The Reading Room

The present and future of PET in imaging

by Lea Halim and Ty Aderhold

Positron emission tomography, or PET, is a functional imaging technique that utilizes radionuclides to observe functional processes in the body. The PET/computed tomography (CT) combination allows for both the structure and the biochemical processes to be shown in an image, which has made PET/CT widely used in oncology. 

Though the first PET scans were conducted in the 1970s, the imaging technique did not take off until it was combined with CT around the turn of the 21st century. In fact, the PET/CT scanner was named the medical invention of the year in 2000 by Time Magazine.

Current PET/CT trends

By 2011, 90% of the PET/CT market was in the diagnoses and monitoring of cancers. Adoption of PET/CT has risen steadily in recent years, which is unsurprising given the relative newness of the technology.

The trend also surfaced in recent survey of Imaging Performance Partnership members on purchasing intent. PET/CT was the clear winner as the most likely imaging equipment to be purchased or upgraded in year 2017. However, while PET/CTs are clearly top of mind when it comes to diagnostic imaging equipment, this is not translating to actual purchasing: Only 34% of respondents were actually planning to purchase the machines.

One factor that may have prevented more imaging programs from purchasing PET/CT could be the previously high cost of PET/CT machines, which used to cost up to $3 million before necessary add-ons such as a rubidium generator.

The future of PET/CT

Looking ahead, dropping prices, increased incidence of cancers monitored by PET/CT imaging, and emergent clinical applications should mean continued growth for the PET/CT market.

Prices for PET/CT scanners have fallen to $1.5 million for entry-level machines as vendors have developed lower-cost options. Beyond these price changes, an aging baby boomer population will lead to increased patient volumes for traditional PET/CT scans to monitor and diagnose cancers. Furthermore, continued development of new radiotracers will lead to a growth in clinical applications for PET/CT. Some of these clinical applications will be in the field of oncology, but others, such as amyloid PET screening for Alzheimer's disease, will be in neuroimaging.

Overall, we project the national outpatient PET market to grow by 9% between 2016 and 2021.

A world beyond PET/CT

Finally, while PET/CT remains the dominant force in the PET world, imaging programs should be aware of the recent development of the PET/MRI scanner. While most PET/MRI scanners are used for research instead of clinical imaging, CMS has ruled that it will reimburse PET exams with MRI as the PET/CT APC rate.

One major draw of PET/MRIs is decreased radiation exposure, as a PET/MRI saves a patient from approximately 100 chest X-rays worth of radiation when compared to a PET/CT. For patients receiving repeated exams to monitor cancer, the reduction in radiation dose could be significant. However, PET/MRIs come with a much higher price tag than PET/CTs, so imaging programs should not be anticipating any major shifts from PET/CTs to PET/MRIs in the coming years.

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