Health Imaging & IT - June 2008 - (Page 15)

ment climate changes, PET/CT providers and radiologists need to address other barriers to more widespread use of PET/CT imaging. “It’s critical for radiologists to interact with our oncology colleagues to make sure they understand the appropriate role of PET/CT,” continues Divgi. In other words, radiologists need to make time to attend tumor boards and multi-disciplinary conferences, where they can educate colleagues about the value of PET/CT imaging. Another key piece of the puzzle is the clinically relevant report. The report should describe areas of increased uptake and SUV and include clinical interpretations that can guide cancer patient management. Sites that plan to incorporate PET/CT into the radiation therapy treatment planning process need to carefully consider equipment. UPMC uses a GE Healthcare Discovery PET/CT scanner. An additional radiation therapy treatment planning package includes a flat table, so patients can be scanned in the relative treatment position. In addition, the wide bore scanner accommodates additional radiation therapy positioning devices. Versatility unveiled: expanded cardiac applications Although PET/CT seems synonymous with oncology imaging, the hybrid scanner is not relegated to a sole specialty. A number of sites across the country have deployed cardiac PET/CT and realized a number of advantages including cost-savings and accelerated decision-making and patient treatment. Take, for example, Emory: Crawford Long Hospital in Atlanta. The cardiovascular imaging department installed Siemens Medical Solutions Biograph 64 PET/CT camera in June 2006 and uses it to scan about 300 cardiac patients monthly. “PET/CT is our first choice for evaluating patients with chest pain. We use it for inpatients, outpatients and in-between patients,” says Randolph Patterson, MD, director of cardiovascular imaging at Emory: Crawford Long Hospital and Professor of Medicine [Cardiology] at Emory. The hospital has seen major benefits in its “in-between” or ED patient population. “PET/CT saves time and money with ED patients. Previously, patients who presented to the ED with chest discomfort were admitted for two to three days of testing. Now, they can be placed in a Clinical Decision Unit, undergo a PET/ CT study and can be released in less than 24 hours if the test is normal,” explains Patterson. “PET/CT is a more sensitive and more specific test for infarction and ischemia than SPECT, and it’s quick and safe.” The cardiovascular imaging department turns to the PET/CT camera for a number of other indications as well. If an outpatient undergoes an equivocal SPECT or stress echo, the cardiologist can turn to PET/CT to clarify the diagnosis. In other cases, a post cardiac catheterization PET/CT can be used to review borderline lesions and determine whether the patient needs stenting, angiography or surgery. Finally, an FDG PET/CT study helps physicians assess cardiac viability; by determining how much live tissue is present the cardiologist can better determine if a patient will benefit from surgery or angiography. On the oncology horizon Treatment efficacy monitoring or response to therapy could be the next major PET/CT application. “It appears that physicians should be able to predict whether or not a therapy is working earlier with PET/CT than with CT alone,” explains Blodgett. Currently, PET/CT is approved only for therapeutic monitoring of breast cancer patients. “As more therapeutic options become available for different types of cancer, it’s important to employ PET/CT imaging for therapeutic monitoring,” continues Blodgett. That’s because physicians can switch a patient’s therapy if the PET/CT data show that the patient is not responding to the first-line therapy. Divgi of the University of Pennsylvania Health Center believes treatment efficacy monitoring could see significant growth in the next few years. Currently, Divgi’s department completes about 16 PET/CT studies daily on its Philips Healthcare Gemini Time of Flight PET/CT scanner. About 20 percent of studies are staging studies, another 20 percent are ordered to evaluate patients for recurrence, and the final 60 percent of studies monitor treatment efficacy. Another growing oncology application is radiation therapy planning. PET/CT offers the same type of benefits for radiation therapy treatment planning as it does for other diagnostic situations, says Blodgett. That is, PET/CT detects more lesions than anatomical imaging modalities, and it helps radiologists better delineate the borders of the tumor. “If we’re going to irradiate a lesion, we need to see it,” sums Blodgett. For example, consider a lung cancer patient with a lesion pressing on a bronchi. The lung could collapse around the tumor, making it impossible for the radiologist to determine where the tumor ends and the collapsed lung begins on a standard CT study. A PET/CT study, on the other hand, provides the anatomical and functional data needed to delineate the lesion and develop a treatment plan that avoids critical and fragile areas. HealthImaging.com The five-year plan PET/CT is in a state of evolution with the modality proving its utility in more oncology applications and offering new options in cardiovascular imaging. The modality is expected to continue to evolve June 2008 | Health Imaging & IT 15 http://HealthImaging.com

Table of Contents Feed for the Digital Edition of Health Imaging & IT - June 2008

Health Imaging & IT - June 2008 Contents On The Web The Enterprise News Update Cover Story: Pushing Productivity: How Imaging is Building Efficiency and Cutting Costs Technology Outlook: Imaging Procedures Poised for Growth Great Expectations: PET/CT Delivers SPECT/CT Proving it's Potential MR/PET Holds Promise Good Image Management: Infiltrating Molecular Imaging SNM Preview Modality Review: Mammography’s Next Step: The Dawning of Breast Tomosynthesis Managing Technology: Radiation Oncology: Opening the Doors to IT Reader's Resource Stat Sheet

Health Imaging & IT - June 2008

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