|
 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.
|
