Single-photon emission computed tomography

So you need technical expertise to actually get them to run, to provide reasonable results for the data you want to give them.

And having these sort of different tools united and robust and reliable at your fingertips, that is, at the bedside, is where clinical decision support systems, CDSS, come into play, where you have a shared interface where you can address problems like data from the surgical evaluation, integrating MRI, PET scans, SPECT, EEG, and doing that quickly and easily enough to be actually usable in the sort of high throughput, busy clinical work we all know too well.

The second part of the question,

are there any problems that are not solvable by machine learning? I'd rather flip that question around.

which gets us to polling question number two.

An older man with heart failure symptoms and preserved EF on echo with a remote history of carpal tunnel syndrome is found to have perigene grade two uptake on technetium pyrophosphate with SPECT scan.

What's the next best F? Okay, so that's an imaging test that can be used as part of the diagnostic algorithm from ATTR amyloidosis.

So it's positive.

So you do not want to miss that diagnosis.

So if your monoclonal protein screen is abnormal, it behooves you to check a biopsy and the biopsy gold standard, the organ of interest, like a heart biopsy to exclude AL.

But if your monoclonal protein screen is negative, you can breathe a deep sigh of relief on behalf of the patient and turn your attention towards radionuclide scintigraphy with SPECT.

Most commonly, this will be a technetium pyrophosphate scan, which if it's positive is 99% accurate or 100% accurate really for ATTR cardiac amyloidosis.

There's evidence that disruptions in GABA transmission have something to do with catatonia, which will not be surprising to people when we get to treatments later.

For example, there are SPECT studies that show reduced GABA-A receptor density in the somatosensory cortex.

So there are a variety of brain regions implicated.

I think the most strongly implicated are the supplementary motor area and the M1 motor cortex.

I love Daniel Amen's work and I think that he's done so much to bring an incredible amount of awareness to how much our brain is kind of defining our life, what's happening in our brain.

The way that a SPECT scan works is that you have a radioactive isotope put in your body, and then the scan is actually looking at where that binds with the oxygen in the brain.

When your brain has more activation, you're consuming more oxygen and glucose, and then it lights up or it doesn't light up depending on where the activation is.

It gives you a really good indication of a snapshot in time of what's happening in your brain.

And it looks at the structures.

So you can see, are the structures of the brain actually getting smaller? Are they growing over time with tests and retests? And so I've done a lot with SPECT.

I've done some with PET.

I've done a lot with MRI, fMRI.

So I wanted to see what's going on from a CNS san- standpoint.

So we were fortunate enough to get a few patients in for SPECT imaging at-

Mm-hmm

... a couple of the Amen Centers, and it's phenomenal when you see some of these SPECT images, these holes in these people's brains where there's just no activity going on at all.

... and I think they marry that up to the qEEG, uh, as well.

They kind of...

And then does that give them a better picture of things, or? And I realize SPECT imaging's very expensive.

It's not in the mainstream for-