Requirements for clinical PET: Comparisons within Europe

The aim was to assess the requirements for a positron emission tomography (PET) cancer imaging service. The UK was used as an example to create a mathematical model for calculating the number of dedicated PET scanners and cyclotron/radiochemistry production facilities required to support the demand for PET studies in lung cancer. This was then extended to all oncological indications for PET and comparison was made with present infrastructure in the UK and Europe. A clinical algorithm for the use of PET in lung cancer management was created and built into a comprehensive computer model with variable parameters. From lung cancer incidences, data reported in the literature and local data, the proportion of patients following each algorithmic path was determined and used to calculate the number of PET scans and hence PET scanners required for lung cancer, and all cancer indications. Substituting lung cancer incidences, the PET infrastructure required for each European country was assessed. From this analysis, 29,886 PET scans per year for lung cancer investigation (provision of 12 scanners) and 121,589 PET scans (2,026.5 per million population) for all indications [provision of 49 scanners (0.82 per million population)] are required in the UK; at present there are seven scanners, and thus 42 new scanners are required. Results reported here demonstrate considerable lack of investment in PET in Europe, with marked variation; Belgium has the most sufficient infrastructure (197.80% of requirements), and excluding France, which is soon to see extensive development, the UK has the least sufficient infrastructure (14.39% of requirements). Considerable investment is required so that cancer management can gain the clinical and cost-effective benefit of this functional imaging technique, which has been established.