Over the past three decades, functional brain imaging, especially as spearheaded by the development of PET, has more radically impacted neuroscientific investigation into the workings of the living human brain than any other single technological advance. Clinical researchers have concomitantly examined a wide range of medical and surgical indications with this tool.
During the last decade, actual clinical utilization of brain PET has nevertheless been vastly outpaced by the dramatic expansion of whole body PET applied to oncologic disease, largely driven by third-party payer policies. The advance in coverage policy for FDG PET scans of the brain announced by the Centers for Medicare and Medicaid Services in 2004, however, sharply fueled the interest of Nuclear Medicine physicians, radiologists, and technologists to garner skills needed for acquiring and reading such scans, and has also piqued the interest of physicians from various specialties who would potentially be referrers of patients for such studies.
Correspondingly, there has been a surge in demand for high-quality educational materials focusing upon brain PET, which can be used in the training of professionals in radiologic and nuclear medicine practices, as well as used by them to educate referring physicians in their communities. Those who have begun to search in earnest for such materials have been uniformly met with the discovery of a stunning penury of available resources aimed at the development of practical skills for carrying out clinical brain PET.
Interest is especially high in the use of brain PET to assist in the evaluation of patients with Alzheimer’s disease and related disorders, as this is the clinical indication for which, by far, the greatest number of patients are expected to be referred. Yet, very little material can be found anywhere that centers around cases acquired for evaluation of dementia on current-generation scanners, for which definitive follow-up has been obtained. This is largely due to the inherent difficulties in eliciting protracted participation and ultimately brain tissue from cognitively impaired patients.
The Neurological PET series offered by WebMedEd.com will cover all established and many emerging clinical indications, including evaluation of patients with epilepsy, central motor disorders, and brain tumors. The CE units being developed and offered first focus upon the content for which there is currently the greatest interest and need – general training in the fundamentals of brain PET acquisition and interpretation, and use of PET in the evaluation of dementia.
The materials offered through WebMedEd.com provide the opportunity to examine scans ordered for the evaluation of cognitive/behavioral symptoms, and correlate them with long-term prognoses or diagnoses established through years of longitudinal follow-up and/or neurohistopathologic confirmation following autopsy. The underlying conditions which are included in the units range from those as common as Alzheimer’s disease and depression, to those as rare as progressive supranuclear palsy or Hallervorden-Spatz disease.
Another special feature of the WebMedEd.com materials is the fluid integration of the qualitative information available from visual interpretation of PET scans with the quantitative information provided by widely available brain PET imaging software tools that have been developed for routine clinical use – tools which offer rapid quantification of cerebral activity in hundreds of regions of each patient’s brain, as well as automatic comparisons to a normal data base for each area.
The learning material is structured to emphasize understanding of why and when PET is appropriate in the evaluation of patients, as well as honing of brain PET interpretive abilities for sensitively and specifically identifying the clinical conditions of interest. To assure practical skill development, interactive case studies are presented alongside didactic material. To maximize the educational value of case presentations with respect to developing visual analytic abilities, standard original PET displays are always presented first, followed by questions concerning associated findings and interpretation. Quantitative analysis displays are presented adjunctively, and both kinds of data are then combined with the clinical information in establishing likely diagnoses and ramifications for therapy.
Whether your objective is to develop mastery in interpreting functional neuroimaging studies used to assist with the evaluation of dementia, or simply to feel a little more comfortable reading brain PET scans, I hope you will find the brain PET materials offered through WebMedEd.com to be helpful in accelerating the achievement of your goal. I welcome your feedback, and can be reached by e-mail at uclasomdan@yahoo.com.
Dan Silverman, MD, PhD
Head, Neuronuclear Imaging Section, UCLA Medical Center
Associate Professor, Dept. Molecular and Medical Pharmacology
Associate Director, UCLA Alzheimer's Disease Center Imaging Core
David Geffen School of Medicine,
University of California, Los Angeles
Daniel H. Silverman, MD, PhD is Head of the Neuro-nuclear Imaging Section and Associate Chief of the Ahmanson Biological Imaging Division at UCLA Medical Center.
He also serves as Associate Director of the UCLA Alzheimer's Disease Center Imaging Core, and Associate Professor in the Department of Molecular and Medical Pharmacology. Dr. Silverman obtained his PhD in Biological Chemistry at Harvard University, and completed his postdoctoral research training in Biological Chemistry and Molecular Pharmacology at Harvard Medical School.
He received his MD from The Ohio State University College of Medicine, subsequently completed post-MD training at UCLA, and was board-certified by both the American Board of Internal Medicine and the American Board of Nuclear Medicine. In addition to his research activities, Dr. Silverman has practiced for the past nine years as an attending physician on the Nuclear Medicine service at UCLA Medical Center.
