1. Dabbling with the Dark Side Birmingham experience of an on-site Private Sector PET/CT facility Chris Boivin Head of Nuclear Medicine, University Hospital Birmingham

2. Birmingham PET Centre Background How service works Lessons learned

3. Background 1997 – Gamma Camera PET Really wanted proper PET ASAP DH funding? –Always about 2 years away Local business case? –Non-starter since no guaranteed income Independent sector? –Began to show interest 2001

4. 2001: PET scanners per 10m

5. ‘Procurement’ Independent sector managed facility On-site PET/CT facility at no cost to Trust Alliance Medical preferred provider 2003 Lengthy contract negotiations –Freedom to negotiate our own contract, but also freedom to cock it up

6. Time line Oct 2003:Mobile PET July 2004:Mobile PET/CT July 2005:PET Centre opens Jan 2006:1000 th scan

13. PET scans per quarter

15. Our Requirements Partnership – integration with Trust Imaging services Involvement in choice of PET/CT camera & centre design Bells & whistles –Radiotherapy treatment planning –Respiratory gating Low-cost research access Involvement of Nuclear Med staff

16. PET Centre Operation Staffed by Alliance –Manager/operator, operator, helper, 2 x clerical FDG shipped in IRR99 & RSA93 – Alliance IRMER – Trust (control over procedures) ARSAC & reporting – Trust radiologists MPE – St George’s, shortly to be transferred to Trust physicists RPA – Trust physicists Trust authorised officer – contract monitoring Monthly service meetings Trust & Alliance

17. IT Integration Probably the most complicated bit Alliance private network with firewalls to Trust network All patients registered on Trust PAS & RIS DICOM worklist RIS to PET/CT Images pushed to Trust PACS Scan reporting on Trust RIS, access to Trust PACS in PET Centre

18. Trust Staff Integration Radiologists – ARSAC, reporting, training Physicists – report checking, IRMER, RPA, incident investigation, audit & contract monitoring, RIS & IT support (bubbling under – MPE, R&D) Technologists – injection assistance (future – supernumerary rotation, permanent staffing?)

19. Service Integration Emergency medical cover Medical & consumable supplies Infection control Waste disposal CleaningPortering Fire alarms Utilities infrastructure

20. Lessons learned Their targets are not necessarily our targets (eg 31 & 62 day cancer waits) IT links and data sharing are a challenge to seamless integration Useful to transfer risk of spiralling costs Glossy literature & service marketing

22. Conclusion High-quality PET/CT service established From user point of view, day-to-day function similar to other Trust imaging modalities –radiologists, IT integration, MDTs etc Goodwill & good communication essential –overcame initial teething troubles, everyone working well together