Eventually in 1999 limited Medicare reimbursement for PET applications using 18FDG began. Over the next four years a number of indications were added. These expanded the usefulness of PET for diagnosing and staging various cancers. Unfortunately in choosing the FDA approval path the PET equipment vendors had unwittingly prevented any future expansion beyond those applications using 18FDG.

The sales of PET scanners in 2000, and two years later hybrid PET/CTs, accelerated on the news of Medicare reimbursement. Everyone believed that PET had arrived. The vendors compared the future sale of PET scanners to that of MRI.


But the equipment vendors were not considering these limitations of PET imaging:
-Short half-lives eliminated large-scale production and distribution of radiopharmaceuticals by centralized vendors.
-The short half-life of PET isotopes limited the delivery area for a nuclear pharmacy. A one-half hour driving radius in any major metro area can be less than 10 miles.
-The process that resulted in the approval of 18FDG by the FDA now demanded that all other PET radiopharmaceuticals be subjected to the same rigorous, high-cost regulatory process.


There was something else that would change the future potential for clinical PET imaging. As a research tool PET was lauded for its ability to take quantitative physiological measurements. The image that the PET scanner produced was interesting but not as important as the measurement of the uptake of the various PET radiopharmaceuticals like 18FDG.

As PET transitioned from being a research instrument to a clinical tool, its ability to take quantitative measurements became less important. It took too much time to take such measurements in an environment driven by throughput. As PET became more valued for the images it took than for the measurements it could make, its usefulness was diminished.

Another reason for the change in focus for PET from that of a quantitative measurement device to a qualitative imaging device may be due to the other PET isotopes and their radiopharmaceutical derivatives not being available. Therefore the only avenue that could be used for PET was as a qualitative clinical imaging device. No matter the reason, PET has been limited by many factors. These all lead to the replacement of PET with another modality.

If you still doubt that PET will be replaced with something else, let's examine how the equipment vendors have managed PET's life cycle.

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