoxy-2-methylpropyl isonitriles (MIBI) in patients with coronary artery disease. Clin Nucl Med 1990;15:307-12.CrossRefGoogle Scholar
  13. 13.
    Dilsizian V, Arrighi JA, Diodati JG, Quyyumi AA, Alavi K, et al. Myocardial viability in patients with chronic coronary artery disease. Comparison of 99mTcsestamibi with thallium reinjection and [18F]fluorodeoxyglucose. Circulation 1994;89:578-87.CrossRefGoogle Scholar
  14. 14.
    Sheikine Y, Berman DS, Di Carli ME. Technetium-99m-sestamibi redistribution after exercise stress test identified by a novel cardiac gamma camera: Two case reports. Clin Cardiol 2010;33:E39-45.CrossRefGoogle Scholar
  15. 15.
    Li QS, Solot G, Frank TL, Wagner HN, Becker LC. Myocardial redistribution of Technetium-99m-Methoxyisobutyl Isonitrile (SESTAMIBI). J Nucl Med 1990;31:1069-76.Google Scholar
  16. 16.
    Sinusas AJ, Bergin JD, Edwards NC, et al. Redistribution of 99mTc-Sestamibi and 201Tl in the presence of a severe coronary artery stenosis. Circulation 1994;89:2332-41.CrossRefGoogle Scholar
  17. 17.
    Richter WS, Cordes M, Calder D, Eichstaedt E, Felix R. Washout and redistribution between immediate and two-hour myocardial images using technetium-99m Sestamibi. EJNMMI 1995;22:49-55.Google Scholar
  18. 18.
    Fleming RM, Kirkeeide RL, Taegtmeyer H, Adyanthaya A, Cassidy DB, Goldstein RA. A comparison of Technetium 99-m teboroxime tomography to automated quantitative coronary arteriography and thallium-201 SPECT. J Am Coll Cardiol 1991;17:1297-302.CrossRefGoogle Scholar
  19. 19.
    Fleming RM, Kirkeeide RL, Taegtmeyer H, Adyanthaya A, Cassidy DB, Goldstein RA. A comparison of Technetium 99-m teboroxime tomography to automated quantitative coronary arteriography and thallium-201 SPECT. J Am Coll Cardiol 1991;17:1297-302.CrossRefGoogle Scholar
  20. 20.
    Fleming RM. Clinical presentation of 74 year old lady with significant LAD and RCA artery disease demonstrated with new dipyridamole teboroxime protocol and verified by quantitative coronary arteriography. (Atlas at Squibb pharmaceuticals).Google Scholar
  21. 21.
    Fleming RM. Chapter 31. Nuclear cardiology: Its role in the detection and management of coronary artery disease. In: Chang John C, editor. Textbook of angiology. New York: Springer; 1999. pp. 397-406.Google Scholar
  22. 22.
    Fleming RM, Harrington GM, Baqir R. Use of parabolic model in tomographic diagnosis of infarction and stenosis. In: The 1st Congress on Controvesies in Cardiovascular Diseases: Diagnosis, treatment and intervention (C-Care), Berlin, Germany, 4-5 July 2008.Google Scholar
  23. 23.
    Fleming RM, Harrington GM, Baqir R, Jay S, Avery K. Multiple post stress imaging more accurate than rest-stress imaging in detecting ischemia. In: 9th International Conference on Nuclear Cardiology. Barcelona, Spain. 10-13 May 2009.Google Scholar
  24. 24.
    Fleming RM, Harrington GM, Jay S, Challapalli S. Sestamibi redistrbution provides better detection of ischemia than rest-stress comparisons. In: BITs 1st International Congress of Cardiology: Combating heart disease, track 5: Diagnostics, therapeutics and clinical management. Shanghai, China. 5-7 Dec 2009.Google Scholar
  25. 25.
    Fleming RM, Harrington GM, Jay S. Quantitative measurement of sestamibi redistribution to detect hidden ischemia made possible by application of Blumgart’s method. J Nucl Med 2011;52:1162.CrossRefGoogle Scholar
