pres et new 04.05.2008
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SPATRANSCRIPT
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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
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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
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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
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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
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05/05/2009 Prepared by Liv B. Østberg MBE 5
PET SCAN
•Cancer cells more “hungry”•Hot spots
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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”
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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
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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?
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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
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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
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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
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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
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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
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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
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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
mb
er o
f ex
amin
atio
ns
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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?
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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
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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..
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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