SNM Board of Directors
Arlington, VA
April 28, 2012
DRAFT
Members in Attendance:
George Segall, MD; Fred Fahey, DSc; Gary Dillehay, MD, FACNM; Dominique Delbeke, MD, PhD;
Richard Noto, MD; Ann Marie Alessi, BS, CNMT, NCT, RT(N); Brenda King, CNMT, FSNMTS; Carolyn
Anderson, PhD; Peter Conti, MD, PhD; Bennett Greenspan, MD; Hossein Jadvar, MD, PhD, MPH, MBA;
Tony Knight, MBA, CNMT, RT(N), NCT; Cindi Luckett-Gilbert, MHA, PET, CNMT, FSNMTS; Michael
Middleton, MD; Jeff Norenberg, PharmD; Harvey Ziessman, MD; Virginia Pappas, CAE
Members Not in Attendance:
Munir Ghesani, MD; Peter Herscovitch, MD; Martin Sandler, MD
SNM Staff in Attendance:
Nikki Wenzel-Lamb, MBA; Jenny Mills, Sabrina Robinson, Judy Brazel, CMP; Joanna Spahr; Bob
Milanchus; Rebecca Maxey; Sue Bunning; Bonnie Clarke; Marybeth Howlett; Pam Colman; Vince Pistilli;
Christine Cachuela; Matt Dickens
1. Welcome and Call to Order
George Segall, MD, SNM President, called the SNM Board of Directors meeting to order at 7:48am.
Richard Noto, MD, SNM Secretary/Treasurer, confirmed a quorum was present.
2. Trends in Molecular Imaging
Dr. Segall explained that there will be five industry partners providing an overview of the trends in
molecular imaging, from their perspective. Once all industry partners have had the opportunity to
present, there will be a panel discussion – which will include all industry representatives.
a. Ward Digby – Siemens
The following serves as a high level overview of the trends described by Ward Digby,
PhD, Director, Molecular Imaging Biomarker Product Management at Siemens.
i. Current Situation
a. SPECT imaging is dropping a bit in terms of equipment volume (more so
in the US than internationally)
b. PET imaging is flat (no growth)
ii. Health care reform has slowed down the purchase of equipment. Also the
economic situation has further delayed the investment of new equipment.
iii. Society was involved in assisting with reduced reimbursement – oddly enough if
reimbursement is reduced, people use the equipment more in order to
compensate for the decreasing reimbursement. This has led to impact on
cardiology environment.
iv. Future Outlook
a. New tracer development will continue to increase in Europe.
b. Launch of Amyvid and eventually other tracers for PET will help increase
imaging in the United States
c. New wave of interest from pharmaceutical companies – Siemens is
unsure of how much of the interest is just using molecular imaging
agents to learn something vs. a companion diagnostic role.
v. Role of the SNM
a. Reimbursement –If there is a way for society to work with self-referring
specialists – rather than excluding them – that would be great.
b. PET/MR – helping to explore other indications, identifying appropriate
use and guidelines and working collaboratively with Alzheimer’s
association on amyloid imaging.
b. Roy Brown and Elaine Hayes – Covidien
The following serves as a high level overview of the trends described by Roy Brown,
MBA, Director, Strategic Alliances and Elaine Hayes, Vice-President & General Manager,
Imaging Commercial Operations, Covidien.
i. Current Situation - SPECT
a. Myocardial perfusion 60% of volume
b. Drivers
i. Aging population
ii. Large installed base of SPECT cameras, advances in
camera technology
iii. Established US Mo-99 supply
iv. Diagnostic benefit of NM, cost effective
c. Restraints
i. Spending for imaging services
ii. Longer term SPECT imaging 2% growth, growth in PET and
new isotopes
iii. Radiation reduction, thallium decline accelerate over next 2
years
iv. Radiology/benefits managers and pre-authorization
v. Reimbursement
vi. Uncertainty in Mo-99 supply
d. Tc-99m procedure volume has dipped since 2009-2010 but still
dominates NM
ii. SPECT favored
a. SPECT procedure currently represent more than 88% of all nuclear
medicine studies
b. SPECT is still expected to represent 85% of the market in 2017
c. Price of PET cameras are significantly higher than SPECT cameras
iii. Working hard to develop new Mo-99 capacity for long-term benefit
iv. Role of SNM
a. Government relations activities
b. Coordination with the Council on Radionuclides and
Radiopharmaceuticals on activities of mutual interest
c. Supporting research initiatives with new PET agents
d. Need to focus on nuclear medicines core products – SPECT
e. Need to initiate comparative effectiveness studies that highlight
SPECT products
f. Assist in helping to educate Center for Medicare and Medicaid
Services on the increasing costs of Mo-99/Tc-99m
c. Piotr Maniawksi - Phillips Healthcare
The following serves as a high level overview of the trends described by Piotr J.
