PET/CT Scan

HORIZON looks at a revolutionary technique that is helping diagnose, treat and manage cancer.

Transcript:

Jose Cardenas:
Tonight on "Horizon," security on the A.S.U. campus following the tragic massacre at Virginia Tech. Plus, we talk about a new anti-gang bill state lawmakers are working on, that would increase sentences for criminals convicted of crimes that are gang related. And we're looking at a revolutionary imaging treatment, the PET CT scan. Those stories next on "Horizon."

Jose Cardenas:
Good evening, I'm Jose Cardenas, welcome to "Horizon." In the aftermath of the tragic killings at Virginia Tech University, questions are being raised about student safety at other colleges and universities. A little earlier today I talked about what Arizona State University is doing to keep its students safe, with Commander Jim Hardina, a spokesperson for the A.S.U. police.

Jose Cardenas:
Commander Hardina, can any university be prepared for a situation like what we saw unfold yesterday at Virginia tech?

James Hardina:
What happened at Virginia Tech could really happen at any large public area, whether it's a university or a shopping mall or a sporting venue. What can be done is we have plans in place, and training and we've done preparation to handle various types' incidents or disasters that could happen at ASU, including something similar to what happened at Virginia tech.

Jose Cardenas:
In light of what happened, are you doing anything different than what you were doing two days ago?



James Hardina:
We've had plans in place to respond to various types of incidences that could happen on campus. But what we've discovered is when something like this happens, the public becomes more sensitive and more aware of what's going on, and so what is happening, and what will probably continue to happen for a little while, we get more reports of suspicious people, or, I think you should look into this situation, you know, review this situation, because I think this person may be threatening or they may need you to look at them a little bit closer.

Jose Cardenas:
We were talking a little about it off camera. You mentioned threat assessment teams, what role do they play?

James Hardina:
A.S.U. has a threat assessment team that includes both people from the mental health profession, the police department, and other departments on the campus. It's a policy at A.S.U., whenever there's actually a threat assessment team for students, and a threat assessment team to look at faculty and staff. Any time a teacher or another student or anybody thinks that a student or staff member may be a threat to someone else, or may be exhibiting threatening behavior, they can alert the dean of their college, or their authorities, and we will actually, you know, analyze the situation and do a threat assessment on the person to determine if they're a threat or if they are not a threat.

Jose Cardenas:
I mentioned that because apparently there was a writing professor who had expressed some concerns to the authorities about the person suspected of having done all these killings. A.S.U. has placed a procedure to respond -- A.S.U. has a procedure in place?

James Hardina:
Yes and we gat cases like that sometimes. We'll evaluate is it criminal behavior, if it's not criminal behavior, maybe it's a mental health issue, we can talk to the student or get counseling. But we can definitely take a look. And our objective is to determine, is this person a threat to themselves or to the campus community at large. If they are a threat, then we'll take the appropriate action for that person's safety and the public's safety.

Jose Cardenas:
I realize you can't get into too many specifics, but can you tell us generally what procedures are in place to deal with a situation like what we saw yesterday?

James Hardina:
We from the police standpoint, our officers are trained in dealing with situations similar to what happened at Virginia tech. We actually train with other -- all the valley agencies, and we have joint training exercises where we actually train for situations similar to this. And the benefit in that is, we can pool resources. So if a situation happened at A.S.U. or Tempe or Chandler or Gilbert, there's more resources available to deal with it. Then we incorporate that into the larger university plan in place, to deal with the situation from not only an operational standpoint, but exactly what would the police do in the situation, and from a mental health standpoint, and a medical standpoint. It's an interdisciplinary approach to dealing with a problem like that.

Jose Cardenas:
Commander Hardina, the big issue at Virginia tech seems to have been communication with the campus, the student body, after the initial shootings in the dormitory. Between that point in time and two hours later when they had the shootings in the classrooms. What kind of plans are there at A.S.U. to communicate events like this?

James Hardina:
Well, A.S.U. actually has -- there are several ways that -- methods in place to communicate with the campus community. It's really -- we can't go into a lot of details on specifically what those plans are, because it may compromise the plan and put students' safety at risk. But it's a multilayered approach. No one method is going to be able to communicate with 100% of the people. We employ just a variety of different methods to communicate and get the word out to as many people as possible.

Jose Cardenas:
I assume at some point there will be an analysis as to what happened at Virginia Tech that might be instructive here. What would that process be?

James Hardina:
We really don't even know what happened at Virginia Tech at this point. Eventually, once everything is over with from a national perspective, the tactics, the police used, how the university responded, and we'll eventually be able to look and analyze the situation, and determine what worked well and what areas could be improved upon. What we will do is take those lessons learned and adjust our plans and procedures and make our plan better.



