Francis Raber was visiting his wife, Mary, who had been hospitalized for anemia at UPMC Presbyterian, when he suddenly needed medical care himself.

	Tony Tye, Post-Gazette At UPMC Presbyterian, Dr. William Follansbee, left, director of nuclear cardiology, shows patient Francis Raber, 72, of Steubenville, Ohio, images of his heart. Click photo for larger image.

"All of a sudden, my jaw started to hurt and my chest, and I was nauseous," said Mr. Raber, 72, recalling the February incident.

The Steubenville, Ohio, resident had no history of heart disease and an electrocardiogram was normal. But a nuclear imaging test known as a SPECT perfusion scan suggested a blockage in blood flow to the back of his heart.

A heart catheterization -- which involves inserting a flexible tube into the blood vessels -- later confirmed he was "hanging on the edge of having a major heart attack," said his cardiologist, Dr. William Follansbee, director of nuclear cardiology at the hospital.

But SPECT findings are not always a reliable indicator of patients who need more invasive catheterization, Dr. Follansbee noted.

In an effort to enhance testing, UPMC researchers plan to begin enrolling patients late this month in a study that will use computer technology to merge SPECT images with cutting-edge CT scans, which provide detailed views of the heart and coronary arteries.

Besides helping some patients avoid needless catheterizations, the approach may eventually be used to identify early changes in cells or nerves that could lead to heart failure or potentially fatal arrhythmias, Dr. Follansbee said.

"The idea has huge promise," said Dr. Gregory S. Thomas, an assistant professor of medicine at the University of California, Irvine and president-elect of the American Society of Nuclear Cardiology.

Dr. James Udelson, director of nuclear cardiology at Tufts-New England Medical Center, noted that about 10 percent of the 5 million or more SPECT studies conducted in the United States each year suggest a problem when none exists. Obesity or other physical characteristics can pose challenges in interpreting the tests.

While techniques exist to adjust for those factors, combined SPECT-CT imagery could "create more precision in diagnosis," he said.

He and others warned that more study is needed to determine the testing's benefits.

Doctors shouldn't necessarily "scan because we can," said Dr. Akash Sharma, director of nuclear medicine at Allegheny General Hospital. He noted that testing can pose a risk from radiation.

But findings from SPECT-CT, combined with a patient's medical history, could "go a long way to deciding who needs to go to cardiac catheterization," Dr. Sharma said. He noted that Allegheny General is upgrading its scanning equipment and considering a similar approach.

SPECT and CT images already can be taken on a single machine, but those systems are expensive and are not widely available. Yet many hospitals have separate CT and SPECT systems.

Doctors at UPMC plan to take images for each patient on different machines, then use computer technology to combine them, guided by markers placed around the body.

The technology could allow many hospitals to perform the combined imaging, said Dr. Prem Soman, UPMC's director of nuclear cardiology research and leader of the project.

"My whole approach is to develop something that can be applied in the community," said Dr. Soman, who was awarded a grant for the project earlier this year from the American College of Cardiology.

Dr. Follansbee said he took the concept several years ago to Philips Medical Systems, which is collaborating with UPMC on the project. He noted that recent advances in CT, which uses special X-ray equipment to obtain cross-sectional images of the body, have fueled interest in its possibilities for cardiac imaging.

Earlier CT technology required patients to hold their breath for about 30 seconds to acquire images, which often was impractical, he said. But newer equipment has reduced that time to about seven seconds, making a quality image of the heart and coronary arteries available without a catheterization.

But blockages indicated by CT imagery will not necessarily indicate a problem in blood flow, Dr. Thomas said. Combining the test with SPECT, which involves injecting a radioactive tracer in the blood, then taking scans of the heart, could indicate whether an apparent blockage actually creates a problem.

SPECT-CT "would allow us to get a complete evaluation of heart structure and physiology," he said.

If the approach is found to be useful and cost-effective, UPMC's nuclear cardiology department will be well-positioned to spread the word, Dr. Udelson noted.

Aided by its computerized information system, the department is a national preceptorship training center in nuclear cardiology and offers a continuing education course for cardiologists on interpreting diagnostic tests.

While many centers rely on dictating test results, which can take days to process, UPMC's system, developed by Dr. Follansbee and the medical center's information technology staff, immediately sends electronic copies of test results to a patient's doctors and to the medical record.

The system allows Dr. Follansbee, the course director, to quickly select cases helpful for teaching purposes and to link patient histories to imaging results.

Looking over his SPECT and catheterization images with Dr. Follansbee, Mr. Raber, a retired engineer, said he was grateful that doctors could quickly diagnose his blockage and take action. He said he exercises regularly and feels much better since bypass surgery restored blood flow to his heart.

Dr. Udelson noted that SPECT imaging was adopted widely in the past decade as its benefits became clear.

"If this next step also proves to be as useful," he said of SPECT-CT, "the wider audience of clinical cardiologists will start incorporating it into their practices."