Maniawski, MSc, Director, Clinical Science - Nuclear Medicine, Phillips Healthcare.
i.
The number of Nuclear Medicine procedures are at best flat, the number of
indications are not changing.
ii.
Possible that PET/MR is the opportunity for something new
iii.
Patient specific outcomes – need to identify how a specific patient gained
from a specific procedure.
iv.
Phillips believes that it is essential to find a way (together) to perform
research that validates role of NM studies
v.
Opportunity to expand education globally as markets are not uniform extending the SNM membership and inviting membership beyond the US
vi.
Extending concepts that have been successfully applied with gathering of
evidence based data – NOPR type approaches beyond FDG PET. PET/MR
may be candidate for lobbying with CMS to create a database.
vii.
Role of SNM
a. Phillips and SNM share the same vision – believe that SNM, working
with industry is the right mix of knowledge, talent and passion to
make it happen.
b. SNM needs to globalize its efforts (education, guidelines, etc.)
c. Collaboration and Strategic Alliances – have engaged multiple
alliances
d. Evidence based approach
e. Concentrated focused effort on relatively small number of projects
(such as considering a strategic plan for PET/MR) and define a
roadmap/blue print for the future.
f. Show benefits of procedures that utilize radiation – need to shift
focus from being defensive to educating on the benefits of imaging
with radiation.
d. Onikepe Adegbola – General Electric
The following serves as a high level overview of the trends described by Onikepe
Adegbola, MD, PhD, Chief Medical Officer, Molecular Imaging and Executive Medical
Director of General Electric.
i. Overall, there has been a downward trend in the nuclear medicine market
ii. GE is invested in PET – yet reimbursement for PET is challenging
iii. Opportunities
1. CZT – radiation dose reduction
2. Multi-tracer imaging
3. Health economic data/clinical evidence
4. Referring physician education
5. Emerging economies
iv. Threats
1. Consolidation and merger of physician practices, hospital employment
2. Increasing imaging competition
3. Technetium supply
4. Radiation dose concerns
5. Economy and healthcare cuts.
v. PET Market Drivers & Limiters
1. Large unmet need for diagnostic tools in neurology and oncology
2. Well established PET infrastructure in developed markets – emerging
market investment in PET infrastructure
3. Public health focus on cost effectiveness
4. Personalized medicine drive in oncology
5. New Alzheimer’s therapeutics imminent
6. Alzheimer’s guidelines under review in US/EU, unclear role for PET
(Strong MR push)
7. PET cost barriers and regulatory uncertainty in emerging markets
reduces access
vi. Role of SNM
1. Influence coding and reimbursement policy by working with other
stakeholders – MITA, CMS, AA, health insurances plans
2. Regulatory hurdles impeding new tracers
3. Outreach and collaboration with other societies and specialty groups to
develop guidelines and education for referring physicians
4. Education and training of NM manpower
e. Colleen Glynn - Cardinal Health
The following serves as a high level overview of the trends described by Colleen Glynn,
CNMT, Sr. Director, Medical Specialty Solutions, Cardinal Health.
i. Two integrated growth platforms
1. Core pharmacy (low energy) – SPECT
2. Manufacturing and Dispensing (high energy) – PET
ii. Industry Perspective
1. Little being done to support MPI at a critical time
2. Broad spectrum of SNM activities, difficult to see progress
3. Lack of transparency in discussions w/ CMS and FDA
4. Exhibit Hall for annual meeting poorly attended
iii. Rolf of SNM
1. Leadership on radiation exposure reduction (adult weight based protocol)
2. New products
3. Public outreach – for example, physicians should submit Nuclear
Medicine information to Wikipedia to get out the correct information
4. Need to build bench strength (residents, PET certification for physicians)
3. Summary of Trends in Nuclear Medicine and Molecular Imaging
Throughout this discussion, several common themes emerged. These items, as well as the specific
focus areas are listed below (the order of listing does not indicate priority):
a. Common Themes
i.
