Greg Freiherr, Industry Consultant
Greg Freiherr, Industry Consultant

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group.

Blog | Greg Freiherr, Industry Consultant | August 29, 2012

When PET Fails

We want absolutes; things we can depend on; certainties in an unfortunately uncertain world. It’s the kind of faith we put into positron emission tomography/computed tomography (PET/CT), even when it’s not warranted.

More than a year ago, the German Institute for Quality and Efficiency in Health Care released a study concluding that there was a dearth of support for the use of PET/CT as a reliable aid in diagnosing or monitoring for the return of melanoma. A systematic search found no published studies to indicate the relevance of PET or PET/CT in either primary staging or in the detection of recurrences of malignant melanoma. Nor was any research uncovered indicating the prognostic accuracy of this technique.

In the absence of documented failures or successes, PET/CT continues to be used by some physicians to stage melanoma or monitor patients for its recurrence. Its results are used, consequently, to ease patient worries, sometimes incorrectly.

So it was that a long-time friend of mine, who had been battling melanoma for the past six years, received a PET/CT, embraced its negative findings, then weeks later encountered symptoms that led him to undergo a brain CT, which revealed a large tumor in his parietal and temporal lobes.

In mainstream medical practice, FDG-PET is considered essential for staging and monitoring patients battling cancers such as lymphoma and that of the lung, according to Michael Vannier, M.D., professor of radiology at the University of Chicago. But PET has specific and significant limitations. These are often related to the type of disease, the isotopic agent and the size of the lesion, Vannier explained.

“We sometimes find that PET has been used inappropriately for certain tumor types. Renal cell cancer and prostate cancer are notoriously difficult to image with FDG-PET,” he told me.

Add melanoma to that list.

When PET/CT is used to do what it cannot do effectively, it may be an expression of an old maxim –  that when all you have is a hammer, everything looks like a nail.

In this age of dwindling resources, we need to be a little pickier about what we hammer. The financial costs of doing so indiscriminately are high. Yet they pale when compared to the emotional price paid by patients whose belief in a bright future is unwarranted.

Related Content

SimonMed Deploys ClearRead CT Enterprise Wide
News | Computer-Aided Detection Software | September 17, 2018
September 17, 2018 — National outpatient physician radiology group SimonMed Imaging has selected Riverain Technologie
Siemens Healthineers Announces First U.S. Install of Somatom go.Top CT
News | Computed Tomography (CT) | September 17, 2018
September 17, 2018 — The Ohio State University Wexner Medical Center in Columbus recently became the first healthcare
Ingenia Ambition X 1.5T MR. This innovation is the latest advance in the Ingenia MRI portfolio, which comprises fully-digital MRI systems, healthcare informatics and a range of maintenance and life cycle services for integrated solutions that empower a faster, smarter, and simpler path to enabling a confident diagnosis
News | Magnetic Resonance Imaging (MRI) | September 14, 2018
Philips, a global leader in health technology, launched the Ingenia Ambition X 1.5T MR.
Amar Kishan, M.D.

Amar Kishan, M.D.

News | Prostate Cancer | September 11, 2018
UCLA researchers have discovered that a combination of high doses of...
Lightvision near-infrared fluorescence imaging system
News | Women's Health | September 11, 2018
Shimadzu Corp.
Videos | Radiation Therapy | September 07, 2018
A discussion with Ehsan Samei, Ph.D., DABR, FAAPM, FSPIE, director of the Duke University Clinical Imaging Physics Gr

Image courtesy of IBA

Feature | Radiation Oncology | September 07, 2018 | By Jeff Zagoudis
According to the latest statistics from the American Cancer Society (ACS), almost 165,000 new cases of prostate cancer...
The Siemens Biograph Vision PET-CT system was released in mid-2018.

The Siemens Biograph Vision PET-CT system was released in mid-2018.

Feature | Nuclear Imaging | September 07, 2018 | By Dave Fornell
Nuclear imaging technology for both single photon emission computed tomography (SPECT) and positron emission tomography...
The CT scanner might not come with protocols that are adequate for each hospital situation, so at Phoenix Children’s Hospital they designed their own protocols, said Dianna Bardo, M.D., director of body MR and co-director of the 3D Innovation Lab at Phoenix Children’s.

The CT scanner might not come with protocols that are adequate for each hospital situation, so at Phoenix Children’s Hospital they designed their own protocols, said Dianna Bardo, M.D., director of body MR and co-director of the 3D Innovation Lab at Phoenix Children’s.

Sponsored Content | Case Study | Radiation Dose Management | September 07, 2018
Radiation dose management is central to child patient safety. Medical imaging plays an increasing role in the accurate...
Carestream Releases Second-Generation Metal Artifact Reduction Software for OnSight 3D Extremity System
Technology | Computed Tomography (CT) | September 06, 2018
Carestream Health has started shipping a new software version for its Carestream OnSight 3D Extremity System that...
Overlay Init