EditorialHow should we introduce clinical positron emission tomography in the UK? Oncologists need to have a (clearer) view
Introduction
It was with great interest that we read the recent editorial by Price and Laking on clinical positron emission tomography (PET) [1]. Although the article was clearly targeted at clinical oncologists in the UK, we believe that the issues raised are internationally relevant. Therefore, we wish to comment from our perspective as clinicians who work at a large cancer centre that contains the first Australian PET facility primarily dedicated to clinical service provision [2]. Over 15 000 scans in around 10 000 patients have been carried out in our institute. Selective use of PET is now integral to our daily clinical practice because of the major impact it has on treatment decisions.
Section snippets
The strength of the evidence for PET
Although the great clinical utility of PET is immediately apparent to any oncologist with practical daily experience of its use, our enthusiasm for PET is also based on an active clinical research programme with prolonged follow-up of our patient population [3]. Furthermore, as Price and Laking acknowledge, there is substantial evidence that clinical PET, using fluorodeoxyglucose (FDG), can improve the diagnostic staging of cancer. More than 10 years of publications have demonstrated the
The cost of positron emission tomography
One of the major issues considered in producing Health Technology Assessment reviews, and echoed in the editorial opinion, is the perception that PET is a high-cost investigation. It is true that PET has been a relatively expensive modality, but economies of scale are already favourably affecting instrumentation and radiopharmaceutical costs. We have seen a significant relative reduction in cost, compared with features delivered, for computed tomography and magnetic resonance imaging, and there
The model of clinical positron emission tomography practice
One of the major dilemmas in how to structure and fund PET services relates to various models of PET practice. Traditionally, PET has been used primarily as a research modality, with a low number of scans and a high staff-to-scan ratio. This model has provided unique insights into the mechanisms of various diseases [8], but leads inevitably to inefficient use of expensive equipment. On the other hand, a combination of high throughput clinical facilities with staffing levels that are appropriate
The way forward
Although we share the enthusiasm of Price and Laking for the research potential of PET, we believe that entrenching the inefficient models of PET practice and research methodologies that have proliferated in ‘academic PET’ centres throughout the world must be resisted. A ‘too little, too late’ implementation of clinical PET will not only impair the UK's reputation as a provider of high-quality cancer care, but will also lead to continuing disadvantage to individual patients who are denied
References (8)
- et al.
How should we introduce clinical PET in the UK? The oncologists need to have a view
Clin Oncol
(2004) - et al.
Early mortality following radical radiotherapy (RRT) for non-small cell lung cancer (NSCLC): comparison of PET-staged and conventionally-staged cohorts treated at a large tertiary-referral center
Int J Radiat Oncol Biol Phys
(2002) - et al.
Technology assessment: an American view
Eur J Radiol
(1992) - et al.
Cost-effectiveness of PET imaging in clinical oncology
Nucl Med Biol
(1996)