|
|
|
|
|
|
|
|
Physician FAQ
1. In what clinical areas is PET/CT useful?
PET/CT has been shown to be useful in a number of clinical areas but most work has centered on oncology, cardiology, neurology and psychiatry. Because of reimbursement issues, only oncology and cardiology are getting serious consideration today with oncology receiving the lion’s share.
Top of Page
2. Why is PET/CT reimbursement primarily for oncology?
PET/CT has been shown to be the most sensitive modality for the detection of many cancers and thus is a significant aid in patient management.
Top of Page
3. How is PET/CT used in oncology?
In general, PET/CT
- can distinguish between benign and malignant masses
- provides the best staging
- is the most sensitive modality for detection of distant metastases
- helps to evaluate the efficacy of therapy.
- can aide in early detection
- can differentiate between tumor recurrence and radiation necrosis or post-surgical changes.
Top of Page
4. Does Medicare reimburse for all PET/CT oncology studies?
No. At the present time only the following imaging studies are reimbursed by Medicare:
- Solitary Pulmonary Nodules
- Lung Cancer
- Colorectal Cancer
- Lymphoma
- Melanoma
- Esophageal cancer
- Head and neck cancers
- Breast Cancer
It should be noted, however, that many private third parties payers do reimburse for many PET/CT studies. Payment does vary considerably by location and by carrier.
Top of Page
5. What other indications are reimbursed by Medicare?
Brain scan for localization of epileptic foci for patients with intractable seizures who are candidates for ablation
Cardiac scans for evaluation of myocardial viability
Top of Page
6. How sensitive is PET/CT for the detection of cancer?
The sensitivity for the detection of most cancers is in the 90-percentile range.
Top of Page
7. How small a lesion can PET/CT detect?
In general tumors greater than about 5 mm in diameter can be detected. In some cases even smaller tumors can be detected.
Top of Page
8. Are there false positives?
Yes, false positives do occur and are mostly the result of artifact or inflammation.
Top of Page
9. Specifically, how is PET/CT used for the indications below?
I. Oncology
In general, in Oncology, PET/CT is useful because it has high sensitivity for visualization of most cancers and can usually detect malignancies as small as 5mm or less. In addition, PET/CT is most often used in a total body scan mode so that distant metastases are detected routinely. Specifics for various techniques are as follows:
Solitary Pulmonary Nodules:
- Used to distinguish benign nodules from malignant ones.
Lung Cancer:
- It is the best method for staging non-small cell carcinoma
- Useful for following the efficacy of therapy
- High sensitivity for the detection of recurrence and for the detection of distant metastases
Colorectal Carcinoma:
- Best method for the detection of recurrence
- Can distinguish between recurrence and post surgical scan when abnormal mass is seen on CT
- Most accurate for staging
- Most sensitive technique for the detection of distant metastases.
Lymphoma:
- Best for staging
- Best method for evaluating efficacy of therapy
- Best method for evaluating recurrence
Melanoma:
- Most sensitive method for staging
Head and Neck Cancers:
- Can distinguish scar from recurrence
- Best method for staging
- Most sensitive method for detection of distant metastases
- Excellent method to follow efficacy of therapy
Esophageal Cancer:
- Most sensitive technique for staging
- Most sensitive method for detection of distant metastases
Breast Cancer:
- Sensitive method for evaluating the breast cancer when the mammogram is inconclusive
- Most sensitive non-invasive technique for evaluating nodal involvement. Particularly appropriate for evaluating for axillary and mediastinal nodal involvement in candidates for partial mastectomy.
- Most sensitive method for staging
- Most sensitive method for detection of distant metastases except for bone metastases
*Prostate Cancer:
- **Helps in determining whether a rising PSA is associated with an aggressive recurrence that requires more aggressive therapy or a more benign recurrence.
*All Other Tumors:
- For most tumors, PET/CT appears to be a very sensitive technique for detection of metastases, for staging and for detecting recurrence. Insufficient work has been done to establish good values for sensitivity and specificity, however.
II. Cardiology:
- PET/CT of the myocardium is the gold standard for distinguishing viable form non-viable myocardium, and is recommended for those patients that are at risk for revascularization procedures to confirm the presence of sufficient viable myocardium to justify the procedure.
III. Neurology:
- Helpful in locating seizure foci in patients with intractable seizures who are candidates for ablation or surgical excision of the foci.
IV. Psychiatry:
- Helpful in the diagnosis of various mental disorders and in distinguishing between various dementias.
Presently not reimbursable by Medicare
**Anecdotal evidence at the present time. Long term studies to verify these conclusions have not been completed.
Top of Page
10. What are indications for Cardiology?
The most common use today is to evaluate myocardium viability in patients that are candidates for revascularization.
Top of Page
11. Can I get scans for conditions not listed above?
Yes, but arrangement for such studies must be through your own institution and according to its policies. Technically, there are no restrictions on what FDG-PET/CT studies neo?PET/CT can provide.
Top of Page
12. How do I order a PET/CT scan for my patients?
neo•pet contracts with hospitals and other health care institutions to provide PET/CT scans through the institution’s own Radiology Dept. Physicians order scans in the manner usual for their institution.
Top of Page
13. Are there special instructions I should give my patients?
Yes, you should tell your patients the following:
- The scan time varies according to the problem but will be 15 to 60 minutes. The total time at the facility will be about 2 to 2 ½ hours because there is about an hour wait between the administration of the radiopharmaceutical and the beginning of scanning.
- The procedure begins with the intravenous administration of FDG, a sugar (deoxyglucose) labeled with Fluorine-18, a radioactive isotope.
- There are no known reactions or side effects to FDG.
- The radiation dose is very small and equivalent to a series of spine X-Ray studies.
- The patient should continue to take their usual medications, if any.
In addition you will have to provide special instructions for particular exams as detailed in the physician instruction sheet provided to all neo?PET/CT clients. Some exams require prescriptions for medication for patient preparation and others for administration during the PET/CT study.
Top of Page
14. What is the cost of a PET/CT scan?
The Medicare reimbursement for PET/CT scans is approximately $2000 for the technical portion. The charge to patients not on Medicare is determined by your own institution. Similarly, indigent patients, research studies, etc. are charged according to the policies of your hospital or health care facility.
Top of Page
|
|
|
|
|
|
