Mobile PET/CT comes to patients hundreds of miles outside London

Lack of cyclotrons in northern U.K. limits service

Alliance Medical is expanding the access of patients in the U.K. to clinical PET with the roll-out of a mobile PET/CT unit, the first such unit in Europe. The mobile service will be launched soon, becoming the only U.K. PET/CT scanner outside London and serving cancer patients hundreds of miles apart.

Alliance has made its name in Europe by helping hospitals boost their imaging capabilities without spending on hardware. The company owns a dozen mobile MR and CT scanners, which mainland European hospitals hire for periods ranging from a few weeks to a couple of years. Other fleets of mobile units, providing MR, CT, and PET, circulate throughout the U.K., Spain, and Italy. These fleets come staffed with radiographers.

Alliance also runs fixed scanners on behalf of 17 state- or privately funded hospitals in the U.K. It opened its first stand-alone imaging facility in London last year.

"Mobile services lend themselves better to the mixed public-private healthcare economies, such as those in the U.K. and Italy," said Mike Pringle, Alliance's regional director. "France historically has not been a market where mobile imaging services have worked, because of government authorization issues. It doesn't easily lend itself to the healthcare market in Germany either."

Purchase of a Discovery ST from GE Medical Systems has doubled Alliance's mobile PET capabilities in the U.K. The company debuted its U.K. mobile PET service last year with an Advance NX/i from GE.

Overall provision for clinical PET in the U.K. is recognized to be poor. A report in this month's European Journal of Nuclear Medicine and Molecular Imaging (2004;31:208-221) recommended U.K. investment in 42 PET scanners to support the seven already performing clinical work. Italy also fared badly in the study, with a mismatch between existing and required clinical PET facilities (11 versus 47). In total, three quarters of the 36 countries surveyed were found to have inadequate clinical PET facilities. Perhaps not surprisingly, Alliance's mobile PET service is enjoying brisk business, according to Pringle.

"Within a year of launch, our route list for the U.K. mobile PET is now full, and our mobile PET/CT will be practically full when it starts," he said.

Pringle blames the Europe-wide PET scanner shortfall on hospitals' reluctance to invest in new and expensive technology that has no immediate waiting list. The company capitalized on the same scenario in 1989, only with mobile MR units. The market for these units has now flattened, though smaller hospitals still welcome buying part-time usage. Now mobile PET and PET/CT are being positioned to replace that growth opportunity.

"It comes down to resource utilization," Pringle said. "Purchasing a large capital asset and using it only one day a week doesn't make an awful lot of sense. When there's limited demand at a hospital, it makes much more sense to have the scanner there one day a week or one day a fortnight, which is where we come in."

The main problem in widening public access to PET is the availability of short-lived radiopharmaceuticals, such as FDG, which have to be made close to scanner sites. The only commercial facilities manufacturing FDG in the U.K. are currently in London. This hampers PET provision in hospitals outside the southeast region of the country.

Alliance is participating in a venture to establish a U.K.-wide network of cyclotrons selling radiopharmaceutical tracers to hospitals and clinics across the country. The first is planned for a university site midway between Manchester and Birmingham.

"The first cyclotron will be operational in 12 months and will initially allow people in the north of England to get routine access to PET scans," Pringle said. "Two or three others are already planned, and this will help us expand."