Discovery rx

Manufactured by GE Healthcare

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The Discovery RX is a laboratory equipment product offered by GE Healthcare. It is designed to perform basic analytical tasks in a clinical laboratory setting. The core function of the Discovery RX is to enable reliable and efficient data collection and analysis for researchers and healthcare professionals.

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36 protocols using discovery rx

Quantitative Myocardial Blood Flow Assessment

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Coronary vascular function was quantified in all patients using a whole-body PET/computed tomography scanner (PET/CT Discovery RX or STE LightSpeed 64, GE Healthcare, Milwaukee, WI). Myocardial blood flow (MBF, in mL/min/g) was measured at rest and during maximal hyperemia by a standard intravenous infusion of adenosine, dipyridamole or regadenoson using either ¹³N-ammonia or ⁸²Rubidium as the flow tracers, as described previously.^{14 (link)} The image acquisition and post processing techniques for quantification of myocardial blood flow (MBF) and flow reserve did not change over the study period. Previous studies have demonstrated that equivalence of dipyridamole, regadenoson, and adenosine as vasodilators for myocardial perfusion imaging and quantitative myocardial blood flow.^{15 (link), 16 (link)} Furthermore, the use of different vasodilator stress agents has not affected the value of quantitative myocardial blood flow by PET for risk stratification.^{15 (link), 17 (link)-19 (link)} The heart rate, blood pressure, and 12-lead electrocardiogram were recorded at baseline and every minute during and after the vasodilator infusion.

Bajaj N.S., Singh A., Zhou W., Gupta A., Fujikura K., Byrne C., Harms H.J., Osborne M.T., Bravo P., Andrikopolou E., Divakaran S., Bibbo C.F., Hainer J., Skali H., Taqueti V., Steigner M., Dorbala S., Charytan D.M., Prabhu S.D., Blankstein R., Deo R.C., Solomon S.D, & Di Carli M.F. (2019). Coronary microvascular dysfunction, left ventricular remodeling and clinical outcomes in patients with chronic kidney impairment. Circulation, 141(1), 21-33.

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Standardized PET/CT and CE-CT Protocols

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All PET/CT and CE-CT examinations followed basic study protocols. For PET/CT, patients fasted for at least four hours, FDG dosage was body-weight adjusted, the uptake time was standardized to 60 minutes in supine position, a non-enhanced CT scan was performed and used for attenuation correction, and data was acquired with arms overhead whenever possible. Blood glucose levels <12 mmol/l were accepted. Body weight, height, and blood glucose level were measured prior to imaging. Five different types of PET/CT scanners were used throughout the study period, i.e. Discovery STE, Discovery LS, Discovery RX, Discovery MI, and Discovery 690 (all GE Healthcare, Waukesha, WI). To compensate for differences in the sensitivity of the different PET/CT scanner generations, we measured the metabolic activity in the mediastinal blood pool and in the liver tissue for reference.
For CE-CT of the abdomen, 80 ml iodinated contrast material (Visipaque® 320, GE Healthcare) were injected, timed for imaging at the portal venous phase with a tube voltage of 120 kV and a tube current–time product of 100–320 mAs. If patients had a recent CE-CT of the region of interest prior to the PET/CT, the CE-CT was not repeated.

Husmann L., Huellner M.W., Gruenig H., Ledergerber B., Messerli M., Mestres C.A., Rancic Z, & Hasse B. (2022). Imaging characteristics and diagnostic accuracy of FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected mycotic or inflammatory abdominal aortic aneurysms. PLoS ONE, 17(8), e0272772.

