PET scans underused; national strategy needed, new report suggests

TORONTO – A new report suggests PET scan technology is underused in Canada and calls for a national strategy to expand use of the technology.

PET scanners – short for positron emission tomography – are nuclear imaging devices that are used for early detection of some forms of cancers.

The report notes that the World Health Organization recommends two PET scanners for every million people in a population – but Canada has fewer than half that number. In Canada, there are .89 PET scanners for every million Canadians, while in the U.S., the ratio of about 6.5 of the devices per million Americans.

Canada currently has 29 publicly-funded PET scanners with 12 located in Quebec and nine in Ontario, the report says.

Quebec accounted for roughly half of all PET scans conducted in Canada in 2009, and the province paid about 36 per cent less per scan than the average cost across the country, according to the report.

The findings were published by Advanced Applied Physics Solutions and TRIUMF, a national laboratory for nuclear and particle physics research and related sciences at the University of British Columbia.

It analyzes use of PET scans on a province-by-province basis. The Ontario section criticizes the province’s approach to use of the technology, saying the government “has done little to support PET as a normal standard of clinical care for
cancer patients.”

But Dr. Carol Sawka, vice-president for clinical programs and quality initiatives at Cancer Care Ontario, said the province’s approach is based on using PET technology where there is evidence it adds to patient care in a cost-effective manner.

“It’s got to add to conventional (case) management in order for it to be considered worthy of publicly funded dollars,” Sawka said. “That’s really the basic premise in the program in Ontario.”

She said the criticism of Ontario’s cautious approach is not new. “The nuclear medicine physicians have raised their objections to the way in which PET scans were introduced in Ontario.”

Sawka said Ontario’s approach has been that to qualify for provincial funding, PET scans would have to be used in settings where they would detect cancers that would not be detected by other types of scans and influence the management of the patients in which it was detected.

The report says the high cost of buying and running the scanners is a barrier to increased use in Canada. It suggests developing a national strategy could cut costs – provinces could negotiate collective purchase agreements with manufacturers.

It also suggests that the perception that other types of imaging technologies – CT scans and MRIs – are overused is impeding adoption of PET scans.

“Governments should consider the merits of PET technology based on its own capabilities, not on the possible overuse of other technologies,” the report says.