Jose Cardenas: Commander Hardina, we've got about 40 seconds left. What is it that the general populace -- by that I mean the students, faculty, on campus -- what should they learn to do as a result of incidents like this?

James Hardina:
You know when things like this happen what the public needs to recognize is, we tend no to think about our safety and think about our security. We're worried about what we're doing on a daily basis. Just remember to use the common sense things that we were taught, be aware of your surroundings. What we find from a police perspective, is the public is the best eyes and ears of things that are happening. And we need the public's help to notify us of suspicious people or suspicious situations, or things that we may be made aware of. We want the public to call us and tell us we think this person's suspicious, or you need to look at this situation. Not just assume it's probably nothing, no big deal. We'd rather be notified, you know I think you need to look at this, and then we can investigate and determine if there is or isn't a problem.

Jose Cardenas:
Jim Hardina Commander ASU police, thanks for joining us on Horizon.

James Hardina:
Thank you.

Jose Cardenas:
Gang activity in Arizona has spurred state lawmakers to craft legislation to increase punishments for gang-related crimes. Two senate bills received support from the state house today the measures would appropriate more money from the general fund for prosecution and to increase the penalties and prison time for gang-related crimes. It also increases the use of a database to track gang members. Here now to talk more about anti-gang legislation Representative Russell Pearce and Representative Ed Ableser. Gentlemen, thanks for joining us on "Horizon." Before we go on to the gang issue, Representative Pearce, you told me while we were off camera that some legislation was just signed by the governor that deals with the issue of law enforcement on campus.

Russell Pearce:
It deals with more than just that, but one of its components is law enforcement on campus. We have campuses around the state, for example Mesa Community College, who have certified police officers, post certified, state certified police officers not carrying weapons. They can't help themselves, nor can they help you. In an environment like this, like happened in Virginia it's simply outrageous that we would allow a police officer, the best defense, the best friend we're going to have in a bad time, he's running around with just a cell phone to call 9-1-1? They should and must be armed. The bill was just signed yesterday by the governor that requires that. It also requires -- earlier the commander of ASU talked about things happening at sporting events, and many times a police officer arrives and he's required to put his gun in a locker -- that's silly.

Jose Cardenas:
It was purely coincidental at the time.

Russell Pearce:
The bill just finally made it to the governor's desk, and it is coincidental. Its good timing. You can't ignore today's world. To disarm a police officer in today's world, it may be what'll save our life or somebody else's life. I'm grateful the governor signed it. It's a great bill and the timing obviously is right on the money.

Jose Cardenas:
Gang violence is what we're here to talk about. And these bills got unanimous support on both sides of the aisle. But I gather there are some differences of opinion as to what the severity of the problem is. Representative Ableser, what's the situation in terms of the amount of gang violence that we're seeing today?


Ed Ableser:
Well Jose we're seeing an increase in gang violence all across the nation essential. Gangs are being run out of prisons. Prison gangs are growing at an exponential rate. They are truly the heads of gang crime. Communities such as Chicago is actually instrumenting some very aggressive prevention programs that are trying to help and prevent gangs from forming. And they're seeing a tremendous amount of success. Here in Mesa, Mesa was one of five cities in the nation chosen to be a pilot program for prevention. They saw a dramatic drop in gang membership, but that funding was taken away from the federal government. And unfortunately gangs are now back on the rise in Mesa.

Jose Cardenas:
Representative Pearce, I understand you have a slightly different view as to the severity of the problem.



Russell Pearce: It's a severe problem. That's why I sponsored the bill dealing with gangs. In the last three years I've worked very close with a statewide task force called GIITEM. Gang enforcement task force that is a multi-jurisdictional task force. In fact, two years ago I added what was taken away in bad budget times, one of the squads. The rural squad was taken away, and I put that back four million dollars into them. Last year I added another 17 million dollars. 200 additional police officers for GIITEM. That's 100 D.P.S. officers and 100 what are called grant officers. That are officers from other agencies.

Jose Cardenas:
These increases come from the legislation that just got passed?

