Executive summary

Positron emission tomography (PET)is a high cost diagnostic imaging technology based on cyclotron-produced radioisotopes. It has been used in research for a number of years. In the USA, there is now an increasing trend toward its use as a routine clinical tool.

Two Australian hospitals plan to establish PET units during 1991:

  • The Royal Prince Alfred Hospital plans to establish a PET unit in association with the National Medical Cyclotron Facility currently under construction at the hospital. The PET unit will have a capital cost of $A5M.
  • The Austin Hospital proposes to establish a PET unit incorporating a small dedicated cyclotron. The capital cost will be $A9M.

There is evidence that PET provides relevant diagnostic information in several clinical applications including:

  • localisation of epileptic foci in candidates for refractory epilepsy surgery;
  • grading the degree of malignancy of cerebral gliomas;
  • distinguishing between recurrent glioma and radiation necrosis.
  • detection of coronary artery disease;
  • assessment of myocardial viability.

In neurological applications, PET has been used in patient management at some overseas centres for some years, but there has been little comparison with alternatives, particularly single photon emission computed tomography (SPECT). In cardiac applications further studies are needed to determine whether PET has advantages for patient management and outcome in comparison with alternatives, particularly new SPECT techniques.

The cost of PET per study depends largely on throughput. At  a realistic throughput of 1200  studies per unit per year, the cost would be about $1,900 per study. Many patients would require two to three studies.            ·

Offsetting savings associated with the use of PET can be identified, but these are unlikely to amount to more than 30 per cent of costs.

It is not considered that a sufficient case has yet been established for the routine use of PET as a clinical service in Australia. Further evaluation is needed of PET as a clinical tool, but it is suggested that there could be some value in using the technology as a primary reference method in developing applications of lower cost techniques.

Although Commonwealth funding has been sought for the operating costs of the two proposed PET units the approaches from the hospitals were made prior to the establishment of the Nationally Funded Centres Program by the Australian Health Ministers Advisory Council, and the proposals were not assessed on that basis.

It is considered that, if one or both PET units are established:

  • the technology should be subject to a coordinated evaluation of clinical and cost benefits;
  • all patients scanned should be suitable for inclusion in evaluation protocols; criteria for the selection of patients for PET scans should be developed;
  • evaluations undertaken should include assessment of patient benefit from the use of PET in cardiac and neurological applications in comparison with alternatives, particularly SPECT in cardiac and glioma studies, and SPECT and magnetic resonance imaging (MRI)in epilepsy studies;
  • studies should be prospective and closely involve referring clinicians. An independent organisation with expertise in evaluation should also be involved;
  • regular reports on the evaluations should be sent to appropriate Commonwealth and State authorities and professional bodies;
  • no further units should be considered until the evaluations, including detailed cost benefit analysis, are completed.