Ontario to finally fund PET exams
After studying the effectiveness of Positron Emission Tomography (PET)
scanning for seven years, the government of Ontario announced it will
start reimbursing specialists for conducting PET exams this fall.
However, the funding will be made only for certain types of medical
conditions, where the province says PET scans have been proven to be
The government didnt announce how much money it is investing in the
expensive scans, which can cost in the neighbourhood of $2,000 per
study. It didnt say, moreover, how many scans it expected to be covered
in the future.
PET scanning is used around the world as a highly effective means of
diagnosing cancers and heart problems, and is also used for surgical
planning and follow-up. Specialists in Ontario have been clamouring for
the government to start funding the modality for years; they have been
even more vocal since the shutdown of the nuclear reactor at Chalk
River, Ontario, has resulted in a shortage of medical isotopes for
standard nuclear medicine procedures.
PET scanning also requires radioisotopes, but they are not produced by
nuclear reactors. Instead, they are created in cyclotrons.
PET technology is said to produce more sensitive results than
conventional nuclear medicine for many types of testing. It can be used
as substitute for many but not all of the tests conducted in traditional
nuclear medicine scanners.
PET scanning can provide information on both the location and the extent
of the metabolic activity of abnormal tissues, such as cancer, and it
has the potential to identify the areas of abnormal metabolic activity
that is not always found through the use of MRIs or CT scans.
For the services that will be insured, PET is useful in determining the
stage or extent of some cancers to aid in treatment decisions. PET has
also been determined to be useful in making treatment decisions in
certain advanced heart conditions.
By October 2009, insured PET scans will be performed in Ottawa, London,
Toronto, Hamilton and Thunder Bay.
Ontario has established one of the largest PET infrastructures in
Canada, with 10 PET scanners at nine centres. However, the scanners have
mostly been used for research purposes.
[This] announcement is a step in the right direction and will benefit
cancer and cardiac patients who meet the clinically proven indications
for PET scans. In addition, the OANM looks forward to working with
government in order to appropriately increase PET access for those
patients requiring this procedure in the future, said Dr. Christopher
O'Brien, President, Ontario Association of Nuclear Medicine (OANM).
The government has made amendments to regulations under the Health
Insurance Act to include PET scans under the Ontario Health Insurance
Plan for patients with the following evidence-based health indications:
Solitary Pulmonary Nodule (SPN): for which a diagnosis could not be
established by a needle biopsy due to unsuccessful attempted needle
biopsy; the SPN is inaccessible to needle biopsy; or the existence of a
contra-indication to the use of needle biopsy.
Thyroid cancer: where recurrent or persistent disease is suspected on
the basis of an elevated and/or rising thyroglobulin but standard
imaging studies are negative or equivocal.
Germ cell tumours: where recurrent disease is suspected on the basis
of elevated tumour marker(s) (beta human chorionic gonadotrophin (HCG)
and/or alpha fetoprotein) and standard imaging tests are negative, or a
mass persists after primary treatment for seminoma when curative
surgical resection is being considered.
Colorectal cancer: where recurrent disease is suspected on the basis
of an elevated and/or rising carcinoembryronic antigen (CEA) level(s)
during follow-up after surgical resection but standard imaging tests are
negative or equivocal.
Lymphoma: for the evaluation of residual mass(es) following
chemotherapy in a patient with Hodgkin's or non-Hodgkin's lymphoma when
further potentially curative therapy (such as radiation or stem cell
transplantation) is being considered; or for the assessment of response
in early stage Hodgkin's lymphoma following two (2) or three (3) cycles
of chemotherapy when the chemotherapy is being considered as the
definitive single modality therapy. Non-small cell lung cancer: where
curative surgical resection is being considered based on negative
standard imaging tests.
Clinical stage III non-small cell lung cancer: that is being
considered for potentially curative combined modality therapy with
radical radiotherapy and chemotherapy.
Limited disease small cell lung cancer: for evaluation and staging
where combined modality therapy with chemotherapy and radiotherapy is
Myocardial viability assessment in a patient suitable for a cardiac
revascularization procedure or cardiac transplantation with ischemic
left ventricular dysfunction (left ventricular ejection fraction of 35%
and prior myocardial viability or stress imaging assessment with
another modality (i.e. SPECT using thallium, MIBI or dobutamine stress
echocardiography) has been equivocal for viability or demonstrated
insufficient viable myocardium.
Ongoing Clinical Trials
The Ministry has been evaluating how best to use PET to improve decision
making for cancer and cardiac treatment through ongoing clinical trials
conducted by the Ontario Clinical Oncology Group. These trials are
resulting in high quality and internationally recognized evidence of
improved patient outcomes. Recommendations for insuring PET for the nine
indicators have been made on the basis of evaluation studies completed
Positron Emission Tomography (PET) Scanning
PET scanning is a nuclear medicine diagnostic imaging exam. PET scanning
can provide information on both the location and the extent of the
metabolic activity of abnormal tissues such as cancer and it has the
potential to identify areas of abnormal metabolic activity before
anatomical changes can be detected by MRIs or CT scans. For the services
that will be insured, PET is useful in determining the stage or extent
of some cancers to aid in treatment decisions. PET has also been
determined to be useful in making treatment decisions in certain advance
A patient undergoing a PET scan is
given a radiopharmaceutical, which is injected into a vein. The
radiopharmaceutical eventually gathers in the organ or area of the body
being examined where it gives off energy in the form of gamma rays.
The PET scanner is a large machine
with a round, doughnut shaped hole in the middle similar to a CT scan
unit. The scanner has multiple rings of detectors that measure the
absorption of the radiopharmaceutical in a person's body. The scanner
produces an image based on the energy given off by the different amounts
of radiopharmaceutical absorbed by different cells in the body (i.e.
cancer calls may absorb more radiopharmaceutical than normal tissue).
The PET scanner works with a
computer to create two- and three-dimensional images of the structure
and function of organs and tissues. It can help determine how well
organs and tissues are functioning by measuring such things as blood
flow, oxygen use and sugar (glucose) metabolism.PET Locations
PET scans are available at the following hospital sites:
University Health Network (Princess Margaret Hospital)
Sunnybrook Regional Cancer Centre
Hamilton Health Sciences Centre
St. Joseph's Healthcare (Hamilton)
London Health Sciences Centre
St. Joseph's Health Care London
The Ottawa Hospital
The Ottawa Heart Institute.
PET scanning will be available at the Thunder Bay Regional Health
Sciences Centre in the fall of 2009.
Posted July 30/09.