Positron Emission Tomography (PET) Markets
TriMark Publications, July 2011, Pages: 225
The medical imaging segments are poised for a major new phase of growth fueled by the availability of new technology coming out of the computer and digital information technology segment. Continuous improvements in technology are resulting in a growing number of new imaging tests that combine high levels of accuracy with rapid, easy-to-use product formats. Part of that medical imaging improvement is coming from positron emission tomography (PET). PET is a scanning technique used in combination with small amounts of radio-labeled compounds to visualize the anatomy and function of the brain.
The purpose of this report is to describe the specific market segment of the diagnostics medical imaging market called PET scanning. This sector includes all of the generally accepted imaging activities that are currently used in PET, including equipment for PET, PET/CT, SPECT and the use of radiopharmaceuticals for imaging. It examines these clinical measurement devices and their reagents and supplies as used in hospitals and clinics. It also reviews associated clinical market segments in which PET scanning has taken a prominent role including cancer treatment, cardiology, and neurology imaging markets.
1. Overview
1.1 Scope of This Report
1.2 Methodology
1.3 Executive Summary
2. PET Technology: An Overview
2.1 History and Development of PET
2.1.1 Early Beginnings
2.1.2 The 1950s: Pioneering Ideas for PET
2.1.3 The 1960s and 1970s: The Development of PET
2.1.4 The 1980s: PET's Advancement and Performance in Research Sector
2.1.5 The 1990s: PET's Progression in the Clinical Sector
2.1.5.1 PET Advancements of the 1990s
2.1.5.2 PETS Ability to Identify Pathophysiology
2.1.5.3 Insurance Coverage for PET
2.1.5.4 Availability of FDG
2.1.6 The 2000s: PET/CT Scanner
2.1.7 The Working of PET
2.1.8 Coincidence Detection
2.1.9 Coincidence Imaging
2.1.10 PET Modes
2.1.11 Obstacles to Widespread Use of PET
2.1.12 Dedicated PET Equipment
2.2 PET's Comparison with Other Conventional Imaging Procedures
2.3 Trends in PET Instrumentation
2.3.1 Advances in PET/CT Imaging
2.3.2 Promise of PET/MR Imaging
2.4 Cost Considerations in PET Scanners
2.5 Economics of Hybrid Systems
2.5.1 Hybrid Optimization
2.5.2 Image Quality and Hybrids
3. PET Applications: An Overview
3.1 Applications of PET and PET/CT in Oncology
3.1.1 PET/CT's Growth in Clinical Oncology in the U.S. and Europe
3.1.2 Cancer: Global Incidence and Mortality
3.1.3 PET: The Most Powerful Imaging Tool in Cancer Management
3.1.4 Increases in Cancer Imaging Costs
3.1.5 New Criteria for Diagnosing Alzheimer's disease
3.1.6 Expanded Applications for PET in Oncology
3.1.6.1 PET Scanning for Prostate Cancer
3.1.6.2 PET/CT in Radiation Treatment Planning for Cancer Patient Treatment
3.1.6.3 PET in Radiation Therapy Planning
3.1.6.4 Imaging Protocols for PET in Radiation Therapy Planning
3.2 Applications of PET in Cardiology
3.2.1 Cost of Cardiovascular Disease
3.2.2 CVD: The Single Largest Killer in Adults
3.2.3 Prevalence of CVD in the U.S.
3.2.4 Economic Cost of CVD in the U.S.
3.2.5 PET: The Established Diagnostic Tool in Cardiology
3.2.6 PET and Heart Disease Diagnosis
3.2.7 PET/CT's Suitability in Cardiac Imaging
3.2.8 Need for Dedicated PET Devices for Cardiac Imaging
3.2.9 Impact of PET in Reducing Biopsies
3.2.10 Current Status of Nuclear Medicine in Cardiology
3.2.10.1 Current Status of Cardiac Nuclear Medicine in Asia
3.2.10.2 Current Status of Cardiac Nuclear Medicine in Europe
3.2.10.3 Current Status of Cardiac Nuclear Medicine in Latin America
