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Papers by Gina Caravaglia

Research paper thumbnail of Society of Nuclear Medicine Procedure Guideline for Breast Scintigraphy

Research paper thumbnail of Scintimammography with Dedicated Breast Camera Detects and Localizes Occult Carcinoma

Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine, Apr 1, 2004

This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated br... more This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated breast camera as an adjuvant to mammography and clinical examination. Methods: The study population comprised 37 patients with dense breasts and a family or personal history of breast cancer. The subjects had no suggestive clinical or mammographic findings. After intravenous administration of 99m Tc-sestamibi, the patients were imaged using a conventional ␥-camera and a dedicated breast camera that allowed breast compression during image acquisition. Images were interpreted independently by 2 reviewers. All patients with positive scintimammography findings underwent biopsy. Results: Dedicated breast camera results were positive in 13.5% (5/37) of patients. Biopsy of these 5 patients yielded 3 carcinomas: an infiltrating lobular carcinoma, a ductal carcinoma in situ, and an infiltrating tubular carcinoma. These 3 carcinomas were undetectable by clinical breast examination or mammography, even on retrospective review. Only one of these, the tubular carcinoma, was readily detectable by the standard ␥-camera. Conclusion: Scintimammography using a dedicated breast camera may augment mammography and clinical breast examination for the subset of women who have dense breast tissue and are at high risk of breast cancer.

Research paper thumbnail of <title>Gated cardiac SPECT in rodents using a dedicated SPECT system: X-SPECT</title>

Penetrating Radiation Systems and Applications VI, 2004

Cardiac function is an important physiological parameter in preclinical studies. Nuclear cardiac ... more Cardiac function is an important physiological parameter in preclinical studies. Nuclear cardiac scans are a standard of care for patients with suspected coronary artery occlusions and can assess perfusion and other physiological functions via the injection of radiotracers. In addition, correlated acquisition of nuclear images with electrocardiogram (ECG) signals can provide myocardial dynamics, which can be used to assess the

Research paper thumbnail of Scintimammography with dedicated breast camera in unifocal and multifocal/multicentric primary breast cancer detection: A comparative study with SPECT

International Journal of Oncology, 2007

This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated br... more This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated breast camera as an adjuvant to mammography and clinical examination. Methods: The study population comprised 37 patients with dense breasts and a family or personal history of breast cancer. The subjects had no suggestive clinical or mammographic findings. After intravenous administration of 99m Tc-sestamibi, the patients were imaged using a conventional ␥-camera and a dedicated breast camera that allowed breast compression during image acquisition. Images were interpreted independently by 2 reviewers. All patients with positive scintimammography findings underwent biopsy. Results: Dedicated breast camera results were positive in 13.5% (5/37) of patients. Biopsy of these 5 patients yielded 3 carcinomas: an infiltrating lobular carcinoma, a ductal carcinoma in situ, and an infiltrating tubular carcinoma. These 3 carcinomas were undetectable by clinical breast examination or mammography, even on retrospective review. Only one of these, the tubular carcinoma, was readily detectable by the standard ␥-camera. Conclusion: Scintimammography using a dedicated breast camera may augment mammography and clinical breast examination for the subset of women who have dense breast tissue and are at high risk of breast cancer.

Research paper thumbnail of <title>Molecular breast imaging using a dedicated high-performance instrument</title>

Hard X-Ray and Gamma-Ray Detector Physics and Penetrating Radiation Systems VIII, 2006

In women with radiographically dense breasts, the sensitivity of mammography is less than 50%. Wi... more In women with radiographically dense breasts, the sensitivity of mammography is less than 50%. With the increase in the percent of women with dense breasts, it is important to look at alternative screening techniques for this population. This article reviews the strengths and weaknesses of current imaging techniques and focuses on recent developments in semiconductor-based gamma camera systems that offer significant improvements in image quality over that achievable with single-crystal sodium iodide systems. We have developed a technique known as Molecular Breast Imaging (MBI) using small field of view Cadmium Zinc Telluride (CZT) gamma cameras that permits the breast to be imaged in a similar manner to mammography, using light pain-free compression. Computer simulations and experimental studies have shown that use of low-energy high sensitivity collimation coupled with the excellent energy resolution and intrinsic spatial resolution of CZT detectors provides optimum image quality for the detection of small breast lesions. Preliminary clinical studies with a prototype dual-detector system have demonstrated that Molecular Breast Imaging has a sensitivity of ~90% for the detection of breast tumors less than 10 mm in diameter. By comparison, conventional scintimammography only achieves a sensitivity of 50% in the detection of lesions < 10 mm. Because Molecular Breast Imaging is not affected by breast density, this technique may offer an important adjunct to mammography in the evaluation of women with dense breast parenchyma.

