(left to right) GE Advance NXi; ADAC Allegro; Siemens Biograph

Positron emission tomography (PET) is the fuel powering the nuclear medicine machine.

The combination of approved and pending reimbursements for PET procedures and the modality’s ability to detect cancer lesions better than other medical imaging technologies is propelling PET’s surge. Estimates are that the worldwide PET market could top $500 million in the next 12 to 18 months.

One indication of PET’s burgeoning influence in nuclear medicine revenues can be seen at GE Medical Systems. Beth Klein, GEMS’ vice president and global manager for nuclear medicine and PET, estimates that PET equipment sales now account for approximately half of GEMS’ nuclear medicine revenues.

“That’s what happens when an industry sees PET as a powerful tool that can save lives,” Klein added. “You can detect lesions earlier with PET; sometimes before they can be seen anatomically. The earlier you detect lesions, the higher that correlates to saving lives.”

PET advocates received more good news in mid-December when the Health Care Financing Administration (HCFA) issued a decision expanding Medicare reimbursement for PET scans for older Americans. Medicare coverage now will provide for the use of PET in six cancer applications — lung, colorectal, lymphoma, melanoma, head and neck and esophageal.

While companies advance their dedicated PET systems with enhanced detector and scintillator technologies, manufacturers also are combining PET with CT to bolster medical imaging capabilities even further.

At RSNA 2000, GEMS showcased its new Advance NXi PET scanner, as well as an image fusion technology that will combine the PET Advance NXi with GEMS’ top-of-the-line LightSpeed multislice CT system.

The Advance NXi is optimized for 2D and 3D clinical studies and research applications. Enhancements include a fast reconstruction array processor and dual-processor workstation. All Advance PET scanners are field upgradeable to the NXi. Depending on the Advance product installed, upgrades to the NXi can range from $10,000 to $80,000. The Advance PET NXi has a price range of $1.4 million to $1.5 million.

GEMS’ plans to combine its LightSpeed CT and the Advance NXi in a works-in-progress. The company anticipates the as-yet-unnamed system to be priced about $2.3 million. FDA clearance could come in early 2001 and shipments in the second half of the year.

GEMS calls the CT/PET combination a logical advance from its Millennium VG Hawkeye, which was the first commercially available system for fusing functional and anatomical images using the same system. The company estimates it shipped approximately 50 Hawkeyes by the end of 2000.

GEMS also has Hawkeye II waiting in the wings. The system will feature a one-inch StarBrite crystal supplied by Saint-Gobain Crystals & Detectors (formerly Bicron of Newbury, Ohio). Klein said the StarBrite scintillator detector gets the technology to “near dedicated PET” image quality. GEMS hopes to have Hawkeye II — currently in clinical trials — commercially available in 2001.

GEMS also added the PosiTrace PET/CT system to its portfolio through the November acquisition of SMV (Sopha Medical Vision of Buc, France). GEMS will position PosiTrace in the upper mid-tier of its product line in the range of $1.2 million.

While much of the attention involving ADAC Laboratories Inc. (Milpitas, Calif.) centered on the company’s pending acquisition by Philips Medical Systems International, the nuclear medicine company still has a few plans of its own.

ADAC at RSNA unveiled its new Allegro dedicated PET scanner with a GSO (gadolinium-oxyorthosilicate) detector. The high-end scanner with its GSO-based, high-efficiency scintillator brings high count rate capabilities to the research area using short-lived radionuclides.

Allegro received FDA 510(k) clearance in November and is poised for its first delivery by the mid-2001.

ADAC also revealed that it is developing a combined PET/CT system. The works-in-progress Gemini system would use ADAC’s own C-PET dedicated scanner and a CT system supplied by Philips. ADAC has not yet submitted the works-in-progress for FDA clearance. The company anticipates a market release date of late 2001.

ADAC’s SkyLight gantry-free dual-headed gamma camera came to RSNA 2000 with FDA clearance. SkyLight debuted as a works-in-progress at RSNA 1999. SkyLight’s detectors are suspended from the ceiling for greater flexibility of imaging, whether it be planar imaging or total-body SPECT (single photon emission computed tomography).

The newest feature on the SkyLight is a Windows-based acquisition system. Shipments of SkyLight have commenced.

With the PET market booming, Siemens Medical Systems Inc.’s Nuclear Medicine Group (Hoffman Estates, Ill.) offers two new systems, which have received FDA clearance.

Siemens’ E.Cat Excel is the first dedicated PET system to introduce the company’s LSO (lutetium oxyortho-silicate) crystal technology, which has been in development for about four years. The benefit is its ability to improve patient throughout, while maintaining image quality. Randy Weatherhead, vice president of nuclear sales and marketing, said the E.Cat Excel can perform a full-body scan in 20 minutes or less, compared to 40 to 45 minutes for conventional systems.

