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Eric J. Sax, MD, MBA, director ofnuclear medicine, says that SPECT-CT,a new hybrid scanning test, provides aprecise “anatomical roadmap.”SPECT-CT unitoffers a range of diagnostic benefitsHybrid scanning testarrives at Emerson this fallAbnormalities, such as the spread of cancerto the spine, “light up” and are localized withSPECT-CT imaging.Some imaging technology captures exquisite pictures of the anatomy,while others reveal physiological function. Hybrid scanningtests, such as PET-CT, combine both. At Emerson, PET-CT,which fuses positron-emission tomography (PET) with CT scans,has been used since 2007 to make a more accurate cancer diagnosisand to monitor a patient’s response to chemotherapy.SPECT-CT, a new hybrid test that debuts at Emerson this fall,takes a well-established test – single-photon emission computedtomography (SPECT) – and marries it with low-dose CT scans.The result is a highly precise imaging test, says Eric J. Sax, MD,MBA, director of nuclear medicine, that uses nuclear physiologictracers for diagnostic purposes. “SPECT, which we’ve usedsince the 1980s, provides a 3D picture of the body,” he explains.“By fusing it with a low-dose CT scan, we get precise clarity inlocating an abnormality. It’s like an anatomical roadmap.”The new test is particularly safe, Dr. Sax adds. “The CT side ofthe test uses low-dose CT scanning. For the SPECT part of thetest, we use tracers that expose the patient to less radiation andrisk than many other tests.”Patient comfort is another benefit. “Those who are familiar withnuclear medicine studies will be happy to know that SPECT-CTis an easier test for the patient,” says Dr. Sax. “It only requiresthat you lie still for about five or six minutes on each side.“© Siemensof its own tracers that are more effectiveat “lighting up” specific tumors andother maladies than PET-CT.The new test will have an impact in cardiology,where traditional SPECT oftenis used to perform cardiac perfusionstudies – tests that measure the amountof blood in the heart during rest and exercise. However, cardiologistshave to “read around” soft tissue structures, such as thediaphragm or breast tissue, that can obscure heart anatomy andlimit diagnostic accuracy, says Benjamin Tillinger, MD, anEmerson cardiologist. That won’t be necessary with SPECT-CT.“The CT scan corrects this problem so that we can be more confidentin interpreting a heart study,” says Dr. Tillinger, noting thatSPECT-CT’s accuracy will save some patients from needing cardiaccatheterization. “Also, some patients are uncomfortablelying still for 20 to 25 minutes on each side – required with traditionalSPECT. They will find SPECT-CT to be an easier test.”Elsewhere, neurologists are enthusiastic about a new tracer forSPECT-CT that differentiates Parkinson’s disease from essentialtremor. An even newer compound for use with SPECT-CT candetect the presence of amyloid plaque in the brain – a distinctivesign of Alzheimer’s disease.A role to play in cancer, cardiology and neurologyDr. Sax anticipates that SPECT-CT will have an immediate impacton care in three broad areas: cancer, cardiology and neurology.“The sentinel node studies that we perform for patientswith breast cancer or melanoma, which check to see if cancerhas spread to the lymph nodes, will now be performed withSPECT-CT,” he says. “Bone scanning also will be done this way.”PET-CT will continue to be used to determine the stage of cancerand monitor treatment. However, SPECT technology has someBecause the test is fairly easy to perform, safe and cost-effective,it will play a diverse role, adds Dr. Sax. “We’ll use SPECT-CT tolook for infections in both soft tissue and bone,” he says. “In patientswho have ‘fever of unknown origin’ we can perform awhole-body white cell scan that will show inflammation.“With SPECT-CT now available at Emerson, we have an additionaloption for making an efficient, accurate diagnosis in a waythat is safe and easy on patients,” says Dr. Sax.6