3.2.10.4 Current Status of Cardiac Nuclear Medicine in North America
3.2.11 SPECT vs. PET in Cardiology
3.3 Application of PET in Neurology
3.3.1 PET's Promising Role in Diagnosing Migraines and schizophrenia
3.3.2 PET's key role in Parkinson's research
3.3.3 PET's Prediction on Surgical Outcome in Refractory Epilepsy Patients
3.3.4 Disease-Specific Applications of PET and PET/CT in Neurology
3.3.4.1 PET Imaging of Brain Tumors
3.3.4.2 PET and Brain Metastases
3.3.4.3 PET in Dementia
3.3.4.4 PET in Epilepsy
4. PET Radioisotopes and Radiopharmaceuticals
4.1 Types of Radiopharmaceuticals
4.1.1 Diagnostic Radiopharmaceuticals
4.1.2 Suppliers of Radiopharmaceuticals
4.1.3 Radioisotopes Used in Medicine
4.1.4 Cyclotron Radioisotopes
4.1.5 FDA-Approved Radiopharmaceuticals
4.1.6 Some Common Radiopharmaceuticals in PET Imaging
4.1.6.1 Nitrogen-13 Ammonia
4.1.6.2 Rubidium-82
4.1.6.3 Oxygen-15 Water
4.1.6.4 Flourine-18 fluorodeoxyglucose (FDG)
4.1.7 Generator-Produced PET Radiopharmaceuticals
4.1.8 New PET Agents for Cardiology
4.1.8.1 New Neuronal Imaging Agents
5. Market Analysis
5.1 Global Market for Medical Imaging Modalities
5.1.1 Global Medical Imaging Market Share by Modality, 2010
5.2 PET and PET/CT Market
5.2.1 Pet and PET/CT's Application Areas
5.2.1.1 Global Spending on Cancer
5.2.1.2 U.S. Spending on Cancer and Cancer Imaging
5.2.1.3 U.K. Spending on Cancer
5.2.2 Global Market for Diagnostic Imaging Equipment for Oncology
5.2.2.1 Improved Diagnosis and Staging by Technological Advances
5.2.2.2 Importance of Imaging to Cancer Treatment
5.2.2.3 PET/CT Market in Oncology Sector
5.2.2.4 Percent Share of PET/CT Utilization by Type of Cancer
5.2.2.5 The Lion's Share of PET/CT Imaging in Oncology
5.2.3 Economic Evaluation of PET and PET/CT in Oncology
5.2.3.1 Costs for PET and PET/CT in Oncology
5.2.3.2 Cost Effectiveness of PET and PET/CT in Selected Cancer Types
5.2.3.3 Cost Effectiveness in the diagnosis of Solitary Pulmonary Nodules
5.2.3.4 Cost Effectiveness in the Detection of Non-Small Lung Cancer
5.2.3.5 Cost Effectiveness in the Detection of Colorectal Cancer
5.2.3.6 Cost Effectiveness in the Detection of Head and Neck Cancers
5.2.3.7 Cost Effectiveness in the Detection of Malignant Lymphoma
5.2.3.8 Cost Effectiveness in the Detection of Pancreatic cancer
5.2.3.9 Cost Effectiveness in the Detection of Other Solid Neoplasms
5.2.4 PET/CT: Business Models
5.2.4.1 The Models
5.2.4.2 Market Forces
5.2.5 Rising Demand for PET
5.2.5.1 Changes in PET Reimbursement
5.2.5.2 Initial Results from the National Oncologic PET Registry (NOPR)
5.2.5.3 The Road toward Open Coverage for PET
5.2.6 Future of SPECT and PET
5.3 Imaging Markets in Cardiology
5.3.1 Nuclear Imaging of Heart
5.3.2 Global Utilization of Nuclear Imaging in Cardiology
5.3.2.1 Future of Global Nuclear Cardiology Utilization
5.3.2.2 Utilization of Nuclear Cardiology Procedures in Developed Countries
5.3.2.3 Utilization of Nuclear Cardiology Procedures in Latin America
5.3.2.4 Utilization of Nuclear Cardiology Procedures in Asia/Oceania
5.3.2.5 Utilization of Nuclear Cardiology in Africa
5.3.2.6 Utilization of Nuclear Cardiology and Mortality Rate
5.3.2.7 Cost-Effectiveness in Nuclear Cardiology
5.3.2.8 Epidemiology of Cardiovascular Diseases in Developing Countries
5.3.3 Global Opportunities for Nuclear Cardiology Products
5.3.3.1 Competition in Nuclear Cardiology Market
5.3.4 Need for Dedicated PET Imaging in Cardiology
5.3.5 Market for PET Imaging Systems
5.3.5.1 Growth Rate for PET Cameras
5.3.5.2 The Decline of SPECT and the Rise of PET
5.3.5.3 Dedicated PET vs. Hybrid PET
