The powerful PET/CT imaging technique holds great promise in the diagnosis and treatment of many diseases; however, its significant price tag may be a major factor for many small community hospitals that need such services but lack funding or patient volume to support an on-site fixed dedicated system, explained SNM member Shashi P. Khandekar, CNMT, with the Cleveland Clinic Foundation, Cleveland, Ohio.
The Cleveland Clinic Health System, which includes CCF and nine community hospitals, decided to provide the mobile service on a break-even basis and took the mobile PET/CT service in-house, a move that would keep revenue within that health network. Since this past September, more than 900 patients have used the system's mobile PET/CT unit, an average of about six patients a day, said Khandekar. The cooperative efforts of all the hospitals have made it a successful operation, she added.
Over a period of about six months, planners worked out details of providing such a service: data connectivity, patient scheduling and transport of the mobile PET/CT truck. Patient scheduling was centralized and provided through a CCF call center. CCF and the participating regional hospitals determined the fee schedules (one based on per exam fee with a daily minimum, geared toward a start-up service, and one based on a flat fee per day for those with a solid referral pattern) and service requirements and outlined the route.
The mobile PET/CT unit, which came with a price tag of nearly $2.4 million, made it convenient for patients in the health system, said Khandekar, indicating that many patients are too sick to travel long distances. "It just hits you when you find out you have cancer," said Khandekar, indicating that patients are able to book appointments quickly--and with their own physicians. This strategy allows local health care providers to maintain "that individual touch" with their patients, rather than sending them to a different hospital and different health care providers. According to the CCHS's plan, each hospital remains responsible for its own billing of patients, and they share an archival system for images. The mobile unit goes to four regional hospitals within the system on a rotating schedule. The health system contracted with a local trucking firm for transport and maintenance of the mobile unit.
PET is a powerful medical imaging modality that noninvasively traces molecular and functional processes in the body. PET images can more accurately define a host of disease processes than conventional, anatomic-based imaging alone (such as CT and MR). PET can play an important role in cardiac, neurologic and whole-body imaging. Currently, the most common use of PET is for whole-body oncologic imaging for diagnosis, staging, restaging and measuring early therapy responses. Combining PET with CT provides images showing function (PET) and anatomy (CT) and a merged or "fused" picture of the body's metabolism and structure. That way, an image can provide a more complete picture of a cancer tumor's location and growth or spread than either test alone. Researchers hope that the combined procedure will improve health care professionals' ability to diagnose cancer, determine how far it has spread and follow patients' responses to treatment. The combined PET/CT scan may also reduce the number of additional imaging tests and other procedures a patient needs.
CCHS health care providers "were always thinking about having a mobile PET/CT service" and wanted to provide state-of-the-art equipment "to give the highest level of patient care," said Khandekar. Getting this service up and running "is truly an example of collaborative team work," she added.
Authors of "Using A 'Win-Win' Economic Strategy to Overcome Hurdles to Mobile PET/CT Imaging" are Shashi P. Khandekar, molecular and functional imaging department, Cleveland Clinic Foundation, Cleveland, Ohio; John Litchney, Regional Radiology, Cleveland Clinic Foundation, Cleveland, Ohio; H. Joseph Parker, division of radiology, Cleveland Clinic Foundation, Cleveland, Ohio; and Gregory W. Baran, regional radiology, Cleveland Clinic Foundation, Cleveland, Ohio.
Technologist Paper 1715
About the Society of Nuclear Medicine
The Society of Nuclear Medicine is holding its 52nd Annual Meeting June 18–22 at the Metro Toronto Convention Centre, Toronto, Canada. Research topics for the 2005 meeting include techniques for the early diagnosis of Alzheimer's disease; advanced imaging for the diagnosis, staging and treatment of cancer; nuclear cardiology; and the collaboration between nuclear medicine and bioengineering in the fight against cancer. SNM is an international scientific and professional organization of more than 16,000 members dedicated to promoting the science, technology and practical applications of molecular imaging/nuclear medicine. SNM is based in Reston, Va.; additional information can be found online at http://www.snm.org.