The advent of PET/CT has been a boon to radiology and oncology. The hybrid scanners combine CT’s exquisite attention to anatomic detail with PET’s unparalleled ability to analyze functional information. This unique combination facilitates more accurate staging of many types of cancers. Consequently, many facilities are budgeting for and deploying hybrid scanners instead of standalone PET systems. The approach is a wise decision from clinical and economic standpoints; however, PET/CT is not without challenges. The site that thoughtfully and proactively considers and addresses these challenges can better optimize its investment and derive the maximum diagnostic and clinical benefits from PET/CT.
Many PET/CT challenges involve IT. PACS integration has been a slow process. Traditionally, PET/CT interpretation required the radiologist to use a separate, specialized workstation, which has a negative impact on workflow.
The good news is vendors are paying attention and developing new systems and applications to overcome integration woes, enabling radiologists to ramp up PET/CT workflow. Other potential challenges relate to the hefty file sizes of PET/CT images and can be addressed up front via network and storage planning.
PET/CT PACS integration in evolution
“The primary IT challenge is that most PACS workstations do a miserable job at displaying nuclear medicine studies, and PET/CT studies are nuclear medicine exams on steroids,” asserts Patrick Barr, MD, director of Southwest Center for Molecular Imaging in Dallas, Texas. The practice invested in a PACS server for storage three years ago when it deployed Philips Medical Systems Gemini PET/CT scanner. The server is integrated with the PACS at Presbyterian Hospital in Dallas and with the main campus of the imaging center.
Most PACS workstations can provide a basic, quick view of PET/CT images, but the process can be time-consuming and fail to meet the demands of clinical diagnosis. For example, Southwest Center for Molecular Imaging uses its PACS to send screen snapshots, but receiving clinicians cannot window or level the images or easily link PET and CT studies to scroll at the same slice thickness. “Right now, data are not presented in a clinically useful manner on the PACS workstation,” states Barr. For example, oncologists cannot view PET/CT studies side by side or fused images. Consequently, clinicians are forced to trek to Barr’s office to view studies on the Philips Extended Brilliance PET/CT Workstation. “The real issue is to design workstations to provide clinicians with access to PET/CT images that is as easy as accessing a chest x-ray,” says Barr.
The workstation issue affects radiologists as well as other clinicians and specialists. In the traditional configuration, radiologists must rely on a specialized PET/CT workstation rather than the ubiquitous PACS workstation to read PET/CT exams. The dual-workstation workflow is not as streamlined as a single, one-stop-shop workstation arrangement.
“The tide is turning,” asserts James Busch, MD, radiologist with Diagnostic Radiology Consultants in Chattanooga, Tenn., whose practice relies on Siemens Medical Solutions Biograph 6 and Biograph 16 PET/CT scanners in conjunction with syngo PACS and syngo 3D task card. The 3D application is “syngoized.” In a nutshell, syngoization means images can be accessed within PACS, enabling the physician to interpret PET/CT images from anywhere a PACS workstation is located rather than a specialized workstation.
PET/CT in the mega-enterprise
Memorial Sloan-Kettering Cancer Center in New York City is a high-volume PET/CT site, performing 30 to 35 scans daily. Other factors further complicate the environment. Every patient at the center has one or multiple prior PET/CT examines that must be reviewed for comparison. Finally, Memorial Sloan-Kettering relies on PET/CT solutions from multiple vendors including GE Healthcare and Siemens Medical Solutions. “Each unit required the radiologist to use its specialized workstation. With a large practice and many radiologists in nuclear medicine, it was a challenge to cope with all of the workstations,” admits Peter Kijewski, PhD, medical physicist.
Several months ago, Memorial Sloan-Kettering Cancer Center equipped a nuclear medicine reading room with nine PACS workstations that included the GE Advantage Windows Suite. This application contains features for reading PET/CT and Volume Viewing and Analysis software. Additional workstations were