Russell Pearce:
No, these increases happened two years ago and a year ago. Also, we can continue that this year. This year it rounds that out. We've had two law enforcement summits that I sponsored one and the speaker of the house sponsored the other, where we had the gang detectives around the state to attend. The second one we had the police chiefs and sheriffs attend. We talked about the gang problem. Out of the summits came some additional tools that they needed. We added vertical prosecutors, the building for them to enter and stay involved in what is called a gang net. That is a system that tracks on gang members coming out of prisons, which as Ed mentioned, it is a serious problem. Gang membership in prison is just huge. The other issue is that it expanded some of the illegal alien gangs around the state that are on the rise, MS13 and others 58-80 thousand strong in America. According to the FBI, it's one of the most vicious and violent gangs we've ever, ever experienced. Arizona is no. 1 in crime. We're the second most violent state in the nation. Those aren't statistics we're proud of. This gang enforcement task force is going to be an additional 230 strong, based on last year, and in addition to what we've done, they're going to have vertical prosecutors, tools to enter the Lexus-Nexus, the tracking system, and tools to enter a system of tracking gang members. They're going to enhance penalties for being gang members. I mean, this is really comprehensive legislation to round off; we're going to go after gangs in this state. Arizona's not going to have the welcome mat anymore. If you're a gang member, you'd better find another place to live. We're giving our law enforcement the tools and resources and ability to make sure that we really are no. 1 in the nation in stopping gang violence. The Border States are the biggest increase in violence throughout the United States. Where other violent crime is going down to some degree around the nation, in the Border States violent crime is really on the rise.

Jose Cardenas:
Looking at some of the specifics in terms of how you prove that the violence is gang related, but representative Ableser as I understand support was unanimous. Democrats support these efforts. But there's concern that it's just enforcement focused, but we're defeating the program because we're putting people in prison, and the prison gangs are controlling the people on the street.



Ed Ableser: The democratic proposal was a four-pronged approach. We had a prevention summit that we were invited to with the juvenile department of corrections, probation officers. We had the schools involved, we had school resource officers and tons of community support in the neighborhoods. They all said the number one thing you can do as a state legislature is fund prevention programs in this state. Fund our children so they don't get into gangs. They all signified that no. 1 is third grade. Third grade is the most important. The second element to our comprehensive plan was intention. That's what 1222 does. The third part is the containment issue. We're dealing with high-risk security threat groups in prison right now. These are the prison gangs actually running the criminal street gangs out of the prison. We need to do something to break the cycle and the lines of communication. That's something we also agreed with the republican caucus on, as well. Unfortunately, the fourth part of this proposal was taken away along with the first. Prevention and reintegration are both not on the table. Democratic proposal put both of these amendments to the floor, and both failed along party lines. The reintegration piece is so important because these are youth. These are 15 and 16 year olds that do a petty offense; they're now part of a gang because they went to juvy. And we're putting them back into the communities back into their father and grandfather who are both gang members their mom and aunt and uncles who all contributes to the system. We're not breaking the cycle. We need to invest in prevention and reintegration into the communities.

Russell Pearce:
There's misinformation here. First of all, this is an enforcement bill. You have federal money now available for reentry. We have money that we're doing for the boys and girls clubs in here for this kind of intervention stuff. We have money in a bill that passed just before this one. There was $12 million for the Arizona criminal justice commission that is grant money for these very programs, we have programs in the parks & recreation, programs in the prison system, programs in the jail system. We've given a lot of money to the department of juvenile corrections for this very issue. This has not been ignored.

Jose Cardenas:
Why not include these programs?

Russell Pearce:
Very simply, there is money out there for these programs. The problem is very simply this is an enforcement bill. We're not going to Christmas tree it up with programs that are filled in. The one amendment that got on there, which is unconstitutional, was the amendment that dealt with -- it sounded good in concept, but it dealt with life time parole and some statues offences. IN 1993 we passed truth in sentencing to end life time parole. It's unconstitutional in some of the things. It also created, if you're an identified threat within the system, known as a security threat group in D.O.C., then immediately, if you committed a crime in prison, you got in as a gang member. Many of the folks in this group are not gang members. So it became a statues offence that didn't fit, which our attorney's tell us is unconstitutional.

Jose Cardenas:
We're running out of time, and I do want to talk about what this bill does, in terms of identifying gang activity that makes you eligible for these enhanced penalties. Representative Ableser.

Ed Ableser:
What the bill, as passed, does, it assists our law enforcement officers with more ways to connect and talk to other departments, talk to our schools. It's the intervention piece which is important. It's finding the criminals doing gang activity and putting them in jail. And then the other element is what to do with them when they're in jail. There's ways to identify membership in security threat groups. Unfortunately, it does not include that reintegration piece. When they leave jail, these young 16- and 17-year-olds who are not adults yet, go back into the system. The other thing that the democrats proposed was making the victims whole. We had this whole program that allowed the offenders to go back into the communities and create dialogue to make the victims whole.

Jose Cardenas:
I'm sorry, we're going to have to end it there. There's a lot to talk about, I appreciate you guys coming on the show to talk hopefully we'll have you back.

Ed Ableser:
Thank you.

Russell Pearce:
Thank you.

Jose Cardenas:
Thank you.

Jose Cardenas:
While technology like the gang database we just talked about is helping advance crime-fighting, it's also driving progress in medicine. This is especially true of a revolutionary technique that is much in demand to diagnose treat and manage cancer. Reporter Pam White has more.

