[Positron emission tomography 2013 in Germany. Results of the query and current status]

Adoption of large-scale medical equipment: the impact of competition in the German inpatient sector

The availability of large-scale medical equipment such as computed tomography (CT), magnet resonance imaging (MRI) and positron emission tomography (PET) scanners has increased rapidly worldwide over the last decades. Among OECD countries, Germany ranks high according to the number of imaging technologies and their applications per inhabitant. In contrast to other countries, there is no active governmental planning of large-scale medical equipment. We therefore investigated whether and how the adoption and distribution of CT, MRI and PET scanners in the German inpatient sector is subject to competition. Using a linear-probability model, we additionally examined the impact of regional, hospital- and population-based factors. In summary, our results indicate that the adoption rate by hospital sites decreases with the number of other sites being already equipped with the respective device and their proximity. However, the effect presumably depends on the technologies' stage within the diffusion process. No influence regarding the amount of state subsidies could be identified. Furthermore, hospital size and university status strongly affect the adoption.

[Large-Scale Medical Equipment - An Analysis of Supply Structures 20 Years after the Abolition of Site Planning]

AIM

The aim of this study was to examine the supply structures of computer tomographs (CT) and positron emission tomographs (PET) 20 years after abolishing site planning of large-scale medical equipment in the German inpatient sector.

METHODOLOGY

Cartographic analyses were used to visualize the inpatient supply with CT and PET between 2010 and 2017. Regional differences were investigated in relation to population and disease burden to identify potentially over- and under-served areas.

RESULTS

Almost German-wide coverage was observed for CT. Only 0.3 percent of the population did not have access to a device within 30 minutes of driving distance. In contrast, larger segments of the population in extensive regions did not have timely access to PET. In addition, there was a high degree of regional variation in supply, which could not be explained either by population density or the disease burden of the region.

CONCLUSION

The supply structures of large-scale medical equipment over decades without concrete regulatory interventions reveal regional variation. This is to be viewed critically from both an economic and a medical perspective. The extent to which strengthening competitive elements or cross-sectoral site planning can lead to a demand-oriented and efficient supply of large-scale medical equipment still needs to be investigated in more detail.

Stationäre nuklearmedizinische Therapie 2010 bis 2012 in Deutschland

Das Ziel dieser Analyse war es, deutschlandweite Daten über den Status und die Entwicklung der stationären nuklearmedizinischen Therapie zu ermitteln. Als Datenquelle wurden die gesetzlichen Qualitätsberichte der Krankenhäuser verwendet. Methodik: Die vom Gemeinsamen Bundesausschuss (G-BA) aus den maschinenverwertbaren XML-Daten der Qualitätsberichte erstellten Referenzberichte aller Kliniken Deutschlands mit nuklearmedizinischer Therapiestation wurden für die Jahre 2010 und 2012 analysiert. Für die Beurteilung der längerfristigen Entwicklung dienten Ergebnisse aus eigenen Voruntersuchungen der strukturierten Qualitätsberichte für die Jahre 2004, 2006 und 2008. Zur Ermittlung der deutschlandweiten Häufigkeit von Schilddrüsenoperationen und der Radioiodtherapie wurden öffentliche Datenbanken des Instituts für das Entgeltsystem im Krankenhaus (InEK) für die Jahre 2004 bis 2012 ausgewertet. Ergebnisse: Die Gesamtzahl der stationären nuklearmedizinischen Behandlungsfälle hat von 2010 mit 50 363 Patienten bis 2012 auf 47 314 Patienten gering abgenommen. Im längeren Verlauf von 2004 bis 2012 findet sich ein deutlicher Rückgang der Fälle von 17,5%. Der Rückgang ist vor allem durch eine Abnahme an Erkrankungen mit Hyperthyreose (ICD-Code E05) bedingt. Seit 2009 ist auch die Anzahl der Schilddrüsenoperationen rückläufig. Ein moderater Anstieg der Fallzahlen von 23,7% zeigt sich für die Diagnose Schilddrüsenkarzinom (ICD-Code C73) von 2004 bis 2012. Schlussfolgerungen: Vermutlich führt die verbesserte Iodversorgung in Deutschland zu einem Rückgang an stationären Patienten mit Hyperthyreose in der Nuklearmedizin und in der Folge zu einer Abnahme sowohl der Anzahl an Radioiodtherapien als auch der Schilddrüsenoperationen in der Chirurgie. Im Gegensatz hierzu ist die Anzahl der Patienten mit der Diagnose Schilddrüsenkarzinom auf nuklearmedizinischen Therapiestationen moderat ansteigend, dies korreliert mit der weltweit zu beobachtenden Steigerung der Inzidenz des Schilddrüsenkarzinoms.

[Nuclear Medicine in Germany. Updated key data and trends from official statistics]

AIM

Updated presentation of the spectrum of nuclear medicine in-vivo examinations and therapies from officially available statistics on out-patient and in-patient care as well as trends of structural data on nuclear medicine in Germany.

METHODS

Data from the German Federal Health Monitoring, from the frequency statistics of the statutory health insurance for out-patients and from the German Medical Association were used and supplemented by data from selective literature searches.