Research paper thumbnail of High-resolution gamma-camera for molecular breast imaging: First clinical results

Physica Medica, 2006

Scintimair mography is a molecular breast imaging technique using tumour-seeking radiopharmaceuti... more Scintimair mography is a molecular breast imaging technique using tumour-seeking radiopharmaceuticals; with standard gamma-cameras, is proved of value especially when mammography is indeterminate and in women with dense breasts; nevertheless, this technique shows a high sensitivity only for cancers &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 cm. The issue of detecting small cancers is critical for the future development and clinical usefulness of breast imaging with radiopharmaceuticals, because other modalities are increasingly employed for early identification of small abnormalities. The use of high-resolution dedicated cameras for breast imaging is the best option to improve small cancers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; detection: they allow greater flexibility in patient positioning, and the availability of projections similar to those of mammography. Moreover, the detector can be placed directly against the breast, and a mild compression is possible, with the results of reducing breast thickness, increasing the target-to-background ratio and the sensitivity. Our first clinical findings using the dedicased camera Lumagem 3200S (Gamma Medica, Inc., Northridge, USA) are very satisfactory. Till now, 29 patients with BI-RADS category III and IV lesions &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=1 cm were prospectively evaluated using a conventional gamma-camera and the dedicated device. Four out nine (44%) of the malignant lesions were detected with the standard gamma-camera, whereas the high-resolution camera visualized all the breast cancers. The standard gamma-camera and the dedicated one showed the same specificity: 19 out of 20 (95%) benign lesions were negative. Our results indicate that molecular breast imaging with this dedicated camera is able to detect small cancers in patients with probably benign or low-suspicion to indeterminate mammographic findings.

Research paper thumbnail of Intraoperative gamma imaging of axillary sentinel lymph nodes in breast cancer patients

Physica Medica, 2006

Sentinel lymph node (SLN) biopsy is now standard practice in the management of many breast cancer... more Sentinel lymph node (SLN) biopsy is now standard practice in the management of many breast cancer patients. Localization protocols vary in complexity and rates of success. The least complex involve only intraoperative gamma counting of radiotracer uptake or intraoperative visualization of blue-dye uptake; the most complex involve preoperative gamma imaging, intraoperative counting and intraoperative dye visualization. Intraoperative gamma imaging may improve some protocols. This study was conducted to obtain preliminary experience and information regarding intraoperative imaging. Sixteen patients were enrolled: 8 in a protocol that included intraoperative counting and dye visualization (probe/dye), 8 in a protocol that involved intraoperative imaging, counting and dye visualization (camera/probe/dye). Preoperative imaging of all 16 patients was performed using a GE 500 gamma camera with a LEAP collimator (300 cpm/muCi). The results of this imaging were not, however, given to the surgeon until the surgeon had completed the procedures required for the study. A Care Wise C-Trak probe was used for intraoperative counting. A Gamma Medica Inc. GammaCAM/OR (12.5 x 12.5 cm FOV) with a LEHR collimator (135 cpm/muCi) was used for intraoperative imaging. Times from start of surgery to external detection of a radioactive focus and to completion of excision of SLNs were recorded. Foci were detected preoperatively via imaging in 16/16 patients. Intraoperative external detection using the probe was accomplished in less than 4 min (mean = 1.5 min) in 15/16 patients, and via intraoperative imaging in 6/8 patients. The average time for completion of excision of nodes was 19 min for probe/dye and 28 min for camera/probe/dye. In one probe/dye case, review of the preoperative images prompted the surgeon to resume axillary dissection and remove one additional SLN.

