Authors' objectives:

The aim of this review is to report on the use of combined positron emission tomography/computed tomography (PET/CT) in France (technical, legislative, medical, economic and organisational aspects) in order to establish equipment selection criteria and organisational implications.

Authors' results and conclusions: (i) Technical aspects: Combining CT with PET provides faster attenuation correction and better localisation of focal 18F-FDG uptake. This may lead to improved diagnostic and therapeutic procedures. Acquisition protocols vary. Techniques and algorithms are available to compensate for the main artefacts. (ii) Legislative and commercial aspects: The rules for installing combined equipment (PET/CT) in a healthcare organisation (HCO) are the same as for installing a PET machine alone. CT equipment should not be used unless it is connected to the PET machine. By June 2004, 60 authorisations had been granted for PET and PET/CT systems (about 75, ie 1 per 800,000 inhabitants, are scheduled in the cancer programme). The machines used in France are mainly PET/CT systems. They use different forms of PET detector and different numbers of detectors in the CT system. PET-only systems will doubtless disappear. The trend is toward increasing the number of detectors (a minimum of 4 and up to 16 in 2004). (iii) Clinical aspects: Thirteen studies, all with design limitations, were selected to compare the performance of PET/CT with that of PET and/or CT. They tended to show that PET/CT had improved sensitivity, and especially specificity, compared with PET alone. The potentially significant clinical impact and the potential for replacing diagnostic CT with PET/CT could not be assessed. The clinical benefit of increasing the number of detectors in PET/CT systems has not been established. (iv) Organisational aspects: The PET/CT system has to be integrated into an imaging network. Multidisciplinary team meetings improve patient care. The relationship between specialists in nuclear medicine and radiologists should be formalised within each HCO. Using the equipment in medical imaging centres or departments should help optimise use of resources and the patient pathway. (v) Survey: Overall, 93% of authorised HCOs responded. In June 2004, 9 PET and 23 PET/CT systems were in operation and 23 new sites were expecting to install a PET/CT system. Specific uses in oncology were for the lungs, lymphomas, colon and the digestive system. Costs depended on whether a PET or PET/CT was used. There was a definite organisational impact.

Authors' recommendations: The experts stressed the need to: - draft good practice guidelines covering technical procedures and examination protocols; - assess the new diagnosis and care strategies made possible by PET/CT systems (timing of imaging examinations, clinical impact) and carry out clinical/economic studies; - assess the organisational impact of PET/CT systems and formalise the relationship between specialists in nuclear medicine and radiology (including oncologists); - adapt the funding measures (French Common Classification of Medical Procedures (CCAM)) in relation to current and expected levels of activity in Health Care Offices; - assess multidetector PET/CT systems in new indications using 18F-FDG and other markers.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-Sante.fr/

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: Haute Autorité de Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: has.seap.secretariat@has-sante.fr

Contact Email: has.seap.secretariat@has-sante.fr

Copyright: Haute Autorite de Sante/French National Authority for Health (HAS)