Business Practices
This issue of Molecular Imaging Insight features several discussions about “Building the Business of Molecular Imaging.” I believe it is important to note that clinical molecular imaging—and here most prominently PET/CT—is still in its infancy with regards to its utilization.
The recent CMS proposal to broaden coverage for PET imaging for U.S. Medicare patients opens the door for its more appropriate and widespread utilization. Recent reports suggest that more than 60 million CT scans are performed annually, while only 1.5 to 1.7 million patients undergo PET scans. Therefore, a strong need exists to continue and intensify educational efforts to familiarize practicing physicians as well as patient advocacy groups with this technology. As discussed in the most recent supplement of the Journal of Nuclear Medicine, it is time to move from size-based to molecular imaging-based diagnostic and patient management criteria.
However, PET imaging plays an important role not only in oncology, but also in cardiology and neurology, and it is even more under-utilized in these specialties.
A healthy and appropriate PET imaging operation should provide expertise in these areas and even beyond this, in imaging of inflammation with FDG and in bone imaging with 18F-NaF. For instance, preliminary reports about PET-based bone imaging suggest that this is superior to conventional bone imaging. This prompted a multicenter trial initiated by the Academy of Molecular Imaging (AMI) to verify this in a large group of cancer patients. More than 2 million bone scans are performed annually in the U.S. All of them are performed as conventional bone scans. It appears likely that shifting these to PET/CT imaging would result in better patient care and also in a better business model for imaging departments and clinics. This, of course, requires evidence that supports the value and validity of this test. Furthermore, an impact on patient management and/or outcome needs to be demonstrable.
The AMI trial is a multicenter trial that randomizes patients with breast, lung or prostate cancer into those who receive conventional bone scans vs. those who receive a PET/CT bone scan. The endpoints of the study are diagnostic accuracy and impact on management. It is hoped that this trial will lead to a shift to PET/CT-based bone imaging which, in turn, should result in better utilization of PET/CT scanners—again a better business proposition.
Several other imaging trials, sponsored by professional organizations such as SNM or by industry, are underway to determine the usefulness of other PET imaging probes in oncology, neurology and cardiology.
These trials, together with the high likelihood of increasing utilization of FDG-PET/CT, will result in a high demand for PET imaging instrumentation and imaging probes and thus, will help to build the business case for PET/CT imaging.
Johannes Czernin, MD, Professor, Molecular & Medical Pharmacology?Director, Nuclear Medicine Clinic, Positron Emission Tomography/Computed Tomography?David Geffen School of Medicine at UCLA, Los Angeles, Calif.
The recent CMS proposal to broaden coverage for PET imaging for U.S. Medicare patients opens the door for its more appropriate and widespread utilization. Recent reports suggest that more than 60 million CT scans are performed annually, while only 1.5 to 1.7 million patients undergo PET scans. Therefore, a strong need exists to continue and intensify educational efforts to familiarize practicing physicians as well as patient advocacy groups with this technology. As discussed in the most recent supplement of the Journal of Nuclear Medicine, it is time to move from size-based to molecular imaging-based diagnostic and patient management criteria.
However, PET imaging plays an important role not only in oncology, but also in cardiology and neurology, and it is even more under-utilized in these specialties.
A healthy and appropriate PET imaging operation should provide expertise in these areas and even beyond this, in imaging of inflammation with FDG and in bone imaging with 18F-NaF. For instance, preliminary reports about PET-based bone imaging suggest that this is superior to conventional bone imaging. This prompted a multicenter trial initiated by the Academy of Molecular Imaging (AMI) to verify this in a large group of cancer patients. More than 2 million bone scans are performed annually in the U.S. All of them are performed as conventional bone scans. It appears likely that shifting these to PET/CT imaging would result in better patient care and also in a better business model for imaging departments and clinics. This, of course, requires evidence that supports the value and validity of this test. Furthermore, an impact on patient management and/or outcome needs to be demonstrable.
The AMI trial is a multicenter trial that randomizes patients with breast, lung or prostate cancer into those who receive conventional bone scans vs. those who receive a PET/CT bone scan. The endpoints of the study are diagnostic accuracy and impact on management. It is hoped that this trial will lead to a shift to PET/CT-based bone imaging which, in turn, should result in better utilization of PET/CT scanners—again a better business proposition.
Several other imaging trials, sponsored by professional organizations such as SNM or by industry, are underway to determine the usefulness of other PET imaging probes in oncology, neurology and cardiology.
These trials, together with the high likelihood of increasing utilization of FDG-PET/CT, will result in a high demand for PET imaging instrumentation and imaging probes and thus, will help to build the business case for PET/CT imaging.
Johannes Czernin, MD, Professor, Molecular & Medical Pharmacology?Director, Nuclear Medicine Clinic, Positron Emission Tomography/Computed Tomography?David Geffen School of Medicine at UCLA, Los Angeles, Calif.