Lymphoproliferative disease – data from PET-CT diagnosis. Left – before treatment, right – after treatment.

As I mentioned before, there’s another aspect to using this method – providing ongoing monitoring of treatment results. You can determine the effectiveness on an anatomical level – for example, seeing that a lesion on a lung has reduced in size. It is also important to know the functional status of the tumour. During treatment, the lesion could still be there, but the cancerous cells may be gone – having been destroyed with drug treatment or radiotherapy. Carrying out PET-CT also allows us to assess the functional effectiveness of a treatment. If after 2 to 3 courses of treatment we see that the tumour is less active, it is clear that the correct course of treatment has been chosen and should be continued. Conversely, if there have been no changes to the capacity of the tumour, we can say with certainty that our treatment hasn’t had the desired effect and that we should change course as soon as possible The ability to monitor whether the treatments we have chosen are working means we can also lessen the toxic effects of chemotherapy.

For what types of tumour is this diagnostic method primarily required?

In the years that PET-CT has been in use, the number of cancers it can be recommended for has increased significantly. Nowadays, the method can be used effectively in practically every part of the body. The all important thing is to choose the right tracer to administer into the tumour to improve its visibility. Worldwide, the vast majority of PET-CT imaging assessments are now carried out using fluorodeoxyglucose.

Administration of radiopharmaceuticals 

As far as diseases that can be successfully treated with the method are concerned, these are primarily lung cancer, lymphoma, head and neck tumours, brain cancers, intestinal and stomach cancers, pancreatic cancer, ovarian, cervical and breast cancers, prostate cancer, melanoma, gastro-intestinal and neuroendocrine tumours. Those dozen or so areas are just the ones that come to mind immediately.

Are there any data available to say how many Russian cancer patients require PET-CT procedures?

Looking at the cancer figures for 2014, we calculated that we would need to carry out around 750 thousand procedures in the Russian Federation. Having said that, for the calculations we used the most recent clinical recommendations. If you took into account everyone who could be helped using PET-CT, the figures would be even higher.

How accessible is PET-CT to Russians?

To come close to European accessibility indicators we will have to increase the number of PET-CT scanners to around 150. To get to US standards we would need two to three times more. PET-CT has been in use worldwide for 10-15 years. It is primarily used before surgical procedures, and in practically all countries this is paid for by insurance companies.

Many of our doctors are professionally well versed in the theory behind the method. However, they don’t have the practical experience of using it widely in their own work. Until the establishment of a federal network of centres for nuclear medicine, PET-CT scanners could only be found in Moscow, Saint Petersburg and a few larger towns and cities; you could count those on the fingers of one hand.

Moreover, in Moscow say, PET-CT procedures are located in state hospitals and clinics, but operate within commercial frameworks, so a patient has to pay for him or herself.

And in the federal network of centres, is the procedure carried out free of charge?

Yes, for example a patient from Bashkortostan can be sent by his or her doctor for a PET-CT procedure in Ufa, covered by compulsory medical insurance. According to our legislation, every citizen, irrespective of where they are registered, has equal access to medical assistance. However, the mechanisms for settling claims between regional subsections of the compulsory insurance system are not yet correctly aligned. When this issue has been resolved, patients from Tula Oblast’ will be able to be referred by a doctor to undergo a procedure free of charge in one of the closest nuclear medicine centres, say in Oryol or Lipetsk. Centres aren’t needed in every region, one scanner can perform around 20 procedures a day, or around 5,000 a year. For some regions this exceeds the requirement, for others it isn’t enough, so in some areas two or three PET-CT scanners will be needed, and in other areas patients will be sent to the neighbouring oblast’. It’s not difficult to work out the requirements for this type of diagnostic method, but only a better claim settlement system and improved patient transfer will allow us to use the federal network to its full potential.

Do you feel that our doctors are already prepared to use the method to its full potential?

Many specialists actually took the view that PET-CT wasn’t the most vital innovation. However, this happened due to the fact that the method itself wasn’t available, and even forward-thinking, intelligent doctors had only heard of it from theoretical papers. As soon as the method begins to be used in a particular region, opinions begin to change – the benefits of a more accurate diagnosis are becoming clearer, as well as effective, ongoing monitoring of the treatment process.

Imagine that you have a well-off patient in your surgery. He asks you whether it would be better to undergo PET-CT here, in Russia, or say, in Israel. What do you recommend?

It is always up to the patient to choose. However it is important to understand that the quality of PET-CT diagnostics depends on two things: the equipment and the specialists’ training. As far as I know, the nuclear medicine centres are well fitted out, and the equipment is from reputable manufacturers. As far as the specialists go, it is important to remember that wherever you go, you are dealing with people and not robots. If a doctor trained in good clinics and hospitals and takes good care of each patient – the results will be as good in Russian centres as in those found abroad.

Source: www.pet-net.ru