Integrating PET/CT unit into the NHS of a small sized EU state: A financial cost efficiency study

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Giannakou ◽  
D Kefallonitou ◽  
I Polycarpou ◽  
K Souliotis
Keyword(s):  
Cost Efficiency ◽  
Financial Analysis ◽  
National Health System ◽  
Emission Tomography ◽  
Alternative Possibilities ◽  
Financial Cost ◽  
Positron Emission ◽  
Pet Ct ◽  
Investment Cost ◽  
Two Alternatives

Abstract Background According to the Ministry of Health in Cyprus, since 2009, every year more than 3.000 new incidents with neoplasm are diagnosed. The National Health System (NHS) of Cyprus aims to offer adequate health services, comparing them with European Union standards. However, it is lacking a Positron Emission Tomography-Computed Tomography (PET/CT) unit. The present study aims to examine whether an investment by the Cyprus NHS of a PET/CT unit can be financially sustainable. Methods A financial analysis of the operating revenues and expenses of a departmental PET/CT with F18-FDG was performed taking into consideration all related parameters. A detailed estimation of the unit's operation expenses (PET/CT unit supply, overheads, salaries, etc.) and incomes was produced for a 15-year period. This initial scenario was not financially viable and therefore two alternatives are also examined. Results After performing a detailed analysis and projection for the evaluation of the feasibility study in the initial scenario, the overall outcome is estimated negative deriving to a €2,2 million losses in the cumulative results by 2035. The second scenario concluded that the required number of incidents to reach a neutral cash flow after a 15-year period should increase from 8.971 to 23.430. The third scenario reached the conclusion that a parallel investment to the purchase of the PET/CT unit by installing a cyclotron unit in the Cypriot NHS provides cumulative results positive of €1,7 million for the PET/CT, in the same period, that can finance the largest part of the €2,5 million required for the installation of the cyclotron unit. Conclusions Our findings show that an investment of a sole PET/CT unit is not a financially viable. Alternative possibilities such as usage of a PET/CT operated by the private sector or supporting patients to travel to another country are within the economic terms recommended. Key messages From a financial viewpoint, the scenario of investing in a PET/CT unit by the Cyprus NHS is not viable. Examining alternative options for patients in need of a PET/CT unit, where the initial investment cost for the state is not financially viable.

scholarly journals Integrating a Positron Emission Tomography/Computed Tomography Into the National Health System of Cyprus: Will It Return on Its Investment?

2021 ◽  
Vol 9 ◽  
Author(s):  
Dimitra Kefallonitou ◽  
Irene Polycarpou ◽  
Kyriakos Souliotis ◽  
Konstantinos Giannakou
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Private Sector ◽  
Health System ◽  
National Health ◽  
National Health System ◽  
Emission Tomography ◽  
Neighboring Country ◽  
Positron Emission ◽  
Pet Ct

A European Union (EU) member state, Cyprus is a country with a population of ~850,000 citizens. According to the Cyprus Ministry of Health, since 2009, more than 3,000 new incidents with neoplasm are diagnosed every year (i.e., 3% increasing rate). Projections estimate an average annual increase of 2.2% of new incidents until 2040. However, the National Health System (NHS) of Cyprus lacks a Positron Emission Tomography/Computed Tomography (PET/CT) care framework and infrastructure. Patients can only have a PET/CT exam in the private sector, either in Cyprus or a neighboring country (e.g., Greece or Israel). This requires the government of Cyprus to cover financial expenses related to medical treatments while the patients may also need to cover their expenses for traveling to a neighboring country. This study presents a cost analysis to examine whether the integration of a PET/CT with, or without, an F18-FDG cyclotron unit in the NHS of Cyprus is an efficient investment that can be recovered within the unit's service life. To perform this study, we estimated necessary resources for purchasing and operating such unit for a period of 15 years. The results of this study indicate that an investment in a PET/CT unit is not financially viable. Alternatives, such as the reimbursement of PET/CT operated by the private sector is recommended.

Motion correction in PET/CT

2005 ◽  
Vol 44 (S 01) ◽  
pp. S46-S50 ◽  
Author(s):  
M. Dawood ◽  
N. Lang ◽  
F. Büther ◽  
M. Schäfers ◽  
O. Schober ◽  
...  
Keyword(s):  
Optical Flow ◽  
Motion Correction ◽  
Motion Vector ◽  
Emission Tomography ◽  
Cardiac Pet ◽  
Novel Approach ◽  
Positron Emission ◽  
Pet Ct ◽  
Flow Algorithm ◽  
Motion Vector Field

Summary:Motion in PET/CT leads to artifacts in the reconstructed PET images due to the different acquisition times of positron emission tomography and computed tomography. The effect of motion on cardiac PET/CT images is evaluated in this study and a novel approach for motion correction based on optical flow methods is outlined. The Lukas-Kanade optical flow algorithm is used to calculate the motion vector field on both simulated phantom data as well as measured human PET data. The motion of the myocardium is corrected by non-linear registration techniques and results are compared to uncorrected images.

