by Wayne Webster

Positron Emission Tomography (PET) has become an accepted component of clinical patient imaging over the past six years. In oncology, neurology and cardiology PET is known and understood. Most believe that PET's future in Radiology is well established.

Within this discussion I will attempt to demonstrate that PET is nearing the end of its life cycle and will be replaced for most if not all of its clinical uses within the next few years.
To understand PET's future we need to understand its past. In 1985 PET was a research device and it remained this way until 1999 because there was no reimbursement by Medicare or almost any other payer worldwide.

Unfortunately for the companies involved with the development and production of PET imaging devices--CTI, Scanditronix, and Philips--limited reimbursement dramatically restricted the number of PET scanners sold.

Why was PET struggling for acceptance by the payers? Nuclear medicine and radiology were growing. PET was a nuclear medicine technique. What was wrong?

In retrospect, the answer is apparent. The isotopes used in PET whether Fluorine-18 as 18FDG, nitrogen-13, carbon-11 or oxygen-15 have half-lives ranging from 2 hours to 2 minutes respectively. The isotopes that made PET attractive as a research and clinical imaging tool were at the core of the problem. Even though PET is a nuclear medicine application, because of the short half-lives of the isotopes it didn't fit the well established nuclear medicine business model.


THE NUCLEAR MEDICINE BUSINESS MODEL


In nuclear medicine a large centrally located radiopharmaceutical vendor develops and distributes product either to a local nuclear pharmacy or directly to the end-user. This is all possible because the half-lives of the isotopes used in standard nuclear medicine range from 6 to 73 hours.

The longer half-lives of single photon isotopes allow for the efficient production and distribution of radiopharmaceuticals over large distances. The radiopharmaceutical manufacturer supports the product with marketplace education (for end user business growth), FDA approval and most important a ready-to-inject dose.

For the nuclear medicine end-user this business model provides real benefits. Without the need to make or compound their own radiopharmaceuticals the nuclear medicine imaging clinic can focus on developing a practice, eliminate inventory risk and remove the need for high-level personnel for the preparation of doses.

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