| Clinical practice guidelines for the utilization of positron emission tomography/computed tomography imaging in selected oncologic applications: suggestions from a provider group. | |
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MedLine Citation:
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PMID: 17701257 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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PURPOSE: Positron emission tomography, combined with computed tomography (PET/CT) has provided clinicians with useful information regarding the diagnosis, initial staging, restaging, and therapy monitoring of malignancies since the beginning of the current century. Our intent here is to identify the critical steps in clinical workups and follow-up, in the true outpatient clinical setting of a freestanding imaging center, for utilization of PET/CT in four different cancer types. METHODS: The four most common reasons for referrals to our facility were identified by reviewing two years of referral data. They were lung cancer (including solitary pulmonary nodule), lymphomas, breast cancer, and colorectal cancer. A review of published literature from 1996 and later was accepted as evidence of appropriateness for utilizing PET/CT in various clinical scenarios. In addition, a medical advisory board consisting of 15 referring physicians representing various specialties was established to provide practical advice regarding the appropriate use of PET/CT in clinical situations. National Comprehensive Cancer Network (NCCN) guidelines were also referenced to establish a baseline for clinical workups at various stages of disease. RESULTS: Several inconsistencies were identified among the three primary sources of information leading to the establishment of a standardized algorithm for each cancer type. NCCN data did not always agree with published literature, which was also often different from actual clinical practices of referring physicians. The most common inconsistencies included differing opinions from the referrers vs what was published in the NCCN guidelines, especially with regard to the utilization of PET/CT for applications not yet covered by insurance companies. After a reconciliation of the medical advisory board's clinical practices and several published articles, a consensus was established by the medical advisory board for the use of PET/CT imaging for the four cancer types, enabling us to identify the appropriate timing of PET/CT utilization in patient work-ups. CONCLUSIONS: A PET/CT-centric clinical practice decision tree algorithm can be established by assessing a variety of sources of information. Although published literature and NCCN guidelines offer validated guidance to appropriateness, and third party insurance payors have established their own appropriateness standards, our experience showed that inclusion of practical experience from referring physicians who frequently utilize PET/CT imaging provided additional, useful input. |
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Authors:
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Ken Manning; Beth Tepfer; Gerald Goldklang; Richard Loyd; Prasad Garimella; Raghuveer Halkar |
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Publication Detail:
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Type: Journal Article; Practice Guideline |
Journal Detail:
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Title: Molecular imaging and biology : MIB : the official publication of the Academy of Molecular Imaging Volume: 9 ISSN: 1536-1632 ISO Abbreviation: Mol Imaging Biol Publication Date: 2007 Nov-Dec |
Date Detail:
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Created Date: 2007-10-23 Completed Date: 2007-12-12 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101125610 Medline TA: Mol Imaging Biol Country: United States |
Other Details:
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Languages: eng Pagination: 324-32; discussion 323 Citation Subset: IM |
Affiliation:
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Trident Molecular Imaging, 545 Old Norcross Road, Lawrenceville, GA 30045, USA. ken.manning@tridentpet.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Algorithms Decision Trees Health Personnel Humans Neoplasm Staging Neoplasms / radiography*, radionuclide imaging*, therapy Positron-Emission Tomography* Referral and Consultation Tomography, X-Ray Computed* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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