Community imaging center once again leads the way with high-performance PET/CT

Situated near the foothills of the Appalachian Mountains, the Rome Imaging Center in Rome, Georgia, USA, is the first site to install the new Biograph Trinion™ PET/CT scanner. This is not the first time this small imaging center in a rural community has been at the forefront of molecular imaging. The center continues to deliver high-quality imaging, all while upholding minimal radiation exposure levels and scan times. 

Photography by Erin Sintos |  Data courtesy of Rome Imaging Center, Rome, GA, USA

Serving patients from the local community as well as surrounding rural areas, the Rome Imaging Center has a long history of being at the forefront of molecular imaging. In 2009, it was the first site to install the Biograph™ TruePoint PET/CT scanner. Nearly 20 years later, it has the distinction of being the first site to install the new Biograph Trinion PET/CT.

"The ability to have a high performance PET scanner that is going to last a number of years and be effective during that time is crucial,” says lead nuclear medicine physician Russell L. Roberts, MD. “When we do get the chance to upgrade, we need to purchase the best that we’re able to, and Biograph Trinion ticked all the boxes.”

The Rome Imaging Center is a partnership between three healthcare organizations that strive to ensure that patients can receive high-quality care without traveling long distances. It performed nearly 1,300 PET/CT scans last year, a number that has grown with the increased use of PSMA and amyloid radiotracers. 

Like many other facilities using PET/ CT, the bulk of the scans the Rome Imaging Center performs are for oncologic imaging. As Roberts and his colleagues evaluated options for a new scanner, they were looking for a system that would enable them to quickly identify small lesions while minimizing radiation dose to patients. 

“The difference between stage two and stage three is often quite significant as far as treatments go for various types of cancers,” Roberts explains. “If we can find the smallest little lesion to put you over into that category, then we can do more aggressive treatment from the start, rather than potentially going to a lesser treatment and thinking a lesion is new when it shows up four, five, or six months down the road. Being able to see those small lesions allows us to target them more quickly and potentially stop them from growing or causing any problems with the appropriate therapy.” 

Biograph Trinion PET/CT, which incorporates air-cooled digital detectors, lutetium oxyorthosilicate (LSO) crystal elements, and ultra-fast time of flight (TOF), has already exceeded their expectations. “Everyone in my group of 21 radiologists—five of us are body and PET specialists—has been blown away,” Roberts says. “I am finding tiny lesions that are 2 millimeters to 4 millimeters at least three or four times a week that normally we would have not seen.”

In addition to providing improved image quality, Biograph Trinion PET/CT allows the Rome Imaging Center to acquire images more quickly and at lower radiation doses than before. A scanning protocol that used to take 20 to 40 minutes, Roberts says, can now be shortened to five to seven minutes. 

For patients with comorbidities that make it difficult to lie on their backs for extended periods, such as congestive heart failure or emphysema, the reduced scan time dramatically improves their experience. In some cases, hospital patients who otherwise might not have been candidates for PET/CT can now be quickly scanned. “I’m not going to say we’re going to routinely use the two-minute PET/CT scan that we performed the other day,” Roberts says, “but if someone comes in and says I’ll give you two minutes, I can get a scan that will give us more data than the CT and MRI.” 

Lead nuclear medicine/CT technologist Betty Harrell emphasizes they have managed to reduce the injected dose without compromising image quality. “We have reduced the dose that we’re injecting and getting even better quality on the new scanner,” she says. “You can tell it’s a very high-quality exam,” Roberts adds. “You get to see anatomy on the PET—not PET/CT but just the PET imaging. You can see the organs much better than on other units that we’re using.” 

In addition to the improved patient experience that comes with reduced scan times, Harrell says that the design of the scanner itself helps put patients at ease. The flared bore makes patients feel less confined while undergoing their scans, she says, and the mood lighting that gradually changes color during the scan or can be set at a preferred color helps patients relax during the scans. She recalls a recent patient who typically takes an anxiety medication before his exams but felt he did not need to after seeing the new scanner. His total-body, head-to-toe exam was 40% faster than with the previous scanner. 

“He had high praise for the scanner,” Harrell says. “He said the lights were comforting for him and that it was an enjoyable experience—and he’s usually quite anxious about getting his PET/CT scan. It was good to see that he had a positive experience with us.”

Several characteristics of the Biograph Trinion PET/CT combine to deliver rapid scan times and an efficient workflow. Digital LSO-based detectors with ultra-fast TOF capabilities improve signal-to-noise ratio and effectively boost scanner sensitivity while also lowering injected dose. 

Biograph Trinion with FlowMotion™ utilizes continuous bed motion technology, which enables technicians to complete patient scans efficiently. It also enables more personalized exam protocols that consider patient anatomy and reduce radiation dose because only the desired area is scanned. “With continuous bed motion, we’re able to plan the scan at a more precise link to their body,” Harrell says. She describes how they had a 40–50% reduction on scan time. Harrell adds that image reconstruction times (initiating concurrently with the acquisition) have dropped from 11 minutes on their previous scanner to two minutes or less on the Biograph Trinion PET/CT and can be done automatically.

Roberts says the ability to customize layouts in syngo.via makes the reading process more efficient for him and his colleagues. Because syngo.via is built on a client-server platform, cases are available at multiple facilities. It also seamlessly integrates with their third-party Picture Archiving and Communication System (PACS). 

The scanner saves technologists time by automatically calibrating itself using the intrinsic properties of LSO and eliminating the need for an external source for daily quality control. The automatic calibration also decreases the staff’s radiation exposure and reduces the need to use and lift heavy phantoms. “There’s less exposure for the techs because we’re not having to pick the phantom up and put it on the table every day,” Harrell says. “We do it manually now once a month versus once a day.”

Biograph Trinion PET/CT was installed in February 2024, and Roberts says the installation process was facilitated by the advice and support that Siemens Healthineers provided on issues ranging from preparing the physical location of the scanner to ensuring that the proper electrical and information technology wiring was in place. “There really was no downtime once the scanner arrived, which we’ve had with other units,” Roberts says. “Siemens Healthineers did their homework beforehand and made it look extremely easy when it showed up.” With regular and timely preventive maintenance, Roberts expects the Biograph Trinion PET/CT to provide high-quality imaging, an efficient workflow, and a comfortable patient experience that minimizes radiation dose for years to come.

Sameh Fahmy, MS, is an award-winning freelance medical and technology journalist based in Athens, Georgia, USA.