Ashok Muthukrishnan, MD, MS
PET-CT Fellowship Director
Associate Professor of Radiology
The Division of Nuclear Medicine encompasses a broad and comprehensive program of clinical and research activities with state-of-the-art facilities and exceptional faculty expertise to provide outstanding patient care, teaching, and research opportunities. Dedicated teaching and clinical experience is provided to all the radiology residents in our ACGME accredited Diagnostic Radiology to ensure satisfaction of the ABR requirements. Additionally, our PET/CT fellowship 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)).
Our state-of-the-art scanners include four GE PET/CT scanners (GE Discovery PET/CT 710 with TOF capability, two 64-slice GE Discovery VCT and 8 slice GE for Radiation Oncology), a Siemens HR+ brain PET scanner, a Siemens mMR Biograph PET/MR system, a Siemens mCT Biograph PET/CT, two GE Discovery NM/CT 670 SPECT-CT scanners, and a GE Discovery NM 630 SPECT/CT. UPMC is also equipped with a robust PACS system (Philips’ iSite) and highly advanced electronic record capability. Animal resources include a pre-clinical PET/CT suite [Inveon small animal PET/CT (Siemens)] and state-of-the-art radiochemistry laboratory. Several scanners are certified to perform clinical research by the SNM clinical trials network (CTN) and the NCI Centers for Quantitative Imaging Excellence (CQIE).
Our strong emphasis on excellence is evident in our sophisticated clinical and research brain scanning. Dedicated brain imaging protocols and analysis facilities are equipped with advanced SPM, FreeSurfer PMOD, MIM, normal databases and in-house statistical software for analysis and MR-fusion mapping of dementia as well as epilepsy, brain tumor and cerebrovascular disease. Protocols for ictal/interictal SPECT subtraction, CVD associated hemodynamic vascular reserve assessment and ICA balloon test occlusion are routinely employed. In addition protocols for dementia assessment with C-11 PIB and the new F-18 amyloid-binding agents have been established.
An extensive variety of other highly advanced nuclear medicine diagnostic procedures are performed by our division in order to serve our wide referral center. Dedicated SPECT-CT with low dose or diagnostic contrast enhanced CT is a unique diagnostic imaging technique performed on our SPECT/CT cameras for precise localization of tumors, such as from parathyroid or neuroendocrine origin. Several sophisticated protocols for radioiodine imaging and treatment of thyroid cancer are provided, including dosimetry to determine the maximum allowable I-131 treatment dose and SPECT/CT imaging. A wide variety of other nuclear medicine treatments are also administered by our division, such as radioembolization therapy using Ytrrium-90 microspheres for advanced liver cancers, radioimmunotherapy for Non-Hodgkin’s lymphoma, Radium-223 and Samarium-153 for metastatic prostate cancer, and experimental radioimmunotherapy such as for pancreatic cancer.
The division’s cancer imaging research program is robust and comprises an impressive collaborative effort between division faculty, the UPMC Hillman Cancer Center faculty, and the department’s own PET Research Center. Current areas of focus include state-of-the-art theranostics, early cancer therapy assessment in colorectal and breast cancers, Gallium-68 PET imaging for neuroendocrine tumors, and development of new cancer imaging agents. The division is also investigating new multi-modality advancements such as PET/MR/optical imaging.
Although initially centered at UPMC Presbyterian Hospital, our Nuclear Medicine division has grown to include full time coverage of UPMC Shadyside, Hillman and Mercy Nuclear Medicine Departments and shared responsibilities at UPMC Children’s and Passavant Hospitals. Additionally, our division provides round the clock assistance to our 24/7 evening/nighttime radiology services by interpreting all emergency nuclear medicine exams during the off hours for a large number of hospitals within our expanding UPMC system.
Our division is leading the Nuclear Medicine Service Line project for our entire UPMC system. This ambitious effort includes active communication with all sites regarding a broad range of important topics, such as radiopharmacy issues, imaging and therapy protocols, radiation safety/physics support and scheduling. For example, this Service line is updating and posting the most current recommended protocols for Nuclear Medicine diagnostic and therapeutic procedures on our universal radiology website for all staff to access and incorporate into their local procedures. The goal of this Service Line is to ultimately achieve a standardized approach to nuclear medicine throughout UPMC according to nationally recognized guidelines.
In summary, our Nuclear Medicine division is dedicated to providing the best possible clinical and research capabilities for our growing community, by ensuring that routine as well as sophisticated nuclear medicine imaging and treatments are available to all patients who need and deserve our best efforts.