Inland Imaging LLC, of Spokane, says a $2 million dual-technology scanner that it installed here last fall should see a sizable jump in use in coming years thanks to broadening Medicare coverage.


The scanner combines the technologies of positron emission tomography (PET) and computed tomography (CT), making it possible to collect both metabolic and anatomic information in a single exam. That integrated imaging capability enables doctors to diagnose cancers and to plan radiation and surgical treatments more accurately, its supporters claim.


PET scans initially were granted Medicare coverage for use in cases involving a handful of different types of cancer, such as colorectal, esophageal, head and neck, large-cell lung, and then breast cancer, says Dr. Edward Holmes, director of Inland Imagings nuclear medicine department.


In recent months, though, thyroid and cervical cancers have been added to that list, Holmes says. Later this year, Medicare coverage of PET scans is expected to be expanded to include brain, ovarian, pancreatic, small-cell lung, and testicular cancer, he says. Small-cell lung cancer is a typically more aggressive form than large-cell lung cancer and normally doesnt respond as well to treatment, he says.


All of that, combined with a likelihood that most private insurers also will begin covering PET scans to mirror the Medicare changes, should translate into increased use of Inland Imagings new scanner, Holmes says.


It will notch it up substantially, but it wont happen overnight because it takes a lot of time to educate people about a change, he says, adding that growth in the number of patient studies performed with the new scanner likely will be gradual.


For a number of years, the diagnosis and staging, or progression assessment and categorization, of cancer, plus post-treatment restaging, have relied on anatomic imaging with CT or magnetic resonance imaging (MRI) scans, various medical sources say. Those scans have been limited, though, in their ability to help identify masses as malignant or benign. More recently, heavier attention has been focused on the molecular-imaging capabilities of PET technology, which capture images of miniscule changes in metabolism in various areas of the body caused by the growth of abnormal cells.


Cancer cells normally consume glucose at a higher rate than normal cells, and patients who are to be scanned are given a special glucose that accumulates quickly in the diseased cells rather than metabolizing. That metabolic tracer, or marker, shows up clearly in PET scans.


CT scans, meanwhile, provide precise internal visualization, allowing physicians to pinpoint the exact location, size, and shape of the diseased tissue or tumor. So, in essence, when the two technologies are used together, cancers are detected with PET scans and then located precisely with CT scans.


Roughly 95 percent of the cancers have a high metabolic rate and therefore can be staged very accurately, Holmes says. Pancreatic cancer, though, is one that has a much slower metabolic rate and thus is a lot tougher to diagnose, he says.


Inland Imaging, which says its the Inland Northwests largest provider of radiology services, installed the PET/CT scanner about eight months ago in the Sacred Heart Imaging Center on the first floor of the Sacred Heart Doctors Building, at 105 W. Eighth. It was the most expensive imaging system Inland has bought and was believed to be one of the first of its type in Washington state.


The expanded Medicare coverage pertains to all PET scans, not just those done with dual-technology machines like Inlands. Cancer Care Northwest PS, of Spokane, installed the areas first stationary PET scanner in the spring of 2001. Its located in the Deaconess Health and Education Center, at the northeast corner of Fifth Avenue and Monroe Street.


Dr. Ron Cocchiarella, Cancer Care Northwests medical director for the PET center there, says, Im very excited about the expanded utilization, and I think were trying to be careful about using it where indicated.


Questions remain about how beneficial PET scans can be at improving outcomes in certain types of cases, he says. Nevertheless, they clearly offer a number of benefits, such as potentially helping reduce the number of chemotherapy sessions a cancer patient might have to endure, if a PET scan comes back showing no remaining sign of the cancer, he says.


The expanded Medicare coverage will definitely bring in new business. Its just that there are more of these scanners coming in to the Northwest, which cuts into the patient load for the scanners located here, Cocchiarella says. He speculates, too, though, that the large population of baby boomers approaching retirement age likely will add to the demand for PET scans.


I think its a technology that has come of age, he says.


Holmes says initial utilization of Inland Imagings new scannerDecember was its first full month of usehas been somewhat slow, probably averaging 20 to 25 patients, but has been on a steady upward track.


The scanner simultaneously uses PET technology to detect diseased tissue or tumors and CT technology to pinpoint their location, size, and shape. The cost is the same as if you did it on two different machines, but the payoff is way better, Holmes asserts.


In addition to improving cancer detection and location pinpointing, he says he expects PET/CT scans to prove beneficial for diagnosing early-stage Alzheimers disease and other ailments. He also has said that he expects integrated PET/CT scans to become the standard, replacing separate PET and CT scans as the preferred method for dealing with many imaging needs.


I think its going to just keep gradually growing, because they keep finding new uses for it, Holmes says.


He says the Centers for Medicare and Medicaid Services (CMA) plans, in conjunction with approving Medicare coverage for additional types of Pet cancer studies, to put those studies on a national registry its developing. That will require the imaging work to be done in a particular way, and findings to be reported back to a federal data bank, he says.


Part of CMAs intent, Holmes says, is to glean more information about which types of cancer benefit most and least from the PET technologys touted capabilities.


Holmes says hes enthused about CMAs plans to provide PET scan-related Medicare coverage for a number of cancers all at once, because that will be much speedier than the normal one-cancer-at-a-time approval process.


I think its great, and something that will result in improved health care, he says.