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PET-CT in the UK a Strategy for Development and Integration of a Leading Edge Technology Within Routine Clinical Practice Contributors

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PET-CT in the UK a Strategy for Development and Integration of a Leading Edge Technology Within Routine Clinical Practice Contributors The Royal College of Radiologists In collaboration with The Royal College of Physicians The Intercollegiate Standing Committee on Nuclear Medicine The British Nuclear Medicine Society The Institute of Physics and Engineering in Medicine and supported by The Society and College of Radiographers PET-CT in the UK A strategy for development and integration of a leading edge technology within routine clinical practice Contributors Dr Rosemary Allan Professor Janet Husband Chair, RCR Radionuclide Radiology Sub-Committee Chair of Working Party Consultant Radiologist, St. George’s Hospital, London President of Royal College of Radiologists (RCR) Professor of Diagnostic Radiology, Royal Marsden NHS Dr Nicholas Ashford Foundation Trust Consultant Radiologist, St. Richard’s Hospital, Chichester Professor Isky Gordon Dr Deborah Cunningham Lead Co-ordinator of Project Consultant Radiologist, St. Mary’s Hospital, London Lead on Working Party’s Standards Sub-Group Miss Margaret Dakin Secretary, Intercollegiate Standing Committee Clinical Manager, St. Thomas’ Hospital Clinical PET Centre, Professor of Paediatric Imaging, Great Ormond Street London Hospital for Children Professor Adrian Dixon Mr Steve Ebdon-Jackson Warden, RCR Faculty of Clinical Radiology Lead on Working Party’s Contracts Sub-Group Professor of Radiology, Cambridge University Radiation Protection Division, Health Protection Agency Dr Fergus Gleeson Professor Kenneth Miles Consultant Radiologist, Radcliffe Hospitals, Oxford Joint lead on Working Party’s Education & Research Sub-Group Chairman Elect, Royal College of Physicians SAC for Nuclear Dr Andrew Hilson Medicine President, British Nuclear Medicine Society (BNMS) Professor of Imaging, Brighton & Sussex Medical School Chairman, RCP Joint Standing Committee in Nuclear Medicine 2 Dr Gary Cook Consultant in Nuclear Medicine, Royal Free Hospital, London Joint lead on Working Party’s Education & Research Sub-Group Consultant in Nuclear Medicine, Royal Marsden NHS Dr Robin Hunter Foundation Trust Dean, RCR Faculty of Clinical Oncology Consultant Oncologist, Christie Hospital, Manchester Dr Paul Dubbins Vice-President and Dean of the Faculty of Clinical Radiology, Mr Andrew Jackson Royal College of Radiologists Network Manager, Kent & Medway Cancer Network Consultant Radiologist, Derriford Hospital Plymouth Professor Michael Maisey Chairman, Radiology Oncology Congresses Dr Paul Marsden Scientific Director, St. Thomas’ Clinical PET Centre, London Member, Institute of Physics and Engineering in Medicine (IPEM) Nuclear Medicine Special Interest Group Dr Brian Neilly Chairman, RCP SAC for Nuclear Medicine Consultant Physician, Glasgow Royal Infirmary Dr Thomas Nunan Chairman, Administration of Radioactive Substances Advisory Committee Consultant in Nuclear Medicine, St. Thomas’ Hospital, London Dr Mary Prescott Chairman, Intercollegiate Committee on Nuclear Medicine Consultant in Nuclear Medicine, Manchester Royal Infirmary Dr Sheila Rankin Consultant Radiologist, Guy’s & St. Thomas’ Hospital, London Dr John Rees Member, RCR Radionuclide Radiology Sub-Committee Consultant Radiologist, University Hospital of Wales, Cardiff Profesor Philip Robinson Ex-chair, RCR Radionuclide Radiology Sub-Committee Professor of Clinical Radiology, St. James’ University Hospital, Leeds Dr Wendy Tindale Immediate Past Honorary Secretary, BNMS Scientific Director, Medical Imaging & Medical Physics, Royal Hallamshire Hospital, Sheffield A Strategy for PET-CT in the UK August 2005 Contents 3 Refer to: Page Refer to: Page References 22 Preface 4 Executive summary 6 Appendices Introduction Appendix 1 8 Appendix 1 Description of PET-CT 23 Model for PET-CT provision in the UK Appendix 2 Existing PET-CT fixed scanning units in the UK installed Appendices, 3,4 10 predominantly for clinical use The Hub - PET-CT scanner unit + cyclotron 11 as of August 2005 24 The Satellite - PET-CT scanner unit 11 Appendix 3 Model for provision of PET-CT Paediatric patients 12 in the UK 25 Multidisciplinary meetings 12 Radiopharmaceuticals 12 Appendix 4 Contractual & service issues Research 12 for PET-CT services 27 Equipment Appendix 2 13 Appendix 5 Staff training for PET-CT 33 PET-CT scanner 13 Appendix 6 Standards for delivering a PET-CT mobile unit 13 PET service within the UK. Scanning facilities 14 Report of the Intercollegiate Standing Committee on Cyclotron 15 Nuclear Medicine 35 Staff Appendices 5, 6 16 Appendix 7a Protocols for PET-CT 41 PET physicians 17 Clinical scientists 18 Appendix 7b Model FDG PET-CT Nuclear medicine technologists 19 oncology report 43 Radiopharmaceutical scientists 20 Appendix 8 Audit of PET-CT 44 Nurses 20 Administrative staff 20 Glossary 45 Standards for the delivery of a PET-CT service in the UK Appendices 6, 7, 8 21 A Strategy for PET-CT in the UK August 2005 Preface Positron emission tomography (PET) has become central in the management of patients with cancer and its role here and in other