The race that never was

By Greg Freiherr, Editor, gfreiherr@cmp.com

The early signs of trends appear in out-of-the-way places. Scientific presentations by luminaries. The dark and underpopulated recesses of exhibitor booths. The databases of federal agencies. Prowling these backwaters of the imaging industry is like scoping out the tables of a flea market. You never know what you'll find.

In the August FDA clearances, I came across a dandy--the description of a dedicated PET scanner built around detector heads rather than a ring. Could this, at long last, be the missing link that would reopen the market for hybrid positron/gamma cameras? No, I was told. This was a novel design, an experimental design, dedicated to PET. Nothing more (see cover story).

"You're barking up the wrong tree," my source said.

I have to disagree. I think I've got the right tree. Why the industry hasn't climbed it is the question.

The conventional nuc med market is in a coma. After growing steadily from 1996 to 1999, sales dropped sharply in 2000 and have not yet recovered. Politics played a big role in the demise of this market. Gamma camera sales were fueled during the late 1990s largely by coincidence cameras capable of positron imaging. Those sales slowed when Medicare began questioning whether coincidence cameras were up to the task of positron imaging. The policy shift away from coincidence cameras toward dedicated PET systems in July 2001 effectively cut gamma camera vendors off at the knees.

At the time, the path to the future seemed clear to me. Turn the equation around. Rather than a gamma camera that does positron imaging, build a PET scanner that can pinch-hit as a gamma camera. The market for such a product had already been proven. Let the race to build such a product begin, I thought. Oddly, it did not.

I'm sure there are technical and political reasons. But these should not stop an industry that has so much to gain from the development of a crossover device. A hybrid PET/gamma camera would homogenize this segment of medical imaging, uniting PET and traditional nuc med. In doing so, it would vastly expand the utility of the imaging equipment, provide physicians unprecedented flexibility, and promote the diffusion of cyclotrons, thus increasing the availability of positron-emitting radiopharmaceuticals and very likely reducing the overall cost of positron studies. Combined with CT, a PET/gamma camera would eliminate the potential for claustrophobic reactions among patients undergoing PET/CTs.

The tree I'm barking up, I think, is a tree worth barking at.