The Potential Value of Hybrid Positron Emission Tomography/Dual-Source Computed Tomography Imaging in Coronary Bypass Surgery

2011 ◽  
Vol 14 (5) ◽  
pp. 283 ◽  
Author(s):  
Andre Plass ◽  
Maximilian Y. Emmert ◽  
Oliver Gaemperli ◽  
Hatem Alkadhi ◽  
Philipp Kaufmann ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Myocardial Perfusion ◽  
Predictive Value ◽  
Bypass Surgery ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct

<p><b>Background:</b> We evaluated how comprehensive assessment of coronary artery lesions and their hemodynamic relevance by means of hybrid positron emission tomography (PET) and computed tomography (CT) imaging would affect decision-making in coronary artery bypass surgery (CABG), compared with using invasive coronary angiography (ICA) alone.</p><p><b>Methods:</b> After undergoing ICA, 27 patients (21 men and 6 women; mean SD age, 66 � 10 years) planned for cardiac surgery were scheduled for myocardial perfusion stress/rest evaluation with [13N]ammonia PET and CT coronary angiography. Only ICA was available to the surgeon. Postoperatively, the performed CABG was compared with the hypothetical strategy based on hybrid PET/CT findings (regional coronary flow reserve [CFR], myocardial perfusion defects). Procedures included CABG (n = 18) alone, CABG combined with valve replacement (n = 6), and CABG combined with isolated valve replacement (n = 3). A total of 56 bypass grafts (28 venous and 28 arterial) and 66 distal anastomoses were placed.</p><p><b>Results:</b> CT evaluation showed 93% concordance (66/71) with ICA regarding significant stenoses, with sensitivity, specificity, positive predictive value, and negative predictive value of 93.1%, 98.7%, 94.4%, and 98.4%, respectively. In the PET scan, 16 patients had 1 ischemic region, and 12 patients had 1 scar region, including 5 patients who presented with mixed conditions (scar and ischemia). One patient had a completely normal myocardium. Compared with the performed surgery, PET/CT fusion evaluation showed that of the performed anastomoses, 48% had documented ischemia (with a CFR <2 in 86%), 38% were nonischemic (although a CFR value <2 was found in 78%), and 14% had scar tissue (fixed perfusion defect).</p><p><b>Conclusions:</b> Although <50% of bypasses were placed to areas with myocardial ischemia, the CFR was low in the majority of nonischemic regions, a finding that may have important prognostic relevance. PET/CT fusion imaging could potentially influence planning for CABG and provide incremental prognostic information.</p>

Influence of Baseline Positron Emission Tomography in Metastatic Gastroesophageal Cancer on Survival and Response to Therapy

Oncology ◽  
2021 ◽  
pp. 1-6
Author(s):  
Ahmed Abdelhakeem ◽  
Madhavi Patnana ◽  
Xuemei Wang ◽  
Jane E. Rogers ◽  
Mariela Blum Murphy ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Response To Therapy ◽  
Emission Tomography ◽  
Gastroesophageal Cancer ◽  
First Line ◽  
First Line Therapy ◽  
Line Therapy ◽  
Positron Emission ◽  
Pet Ct ◽  
Metastatic Burden

<b><i>Background:</i></b> The value of baseline fluorodeoxyglucose-positron emission tomography-computed tomography (PET-CT) remains uncertain once gastroesophageal cancer is metastatic. We hypothesized that assessment of detailed PET-CT parameters (maximum standardized uptake value [SUVmax] and/or total lesion glycolysis [TLG]), and the extent of metastatic burden could aid prediction of probability of response or prognosticate. <b><i>Methods:</i></b> We retrospectively analyzed treatment-naive patients with stage 4 gastroesophageal cancer (December 2002–August 2017) who had initial PET-CT for cancer staging at MD Anderson Cancer Center. SUVmax and TLG were compared with treatment outcomes for the full cohort and subgroups based on metastatic burden (≤2 or &#x3e;2 metastatic sites). <b><i>Results:</i></b> We identified 129 patients with metastatic gastroesophageal cancer who underwent PET-CT before first-line therapy. The median follow-up time was 61 months. The median overall survival (OS) was 18.5 months; the first progression-free survival (PFS) was 5.5 months. SUVmax or TLG of the primary tumor or of all metastases combined had no influence on OS or PFS, whether the number of metastases was ≤2 or &#x3e;2. Overall response rates (ORRs) to first-line therapy were 48% and 45% for patients with ≤2 and &#x3e;2 metastases, respectively (nonsignificant). ORR did not differ based on low or high values of SUVmax or TLG. <b><i>Conclusions:</i></b> This is the first assessment of a unique set of PET-CT data and its association with outcomes in metastatic gastroesophageal cancer. In our large cohort of patients, detailed analyses of PET-CT (by SUVmax and/or TLG) did not discriminate any parameters examined. Thus, baseline PET-CT in untreated metastatic gastroesophageal cancer patients has limited or no utility.

scholarly journals 18F-Fluciclovine Positron Emission Tomography in Prostate Cancer: A Systematic Review and Diagnostic Meta-Analysis

