Nuclear Stress Testing

Monograph from "Seminar in a Box" ProClinica developed for launch of Tl-201 Stress Imaging

Helping NEN/DuPont build the first $100 million nuclear imaging agent

As the agency of record for New England Nuclear/DuPont Imaging, ProClinica was deeply involved with thallium-201 myocardial perfusion imaging even while the procedure was investigational. Our writers and medical director collaborated closely with the chief investigators on the imaging agent, nuclear physician William Strauss, MD, head of nuclear medicine at Mass General, and cardiology fellow Gerald Pohost, MD.

Market research before the launch showed ProClinic and NEN that a great deal of education would be necessary to gain phyisican acceptance of the thallium stress test.

Nuclear medicine specialists had no interest in the study bec ause the images were fuzzy, required a costly ($136) isotope with a 72-hour half-life, and necessitated a treadmill test of unpredictable length -- meaning collaboration with a cardiologist for the stress, and keeping a nuclear camera unused and unproductive during the stress test.
Cardiologists saw no need for the study, since patients with angina always got an angiogram, and then -- if positive -- a
bypass procedure.

ProClinica's research showed an interesting possible niche for the thallium stress test: Helping internists to determine whether or not to refer a patient with atypical exertional symptoms to a cardiologist.

Launch day featured a press conference at Mass General, where Drs. Strauss and Pohost exercised a patient for the media, and showed off a post-stress image. The next, Drs. Pohost and Strauss were interviewed for almost a half hour on Good Morning America, exposing millions of prospective patients to a new, noninvasive imaging study.

The promotional approach chosen was a "Seminar in a Box(TM)" program developed by ProClinica writers interviewing a broad range of investigators and early post-launch adopters in the nuclear medicine and cardiology fields. The "box" contained a set of 35mm slides and a "lecture outline" -- actually, a script -- plus a home study monograph and self-test that hospital directors of CME could use to comply with JCAHO guidelines on the continuing education of MDs with attending privileges.

In addition, ProClinica created spread ads for the New England Journal of Medicine, JAMA and other publications -- each depicting a subset of angina patients an internist might "worry about" -- and an actual case showing how a thallium stress test contributed to the evaluation of the angina patient.

ProClinica developed and helped NEN/DuPont implement hundreds of hospital presentations of on-label CME programs on thallium imaging across the U.S., and many additional monographs and wall charts teaching nuclear physicians how to perform and interpret the studies. The program ended a decade after it started, when thallium-201 became generic, and DuPont launched Cardiolite.