– More than five times more PET examinations in Denmark – Research, Specialist health service, Cancer, Public health
Rune Sundset, head of department at the PET center, University Hospital North Norway HF, says that in Helse Nord they have one PET-CT scanner and one PET-MR scanner. Both are located at UNN in Tromsø.
– Proximity to the offer has something to say for its use. With a population center of gravity in Bodø, Nordland Hospital in Bodø should also have had a PET scanner.
Hanging on
Sundset says that if you compare Norway and Denmark, you can say that Norway has actually been in development for ten years.
-More than five times more PET examinations are done in Denmark compared to Norway. Nevertheless, I believe that today, PET examinations are largely done in accordance with the Norwegian national guidelines.
The department head points out the importance of the guideline reflecting the development.
-My contradiction is in our national guidelines, which are not well updated on the development of the international literature with regard to indications for PET / CT examinations. Professional development is so rapid that it is easy to lag behind in the national guidelines if these cannot be improved – and updated well enough.
He says that when updating the guidelines, it is therefore absolutely necessary that it also includes professionals with expertise in PET.
Does not cover half of the need
Sundset explains that for Helse Nord, with a population of about half a million, the estimated need is about 3,500 examinations per year.
– In practice, we now do about 1500 PET examinations per year, just under half of what we believe should be carried out. This means that, in our opinion, it is to get patients who are offered the examination and that PET is used too little in the individual patient processes. This applies, among other things, to patients with lymphoma.
He says that the consequence may be that patients do not receive the right follow-up during treatment.
– Since PET images represent functional changes in the disease tissue, PET can be used in the evaluation of treatment, as functional changes occur much earlier than structural anatomical changes.
Sundset points out that this is about personalized treatment, where PET can respond to treatment early in the course of treatment.
– In personalized medicine, it is absolutely crucial to select patients well with precision diagnostics such as PET, so as to avoid patients receiving treatment that does not work. After all, the most expensive medicine is the one that does not work, and in addition, it has significant negative consequences for the patient.
– Will be of great importance
He explains that not only in the field of cancer are PET examinations used, but that the majority of the patients who are relevant in Norway today are cancer patients.
– In other countries, PET was also used to a much greater extent in cardiovascular disease and inflammatory conditions. With the development of PET radiopharmaceuticals and increasing treatment options for dementia, PET will also be of great importance in dementia investigation and also other conditions in mental health.
In addition to the machines themselves, Sundset points out that one must not forget the need for competence building of radiographers and doctors specializing in both nuclear medicine and radiology.
– There must also be medical physicists present to quality control of machines and calculation of dosimetry, ie radiation exposure to various organs, PET is used for planning and follow-up of treatments with radioactive isotopes.
– A lung smaller and still spreading
Haseem Ashraf is a radiologist at Ahus and an associate professor at UiO. He says that as a Danish doctor, it was surprising for him to see the difference between the practice in Denmark and Norway.
-I came to Norway from Denmark in 2010 and for me it was a little culture shock that you did not have access to PET-CT to the same degree. I was used to using PET scans much more than you do here. It was a big surprise for me to experience that there was so little access.
-As I was used to working in Denmark, one hardly investigates for lung cancer without a PET-CT having been taken in advance.
Access to a PET-CT machine at the hospital means that more people are offered the examination, he believes.
-At Akershus University Hospital (Ahus) we have got a PET-CT scanner and it gives a completely different collaboration when you have it available at the hospital. Now we refer more to PET-CT examinations and we often have the answer ready before we go in and take samples.
He describes why he believes that a PET-CT scan can have a big impact on patients.
-An example might be a patient who has a tumor where a PET-CT scan can reveal metastases that are located in a completely different place in the body.
Without PET-CT, dealing with patient surgeries and functions can be considered fresh when the reality is that the patient has proliferation and should not be operated on, he explains.
– Imagine that there is cancer in the left lung. If it is only local, one can choose to remove all or part of the left lung and in principle cure the disease. However, if it is already spreading and one chooses to remove a lung, then the patient has a smaller lung and still spreading.
– Having cancer is bad in itself, but then patients can undergo surgery, which they may not have to have.
He adds that with a PET-CT can get information about the latest patient’s cancer stage, from that you have had a curable cancer to incurable cancer.
– Lately, you can thus become more gentle if you have not been through unnecessary and extensive surgery.