05/05/2009 Prepared by Liv B. Østberg MBE 1

PET Positron emission tomography

A cost-effective way to extend life length and improve the quality

of life for cancer patients

05/05/2009 Prepared by Liv B. Østberg MBE 2

THE AIM OF PRESENTATION

Overview of what PET

can contribute to in more precise cancer diagnostics

05/05/2009 Prepared by Liv B. Østberg MBE 3

Agenda

• Introduction – PET scan• A tool to fight cancer

● PET/CT can answer critical questions

3. Cost-benefit short and long term● Benefits for Physicians and Patients

4. PET in Norway and need for more capacity

05/05/2009 Prepared by Liv B. Østberg MBE 4

Introduction to PET/CT scan Positron emission tomography

Diagnostic toolNuclear medicine technology

• Find cancer early• Radioactive sugar into bloodstream

• Treatments• Chemo therapy (cytotoxin)

• Radiation therapy

• Surgery

NOK 1506

05/05/2009 Prepared by Liv B. Østberg MBE 5

PET SCAN

•Cancer cells more “hungry”•Hot spots

05/05/2009 Prepared by Liv B. Østberg MBE 6

The Needle and the Haystack

Computer Tomography

CT

Computer Tomography

CT+ PET

Positron Emission

Tomography

•Cancer cells more “hungry”•Seen as “hot spots”

05/05/2009 Prepared by Liv B. Østberg MBE 7

Two weeks after one cycle with

chemotherapy

Determinate stage - > Monitor treatment <- Change therapyExpose recurrence

Baseline

05/05/2009 Prepared by Liv B. Østberg MBE 8

PET/CT can answer critical questions

A tool to fight cancerA tool to fight cancer

Where is the tumor? Is it spreading? How large is it?

What is the optimal therapy? Is the therapy working?

Is there a recurrence? And if so, where and to what extent?

05/05/2009 Prepared by Liv B. Østberg MBE 9

A tool to fight cancerA tool to fight cancer

Results of PET scan

For 30% to 40% of cancer patients management is changed

•Painful and useless surgery is not executed

•Treatment previously regarded as useless is executed

05/05/2009 Prepared by Liv B. Østberg MBE 10

A tool to fight cancerA tool to fight cancer

Benefits for patients and physicians

•Diagnostic confidence•Monitor treatment

•Reduction of invasive procedures such as biopsies•Potential reduction of futile surgeries

05/05/2009 Prepared by Liv B. Østberg MBE 11

A tool to fight cancerA tool to fight cancer

• Cured by chemo therapy - chest• CT:

● Residual cancer ?

or● necrotic tissue ?

• Radiation therapy->heart and lung failure

Girl 16 years old -> 89 year

05/05/2009 Prepared by Liv B. Østberg MBE 12

A tool to fight cancerA tool to fight cancer

PET:PET:• Disclose need of further treatment• Avoid early death• Birthday cake

Girl 16 years old -> 89 year

05/05/2009 Prepared by Liv B. Østberg MBE 13

A tool to fight cancerA tool to fight cancer

Cost – Benefit Long term

Health economic considerations and evaluation are difficult

• Time from diagnosis to outcome• Conditions change both for treatments and

diagnostics• The patient hit by other diseases• The patient is older

05/05/2009 Prepared by Liv B. Østberg MBE 14

PET unmasks NOK 20 000

Why spend money on treatment that doesn't work?

Cost – Benefit Short term

Cytotoxin one cycle NOK 17 000 Other costs + ??? + Pain

Baseline Two weeks after first cycle of chemotherapy

PET AND CT - Transaxial slice upper abdomen

05/05/2009 Prepared by Liv B. Østberg MBE 15

PET capacity in NorwaySupply and demand

• 2008: 2 800 scans• Calculated need 30 000 scans

PET capacity in Norway

0

5000

10000

15000

20000

25000

30000

35000

Supply 2008 Supply 2009 Demand

Nu

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f ex

amin

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05/05/2009 Prepared by Liv B. Østberg MBE 16

PET capacity in NorwayMeet the demand

• Screening..• Save life and pain • Save costs• Think about:

● Can Health Authorities in other countries invested in this equipment if it is not a helpful tool to save life and money?

05/05/2009 Prepared by Liv B. Østberg MBE 17

- If this medicine doesn't help, please come back and you will get something else.- Couldn't I rather get the something else right away?

Version 1(Storm P)

inexpensive

05/05/2009 Prepared by Liv B. Østberg MBE 18

- If we don't find your tumor with CT and MRI we will order a PET/CT.- Couldn't I rather get a PET/CT right away?

Version 2(Trond 2007)

expensive and may be..

05/05/2009 Prepared by Liv B. Østberg MBE 19

- If we don't find your tumor with CT and MRI we will order a PET/CT.- Couldn't I rather get a PET/CT right away?

Version 3(Trond 2007)

Sure, and if needed we will add a PET, MR or US

within a few days

Overuse…

Principle ofLowest Level ofTreatment