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Revolutionary diagnostic technology defines diseased tissue with new clarity, precision

by Kathy Hagood
Brevard Technical Journal

Dr. Maureen Holasek of Cancer Care Centers of Brevard stands with the clinic's new PET/CT scanner. Photo by Emily Barnes, © 2004.

A revolutionary diagnostic technology has come to Brevard County.

The Cancer Care Centers of Brevard introduced its new PET/CT scanner to its Melbourne clinic in late August.

The PET/CT combines the technologies of Positron Emission Tomography (PET) and Computed Tomography (CT) to create imaging that defines diseased tissue with clarity and precision not possible with PET or CT alone.

That's because PET alone shows metabolic changes in tissues but provides a fuzzy view of anatomical structures. And a CT scan alone clearly shows anatomical structures but only is able to detect changes caused by advanced disease or injury.

When both forms of data are gathered simultaneously and fused by the PET/CT scanner, the disease process is uncovered and shown in 2-D anatomical slices that can be observed via computer in three dimensions.

While the clinic will use the scanner to both discover and pinpoint cancer, the technology can also be used to detect even slight brain damage that indi-cates early Alzheimer's disease. It can also uncover changes that signal heart disease and help map the heart more accurately for coronary bypass surgery.

The technology, in fact, has numerous applications in the fields of oncology, neurology and cardiology.

"Before we were limited to comparing PET and CT tests and making our best guess as to where the cancer was located. Now we can clearly see where it is," said Dr. Maureen Holasek, a radiation oncologist with Cancer Care Centers.

Dr. Holasek held up a fuzzy PET film and compared it to a CT scan to show the difficulty in eye-balling the two tests and coming up with an estimate of the extent of the cancer.

The technology also allows for the discovery of tumors that likely would have otherwise gone undetected.

"The whole body is scanned, so even small tumors that haven't caused symptoms can be discovered," Dr. Holasek said.

Determining the location and extent of cancer can be critical for successful radiation treatments. Holasek and other physicians at the clinic carefully design radiation fields so that cancerous tissue is destroyed and healthy tissue saved.

Other radiation oncologists at the clinic include Dr. Silas J. Charles, who owns the clinic, and Dr. Fe V.S. J. Pancito and Dr. Jeffrey Kanski.

The $2 million GE Healthcare Discovery ST4 was a significant expenditure for the clinic.

"You have to hand it to Dr. Charles for being willing to invest in the technology to ensure better patient care. He's on the leading edge," said Debra Zeman, the local GE representative.

Fortunately Medicare and insurance providers cover PET/CT tests in specific cases. Because the $1,800 test uncovers disease at early stages, it is sometimes requested for executive physicals.

"It's also an option for people who smoke, or did smoke, and are worried they might develop lung cancer. It's critical to detect lung cancer as early as possible, so it could be well worth the personal investment in cases where the test isn't covered by insurance," said Dr. Holasek.

Her father, a former smoker, has a spot on his lung she's monitoring with periodic PET/CT scans.

"If my patients with advanced lung cancer could go back in time and pay for a test to detect the beginning stages of their disease, I'm know they would," Dr. Holasek said.

There are only 20 PET/CT scanners in Florida. The closest scanners besides the one at Cancer Centers in Melbourne are at Florida Hospital in Orlando and in a clinic in Port St. Lucie.

"Interest in the technology continues to grow, so its use will become more widespread," Zeman said.

Its use for detecting Alzheimer's in specific cases was recently approved for Medicaid reimbursement, which is a significant breakthrough, Dr. Holasek said.

"Physicians want to detect Alzheimer's as early as they can, and this gives them a better tool to do so," she said.

Like other forms of imaging, PET/CT scans are painless. The scanner is an open system, providing maximum comfort for the patient.

Before the test, a short-lived radioactive material is ingested. Because the material contains a sugar it quickly collects in diseased tissue. The scanner then detects the areas where the sugar is rapidly absorbed. The idea of fusing PET and CT tests first occurred to the technology's inventors in 1992, but the concept was originally rejected by research grant providers.

Fortunately inventors Dr. Ronald Nutt, an electrical engineer, and Dr. David Townsend, a physicist, persevered and the revolutionary technology was born. The PET/CT prototype was introduced at the University of Pittsburg Medical Center in 1998. Sloan-Kettering in Manhattan was an early adopter.

Since then, numerous studies published in periodicals like the Journal of the American Medical Association have shown that the technology provides for more accurate diagnosis than other forms of imaging and changes doctors' treatment choices in a significant number of patients.

Time Magazine declared PET/CT the technology the Medical Invention of the Year in 2000.

The original PET/CT scanner was developed with the assistance of an engineering team at Nutt's CPS Innovations, a unit of Knoxville-based CTI Molecular Imaging. The scanners are now manufactured by other companies as well, including GE and Philips Electronics.

For more information on Cancer Care Centers of Brevard, visit www.cancercare centersofbrevard.com.