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Northwestern Memorial Hospital houses this traditional PET scan, which is used primarily for cancer screening, as well as epilespy, Alzheimer's and heart disease.

Feds propose making PET scans more widely available

by Julia Hawes
Feb 04, 2009


Julia Hawes/MEDILL

A patient can spend anywhere from eight to 22 minutes inside of a PET scanner during a screening. Patients with epilepsy are scanned from the neck up; those with risk of melanoma are scanned from the base of the skull to the ankles.

A federal agency is proposing that PET scans, tests shown to help diagnose cancer and other diseases, be more widely available to people covered by the Medicare and Medicaid programs.

The U.S. Centers for Medicare & Medicaid Service is proposing that Medicare coverage of the test be expanded. The agency is now collecting physician opinions online and is expected to rule on it in April.

Dr. Bill Spies, a nuclear medicine specialist at Northwestern Memorial Hospital, said PET scanning is valuable in patient care and insurance coverage should be expanded.

“Imaging is quite expensive—we’re talking about machines that cost millions of dollars," he said. "But it benefits a lot of patients. PET scans help sort things out."

PET scanning, short for positron emission tomography, is commonly used to diagnose a variety of cancers as well as to map the brain for epilepsy and dementia. It's also used to diagnose heart disease.

PET scans can determine whether a solitary nodule—a spot—on a lung is cancerous.  It’s a useful tool for doctors to distinguish between dead tissue and malignant tumors in a patient.

But the scans are expensive, often costing $3,000 or more per scan, depending on the type of cancer treatment a patient is receiving, and may not be covered by health insurance.

While some medical scans assess anatomical features, including density and shape, a PET scan evaluates the active, metabolic characteristics of a tumor. It can also help doctors tell whether a cancerous mass has spread to the lymph nodes.

After a patient has been injected with a simple radioactive sugar, the PET scan uses a ring of detectors to record the emission of positrons, or positive electrons, to produce a computerized image of a patient’s body.

Aileen Carey, manager of nuclear medicine at Northwestern Memorial Hospital, said the radioactive sugar is immediately attracted to the highly metabolic cancer cells, making them easy to spot on the PET scan. The machine's camera attracts the emission rays from all angles, allowing technicians to create a 3-D image based on the scan.

“It’s very valuable to physicians,”  she said, pointing to a scan of a woman with recurring breast cancer. The PET scan showed ink-black spots in the neck, spine and breasts, cancerous masses that might not have been obvious in a standard CT scan. In this case, doctors will be able to evaluate how to move forward with the patient’s treatment.

Carey said the hospital performs about 10 PET scans daily. A PET scanner is physically similar to CT and magnetic resonance imaging, or MRI, machine. It’s large, beige and doughnut-shaped, with a round entry. Patients lie on a table that slides in and out of the scanner.

The new national coverage determination would cover one PET scan for cervical, ovarian, pancreatic, testicular and soft tissue sarcoma cancers, all of which were not previously by Medicare and Medicaid.

According to Spies, approval has been given to the cancers where the data is strongest and most compelling for PET scan use. But he said the extended coverage is still less than what was asked for.

“It still doesn’t give blanket coverage,” he pointed out. “It’s basically proposing to allow patients to be covered for one PET scan if they have one of the approved tumors. A lot of people think this is a good step, but it doesn’t go far enough.”

The hope is that covering early PET scans will lessen the need for repeated scanning—if the cancer is caught before it spreads, the tool could be more cost-effective in the long run.

Spies explained the issue of shrinking health care dollars that CMS has faced with regard to new technology, which is often introduced without any control, resulting in effective modalities being overused. In turn, much of the approval for PET scanning has been piecemeal, where only certain kinds of cancer are covered by insurance.

Ilyse Schuman,  managing director of the Medical Imaging & Technology Alliance in Virginia, is an active supporter for the CMS expansion proposal.

Before joining MITA, Schuman spent seven years as the minority staff director and chief counsel of the U.S. Senate Committee on Health, Education, Labor, and Pensions, and felt the PET scan coverage initiative had major implications in expanding health care quality across the country.

“I think it really does highlight what we consider as the broader health care reform picture,” Schuman said. “And that’s the role medical imaging and innovative technologies play in making sure that patients are getting the best treatments.”