Volume and sales have decreased since 2007, and projections for growth in
the US through 2017 are flat to minimal
ii.
The majority (85-87%) of procedures will continue to be based on Tc-99m and
other single photon agents (SPECT and planar)
iii.
Emerging markets and the US market are at different time points in
development. Education regarding the value of nuclear medicine/molecular
imaging that is evidence based is very important
iv.
More outreach is needed to patients, referring physicians, payers and
regulatory agencies.
v.
Continued emphasis on advocacy is important – CMS, FDA (and partnerships)
vi.
Health care reform is driving medicine that is evidence based and patient
centered
vii.
New tracers and new technologies will drive growth
viii.
Quality is important to drive growth
a. Training of professionals
b. Quantification
c. Standardization
ix.
Concerns about radiation safety should be addressed by dose optimization and
education about the benefits of nuclear medicine/molecular imaging
x.
Collaboration and Strategic Partnerships are very important to achieving goals
b. Focus
i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
Areas
PET/MR
PET/CT
SPECT
Tracer Development / New Products
Reimbursement
Evidence based medicine research
International outreach
Collaboration/Strategic Partnerships
The SNM Board of Directors adjourned at 12:23pm for lunch.
The SNM Board of Directors reconvened at 1:05pm.
4. Commencement
a. Approval of Agenda and Standing Rules
A motion was made to approve the SNM Board of Directors agenda for April 28, 2012.
It was moved, seconded and unanimously voted to approve the SNM Board of
Directors agenda for April 28, 2012.
A motion was made to approve the standing rules.
It was moved, seconded and unanimously voted to approve the standing rules.
b. Approval of Meeting Minutes
A motion was made to approve the February 21, 2012 minutes with changes.
It was moved, seconded and unanimously voted to approve the February 21, 2012
minutes with changes.
A motion was made to approve the March 20, 2012 minutes.
It was moved, seconded and unanimously voted to approve the March 20, 2012
minutes.
5. Strategies to Address Common Themes
Dr. Segall requested feedback from board members regarding the common themes presented by
the industry representatives.
The board agreed to focus on the following strategies:
a. Education and outreach - Back to Basics
b. Create small working group to develop a tactical plan on how we can improve quality as
well as educate value of Tc-99m based nuclear medicine using innovative and traditional
tools of education based on resources we already have.
c. Continue discussion with industry at Molecular Imaging Industry Leaders Working Group
(MIILWG) meeting at the SNM Annual Meeting.
6. Professional Standing of Nuclear Medicine Profession
Henry Royal, MD, Executive Director of the American Board of Nuclear Medicine (ABNM),
provided an overview of the current standing of the nuclear medicine profession. Currently the
ACR and SNM are not working together, nor are the ABR and ABNM on training issues.
Board members agreed that SNM should focus professional standards for quality and practice
through guidelines. There have been some challenges in working with ACR regarding Training
Task Force II.
Board members agreed that SNM should stop reacting to standards released by ACR. The SNM
should move forward in a politely assertive yet respectfully vocal manner with respect to best
practices involving nuclear medicine and molecular imaging procedures and start marketing
SNM’s guidelines as best practice for nuclear medicine and optimal patient care.
It was agreed that SNM develop several statements on quality and publish them over the next
several months. Dominique Delbeke, MD, PhD, Task Force II SNM Co-Chair will circulate a draft
Joint Position Statement on Optimizing Training in Nuclear Medicine in the Era of Multimodality
and Hybrid Imaging to the board for review. A second article, written by Richard Noto, MD, will
be published and will highlight the need for appropriate training from a radiologist perspective.
The Board will review the impact following the publication of these articles.
7. Global Outreach
Fred Fahey, DSc., SNM President-Elect, explained that during the 2020 Task Force exercise, one
of the working groups consistently identified the need to work more collaboratively with
international organizations. Over the past several years, the SNM leadership has increased their
efforts to partner with international organizations on guidelines and educational courses. In
addition, the Center for Molecular Imaging Innovation and Translation (CMIIT) is working to
develop a Global Pre-Clinical Training Curriculum.
Board members agreed that international outreach and collaboration was essential to SNM and
the future of the field, however, they noted that it was important to explain the need for
international collaboration to the membership.
8. Adjournment
A motion was made to adjourn the April 28, 2012 SNM Board of Directors meeting at 5:15pm.
It was moved, seconded and unanimously voted to adjourn the April 28, 2012 SNM Board
of Directors meeting at 5:15pm.