Health Imaging & IT - October 2007 - (Page 35) For an in-depth update on key PET/CT clinical studies, visit MolecularImaging.net patient should present with a reasonable likelihood of disease. At the same time, the hybrid machines continue to play a critical clinical role in staging disease and detecting recurrent tumors and metastases. Despite the promise, there are still some bugs to work out of PET/CT. On one end, vendors are producing new scanners with improved detectors for better image quality. On the other, image management still hinders hybrid scanning. The biggest beef? Physicians can’t compare serial PET/CT studies at PACS workstations. The standard approach is the dedicated PET/CT workstation, a known workflow-buster, but Larson is hopeful that change is on the horizon as private PET/CT clinics vocalize their frustrations with the status quo. PACS isn’t the only challenge in the hybrid world. Training of both physicians and techs is tricky. “PET/CT has raised all sorts of questions like who is best-trained to read PET/CT studies—radiologists or nuclear medicine physicians?” notes Larson. A similar conundrum is evident with techs as a PET/CT tech should be licensed in both modalities. The good news is professional organizations are tackling the challenge and answering the tough questions about standards, training and competency assurance. Larhs of Tacoma Radiology Associates envisions the advent of medical imaging of oncology rather than the subset of radiology and nuclear medicine. The specialty implies PET/CT and training in radiology and nuclear medicine for physician-interpreters and techs, he says. the next frontier: tumor response The real promise of PET/CT could be right around the corner. “In the future, we won’t do first-class cancer therapy without PET/CT,” predicts Busch. One class of upcoming applications is therapy HealthImaging.com response. When PET first hit the imaging arena, patients were scanned after three to four cycles of medical therapy or radiation oncology. Today, some patients are scanned after the first cycle. The results allow physicians to change a therapy that isn’t working, or stop therapy altogether if no benefit is seen. On the other hand, a scan can confirm successful treatment. Take for example the ovarian cancer patient whose PET/ CT showed tumor markers in the normal range, allowing her oncologist to prescribe a “break” from chemotherapy. This has a positive quality-of-life impact on the patient and alleviates the need for expensive chemo treatments. Similarly, physicians can prognosticate the outcome of radiation oncology for a lung cancer patient within a matter of weeks. Unlike a traditional CT, which does not discern active lymphoma, PET/CT can detect whether or not active lymphoma is present to determine if a lung cancer patient is a surgical candidate. At Memorial Sloan-Kettering, treatment response goes beyond the clinical and incorporates treatment development. “A number of companies want to incorporate PET/CT into their treatment monitoring algorithms,” confirms Larson. In either case, PET/CT holds the potential to reinvent oncology care. “PET/CT is more than wishful thinking or hope. It produces data,” Busch says. That data can help optimize treatment and spare patients from needless surgery, a tidbit that thirdparty payors will appreciate, too. “We will see the day when third-party payors refuse to allow separate scans and insist on PET/CT in one shot,” predicts Busch. That is a welcome forecast for practices wrangling with the impacts of diminished reimbursement. Still, deploying PET/CT to monitor therapy can be tricky. “We’re dealing with a heterogeneous disease. Tumor response differs for different cancers and in radiation therapy and medical treatment,” explains Busch. the hybrid future While treatment response is the rage in nuclear medicine and oncology circles, it isn’t the only upcoming development in PET/CT. Larhs points to “tremendous interest” in approving PET/CT for infection imaging, namely fever of unknown origin. “Infection is a cousin of cancer, and there is no good, single imaging method to diagnose infection,” explains Larhs. Infection could obtain CMS approval by the end of 2007. New tracers also are in the works as FDG is one of hundreds of potential tracers, but it is very expensive to investigate and market a new tracer. Still, Larson predicts growth in the radiotracer market. For example, certain tracers may help tailor treatment by determining if a tumor is susceptible to a particular drug. Another area of growth is radio-labeled antibodies, which could ease detection by facilitating quantification and boosting sensitivity. “This technology is by no means completely mature,” concludes Larson. the hybrid evolution at a glance PET/CT continues to have a major impact on practice of oncology. The combination of anatomy and function provides physicians with the data needed to more accurately stage cancers, and, more recently, determine the effectiveness or appropriateness of a particular treatment. Each advance delivers multiple benefits; with accurate data, patients are more appropriately treated, which saves time and money and lives. And the technology continues to evolve as practitioners look forward to improved image management and review systems. New tracers promise to help further tailor treatment. Health Imaging & IT | O C T O B E R 2 0 07 35 http://MolecularImaging.net http://HealthImaging.com
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