Dear all,

I am currently an undergrad “Granny” student of diagnostic 
radiography  – am very interested in comparative research on referral 
procedures for PET scans in the diagnosis of cancer in various 
countries, in particular within the EU and Asia.  Am not sure if this 
is of any interest to members, but if anyone has any thoughts or 
comments on this recent news release, I would be delighted if they 
would be shared (either by emailing myself or all list members):  

“PET affects treatment in over a third of cancer cases”

http://www.diagnosticimaging.com/showNews.jhtml?
articleID=206905457&cid=DIMAG-news-weekly-04108

... perhaps a quick (multi-disciplinary) brainstorm on the key factors 
influencing how "welcome" PET scanning/other diagnostic technologies 
are (in your country)? 

Best wishes,
Ella 

PET affects treatment in over a third of cancer cases
A study based on nearly 23,000 patients at 1200 U.S. healthcare 
facilities has found that FDG-PET or PET/CT led referring physicians 
to alter their opinion about the optimal treatment for about 37% of 
cancer patients. 
The results summarize the first-year experience of the National 
Oncology PET Registry, an effort that is measuring how numerous cancer-
related PET applications that have conditional approval for Medicare 
payment influence patient management. 
NOPR was organized in 2005 as a negotiated compromise between the 
Academy of Molecular Imaging and Medicare. AMI supported payment for 
more cancer-related PET indications beyond the nine procedures 
approved for Medicare beneficiaries up to that time. Medicare's 
administrator, the Centers for Medicare and Medicaid Services, 
responded with a Coverage with Evidence Development ruling that 
temporarily granted payment but required more research to determine 
PET's clinical influence. 
The American College of Radiology Imaging Network acted as the 
research agency for the resulting patient registry. NOPR began 
compiling data on May 8, 2006, for FDG-PET procedures performed on 
patients with brain, cervical, ovarian, pancreatic, small cell lung, 
testicular, and other cancers not already covered by Medicare. 
Indications included staging, restaging, diagnosis of suspected 
recurrence, and therapy monitoring 
Medicare paid for individual FDG-PET procedures only after 
confirmation that the referring physicians had completed and filed two 
web-based surveys with NOPR. One described the physician's management 
plan before FDG-PET was ordered, and the other covered PET's effect on 
decision making after its findings were known. About 86% of the 
studies were performed on a PET/CT scanner, with the remainder scanned 
on a dedicated PET platform. 
Based on the first year of data collection, registry results reported 
in the March 24 Journal of Clinical Oncology show that PET has a 
substantial effect. Lead author Dr. Bruce Hillner, a professor of 
medicine at Virginia Commonwealth University, found that a major 
change in intended management occurred in 30.3% to 39.7% of the cases, 
depending on the indication. 
The findings confirmed the results of numerous small clinical trials 
that evaluated the effect of PET on staging and restaging for various 
types of cancer, according to coauthor Dr. Anthony Shields, a 
professor of medicine and oncology at Wayne State University in 
Detroit. 
"They all came pretty much to the same conclusion. PET will change the 
treatment plan from 30% to 40% of the time," he said. 
Data from the NOPR also showed that referring physicians were three 
times more likely to shift from nontreatment to treatment after PET 
imaging than vice versa (28.3% versus 8.2%). PET was associated more 
frequently with upstaging than downstaging. 
PET had a big effect on biopsy recommendations. Referring physicians 
were inclined to recommend biopsy for 15% of the cases before PET, but 
for only 3.8% after the PET results were appreciated. 
Referring physician confidence in PET appeared to be high. Hillner and 
colleagues reported that a recommendation for some other form of 
imaging was the most popular strategy before PET. But afterward, the 
strategy shifted to either pursuing specific therapies or watchful 
waiting. 
The results are powerful enough for CMS to raise its restrictions on 
payment for PET imaging for staging, restaging, and diagnosis of 
suspected recurrence, said coauthor Dr. R. Edward Coleman, director of 
nuclear medicine at Duke University Medical Center. 
"Any study that changes management more than a third of the time is 
making a major impact on how these patients are being cared for. We 
think it does support our request for reimbusement," he said. 
He expects an application will be submitted within a few days of the 
article's online publication March 24. The Academy for Molecular 
Imaging will file that application, Hillner said. 
Data concerning the effect of PET as a therapy monitoring tool have 
been set aside for future analysis, he said. 
"Except for breast cancer, PET hasn't really been used often to 
monitor therapy," Coleman said. "We have results for several thousand 
studies, but we thought that data deserved their own evaluation. It 
should be completed in a few weeks. 
The future of NOPR is ultimately in the hands of CMS, Hillner said. 
Because of residual questions concerning value of PET for therapeutic 
monitoring, the registry is likely to continue for at least another 
year. 
For more information from the Diagnostic Imaging archives: 
PET alters management for one in three patients 
NOPR paperwork bedevils payment for PET applications 
Launch of registry aims to advance PET reimbursement 

-- By James Brice