Thyroid diseases are among the most common of the endocrine
disorders, affecting approximately 13 million Americans, according
to theAmerican Thyroid Association.
For patients with suspected thyroid dysfunction, the diagnostic
work-up generally includes a scan of the thyroid gland and a
thyroid uptake study. As healthcare facilities continue the
migration to a digital and PACS environment, imaging studies are
more commonly being stored in an electronic format.Most thyroid
uptake study results, however, are still presented on
paper.Capintec, Inc. (Ramsey, NJ) recently added a DICOM
compatibility feature to its Captus 3000 Thyroid Uptake System,
which will allowimaging facilities to electronically view and store
thyroid uptake study results along with the scan results.
The Captus Thyroid Uptake System
The Captus Thyroid Uptake System, which has been on the market
for approximately 20 years, was designed to measure and quantify
thyroidfunction and aid in the diagnosis of thyroid disease. "It is
used mostly in nuclear medicine departments," said John Viscovic,
Vice President, Domestic Sales and Accounts at Capintec. "But there
are also some cardiologists and mobile imaging units that use this
equipment. Its basic functionality is to quantify thyroid function,
and this is done by measuring the current and residual activity of
iodine (I)-123 and I-131."
The company's ﬂagship system is the PC-based Captus
3000 Thyroid Uptake and Well System (Figure 1). "We also have the
Captus 600,which is a microprocessor-based unit," Viscovic said.
"Of course, the PC-based unit is more popular. It's somewhat easier
to work with and,because it is built on a PC rather than a
microprocessor, it allows the user to save more data and can run
additional types of programs thatthe microprocessor-based system
The system features two 2-inch NaI detectors and
ﬂat-field collimation. The 1024 Multichannel Analyzer
(MCA) module allows for measurement of energies up to 2 MeV and
contains a library of >90 preloaded isotopes. Its computer
features a 1.6-GHz processor with a 20-GB hard drive, a color
monitor, keyboard, trackball, and color printer. The standard
system configuration includes a mobile stand, thethyroid uptake
probe, and the drilled crystal well. It is also available in a
tabletop version, a version that includes a well counter, and a
The system allows the user to set multiple protocols for studies
using I-123, I-131, and technetium-99m (Tc-99m) using a standard
capsulemethod or through an automatic decay correction for the
administered dose. Prior to the examination, the patient is given
the radioactive iodine;he or she is then asked to come back for
studies at either 4 or 6 hours and again at 24 and 48 hours. "For
the patient," Viscovic said, "the experience is pretty easy.The
doctor and the physicist at each individual facility determine the
specific timing of the studies. Each facility will haveits own
preferred protocol, but patients are usually asked to come back at
either 4 or 6 hours and then again at 24 and 48 hours."
Once the study is complete, the findings are presented in a
Thyroid Uptake Report with detailed count information and automatic
percentageuptake calculations. All findings outside defined normal
ranges are ﬂagged within the report.
The company recently added optional DICOM compatibility to the
Captus 3000. With this software, known as Cap-DICOM, the
thyroiduptake results are presented in a DICOM-compatible image
format that can be viewed at any workstation and can be stored on
the PACSsystem.The software creates a DICOM-compatible secondary
capture image that includes all the information generated during
the uptake study. This information is then merged with the thyroid
scans and displayed as a DICOM image. This combined report can then
be exported to a workstation or stored on the PACS.
"CAP-DICOM allows patient data from the Captus to be saved and
viewed on the DICOM and PACS system," explained Viscovic."The way
it works is this: A patient comes in for a thyroid uptake and scan.
The scan is done on a gamma camera. Today, in most departments, all
the images are saved on the DICOM server and viewed on a PACS
viewer. In order to simplify the process, we can now capturethe
data from the Captus uptake and make an image out of it. We then
have the image sent over to the DICOM and saved there. Theseresults
can now be viewed with the actual thyroid gland images on any PACS
viewer on the network."
In addition, the DICOM compatibility software allows the system
to interface with the hospital information system (HIS) and/or
radiologyinformation system (RIS) and pull patient data from the
database."This also allows the patient data to be imported into the
Captus database,"he continued. "So this way, if you were to go in
and get a thyroid uptake done, the tech could simply call up your
information from the DICOMserver and load it directly on the
Captus. There doesn't have to be any manual input. The screen gets
automatically populated. It captures allpatient demographics: name,
date of birth, doctor, dose--everything is captured on that screen.
This helps to cut down on mistakes." With thissoftware, the user is
able to query the worklist by accession number, patient ID, patient
name, or date and can correct any patient information,if necessary,
before exporting the data.
The DICOM compatibility also helps make the report more
portable, according to Viscovic. "In the past, the information from
the Captuswould have been presented in an uptake report on 3 or 4
sheets of paper. This document would then be saved with the hard
copy film of thethyroid gland. Considering that everyone is going
digital so that everything is being saved with the DICOM and viewed
on the PACS, theadded DICOM functionality helps to further
alleviate the need for paper."
Additional system features
Other features of the Captus system include a "Quick Start"
instruction module. This feature takes the technologist through the
basic tenets ofthe system. "It's a demo that the techs go through
and it quickly allows the techs to start utilizing the Captus
without having to have someone sitwith them and take them through
each and every step," explained Viscovic.
"The 'Custom Protocol' feature allows techs and doctors to
establish their own protocol and template for how they want to do
the uptakestudies," he added. "Some physicians like to bring the
patient back in 4 hours, some like to bring the patient back in 6.
Some do only 24-hourrepeat studies; some do 24- and 48-hour
studies. This feature lets the user customize the protocol. It's
very easy to learn and it's very intuitive."
The Captus 3000 also features a new software package that
enables the system to perform a variety of additional tests,
including QualityAssurance, Wipe Testing, Bioassay, Multichannel
Analyzer and Lab Tests, including Schilling, Red Blood Cell (RBC)
Survival, and I-125 andChromium-51 (Cr-51) Blood Volume.
"The Captus' main purpose is to determine the functionality of
the thyroid, but it also does wipe tests, Schilling tests, red
blood cell survival, and bioassay," said Viscovic. "You can use the
Captus for bioassay, for monitoring your personnel, as well as
other custom protocols for additional applications that are not as
commonly used in nuclear medicine."
For wipe testing, the program performs an automatic peak and
isotope identification of wipe results using either pre-set or
user-definedtrigger levels. The system then maintains the results
history in a printable format. The bioassay feature allows the
system to be used to measure staff thyroid burden for I-123, I-125,
and I-131. Cumulative histories can be maintained on the system or
via hard-copy printouts for regulatory requirements.
"There are quite a few things the Captus 3000 can do," concluded
Viscovic. "The optional Cap-DICOM software really helps to cut down
ontime and paper, and it simplifies things within the department.
As a company, we had discussed this a few years ago, but we waited
a little whilebecause PACS was not yet in the mainstream at that
time. Now that even smaller community hospitals are moving to PACS
and doing away withhard film, we decided that it is now a really
good time to add this functionality."
- American Thyroid Association. About the ATA: Press Room.
Available at: http://www.thyroid.org/ about/pressroom.html.
Accessed May 9, 2008.