Internists, Nuclear Medicine Specialist, Radiologist
27 years of experience

Accepting new patients
Milford Mill
Advanced Radiology
7253 Ambassador Rd
Windsor Mill, MD 21244
443-436-1116
Locations and availability (4)

Education ?

Medical School Score Rankings
Yeshiva University (1983)
  • Currently 3 of 4 apples
Top 50%

Awards & Distinctions ?

Awards  
Castle Connolly's Top Doctors™ (2012 - 2013)
Associations
American Board of Nuclear Medicine
American Board of Internal Medicine

Affiliations ?

Dr. Spiegler is affiliated with 4 hospitals.

Hospital Affilations

Score

Rankings

  • Greater Baltimore Medical Center
    6701 N Charles St, Towson, MD 21204
    • Currently 4 of 4 crosses
    Top 25%
  • St Joseph Medical Center
    7601 Osler Dr, Towson, MD 21204
    • Currently 4 of 4 crosses
    Top 25%
  • Saint Agnes Healthcare
    900 Caton Ave, Baltimore, MD 21229
  • Baltimore Washington Medical Center
    301 Hospital Dr, Glen Burnie, MD 21061
  • Publications & Research

    Dr. Spiegler has contributed to 12 publications.
    Title Acute Resting Myocardial Perfusion Imaging in Patients with Diabetes Mellitus: Results from the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (erase Chest Pain) Trial.
    Date February 2005
    Journal Journal of Nuclear Cardiology : Official Publication of the American Society of Nuclear Cardiology
    Excerpt

    BACKGROUND: Resting myocardial perfusion imaging (MPI) improves the triage of patients presenting to the emergency department (ED) with symptoms suggestive of acute cardiac ischemia (ACI). In the ED setting the presence of diabetes mellitus (DM) is a predictor of ACI and hospitalization, but the role of resting MPI in patients with DM is unknown. METHODS AND RESULTS: A secondary data analysis of a prospective, multicenter, randomized, controlled trial of ED evaluation strategies in patients with symptoms suggestive of ACI and normal or nondiagnostic electrocardiograms was performed. In the main trial 2475 patients were randomized to receive either the usual ED evaluation strategy (n = 1260) or the usual strategy supplemented by results from resting MPI by use of single photon emission computed tomography (SPECT) technetium 99m sestamibi (n = 1215). Patients with diabetes (n = 341) were evaluated separately. Imaging results, final diagnoses, effect on triage, and prognostic value of the SPECT imaging were compared between diabetic and nondiabetic patients. Of the 341 patients with diabetes, 153 (45%) were randomized to the imaging strategy. Patients with DM had higher rates of hospitalization (66% vs 49.6%, P = .0001) and ACI (21.1% vs 12.0%, P < .001) than patients without DM. Among diabetic patients without ACI, the admission rate was 63% in the usual strategy group versus 54% in the imaging strategy group (relative risk [RR] = 0.91 [95% CI, 0.76-1.06]; P = .24). There was no difference in the magnitude of this reduced risk of admission compared with patients without DM (RR = 0.84 [95% CI, 0.77-0.92]; P = .0002 for patients without DM and P = .35 for interaction of diabetes and RR reduction). CONCLUSIONS: Acute resting MPI with Tc-99m sestamibi is associated with improved triage decision making in symptomatic ED patients with diabetes.

    Title The Use of Sestamibi Imaging in Parathyroid Hyperplasia.
    Date April 2003
    Journal Clinical Nuclear Medicine
    Excerpt

    The authors describe a 42-year-old man with parathyroid hyperplasia secondary to chronic renal failure. Parathyroidectomy was indicated because of persistent hypercalcemia and an increasing parathyroid hormone level despite medical management. A parathyroid sestamibi scan was performed immediately before operation and a gamma-detecting probe was used during operation. Six parathyroid glands weighing nearly 21 g were present. Without the use of the gamma-detecting probe during operation, one of the glands would have been missed. The efficacy of sestamibi scanning with parathyroid hyperplasia is discussed.

    Title Myocardial Perfusion Imaging for Evaluation and Triage of Patients with Suspected Acute Cardiac Ischemia: a Randomized Controlled Trial.
    Date December 2002
    Journal Jama : the Journal of the American Medical Association
    Excerpt

    CONTEXT: Observational studies of acute myocardial perfusion imaging in emergency department (ED) patients with chest pain have suggested high sensitivity and negative predictive value for acute cardiac ischemia, but use of this method has not been prospectively tested. OBJECTIVE: To assess whether incorporating acute resting perfusion imaging into an ED evaluation strategy for patients with suspected acute ischemia but no initial electrocardiogram (ECG) changes diagnostic of acute ischemia improves clinical decision making for initial ED triage. DESIGN, SETTING, AND PATIENTS: Prospective, randomized controlled trial conducted at 7 academic medical centers and community hospitals between July 1997 and May 1999 among 2475 adult ED patients with chest pain or other symptoms suggestive of acute cardiac ischemia and with normal or nondiagnostic initial ECG results. INTERVENTION: Patients were randomly assigned to receive either the usual ED evaluation strategy (n = 1260) or the usual strategy supplemented with results from acute resting myocardial perfusion imaging using single-photon emission computed tomography with injection of 20 to 30 mCi of Tc-99m sestamibi (n = 1215), interpreted in real time by local staff physicians and with results provided to the ED physician for incorporation into clinical decision making. MAIN OUTCOME MEASURE: Appropriateness of triage decision either to admit to hospital/observation or to discharge directly home from the ED. RESULTS: Among patients with acute cardiac ischemia (ie, acute myocardial infarction [MI] or unstable angina; n = 329), there were no differences in ED triage decisions between those receiving standard evaluation and those whose evaluation was supplemented by a sestamibi scan. Among patients with acute MI (n = 56), 97% vs 96% were hospitalized (relative risk [RR], 1.00; 95% confidence interval [CI], 0.89-1.12), and among those with unstable angina (n = 273), 83% vs 81% were hospitalized (RR, 0.98; 95% CI, 0.87-1.10). However, among patients without acute cardiac ischemia (n = 2146), hospitalization was 52% with usual care vs 42% with sestamibi imaging (RR, 0.84; 95% CI, 0.77-0.92). CONCLUSIONS: Sestamibi perfusion imaging improves ED triage decision making for patients with symptoms suggestive of acute cardiac ischemia without obvious abnormalities on initial ECG. In this study, unnecessary hospitalizations were reduced among patients without acute ischemia, without reducing appropriate admission for patients with acute ischemia.