  26. 26.
    Fleming RM, Harrington GM, Jay S. Reducing patient radiation exposure while improving diagnostic testing. In: Continuing Education Credits for the 58th SNM Annual Meeting, San Antonio, TX, USA. 8 June 2011.Google Scholar
  27. 27.
    Fleming RM, Harrington GM. TAM-A.7 Sestamibi redistribution measurement defines ischemic coronary artery lumen disease. In: 56th Annual Meeting of the Health Physics Society. (American Conference of Radiological Safety) West Palm Beach, FL, USA, 30 June 2011. http://hpschapters.org/2011AM/program/singlesession.php3?sessid=TAM-A.
  28. 28.
    Fleming RM, Harrington GM. FHRWW release of WiWo increases diagnostic detection of coronary artery disease and specifically the detection of vulnerable inflammatory plaques (cardiology’s black holes). In: 1st Lombardy International Meeting of Cardiovascular Surgery. Milan Italy, 13-14 April 2012.Google Scholar
  29. 29.
    Fleming RM, Harrington GM, Kearney D, Tomsho M, Sheils J. Myoview and Sestamibi redistribution, stress once—image twice protocol improves detection of ischemia in addition to improving patient throughput and reducing patient radiation to 3.75 mSv. J Nucl Med 2012;53:1831.Google Scholar
  30. 30.
    Fleming RM. FHRWW: The end of the era of rest-stress nuclear cardiac imaging and why it misses critical heart disease. In: International Conference on Translational Medicine. San Antonio, TX, USA. 17-19 Sept 2012.Google Scholar
  31. 31.
    Fleming RM, Harrington GM, Kearney D, Tomsho M, Sheils J. Rapid image acquisition and assessment of coronary ischemia using FHRWW protocol. In: 4th Annual International Conference of Cardiology. Guangzhou, China, 2-4 Dec 2012.Google Scholar
  32. 32.
    Fleming RM. The redistribution properties of Tc-99m isotope agents, sestamibi and myoview. Invited Presentation. In: Toronto International Pharmacy Conference, Toronto, Canada. 27-29 Sept 2012.Google Scholar
  33. 33.
    Fleming RM, Harrington GM. RIA-FHRWW analysis of the redistribution properties of Tc-99m isotope agents, Sestamibi and Myoview, enhances the detection of ischemic heart disease. Invited presentation. In: 3rd International Conference on Clinical & Experimental Cardiology. Emerging interventions in clinical cardiology and cardiac surgery. Chicago, Ill. USA 15 April 2013. J Clin Exp Cardiol 2013;4:131.Google Scholar
  34. 34.
    Fleming RM, Fleming MR, McKusick A, Chaudhuri T, Dooley WC. The B.E.S.T. protocol for early breast cancer detection. In: 47th Annual Meeting Florida Nuclear Medicine Technologists (FNMT), Tampa, FL, USA 6 May 2018.Google Scholar
  35. 35.
    Won KS, SH Kim. Five-minutes post-stress gated myocardial perfusion SPECT using Tc-99m tetrofosmin. SNMMI 2012.Google Scholar
  36. 36.
    Medrano R, Lowry RW, Young JB, et al. Assessment of myocardial viability with 99mTc Sestamibi in patients undergoing cardiac transplantation. A scintigraphic/pathologic study. Circulation 1996;94:1010-7.CrossRefGoogle Scholar

Copyright information

© American Society of Nuclear Cardiology 2018

Authors and Affiliations

  • Richard M. Fleming
    • 1
    Email author
  • Matthew R. Fleming
    • 1
  • Andrew McKusick
    • 1
  • Tapan Chaudhuri
    • 2
  1. 1.FHHI-OmnificImaging-CamelotEl SegundoUSA
  2. 2.Eastern Virginia Medical SchoolNorfolkUSA

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