TAMC shows Hawaii new imaging capabilities

| May 27, 2016 | 0 Comments
Edward Kawaoka, senior technician,  Department of Nuclear Medicine, Tripler Army Medical Center, conducts a Single-photon emission computed tomography (SPECT) scan on a patient.  This machine is used to conduct multiple types of body scans including the Dopamine Transporter scan which uses Iodine-123 Ioflupane, the drug necessary to conduct the scan and confirm Parkinson's syndrome.

Edward Kawaoka, senior technician, Department of Nuclear Medicine, Tripler Army Medical Center, conducts a Single-photon emission computed tomography (SPECT) scan on a patient. This machine is used to conduct multiple types of body scans including the Dopamine Transporter scan which uses Iodine-123 Ioflupane, the drug necessary to conduct the scan and confirm Parkinson’s syndrome.


William Sallette

Tripler Army Medical Center Public Affairs
HONOLULU — Tripler Army Medical Center prides itself on being at the forefront of medicine, and TAMC recently accomplished a task that no other hospital in the state has been able to accomplish.
Tripler is now using the DaT scan.

Newly available drugs at Tripler Army Medical Center are essential to create scans for checking Parkinson's disease in single-photon emission computed tomography scans like the one pictured above.

Newly available drugs at Tripler Army Medical Center are essential to create scans for checking Parkinson’s disease in single-photon emission computed tomography scans like the one pictured above.

What is the DaT scan?
A Dopamine Transporter Scan is a helpful tool in the early stages  of diagnosis of Parkinson’s disease.

According to the Parkinson’s Disease Foundation, more than 60,000 people are diagnosed with Parkinson’s disease each year, and a positive scan can assist detection of brain activity associated with the condition.

The scan is particularly useful when symptoms are clinically ambiguous. Differentiation between other tremor, or shaking conditions, such as essential tremor, can be clinically difficult.

This type of scan to detect early stages of Parkinson’s disease uses an injection of Iodine-123 Ioflupane, a special type of neuro-imaging radiopharmaceutical drug that allows the scan to see the amount of working dopamine transporters in the brain. The fewer active dopamine transporters, the more likely the patient has a Parkinsonian condition, including Parkinson’s disease.

The challenge
The problem with this drug is that it has a usable shelf life of less than a day, in truth closer to half a day. From the time it is produced at a lab in Schenectady, New York, and transported on the most efficient scheduled flights to Honolulu and TAMC, the drug will be good only until 1 p.m., Hawaii time.  This has previously prevented any hospital in the state from being able to conduct the scan.

However, when Dr. Amitabh Gupta was hired last November to establish and direct a movement disorders program for TAMC neurology, the need for DaT scan technology became pertinent to the program’s success.

It took Lt. Col. Yang En Kao to determine that with proper coordination and planning, TAMC could manage to pull off this seemingly impossible logistical task of receiving Iodine-123 Ioflupane within hours of its creation nearly a quarter of the way around the world.

Strategy development
Nearly six months ago, Kao contacted the producer of the drug and began coordinating for proper training on the shipping, handling and administration of the drug.

“It took many months of coordination and training between multiple departments of the hospital before we were even able to give the go ahead to ship the materials,” said Kao. “Representatives from the drug producer came out to assist in the preparation and training of the pharmacy personnel for receiving and control, and the technicians on the proper use of the materials in the scan itself.”

After much planning and coordination, Kao decided it was time to test their plan.

On April 14th, Kao performed the first successful DaT scan in the state of Hawaii.

“The test was successful, and we confirmed that the first patient we scanned does not have Parkinson’s,” said Kao. “Treatment for Parkinson’s disease and essential tremor is completely different, so it was very important to find out for sure that this patient did not have Parkinson’s disease.  This allows us to move to the correct treatment process and improve the health for the patient immediately.”

Prior to this new availability, doctors would evaluate the patient and treat the symptoms based on their knowledge of the diseases.

“Without DaT scan, we would have to rely on clinical monitoring and see if more symptoms, compatible with the diagnosis, eventually would develop,” said Gupta.  “A DaT scan is particularly helpful in challenging cases, so in these cases, without DaT scans, only time would tell, and we would be limited as to what to suggest to a patient in terms of long-term career and health planning.”

Growing future
Since the inception of the movement disorders program a few months ago, seven patients from TAMC have benefitted from the DaT scan. This number is expected to grow each year as more patients are recruited to the Movement Disorders Program at TAMC.

“For those patients who will be receiving this new imaging at TAMC, it has a profoundly positive impact,” said Gupta.  “It (DaT results) allows us to make an early decision about a patient’s life, in terms of career and health, which allows accurate and timely preparation for the patient and family as to what is to come – either way.”

Now that Kao has proved that, through coordination and planning, a DaT scan can be successfully completed here in Hawaii. Area civilian hospitals are now beginning to examine the logistical viability of the DaT scan elsewhere here in the islands.

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Category: Community, Health

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