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Cardiac Perfusion Imaging Protocol

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The PETscans were conducted using Discovery RX or STE Lightspeed 64 systems (GE Healthcare, Milwaukee, WI) and either ⁸²Rubidium or ¹³N-ammonia as the flow tracer at rest and stress as previously described.^{39 (link)} Vasodilator stress was achieved by infusion of dipyridamole, adenosine, or regadenoson, using standard protocols. The extent and severity of myocardial scar and ischemia were semi-quantitatively, visually analyzed^{40 (link)}; left ventricular ejection fraction was calculated from gated myocardial rest and stress perfusion images, using commercial algorithms (4DM, INVIA, Ann Arbor, MI). Absolute myocardial blood flow (MBF) was calculated using hybrid factor analysis and a 2-compartment tracer kinetic model.
Coronary flow reserve was defined as the ratio between hyper-emic and resting MBF. An index of coronary vascular resistance was calculated by dividing the mean aortic blood pressure by MBF. Unless otherwise noted, MBF, CFR, and coronary vascular resistance are presented as averages of all the left ventricular values. To normalize for the impact of cardiac workload on MBF, we calculated the corrected CFR, in which resting myocardial blood flow was normalized by dividing by the rate–pressure product, an index of cardiac workload, and multiplying by 10,000.

Charytan D.M., Skali H., Shah N.R., Veeranna V., Cheezum M.K., Taqueti V.R., Kato T., Bibbo C.R., Hainer J., Dorbala S., Blankstein R, & Di Carli M.F. (2017). Coronary flow reserve is predictive of the risk of cardiovascular death regardless of chronic kidney disease stage. Kidney international, 93(2), 501-509.

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18F-FDG PET/CT Imaging Protocol

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Patients were instructed to fast for at least 4 h before administrating 18F-FDG. After measuring blood glucose, 18F-FDG was injected into a peripheral vein. One hour later, patients underwent PET/CT imaging from the skull to the pelvis (including a non-contrast, free-breathing, non-gated CT scan). Images were acquired in 3D mode on a Discovery VCT or Discovery RX scanner (GE Healthcare, Waukesha, WI) using well established clinical imaging protocols. The CT scan was acquired using at a tube voltage of 120 or 140 kV and with a low tube current (range 59–80 mAs). Radiation dose was 3.4 ± 0.6 mGy CT dose index volume and 422.4 ± 378 mGy*cm dose length product. Images were reconstructed using a standard soft tissue kernel and with a slice thickness and increment of 1.25 mm. PET/CT and CT images were merged and analyzed using Advantage Window volume viewer software (GE Healthcare, Milwaukee, WI, USA), as previously described^{12 (link)}. The CT scan as acquired for hybrid 18F-FDG PET/CT w.

Sartoretti E., Gennari A.G., Maurer A., Sartoretti T., Skawran S., Schwyzer M., Rossi A., Giannopoulos A.A., Buechel R.R., Gebhard C., Huellner M.W, & Messerli M. (2022). Opportunistic deep learning powered calcium scoring in oncologic patients with very high coronary artery calcium (≥ 1000) undergoing 18F-FDG PET/CT. Scientific Reports, 12, 19191.

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Cardiac Imaging with PET/CT and SPECT/CT

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The FDG PET protocol has been described in detail elsewhere.^{13 (link)} Rest myocardial perfusion images were obtained using ⁸²Rubidium (~50 mCi) or ¹³N-ammonia (~20 mCi) PET/computed tomography (CT) (Discovery RX or DSTE Light Speed 64, GE Healthcare, Milwaukee, WI), or ^99mTc-sestamibi (~20 mCi) single-photon emission computed tomography (SPECT)/CT (Symbia T6, Siemens Healthcare, Hoffman Estates, Chicago, IL). After perfusion imaging, 10–12 mCi of ¹⁸F-fluorodeoxyglucose (FDG) was used to perform dedicated cardiac and whole body FDG PET/CT scans.
All patients were instructed to follow a high fat, very low carbohydrate diet (at least two meals) followed by a fast of at least four hours prior to the test to shift normal myocardial metabolism to primary fatty acid utilization and, therefore, suppress the uptake of FDG by normal myocardium.^{14 (link), 15 (link)}

Divakaran S., Stewart G.C., Lakdawala N.K., Padera R.F., Zhou W., Desai A.S., Givertz M.M., Mehra M.R., Kwong R.Y., Hedgire S.S., Ghoshhajra B.B., Taqueti V.R., Skali H., Dorbala S., Blankstein R, & Di Carli M.F. (2019). Diagnostic Accuracy of Advanced Imaging in Cardiac Sarcoidosis: An Imaging-Histologic Correlation Study in Patients Undergoing Cardiac Transplantation. Circulation. Cardiovascular imaging, 12(6), e008975.

