 Abstract of the lecture presented at the 12th ASEAN Association of Radiology Congress, Sep 2004 by Professor Rodney J Hicks, Director, Centre for Molecular Imaging, the Peter MacCallum Cancer Centre, Melbourne, Australia
Competition is a wonderful thing for the consumer. In the imaging field we are spoilt for choice. The major equipment makers all now have strong research and development teams that are constantly trying to gain an advantage in the market place in terms of the performance, accuracy or cost of their products.
While PET was an unproven modality used primarily in academic centres, advances in instrumentation were slow and accompanied by high costs. PET was for many years a highly unprofitable business, so much so that GE Medical Systems tried to sell its PET business in 1996. Now PET/CT is the most rapidly growing sector of the imaging market with hundreds of scanners being delivered by each of the major manufacturers in the last year.
Instead of PET scanners being made by hand and in small numbers, PET/CT scanners have become production line products incorporating the latest robotic technologies. Teams of hardware and software engineers are now allocated to research and development since the costs of such enterprises can now be amortised across a much larger base of sales. These economies of scale have seen significant improvements in instrumentation design. There are now many more choices that the consumer is confronted with when buying a piece of equipment even if there is an existing corporate relationship with an individual supplier.
Although price is often an important factor and may be the main consideration, there are many other things that might be important in the selection of a PET/CT. These considerations include factors specific to the site of practice, including the patient demographics and the expertise of the users, and those germane to the performance of the scanner including the type of crystal, acquisition modes, CT design and software. While manufacturers will focus on the optimised performance of their scanner, often the images that they show are not representative of routine clinical practice.
For example, recently examples of sub-10 minute acquisition whole-body PET scans have been circulated. While this might appear to be a boon to patient throughput, these scans are often acquired in very thin patients scanned after administration of a large amount of activity. Such scanning protocols raise questions regarding occupational and patient radiation exposure and potentially significantly increase radiopharmaceutical costs. Further, since the uptake period of FDG should be at least 45 minutes and preferably more than an hour, the discordance between uptake and scanning durations can pose logistical problems.
When planning to purchase a PET/CT scanner, a department should consider the number and type of patients that would be expected to be scanned, the source and cost of radiopharmaceutical and the physical infrastructure of the department in which the scanner is to be housed. This information will influence the choice of detector material used in the PET, whether 2-D or 3-acquisition modes are required, the need for dynamic acquisition and gating algorithms, and the number of slices on the CT.
How the CT component of the scanner will be used is also of importance. The utility and ease of use of display software is also a vital ingredient in the purchase decision. Finally, the quality of the local representatives of the company in the sales, customer services and maintenance areas should also be considered.
Luckily, it is hard to buy a bad PET/CT scanner at present. Nevertheless, some simple ground rules can make the choices easier, just don’t rely on companies to tell them to you. |
