Issue 1: Positron Emission Tomography Scanning in Canada

Positron emission tomography (or PET) is a nuclear diagnostic imaging tool that does not require technetium-99m (Tc-99m), the isotope used in most single photon emission computed tomography (or SPECT) scans. A cyclotron is used to manufacture the kinds of isotopes used in PET scans.

While there are publicly funded PET scanners across Canada, the necessary infrastructure is not currently sufficient for PET to replace the work of Tc-99m isotopes for heart ailments, and cancer diagnosis and staging.

In addition, up until July 2009, PET was only accessible via clinical trials for specific cancers in Ontario or via individually approved access through the Ontario PET Registry Program. Ontario has now made PET scanning a publicly insured health service available to cancer and cardiac patients under conditions where PET scans have proven to be clinically effective.

SPECT and PET are the most commonly used molecular imaging modalities.¹ They operate on the same basic design principles by providing images of the structure and function of tissue and organs that reflect biochemical processes and blood flow. The major attribute of PET and SPECT that distinguishes them from magnetic resonance imaging (MRI) and X-ray computed tomography (CT) methods is the high sensitivity with which they can detect metabolic activity and trace the concentration of specific proteins in the body.² CT and MRI, on the other hand, provide images of the structure of tissue and organs. 

Canada, unlike the US and other G8 countries, has not experienced universal clinical acceptance of PET. This is because of uncertainty about its clinical and cost-effectiveness, and the significant capital and operating costs associated with its use. This has led to a more thorough evaluation of PET’s contribution to health care sustainability and suitability for particular clinical applications.³

Back to Contents

• What is the number of publicly and privately funded scanning services in each Canadian jurisdiction?
• What is the number of annual scans funded by each jurisdiction?

The information in this report that is not referenced is based on communications with health program leaders and administrators in Canadian jurisdictions.

Back to Contents

Publicly funded PET scanners and number of annual scans

As of July 2009, there were approximately 28 centres performing publicly funded scans in seven Canadian provinces. These provinces are: Nova Scotia, New Brunswick, Quebec, Ontario, Alberta, Manitoba, and British Columbia. Table 1 provides additional information on the location of these facilities.

Nova Scotia currently has a single PET/CT scanner located in Halifax. The province funds approximately 1,500 PET scans annually.

New Brunswick currently has a single PET/CT scanner located in Saint John. Another PET/CT scanner is scheduled to be in operation by late 2010 or early 2011 in the city of Moncton. In 2008, New Brunswick funded approximately 600 PET scans. The number of PET scans is expected to double when the second PET/CT scanner becomes operational in Moncton.⁴

The province of Quebec has funded pet scans since 2003. There are 11 PET/CT scanners performing clinical scans in the province. There are five in Montreal and one each in the following cities: Quebec City, Sherbrooke, Trois-Rivières, Rimouski, Chicoutimi, and Gatineau. In 2008, there were approximately 21,000 PET procedures funded in Quebec.⁴

There are currently 11 PET scanning facilities in Ontario: five in Toronto, two in Hamilton, one in London, two in Ottawa, and one in Thunder Bay. PET scanning is presently not an insured health service in Ontario. However, in July of 2009, the Ontario government made PET scans a publicly insured health service available to certain cancer and cardiac patients. By October 2009, insured PET scans will be performed in Ottawa, London, Toronto, Hamilton, and Thunder Bay. Ontario currently provides funding for approximately 1,500 PET scans per year (over a two-year period) for patients enrolled in five clinical trials and six registry studies.⁵ Recently, the Ontario Ministry of Health and Long-Term Care committed a one-time funding of $1.4 million to produce an alternative PET isotope during the current isotope crisis.

Alberta has three PET/CT scanning facilities that are used for clinical purposes: two in Edmonton and one in Calgary. Alberta also has one PET scanner in Edmonton that is used exclusively for research. In 2008, Alberta funded approximately 3,500 clinical PET scans.⁴

Manitoba has one PET/CT scanning facility located in Winnipeg. In 2008, Manitoba funded approximately 1,000 PET scans. It is believed that this number will double once the province’s new cyclotron is operational this summer.⁴

Back to Contents

Table 1: Location of Publicly Funded PET Scanners and Cyclotrons in Canada (2009)*

Back to Contents

Privately funded PET scanners

There are currently three sites offering private PET scans in Canada. Two of these are located in the province of Quebec (Montreal and Quebec City). Ontario has one fee-based PET scanning facility based in Mississauga. British Columbia did have a private PET scanning facility in Vancouver. However, this facility is temporarily closed until it relocates within the province.

Results of this report are based on a limited literature search and on personal communications with Canadian health care officials. As such, the comprehensiveness of this report cannot be guaranteed. This report is based on information gathered as of June 2009 and may not reflect the most current information.

There were approximately 28 centres performing publicly funded scans in seven Canadian provinces. There are three centres performing privately funded scans in Canada, two of which are in the province of Quebec, and one in Ontario.

There were approximately 33,000 publicly funded PET scans performed in Canada in 2007.  This number is anticipated to increase in the future due to the current isotope shortage and more widespread adoption of PET scanning technology.

Back to Contents

1. Making medical isotopes: Report of the Task Force on Alternatives for Medical-Isotope Production. Vancouver (BC): TRIUMF; 2008. Available from: http://admin.triumf.ca/facility/5yp/comm/Report-vPREPUB.pdf
2. Budinger T. Functional biomedical imaging. Bridge. 2000;30(1). Available from: http://www.nae.edu/nae/bridgecom.nsf/BridgePrintView/NAEW-4NHMPN?OpenDocument
3. Medical imaging in Canada. Toronto: Canadian Institute for Health Information; 2008. Available from: http://secure.cihi.ca/cihiweb/products/MIT_2007_e.pdf
4. CADTH. PET scan funding in Canada. Health Tech Update. 2008;(8). Available from: http://www.cadth.ca/index.php/en/hta/reports-publications/health-technology-update/health-tech-update-issue8/pet
5. Positron emission tomography (PET) studies/programs funded by the Ministry of Health and Long-Term Care, Ontario, Canada. In: OHIP bulletins: physician services. Toronto: Government of Ontario Ministry of Health and Long-Term Care; 2007. Chapter 4452. Available from: http://www.health.gov.on.ca/english/providers/program/ohip/bulletins/4000/bul4452.pdf
6. Ontario PET Steering Committee. Pet scan primer: a guide to the implementation of positron emission tomography imaging in Ontario.Cancer Care Ontario; 2008. Available from: http://www.health.gov.on.ca/english/providers/program/ohip/outofcountry/pdf/pet_scan_primer.pdf