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18F-DOPA-PET Imaging Protocol for Neurodegenerative Diseases

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DOPA is a neutral amino acid that resembles natural L-DOPA (dopamine precursor). It enters the catecholamine metabolic pathway of endogenous L-DOPA in the brain and peripheral tissues and can be labeled with ¹⁸F (half-life 110 min) for PET imaging. Incerased uptake of ¹⁸F-DOPA is seen in tissues with high activities of L-DOPA decarboxylase. ¹⁸F-DOPA-PET was used at our institution after its formal approval for use in Europe (November 2006). Patients were asked to fast for at least 4–6 h before ¹⁸F-DOPA injection. ¹⁸F-DOPA-PET was performed 45 min after injection ¹⁸F-DOPA (mean 202.8±36.7 MBq, range 25–263 MBq) into a peripheral vein.[14 (link)] Images were acquired in 3D mode on different scanners (Discovery VCT or Discovery RX (GE-Healthcare, Milwaukee, WI, USA). The imaging protocol consisted of a scout view followed by low-dose CT acquisition for attenuation correction and subsequent PET acquisition. PET emission scans were acquired from the base of the skull to mid-thigh during 20 min (5–7 bed positions of 2–3 min each). Iterative reconstruction and CT-based attenuation correction were used. PET and CT images were fused using a dedicated software package (AW 5.0 GE-Healthcare). PET scans were acquired without premedication with carbidopa.

Burger I.A., Lohmann C., Messerli M., Bengs S., Becker A., Maredziak M., Treyer V., Haider A., Schwyzer M., Benz D.C., Kudura K., Fiechter M., Giannopoulos A.A., Fuchs T.A., Gräni C., Pazhenkottil A.P., Gaemperli O., Buechel R.R., Kaufmann P.A, & Gebhard C. (2018). Age- and sex-dependent changes in sympathetic activity of the left ventricular apex assessed by 18F-DOPA PET imaging. PLoS ONE, 13(8), e0202302.

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Quantifying Myocardial Blood Flow by PET

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Patients underwent a whole-body PET/computed tomography scanner (Discovery RX or STE LightSpeed 64, GE Healthcare, Milwaukee, WI) after at least 4 h of fasting. The study protocol for PET is similar to our previous work described elsewhere [26 (link)]. Briefly, ¹³N-ammonia was used as a flow tracer at rest and stress for PET, [27 (link)] and an intravenous infusion of regadenoson was given as a stressor. We quantified MBF in ml/min/g during rest and peak stress using ¹³N-ammonia and calculated CFR as the ratio of stress MBF over rest MBF [28 (link)–31 ]. Clinically relevant cardiologic variables including heart rate, blood pressure, and 12-lead ECG were assessed at baseline and throughout the test. With commercially available software, we calculated left ventricular ejection fraction (LVEF) at rest and stress from gated myocardial perfusion images. In addition, summed rest, stress, and difference scores were computed. Higher summed stress scores reflect larger areas of myocardial scar and ischemia. In general, normal scans have the summed stress score ≤ 3 [32 (link)–34 (link)].

Kim S.C., Di Carli M.F., Garg R.K., Vanni K., Wang P., Wohlfahrt A., Yu Z., Lu F., Campos A., Bibbo C.F., Smith S, & Solomon D.H. (2018). Asymptomatic hyperuricemia and coronary flow reserve in patients with metabolic syndrome. BMC rheumatology, 2, 17.