Pat White:
The latest hero in the ongoing battle against cancer is this machine.

Laurence Hanelin:
We use it commonly. Quite honestly, I will order two to three pet scans a day in this practice.

Pam White:
It's called a pet CT can. Pet is short for positron emission tomography. It's a nuclear medicine technique to find out what's wrong on a molecular level. Glucose stored sugar combine with a radioactive tracer is first injected into the bloodstream.



We use glucose because that's the major substrate for tumors. That's what tumors like to eat and they live on that and they live on lots of it. It gives us a real window into how those tumors are acting. Ct doesn't do that, and neither did MRI.

Pam White:
Dr. Laurence Hanelin is director of nuclear medicine at Tucson medical center. The PET scan alone has been used for several years. While it can detect small cancers before other tests, it's a challenge sometimes trying to distinguish the normal from abnormal.

Laurence Hanelin:
So what we're dealing with then with pet was a situation where we got some of the isotope in front of the radio pharmaceutical to the tumor, but a lot of it goes to other structures. And so our problem then is trying to figure out where in space the actual tumor is, and to make sure that the other activity is not being called cancer when it's just really part of the normal distribution of that radiopharmaceutical.

Pam White:
To better locate problems, the PET scan technique was combined with a commonly used x-ray procedure called the CT scan.

Laurence Hanelin:
What you get with CT is exquisite anatomic detail with millimeter lesions being able to be detected. It's terrific. So some real clever folks got together and said, what if we put a ct scanner on the back of the pet scanner, so we could do a ct scan first, see what all the anatomy, and then do the pet scan, and with software combine the two. This patient, I would say this unfortunate patient, has a carcinoma of the breast which has metastasized widely to multiple bones. The question might come up, where are these lesions exactly. Well, we can use the CT to show us. We take our cursor, place it right here. And if we look at the CT, which is down here, we can see that that's sitting right in a vertebral body, the L-5, the lowest lumbar vertebral body.

Pam White:
The PET scan and CT scan are taken almost simultaneously. Not only is it a powerful tool in finding cancerous tumors, it's crucial in helping doctors see if radiation treatments are effective or if the cancer is spreading.

Laurence Hanelin:
This is, by the way, the head, this is the pet portion of the study. This is the patient's mandible, right here, and this is their tongue. This black spot here is a large cancer they have on their tongue. And not only that, but this has metastasized to a lymph node in the left side of the neck. This patient was treated with a combination of radiation therapy and chemotherapy and is returned to us for a follow up assessment. This large lesion in the tongue has completely disappeared, and the lymph notes that were positive before have also completely resolved.


Michael Manning:
That's always a smile, to get the report the same day or the next day, that there's no evidence of tumor in the area that you treated or anywhere else, that you've had a complete response. That's really saying something. And of course when you call the patient and tell them, they're really happy. I mean, that's a true celebration.

Pam White:
Dr. Michael Manning is a radiation oncologist for Arizona oncology associates. He says advances in technology has revolutionized the way he and other oncologists practice. Seeing exactly where the cancer is, is also improving treatment techniques.

Michael Manning:
Therefore, it improves my ability to treat the tumor and give the patient less side effects. Then, of course, it represents a great way to follow the patient. Have we succeeded, has the tumor responded, is it totally gone, is it partially gone, do we need further treatments, do we need more chemo, things of this nature. For the field of radiation, it's absolutely, completely necessary at this point, and something that we never had.

Doctor:
Okay, I'm going to turn on some bright laser lights to line you up, so I want you to keep your eyes closed. Don't open your eyes.

Pam White:
The pet CT scan device costs about $3 million, and there are currently three of them in Tucson. Dr. Hanelin says Medicare is already approved it's use for several types of cancers including breast and lung cancer. And as successful as this technology is he says its only going to get better.

Laurence Hanelin:
We're looking at frankly this is just the tip of the iceberg. We're talking fundamental about one radiopharmaceutical, a fluorinated glucose molecule that we're using. There are many other drugs in the pipeline. It's just going to keep exploding. I hope I see some of this in my lifetime. People coming into this field are just going to see continued evolution of that. It's very exciting.

Jose Cardenas:
Here in the Phoenix area, Scottsdale Medical Imaging provides pet ct scans. To see video of this and other Horizon segments on the internet, go to azpbs.org and click on horizon. You can also get transcripts and find out about upcoming topics.

David Majure:
Making sure work sites control their dust is the job of Maricopa County's air quality inspectors. But rules they enforce have not been enough to fix the problem. Now Arizona must submit a plan to reduce dust and other particulate pollution or risk losing millions of federal dollars. We'll dig into the issue Wednesday at 7 on Horizon.

Jose Cardenas:
Thanks for joining us on this Tuesday evening, I'm Jose Cardenas. Have a good evening.