Nuclear medicine outlook: The road ahead, a glance back

Expanded coverage for PET drove demand for procedures in 2006, helping push unit sales, which also benefited from local pressures on providers to keep up with the competition. Demand for upgrading the installed base to PET/CT from dedicated PET could bolster sales in the near term, just as the popularity of the modality continues to rise.

About 1.13 million PET procedures were performed in 2005, according to the market research firm IMV, up 60% from 706,000 in 2003, an annualized 30% growth rate. Future growth will depend particularly on the expansion of PET/CT into new applications.

A major opportunity is cardiac imaging, but expansion into this area will hinge on the adoption of CT scanners for coronary CT angiography. Other opportunities are in breast and thyroid applications. Supporting future growth will be advanced visualization tools, particularly for multimodality image fusion.

Working against future growth will be reductions in PET reimbursement under Medicare and Medicaid due to cuts in the Outpatient Prospective Payment System (OPPS) and the Deficit Reduction Act. OPPS cuts PET studies from 24% to 71% below 2006 reimbursement levels, while the DRA caps the Medicare technical component reimbursement for these facilities to the lesser amount of either OPPS or the Medicare Part B Physician Fee Schedule.

The PET community is trying to offset these losses by pushing a PET registry that provides provisional coverage for new applications, such as cervical, brain, pancreatic, ovarian, and testicular cancers. The idea is to get revenue flowing for these on an interim basis, while pushing for long-term coverage supported by clinical trials.

SPECT/CT remains the wild card in nuclear medicine. Coming developments in radiopharmaceuticals that could compete with PET radiotracers could make the difference. These new radiotracers would necessitate the same kind of anatomical landmarking seen in PET/CT, spurring growth of SPECT/CT as a less costly and more flexible imaging modality.

Market snapshot

Gamma cameras have been going nowhere for a long time. Last year was more of the same. The nuclear medicine marketplace served as the canvas for a bleak picture, except for PET, the one bright light in an otherwise gloomy landscape.

By midyear 2006, the total nuclear medicine market was running at an annual clip of about $700 million in new unit sales, down from the previous year's $740 million, according to industry sources. If not for PET/CT, the outlook would have been much worse.

In 2005, PET/CT new unit sales rose to $390 million from $315 million in 2004. By midyear 2006, PET/CT sales had reached about $180 million, exactly on pace with last year's performance.

Meanwhile, gamma camera sales continued to sink, as new unit sales accounted for just $145 million at midyear. If the pace continued through the final days of 2006, the year end could easily have been under $300 million, representing more than a 10% hit from new unit sales in 2005.

RSNA highlights

A scalable dual-head gamma camera, BrightView, from Philips Medical Systems offers the best of two worlds, economy and high performance. Its value-oriented design provides an entry-level price point, while the standard configuration serves as the company's new flagship among gamma cameras, pushing aside Philips' SkyLight and Forte. BrightView can handle any exam, including cardiac studies. Its variable-angle detectors are designed to get extraordinarily close to the patient so as to reduce dead space that can reduce resolution. Bodyguard body contouring technology uses electromagnetic sensors to define patient contours. Customizable automated data acquisition supports multiple acquisition protocols simultaneously. The system can be equipped with either 3/4-inch or 3/8-inch detector crystals. BrightView's open 10-axis gantry affords increased patient comfort.

Numa promised greater connectivity within and outside the nuc med department with enhancements for its NumaLink, a cross-vendor data translation product, and NumaStore, a gamma camera and PET/CT image management system. NumaLink enhancements include DICOM translation capabilities for proprietary PET data sets from PET systems made by Siemens and GE. The NumaStore upgrade supports Siemens' preclinical microPET and the Inveon Dedicated PET small animal imaging systems.

MIMvista highlighted an automated contouring application for PET studies. Using a technique known as absolute threshold, MIM 4.0 takes the guesswork out of using data from fused PET/CT or PET/MR imaging studies for planning radiotherapy by providing contours based on standardized uptake values, after a physician sets a baseline SUV. A spatial derivative technique called autocontour outlines the boundary of a lesion, defining the volume not only for solid tumors but also for those with a necrotic center or fingerlike configuration. Autocontour has 2D and 3D editing options, so physicians can edit on sagittal and coronal planes and have their editing apply to subsequent axial slices.

Privately held Naviscan PET Systems launched its second generation of positron emission mammography (PEM) devices. PEM Flex Solo II is intended as an adjunct to x-ray mammography, providing a metabolic characterization of suspected disease.

Other notable products included:

• LumiGem from Gamma Medica-Ideas, a dual-head breast scanner with detectors made from CZT, providing high-energy resolution and uniform-appearing images from chest wall to nipple

• GE Healthcare's CardIQ Fusion software, which enables multimodality image fusion of CT, PET, and nuclear medicine images on Advantage Workstations

• ImagenPRO and ImagenMD software from Hitachi Medical Systems America, designed to support myocardial perfusion imaging with PET. Developed by Cardiovascular Imaging Technologies, this software enhances the company's AVIA (Advanced Visualization and Image Analysis) workstation, which is used to process studies performed on its SceptreC cardiac PET system.

• NeuroLogica's work-in-progress mobile SPECT camera, NeuroFocus SPECT

• Spectrum Dynamics' innovative SPECT camera, D-SPECT (dynamic SPECT), which is pending FDA clearance (first shown at RSNA 2005). The camera is composed of solid-state detectors made from cadmium zinc telluride crystals, a mechanism that moves the detector inside its casing, and algorithms that optimize acquired data.