1. Positron Emission Tomography in Clinical Medicine Michael N Maisey 2. Physics and Instrumentation in PET Dale L Bailey, Joel S Karp and Suleman Surti 3. Data Acquisition and Performance Characterization in PET Dale L Bailey 4. Image Reconstruction Algorithms in PET Michel Defrise, Paul E Kinahan and Christian J Michel 5. Quantitative Techniques in PET Steven R Meikle and Ramsey D Badawi 6. Tracer Kinetic Modeling in PET Richard E Carson 7. Coregistration of Structural and Functional Images David J Hawkes, Derek LG Hill, Lucy Hallpike and Dale L Bailey 8. Anato-Molecular Imaging: Combining Structure and Function David W Townsend and Thomas Beyer 9. Radiohalogens for PET Imaging N Scott Mason and Chester A Mathis 10. Progress in 11C Radiochemistry Gunnar Antoni and Bengt Langstrom 11. Metal Radionuclides for PET Imaging Paul McQuade, Deborah W McCarthy and Michael J Welch 12. Radiation Dosimetry and Protection in PET Jocelyn EC Towson 13. Whole-Body PET Imaging Methods Paul D Shreve 14. Artefacts and Normal Variants in Whole-Body PET and PET/CT Imaging Gary J R Cook 15. The Technologist's Perspective Bernadette F Cronin 16. PET Imaging in Oncology Andrew M Scott 17. The Use of Positron Emission Tomography in Drug Discovery and Development William C Eckelman 18. PET as a Tool in Multimodality Imaging of Gene Expression and Therapy Abhijit De and Sanjiv Sam Gambhir

The role of FDG-PET imaging in treatment evaluation is most firmly established in posttreatment assessment of Hodgkin’s disease and non-Hodgkin’s lymphoma. Clinical effectiveness has also been demonstrated for postchemotherapy or postradiation assessment of head and neck cancer and postchemotherapy assessment of testicular tumors. Early results support the use of FDG-PET imaging for preoperative assessment of neoadjuvant therapy in lung cancer to avoid pneumonectomy for tumors that have not responded to treatment. A potentially valuable application of PET imaging lies in the early prediction of treatment response in lymphoma and in neoadjuvant therapy of locally advanced primary breast cancer and locally advanced esophageal cancer. Treatment evaluation of colorectal cancer metastatic to the liver by PET demonstrates different approaches but has little potential for clinical impact. Semiquantitative assessment of FDG uptake by means of SUV appears to be sufficiently accurate for assessment of uptake in serial studies of the same patient under the same conditions.

UNLABELLED Whole-body PET imaging with 18F-FDG has been used successfully to stage colorectal cancer. However, the impact of FDG PET on patient management from the referring physician's point of view has not been determined. METHODS A questionnaire was sent to referring physicians to determine whether and how PET altered the management of colorectal cancer patients. Management changes, when present, were classified as intermodality (e.g., medical to surgical, surgical to radiation, medical to no treatment) or intramodality (e.g., altered medical, surgical, or radiotherapy approach). RESULTS Of 60 responses from referring physicians, changes in clinical stage were reported for 25 patients (42%). Among these, the disease was upstaged in 20 patients (80%) and downstaged in 5 patients (20%). The PET findings contributed to intermodality management changes in 22 of the 60 patients (37%), intramodality changes in 11 patients (18%), a combination of management changes in 4 patients (7%), and no change in 19 patients (32%). Two of the 60 patients (3%) had other changes, and no response to this question was received for the remaining 2 patients (3%). As a result of PET findings, physicians avoided major surgery in 41% of patients for whom surgery was the intended treatment. CONCLUSION This survey-based study of referring physicians shows that FDG PET had a major impact on the management of colorectal cancer patients and contributed to changes in clinical stage and major management decisions in >40% of patients.

UNLABELLED:Accurate assessment of lung carcinoma remains a significant clinical problem, often leading to surgical procedures without curative potential. PET with 18F-fluorodeoxyglucose (FDG) has shown promise in differentiating benign from malignant lesions and in staging the extent of disease, resulting in improved treatment at a significant cost savings. This multicenter prospective study used dual-detector coincidence imaging with FDG to categorize pulmonary lesions as benign or malignant. The goal of this study was to determine the sensitivity and specificity of dual-detector coincidence imaging of FDG in patients with pulmonary lesions who were scheduled to have a diagnostic procedure for histopathologic confirmation.METHODS:A total of 96 patients with pulmonary lesions with a lesion size ranging from 1 to 7 cm with a mean of 3.44 cm based on their chest radiograph or CT scan were studied using FDG scans with a dual-detector coincidence detection system. An additional 24 patients were entered as control subjects. The studies of 120 subjects were interpreted in random order by three physicians experienced in the use of FDG in patients with lung cancer. Surgical pathology was used as the standard for identifying malignant lesions.RESULTS:There was 94% agreement between the readers in the independent interpretation of the FDG studies. In the 96 patients with pulmonary lesions, FDG studies were 97% sensitive and 80% specific in identifying proven malignant lesions.CONCLUSION:The results of this prospective study provide evidence that dual-detector coincidence imaging with FDG provides an accurate, sensitive and specific means of diagnosing malignancy in patients with pulmonary lesions.

The lack of consistent reimbursement for positron imaging has hampered the growth of this modality, thereby denying patients access to this important technology. Reimbursement has improved dramatically over the past three to five years with the most significant step occurring in January, 1998, which is when Medicare reimbursement was approved for staging lung cancer and characterizing indeterminate pulmonary nodules. The decision to reimburse for positron imaging for oncologic applications would not have occurred if clinical data were not available, and if the clinical effectiveness of positron imaging were not validated through technology assessments conducted by qualified research organizations. Even with the reality of reimbursement, the process by which positron imaging studies are reimbursed needs to be explored and standardized. On the Medicare front, each Medicare carrier will need help from the positron imaging community in implementing the Medicare National Coverage Instructions. The rate of reimbursement for positron imaging is a constant concern, especially with the variation of positron imaging devices and their associated capital and operational costs. This article summarizes the process involved in reimbursement for positron imaging, i.e., contracting with third-party payers and obtaining the support of referring physicians for positron imaging. The process of technology assessment for new procedures is integral to the growth, development and acceptance of positron imaging procedures by government and private-payer entities. We have made a significant step forward in reimbursement, but there is tremendous work to be done in establishing the process of reimbursement for positron imaging.

To examine the role of positron emission tomography (PET) with labeled flourodeoxyglucose (FDG) in patients with primary neoplasms of the head and neck. Between 9/92 and 9/94, forty-four FDG PET scans were performed on 27 patients with head and neck neoplasms. FDG uptake at the tumor sites was quantified with standardized uptake values (SUV).