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
2005
2009
Lung cancer
10,000
12,500
Lymphoma
15,000
20,500
Colorectal
5,000
3,125
Anal
Oesophageal
2,000
75
3,500
GIST
-
625
Melanoma
-
1,500
Paraneoplastic syndromes
-
75
Brain/spinal
-
150
Head & neck
3,000
1,500
Suspected relapse unconfirmed on conventional scanning
-
3,000
Cervix/endometrium
-
500
Cholagiocarcinoma/gall-bladder
-
500
Contingency studies (15%)
-
5,000
Total
Number per million population
35,000
52,550
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
Broadgreen (North West SHA)
Contracted
Actual
140
120
100
80
60
40
20
0
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
The number of scans performed on
the Clatterbridge site
Contracted
Clatterbridge (North West SHA)
Actual
70
60
50
40
30
20
10
0
Jan
Feb
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
The percentage of reported returned
to the referring Trust within 2 days
Broadgreen
Ja
n
ec
D
ct
ov
N
O
D
N
O
Ju
ly
A
ug
Se
pt
0%
M
ay
Ju
ne
0%
pr
20%
A
20%
M
ar
40%
Ja
n
40%
Ja
n
60%
ec
60%
ov
80%
ct
80%
Ju
ly
A
ug
Se
pt
100%
M
ar
A
pr
M
ay
Ju
ne
100%
Fe
b
120%
Ja
n
120%
Fe
b
Clatterbridge
Patient Satisfaction
Satis factor y
V e r y Good
Exce lle nt
Broadgreen Patient Satisfaction Survey Results
120%
100%
80%
60%
40%
20%
0%
Ja n
Fe b
Ma r
Apr
Ma y
June
July
Aug
Se pt
Oct
Nov
De c
Ja n
Satis factor y
Ve r y Good
Exce lle nt
Clatterbridge Patient Satisfaction Survey Results
120%
100%
80%
60%
40%
20%
0%
Jan
Fe b
Mar
Apr
May
June
July
Aug
Sept
Oct
Nov
Dec
Jan
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.