New leadershipfor Weight Loss ProgramDavid Lautz, MD, brings impressive background and expertiseDavid Lautz, MD, medical director of the Emerson-Mass General Weight Loss Program, is experiencedin performing the sleeve gastrectomy, a new surgical option.David Lautz, MD, a respected bariatric surgeon whohas played a national role in making weight loss surgeryincreasingly safe and successful, recentlyjoined Emerson Hospital as medical director of theEmerson-Mass General Weight Loss Program. Earlierthis year, the program formed a collaboration withMassachusetts General Hospital with the goal ofbringing the most advanced care to the community.Dr. Lautz served as director of bariatric surgery atBrigham and Women’s Hospital from 2003 to 2011.In addition to the well-known laparoscopic gastricbypass and lap-band procedures, he is experiencedin performing the sleeve gastrectomy – a new surgicaloption in which the stomach is shaped into anarrow pouch (see sidebar). “Each operation has itsown personality, as well as risks and benefits,” saysDr. Lautz. “Our job is to describe all of that to patients,answer their questions and let them decide ifbariatric surgery will fit into their life.”He understands what brings an individual to concludethat it is time to consider surgery. “Most patientsare well-motivated, because they have triedeverything they can to lose weight,” says Dr. Lautz.“They know this is not a quick fix, and they arecommitted to making the necessary changes in theirlives. Weight loss surgery is not like having yourgallbladder removed; it’s much more personal.”After surgery, it can take the mind a while to catchup to how much the body has changed, he notes.“Many of my patients were obese their entire lives,and it became part of their persona. It is not uncommonfor someone to go shopping and, despite havinglost 100 pounds, still walk to the size 20 rack. Itcan take a person a year or two to realize they arenot heavy anymore.”Once they lose weight, patients will often lose manyof their medical problems, including hypertension,sleep apnea and diabetes. “Weight loss surgery deliversa one-two punch at type 2 diabetes,” saysDr. Lautz, who is the co-principal investigator on aNational Institutes of Health clinical trial comparingbariatric surgery with intensive medical weight lossand diabetes management at the Joslin DiabetesCenter. “Many studies show that 80 percent of individualswith diabetes can stop taking medicationafter having weight loss surgery.”He has worked, locally and nationally, on effortsto lower the rate of complications that can followweight loss surgery. “Today the complication ratefor bariatric surgery is a fraction of what it used tobe,” he says. “The field is considered to be a modelfor how to improve clinical outcomes.” In 2005,Dr. Lautz was one of 12 surgeons asked to join theGoverning Committee of the American College ofSurgeons Bariatric Surgery Center Network, whichaccredits bariatric surgery centers of excellenceacross the U.S. Emerson achieved Level 1A accreditationin 2010.Despite his national prominence, Dr. Lautz says henever loses sight of his connection with his patients.“I believe the surgeon must play a role throughoutthe course of an individual’s care,” he says. “Mygoal is to provide high-quality care in a supportiveenvironment.”sleeve gastrectomyis new to emersonThe sleeve gastrectomy accomplishestwo things at once: it reshapesthe stomach into a long,narrow pouch, and it affects thesecretion of ghrelin, a hormoneknown to cause hunger. “Thesleeve gastrectomy restricts howmuch you can eat at a given time,and it keeps food in the stomachpouch long enough that you aresatisfied by eating a much smallermeal,” Dr. Lautz explains. “It alsosuppresses hunger, likely throughchanging gut hormone secretion,most notably ghrelin.”Unlike a gastric bypass, the sleevegastrectomy does not reroute thegastrointestinal tract. “It’s a simpler,easier operation,” notes Dr.Lautz. The sleeve gastrectomy canbe performed as a standalone surgery.For heavier patients, whoneed to lose much more weight, itcan serve as step one, to be followedlater by a gastric bypass.How does it compare with otherprocedures? “Lap-band patientscan expect to lose 40-50 percent oftheir excess weight, on average,”Dr. Lautz says. “Gastric bypass patientstypically lose about 60-70percent of their excess weight.Sleeve gastrectomy patients, basedon the current data, are somewherein the middle.”7
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