Joint venture promotes outpatient cardiac PET

The third phase of clinical PET adoption appears imminent and Integrated Cardiac Solutions intends to be ahead of the curve.

ICS is a joint venture between the Bracco Group, a provider of the PET perfusion agent rubidium-82, and practice management specialist Integrated Medical Solutions. Its sole goal is promoting cardiac PET among outpatient cardiology groups and heart centers.

"We've seen the development of PET for oncology and neurology applications," said Stan Grice, ICS president and CEO. "Now it's time for the third application to take hold, cardiac PET.

ICS is gearing up to provide the clinical, administrative, and marketing assistance that outpatient clinics will need to successfully launch the modality in their local communities. The company's foot in the door consists of a complimentary practice assessment to determine whether a cardiac PET program is economically feasible for the provider. The fledgling company is already working with one group considering a cardiac PET practice and has about a half dozen more that are interested.

"We caution everyone before getting into a cardiac PET program to do a thorough job of assessing all the patient and cost data, because the last thing you want to do is pay a lot of money for equipment and then not have the patient flow to pay off that debt," Grice said.

Patient flow for many practices, especially those performing cardiac SPECT, however, may not be a problem. Recent peer-reviewed publications indicate that PET perfusion is more accurate in detecting coronary artery disease than the widely used SPECT application, especially in women. And a reimbursement hike for Medicare to about $2600 per exam, implemented in January for this application, has made it easier for operations to turn a profit.

The company has a rich target environment in which to argue its case for cardiac PET. Grice estimates that about 4000 outpatient cardiology practices in the U.S. perform cardiac SPECT. Many of these considered PET years ago, but dismissed the modality as having too many barriers to entry. With changes in reimbursement and proven clinical advantages, those barriers are coming down.

Even the purchase of a PET scanner is not so daunting anymore. Refurbished PET cameras, whose clinical value has eroded since the introduction of PET/CT for oncology and neurology, are bargains, according to Bill Abbott, general manager of nuclear medicine at Bracco Diagnostics. Some can be had for prices approaching those of SPECT cameras.

"This significantly reduces the barrier for entry," said Abbott, who serves as chairman of the board for ICS.

Bracco has plenty to gain from promoting the use of cardiac PET, as it provides the only widely available, FDA-approved radionuclide for cardiac PET perfusion, rubidium-82, derived from its CardioGen-82 generator. Over the past 18 months, the number of new CardioGen-82 sites has increased by nearly 90%, Abbott said. The number of sites using these generators, however, remains small, at about 60, he said. Building this number will boost Bracco revenues and also improve community-based medicine.

"Most cardiac PET programs are in academic medical centers, like the one at Brigham and Women's Hospital," he said. "Bringing PET to outpatient cardiology practices brings academic-level medicine to local communities."

And there's more to the convenience angle than just travel time for patients. A rest/stress test using cardiac PET perfusion runs approximately 30 minutes versus three to four hours for the average cardiac SPECT perfusion exam. The trick is in the short half-life of rubidium-82, which rapidly clears the body, whereas SPECT radionuclides require much more time. Abbott expects that this card will play well when promoting PET as well as ICS.

"Ask yourself which study you would rather have done if you are suspected of having heart disease: a study that takes a half-hour or one that takes an entire morning?" he said.