Positron Emission Tomography (PET)
PET Activities in INAHTA
Presented below is an overview of activities in INAHTA related to assessment and/or implementation of PET (Positron Emission Tomography). These activites are listed in the following order (click to jump to that item):
- INAHTA Joint Project on PET (1999 & 2006 update) and INAHTA workshop on PET (2004)
- PET survey from KCE (Belgium)
- PET project at NCCHTA (UK)
- PET project at MAS (Canada)
- PET updates from three agencies: ICTAHC (Israel), CADTH (Canada) NIHR (UK), UETS (Spain) and DH (Australia)
INAHTA Joint Project on PET (1999): Experience with PET and Synthesis of the Evidence
At the fifth Annual Meeting of INAHTA in 1997, members initiated a joint project on PET scanning in clinical medicine in response to a growing interest in the technology worldwide. INAHTA members have experianced different motivations or hindrances to the diffusion on PET, and their assessments reflect different lokal health care system environments. The goal of this collaboration is to synthesize the range of approaches and assessment questions into a broadly applicable document that will expand the scope of individual agencies' assessments, and, ultimately, strengthen the support for policy and regulation of PET.
Update on INAHTA's joint project on PET (2006)
Part 1 of this Joint Project report presents survey results on diffusion, assessment activities, and policy for clinical use related to PET among INAHTA members since 1999. Part 2 of this updated Joint Project report summarizes HTA-based strategies for directing the clinical use of PET and a discussion on the value of HTA in managing the diffusion of high cost diagnostic technologies, which were presented at an INAHTA-sponsored workshop at the HTAi Annual Meeting in 2004 on strategies for managing high cost diagnostic technologies.
INAHTA Workshop on PET
This workshop was held on May 30, 2004 at the HTAi Annual MEeting in Krakaw, Poland. The workshop presented: 1) survey results from the INAHTA joint project on diffusion, evaluation and policy implementation of PET within its members' healthcare systems; 2) case examples from INAHTA members of policy implementation, including assessment strategies that are helping to define PET's benefit to patient care.
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In the context of an HTA on PET scanners in Belgium, KCE is updated the results of the INAHTA survey presented in 2004. This survey showed that Belgium is the leading country in terms of number of PET scanners per million population. However, in most other countries things are moving fast in the PET-field. Therefore, KCE surveyed countries, which participated in last year's survey, on actual situation, their future plans, how decisions on planning are taken, decision process, major stakeholders in the demand for PET-scanners, and on the provision of PET-tracers.
The report was published in 2005 by KCE, which describes the current Belgian situation of PET and formulated recommendations for planning and financing.
Survey Questions used:
KCE survey questions used:
- How many PET scanners are currently operational in your country (total number + number per million population)?
- How many more PET scanners are planned for the future, within which time frame are these meant to become installed?
- Who were the most important stakeholders in the demand for more PET scanners (patients, oncologists, hospitals,…)?
- How was the decision on the number of PET scanners needed made (which information was taken into account; which aspects were considered to be important for the number of PET scanners needed in your country).
- Facultative: Has there ever been a discussion in closing down existing PET scanners in your country and how was it handled?
- Facultative: How is the provision of the PET-tracers organised? How many cyclotrons are there in your country? Are they located in the close neighbourhood of the PET-scanner or does one cyclotron supply multiple PET scanners?
Project title: Overview of the clinical effectiveness of positron emission tomography (FDG-PET) imaging in selected cancers
The aim of this study was to provide a robust systematic review of the clinical effectiveness of Positron Emission Tomography imaging using 2-18F-fluoro-2-deoxy-D-glucose (FDG-PET) in the management eight specific cancers (breast, colorectal, head and neck, lung, lymphoma, melanoma, oesophageal and thyroid). Cancer management decisions of diagnosis, staging and progression (including recurrence) will be evaluated in detail. The newer use of therapy response will be considered in the discussion. This systematic review built on systematic reviews published since 2000 and augment them with English and European primary studies published up to August 2005. All studies on the newer combined technology of PET/CT were summarised separately, as will any economic evaluations.
Link: More about the project
- A Prospective Cohort Study to Determine the Sensitivity of PET in Detecting Metastatic Cancer in Neck Lymph Nodes in Patients with Squamous Cell Head and Neck Cancer Managed with Primary Radiation Therapy (PET PREVENT Study)
- The Impact of PET Imaging in Stage Three Non-Small Cell Lung Cancer: A Prospective Randomized Clinical Trial. (PET START Trial)
- The Impact of PET Imaging in Staging Potentially Surgically Resectable Non-Small Cell Lung Cancers: A Prospective, Multicenter Randomized Clinical Trial (ELPET Trial)
- A Prospective Study to Determine the Role of 2[18F] Fluoror-2-deoxy-D-glucose PET in the Assessment of Regional Nodal Spread of Disease in Breast Cancer Patients (PET PREDICT Study).
- The Impact of PET Imaging Prior to Liver Resection for Colorectal Adenocarcinoma Metastaes: A Prospective, Multicenter Randomized Clinical Trial (PET CAM Trial)
- PET For the Investigation of Solitary Pulmonary Nodules (SPN) and Biomarker Positive-Anatomical Imaging Negative (BMPAIN) Thyroid, Germ Cell, and Colorectal Cancers: A Registry Study.
- There are other PET research studies being conducted in the province that are not being directly funded by the Ministry of Health and Long-Term Care (e.g. cardiac PET research at the University of Ottawa Heart Institute and PET research at the Centre for Addiction and Mental Health).
In Israel, special medical devices represent a large economic cost and therefore are a burden on the budget of the MOH. These devices are authorized by the Technology Division at the MOH. Evaluations have been conducted to estimate the national needs for PET in Israel. This work has not yet been completed.
It appears that in Israel we shall continue to limit the number of devices according the basic principles of CON (Certificate of Need) enacted here in Israel for large expensive medical devices. This report also relates to the mapping of indications and it seems that PET will be replacing other forms of imaging devices for certain indications.
CADTH has conducted an extensive literature review of all indications for which PET is potential.
CADTH has published an issue of the Health Technology update Newsletter (issue 8, January 2008) that contains a feature on PET in Canada (location of PET & PET/CT units and cyclotrons, provincial funding for PET scans and information on licensing of radiopharmaceuticals in Canada).
Newsletter available here:
A framework for the development of PET scanning services in England has been developed by the Department of Health at the request of Strategic Health Authorities and specialised commissioning groups. It is intended to guide commissioners and potential providers of services by providing advice on the current evidence of benefit from PET scanning; the current state of the technology; the number of scanners likely to be required; workforce and training issues; capital and revenue costs and further research and evaluation.
English summary of the review "Effectiveness and safety of Positron Emission Tomography in Breast Cancer" conducted by UETS is now available. The objective of the review is to assess effectiveness and safety of 10-FDG-PET in evaluating breast cancer in the main indications comparing the outcomes with other imaging techniques.
Summary_Efficacy and Safety of PET System in Breast Cancer