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Quantitative Perfusion PET Protocol

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Patients were imaged with a standard hybrid whole-body PET-computed tomography scanner (Discovery RX or STE LightSpeed 64, GE Healthcare, Milwaukee, Wisconsin) with ¹³N-ammonia or ⁸²rubidium as flow tracers at rest and pharmacologic stress, as previously described (21 (link)). Summed rest, stress, and difference scores, with higher scores reflecting larger areas of myocardial scar, scar plus ischemia, or ischemia, respectively, were computed; summed stress scores ≤2 were considered normal (22 (link)). Rest LVEFs were calculated from gated myocardial perfusion images with commercially available software (Corridor4DM, INVIA Medical Imaging Solutions, Ann Arbor, Michigan). Coronary hyperemia was achieved with vasodilation using standard protocols. Absolute global myocardial blood flow (in ml/min/g of tissue) was quantified at rest and at peak hyperemia using commercial software, as previously described (21 (link)). Per-patient global CFR was calculated as the ratio of stress to rest absolute myocardial blood flow for the entire left ventricle. Quantitative measures of CFR were obtained from routine post-processing of PET scans at no additional clinical cost, imaging time, or radiation exposure to patients.

Bajaj N.S., Osborne M.T., Gupta A., Tavakkoli A., Bravo P.E., Vita T., Bibbo C.F., Hainer J., Dorbala S., Blankstein R., Bhatt D.L., Di Carli M.F, & Taqueti V.R. (2018). Coronary Microvascular Dysfunction and Cardiovascular Risk in Obese Patients. Journal of the American College of Cardiology, 72(7), 707-717.

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FDG PET–CT Imaging Protocol for Post-Operative Evaluation

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Patients fasted for at least 6 h before FDG PET–CT¹¹ (link). FDG was administered intravenously according to patient weight with a dose of 4 MBq/kg (108 μCi/kg), minimum 200 MBq and maximum 400 MBq. After injection, the patient rested for 30 min after which they were hydrated with 800 ml water orally over less than 30 min. Some 60 (± 5) min after tracer injection, the patient was scanned from the base of the skull to the proximal femur. The first and last scans (after 3 and 24 months respectively) were performed with diagnostic contrast-enhanced CT to establish the postoperative anatomy, whereas the interim scans comprised low-dose CT without contrast, to reduce the radiation load. CT and PET were performed on either Discovery STE^™, Discovery VCT, Discovery RX, Discovery 690 or Discovery 710 scanners (GE Medical Systems, Milwaukee, Wisconsin USA). PET–CT images were interpreted by specialists in nuclear medicine and radiology as part of daily routine practice.

Bjerring O.S., Hess S., Petersen H., Fristrup C.W., Lundell L, & Mortensen M.B. (2020). Value of regular endosonography and [18F]fluorodeoxyglucose PET–CT after surgery for gastro-oesophageal junction, stomach or pancreatic cancer. BJS Open, 5(2), zraa028.

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Rest-Stress Cardiac PET Protocol

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The rest/stress cardiac positron emission tomography (PET) was performed using a standard PET-computed tomography scanner (Discovery RX or STE LightSpeed 64, GE Healthcare, Milwaukee, WI). Details of the protocol are described in Gupta, et al(12 (link)). Briefly, patients followed a standardized protocol including abstaining from caffeine and methylxanthine-containing substances and drugs for 24 hours prior to the scan. Myocardial blood flow (MBF) at rest and at maximal hyperemia were measured with ⁸²Rubidium (1480–2200 MBq) or ¹³N-ammonia (700–900 MBq) as the flow tracer. The stress agents used included dipyridamole, adenosine, regadenoson, or dobutamine; the choice of stress agent was selected based on the agent preferred by the lab as well as the patient comorbidities. The CFR was calculated as the ratio of maximal myocardial blood flow at peak hyperemia over that at rest for the left ventricle and corrected for differences in baseline heart rate-pressure product as previously described. Measurements of CFR and MBF were not available in the clinical reports during the study period and, therefore, did not impact clinical care.

Liao K.P., Huang J., He Z., Cremone G., Lam E., Hainer J.M., Morgan V., Bibbo C, & Carli M.D. (2021). Coronary microvascular dysfunction in rheumatoid arthritis compared to diabetes mellitus and association with all-cause mortality. Arthritis care & research, 73(2), 159-165.

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