Summer 2005

PET/CT: A Doctor’s Best Friend

The Next Generation of Diagnostic and Treatment Technology is now at AAMC

Imagine a device that looks at a tumor and analyzes it with two different technologies. One of those technologies, a Positron Emissions Tomography (PET) scan, searches for the distinct metabolic signature of cancer cells. The other, a Computed Tomography (CT) scan, plots the exact location, shape and size of the tumor.

Jack Van Geffen, M.D.

Most people have heard of one or both technologies. Not nearly as many have heard of them combined into one system, as they have been now for two years at Anne Arundel Medical Center. The GE Discovery ST PET/CT scanner was and is the gold standard in imaging and diagnostic technology, according to Jack Van Geffen, M.D., medical director of Nuclear Medicine at AAMC.

“The PET/CT combination is out at the very edge of technology in terms of pinpointing and analyzing the tumor and making a determination whether a mass is cancerous,” he said.

PET scanning technology had been available as a stand-alone system when AAMC officials several years ago weighed options as to which of the available technologies were the state-of-the-art. The hospital’s commitment to stay at least one step ahead in technology pointed to a decision that moved beyond just PET technology as a separate system. Instead, officials embraced what was then and remains today the next generation in cancer imaging technology: a system that combines the best imaging capabilities of PET and CT scanning. The initial cost was higher by a substantial margin. Yet the benefits of PET/CT to patients and physicians, in better outcomes and fewer unnecessary surgeries, ultimately lowered costs overall.

Answers to urgent questions, quickly

AAMC’s acquisition of the GE Discovery ST PET/CT scanner catapulted the hospital into the vanguard of cancer diagnosis and treatment. The GE system blends two body images, fusing both patient anatomy and physiology into a single image so that the doctors treating the patient know exactly where the patient’s tumor is, whether it’s cancerous, and, if it is, whether surgery, radiation or chemotherapy is the best type of treatment.

“If it’s not cancer, then we wouldn’t have to operate,” Dr. Van Geffen said. “If it is cancer, the PET/CT can help tell us which is the more effective treatment? surgery or radiation. In addition, because the PET/CT tells us the exact size of the tumor, it also tells us how to direct radiation in order to spare as much of the healthy tissue as possible.”

The purchase of the PET/CT also helped AAMC become the world’s first See and Treat® Cancer Care Center of Excellence for treating patients using the most advanced medical imaging equipment from GE Healthcare and radiation therapy technologies from Varian Medical Systems. With the PET/CT technology, AAMC became the first hospital in Maryland and one of only a handful in the United States that could find a tumor, identify it as cancerous and then treat it with this advanced equipment. Not only are patients being treated with better technology, but they also spend less time for each treatment.

Keeping pace with the next step, and the step after that

As part of being named a See and Treat® Cancer Care Center of Excellence, AAMC has made a commitment to not only acquire these technologically advanced systems but also the high-caliber clinical team to use them to deliver exceptional patient care. “We made a decision some time ago to commit to the companies we believe will continue to set the pace,” said Oncologist Stanley Watkins, Jr., M.D., Medical Director of the Geaton and JoAnn DeCesaris Cancer Institute. “Not only has that made integration of upgrades and new systems more effective, it’s also created a longstanding relationship with these companies, which ultimately led to the See and Treat Center of Excellence program.”

The program Dr. Watkins refers to has four basic components as its foundation. First, AAMC commits to acquiring and employing each new generation of See and Treat Cancer Care technologies when they are released. Second, clinicians from AAMC will participate in a special See and Treat Medical Advisory Board, and provide Varian and GE with clinical feedback and ongoing input for continuous improvement. This shared pool of experience ensures that current and future patients will benefit from clinical and technological advances in detection and treatment of cancer. Third, AAMC’s DeCesaris Cancer Institute will serve as a model for clinicians from other cancer programs to observe. Finally, a demanding and extensive information-reporting requirement must be met and maintained.

From left, the first image, CT scan of a slice through the spine; second image, PET scan slice; third image, PET/CT fusion; fourth image, front view PET image. The bright areas, or hot spots, reveal many malignant tumors. (The brain and bladder normally appear bright.)

“Our roster of physicians, information technology engineers, physicists and dosimetrists has grown in size and depth, with credentials that place them in the top tier of people in their fields,” Dr.Watkins said. “It’s a highly productive and exciting equation between the best people getting the utmost performance from the next generation of diagnostic and treatment technology.”

For Maryland, good news at the right time

Dr. Watkins placed the implications of the Center of Excellence designation in a context readily understood by people in the region served by AAMC.

“Maryland’s cancer statistics generally, and Anne Arundel County’s specifically, have placed us squarely on the front line in the fight against cancer,” he said. “The See and Treat technology and Center of Excellence designation are signals to the community that the resources—the people and technology—to gain the upper hand in that fight are here now and will remain here for some time to come.”

Currently Medicare only will cover the use of the PET/CT scanner for treating several common types of tumors; however, Dr. Van Geffen said that number is expected to increase dramatically very soon.

“They are finding that this machine really works in determining how far the cancer has spread and whether the cancer is surgically resectable or should be treated with radiation or chemotherapy,” Dr. Van Geffen said.

Clinical applications for the technology include reducing biopsy sampling errors, improving therapy planning and assessing response to treatments such as chemotherapy and radiation therapy. The PET/CT can also be used for looking at the heart or the brain.

Dr. Van Geffen, along with radiologists Vernon Croft, M.D., Tom Lank, M.D., Nick Malakis, M.D., and James W. Reinig, M.D. work closely with primary care physicians and specialists to use PET/CT technology to ensure patients are getting the most advanced technology available.

“We are in the midst of tremendous breakthrough in the ways our hospital can diagnose and treat cancer—a breakthrough based in part on our purchase of the PET/CT scanner,” Dr. Van Geffen said. “These are exciting times for a community hospital that has graduated to the status of a top-flight medical resource for the Baltimore-Washington region.”

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