This year has been a miserable one for the makers of PET/CT units, so miserable that one vendor-Hitachi Medical Systems of America-has stopped marketing its hybrid scanners. Others are struggling under the weight of a plunge in sales of some 30% compared with the same periods last year.
The obvious culprits are the Deficit Reduction Act and other Medicare reimbursement cuts that have shredded demand for PET/CT. Most of these systems are sold to outpatient imaging centers, which have been most directly affected by the cuts.
Adding to the misery is excess capacity at many imaging centers that got caught up in the clinical excitement surrounding PET/CT and the need to compete with neighboring facilities. From this dark cloud, however, manufacturers hope to spin silver-if not in the near future, then in the not-too-distant one.
Major vendors at the RSNA meeting will be promoting PET/CT systems equipped with fast crystals and advanced electronics and software as answers for the pent-up demand executives say is all but inevitable after a major drop in purchasing of imaging equipment. It may take another 12 to 18 months for this demand to surface, as patient volumes rise and, eventually, outstrip the capacity of installed systems. Vendors will be planting on the exhibit floor the seeds they hope will take root. They also plan to offer immediate answers for centers that already need to replace outdated systems to boost capacity.
"To fight DRA, the PET/CT industry can offer much faster scanning than most imaging centers can do," said Sergio Calvo, director of marketing for the molecular imaging division of Siemens Medical Solutions.
Siemens will highlight syngo TRUE D, a 2006 release that allows radiologists to place pre- and post-treatment scans side by side and track the evolution of a patient's cancer and its treatment. Without such a tool, a physician would likely have to open several studies and compare each side by side or print them out. By streamlining the process, TRUE D can reduce reading time from 60 to 30 minutes, Calvo said.
GE's Vue Point, which the company introduced at the 2007 Society of Nuclear Medicine meeting, corrects for scatter and incorporates a patented image projection technique to improve productivity as well as lesion detection. Vue Point is available on the Discovery Dimension or as a Continuum field upgrade for Discovery ST systems.
Helping to take the edge off a bitterly disappointing general market for PET/CT, vendors will also be appealing to specialty facilities. An obvious choice, given PET/CT's nearly total focus on cancer, is the radiation oncology center.
Offering an advantage to these centers is Philips' 85-cm large-bore PET/CT scanner, said Peter Cempellin, general manager of the PET business. Radiation oncology patients typically are imaged and treated in a slightly inclined position, but traditional PET systems with a small bore cannot image patients on an incline. Philips' large-bore PET/CT, still pending FDA clearance, can do this, and Cempellin and staff plan to point this out on the RSNA exhibit floor.
GE will also target radiation oncology with an updated version of the Discovery Dimension system, whose respiratory motion capability minimizes the blur caused by respiratory and cardiac motion. The 4D PET/CT, released at the 2007 SNM meeting, captures images at different respiratory cycles, then pieces the information together to correct mismatches between lung and heart motion, said Henry Hummel, GE's general manager for PET.
Control of motion is key for the evolution of PET/CT for radiation oncology, according to Hadi Moufarrej, general manager for GE Healthcare's molecular imaging business. Moufarrej cited clinical studies showing that 34% of the differences in tumor volume can be attributed to motion.
An innovation aimed at expanding the PET/CT market over the long term is HD-PET, an addition to Siemens' Biograph TruePoint family of hybrid PET/CT scanners. First shown at the SNM 2007 meeting, HD-PET counteracts an intrinsic problem with PET image quality: degradation of image quality with increasing distance from the center of the field-of-view. HD-PET provides uniform image resolution throughout. Resolution is as good as 2 mm, and contrast is twice as good as with standard PET, Calvo said. HD-PET enhances the TruePoint platform, which uses an extended field-of-view to capture more axial volume for each step or bed position during the exam.
Philips will be showing its own proprietary way to improve image quality. Its Gemini TF (TrueFlight) was introduced last year as the first commercial time-of-flight PET/CT. Advanced detectors, electronics, and software record the precise point of positron annihilation that occurs when this bit of antimatter collides with matter, creating two gamma ray photons that fire away from each other at almost exactly 180 degrees . This advance means the location of the radiotracer can be pinpointed exactly.
