Ashok Muthukrishnan, MD, MS
PET-CT Fellowship Director
Associate Professor of Radiology
The Nuclear Medicine Division is a national leader in PET/CT clinical volumes and research. In addition to PET/CT, the Division has a comprehensive PET imaging center, which provides a full range of diagnostic and therapeutic nuclear medicine services. The PET/CT fellowship program within the Nuclear Medicine Division provides highly supervised clinical instruction in both PET and diagnostic CT interpretation. UPMC is a world leader in research and development of both instrumentation (the first PET/CT scanner was invented at UPMC) and radiotracers (over 100 radiolabeled compounds for human and animal use, including Pittsburgh Compound B (PiB)). Research opportunities are available in the use of experimental PET radiopharmaceuticals in novel cancer therapy trials and the role of PET-CT and PET-MR imaging biomarkers for early cancer therapy response assessment.
Human imaging resources include four GE PET/CT scanners (8- and 16-slice; two new 64-slice Discovery VCT), a Siemens HR+ brain PET scanner, a Siemens mMR Biograph PET/MR system and a Siemens mCT Biograph PET/CT, three new GE Discovery NM/CT 670 SPECT-CT scanners and a GE Discovery NM 630 SPECT. In addition, dedicated brain imaging protocols and analysis facilities are equipped with advanced SPM and normal database statistical software for analysis of dementia, epilepsy and brain tumors. UPMC is also equipped with an advanced PACS system (Philips’ iSite). Animal resources include a pre-clinical PET/CT suite [Inveon small animal PET/CT (Siemens)] and a state-of-the-art radiochemistry laboratory.
Many radiopharmaceutical therapeutic procedures are also provided, with the most common treatment involving iodine-131 for differentiated thyroid cancer and Lu-177 DOTATATE for neuroendocrine tumor. The division serves as a referral center for thyroid cancer and other thyroid and parathyroid imaging in the region, including western Pennsylvania and eastern Ohio. Dedicated SPECT-CT with diagnostic contrast enhanced CT is a unique diagnostic imaging technique performed only at UPMC for challenging cases of parathyroid and neuroendocrine tumors, such as carcinoids and pheochromocytomas. UPMC is also a leading center for the radioimmunotherapy of lymphoma, radioembolization therapy using Ytrrium-90 microspheres for advanced liver cancers, Radium-223 alpha and Samarium-153 radiation therapy for widespread bone metastatic disease in prostate cancer.
UPMC Nuclear Medicine has made significant contributions to medical imaging over the last few decades. The division’s cancer imaging research program is robust and relies heavily upon collaborative effort between the division faculty, the UPMC Hillman Cancer Center oncologists, and the department’s own PET Research Center. The division is partnering with the industry in an effort to radiolabel activated T-cells PD-1/PDL-1 receptors that would allow for T-cell imaging and help better understand cancer immunotherapy. The division also actively participates in clinical trials with respect to the ‘theranostic’ movement in nuclear medicine. Our division has been very active in recruiting patients for the first FDA approved theranostic agent for treating neuroendocrine tumors using Gallium-68 and Lutetium-177 DOTATATE. There are many new theranostic agents under development for a wide variety of cancers. A keen interest of our faculty is to incorporate alpha emitting isotopes into new theranostic paradigms using the Prostate-specific membrane antigen (PSMA) that specifically targets prostate cancer. The division is also investigating novel multi-modality advancements, such as PET/MR as well as optical imaging.
The nuclear medicine division has played a major role in organizing and advancing two important initiatives for the entire UPMC system - the UPMC Nuclear Medicine Service Line and the Radiation Physics Oversight committee. The division implements system-wide electronic accessibility of the most up to date protocols for Nuclear Medicine diagnostic and therapeutic procedures, which are currently being performed at the main campus sites of UPMC Presbyterian and UPMC Shadyside hospitals. This service line resource is available on the UPMC network and is continually being expanded to include the increasing group of interpreting nuclear medicine physicians and technologists all across the UPMC sites. The division has been rapidly expanding its nuclear medicine coverage at multiple sites, for both "day" and "after hours" patient care. In addition to providing full-time coverage for UPMC Presbyterian, UPMC Shadyside, UPMC Hillman cancer center, and PET/CT, as well as part-time day coverage at Children's Hospital, the division expanded its services in FY16 and now provides full-time day coverage to UPMC Mercy and part-time day coverage to UPMC Passavant including for all nuclear medicine therapies. Moreover, the division also provides "after hours" coverage for UPMC Presbyterian, UPMC Shadyside, Children’s hospital, and UPMC Mercy, Bedford and Altoona.