Charter Radiology has always offered the most advanced, low-dose CT imaging for lung screening, and now, with the addition of Charter’s powerful PET/CT technology in our state-of-the-art Clarksville center our patients have another powerful tool for early detection of lung disease and lung cancer

Lung cancer is the leading cause of cancer-related death in the United States, and 40% of newly diagnosed lung cancer patients have distant metastasis.  Accurate staging and detection of metastases in non-small cell lung cancer (NSCLC) is critical to avoid futile surgery and select appropriate treatment.

PET/CT can improve the detection of nodal and distant metastases and change the management plan.

• Tumor staging with PET/CT immediately before surgery revealed more patients with mediastinal and distant metastatic disease than conventional imaging.
• Initial PET/CT changed the stage in 29% of NSCLC cases.
• PET/CT had a medium to high impact on the management plan in 37% of patients when staging lung cancer.

PET/CT’s Impact on Radiation Therapy

• Positive effect on tumor volume delineation
• Altered radiation therapy volume in 58% of patients and led to a decrease in normal tissue toxicity

Medicare recognizes the utility of PET and PET/CT in non-small cell lung cancer. 

For the Initial Treatment Strategy (formerly Diagnosis and Staging) PET/CT may be used:

• To determine whether or not the patient is an appropriate candidate for an invasive diagnostic or therapeutic procedure
• To determine the optimal anatomic location for an invasive procedure
• To determine the anatomic extent of a tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor

Subsequent Treatment Strategy (Restaging)

PET/CT is appropriate:

• After the completion of treatment to detect residual disease
• For detecting suspected recurrence or metastasis
• To determine the extent of a known recurrence
• If it could potentially replace one or more conventional imaging studies when it is expected that conventional study information is insufficient for the clinical management of the patient. Restaging applies to testing after a course of treatment is completed, and is covered subject to the conditions above.

Monitoring Response to Therapy

PET is covered for monitoring tumor response to treatment during the planned course of therapy (i.e. when a change in therapy is being considered). 

Charter Radiology’s Pulmonary Nodule Clinic

While conventional imaging establishes the presence of solitary pulmonary nodules (SPNs), invasive procedures that involve risk may be required to characterize the lesions.

PET/CT utilization as a diagnostic tool could reduce the number of unnecessary biopsies or thoracotomies on benign SPNs.

Nodules that were classified as indeterminate on CT were correctly characterized on PET in over 80% of the cases.

PET should be obtained in the diagnostic work-up of patients with SPN.

PET enables the physician to make a more informed clinical decision. 

The American College of Chest Physicians recommends: In patients with a low-to-moderate pretest probability of malignancy (5% to 65%) and an indeterminate SPN that measures at least 8 mm in diameter, we suggest that functional imaging, preferably with positron emission tomography (PET), should be performed to characterize the nodule.

Medicare recognizes the utility of PET and PET/CT in solitary pulmonary nodule (SPN).

Initial Treatment Strategy

Medicare covers PET scans for characterization of a single pulmonary nodule under Initial Treatment Strategy of Lung Cancer. For the Initial Treatment Strategy, PET/CT may be used:

• To determine whether or not the beneficiary is an appropriate candidate for an invasive diagnostic or therapeutic procedure
• To determine the optimal anatomic location for an invasive procedure
• To determine the anatomic extent of the tumor when the recommended anti-tumor treatment reasonably depends on the extent of the tumor

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) Center of Excellence PET PROS Diagnosis of Pulmonary Nodules:

• PET and PET/CT are approved by the Centers for Medicare and Medicaid Services (CMS) for characterization of solitary pulmonary nodules not exceeding 4 cm to determine the likelihood of malignancy. Claims should include evidence of the initial detection of a primary lung nodule, usually by computed tomography.
• The U.S. Preventive Services Task Force (USPSTF) recently released an updated, final recommendation for CT lung cancer screening that lowers the starting age from 55 to 50 years and adjusts smoking history from 30 pack years to 20 pack years.

Case Study: PET/CT Helps Diagnose Non-Small Cell Carcinoma

A 66-year-old male former smoker presented to evaluate a right upper pulmonary nodule.

Figure 1. A. There is spiculated 2.1 cm right upper lobe nodule seen on the CT scan. B, C. The nodule demonstrated high metabolic uptake SUV of 7.4, highly suspicious for malignancy. Biopsy showed Non-Small Cell Carcinoma. FF

SERVICES OFFERED AT CHARTER RADIOLOGY

WHOLE BODY PET/CT Imaging with F18-FDG

FDG is by far the most common radiotracer used for PET imaging. Although FDG is a glucose analogue, it does not enter the glycolytic pathway after phosphorylation but is trapped in the cell which allows nuclear medicine physicians to identify the abnormal activity. Most cancer cells are metabolically active and may absorb glucose at a higher rate. Thereby, FDG PET has become an important imaging study in the diagnosis and staging of numerous oncological diseases including lung cancer and distant metastasis. FDG is eliminated from the body via renal excretion with a short half-life of 110 minutes. A typically administered activity (dose) is about 350 MBq or 7mSV which is relatively low (compare to a regular CT scan radiation dose 7 mSV without contrast and >15 mSV with contrast).

CHARTER RADIOLOGY – where care starts at the molecular level with our state-of-the-art 128 slice PET/CT Biograph mCT