Diagnostics ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. 304
Author(s):  
Giuseppina Biscontini ◽  
Cinzia Romagnolo ◽  
Chiara Cottignoli ◽  
Andrea Palucci ◽  
Fabio Massimo Fringuelli ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Meta Analysis ◽  
False Negative ◽  
Final Analysis ◽  
Emission Tomography ◽  
True Negative ◽  
Positron Emission ◽  
Pet Ct

Background: to explore the diagnostic accuracy of 18F-Fluciclovine positron-emission tomography (PET) in prostate cancer (PCa), considering both primary staging prior to radical therapy, biochemical recurrence, and advanced setting. Methods: A systematic web search through Embase and Medline was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies performed from 2011 to 2020 were evaluated. The terms used were “PET” or “positron emission tomography” or “positron emission tomography/computed tomography” or “PET/CT” or “positron emission tomography-computed tomography” or “PET-CT” and “Fluciclovine” or “FACBC” and “prostatic neoplasms” or “prostate cancer” or “prostate carcinoma”. Only studies reporting about true positive (TP), true negative (TN), false positive (FP) and false negative (FN) findings of 18F-fluciclovine PET were considered eligible. Results: Fifteen out of 283 studies, and 697 patients, were included in the final analysis. The pooled sensitivity for 18F-Fluciclovine PET/CT for diagnosis of primary PCa was 0.83 (95% CI: 0.80–0.86), the specificity of 0.77 (95% CI: 0.74–0.80). The pooled sensitivity for preoperative LN staging was 0.57 (95% CI: 0.39–0.73) and specificity of 0.99 (95% CI: 0.94–1.00). The pooled sensitivity for the overall detection of recurrence in relapsed patients was 0.68 (95% CI: 0.63–0.73), and specificity of 0.68 (95% CI: 0.60–0.75). Conclusion: This meta-analysis showed promising results in term of sensitivity and specificity for 18F-Fluciclovine PET/CT to stage the primary lesion and in the assessment of nodal metastases, and for the detection of PCa locations in the recurrent setting. However, the limited number of studies and the broad heterogeneity in the selected cohorts and in different investigation protocols are limitation affecting the strength of these results.

scholarly journals 68Ga-DOTATOC PET/CT Follow Up after Single or Hypofractionated Gamma Knife ICON Radiosurgery for Meningioma Patients

2021 ◽  
Vol 11 (3) ◽  
pp. 375
Author(s):  
Fabio Barone ◽  
Francesco Inserra ◽  
Gianluca Scalia ◽  
Massimo Ippolito ◽  
Sebastiano Cosentino ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Case Series ◽  
Biological Response ◽  
Standardized Uptake Value ◽  
Emission Tomography ◽  
Tumor Diameter ◽  
Relative Percentage ◽  
Positron Emission ◽  
Pet Ct

68Ga-DOTATOC represents a useful tool in tumor contouring for radiosurgery planning. We present a case series of patients affected by meningiomas on who we performed 68Ga-DOTATOC positron emission tomography (PET)/CT pre-operatively, a subgroup of which also underwent a post-operative 68Ga-DOTATOC PET/CT to evaluate the standardized uptake value (SUV) modification after Gamma Knife ICON treatment in single or hypofractionated fractions. Twenty patients were enrolled/included in this study: ten females and ten males. The median age was 52 years (range 33–80). The median tumor diameter was 3.68 cm (range 0.12–22.26 cm), and the median pre-radiotherapy maximum SUV value was 11 (range 2.3–92). The average of the relative percentage changes between SUVs at baseline and follow up was −6%, ranging from −41% to 56%. The SUV was reduced in seven out of 12 patients (58%), stable in two out of 12 (17%), and increased in three out of 12 (25%), suggesting a biological response of the tumor to the Gamma Knife treatment in most of the cases. 68Ga-DOTATOC-PET represents a valuable tool in assessing the meningioma diagnosis for primary radiosurgery; it is also promising for follow-up assessment.

scholarly journals Additive value of positron emission tomography/computed tomography scan for detection of aortic tube graft infection: a case report

2020 ◽  
Author(s):  
Farnoosh Larti ◽  
Mohammad Amin Khadembashiri ◽  
Mehrshad Abbasi ◽  
Alborz Sherafati
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Diagnostic Accuracy ◽  
Ct Scan ◽  
Graft Infection ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
History Of ◽  
Pet Ct Scan

Abstract Background Diagnosis of aortic graft infection is challenging, and delayed diagnosis is associated with poor prognosis. Positron emission tomography/computed tomography (PET/CT) has improved diagnostic accuracy. Case summary A patient with a history of congenital heart disease was admitted due to fever. He had a history of four cardiac surgeries, including the Bentall procedure for endocarditis. Blood cultures were negative. A semi-mobile mass was detected in the distal portion of the aortic tube graft in echocardiography. PET/CT scan was used to confirm tube graft infection and to support proceeding to cardiac surgery. Discussion Using multimodality imaging, including PET/CT scan in combination with echocardiography, can improve diagnostic accuracy for the detection of aortic tube graft infection, infection of prosthetic valves, or intra-cardiac devices, especially in high-risk surgical cases.

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