Research paper thumbnail of Society of Nuclear Medicine Procedure Guideline for Breast Scintigraphy

Research paper thumbnail of Scintimammography with Dedicated Breast Camera Detects and Localizes Occult Carcinoma

Journal of Nuclear Medicine Official Publication Society of Nuclear Medicine, Apr 1, 2004

This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated br... more This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated breast camera as an adjuvant to mammography and clinical examination. Methods: The study population comprised 37 patients with dense breasts and a family or personal history of breast cancer. The subjects had no suggestive clinical or mammographic findings. After intravenous administration of 99m Tc-sestamibi, the patients were imaged using a conventional ␥-camera and a dedicated breast camera that allowed breast compression during image acquisition. Images were interpreted independently by 2 reviewers. All patients with positive scintimammography findings underwent biopsy. Results: Dedicated breast camera results were positive in 13.5% (5/37) of patients. Biopsy of these 5 patients yielded 3 carcinomas: an infiltrating lobular carcinoma, a ductal carcinoma in situ, and an infiltrating tubular carcinoma. These 3 carcinomas were undetectable by clinical breast examination or mammography, even on retrospective review. Only one of these, the tubular carcinoma, was readily detectable by the standard ␥-camera. Conclusion: Scintimammography using a dedicated breast camera may augment mammography and clinical breast examination for the subset of women who have dense breast tissue and are at high risk of breast cancer.

Research paper thumbnail of <title>Gated cardiac SPECT in rodents using a dedicated SPECT system: X-SPECT</title>

Penetrating Radiation Systems and Applications VI, 2004

Cardiac function is an important physiological parameter in preclinical studies. Nuclear cardiac ... more Cardiac function is an important physiological parameter in preclinical studies. Nuclear cardiac scans are a standard of care for patients with suspected coronary artery occlusions and can assess perfusion and other physiological functions via the injection of radiotracers. In addition, correlated acquisition of nuclear images with electrocardiogram (ECG) signals can provide myocardial dynamics, which can be used to assess the

Research paper thumbnail of Scintimammography with dedicated breast camera in unifocal and multifocal/multicentric primary breast cancer detection: A comparative study with SPECT

International Journal of Oncology, 2007

This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated br... more This study assessed the utility of scintimammography using a standard ␥-camera and a dedicated breast camera as an adjuvant to mammography and clinical examination. Methods: The study population comprised 37 patients with dense breasts and a family or personal history of breast cancer. The subjects had no suggestive clinical or mammographic findings. After intravenous administration of 99m Tc-sestamibi, the patients were imaged using a conventional ␥-camera and a dedicated breast camera that allowed breast compression during image acquisition. Images were interpreted independently by 2 reviewers. All patients with positive scintimammography findings underwent biopsy. Results: Dedicated breast camera results were positive in 13.5% (5/37) of patients. Biopsy of these 5 patients yielded 3 carcinomas: an infiltrating lobular carcinoma, a ductal carcinoma in situ, and an infiltrating tubular carcinoma. These 3 carcinomas were undetectable by clinical breast examination or mammography, even on retrospective review. Only one of these, the tubular carcinoma, was readily detectable by the standard ␥-camera. Conclusion: Scintimammography using a dedicated breast camera may augment mammography and clinical breast examination for the subset of women who have dense breast tissue and are at high risk of breast cancer.

Research paper thumbnail of <title>Molecular breast imaging using a dedicated high-performance instrument</title>

Hard X-Ray and Gamma-Ray Detector Physics and Penetrating Radiation Systems VIII, 2006

In women with radiographically dense breasts, the sensitivity of mammography is less than 50%. Wi... more In women with radiographically dense breasts, the sensitivity of mammography is less than 50%. With the increase in the percent of women with dense breasts, it is important to look at alternative screening techniques for this population. This article reviews the strengths and weaknesses of current imaging techniques and focuses on recent developments in semiconductor-based gamma camera systems that offer significant improvements in image quality over that achievable with single-crystal sodium iodide systems. We have developed a technique known as Molecular Breast Imaging (MBI) using small field of view Cadmium Zinc Telluride (CZT) gamma cameras that permits the breast to be imaged in a similar manner to mammography, using light pain-free compression. Computer simulations and experimental studies have shown that use of low-energy high sensitivity collimation coupled with the excellent energy resolution and intrinsic spatial resolution of CZT detectors provides optimum image quality for the detection of small breast lesions. Preliminary clinical studies with a prototype dual-detector system have demonstrated that Molecular Breast Imaging has a sensitivity of ~90% for the detection of breast tumors less than 10 mm in diameter. By comparison, conventional scintimammography only achieves a sensitivity of 50% in the detection of lesions < 10 mm. Because Molecular Breast Imaging is not affected by breast density, this technique may offer an important adjunct to mammography in the evaluation of women with dense breast parenchyma.

