AN INTRODUCTION TO PET-CT SCANNING Ray Murphy Chair – MCCN Partnership Group

PET-CT Scanning A PET-CT scan is a diagnostic imaging tool used in the investigation of cancers It is a two fold process by which the anatomic detail of the CT scan (Computerised Tomography) is combined with the glucose uptake detection of the PET scan (Positron Emission Tomography). This give a very accurate determination of the disease and identifies small metastases that would be undetected by CT alone

PET-CT Use Cancer diagnosis and treatment planning are the main uses for PET-CT, which may : Identify cancer earlier than other imaging technologies Distinguish between malignant and benign tumours Determine the location and extent of cancer indicating spread to other areas of the body such as lymph nodes, liver or bones (metastatic disease) Identify recurrent cancer distinguishing it from scar tissue or fibrosis Demonstrate the response of cancer to treatment

PET-CT Scan

Lung Tumour

Metastatic Spread

Response to Treatment

Merseyside and Cheshire PET-CT Service The Merseyside and Cheshire PCTs are part of the Department of Health’s national contract for the provision of PET-CT services We are now in year 3 of a 5 year contract in which Alliance Medical are the providers of a mobile PET-CT service The mobile units visit two sites, Broadgreen in the north and Clatterbridge in the south The planned number of scans is in the order of 2000 per year in this Network

Current Criteria All lung cancer patients suitable for radical surgery or radiotherapy. Also for patients post radical therapy with suspected disease relapse when detection of recurrence would affect management All lymphoma patients All patients with anal cancer suitable for radical radiotherapy Patients with colorectal cancer who are considered for radical treatment with a prior history of colorectal cancer and proven or suspected disease relapse, and patients with synchronous metastases at presentation potentially suitable for resection Oesophageal cancers

Current Criteria (cntd…) Some head and neck, melanoma and brain tumours All patients with gastro intestinal tumours unsuitable for complete surgical resection In patients with locally extensive uterine carcinoma (cervix/endometrium) which is potentially curable by exenterative surgery In patients with intrahepatic cholangiocarcinoma or gallbladder carcinoma which is potentially curable by radical surgery Patients with suspected tumour relapse not confirmed on conventional scanning, when detection would alter therapy and outcome

The UK PET-CT Advisory Board have recently made their recommendations Estimated number of cases for England Lung cancer 10,000 12,500 Lymphoma 15,000 20,500 Colorectal 5,000 3,125 Anal - 75 Oesophageal 2,000 3,500 GIST Melanoma - 1,500 Paraneoplastic syndromes - 75 Brain/spinal Head & neck 3,000 1,500 Suspected relapse unconfirmed on conventional scanning - 3,000 Cervix/endometrium Cholagiocarcinoma/gall-bladder Contingency studies (15%) - 5,000 Total 35,000 52,550 Number per million population 800 1,000

Alliance Medical Service Operates from mobile units at both Clatterbridge and Broadgreen Has a requirement to scan a patient within 5 days of their referral Uses several local NHS radiologists reporting the finding of the scans Has a requirement to return the images and the reports to the referring clinician within 2 days of the scan

Activity Levels In the first year of the contract the level of activity performed was far lower than the levels contracted for, mainly due to a lack in clinical confidence in the service following an initial reporting problem and the time take for the reports to be returned to the MDTs This year the activity levels have risen far closer to the planned levels More patients are scanned at Broadgreen that Clatterbridge but work is underway to balance this out

The number of scans performed on the Broadgreen site

The number of scans performed on the Clatterbridge site

The percentage of reported returned to the referring Trust within 2 days

Patient Satisfaction

Mobile PET-CT Scanners

Service Issues One of the local residents adjacent to the Broadgreen site has been throwing fruit and vegetables at the scanner. This is in protest to the noise and timing of the scanner movements. The Trust and AML have agreed a compromise with the individual and the problem seems to be resolved.