an introduction to pet-ct scanning ray murphy chair – mccn partnership group
TRANSCRIPT
AN INTRODUCTION TO PET-CT SCANNING
Ray Murphy
Chair – MCCN Partnership Group
PET-CT Scanning• A PET-CT scan is a diagnostic imaging tool
used in the investigation of cancers
• It is a two fold process by which the anatomic detail of the CT scan (Computerised Tomography) is combined with the glucose uptake detection of the PET scan (Positron Emission Tomography). This give a very accurate determination of the disease and identifies small metastases that would be undetected by CT alone
PET-CT Use
Cancer diagnosis and treatment planning are the main uses for PET-CT, which may:• Identify cancer earlier than other imaging technologies• Distinguish between malignant and benign tumours• Determine the location and extent of cancer indicating spread to other areas of the body such as lymph nodes, liver or bones (metastatic disease)• Identify recurrent cancer distinguishing it from scar tissue or fibrosis• Demonstrate the response of cancer to treatment
PET-CT Scan
Lung Tumour
Metastatic Spread
Response to Treatment
Merseyside and Cheshire PET-CT Service
• The Merseyside and Cheshire PCTs are part of the Department of Health’s national contract for the provision of PET-CT services
• We are now in year 3 of a 5 year contract in which Alliance Medical are the providers of a mobile PET-CT service
• The mobile units visit two sites, Broadgreen in the north and Clatterbridge in the south
• The planned number of scans is in the order of 2000 per year in this Network
Current Criteria• All lung cancer patients suitable for radical surgery or
radiotherapy. Also for patients post radical therapy with suspected disease relapse when detection of recurrence would affect management
• All lymphoma patients• All patients with anal cancer suitable for radical radiotherapy • Patients with colorectal cancer who are considered for radical
treatment with a prior history of colorectal cancer and proven or suspected disease relapse, and patients with synchronous metastases at presentation potentially suitable for resection
• Oesophageal cancers
Current Criteria (cntd…)
• Some head and neck, melanoma and brain tumours• All patients with gastro intestinal tumours unsuitable for
complete surgical resection• In patients with locally extensive uterine carcinoma
(cervix/endometrium) which is potentially curable by exenterative surgery
• In patients with intrahepatic cholangiocarcinoma or gallbladder carcinoma which is potentially curable by radical surgery
• Patients with suspected tumour relapse not confirmed on conventional scanning, when detection would alter therapy and outcome
The UK PET-CT Advisory Boardhave recently made their recommendations
Estimated number of cases for England 2005 2009
Lung cancer 10,000 12,500
Lymphoma 15,000 20,500
Colorectal 5,000 3,125
Anal - 75
Oesophageal 2,000 3,500
GIST - 625
Melanoma - 1,500
Paraneoplastic syndromes - 75
Brain/spinal - 150
Head & neck 3,000 1,500
Suspected relapse unconfirmed on conventional scanning - 3,000
Cervix/endometrium - 500
Cholagiocarcinoma/gall-bladder - 500
Contingency studies (15%) - 5,000
Total 35,000 52,550
Number per million population 800 1,000
Alliance Medical Service
• Operates from mobile units at both Clatterbridge and Broadgreen
• Has a requirement to scan a patient within 5 days of their referral
• Uses several local NHS radiologists reporting the finding of the scans
• Has a requirement to return the images and the reports to the referring clinician within 2 days of the scan
Activity Levels
• In the first year of the contract the level of activity performed was far lower than the levels contracted for, mainly due to a lack in clinical confidence in the service following an initial reporting problem and the time take for the reports to be returned to the MDTs
• This year the activity levels have risen far closer to the planned levels
• More patients are scanned at Broadgreen that Clatterbridge but work is underway to balance this out
The number of scans performed on the Broadgreen site
Broadgreen (North West SHA)
0
20
40
60
80
100
120
140
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan
Contracted
Actual
The number of scans performed on the Clatterbridge site
Clatterbridge (North West SHA)
0
10
20
30
40
50
60
70
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan
Contracted
Actual
The percentage of reported returned to the referring Trust within 2 days
Broadgreen
0%
20%
40%
60%
80%
100%
120%
Jan
Feb Mar Apr
May
June
July
AugSep
tO
ctNov
Dec Jan
Clatterbridge
0%
20%
40%
60%
80%
100%
120%
Patient SatisfactionBroadgreen Patient Satisfaction Survey Results
0%
20%
40%
60%
80%
100%
120%
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan
SatisfactoryVery GoodExcellent
Clatterbridge Patient Satisfaction Survey Results
0%
20%
40%
60%
80%
100%
120%
Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec Jan
SatisfactoryVery GoodExcellent
Mobile PET-CT Scanners
Service Issues
• One of the local residents adjacent to the Broadgreen site has been throwing fruit and vegetables at the scanner. This is in protest to the noise and timing of the scanner movements. The Trust and AML have agreed a compromise with the individual and the problem seems to be resolved.