Research paper thumbnail of High-resolution gamma-camera for molecular breast imaging: First clinical results

Physica Medica, 2006

Scintimair mography is a molecular breast imaging technique using tumour-seeking radiopharmaceuti... more Scintimair mography is a molecular breast imaging technique using tumour-seeking radiopharmaceuticals; with standard gamma-cameras, is proved of value especially when mammography is indeterminate and in women with dense breasts; nevertheless, this technique shows a high sensitivity only for cancers &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;1 cm. The issue of detecting small cancers is critical for the future development and clinical usefulness of breast imaging with radiopharmaceuticals, because other modalities are increasingly employed for early identification of small abnormalities. The use of high-resolution dedicated cameras for breast imaging is the best option to improve small cancers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; detection: they allow greater flexibility in patient positioning, and the availability of projections similar to those of mammography. Moreover, the detector can be placed directly against the breast, and a mild compression is possible, with the results of reducing breast thickness, increasing the target-to-background ratio and the sensitivity. Our first clinical findings using the dedicased camera Lumagem 3200S (Gamma Medica, Inc., Northridge, USA) are very satisfactory. Till now, 29 patients with BI-RADS category III and IV lesions &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;/=1 cm were prospectively evaluated using a conventional gamma-camera and the dedicated device. Four out nine (44%) of the malignant lesions were detected with the standard gamma-camera, whereas the high-resolution camera visualized all the breast cancers. The standard gamma-camera and the dedicated one showed the same specificity: 19 out of 20 (95%) benign lesions were negative. Our results indicate that molecular breast imaging with this dedicated camera is able to detect small cancers in patients with probably benign or low-suspicion to indeterminate mammographic findings.

Research paper thumbnail of Intraoperative gamma imaging of axillary sentinel lymph nodes in breast cancer patients

Physica Medica, 2006

Sentinel lymph node (SLN) biopsy is now standard practice in the management of many breast cancer... more Sentinel lymph node (SLN) biopsy is now standard practice in the management of many breast cancer patients. Localization protocols vary in complexity and rates of success. The least complex involve only intraoperative gamma counting of radiotracer uptake or intraoperative visualization of blue-dye uptake; the most complex involve preoperative gamma imaging, intraoperative counting and intraoperative dye visualization. Intraoperative gamma imaging may improve some protocols. This study was conducted to obtain preliminary experience and information regarding intraoperative imaging. Sixteen patients were enrolled: 8 in a protocol that included intraoperative counting and dye visualization (probe/dye), 8 in a protocol that involved intraoperative imaging, counting and dye visualization (camera/probe/dye). Preoperative imaging of all 16 patients was performed using a GE 500 gamma camera with a LEAP collimator (300 cpm/muCi). The results of this imaging were not, however, given to the surgeon until the surgeon had completed the procedures required for the study. A Care Wise C-Trak probe was used for intraoperative counting. A Gamma Medica Inc. GammaCAM/OR (12.5 x 12.5 cm FOV) with a LEHR collimator (135 cpm/muCi) was used for intraoperative imaging. Times from start of surgery to external detection of a radioactive focus and to completion of excision of SLNs were recorded. Foci were detected preoperatively via imaging in 16/16 patients. Intraoperative external detection using the probe was accomplished in less than 4 min (mean = 1.5 min) in 15/16 patients, and via intraoperative imaging in 6/8 patients. The average time for completion of excision of nodes was 19 min for probe/dye and 28 min for camera/probe/dye. In one probe/dye case, review of the preoperative images prompted the surgeon to resume axillary dissection and remove one additional SLN.