RESULTS

In descending order, thyroid, bone and cardiac scans continue to be the most frequent nuclear medicine procedures. With a marked increase of PET/CT and SPECT/CT, the number of basic scintigraphies is declining. Cardiac, lung and brain scans as well as lymph scintigraphies are increasingly requested, bone and thyroid scan decrease. The consultation of nuclear medicine physicians in private practices is increasing by 4 % per year (2009: 2 164 664; 2015: 2 687 359). The number of nuclear medicine physicians in the out-patient sector rose significantly (2009: 756, 2015: 939, growth 24 %) and has remained constant due to restrictions since 2013. The specialist recognitions of women in nuclear medicine increased (proportion currently 46 %). In hospitals, more PET(/CT) scanners (2009: 97; 2015: 125) and fewer gamma cameras (2009: 594; 2015: 550) are operated. The number of non-thyroid (and also out-patient) radionuclide therapies continued to increase.

CONCLUSION

With increased use of hybrid technologies, the nuclear medicine spectrum shows positive trends especially in nuclear cardiology and extra-thyroid therapy. These developments must be taken into account when amending regulations of specialist training and medical student teaching.

Radiolabelled Polymeric Materials for Imaging and Treatment of Cancer: Quo Vadis?

Owing to their tunable blood circulation time and suitable plasma stability, polymer-based nanomaterials hold a great potential for designing and utilising multifunctional nanocarriers for efficient imaging and effective treatment of cancer. When tagged with appropriate radionuclides, they may allow for specific detection (diagnosis) as well as the destruction of tumours (therapy) or even customization of materials, aiming to both diagnosis and therapy (theranostic approach). This review provides an overview of recent developments of radiolabelled polymeric nanomaterials (natural and synthetic polymers) for molecular imaging of cancer, specifically, applying nuclear techniques such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT). Different approaches to radiolabel polymers are evaluated from the methodical radiochemical point of view. This includes new bifunctional chelating agents (BFCAs) for radiometals as well as novel labelling methods. Special emphasis is given to eligible strategies employed to evade the mononuclear phagocytic system (MPS) in view of efficient targeting. The discussion encompasses promising strategies currently employed as well as emerging possibilities in radionuclide-based cancer therapy. Key issues involved in the clinical translation of radiolabelled polymers and future scopes of this intriguing research field are also discussed.

Trends in the utilization of nuclear medicine and radiopharmaceuticals in an aging population

AIM

To investigate the trends in the utilization of nuclear medicine procedures and radiopharmaceuticals in an aging population and to establish the prediction models.

METHODS

Based on Taiwan's National Health Insurance Research Database, a longitudinal study was conducted from 2000 to 2012. Descriptive statistics were adopted to analyze the frequencies and distributions of nuclear medicine procedures. Multiple linear regression analysis was applied to establish the prediction model for the utilization of nuclear medicine.

RESULTS

The utilization of myocardial perfusion imaging increased most significantly, i.e. 250 per million population (pmp) increment annually, followed by the whole-body bone scan (176 pmp) and whole-body PET scan (100 pmp) in Taiwan during the period of 2000-2012. The use rate of nuclear medicine procedure which the first quartile (Q1) of age at examination above 35 years fits the regression model: Use rate expected year = 0.03 Q1 of age at examination × use rate baseline year + 14797 life expectancy expected year / life expectancy baseline year - 15030. Adversely, the use rate of procedure which Q1 of age at examination below 35 years fits the model: Use rate expected year = 0.01 Q1 of age at examination × use rate baseline year - 4565 life expectancy expected year / life expectancy baseline year + 4749. In addition, the similar models were found in the applications of radiopharmaceuticals.

CONCLUSION

This study demonstrates the age at examination and life expectancy can be used to predict the utilities of nuclear medicine procedures and radiopharmaceuticals in an aging population. Nuclear medicine practice applied in the geriatrics would increase significantly with the aging of population.

Clinical utility of F-18 FDG PET-CT in the initial evaluation of lung cancer

PURPOSE

Positron emission tomography-computed tomography (PET-CT) is a resource-demanding imaging modality with increasing popularity in the workup of patients with suspected or proven lung cancer.

METHODS

To review the clinical usefulness of this imaging modality in the diagnosis, staging, and pre-operative evaluation, we conducted a systematic literature search, review, and quality assessment using the rapid evidence assessment toolkit and the Oxford Centre for Evidence-Based Medicine methodology. The literature search resulted in 4,208 records including 918 reviews, of which 139 met the predefined criteria and were read in full to identify relevant original articles on F-18 FDG PET-CT (1) in the evaluation of solitary pulmonary nodules (n = 14), (2) in curative-intent treatment trials (n = 9), and (3) in planning of invasive procedures (n = 18).

RESULTS

We found the following important results from the literature review: 1) PET-CT can rule out malignancy in most solitary pulmonary nodules due to high sensitivity (recommendation level A). 2) PET-CT reduces the number of futile treatment trials (recommendation level A). 3) The sensitivity of PET-CT in general is insufficient to rule out mediastinal lymph node metastasis (recommendation level A).

CONCLUSIONS

ᅟ 1) With few exceptions, solitary pulmonary nodules can safely be considered benign if the PET-CT scan is negative. Exceptions consist of small (<1 cm) and non-solid, solitary pulmonary nodules. These abnormalities should be followed up by CT in a structured programme. 2) No curative-intent treatment should be commenced until a PET-CT scan has excluded occult distant metastases. 3) In general, lymph node metastasis in the mediastinum cannot be ruled out on the basis of a negative PET-CT, and confirmative invasive staging should be performed in most patients before mediastinal metastasis is confirmed or ruled out.