5.3.5.4 The Different Paths of SPECT/CT and PET/CT
5.3.6 U.S. PET Landscape
5.3.6.1 PET and PET/Studies in the U.S. for Oncology
5.3.6.2 PET/CT Studies in the U.S. for Cardiology
5.3.6.3 PET/CT Studies in the U.S. for Neurologic Studies
5.3.6.4 U.S. Growth Rate for PET Procedure Volume
5.3.7 Utilization of PET Scanners in the U.S. Finger Lakes Region
5.3.7.1 U.S. PET Utilization by Body Site
5.3.7.2 PET Utilization by Payment Type
5.3.7.3 U.S. PET Utilization Rates
5.3.7.4 U.S. Demand for SPECT, SPECT/CT, PET and PET/CT
5.3.8 U.S: Cardiac PET Payments
5.3.8.1 Opposition for Reduction
5.3.8.2 Breakeven Point
5.3.9 CMS Coverage for Cancer Patients and PET/CT Growth
5.3.9.1 Opportunities for the Providers of PET and PET/CT
5.3.10 Medicare Reimbursement for PET Procedures
5.3.10.1 Coding
5.3.10.2 Reimbursement
5.3.10.3 Payment for Diagnostic Radiopharmaceuticals
5.3.11 U.S. Market for PET
5.3.12 PET Landscape across Canada
5.3.13 PET scanning in Canada
5.3.13.1 Publicly Funded PET Scanning in Canada
5.3.13.2 Privately Funded PET Scanning in Canada
5.3.13.3 Utilization of PET in Ontario
5.3.13.4 CVD: Number One Killer in Canada
5.3.14 PET Landscape in Europe
5.3.14.1 PET Installations in Europe
5.3.14.2 Growth of PET/CT in the E.U. Market
5.3.14.3 PET/CT Procedures in Europe
5.3.14.4 Locations of PET Centers in Europe
5.3.14.5 PET Studies per Million Population in Europe
5.3.14.6 The Commercial Isotope Market in Europe
5.3.15 Availability of PET in U.K
5.3.15.1 PET Units in Europe
5.3.15.2 Cyclotron-Based Isotopes
5.3.15.3 Nuclear Imaging Leaders in Europe
5.3.15.4 European Market for PET/CT
5.3.15.5 Nuclear Imaging System Market in Germany
5.3.15.6 Nuclear Imaging Market in France
5.3.15.7 U.K. Nuclear Imaging System Market
5.3.15.8 Nuclear Imaging System Market in Italy
5.3.15.9 PET Services in Europe
5.3.15.10 PET Services in England
5.3.15.11 Availability of PET in U.K
5.3.16 Costs of Setting up a PET Center in U.K. with a Distant Supply of Tracer
5.3.16.1 Capital Costs
5.3.16.2 Operating Costs
5.3.16.3 Fixed Costs
5.3.16.4 Variable Costs
5.3.16.5 Costs of Setting up a PET Center in U.K. with Full Production of Tracer
5.3.16.6 Operating Costs
5.3.16.7 Staff Costs
5.3.16.8 Radiotracer Production
5.3.16.9 Fixed Costs
5.3.16.10 Variable Costs
5.3.16.1 Radiotracer Production
5.3.17 Nuclear Medicine Equipment and Consumables in India
5.3.17.1 Market Trends
5.3.17.2 Key Market Drivers
5.3.18 Status of PET in India
5.3.18.1 Historic Perspective
5.3.18.2 The Isotope
5.3.18.3 FDG Supply
5.3.18.4 Ownership of Cyclotron
5.3.18.5 Issues of the Cyclotron
5.3.18.6 Regulation for Cyclotron and Isotope Supply
5.3.18.7 Cyclotron Supply Issue
5.3.18.8 Isotope within the End User Site
5.3.18.9 Hardware Issues
5.3.18.10 Indications for PET Studies in India
5.3.18.11 Indian Nuclear Medicine Equipment Market
5.4 Nuclear Medicine
5.4.1 Shortage of Isotopes for Medical Imaging
5.4.2 The Supply of Medical Radioisotopes
5.4.3 Isotopes Used in PET Imaging
5.4.4 Isotopes Used in SPECT Imaging
5.4.5 Rapid Growth of Radiotracers
5.4.6 Global Market for Mo-99/Tc-99m
5.4.6.1 Global Market for Mo-99 by Geography
5.4.6.2 Global demand for Tc-99m
5.4.6.3 Market Trends for Tc-99m
5.4.6.4 Supply Uncertainties
5.4.6.5 Pricing
5.4.6.6 Impact of Tc-99m Pricing on Health Care Budgets
5.4.7 Impact of Technetium Shortage
5.4.7.1 Global Impact
5.4.7.2 Popular Medical Uses of Tc-99m
5.4.7.3 Market Trends for Tc-99m
5.4.7.4 Supply Uncertainties
5.4.7.5 Pricing
5.4.7.6 Impact of Tc-99m Pricing on Health Care Budgets
5.4.8 18F-fluorodeoxyglucose (FDG) Positron Emission tomography (PET)
