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A PET-CT fusion study in another patient with Lymphoma in the chest; normal FDG uptake is also seen in the heart - an organ that is normal hypermetabolic. In this picture, the PET data has been superimposed upon a coronal CT image of the same patient, providing more precise
localization of abnormal areas.

What is PET?
PET stands for Positron Emission Tomography. It is a procedure that adds an important new dimension to our ability to diagnose and manage disease. Instead of detecting changes in the physical size or shape of internal organs (as with CT or MRI), PET detects changes in cellular function – how cells utilize nutrients like sugar and oxygen. Since these functional changes often take place before anatomical changes occur, PET can provide information that enables your physician to make an earlier diagnosis. If abnormalities have already been detected by CT or MRI, PET can often better define the extent of disease, and characterize cellular function earlier in its course. This added information often means faster initiation of the best possible treatment, while avoiding more invasive exams or exploratory surgery.

“In all my years of being in and out of medical offices and hospitals, I have never been greeted or treated so kindly. The entire staff was pleasant and made me feel comfortable and at ease.”

How does PET work?
PET employs a positron-emitting radioisotope, Fluorine-18, coupled to glucose, a simple sugar; the resulting radiopharmaceutical is called fluorine-18 deoxyglucose, or FDG. Fluorine-18 is produced in a cyclotron and has an extremely short half-life (110 minutes), requiring that every dose be delivered to us within a few hours of when it will be used. Following intravenous injection, FDG is taken up by cells throughout the body, just as though it were glucose. Glucose is necessary for all metabolic activity in the body, and the cells that are most metabolically active take up more FDG than other cells. Once located inside cells, the distribution of FDG within the body can be imaged with a dedicated PET scanning system that incorporates a full ring of specialized detectors surrounding the body. River Radiology has recently installed the first and only dedicated PET scanner in the Mid-Hudson region (the GE “Advance” System).

What is PET-CT?
While PET scans alone are excellent for demonstrating areas of abnormal metabolism, the lack of anatomic features in the scans sometimes makes it difficult to pinpoint the exact location of a small abnormality seen within the patient. This is important, since FDG activity within a part of the intestine can be perfectly normal, but if the increased metabolic activity is actually located within a lymph node adjacent to the intestine, it may be abnormal. This problem has now been solved by using sophisticated software to superimpose PET metabolic information directly onto a CT scan performed at the same time. This combined approach, called “PET-CT” or “Fusion” imaging, has been shown to increase the accuracy of PET scans by 20-30%.

River Radiology is currently the only facility in central New York State (between Westchester and Buffalo) to be performing routine fusion imaging—PET-CT—on 100% of our PET studies.

When is it used?
A PET-CT study not only helps your physician diagnose a problem, it can also help predict the likely outcome of various treatment alternatives and monitor your progress. If you’re not responding as well as expected, you can be switched to a more effective therapy immediately. Today, PET is more and more frequently being used in the management of common cancers, including:


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  lung cancer

colon cancer

breast cancer

head & neck cancers

esophageal cancer

lymphoma

melanoma

Other uses of PET-CT include the evaluation of coronary artery disease and cognitive brain disorders. As additional positron-emitting radiopharmaceuticals are developed, it is expected that more uses for PET will be employed in the future.

Your PET-CT exam
This exam requires patient preparation in advance, including no solid foods for 6 hours prior to the exam, no strenuous activity for 3 days prior, and your last meal should be high in protein, low in carbohydrates. If you are diabetic, you must have a blood glucose level less than 200 mg/dl at the time of the examination, and you must not have taken insulin or other diabetic medication for four hours prior to your appointment. Wear metal-free clothing such as jogging or sweat pants with elastic waste and no zippers, and follow specific instructions if you are a diabetic patient. A nurse or technologist will administer an intravenous injection approximately 1 hour before the exam, after which you will relax in our “quiet room” while the injectable is absorbed throughout your body. It is important that you remain relaxed during the procedure. If you think you may require anti-anxiety medication, then you should bring it with you for your appointment, and take it when instructed by the technologist or nurse. Allow 2-1⁄2 hours for the appointment.

What should I bring to the appointment?
It is important that you hand carry your most recent X-ray/CT/MRI films to your appointment. The films can be returned to you before you leave, or we can mail them back for you.

What will happen during the PET-CT examination?
After receiving an intravenous injection of FDG, you will be asked to wait in a quiet room, without talking or moving, for 45-60 minutes. You will then be asked to lie on a comfortable table that moves slowly through the ring-like PET scanner. You should not feel a thing during the entire scanning procedure, which usually takes about 60 minutes to complete. You should plan on spending a total of 2-3 hours with us, from the time that you arrive until you’re ready to leave.

Are there any risks associated with PET-CT scanning?
PET is a very safe procedure. You will receive some radiation from the examination – roughly equivalent to what you might receive from X-rays or CT scans. Fluorine-18 has an extremely short physical and biological half-life, and quickly disappears from the body. Intravenous injection of FDG has not been reported to cause significant allergic reactions.

Are PET-CT scans covered by insurance?
PET is covered by Medicare and most other types of insurance, for the uses described above. Additional uses are being covered every year, so please ask your physician or call us for up-to-date information about insurance coverage.

When can my physician expect a copy of my report?
In most cases, reports are provided within two business days.

PET/CT FUSION of patient with history of COLON CA, mets seen in the mesentery.



PET/CT FUSION performed on a patient with history of
ESOPHAGEAL CA, shows adrenal mets.



ESOPHAGEAL CA recently diagnosed, with no PET evidence that the
cancer has spread to any other site.


