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CADTH » Search All Products » Environmental Scanning » Health Technology Update » Issue 8, January 2008 » Positron Emission Tomography in Canada: An Update

Positron Emission Tomography in Canada: An Update

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Siemens Biograph™ 16 HR PET/CT scanner

Photo courtesy of the Great-West Life PET/CT Centre at the Health Sciences Centre, Winnipeg.


Positron emission tomography (PET) is a non-invasive nuclear medicine imaging technology that produces images of metabolic processes in the body. PET can be used to visualize abnormalities of metabolism caused by cancer, heart disease, and neurological disorders.

Hybrid PET/CT Scanners

Hybrid scanners that have both PET and computed tomography (CT) components became commercially available in 2001.[1] These are quickly replacing stand-alone PET scanners.

The hybrid machine allows CT and PET images to be collected sequentially on the same device. The x-ray CT image shows a detailed view of the anatomy, while the PET component maps both normal and abnormal tissue function. The resulting fused image allows functional abnormalities to be
pinpointed within the body with greater accuracy.[1-3]

The hybrid machine also reduces the overall scanning time by 30% to 40% compared with a stand-alone PET scan. This allows higher patient throughput and a more comfortable exam for the patient,[2] which can be completed during a single session.

How It Works

Prior to the PET/CT scan, patients receive an intravenous injection of 18-fluoro-2-deoxyglucose (FDG), a glucose molecule that is attached to a radioactive tracer (fluorine-18). Fast-growing tumour cells absorb glucose more quickly than healthy tissue; and when the radiolabelled glucose accumulates in malignant tissues, it shows up as “hot spots” on the PET scan image. In heart disease and neurological disorders, the PET image can reveal the location of malfunctions, such as the locus of seizures in epilepsy or areas of poor blood flow in heart disease.

FDG Production

FDG is produced in a laboratory from radioisotopes generated by a cyclotron (particle accelerator). FDG has a short shelf life and must be delivered to the PET scanning facility within five hours of production.[4] Therefore, PET scanners must be located relatively close to a cyclotron, which may limit the use of this technology in some parts of Canada. Click to view a chart showing the locations of publicly funded cyclotrons.

FDG Regulations

In Canada, FDG is regulated as a radiopharmaceutical drug. Four manufacturers have obtained Health Canada approval to use FDG for specific indications (see the table below).

However, most FDG used for clinical PET scanning in Canada is currently regulated as an investigational drug and accessed using a Clinical Trial Application. Centres that provide PET scans must serve as a clinical trial sponsor and gather clinical efficacy and safety data for all patients who receive FDG.

FDG products that have received Health Canada approval

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*private company

  • Recent Report Assessing PET
    A review of the clinical and cost-effectiveness of PET is beyond the scope of this newsletter, but a recent report from the UK may be of interest: Overview of the clinical effectiveness of positron emission tomography imaging in selected cancers. UK National Institute for Health Research, Health Technology Assessment Programme.
    Available: http://www.hta.ac.uk/fullmono/mon1144.pdf

References

[1] Gamez C, et al. J Thor Oncol 2006;1(1):74-7.
[2] Sureshbabu W, et al. J Nucl Med Technol 2005;33(3):156-61.
[3] Ratko TA, et al. J Clin Outcomes Manage 2006;13(3):157-8,161-75.
[4] Pearcey R, et al. Cancer Care Can 2006;15-6. Available: http://www.canceradvocacy.ca/reportcard/2006/PET%20SCANNING%20IN%20CANADA%20-%20CACC%20REPORT%20CARD%20ON%20CANCER%202006.pdf