PET-CT seeing increasing adoption, and now more affordable systems have facilities taking a closer look
The American Society of Nuclear Cardiology (ASNC) says positron emission tomography (PET) nuclear imaging has seen wider adoption in the past few years, and many cardiac imaging experts say it could become the workhorse technology for nuclear cardiac assessments over the next decade.
PET has always had improved image quality over the current standard of care, single photon emission computed tomography (SPECT), especially with its added value of coronary flow reserve (CFR) quantification to evaluate microvascular disease. But the costs associated with PET radiotracers and early technical limitations with hybrid PET-computed tomography systems limited adoption.
But things have changed for the better. Technical issues with PET-CT now have been overcome, computing speeds have greatly increased and there are many more viable FDA-cleared commercial PET radiotracers available.
While dedicated PET scanners using rod-attenuation correction were fine for lower-volume centers, the expected growth of PET and increasing numbers of patients will require adoption by higher volume centers to PET-CT systems. These use CT attenuation correction, which is much faster than rod based attenuation correction. With this added speed, dedicated PET systems are able to scan up to 12 patients per day, while PET-CT systems can handle up to 20+ exams per day.
CT also offers facilities the advantage of adding detailed anatomical information with the PET imaging to allow a more comprehensive evaluation of lesions. It can help determine if revascularization is needed, and if patients are better suited for percutaneous coronary interventions (PCI) or surgical coronary bypass grafting.
CT attenuation correction scans enable centers to perform opportunistic coronary calcium scoring exams, which add more information about patient risk factors and can provide additional revenue from the scans.
The price point for PET-CT systems has been a big consideration because of the considerably higher price tag than dedicated PET systems. But as the advantages of PET-CT continue to bloom over SPECT, healthcare facilities and offices are looking for PET-CT systems that can offer quality imaging at an affordable price point.
A primary consideration of imaging facilities deciding between dedicated PET and PET/CT is often price, as PET/CT traditionally has been significantly more expensive. However, as the advantages of PET are realized, healthcare providers are seeking a low-cost option that can still provide high quality images.
A new entry to the U.S. market, the NeuSight PET-CT 64 Slice from Positron, brings quality images at an affordable price point.
Positron's NeuSight and Affinity PET-CT offer innovation and value
Positron pioneered one of the first dedicated PET systems and entered the cardiac imaging market with a low-cost point of entry, and it’s continuing that trend with its first PET-CT system. Developed in partnership with established medical device developer and manufacturer Neusoft Medical Systems, the NeuSight PET-CT offers an enhanced Attrius PET system integrated with a cutting-edge 64-slice, low-dose CT system. While designed for cardiovascular, oncological and neurological applications, the base system is derived from Positron's dedicated cardiac PET platform. Despite being new to the U.S. market, the NeuSight system has a strong track record of success internationally, thanks to its established presence through Neusoft Medical System.
The NeuSight PET-CT was released in the summer of 2024 and has distinguished itself from the imaging landscape with its advanced technical features and established excellence in cardiac imaging that are optimized for myocardial perfusion imaging.
Key specifications include:
- 720 mm aperture for accommodating a larger range of patients
- 700 mm scan field
- 16 mm field-of-view (FOV)
- High sensitivity and specificity performance
- 99% system uptime
- Seamless integration with 3rd party quantification software for advanced diagnostic capabilities, including coronary flow reserve (CFR) analysis
The NeuSight PET-CT offers the smallest footprint in the industry, making it ideal for facilities with limited space. The system is 7.2 feet by 4.88 feet wide and weighs 7,000 pounds. The recommended room size is 26 by 14 feet to ensure ease of installation and operation. Positron also offers end-to-end clinical, technical and operational support tailored to each practice and hospital. This includes rapid response support with 24/7 remote support, and onsite representation available within 24 hours.
It is the most economical PET-CT system available on the market. Positron also offers an all-inclusive price rental option for the scanner and associated clinical, technical and training services.
Current users of the Attrius PET-only systems report the ability to perform up to 200 scans per month. With the NeuSight PET-CT, practices can significantly enhance productivity, as the advanced CT attenuation correction streamlines workflows and dramatically expands throughput potential.
Training and ongoing education programs through Positron allow a seamless transition to PET-CT imaging.
New 4D Affinity PET-CT 64 slice expected to gain FDA in 2025
Positron is expected to launch its new Affinity 4D PET-CT system in the second quarter of 2025, pending an amended 510(k) submission. The system also will mark Positron’s expansion into advanced oncology and neurological diagnostics.
The Affinity 4D system is equipped with lutetium–yttrium oxyorthosilicate (LYSO) crystal technology for enhanced image clarity and performance, higher throughput and better timing and energy resolution. It also has a compact design similar to NeuSight for easier installation and facility space savings.
AI-enhanced motion monitoring automatically alerts technologists when there is patient motion to allow them to redirect patient or repeat suboptimal scan/reduce motion artifacts.
The system also has several technologies to help speed exams and improve image quality and workflow.
- Device-free respiratory gating helps to reduce motion artifact without additional hardware.
- Clearview, a proprietary scanning method, reduces patient radiation dose without compromising image quality.
