Diagnostic determination of disease and treatment responses has been limited to qualitative imaging, measurement of serum markers of disease, and sampling of tissue. In each of these instances, there is a built in error either due to sensitivity and specificity issues, clinician interpretation of results, or acceptance of the use of an indirect marker (blood test) of what is happening elsewhere in the body - at the tissue level. The Fleming Method for Tissue and Vascular Differentiation and Metabolism (FMTVDM) using same state single or sequential quantification comparisons [1] provides the first and only patented test (#9566037) - along with the associated submitted patent applications ruled to be covered under #9566037 - that quantitatively measures changes in tissue resulting from inter alia a disease process. This includes inter alia coronary artery disease (CAD), cancer and infectious/inflammatory processes including CoVid-19 pneumonia (CVP) resulting from the metabolic and regional blood flow differences (RBFDs) caused by these diseases. The purpose of this paper is to make clinicians and researchers aware of this proposed method for investigating the prevalence and severity of CVP - in addition to providing rapid determination of treatment response in each patient, directing treatment decisions; thereby reducing the loss of time, money, resources and patient lives.
FMTVDM - See Appendix A.
1. Quantitatively calibrates the nuclear camera to guarantee that the measurements made by
the camera are accurate, consistent and reproducible. This quantification is dependent
upon the isotope being used, the camera and the timing sequence of image acquisition.
Such calibration is NOT currently done and it is part of the patent. Studies have
demonstrated that the lack of this quantitative calibration has resulted in up to 1/3 of
the data being lost for SUV and qualitative interpretation; in addition to making
quantification impossible.
2. The patient presents in a fasting state - to eliminate digestive processes from
interfering with blood flow distributions - and the differences in metabolic and
regional blood flow differences (RBFDs) are enhanced with vasodilatory agents, shifting
blood flow and isotope towards regions of greater blood flow and metabolism; enhancing
isotope delivery, uptake and quantification.
3. With a now quantitatively calibrated nuclear camera - in this instance a PLANAR camera -
or SPECT/CT or PET/CT/MRI if specifically approved - to allow imaging to be done at
patient's bedside reducing the use of hospital resources required for transport and
decrease potential for patient complications resulting from a transport - image
acquisition will occur for 10-minutes following peak enhancement effect of the
vasodilatory agent and timed injection of the isotope based upon the enhancing agent.
Regions-of-interest (ROIs) will drawn by the nuclear technologist - either at the
bedside or in the nuclear laboratory - to provide FMTVDM measurements using software
already present in the nuclear camera systems. Specific ROIs will be drawn of the right
lung (total), left lung (total), mediastinum (thymus activity), and any specific areas
where increased tracer uptake is noted.
4. These FMTVDM measurements including MAXIMAL COUNTS +/- VARIANCE, provide the values of
the most active pulmonary tissue resulting from the CoVid-19 infection and inflammatory
response; just as it has previously been used for CAD and Cancer.
5. From these FMTVDM measurements, the pulmonary tissue and the CoVid-19 infectious process
results are placed on a Health-Spectrum showing where in the tissue transitioning
process the patient is. The measurements also provide information about how rapidly the
tissue is changing. FMTVDM provides the quantitative measurement of where the patient is
at any point in time during their course of treatment and how they compare with other
patients.
6. Once the FMTVDM measurements have been obtained, treatment decisions can be made based
upon serial changes in FMTVDM. Treatments outcomes are based upon FMTVDM measurements,
including the maximum FMTVDM and the variance in those measurements. By comparing serial
FMTVDM results, improvement or deterioration in the patient's health and the success or
failure of the current treatment regimen is measured, providing patient-centered,
patient-specific, patient-oriented and patient-directed decisions. Thus saving time,
money, resources and lives - not to mention unnecessary side effects from treatment,
which is not working.
Drug: Hydroxychloroquine, Azithromycin
FMTVDM Planar, SPECT, PET
Drug: Hydroxychloroquine, Doxycycline
FMTVDM Planar, SPECT, PET
Drug: Hydroxychloroquine, Clindamycin
FMTVDM Planar, SPECT, PET
Drug: Hydroxychloroquine, Clindamycin, Primaquine - low dose.
FMTVDM Planar, SPECT, PET
Drug: Hydroxychloroquine, Clindamycin, Primaquine - high dose.
FMTVDM Planar, SPECT, PET
Drug: Remdesivir
FMTVDM Planar, SPECT, PET
Drug: Tocilizumab
FMTVDM Planar, SPECT, PET
Drug: Methylprednisolone
FMTVDM Planar, SPECT, PET
Drug: Interferon-Alpha2B
FMTVDM Planar, SPECT, PET
Drug: Losartan
FMTVDM Planar, SPECT, PET
Drug: Convalescent Serum
FMTVDM Planar, SPECT, PET
Inclusion Criteria: CoVid-19 -
Exclusion Criteria: Decision by patient to not participate.
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FHHI-OI-Camelot; QME
Los Angeles, California, United States
Richard M Fleming, PhD, MD, JD, Study Chair
FHHI-OI-Camelot;QME