    Title Emergency Department Perfusion Imaging for Suspected Coronary Artery Disease: the Erase Chest Pain Trial.
    Date August 2001
    Journal Maryland Medicine : Mm : a Publication of Medchi, the Maryland State Medical Society
    Title Minimally Invasive Parathyroidectomy Utilizing a Gamma Detecting Probe Intraoperatively.
    Date June 1999
    Journal Maryland Medical Journal (baltimore, Md. : 1985)
    Excerpt

    The most common pathologic finding in primary hyperparathyroidism is a single adenoma. Traditionally, all four glands have been explored during surgery for primary hyperparathyroidism. With the advent of accurate localizing diagnostic studies, such as the sestamibi scan, some surgeons are now recommending single-gland exploration. In addition, when a sestamibi scan is performed the day of surgery, a gamma detecting probe can be used intraoperatively to direct the dissection. Although an experienced surgeon will successfully locate the abnormal gland 95% of the time with the traditional approach, this new technique results in a smaller incision with better cosmetic results as well as decreased operative time. Our initial experience with eight cases utilizing this technique is presented.

    Title Implementation of an Acute Myocardial Perfusion Imaging Program for Patients with Chest Pain and Nondiagnostic Electrocardiogram: the St. Agnes Experience.
    Date March 1998
    Journal Maryland Medical Journal (baltimore, Md. : 1985)
    Excerpt

    One of the current focuses of the chest pain emergency department (CPED) movement is to improve community awareness of chest pain signs and symptoms and thereby encourage patients to be evaluated early. However, such a strategy may overwhelm the mechanisms currently in place to evaluate these patients in a timely and cost-effective manner. In this article, the author reviews the experience of St. Agnes HealthCare using acute myocardial perfusion imaging (MPI) to help stratify patients who present with chest pain and nondiagnostic or normal ECG into low- and high-risk groups for the development of acute cardiac events. Currently, St. Agnes is participating in a randomized, multicenter trial to assess clinical and cost efficacy of employing a strategy of acute MPI in the CPED.

    Title Incidental Detection of Hurthle Cell Adenoma and Papillary Carcinoma of the Thyroid During Gated Blood Pool Scintigraphy.
    Date January 1993
    Journal Clinical Nuclear Medicine
    Title A Noninvasive Test of Sphincter of Oddi Dysfunction in Postcholecystectomy Patients: the Scintigraphic Score.
    Date July 1992
    Journal Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine
    Excerpt

    The ideal noninvasive test of sphincter of Oddi dysfunction (SOD) does not exist and the diagnosis of patients with postcholecystectomy pain often relies on invasive procedures. In this paper we describe a scintigraphic test for SOD: the scintigraphic score. This score combines quantitative and visual criteria for interpretation of hepatobiliary scans. Twenty-six consecutive postcholecystectomy patients underwent hepatobiliary imaging, ERCP, and sphincter manometry. Twelve patients had SOD and 14 had normal sphincters determined by clinical findings, ERCP, and manometric studies. All patients with normal sphincter had scores of 0-4, while patients with SOD had values of 5-12 for a perfect sensitivity and specificity of 100%. Hepatobiliary scans scored in this fashion may become the noninvasive test of choice to screen postcholecystectomy patients with suspected SOD.

    Title Incidental Rectus Abdominis Muscle Visualization During Bone Scanning.
    Date November 1991
    Journal Clinical Nuclear Medicine
    Title Prominent Cisterna Magna. Tc-99m Hmpao and Mri Correlation.
    Date September 1991
    Journal Clinical Nuclear Medicine
    Title Detection of Tricuspid Regurgitation by Tc-99m Dtpa Renal Scintigraphy.
    Date April 1991
    Journal Clinical Nuclear Medicine
    Excerpt

    Tc-99m DTPA renal scintigraphy is an established technique for evaluating renal perfusion and function. A patient is described with clinically unsuspected tricuspid regurgitation detected during the perfusion phase of renal scintigraphy and confirmed by Doppler echocardiography. A review of extrarenal anomalies detected during renal blood flow imaging is presented.

    Title Myocardial Uptake and Clearance of T1-201 in Healthy Subjects: Comparison of Adenosine-induced Hyperemia and Exercise Stress.
    Date June 1990
    Journal Radiology

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