PET-CT is only one option

Excerpt

We read with great interest the editorial comments of Alavi et al. [1] on limitations of positron emission tomography computed tomography (PET-CT) for use in clinical work. We would like to emphasize this aspect and also add a further limitation for the new hybrid imaging modalities, which concerns the discussion of cooperation or fusion with radiology departments. As the colleagues emphasize, there is still a long way to go to establish robust protocols for the use of PET-CT in clinical routine in order to maintain a good patient-based practice and ensure radiation exposure safety of the patients. Therefore, it will be necessary to focus the discussion regarding hybrid imaging modalities on the sophisticated use in routine hospital work rather than to discuss immature political fusion of the imaging specialities. Nuclear medicine has a wide spectrum of functional procedures ,which are not all an immanent part of hybrid systems. From our personal point of view, it is absolutely necessary to interpret nuclear medicine as functional imaging and not to use F-18 fluorodeoxyglucose (FDG) as contrast agent for the X-ray CT scan. PET imaging is easy to perform but complicated in terms of interpretation if you do not consider, for example, different attenuation and scatter correction methods and partial volume corrections. In a department of nuclear medicine, there needs to be good communication between different specialities on a daily basis, such as clinicians, technicians, and physicists. The nuclear medicine community (physicians, physicists, and industry) has still failed to implement dynamic PET scanning in clinical routine. Advanced tools are necessary because—not only for PET imaging but also for routine nuclear medicine applications—it is crucial to give the referring physicians hard facts such as quantitative values rather than standard uptake value (SUV). In our opinion, it is also a tremendous disadvantage to disregard the various tools that have been developed in the past, such as radionuclide venography (RNV), kidney analysis, brain imaging, bleeding source, salivary gland imaging, sentinel node scintigraphy, etc., and replace functional nuclear medicine with “hot-spot” fusion modalities. Unfortunately, the development of new devices rarely enables conversion of the already existing software tools (i.e., semiquantitative lymphoscintigraphy, early uptake renal analysis ) to newly installed computer systems. …