Advancements in PET CT

Advancements in PET CT. PET-CT designs have evolved due to improvements in performance of individual CT and PET components and enhanced software integration, says Rajib Karmakar.

What is driving the growth of PET CT market? The rise in incidence and prevalence of diseases, both malignant and non-malignant, infectious, Alzheimer, and cardio vascular diseases drive the market. In addition, the growth of geriatric population that is susceptible to taking medications for their wellbeing is expected to fuel the growth of the market. However, the high cost of PET-CT scanner is anticipated to restrict the market growth By geography, the global PET-CT scanner device market is segmented into North America, Europe, Asia-Pacific, and LAMEA. Asia-Pacific held the largest share of the market in 2016, followed by North America.

In addition, Asia is anticipated to be the fastest-growing regional segment during the analysis period. The key factors that drive the growth of the market include increase in pool of patient population, growth in prevalence of infectious and chronic diseases, and rise in government investments for the development of better healthcare facilities and R&D. Asia-Pacific is expected to emerge as the area with maximum growth potential due to the focus of key players in the emerging economies and improvements in healthcare infrastructure.

Increase in Prevalence of Diseases 

In the past few decades, increasing prevalence of diseases cases have reached an alarming proportion due to rise in morbid lifestyle. It is estimated approximately 46.8 million people worldwide were living with dementia in 2015. And this number is anticipated to increase to 74.7 million in 2030. According to the WHO, approximately 36.7 million people were reported living with infection (HIV/AIDS) worldwide in 2016. The high-tech imaging technology of PET-CT scanner provides early detection, accurate staging and localisation, and precise treatment and monitoring of the diseasesthereby giving patients a better glance of treatment outcome, disease detection, as well as avoid unnecessary procedures. This is anticipated to boost the market growth in the future.

Large Pool of Geriatric Population 

The global geriatric population has increased significantly and is vulnerable to various diseases and disorders, such as cancer, Alzheimer, HIV, and cardiac disorders. Geriatric population is particularly vulnerable to various diseases and has a high incidences of acquiring diseases compared to other age group. The escalation in rate of the geriatric population is expected to raise the demand for diagnosis, thereby driving the PET-CT scanner device market.

Technological Advancements 

Technological advancements in PET-CT scanner result in added features such as high image resolution and contrast, time-of-flight acquisition, improved large field-of-view imaging, low FDG dose and faster acquisition. For instance, in 2014, Philips developed the world's first and only digital PET-CT scanner Vereos PET CT systems, which enables scans within 5 mins, gentle system warm-up, automatic standby for reduction in power consumption, and have Guardian Program that predicts system issues before they occur and lowers cost related to unplanned downtime by 43%.

How the PET CT technology has evolved?

In the past years, PET/CT designs from all vendors have evolved, mainly because of improvements in the performance of the individual CT and PET components and enhanced software integration. The need for high-speed CT, driven mainly by the cardiology market, has seen the original two- or four-slice scanners replaced with 16, 40, 64 and 128 slices/rotation models, and also developments in PET crystal and hardware have resulted in improved lesion detection, efficiency and accuracy. PET CT design is continually being innovated. The newer technology enables more precise measurements of metabolic processes and data quantification, including assessment of neurologic disease, malignant, non malignant, infectious and cardiac perfusion and viability.

In the past years, Time Of Flight (TOF) technology for PET is designed to enhance image quality by reducing image artifacts, providing higher sensitivity and lesion localisation (location of annihilation). Most recently, a new generation PET CT scanner has been designed based on detector technology, detector material and data acquisition methods called Digital PET CT system, utilising DPC (Digital Photon Counter) photodiode detectors that will further improve technical performance. The resulting images help clinicians better detect and locate lesions to increase diagnostic confidence and preserve healthy tissue during treatment with lower FDG dose and faster acquisition time.

