As home to approximately 330 million1 individuals, the United States is presently the third most populous country in the world1. About 80%2 reside in urban areas. That is simply where employment opportunities are – along with advanced healthcare facilities. Yet some 97%3 of our nation’s land area is rural. The 60 million3 or so people who live in a more rustic setting may not have access to state-of-the-art medical innovations that aid in cancer care. Iceland serves as a model for bringing the early detection, staging, treatment planning, and monitoring advantages of PET/CT scan technology to remote locations4.
PET and CT – the concept behind advanced cancer care
Today, most medical diagnoses are laced with acronyms for efficiency and to simplify patient understanding. However, a grasp of fundamentals of the complex technology behind the alphabet soup is essential in understanding hurdles faced by rural healthcare providers.
Positron emission tomography (PET) is a type of medical imaging that provides detailed information about tissues and organs – from both a structural and functional perspective. PET illustrates abnormal activity or changes in the subject’s body at cellular and molecular levels, making it ideal for early-stage detection of conditions such as cancer and certain neurological disorders. It also provides almost immediate feedback on the patient’s response to therapeutic treatment. A CT scan delivers detailed slice pictures of tissues and organs, rounding out information gained by the PET scan. This combination technique is especially beneficial in cancer care5.
PET information is obtained by introducing a tracer, a radioactive drug in a minute dosage, into the patient by injection, inhalation, or oral ingestion. Emissions from the tracer are recognized by the PET camera. In 1930, Ernest O. Lawrence invented the cyclotron6 (later winning the Nobel prize in physics for this work). This type of particle accelerator is still used to produce isotopes necessary in the production of tracers.
Tracers have a notoriously short half-life, losing potency and thus effectiveness quickly. For example, isotopes commonly used in PET imaging include Oxygen-15 with a two-minute half-life and Fluorine 18 which breaks down in about two hours4.
That means a medical facility, in addition to having a PET/CT scanning machine on site, must be within short travel distance of a cyclotron or a tracer distribution network.
The Icelandic solution to the PET/CT scan puzzle
The Nordic island nation of Iceland is nearly 2,000 kilometers (over 1,200 miles) from Copenhagen in Denmark, formerly where the nearest PET/CT scan capability resided. The three- to four-hour flight was physically and emotionally demanding for patients anxious to find out if their cancer treatment was working. In cancer care, delays in diagnosis, treatment planning, and treatment modifications can make a fatal difference.
Landspítali Hospital in Reykjavik, Iceland recognized this and, partnered with GE Healthcare to change the situation for their patients. The hospital brought the first TRACERcenter to the country, installing a cyclotron, radiochemistry facility, and PET/CT scanner on site.
This full PET radiopharmacy solution includes:
- Discovery 710 PET/CT from GE Healthcare
- MINItrace cyclotron
- TRACERlab FX2 and FASTlab chemistry systems
The facility is now set up for routine production of clinical tracers, and there are potential research capabilities, as well.
According to Petur Hannesson, Head of Radiology at Landspítali Hospital, “Like many Western countries, Iceland’s population is aging, which increases the burden on our healthcare system and medical professionals. Every year, we found ourselves referring more patients overseas and waiting on the results to make diagnostic and treatment decisions. Ultimately, it was unavoidable to have access to our own PET/CT, cyclotron and PET radiopharmacy to provide our clinicians with faster access to information and help increase our patients’ quality of care.”
Erik Strömqvist, Cyclotron and TRACERcenter General Manager at GE Healthcare adds, “It’s really quite amazing. All this technology – including the cyclotron, the radiopharmacy, and PET/CT – completes a different part of the puzzle to create pictures with highly detailed information about both the structure and function of organs and tissues in the body. This has become essential technology for clinicians to look at how certain diseases progress and develop in the body.”
Can it work in the rural US?
Iceland’s universal healthcare scheme operates differently than the hybrid system in the United States7 of private health plans, Medicare and Medicaid, VA or military care, and those with no insurance. Consider, however, that the first integrated PET/MRI system was installed in the US in 20108. PET/CT systems are now the more widely available option, spurred by the more affordable price tag of CT compared to MRI, with 1,600 units in this country.
This could be an indication that, with increased awareness of the benefits of PET/CT scanning and a community’s genuine drive to improve healthcare for cancer (and other) patients, more medical facilities in less-populated locales may invest in their own radiopharmacy centers. Based on 2014 to 2016 data presented by the National Cancer Institute9, 39.3% of men and women in this country will receive a diagnosis of cancer during their lifetime. That figure, combined with the innate sense of fairness integral to a culturally advanced society, may equate to greater PET/CT scan availability to rural locales in the future.
- United States Census Bureau. U.S. and World Population Clock. https://www.census.gov/popclock/ May 22, 2019.
- The Washington Post. Americans say there’s not much appeal to big city living. Why do so many of us live there? https://www.washingtonpost.com/business/2018/12/18/americans-say-theres-not-much-appeal-big-city-living-why-do-so-many-us-live-there/?noredirect=on&utm_term=.990b66b92fef May 22, 2019.
- United States Census Bureau. New Census Data Show Differenced Between Urban and Rural Populations. https://www.census.gov/newsroom/press-releases/2016/cb16-210.html May 22, 2019.
- GE Healthcare. Iceland’s Cancer Patients No Longer Have to Travel 1,808-Kilometers to Receive a PET/CT Scan. http://newsroom.gehealthcare.com/icelands-cancer-patients-travel-1808-km-receive-petct/ May 22, 2019.
- Net. Positron Emission Tomography and Computed Tomography (PET-CT) Scans https://www.cancer.net/navigating-cancer-care/diagnosing-cancer/tests-and-procedures/positron-emission-tomography-and-computed-tomography-pet-ct-scans Web. May 22, 2019.
- Cyclotron. https://en.wikipedia.org/wiki/Cyclotron Web. May 22, 2019.
- Department for Professional Employees AFL-CIO. The U.S. Health Care System: An International Perspective. https://dpeaflcio.org/programs-publications/issue-fact-sheets/the-u-s-health-care-system-an-international-perspective/ May 22, 2019.
- US National Library of Medicine National Institutes of Health. PET/MRI: Where Might it Replace PET/CT? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623147/ May 22, 2019.
- National Cancer Institute. Cancer Stat Facts: Cancer of Any Site. https://seer.cancer.gov/statfacts/html/all.html May 22, 2019.