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PET-CT in Scotland Dr Fergus McKiddie John Mallard PET Centre Aberdeen Royal Infirmary
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What is PET? PET is Positron Emission Tomography A specialised form of Nuclear Medicine Requires specialist imaging and radiopharmacy equipment
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Proton rich radioisotope decays by positron emission Proton decays to a neutron, a positron and a neutrino Positron loses energy until it annihilates with an electron to produce two colinear 511 keV photons
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Positron Producing Radioisotopes
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2-fluoro-2-deoxy-D-glucose, commonly called Fluorodeoxyglucose or FDG Similar metabolic pathway to glucose in vivo, but remains trapped within tissue Useful in oncology as proliferating cancer cells have a higher than average rate of glucose metabolism (O Warburg 1931 "The metabolism of tumors" New York: Richard Smith;129-161) 18 F-FDG
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Proton bombardment of 18 O enriched water 18 F produced as hydrofluoric acid Synthesis completed in automated rig within ‘hot cell’ 18 F-FDG Synthesis
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Multimodality Imaging 18 F-FDG PET
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CT
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Fused PET-CT
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Second scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1985 - Research PET scanner installed at Aberdeen University 2001 - Scottish Government commissions Health Technology Assessment into cost effectiveness of PET 2003 - Scottish Government commits £5 million for provision of PET in Scotland 2005 - Ordered placed for first two scanners 2006 - 26 th March, first patient scanned at Aberdeen Royal Infirmary 2007 - Scanner opens at Beatson Oncology Centre, Glasgow 2010 - Scanners opened in Edinburgh and Dundee 2014 - Funding for all future scanners confirmed from central funding moving forward Timeline for PET in Scotland
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1.John Mallard PET Centre, ARI Scanner (NHS), Cyclotron (Uni) 2.Beatson West of Scotland Cancer Centre, Gartnavel 2 x Scanner + Cyclotron (NHS) 3.Clinical Research Imaging Centre, ERI Scanner + Cyclotron (NHS/Uni) 4.Clinical Research Imaging Facility, Ninewells Scanner (NHS/Uni) 1 2 3 4
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PET-CT is expensive:£1600 - £2000 per scan Funding is top-sliced to spread cost Only indications with proven evidence funded 2006: Lung, Lymphoma, Recurrent colorectal Clinical Indications for PET in Scotland
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Additional indications added as evidence becomes available 2014: Lung, Lymphoma, Recurrent colorectal, Oesophageal, Head and neck, Gynaecological Clinical Indications for PET in Scotland
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Additional indications added as evidence becomes available 2014: Lung, Lymphoma, Recurrent colorectal, Oesophageal, Head and neck, Gynaecological Clinical Indications for PET in Scotland
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Funding has always been provided for justifiable ‘Other’ indications Examples include Melanoma, Vasculitis, Sarcoidosis, Unknown Primary ca, PUO Clinical Indications for PET in Scotland
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Royal College of Radiology Guidelines Published 2013 Provide guidance for 23 cancer indications Additionally 6 non-cancer indications Information about other non-FDG tracers
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Royal College of Radiology Guidelines Published 2013 Provide guidance for 23 cancer indications Additionally 6 non-cancer indications Information about other non-FDG tracers
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Royal College of Radiology Guidelines CancerNon -Cancer BrainMyelomaNeurological Head and NeckSkinCardiological ThyroidMusculoskeletalVasculitis LungParaneoplastic syndromesSarcoidosis PleuralNeuroendocrineInfection ThymicUnknown PrimaryPUO Oesophago-gastricRare tumours in children GI Stromal Breast Hepato-pancreatico-biliary Colorectal Urological Gynaecological Testicular Anal and Penile Lymphoma
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Historically no national provision Competitive tender process carried out through 2014 Feb 2015, Collaborative Network, led by Alliance Medical, announced as providers at 31 sites on a 10 yr contract Also announced that they will fund all indications in the RCR Guidelines PET in England
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Decision made to match NHS England funded criteria i.e., RCR Guidelines Workgroup established to develop local guidance for each of the 29 indications Future Indications for PET in Scotland
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Anticipated that current 10-15% annual workload uplift will continue Many indications already covered by ‘Other’ category Future Indications for PET in Scotland
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