Health Imaging & IT - October 2007 - (Page 34) special section: Oncology Imaging the integrated approach Tacoma Radiology Associates in Tacoma, Wash., is a relative newcomer to the PET/CT arena. For the last several years, the practice focused on hybrid fusion via software to produce integrated imaging reports that incorporated not only PET and CT, but also MR and lab results. “We wanted to wait for a true advance in PET design before investing in PET/CT,” says Anthony Larhs, MD, director of nuclear medicine and clinical PET. Late last year, the practice invested in Philips Medical Systems Time of Flight PET/CT scanner. The hybrid system improves localization of information of interest, particularly as the patient’s girth increases; Time of Flight compensates for increased girth to produce images of consistent quality. The scanner also completes PET scanning at a rate of one image per bed position regardless of patient size, allowing the practice to schedule at least twice as many patients daily on the PET/CT scanner as it did on its PET system. Techs are able to complete most patient studies within 10 minutes, says Larhs. The move to hybrid scanning has delivered other benefits as well. For example, Tacoma Radiology Associates used to employ a staff person to track CT images for hybrid fusion. The position is no longer necessary. “PET/CT allows us to condense services. We have one machine that combines anatomy and function in one place,” confirms Larhs. Tacoma Radiology Associates is employing cutting-edge protocols that forego the traditional PET scan combined with a nondiagnostic transmission CT. The practice acquires diagnostic PET and diagnostic CT images on its PET/CT scanner to provide physicians with the information for a comprehensive report that describes the size, contour, density, location and metabolic activity of each lesion, which Larhs dubs “PETCT.” “It’s an education process,” admits Larhs. “We recommend and insist on diagnostic quality CT with each and every PET/CT exam.” The approach has no impact on exam time or workflow, says Larhs, but it adds considerable diagnostic value to the exam. The difference between a transmission CT and a diagnostic CT is fewer than 10 seconds. The hitch is tech training; a diagnostic CT requires a tech trained in CT, which means the tech should be dually trained in PET and CT. looking into the future at the mega-enterprise Memorial Sloan-Kettering Cancer Center in New York City, is a PET/CT pioneer; the premier cancer center phased out standalone PET by 2002, replacing its cameras with hybrid systems like GE Healthcare Discovery STE PET/CT scanners. The center plans to increase its current inventory of five PET/CT systems by another three in the next year, placing two of the new systems in a breast center and a center for image-guided intervention. It’s no surprise that Nuclear Medicine Chief Steve Larson, MD, foresees a dramatic increase in volume by 2010 from its current volume of 35 to 40 patients daily. PET/CT is expanding beyond the initially approved applications, says Larson, mainly because the PET Registry opens the door to other types of cancers. Consequently, Memorial Sloan-Kettering now deploys PET/CT for cancers that aren’t on CMS’ original approved list, such as prostate and neuro-endocrine tumors. “I think the data will show that PET/CT is useful as long as we carefully select patients for PET/CT studies,” says Larson. That is, the HealthImaging.com Memorial Sloan-Kettering Cancer Center in New York City has implemented five GE Healthcare Discovery STE PET/CT scanners, and will add three more next year. 34 O C T O B E R 2 0 07 | Health Imaging & IT http://HealthImaging.com
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