Referring physicians expressed considerable skepticism and confusion regarding appropriate use of oncologic PET/CT and also voiced concerns about the high cost of the exam, according to a survey published Aug. 23 in Journal of Nuclear Medicine.

Although oncologic PET/CT has garnered fairly wide acceptance in clinical practice, little is known about referring physicians’ attitude toward the modality, according to Dimitrios Karantanis, MD, of the department of molecular and medical pharmacology at University of California, Los Angeles, and colleagues.

Karantanis and colleagues sought to gather information about referring physicians’ perspectives about PET/CT and sent a web-based survey to 19,053 corresponding authors of studies published in major clinical oncologic journals. A total of 963 physicians completed the 20-question survey, including 371 oncologists, 292 surgeons, 158 hematologists and 87 radiation oncologists.

The prevailing uncertainty about the appropriate use of PET/CT was the most significant survey finding, according to Karantanis et al. Nearly three-quarters of respondents did not feel indications for PET/CT are well defined and established, and almost half reported frequent uncertainty about indications.

Exacerbating this challenge is the reported difficulty physicians face in accessing updates on indications for PET/CT. Only 32.4 percent of respondents described information about PET/CT indications as “absolutely” or “in most of the cases” accessible. The authors noted that survey respondents were academically oriented, and suggested the average referring physician may have more limited access to literature and information about indications.

The authors reported a number of other significant findings, including:

• 65.7 percent of respondents considered consultation with an imaging expert in cases of uncertainty before a scan to be useful always or most of the time;
• 90.6 percent of respondents rated the clinical importance of providing an accurate and detailed history to the interpreting physician as essential or very important;
• 39.1 percent of respondents reported at least a frequent necessity for discussion with an imaging expert;
• 96.3 percent of respondents agreed even more interaction between referring and interpreting physicians would benefit patients;
• 86 percent of respondents considered a differential diagnosis for PET/CT abnormalities important;
• 60.5 percent of respondents always read the entire PET/CT report;
• 30.3 percent of respondents reported ambiguity, poor explanation and lack of familiarity with report terminology;
• 84.8 percent of respondents expressed desire for access to PET/CT  images;
• 47 percent of respondents raised concerns about the high cost of PET/CT exams; and
• 40.9 percent of respondents expressed concern about overinterpretation of imaging findings. 

The researchers acknowledged the low survey response rate of 5.2 percent, which is in line with most web-based surveys. It also is possible that many of the initially targeted respondents were ineligible for participation.