gms | German Medical Science

Positron emission tomography (PET) has found an increasing acceptance in clinical practice since the mid-90`s and the number of PET installments in Germany raised slowly but steadily (Figure 1 [Fig. 1]). Despite this promising development PET accounts only for a small part of diagnostic imaging. The applicability and recognition of PET as an imaging modality in diagnostic oncology is affected by several factors. Reimbursement seems to be a major obstacle for PET in Germany. Additionally excessive requirements for regulatory approval of radio-pharmaceuticals are serious problems influencing the development of PET. Fear of radiation level, insufficient cooperation between nuclear medicine physicians, radiologists and oncologists, under-representation of PET studies in professional journals and a minimum level of communication between different manufacturers of PET and PET/CT further amplify the suppressed recognition of this technique. Its scope and power is still too little known by physicians and patients and therefore rarely be considered in daily diagnostics. Nevertheless, the slowly increasing number of PET/CT installations leads to the question if PET will be replaced by PET/CT in future. With the additional anatomic information PET/CT might become the modality-of-choice for the majority of diagnostic oncology exams. The synergistic cooperation between radiologists and nuclear medicine physicians improves the diagnostic accuracy of the image review. This applies to a wide variety of cancers including colorectal carcinoma, lung cancer, lymphoma Hodgkin’s disease, pancreatic and ovarian cancer. However, a stand-alone PET scan is sufficient for a number of diagnostic needs and will be available in parallel with new PET/CT systems. Undoubtedly, evolution in this field is certain and the combined technique is a further step in the generation of PET. Despite a number of serious obstacles we believe that PET/CT can be operated successfully in a private practice in Germany. Its application will lead to a reduction of patients’ strain and a targeted diagnosis if certain preconditions are given. Most important is an efficient cooperation between radiologists, nuclear medicine physicians and referring doctors. The staging and restaging of oncological diseases in whole body imaging will be the most significant aspect of this technique.