diseases continues to evolve. However, in the UK the development of PET services has been slow, compared with the United States and other European countries. In 2003, the Intercollegiate Standing Committee on Nuclear Medicine (ICSCNM) issued a document Positron emission tomography - A strategy for provision in the UK 1 and in 2004 the Department of Health (DH) published a consultation document A Framework for the Development of Positron Emission Tomography (PET) Services in England 2 which identified the need for a comprehensive strategic approach for the delivery of PET services and sought views from the profession and many other key stakeholders. Whilst response to this document has been provided by many Royal Colleges and other major bodies, a more detailed plan for the provision of a PET service is now needed to address both practical and professional issues. Such a detailed plan will contribute to the way in which PET services are introduced nationally. Recognising this opportunity, and building on the previous ICSCNM document, the Royal College 4 of Radiologists (RCR), and with full support from the National Cancer Director, Professor Michael Richards, set up a short-lived Working Party in collaboration with the Royal College of Physicians (RCP), ICSCNM, The Institute of Physics and Engineering in Medicine (IPEM) and the British Nuclear Medicine Society (BNMS). Other important groups of healthcare professionals have also been recruited to the working group to develop a detailed strategy. In this document, produced by the Working Party, we present a vision for the delivery of PET services within the UK which is aimed at providing a uniform, high quality service for patients irrespective of where they live or of what local services are currently available to them. This document will be presented in the first instance to the Department of Health in England, but has been prepared as a guide to development of PET-CT in all four countries in the UK. In so doing we have taken into account current PET installations and those at an advanced stage of preparation. The strategy is based on the need for an integrated diagnostic service for patients with cancer but also recognises the evolving applications for PET in cardiology, neurology and paediatrics. Nevertheless, it is recognised that PET is an expensive technology and not every hospital requires an installation. Thus, the service needs to be developed according to a logical plan. Our plan proposes that all new PET services should be delivered through PET-CT scanners and that the service should be based on a Hub unit of a PET-CT scanner (the majority with a cyclotron) plus, where appropriate, a Satellite unit of a PET-CT scanning unit alone. The location of PET-CT scanners and the strategic placement of cyclotrons are addressed, as are contractual and service issues. The Working Party has drawn on the expertise and previous work of the ICSCNM, and we have incorporated the document produced by this Committee, entitled Standards for delivering a PET service within the UK.3 A proposal for staffing requirements is laid out within the document, which also incorporates a model for education and training. The objective of this model is to provide a fully staffed, comprehensive service for the NHS in the longer term. A Strategy for PET-CT in the UK August 2005 The model for delivery has been presented as a two-phased approach. Although at present, we believe that there are sufficient physicians in the UK trained in PET to commence a service, major investment will be required to support all the staffing needs in the longer term, particularly with regard to radiopharmaceutical scientists and nuclear medicine technologists. In Phase I mobile PET-CT services will be essential, but in Phase II a greater number of static sites is envisaged. The pathway from Phase I to Phase II should be planned from the outset and be seamless and contiguous. This proposal for a comprehensive plan to deliver PET-CT services provides a unique opportunity for the UK to conduct prospective research and audit studies within the NHS, which should be an integral part of the strategic plan. Our focus has been on improvements in patient outcome that will be achieved by the planned development of PET-CT. PET-CT is likely to be at least as effective as PET alone and probably more so but, as yet, there is insufficient data available on PET-CT to make a substantive statement. PET-CT has already been shown to obviate the need for additional imaging investigations in certain cancers, 5 and this may have important implications for economic and workforce issues. Equally important, appropriate deployment of PET-CT may make a valuable contribution to a reduction in the bottleneck of diagnostic services, thereby contributing to the achievement of cancer targets as defined in The NHS Cancer Plan 4 and to the 18-week target from GP referral to treatment for all patients, to be achieved by 2008.5 Workload issues have been addressed in the document Positron emission tomography - A strategy for provision in the UK.1 The Working Party first met in April 2005, and I am extremely grateful to all its members who have worked tirelessly to produce this comprehensive document in a very short period of time.
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