QUANTICARDI: a federative heart imaging project based in Nantes

The Quanticardi project consists in developing the use of positron emission tomography (PET) imaging in the field of cardiology in Europe. The project has been funded by the French government and accredited by Atlanpole Biotherapies as part of the cluster’s radiopharmaceuticals theme. Quanticardi is led by the company Lemer Pax, with Keosys, Arronax and the University of Nantes’ Subatech, IRCCyN and CRCNA groups as project partners. The project has considerable medical and economic potential.

The need to improve conventional methods
In the field of cardiology, imaging is mainly used to study myocardial perfusion. This is a frequent examination, with 400,000 procedures per year in France, 3 to 4 million in Europe and 6 to 7 million in the USA. The technique used in Europe is conventional scintigraphy, which presents a certain number of drawbacks, such as a lack of specificity. With a false-positive rate of about 25%, conventional scintigraphy often identifies anomalies in the absence of any problems (particularly in women with dense breasts and in overweight patients). Another disadvantage is low accuracy in the measurement of myocardial activity. The key indicator here is coronary reserve - the ratio between the blood flow during effort and that at rest. Coronary reserve is a good prognostic marker for the subsequent occurrence of cardiac events (infarctions, etc.). However, these flow measurements are impossible with conventional scintigraphy. Lastly, scintigraphy involves exposure of the patient to a relatively high dose of radiation.
PET – a promising alternative
Positron emission tomography is an alternative to conventional scintigraphy. Although this technique is hardly used in Europe in cardiology, it has been employed for over 20 years in the United States, with 5 times more machines (3000, versus 600 in Europe).
In France, clinical PET was introduced in 2000 but is almost exclusively used in oncology, with about 170,000 examinations per year. The cities of Nantes and Rennes were the first centers to use PET. At present, Nantes has 3 machines (2 at the Institut de Cancérologie de l’Ouest and 1 at Catherine de Sienne Cancer Center).
Positron emission tomography has many advantages over conventional scintigraphy. Firstly, the false-positive rate is only 5%. Secondly, PET accurate estimates coronary reserve and delivers a much lower dose of radiation. Nevertheless, the main difficulty in using these machines relates to the scarcity of strontium 82, the raw material used in the production of the rubidium 82 used in PET diagnostic imaging in cardiology.
The Quanticardi project addresses several needs because its objective is to develop innovative tools (relative to those used in the USA) for strontium 82 production and its transformation into rubidium for injection. In fact, the Arronax cyclotron (a project partner) is the only machine in Western Europe capable of making large quantities of this radionuclide for the radiopharmaceutical industry (with the prospects of imminent sales to North America). The collaborative project will also feature other particularly interesting innovations.
A system offering traceability, safety and environmental compatibility
The specialist radioprotection company Lemer Pax is in charge of producing the generator and the injector. Both offer advanced traceability and safety features. A geopositioning system enables the operator to track the strontium 82 generator’s position in real time, from the loading site to the patient’s bedside. The safety of rubidium-82 injection is ensured by a computerized system interfaced with the hospital database (i.e. what has been administered, where, when and by whom). The generator’s performance levels will be validated by radiopharmacists from the CRCNA lab.
Another safety feature relates to the key that will be needed to open the generator containing the injectable product. This system will considerably reduce the risk of radioactive leakage and environmental contamination. Moreover, automated injection of the product into the patient will minimize the healthcare staff’s exposure to radiation.
Lastly, the system’s high environmental compatibility is also related to the Novashield material used to make the generator’s shielding module. With this innovative, recyclable and radioprotective material, Lemer Pax has found an alternative to lead.
Automated measurement
The company Keosys and the Nantes Communications and Cybernetics Research Institute (IRCCyN) will develop coronary reserve measurement software for PET images, enabling reliable automation of a hitherto manual measurement.
A key competitive advantage
With new patents and a growing global worldwide market, the Quanticardi project should provide the Pays de la Loire region with a significant competitive advantage and a higher international profile. For both patients and healthcare staff, the system will reduce diagnostic errors, the number of invasive procedures (such as coronography and surgery) and exposure to radiation. In conclusion, Quanticardi will have both economic and public healthcare benefits.
Project budget: €3.22 million; grants-in-aid applied for: €1.86 million; grants-in-aid awarded: €1.37 million (co-funding by the Pays de la Loire Regional Council).
Contact: Pierre-Marie Lemer, CEO, Lemer Pax (project coordinator) - Tel. +33 240 252 652