The hybrid technology has widely been accepted by oncologists, cardiologist and neurologists all over the world, thereby validating its excellent technical performance, clinical utility and scientific potential. So much so, in fact, the main imaging vendors in the market are no longer producing standalone PET scanners and, consequently, only PET CT machines are now sold new into the market. As a consequence of the great improvements in technology and growing evidence that a PET CT examination demonstrates superior diagnostic performance over separate PET and CT exams that are interpreted side by side, there has been significant growth in the usage of PET CT in clinical practice. PET CT is the full-performance dualtechnology medical imaging modality. As such, it opens up a whole new dimension of possibilities for technological development in medical imaging.

In which areas, is PET CT being used? 

PET scans are most commonly used to detect malignant and non malignant disease, infection imaging, cardiac viability and perfusion imaging (non-invasively) and brain disorders. The majority of these PET scans are performed to evaluate cancer using the glucose analog fluorine-18 fluorodeoxyglucose (F-18 FDG). In most cases, cancer cells are more metabolically active and divide more rapidly than normal tissues. By using radiopharmaceuticals that target physiological parameters such as glucose metabolism, PET enables imaging and quantification of cellular function and tumor detection. This approach has several potential advantages over anatomical modalities such as computed tomography (CT). CT imaging relies on size and architectural changes to diagnose malignancy, which limits sensitivity and specificity.

How does one ensure quality of clinical outcomes by using this diagnostic procedure? 

PET CT is the full-performance dual-technology medical imaging modality in one umbrella and PET CT procedure covers whole body scan of the patients which includes from brain to mid thigh, the PET gives functional information of tissue while CT gives anatomical information of same tissue. On fusion of function, information image over anatomical tissue images results in dual function and exact location is obtained in one go and help in improving diagnostic accuracy and outcome which is quite difficult with standalone modality like CT, MRI and PET.

What kind of trained personnel should man the department? 

PET CT scans require unsealed radiation emitting isotope medicine (radiotracer) FDG, and from radiation safety point of view, always trained staff can work in such a facility. In India, regulatory body AERB, responsible to issue license to run such facility under the safety control, and regulations demand the presence of a full-time nuclear physician (DRM, DNB or MD in Nuclear Medicine), qualified NM Physicist (MSc Nuclear Medicine) and RSO (MSc Nuclear Medicine) approved by the AERB and entire facility should register under ELORA AERB with individual radiation professional identity number.

What are some of the key challenges that a PET CT centre usually face? 

The key challenges that PET CT facility usually face are: 

1. Infrastructure: There is a dedicated layout plan for PET CT facility from the AERB, the construction of such facility requires huge investment and step wise approval, and a mild deviation in the plan results delayed approval for machine installation. 

2. Qualified man power: Qualified manpower is mandatory, otherwise the AERB won’t give license to run the facility and to procure FDG from the regional medical cyclotron centre. 

3. Availability of FDG medicine: PET CT examination requires FDG medicine to perform scan and FDG is a radioactive medicine with half life of 110 min (it become half of its original value in every 110 min). The FDG preparation needs dedicated medical cyclotron machine which is three to fur times costlier than PET CT scanner, putting a cyclotron along PET CT is not viable due to cost reason, that is common in government setup but not in private set-up. There is a number of commercial cyclotron facility in different parts of India and every cyclotron facility supply FDG to 10 to 20 PET CT centres under the supervision of the AERB. Due to limited number of such cyclotron facility, many parts of India does not have any PET CT centre especially in remote and rural areas.

4. Cost: One of the big challenge is cost, as a PET CT scanner itself very costly equipment and then there is infrastructure cost, qualified man power and running cost. 

5. Regulatory policies: The AERB regulatory policies are very strict and violation as such results in license cancellation and it requires renewal of licenses and NOC on a yearly basis for any change in the practice cause delaying in license.

What measures can be taken to make PET CT more affordable? 

In the recent past, a number of PET CT facilities has come up in different parts of India, and this has resulted in reducing cost. As per the current scenario, the PET CT cost is almost similar to MRI and CT angiography procedure,. Earlier, this was three to four times. Many new radio tracers which do not requires any cyclotron are coming to clinical practice and this might replace the FDG by about 50 to 60%, as NM researchers are claiming that every PET CT facility would be able to prepare medicine in-house and that is going to make the technology more affordable.

Sources: Healthcare Radius, July 2018

Tweet

Subscribe to receive free email updates: