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Radiologists Blamed For PET Lag In Canada

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“Canada is far behind the United States and Europe in its adoption of PET and other diagnostic technologies,” says a new report sponsored in part by the Canadian government.

The report places some of the blame on radiologists. It says:

Different spending priorities suggest that radiologists will advocate for more CT and MRI equipment while nuclear medicine physicians advocate for PET technology.

Advanced Applied Physics Solutions and TRIUMF sponsored the report, The Use of Positron Emission Tomography (PET) for Cancer Care Across Canada: Time for a National Strategy. Susan D. Martinuk, a freelance writer and speaker who specializes in public policy issues, wrote it. TRIUMF is Canada’s national laboratory for particle and nuclear physics. Advanced Applied Physics Solutions is its commercialization affiliate.

The report, released Monday, runs 197 pages (including a lot of repetition and blank pages). It says Canada’s national health system has only 29 PET scanners, or 0.86 per million people, compared with 2,000 in the United States, or about 6.5 per million people. The report does not address the handful of PET scanners outside the national health system, most of which are not primarily used in health care.

The report says the only province that effectively uses PET is Quebec, which has 12 of the 29 scanners. Quebec, the report says, does not allow physicians to specialize in both radiology and nuclear medicine. So, it says, nuclear-medicine specialists have a strong influence on the provincial government. “Their attention is not divided by radiologists who would prefer the government to focus on obtaining more MRI or CT machines.”

In general, the report says, “There appears to be some amount of acrimony between nuclear medicine and radiology specialists as they advocate for new technology for their hospitals. At the core of this discord is the dual nature of the hybrid PET/CT technology.

“Nuclear medicine physicians are not all trained in reading CT scans and therefore require a radiologist to read the CT portion of the scan. Conversely, most radiologists are only minimally trained to read PET images and, in theory, require a nuclear medicine physician to read that portion.”

The report also suggests that radiologists are suppressing PET usage out of personal greed:

Some worry that radiologists are attempting to enhance their incomes by restricting the emergence of newer PET technology so they can focus on reading more lucrative CT and MRI scans. One physician estimated that radiologists can read (and be paid for) about 30 to 40 CT scans per day. In contrast, they can probably only read 10 to 15 PET exams per day.

The report does not quote any of these accusatory sources by name. It adds, “According to one physician, ‘It’s all about the billing,’ while another commented, ‘If the public knew about the turf wars, they would march all the doctors off the end of the gangplank.'”

You can download the report here and view the Web site devoted to it here.

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