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Section of
Cardiovascular Medicine
Yale University
School of Medicine
333 Cedar Street
PO Box 208017
New
Haven,
CT 06510
USA
(203) 785-4114
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Yale
| Cardiovascular Medicine | Nuclear Imaging
Nuclear
Cardiology and Stress Testing Service
Clinical
Training Environment
Nuclear cardiology laboratories are located both at Yale and the VA Medical
Center. The Cardiovascular Nuclear Imaging and Exercise Laboratories at Yale
comprise a comprehensive exercise and imaging center that is fully accredited
by the Intersocietal Commission for Accreditation
of Nuclear laboratories (ICANL). The laboratory performs cardiac perfusion
and function studies, utilizing state-of-the-art tomographic
and planar imaging equipment. Both Thallium and Technetium-labeled tracers
are used daily in conjunction with physical and pharmacological stress
testing, Static and ECG-gated tomographic and
planar images are interpreted both visually and with commercially available
quantitative software developed and validated in our laboratory. In addition,
the laboratory provides Yale-New Haven
Hospital Emergency
Department Chest
Pain Center
with complete stress testing capabilities including SPECT imaging. The
laboratory is fully digital and networked. All imaging studies are digitally
archived. The laboratory has unique logistics in place for remote internet
reading of clinical studies through a dedicated Yale Nuclear Cardiology
Laboratory web site.
The nuclear cardiology service at the VA Medical Center is comprised of
state-of-the-art SPECT cameras, with ultra-high energy imaging capability.
The recently upgraded positron emmission tomography
(PET) camera and cyclotron also are located on the VA campus. The lab
performs all types of nuclear imaging and stress testing, including cardiac
PET studies.
The staff includes 6 attendings in Nuclear
Cardiology, 2 senior fellows in Nuclear Cardiology, and a team of nuclear
medicine technologists, nurses and exercise physiologists.
Clinical
Activities
The laboratories at Yale and the VA perform over 7,000 clinically requested
studies in out-patients and in-patients. Most studies are performed in
conjunction with either physical or pharmacological stress testing. The
laboratory performs the following stress modalities: physical
treadmill/bicycle exercise, pharmacologic vasodilation
with either dipyridamole or adenosine, pharmocologic stress with dobutamine,
exercise cardiopulmonary testing. Most stress tests are performed with
radionuclide imaging, but stress echocardiography is also available. Left and
right ventricular function studies are mostly performed at rest using the
first pass or equilibrium technique. An important clinical service is
provided in the Chest Pain
Center. On an average 4-5
patients/day are evaluated for acute chest pain by either resting imaging or
stress testing.
Research
The Yale laboratory has served as the Core Laboratory for many multicenter clinical trials, including the TIMI trials,
the recently completed Acute Chest Pain Tetrofosmin
Trial, and the ongoing Detection of Ischemia in Asymptomatic Diabetics (DIAD)
trial, for which Dr. Wackers is the principal
investigator. The VA laboratory is also active in clinical research projects.
In addition, research laboratories dedicated to molecular imaging are located
on the VA campus.
Dr. Wacker's research interests include imaging in
patients with acute coronary syndromes, the use of radionuclide imaging in
the Emergency Department, and the evaluation of new imaging agents such as
Tc99m-NOET, Tc99m-Teboroxmime, and Tc99m-Annexin. In collaboration with Dr.
Liu, Dr. Wackers developed the commercially
available (Eclipse Systems Inc) quantitative software for integrated analysis
of SPECT myocardial perfusion images.
Dr. Zaret's initial work involved the development
of the two major imaging techniques that are presently routine
in any nuclear cardiology laboratory, i.e. stress myocardial perfusion
imaging and equilibrium ventriculography. His more
recent interests focus on molecular imaging, incorporating molecular and
cellular biology to create new means of evaluating disease processes.
Dr. Sinusas' work focuses on the development of
noninvasive imaging approaches for the assessment of myocardial viability,
utilizing both animal and clinical studies with SPECT, echocardiography and
magnetic resonance imaging, to explore the interrelationship of myocardial perfusion,
metabolism and function.
Dr. Russell's area of expertise involves regulation of cardiac metabolism in
the setting of ischemia, heart failure and diabetes. These interests include
studies in animal models and clinical PET imaging in patients.
Dr. Sadeghi's research focus is in the development
of molecular imaging techniques includinfg
evaluation of such techniques in small animals.
Dr. Soufer's research focuses on the pathophysiology of mental stress ischemia with an
emphasis on neurocardiac interactions.
Training
and Teaching for Fellows
Each year the laboratory has several senior fellows in Nuclear Cardiology,
based at Yale-New Haven
Hospital and the VA Medical
Center. Training lead to ACC/ASNC Level III certification in Nuclear
Cardiology and Nuclear Regulatory Committee licensure after completion of the
radiation physics course offered through the Yale University School of
Medicine. In addition one first or second year clinical cardiology fellow
rotates monthly through the laboratory for basic training (Level I) in
Nuclear cardiology and stress testing. The senior and rotating clinical
fellows attend the daily one-hour conference (didactic, case presentations,
journal review), during which a variety of clinical and technical aspects of
Nuclear Cardiology are covered. The nuclear cardiology fellows and the
rotating fellow participate in all stress laboratory activities including the
daily interpretation of all studies. Additional learning resources include
teaching material on CD-ROM's and videodisc, as well as an extensive hard
copy and computer-based files of teaching cases.
Faculty
Yi-Hwa Liu, Ph.D.
Assistant Professor of Medicine
Raymond R. Russell, M.D., Ph.D
Assistant Professor of Medicine
Mehran Sadeghi, M.D.
Assistant Professor of Medicine
Albert J. Sinusas,
M.D.
Associate Professor of Medicine and Diagnostic Radiology
Director, Animal Research Laboratories
Associate Director, Cardiovascular Imaging Laboratory
Robert Soufer,
M.D.
Associate Professor of Medicine
Chief, Cardiology Service, VA Connecticut Healthcare System
Aseem Vashist,
M.D.
Assistant Professor of Medicine
Frans J. Th Wackers, M.D, Ph.D.
Professor of Diagnostic Radiology and Medicine
Director, Cardiovascular Nuclear Imaging and Exercise Laboratories
Barry L. Zaret,
M.D.
Robert W. Berliner Professor of Medicine, Prof. Diagnostic Radiology
Chief, Cardiovascular Medicine
Copyright
© 2000, Yale University, New Haven, Connecticut, USA.
All rights reserved. Comments or suggestions to site editor.
Certifying authority:
Last modified: Tuesday, 05-Jul-2005 09:50:14 EDT(PL).
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