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 | November 20, 2012

When Seeing Means Business

PET/CT routinely plays an essential role in staging and monitoring a wide range of cancers, including lymphoma and the lung. But it has specific and significant limitations.

PET/CT routinely plays an essential role in staging and monitoring a wide range of cancers, including lymphoma and the lung. But it has specific and significant limitations.

In a skeptical world, old maxims fall hard. Photojournalists can attest to that. Seeing today is anything but believing. Not seeing has fallen just as hard. We’d like to know that we can relax when we don’t see signs of cancer’s return. Positron emission tomography/computed tomography (PET/CT) provides that kind of relief in many cases…but not all.

Although it has become the gold standard in oncology diagnosis and monitoring, PET/CT falls short in some cases. And, in those cases, its use can create a false sense of security.

 “We sometimes find that PET has been used inappropriately for certain tumor types,”  Michael Vannier, M.D., professor of radiology at the University of Chicago, told me. “Renal cell cancer and prostate cancer are notoriously difficult to image with FDG-PET.”  

Make no mistake — PET/CT routinely plays an essential role in staging and monitoring patients battling a wide range of cancers, including lymphoma and that of the lung. But it has specific and significant limitations. Prescribing and administering the correct diagnostic tests should restore faith in the maxim, “Seeing is believing.”  Knowing which modalities to use under what circumstances constitutes the great contribution that radiology has to make to medical practice now and in the future.

You’d think, therefore, that radiologists would want to enhance their credibility by supplying to referring physicians the images upon which they base their findings. Yet, for the most part, radiology reports are textual…not visual. Perhaps referring docs have grown used to this and, despite the unprecedented ease by which images can be transferred today, they have no interest in getting those images.

What could change this attitude would be a groundswell of interest by the patients themselves. The explosion in smart phones and their applications has put the ability to view medical images at patients’ fingertips. At the same time, an increasing availability of patient portals is laying the foundation for accessing these images. If patients have them — and want to discuss them with their doctors — you can be sure doctors will want them as well. 

With that could come a dramatic change in the practice of radiology. The question is whether radiologists will be ready, when seeing means business.

Greg Freiherr has reported on developments in radiology since 1983. He runs the consulting service, The Freiherr Group. Read more of his views on his blog at itnonline.com.

Related Content

JNM celebrates 60 years of nuclear medicine research. Image courtesy of Society of Nuclear Medicine and Molecular Imaging.

News | Nuclear Imaging | December 14, 2020
December 14, 2020 — The Journal of Nuclear Medicine
Videos | PET-CT | December 04, 2020
This is an example of Canon's...
ASG well positioned for growth as healthcare marketplace continues to evolve 

Allan Klotsche

News | Radiology Imaging | November 24, 2020
November 24, 2020 — Alpha Source Group (ASG), a comprehensive next-generation services partner, has named...
"Initial report of a randomized trial comparing conventional- vs conventional plus fluciclovine (18F) PET/CT imaging-guided post-prostatectomy radiotherapy for prostate cancer" was presented by Ashesh Jani, M.D., Winship Cancer Institute of Emory University, at ASTRO20
News | PET Imaging | October 26, 2020
October 26, 2020 — Adding the advanced PET radiotracer...
Moffitt Cancer Center researchers are developing a noninvasive, accurate method to analyze a patient's tumor mutations and biomarkers to determine the best course of treatment.

Getty Images

News | Lung Imaging | October 19, 2020
October 19, 2020 — Personalized treatment options for patients with...
Indeterminate lesion on PET/CT classified by PET/MRI for 53-y-old man with lung cancer.

Indeterminate lesion on PET/CT classified by PET/MRI for 53-y-old man with lung cancer. Contrast-enhanced CT (A), PET (B), and fused 18F-FDG PET/CT (C) images are displayed in comparison with contrast-enhanced T1-weighted MRI (D), PET, and fused 18F-FDG PET/MRI (F) images. In CT (A), hyperdense, subcentimeter liver lesion (arrows) in segment VII is suggestive of transient hepatic attenuation difference or small hemangioma. As malignancy cannot be excluded, it needs further investigation. On PET/MRI, lesion is clearly classified as metastasis because of contrast enhancement and tracer uptake due to later acquisition time point. Follow-up CT confirmed diagnosis after 78 d. Images created by Ole Martin, University Dusseldorf, Medical Faculty and Benedikt Schaarschmidt, University Hospital Essen.

News | PET-MRI | September 18, 2020
September 18, 2020 — A single-center observational study of more than 1,000 oncological examinations has demonstrated
A 12-year-long collaboration with Canon Medical Research USA, Canon Medical Systems Japan and Southern Nevada outpatient radiology leader Steinberg Diagnostic Medical Imaging (SDMI) has resulted in the development of 3 PET scanners, each generation more advanced than the last
News | PET-CT | September 08, 2020
September 8, 2020 — A 12-year-long collaboration with...
a) Includes scintigraphy and PET with and without concomitant CT. b) Includes conventional radiography, dual-energy x-ray absorptiometry, fluoroscopy, and radiography performed during radiologic interventions. c) Includes general, cardiothoracic, maxillary, plastic, and orthopedic surgery and neurosurgery. d) Includes allergology, cardiology, geriatrics, general internal medicine, pulmonology, gastroenterology, and rheumatology

a) Includes scintigraphy and PET with and without concomitant CT. b) Includes conventional radiography, dual-energy x-ray absorptiometry, fluoroscopy, and radiography performed during radiologic interventions. c) Includes general, cardiothoracic, maxillary, plastic, and orthopedic surgery and neurosurgery. d) Includes allergology, cardiology, geriatrics, general internal medicine, pulmonology, gastroenterology, and rheumatology. Image courtesy of American Roentgen Ray Society (ARRS), American Journal of Roentgenology (AJR)

News | Radiology Imaging | August 14, 2020
August 14, 2020 — According to ARRS' ...