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Special report: Will molecular imaging deliver on its promises?

by Carol Ko, Staff Writer | June 14, 2013
International Day of Radiology 2012
From the June 2013 issue of HealthCare Business News magazine

Indeed, although its potential for clinical applications has yet to be fully explored, and though it holds an edge over PET/CT in certain areas, some experts say it’s doubtful whether this new hybrid technology will displace the well-established, decade-old PET/ CT anytime soon, even as dose awareness continues to be a hot topic among OEMs and clinicians. “PET/MR is too expensive at this point. They’re not being used for prac tical clinical use,” says Frost and Sullivan’s Aranibar.

SPECT/CT hasn’t quite caught up with its younger, popular sibling PET/CT in widespread adoption—partly because reimbursement coding hasn’t evolved. While Medicare eventually created a separate reimbursement billing code for PET/CT, the same never happened for SPECT/CT.

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“Unless there’s some movement in that direction, most hospitals won’t be able to financially justify replacing their SPECT cameras with SPECT hybrids,” says Dr. Patrice Rehm, professor of radiology and medical imaging and director of the division of nuclear medicine at University of Virginia.

But the advantages of SPECT/CT parallel PET/CT in many ways. In SPECT, clinicians inject a radiopharmaceutical into the bloodstream that emits gamma radiation picked up by a gamma camera that detects images as it rotates around the patient. By combining SPECT with CT, doctors are able to fuse SPECT data with anatomic precision, correcting limitations of standalone SPECT images for attenuation and photon scatter. This helps clarify inconclusive SPECT results in oncology, neurology and cardiac applications.

To further enhance accuracy, Siemen’s Symbia T Series SPECT/CT offers an HD SPECT/CT detector that utilizes highly integrated detector electronics, collimators and photomultiplier tuning for high-quality image detection, according to Siemens.

Reducing exam times and dose continue to be key concerns in this market as well. In June 2012 GE released the Optima NM/ CT 640, a low-dose, fast rotation SPECT/CT hybrid system that can cut image acquisition times for certain scans from 39 minutes to 22. The Optima was rolled out with the ability to purchase upgrades in the future.

Despite the reimbursement code issue, some experts are optimistic about the eventual adoption of SPECT/CT. “PET/CT blew away PET alone and we’re going to see that with SPECT. I think anyone who can afford to purchase SPECT/CT would prefer interpreting images on it,” says Goldsmith.

Whether SPECT is going to go the way of the dinosaur in the future is still an open debate and depends largely on whether manufacturers are willing to invest in new technological innovations for these systems, according to experts.

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