Trends in PET/CT and Fusion Imaging

At the EANM Conference in Istanbul in October of this year, a symposium dedicated to a review of PET and PET/CT utilization and reimbursement in the USA and Europe provided interesting insight into the emerging trends in this area. Dr Peter Conti of the University of Southern California presented data on the utilization of these modalities in the USA.

In 2002 a total of 18.4 million nuclear medicine procedures were carried out in the USA and of these procedures Dr Conti stressed that the number of PET procedures are expected to increase.

In general, Dr Conti stated that the evolution of diagnostic imaging has been achieved through improvement in visualisation for both anatomical and functional features, with PET being increasingly important in the visualisation of different types of tissue metabolism and biochemical processes and as an adjunct to diagnosis and staging of diseases in the absence of clear anatomic findings. Driven by the continuing prominence of PET/CT in oncology indications the market for 18F-FDG is also anticipated to increase at a very healthy 30-35% over the next 3-5 years.

Table 1 – Market value of 18F-FDG in the USA

Dr Conti also presented data which demonstrated the shift to integrated PET/CT from PET which has been seen in the USA over the last four years within the main oncology indication.

Table 2 – PET and PET/CT utilization in oncology in the USA

In line with the rapid technologic developments in the field of integrated PET/CT the Centers for Medicare and Medicaid Services (CMS) has reviewed the reimbursement levels for PET/CT scans and introduced such initiatives as “Pay for Performance” which offers favourable reimbursement for those physicians following strict practice guidelines which achieve and maintain a high standard of care. Another important development has been the expansion of approved indications for PET resulting from a “Coverage with Evidence Development,” (CED) which seeks to reimburse for those procedures carried out as part of a designated clinical study which adds to existing health outcomes data for a particular condition. As well as expanding PET utilization in oncology the CED initiative addresses reimbursement of procedures for clinical trials where PET procedures are found to be beneficial in the effective diagnosis and treatment of Medicare beneficiaries with mild cognitive impairment or early dementia. PET reimbursement is already in place for procedures which assess the differential diagnosis of Alzheimer’s disease versus frontotemporal dementia.

Professor Gustav von Schulthess in his symposium presentation provided details of a study conducted to understand the clinical utilisation of PET and PET/CT throughout Europe. The message emerging from this presentation was that PET use was in considerable decline -being overtaken rapidly throughout Europe by PET/CT. In 2005, Prof. von Schulthess highlighted the fact that the use of PET/CT was growing by 60% whereas PET use was declining at a rate of 20%. Overall, the geographic distribution of cyclotrons throughout Europe, and thus the supply of 18F-FDG meant that development of PET/CT at the current rate could be sustained. While Germany, with 94 PET and PET/CT scanners, had the highest installed base of these modalities in Europe, the major markets of the UK and France which are late adopters of the technology, were lagging far behind. In 2003, France had only 4 scanning units each serving a population of nearly 15m. As part of “Plan Cancer” the French government has committed to the installation of a further 75 units in order to tackle the increased demand. In October 2005, the UK Department of Health announced a “Framework for the development of PET services in England” in which plans to increase the number of PET scanners from the current 15 (including mobile scanners) to 23 units were discussed. However, by December 2005, the UK’s NHS Purchasing and Supply Authority was still uncertain as to how the plans for procurement of PET/CT scanners was developing.

Of the current installations in Europe the market is dominated by Siemens Medical Solutions as the following figure shows,

Table 3 - Distribution of PET and PET/CT Scanners Installed Base by Manufacturer in Europe (2004)

The total number of scans per million head of population varied considerably from one country to another. The total number of scans per scanner or utilisation rate varied considerably from one European country to another. The reimbursement fee for PET varies considerably throughout Europe. For example, in Great Britain it is €222, in Belgium €825, in France €1050, in Switzerland €1230 and in the Czech Republic €2050. It is anticipated that the applications that have emerged for PET/CT technology with 18F-FDG as the radiotracer will expand further, driven by the array of promising new tracers although some reimbursement and regulatory hurdles will still hamper market development.

MRI and MDCT fusion imaging

The European association Conectus, of which Siemens AG is one of the members, comprises a group of leading European companies with the shared vision that full commercialization of superconductor technology will translate into significant benefits to Europe’s economy and society. According to Conectus the field of medical technology is currently the biggest market for superconductor technology and will, for the foreseeable future, offer the greatest opportunity for that market’s development. Part of the reason for this is that recent trends and developments towards stronger magnets and the increased accessibility of systems have extended the range of diagnostic options. Together these factors contribute to an analysis by Conectus forecasting that the global market for superconducting magnets for MRI will increase from €2.95bn in 2004 to €4.62bn in 2010 displaying annual growth rates of at least 10%.

As PET/CT fusion imaging begins to overtake PET use in certain indications, another integrated imaging technique is also mooted to gain wider acceptance by some doctors, especially in the cardiac field. Currently, magnetic resonance imaging and contrast-enhanced multidetector CT may be used in diagnosing complications in patients with coronary artery disease which cause ischaemic cardiac disease. Areas where integrated MRI/MDCT are showing signs of application, based on the provision of superior imaging and diagnostic capabilities in the assessment of complications of myocardial infarction (MI) include,