PET-CT has matured quickly from the newest imaging solution to the gold standard for a variety of oncologic indications. “We could not practice oncology without PET-CT,” affirms Shyam Paryani, MD, director of Florida Radiation Oncology Group (F.R.O.G.) of Jacksonville, Fla.
PET-CT packs its punch by marrying functional and anatomic imaging to create a sum greater than its parts. “PET provides the ability to determine very accurately whether or not metastatic disease is present and determines the extent of disease. PET is more accurate than other modalities, and the addition of [anatomic CT images] makes it very accurate,” explains R. Edward Coleman, director of the nuclear medicine division at Duke University in Durham, N.C. Studies show that PET-CT has a major impact on management of 15 to 50 percent of patients scanned. Patients may be upstaged or downstaged and shifted to surgery, chemotherapy or radiation therapy depending on PET-CT results. Francois Benard, MD, associate professor of nuclear medicine at Sherbrooke University Medical Center in Quebec, adds to the list of benefits. Increased diagnostic precision with Philips Medical Systems Gemini PET-CT scanner translates into fewer equivocal results, decreased need for ancillary tests and fewer delays in diagnosis.
Although PET-CT has produced some powerful results in oncology, researchers (and payors) are still determining the full extent of its clinical utility. Currently, Medicare covers PET-CT for multiple indications: lung, esophageal, gynecological, thyroid, colorectal, advanced breast and head and neck cancers and lymphoma and melanoma. But the Feds, with the help of the Academy of Molecular Imaging and American College of Radiology, are studying expanded coverage for PET and PET-CT scans.
The Centers for Medicare and Medicaid Services (CMS) recently commenced a large-scale project to determine if it should cover PET for additional oncologic applications. The National Oncologic PET Registry (NOPR) started covering PET scans for non-approved indications among Medicare patients early this year.
As CMS gathers data, providers can plan for a successful PET-CT deployment or improve a current deployment by going beyond the clinical and addressing the triumvirate of the PET-CT business: finances and operational planning, IT and marketing.
Mobile PET-CT in practice
F.R.O.G. deployed Siemens Medical Solutions biograph duo PET-CT scanner three years ago and has seen the scanner emerge as a standard of care. Approximately 60 percent of PET-CT patients undergo a hybrid scan, and others receive a stand-alone CT on the CT unit of the PET-CT. The practice relies on PET-CT for all treatment planning. “We position the patient in the same anatomical position on the flat table and use the same immobilization devices and built-in lasers,” says Paryani. More accurate placement translates into a more precisely aimed radiation beam. And the combination of PET and CT more clearly defines abnormal areas, allowing physicians to restrict the beam and spare normal tissue.
As PET-CT volumes grew, F.R.O.G. added a biograph 6 PET-CT scanner in August 2005. Both units are mobile and travel among the practice’s six sites. “We’ve pioneered the mobile model. This model overcomes cost, which is a major barrier to entry in the PET-CT market,” explains Paryani.
Mobile scanning is not without its challenges. Staff travels with the van, essentially working in a new office every day. Ensuring that fluorodeoxyglucose (FDG) arrives at the right place at the right time adds a second logistical challenge. F.R.O.G. implemented a rigorous logistics program to address FDG dosing, scheduling and staffing.
The final challenge with mobile PET-CT is IT. Initially, radiologists traveled with the van or read scans at the end of the day, but as volumes grew, F.R.O.G. required a system to transfer datasets to a central facility for interpretation. The group upgraded from a broadband network to T1 lines, so that it could easily move studies that average 175 megabytes. Image viewing was the next hurdle. “Most PACS are not designed for multiple remote connections,” notes Paryani. F.R.O.G. deployed Numa, Inc.’s NumaStore mini-PACS for PET-CT and nuclear medicine, which enables transfer and remote access of PET-CT studies.
Succeeding in the PET-CT business
Southwoods X-Ray and Open MRI in Youngstown, Ohio, deployed a Hitachi Sceptre P3 PET-CT scanner late in 2004. The full-service imaging practice