- Proprietary reconstruction algorithms also can create high-resolution images from count deficient exams.
- Patient Registration assistant simplifies patient information transfer, saving clerical and clinical review time.
Positron has a well-established history of quality in cardiac PET
Positron was one of the early innovators in PET, with its dedicated Attrius PET system and a software analysis package developed by PET pioneer Lance Gould, MD, which many in the industry still consider the gold-standard in PET myocardial perfusion imaging.
"Over the years, I've probably played and tested almost every camera on the market. PET systems have become better and better over the years,” explains Robert Bober, MD, FACC, who was previously medical director of cardiovascular molecular imaging at Ochsner Health System, and recently moved over to Sutter Health in Oakland, California. “But one of the things that I still go back to is the Attrius. It was such a beast in what it could do. This was a plug-and-play system and is a really great camera."
Ochsner Health used the Attrius to build its front-line PET program for more than a decade. A workhorse, Bober says the system never had any down time. There were no issues with corrections, and it could do high dose rubidium scans with ease. The system was designed as a dedicated cardiac scanner without compromises to be a general imaging scanner shared with oncology.
"That was a difference,” he says. “It was made for cardiac imaging, as opposed to a lot of the scanners that are really a square peg trying to fit into a round hole.”
Gould also designed the base software for the Positron system, which Bober says outperforms PET software systems from other vendors.
"The bottom line is CT is faster. You can do more volume with it with a PET-CT versus a standalone PET system. So, continuing with standalones in this day and age is limited.”
Robert Bober, MD, Cardiac Imager, Sutter Health and former Medical Director of Cardiovascular Molecular Imaging, Ochsner Health System
The first PET-CT 3D systems that rolled out 15 years ago had some issues with count rates and their corrections, but that started to change in 2015. Bober says at that time the workstations also improved and greatly decreased the time it took to reconstruct images. These factors helped to increase interest in PET-CT systems and their ability to increase patient throughput. PET-CT image reconstruction time also has decreased over the past decade from around 45 minutes down to just four minutes.
"The bottom line is CT is faster,” Bober says. “You can do more volume with it with a PET-CT versus a standalone PET system. So, continuing with standalones in this day and age is limited."
Best quality at the lowest cost is the main driver in purchasing a PET-CT
Today, Bober says all PET-CT cameras can do cardiac—but some do it better than others. With some systems, it can be harder to image large patients with high doses. Based on the quality of Positron system and the software in the past, he is looking forward to seeing what their new PET-CT system is capable of.
Quality is important, he notes, but in today’s healthcare environment, cost also is a key point.
"It really comes down to cost, the bells and whistles, and how it compares to other systems,” he says. “It's like buying a car. Do you really care about the torque, when all you really care about is how it rides? And part of that ride to me is the software. And if the new Positron PET-CT comes inherent with Gould's software package, that's definitely a huge selling point. This new system has many key features and if it's on the same price point as either the low-end or the medium-end PET-CT systems, then the demand for the camera will be huge.”
Positron PET systems impact care
"The Attrius is an excellent camera and the downtime is remarkably low," explains Michael Merhige, MD, MS, FACC, who is CEO of his own private general cardiology practice in Buffalo, New York.
An early adopter of PET, Merhige has used Positron's dedicated PET systems since 1995. The Attrius system served him very well when he was in hospital practice. Now in private practice, he says: "I absolutely think the camera's great. It's excellent. When I get my own PET scans, which are probably once every five or six years, I happily climb in my camera, secure the knowledge that I'm going to get excellent pictures."
When Merhige was at Niagara Falls Memorial Hospital, they installed a Positron PET camera in the emergency room to enable 24/7 scanning on chest pain patients when ECG changes were not clear on how to best manage the patient. The hospital did not have a cath lab, so PET scans were performed to avoid shipping patients off to another center for a diagnostic cath unless it was clear that was a necessary step.
"I did that for about nine years, and we actually ended up reducing mortality,” Merhige says. “If a patient presented to the hospital with a prime diagnosis of acute chest pain back in 2000, the death rate was about 15%. The death rate when we started using PET in the ER went down below 4%.”
In the past, SPECT scans and cardiac CT scans would often result in patients being sent too often to the cath lab for diagnostic angiography, only to find the blockages were not nearly as obstructive as originally thought. But PET offers intrinsic value by offering more specific information that can help reduce the need for diagnostic catheterizations.
"The holy grail for PET imaging or myocardial flow reserve (MFR) is to noninvasively pick out those patients who really need revascularization from a cost efficacy standpoint," Merhige says. “Basically, the ability to do absolute coronary flow and come up with coronary flow capacity is what I need to manage my patients.”
He argues MFR greatly increases the value PET over SPECT and cardiac CT. It also has the advantage over those other technologies for being able to evaluate microvascular disease in patients without clear coronary blockages, as in the case of ischemia with non-obstructive coronary arteries (INOCA).
As cardiac PET continues to see wider adoption, most of these centers are buying new PET-CT systems. Positron Corporation is looking to open a new chapter with the introduction of its new PET-CT systems to address this demand.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com