A few leading hospitals share details about their unique PET CT

A few leading hospitals share details about  their unique PET CT. PET-CT imaging system is moving toward low radiation and better imaging. By identifying body changes at the cellular level, PET may detect the early onset of disease before it is evident on other imaging tests. Here’s a look at the PET CTs of a few leading hospitals:

Aster Medcity

Type of PET CT being used: The group uses Time of Flight (ToF) PET CT with 16 slice from Philips - Philips TruFlight Select at Aster MIMS, Calicut and Aster Medcity, Kochi. 

Procedures for which PET CT is used: 

• Whole body PET CT Scanning using FDG 

• PSMA PET CT scanning using Gallium 68 

• Ga-68 DOANOC PET CT for Neuroendocrine tumours 

• Simulation procedures for radiotherapy planning 

Number of patients that use PET CT on a monthly basis: Around 175 

Type of isotope used: Fludeoxyglucose , FDG (F 18) and Gallium 68

Steps to ensure quality of clinical outcomes by using PET CT: Staging and care of plan, during treatment interim PET CT, change protocol based on it Eg: lymphoma, end of treatment - evaluate the efficacy of chemo/RT . plan for continual treatment, follow ups. 

Says Gopinath M, Chief Medical Physicist, RSO & Senior Manager Operations, Aster Medcity, Kochi, “PET CT has an important role in the entire course of treatment starting from staging and developing a plan of care, to know the response during treatment and post treatment and for follow-ups.” 

Onsite or Offsite Cyclotron: Offsite. “We have a Cyclotron facility in Ernakulam (Molecular Cyclotrons) and in case of non availability, we procure from Bengaluru,” says Gopinath. 

Precautions taken to ensure safety of personnel manning the department: 

a) Continuous training on safety aspects - Sensitising, Awareness and safe handling 

b) Qualified staff 

c) Personnel Radiation Monitoring services 

d) Personnel Radiation Protection Equipments 

e) Facility Design - Fume Hoods / Delay Tanks / CCTV Monitoring/ Structural Shielding etc 

f) Spill management mechanisms and personnel decontamination facilities like eye wash/ shower etc g) Access control to the Nuclear Medicine Facility - Double lock mechanism 

h) Strict adherence to Regulatory guidelines and protocols (AERB / IAEA ) 

Trained personnel manning the department: 

a) Nuclear Medicine Physician: MD in Nuclear Medicine Dip NB in Nuclear Medicine Diploma in Radiation Medicine Fellow in European Board of Nuclear Medicine 

b) Medical Physicist and RSO L III MSc in Radiation Physics / RSO L III certification from AERB PG Dip in Radiation Physics 

c) Nuclear Medicine Technologist DMRIT (Diploma in Medical Radiation Isotope Technology) B.Sc MRIT 

Suggestion to make PET CT more affordable: Says Gopinath, “Having a cyclotron in the city or nearby areas reduces consumable cost and ensures more equipment utilisation. To improve utilisation, one can make referral pattern with peripheral hospitals than increasing the number of PET CT units in same city. Also, R&D in developing indigenous PET CT reduces the capital investment."

American Oncology Institute

Type of PET CT being used: Discovery IQ 3-Ring 16-Slice PET CT, manufactured by GE Healthcare. The 1st PET CT of the group, Discovery-600 from GE installed, was installed in Hyderabad in 2011. According to Nilesh Gupta, Zonal Director, American Oncology Institute, “Currently, we have five installations of these PET CTs in South Asia and about 8-10 more will get installed at various locations over the next 18 months.” 

Number of patients that use the PET CT on a monthly basis: About 300. 

Type of isotope used: Major consumption is of 18F-FDG (>95%) & few units of 18F-NAF. On-site or off-site cyclotron: “We do not have cyclotron either onsite / offsite,” says Nilesh. 

Procedures for which the PET CT is used: “In our institute, PET/CT is mainly used for performing oncologic whole body PET/CT studies (more than 90 %) for patients with diagnosed cancer. We also perform studies for diagnosing and understanding clinically challenging non-oncology diseases including PUO, vasculitis, sarcoidosis etc,” says Nilesh. It is performing FDG PET/CT, which is a proven diagnostic modality for:

1. Accurately staging the cancer and thus impacting the treatment plan in up to 15-45 % of patients (depending on type of cancer) as compared to conventional imaging 

2. Better assessment of response to treatment 

3. Identifying recurrence of cancer at early stages 

4. Long-term surveillance of patients who received treatment for cancer 

5. Diagnosing certain rare clinical conditions in non-oncology patients that otherwise are not identified by conventional modalities (CT, MRI etc) 

Precautions taken to ensure the safety of personnel in the department: The departments are manned with personnel who are well-trained in radiation safety standards. They are equipped with all essential radiation safety equipment (radiation monitors, Lead aprons, lead bins, lead shielded doors etc.). “Also, we ensure that policies for standard operating procedures are followed strictly while handling radioactive material and radioactivity administered patients. An institutional radiation safety committee is constituted and meetings for appraising the safety status and updating the SOPs are held at regular intervals,” says Gupta. 

Trained personnel manning the department: The departments are headed by a qualified and trained nuclear medicine physician, who supervises the work flow of the department. It also has: 

1. A qualified radiation safety officer for supervising the safety and regulatory aspects, 

2. Two trained technologists for performing the PET/CT studies and 

3. Additional support staff trained specifically for handling patients scheduled for PET/CT (including a patient coordinator, dedicated nursing and housekeeping staff).

AMRI Hospitals

Type of PET CT being used: Fluorodeoxyglucose (FD)PET-CT from GE at the Dhakuria unit of the group. It was first installed in 2011 which was first in Kolkata. Later, it was re-installed in October, 2014. 

PET CT is used for: For different type of oncological indication like staging, response assessment, detection of recurrences and re staging. However, in recent years, it has gained considerable attention in non-oncological purpose like detection for pyrexia of unknown origin, assessment of dementia and cardiac viability. 

Number of patients that use the PET CT on a monthly basis: Around 100 patients. 

Type of isotope used: Fluorodeoxyglucose (FDG) 

On-site or off-site cyclotron: It has an offsite cyclotron at Rajarhat, Kolkata, established by a joint venture of EKO and Siemens. The cyclotron serves all the centres in Kolkata. 

Precaution taken to ensure the safety of personnel and the facility in the dept: Says Dr Anirban Mukherjee, Nuclear Medicine, AMRI, “The department has a dedicated radiation safety officer for nuclear medicine who ensures proper operation from radiation point of view. Regular training of staffs and concerned personnel has also been taken by the physician associated with the department.” Suggestion to make PET CT more affordable: Says Dr Mukherjee, “Decreasing the cost of FDG, the main isotope used for PET-CT, will help decrease the cost of PETCT. Also increase in the number of patients will help in decreasing the cost of the procedure.”

Sources: Healthcare Radius, July 2018

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