1. Derek Martinig Suzanne Lane Julia Barnscher

3.  FDG (18-fluoro-2-deoxyglucose) – Radioactive F in place of O in glucose  Fluoride decays back to Oxygen and emits positrons  Cellular consumption of glucose molecules can be observed using a PET scanner  Used for research, cancer, blood clots, Alzheimers

4.  1952 – First positron imaging device  Mid 70s – First PET scanners using Fluoride  Late 70s – first PET scanners using in clinical settings  1980s – Research showing clinical utility  1988- U.S.A – Medicare funded first PET Scan  1992 – Australia’s first PET Facility

5.  Lack of Personnel  High Costs  Accessibility of FDG  Lack of Standardized Protocols  Government Regulations

6.  Radiopharmaceutical drug - Investigation drug - Biologics and Genetic Therapies Directorate (BGTD) branch of Health Canada  Over 5,000 studies demonstrating safety and benefits of FDG  Support from:  Canadian Association of Radiologists  Canadian Society of Nuclear Medicine  European Association of Nuclear Medicine  American Society of Nuclear Medicine

7. The power of PET over traditional imaging modalities

8.  72 year old Male  Diagnosed with Esophageal Tumor  CT scan revealed abnormality in distal esophagus  Treatment Plan: radiation & chemo. then Surgery

9.  PET/CT Imaging revealed two undiagnosed lymph nodes  Staging and treatment volume were both altered.  Studies found that up to 62% of treatments were adjusted as a result of a PET Scan

10. 82 year old female with Rectal Bleed Mass found in Right transverse colon during colonscopy CT performed and revealed mass in presacral area Liver was unremarkable on CT Scan Patient underwent colectomy and 8 out of 9 nodes tested were positive for metastases

11. Follow up PET Scan was completed after surgery The presacral mass was localized once again Two additional liver metastases were identified Findings would have resulted in patient not undergoing surgery

13.  Regulations changed in 2003  Approval for production and use of FDG by BGTD  New drug submission  4 manufacturers approved for limited uses  Non approved uses must be carried out under clinical trial applications

14.  Limited number of funded scans per province  Not related to size of population or availability of scanning facilities  Not available in all provinces  Public and private not equivalent  Up to 6 week waiting period

15.  Canada approves scans for fewer conditions than other countries  US, European Union, Australia  Lung, breast, colorectal cancers  Revisions suggested as of March 2009  Will not have any rapid effect to increase availability of FDG

16. Those impacted by the Current Regulations on PET in Canada

18. Pros: Still Pending.... Cons: -”Brain Drain” still exists as a result of limitations on research (6 months in US, 3 years in Canada) -Costly and time consuming clinical trials -Redundancy of research -Lack of motivation to continue with research in the field.

19. Pros: -Limit initial healthcare spending -Capital Investments -Exam Reimbursement Cons: -Less cost-effective -Reduction in Surgeries -More effective treatment regiments -Perception of not providing best possible care.

20. Pros: Monopoly Power....really? Cons: Expensive licensing costs & Low demand lead to Inability to control pricing

25. What needs to be done to fix this problem...

27.  Remove the Clinical Trial Label  Eliminate Redundancy of NDS  Provide Guidelines for Production of FDG _____________________  Result in Increased Provision!

28.  Collaboration of College of Physicians and Government  Set Fee Structure  Cover cost of PET under provincial health plans _____________________  Resulting in Increased Utilization and Provision

29.  Advertising and Promotion of PET  Increase Physician Awareness  Increase Patient Awareness  Increase Research _____________________  Optimal Utilization of PET