Siemens also unveiled its new Biograph, which combines Siemens’ top-of-the-line PET system — the HR Plus — with its premium spiral CT technology in the Somatom Emotion.

Biograph’s name come from the combination of biological and functional information and fusing it with anatomical information.

Biograph’s price point is in the $2.5 million to $3 million range, depending on options. Siemens is targeting PET centers with high demand and institutions with oncology applications.

Both the Excel and Biograph are in production. Shipments are set for the second quarter.

Marconi Medical Systems featured gamma yPETAZ among its nuclear medicine products at RSNA. When used with Marconi’s Irix triple-head gamma camera, the company said gamma PETAZ greatly enhances image quality.

“A combination of precision detectors and an event-handling algorithm provides the capability to get image quality and lesion delectability as good as — if not better than — dedicated PET,” added Gina Larkin, Marconi’s manager of nuclear medicine marketing.

Gamma PETAZ is available as an upgrade to Marconi customers. “We are shipping all of our IRIS and AXIS systems with gammaPETAZ as an option,” Larkin added. GammaPETAZ upgrades began shipping in September.

Digirad Corp. (San Diego) rolled out its new 2020tc Imager for nuclear medicine studies. Traditionally, gamma camera technology requires vacuum tubes, making the equipment weigh between 3,000 and 5,000 pounds and be stationary.

Digirad’s solid-state technology improves image quality to produce clearer images. The 2020tc Imager’s low weight (425 pounds) and compact design permit portability impossible until now. Patients who cannot easily be transported to a traditional nuclear medicine scanner, can have this scanner brought to the bedside.

Digirad has shipped 35 of the new systems in 2000, and has orders for 60 more units to date. The price point is $300,000.

The 2020tc Imager, used in conjunction with Digirad’s SPECTour chair, enables cardiac SPECT studies. As an outgrowth of these features, Digirad has acquired the Florida Cardiology and Nuclear Medicine Group to launch its new Orion Imaging Systems

mobile nuclear cardiology subsidiary. By transporting the scanner and chair to a variety of sites by van, Orion offers nuclear cardiology

procedures in a physician’s office or any other site selected by customers.

Positron Corp. (Houston) is continuing its strong comeback in the nuclear medicine market with enhancements that will become standard features on its mPower PET system in 2001 without an increase in price. The upgrades include more powerful computing capabilities and a re-design that eliminates the electronic cabinets with a greater than 10 percent decrease in installation floor space.

“There also are new reconstruction algorithms that give finer resolution, in particular in oncology,” added John Ariatti, vice president of sales and marketing.

Positron is using the more powerful Ultra Sparc processor from Sun Microsystems Inc.’s (Mountain View, Calif.) for view stations and post-processing applications.

Positron introduced the mPower in June 2000 at the annual meeting of the Society of Nuclear Medicine, as the company kicked off its return to the industry.

“We shipped five [systems in 2000] through three quarters,” said Positron President Gary Brooks. “That’s the biggest year for Positron ever. This is the comeback year and what you see this year will be more indicative of what will happen.”

The e.soft acquisition workstation, Toshiba America Medical Systems Inc.’s (Tustin, Calif.) newest nuclear medicine offering for its T.Cam gamma camera, is a joint effort between Toshiba Corp. (Japan) and Siemens Medical Systems. Designed to maximize productivity by managing workflow, the fully automated e.soft system tracks the entire nuclear medicine procedure from acquisition to output, and is compatible with hospital information systems and radiology information systems. Applications include quantitative gated SPECT, quantitative perfusion SPECT and gated blood pool SPECT.

Daniel Davis, the manager of Toshiba’s nuclear medicine business unit, said the two companies also have collaborated on InterFile, DICOM-compliant modules that allowed gamma cameras to talk to one another. The e.soft acquisition workstation is “our first real visible partnership,” he added.

Davis said the motivation for fusion imaging applications comes from the increased use of what he called “tumor specific” radiopharmaceuticals.

“The whole idea in nuclear medicine is contrast and resolution,” he said. As more of the injected radiopharmaceuticals target the tumor for identification, less is left in the background for soft-tissue delineation, which physicians use to help in diagnosis. Fusing CT or MR studies with nuclear medicine studies supplies that soft-tissue information and produces one full image for diagnostic purposes, he said.

Davis also noted that Toshiba is adding a T.Cam Duet to its product lineup that has a one-inch sodium iodide crystal designed to improve coincidence imaging. He said the company is expected to make a formal announcement about the product in the first quarter of this year.