In 2008, Dr. Ernie Garcia was a healthy 60-year-old who knew the importance of a heart-healthy lifestyle. When he experienced a chest pain episode, his cardiologist insisted he had nothing to worry about. But the symptoms persisted, spurring him to request a nuclear cardiology study — a non-invasive test done on what’s known as a PET scanner. “When I got off the machine, I just looked at the computer, and from about 20 feet away I knew exactly what was going on with me,” Garcia says.
In that moment, Garcia became one of more than 4 million patients whose cardiac images are interpreted each year using Emory Cardiac Toolbox (ECTb) software. But Garcia wasn’t just a patient — he was the researcher who had developed ECTb a decade before and the chief scientific advisor for Syntermed, a provider of nuclear imaging software. In June GE Healthcare launched a new version of ECTb with Syntermed Live, which allows clinicians to remotely access and review clinical images from virtually any computer system.
For Garcia, the software showed he had a large coronary artery perfusion defect associated with ischemia. Images from the PET scan were submitted to the ECTb algorithm that calculated the calcium score in each of his coronary arteries, a measure of arterial plaque that indicates the likelihood of a heart attack. A normal score is less than 100 and a score around 400 indicates the need for intervention. Garcia’s score was a staggering 700. “The score of 700 was significantly abnormal and told me that the disease had already spread to other regions,” says Garcia, a professor of radiology and the director of the Nuclear Cardiology R&D Laboratory at Emory University in Atlanta. He underwent quadruple bypass surgery.
Imaging a beating heart became possible in the 1970s, but images were displayed without measurements or explanations, meaning physicians had to rely on experience or intuition to determine what was clinically significant. “I saw that the physicians were very proud of the fact that they practice the art of image interpretation, which comes with pluses and minuses, particularly subjectivity,” Garcia says. “This is why I wanted to transform the art of image interpretation into the science of interpretation.”
Emory licensed the first version of the ECTb in 1998. The next year, Garcia and his colleagues founded Syntermed, which took over selling the software directly to users, and ECTb was licensed from Emory to Syntermed. ECTb is now used in nearly half of all nuclear medicine labs nationwide.
Remote access is a crucial addition to the system. “The lack of remote access to critical patient information can have a potentially detrimental impact on the efficiency, productivity and quality that physicians provide to their patients,” Garcia says. “Emory Toolbox is a cost-effective solution that can help address these challenges — especially for the small-to-medium-sized clinics in the country that have less financial resources.”
This has encouraging implications for patients’ diagnoses and treatments. “Regardless of where patients have their nuclear studies done, if they are processed and interpreted using ECTb, the accuracy of the interpretation can be raised,” Garcia says.