SLIDE 1
Lowe,VJ
Lowe,VJ
Unstable parent nucleus Proton decays to neutron in nucleus Positron and neutrino emitted Positron combines with electron and annihilates
Two 511 keV photons produced ~180 apart
Overview & State of the Art Val J. Lowe, MD Val J. Lowe, MD - - PowerPoint PPT Presentation
Overview & State of the Art Val J. Lowe, MD Val J. Lowe, MD - - PowerPoint PPT Presentation
PET/CT in Cancer: A General Overview & State of the Art Val J. Lowe, MD Val J. Lowe, MD PET Facility Mayo Clinic Lowe,VJ Radioisotopes Unstable parent nucleus Positron combines with electron and annihilates Proton decays
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SLIDE 3
Lowe,VJ
Increased glucose metabolism in cancer (Warburg 1930) [18]F-2-deoxy-2-flouro-D-glucose (FDG) trapping in tumor cells has been described and is the result of the increased glucose metabolism in tumors (Gallagher, 1978) [18]F-2-deoxy-2-flouro-D-glucose (FDG)
SLIDE 4
Lowe,VJ
OH OH OH OH HO O OH OH OH HO O OH OH OH HO O
F
D-Glucose 2-Deoxy-D-Glucose 2-Deoxy-2-Fluoro-D-Glucose
FDG Physiology
SLIDE 5
Lowe,VJ Vascular Capillary Extra- Intracellular metabolism compartment membrane cellular space Hexokinase Glucose Glucose G - 6 - P Hexokinase
18FDG 18FDG
G - 6 - P Glycogen Phosphorylase 'a' G - 1 - PO4 G - 6 - PO4 F - 6 - PO4 CO2 + H2O 18FDG - 6 - PO4 Cell membrane
FDG Physiology
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Lowe,VJ
15 years ago: PET Lung Scan 20 minute emission for 20 cm axial field of view + 20 minutes for attenuation correction = 40 minutes for 20 cm
PET/CT Development
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Lowe,VJ
7 years ago: CT unit fusion to PET: Responded to the need for anatomic information coupled to PET Provided a faster way to get attenuation correction leading to 40 minute body scans
PET/CT Development
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Lowe,VJ
Summary Today: Imaging Speed: Different machines can give 15-40 minute whole-body images Anatomic CT fusion: A selection of CT resolutions
PET/CT Development
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Lowe,VJ
In the works for tomorrow’s “State
- f the Art”:
Imaging Speed: ?? 5 minute whole body scans Improved Accuracy: New tracers Time of flight reconstruction
PET/CT Development
SLIDE 10
A B C D
Coronal images of an average patient with a BMI of 27 kg/cm2. A) 2D acquisition, 5 min per bed; B) 3D acquisition, 5 min per bed; C) 3D acquisition, 3 min per bed; D) 3D acquisition, 2 min per bed.
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Lowe,VJ
PET/CT Equipment
PET component Respiratory gate triggering Allows respiratory gating and positioning of a lung nodule more accurately The data is sparse but this could improve the characterization of some lung nodules
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Lowe,VJ
PET New Developments
Respiratory gating: After WB scan, acquire
respiratory gated study centered on lesion
3D, list mode, 8 bin, 10 min, one bed
Summed Gated, bin 3
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Lowe,VJ
- PET/CT can perform the most
accurate N and M staging in almost all aggressive cancers compared to CT, MRI or US.
- PET has great potential to evaluate
cancer therapy; results better than CT
- PET may provide more specific
molecular targeting capability in the future
PET/CT in Cancer: A General Summary of Performance
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Lowe,VJ
Medicare and Insurance Coverage
- Steady indication by indication
approval by CMS of PET/CT in
- ncology in the last 2 decades
- Still, FDA approvals lagging for its
use but not hampering clinical use and reimbursement
- Specific language needs to be used in
- rdering
SLIDE 15
Final Fram ework Solid Tumo r Ty pe Ini tial Tre atm ent Strat egy* Subs eque nt Tre atment Strat egy ** Colorectal Cover Cover Es op hagus Cover Cover Head & Neck (not thyroid
- r CNS)
Cover Cover Lymphoma Cover Cover Non - s mall ce ll lung Cover Cover Ovary Cover Cover Brain Cover CED Cervix 1 or CED Cover Small ce ll lung Cover CED Soft Tis sue Sarcoma Cover CED Panc re as Cover CED Test es Cover CED Bre ast (fe male and male) 2 Cover Melanoma 3 Cover Prostate N/ C CED Thyroid Cover 4 or CED All o the r sol id tu mors Cover CED Myeloma Cover Cover All o the r cance rs no t l is ted her e in CED CED 1) Cervix: Covered for the detection of pre- treatment metastases (i.e., staging) in newly diagnosed cervical cancer subsequent to conventional imaging that is negative for extra-pelvic metastasis. All other uses are CED. (2) Breast: Noncovered for diagnosis and/or initial staging of axillary lymph nodes. Covered for initial staging of metastatic disease. (3) Melanoma: Noncovered for initial staging of regional lymph nodes. All
- ther uses for initial staging are
covered. (4) Thyroid: Covered for subsequent treatment strategy of recurrent
- r residual thyroid cancer of follicular cell
- rigin previously treated by thyroidectomy
and radioiodine ablation and have a serum thyroglobulin >10ng/ml and have a negative I-131 whole body scan. All other uses for subsequent treatment strategy are CED.