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

Evaluation of therapeutic efficacy of drug candidates in preclinical oncology with positron emission tomography (PET)

Getty Images

Feature | PET Imaging | September 14, 2021 | By Todd Sasser, Ph.D.
PET, PET imaging, PET-CT, FDG PET, PET cancer assessment, pet scanner, nuclear imaging, molecular imaging

A PET-CT head and neck cancer scan showing various image reconstructions. The top left image is the separate CT scan showing the anatomy. The top right scan shows the fused PET and CT scans with false color added to help interpret the image. The bottom left scan is an initial FDG PET image showing tracer hot spots in the neck and a lymph node in the right jaw due to cancer. The right bottom image is a delayed enhancement scan showing tracer uptake over time, with normal hot spots in the bladder, kidneys, testicles and brain, which normally have higher metabolic activity. The low-grade gray shading of the anatomy is due to the normal cellular metabolism uptake of the FDG throughout the body. 

News | PET-CT | August 04, 2021
August 4, 2021 — PET/CT systems are exp

Image courtesy of Vital Images

News | Molecular Imaging | August 02, 2021
August 2, 2021 — The global molecular imaging marke
Registration is now open for the Radiological Society of North America (RSNA) 107th Scientific Assembly and Annual Meeting, the world’s largest annual radiology forum, to be held at McCormick Place Chicago, Nov. 28 – Dec. 2, 2021

Getty Images

News | RSNA | July 21, 2021
July 21, 2021 — Registration is now open for the Radiological Society of North America (...
A performance evaluation of the uEXPLORER total-body PET/CT scanner showed that it exhibits ultra-high sensitivity that supports excellent spatial resolution and image quality. Given the long axial field of view (AFOV) of the uEXPLORER, study authors have proposed new, extended measurements for phantoms to characterize total-body PET imaging more appropriately. This research was published in the June issue of The Journal of Nuclear Medicine.

Human imaging examples of performance of uEXPLORER total-body PET scanner. (A) Axial slice from 18F-fluciclovine PET image (right), with corresponding fused image (middle) and CT image (left), of 68-y-old patient with castration-resistant metastatic prostate cancer, demonstrating clear visualization of 18F-flucicovine accumulation within 2.5-mm-diameter pulmonary nodule. (B) Maximum-intensity projection of representative clinical oncology 18F-FDG PET scan reconstructed with 20-, 5-, and 2.5-min durations, of 59-y-old patient with lung cancer. Images show primary tumor in left lower lobe of lung (dashed circle), with multiple variable-sized (0.8-6 cm) hilar, mediastinal, and lower esophageal nodal metastases (arrows) and ~1-cm 18FFDG-avid left adrenal nodule (arrowhead), which is visualized for all scan durations. Image created by Y. Abdelhafez and B.A. Spencer, EXPLORER Molecular Imaging Center, UC Davis, Sacramento, CA

News | PET Imaging | July 10, 2021
July 10, 2021 — A performance evaluation of the uEXPLORER total-body PET/CT scanner showed that it exhibits ultra-hig
A phase III clinical trial has validated the effectiveness of the prostate-specific membrane antigen (PSMA)-targeted radiotracer 18F-DCFPyL in detecting and localizing recurrent prostate cancer.

Figure 1. Case example: A 54-year-old man with a history of RP+LND and a subsequent PSA of 1.25 ng/mL had no evidence of disease by baseline imaging. Piflufolastat F 18 (18F-DCFPyL)- PET/CT accurately detected biochemically recurrent prostate cancer with the PSMA PET/CT scan identifying positive left (left panel) and right peri-rectal lymph nodes (right panel).

News | Prostate Cancer | June 21, 2021
June 21, 2021 — A phase III clinica...