LUNG CA This patient has a history of breast cancer. Chest x-ray showed a spot on the left lung that could be pneumonia. PET showed the lungs to be a second primary site, not mets from the breast. There was no evidence that it had spread to the lymph nodes. CT has 65% accuracy, PET has 92% accuracy in staging lung cancer.



LYMPHOMA STAGING: Large chest mass with many small lymph nodes in the mediastinum and supraclavicular region. Nodes not appreciated on CT because they are normal in size. This proves to be stage 2 lymphoma because it involves 2 contiguous sites on one side of diaphragm.



Coronal body section images from an actual PET scan. Increased tracer activity can be seen in the heart and urinary tract (which is normal) and also in a malignant lung tumor. There is no evidence that the lung tumor has spread to other parts of the body.


PET in the News

River Radiology Will Join National PET EXAM Registry Providing Medicare Coverage for PET EXAMS

River Radiology is pleased to announce participation in the National Oncologic PET Registry (NOPR) that is expected to be operational by mid summer. River Radiology’s joining the NOPR will directly benefit many cancer patients in the Hudson Valley. “Some patients have cancers and indications that are not usually eligible for reimbursable PET scans by Medicare,” said Dr. David Hall, radiologist and head of Nuclear Medicine at River Radiology, in Kingston, NY. “Our participation in NOPR means that Medicare will cover PET imaging for many of these cancer patients.”

PET stands for Positron Emission Tomography and is especially effective for detecting the presence and extent of malignancies. The goal of the National Oncologic Pet Registry is to assess the effect of PET on the management of patients with particular cancers. Medicare doesn’t usually cover PET scans for patients with brain, cervical, small cell lung, pancreatic, ovarian and testicular cancers. Because River Radiology is participating with the NOPR study, Medicare will soon cover the cost of these PET procedures for area patients.

This is not the first time Medicare has announced an expanded coverage of PET scans. Last year, Medicare announced it would cover PET for the diagnosis of Alzheimer’s Disease in patients with a possible diagnosis of dementia and a documented cognitive decline of at least 6 months duration. The evaluation of the patient must be conducted by a neurologist or other physician experienced in the diagnosis and assessment of dementia.

PET technology detects changes in brain metabolism that cannot be seen on CT or MRI scans. Patients undergoing PET receive an injection of a short-lived radioisotope, and are scanned one hour later. The scanning procedure is painless, and takes about 30 minutes. In addition to Alzheimer’s diagnosis, PET has been widely used for the detection and evaluation of many different kinds of cancer. According to Dr. Hall, River Radiology installed the first PET scanner in the Hudson Valley in 2002. River Radiology received PET accreditation from the American College of Radiology in September, 2004 and is the only facility in Ulster County with such accreditation.

River Radiology is a full service imaging center offering high field and open MRI, CT, PET and combined PET-CT, Ultrasound, Mammography, Bone Densitometry, X-ray, and Nuclear Medicine. River Radiology is open seven days a week. For information call 845.340.4500 or visit www.riverradiology.com.


MEDICARE REIMBURSEMENTS NOW AVAILABLE FOR ALZHEIMER’S PET SCANS

Kingston, NY—November 8, 2004. The Centers for Medicare and Medicaid Services (CMS) recently announced the expansion of coverage for PET brain scans to individuals with suspected Alzheimer’s Disease and related dementias. “Our hope is that the expanded Medicare coverage will result in earlier diagnosis and treatment for patients with this debilitating disease,” said Dr. David Hall, radiologist and head of Nuclear Medicine at River Radiology, in Kingston, NY.

Effective September 15, 2004, Medicare is now covering PET for the differential diagnosis of Alzheimer’s Disease in patients with a recent diagnosis of dementia and a documented cognitive decline of at least 6 months. The evaluation of the patient must be conducted by a physician experienced in the diagnosis and assessment of dementia.

“Prior to PET, the clinical diagnosis in early cases of suspected Alzheimer’s disease was extremely difficult. Sometimes the condition is present for months or years before the diagnosis is made. Since current medical therapy is most effective early in the disease, early diagnosis has become more important. In clinical trials, PET has been shown to be approximately 85-90% accurate in the diagnosis of Alzheimer’s—compared to about 60% accuracy for clinical evaluation alone,” said Dr. Hall.

Alzheimer’s disease is an age-related and irreversible brain disorder that results in memory loss of gradually increasing severity. Eventually there are behavioral and personality changes, and a general decline in intellectual abilities. It is the most common cause of age-related dementia representing approximately two-thirds of cases. By age 85, approximately 30-40% of individuals show some signs of the disorder.

PET technology detects changes in brain metabolism that cannot be seen on CT or MRI scans. Patients undergoing PET receive an injection of a short-lived radioisotope, and are scanned one hour later. The scanning procedure is painless, and takes about 30 minutes. In addition to Alzheimer’s diagnosis, PET has been widely used for the detection and evaluation of many different kinds of cancer. According to Dr. Hall, River Radiology installed the first PET scanner in the Hudson Valley, in 2002. River Radiology received PET accreditation from the American College of Radiology in September, 2004 and is the only facility in Ulster County to receive such accreditation.

River Radiology is a full service imaging center offering high field and open MRI, PET-CT, CT, Ultrasound, Mammography, Bone Densitometry, X-ray, and Nuclear Medicine. River Radiology is open seven days a week. For information call 845.340.4500.

On the left is a normal PET scan. On the right is a PET scan of the brain in someone with early Alzheimer's Disease. The arrows point to areas of diminished metabolism in the this patient's parietal cortex, on both sides of the brain. Decreased metabolic activity in the parietal and temporal cortex is the hallmark of Alzheimer's Disease on PET scans. This patient had a perfectly normal CT scan and MRI of the brain, because there is no gross anatomic abnormality - only a metabolic one.



 

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