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PET/CT: Several barriers impede larger-scale use
The need for more data and research is just one of the barriers to larger-scale use of positron emission tomography/CT (PET/CT). Another issue is availability of resources.
The first commercial PET/CT systems began to appear in 2001, and the technology took off rapidly, but there are still only slightly more than 3,000 PET/CT systems in operation in the United States, according to David Townsend, PhD, who was involved with the development of the first PET/CT system and is the director of the molecular imaging and translational research program at the University of Tennessee Graduate School of Medicine in Knoxville.
"Last year there were something like 1.7 million PET/CT scans performed, whereas there were 20 million to 30 million CT scans done," Townsend says. "Certainly, there are still places where access to the technology is difficult, and it is not easy to get a PET/CT, so patients tend to be sent for CT."
However, he suggests that a bigger issue might simply be a lack of education about the benefits of PET/CT among physicians. "There is almost a knee-jerk reaction [to order a CT] because CT has been around since 1972," says Townsend. He notes that head and neck cancer patients often will be referred for a CT scan and then for a PET/CT when the physicians find that they need more information. In many of these cases, patients simply could have had PET/CT in the first place, adds Townsend, noting that most major medical institutions now go straight to PET/CT in these cases.
Financial matters also clearly figure into utilization of PET/CT, according to Daniel Mollura, MD, a fellow in the Division of Nuclear Medicine, Department of Radiology, at Johns Hopkins University School of Medicine in Baltimore, MD. "There is a high cost associated with starting a PET/CT service in a medical center, so dropping reimbursements would make it more difficult for imaging centers to build the service," he says.
Despite these roadblocks, however, Mollura believes that additional research likely will drive increased utilization of PET/CT. "As more data is discovered, more oncologists may change their management patterns, which includes the choice of imaging modality for monitoring," he says.