5.4.9 FDG Utilization in Europe
5.4.10 Future of Radiopharmaceuticals
5.4.11 U.S. Radioisotopes Industry
5.4.11.1 Industry Trends and Developments
5.4.11.2 Market Trends for Radiopharmaceuticals and Brachytherapy
5.4.11.3 Supply Disruptions
5.4.11.4 U.S. Shipments, Consumption and Trade
5.4.11.5 U.S. Trade of Radioisotopes
5.4.11.6 U.S. Exports of Radioisotopes
5.4.11.7 U.S. Imports of Radioisotopes
6. Company Profiles
6.1 Actinium Pharmaceuticals, Inc.
6.2 Advanced Medical Isotope Corporation
6.2.1 AMIC's Medical Isotope Products
6.3 Bio-Nucleonics
6.3.1 Strontium Chloride Sr89
6.3.2 Rubigen
6.4 Bracco Diagnostics, Inc.
6.4.1 CardioGen-82
6.5 Covidien, PLC
6.5.1 Covidien's Nuclear Medicine Products
6.5.1.1 Duosafe
6.5.1.2 Indium In-111 chloride sterile solution
6.5.1.3 Octreoscan
6.5.1.4 Sodium Iodide I-131 Capsules
6.5.1.5 Technescan HDP
6.5.1.6 Thallous Chloride Tl 200
6.5.1.7 Ultra-Technekow Dry-Top Eluting (DTE)
6.5.1.8 Gallium Citrate Ga-67 Injection
6.5.1.9 Tc 99m Sestamibi
6.5.1.10 Sodium iodide I-123
6.5.1.11 Technescan MAG3
6.5.1.12 Technescan PYP
6.5.1.13 Ultratag RBC
6.6 DRAXIMAGE, Inc.
6.7 FluoroPharma, Inc.
6.7.1 FluoroPharma's technology
6.7.1.1 CardioPET
6.7.1.2 BFPET
6.7.1.3 VasoPET
6.8 GE Healthcare
6.8.1 GE's PET and PET-Related Products
6.8.1.1 CardIQ Fusion
6.8.1.2 CardIQ Physio
6.8.1.3 Dynamic VUE
6.8.1.4 MINItrace
6.8.1.5 PETtrace
6.8.1.6 Discovery PET/CT 600
6.8.1.7 Discovery PET/CT 690
6.8.1.8 Discovery VCT
6.8.1.9 Discovery STE
6.8.1.10 Discovery ST
6.8.1.11 Optima PET/CT 560
6.9 Lantheus Medical Imaging, Inc.
6.9.1 Selected Products from Lantheus
6.9.1.1 Cardiolite (Kit for Technetium Tc99m Sestamibi for Injection)
6.9.1.2 Technetium Tc 99m Generator
6.10 MIM Software Inc.
6.10.1 MIMfusion
6.10.2 MIMcardiac
6.10.3 MIMviewer
6.10.4 MIM Storage Server
6.11 Neusoft Medical Systems Co., Ltd.
6.11.1 Truesight PET
6.11.2 BeyondImage Workstation (BW)
6.11.3 CardioCARE
6.11.4 PETCare
6.12 Nordion Inc.
6.12.1 Nordion's Business Strategy
6.12.2 Nordion's Medical Isotope Business Priorities
6.12.3 Nordion's Sterilization Technologies Business Priorities
6.12.4 Nordion's Medical Isotopes
6.13 Numa, Inc.
6.13.1 NumaLink
6.13.2 NumaList
6.13.3 NumaList Plus
6.13.4 NumaStore
6.13.5 NumaRead
6.13.6 NumaServer
6.13.7 NumaManage
6.13.8 Numa's Core Lab system
6.14 Philips Healthcare
6.14.1 Ingenuity TF PET/CT
6.14.2 GEMINI TF Big Bore PET/CT
6.14.3 GEMINI TF PET/CT
6.14.4 GEMINI TF Ready PET/CT
6.14.5 GEMINI LXL
6.15 Positron Corporation
6.15.1 Attrius
6.15.2 Cardio-Assist
6.15.3 Radiopharmaceuticals
6.15.4 Tech-Assist
6.16 Siemens Healthcare
6.16.1 Biograph TruePoint (16-slice PET/CT)
6.16.2 Syngo.via
6.17 Thinking Systems Corporation
6.17.1 MDStation
6.17.2 MDStation for PET and PET/CT
INDEX OF FIGURES
Figure 2.1: Illustration of the SMART Scanner 22
Figure 2.2: Illustrations of PET, CT and Fused PET/CT Scans 22
Figure 2.3: Collision of a Positron and Electron and the Creation of Two Resultant Gamma Rays 23
Figure 2.4: Discharge of Two Gamma Rays at 180 Degrees 24
Figure 2.5: A Sinogram with Coincidence Lines 24
Figure 2.6: PET Images Viewed in Axial, Coronal and Sagittal Planes 25
Figure 2.7: Block Diagram of PET Scanner 26
Figure 2.8: Principles of Operation of a Combined PET/CT Scanner 30
Figure 2.9: Two Scanners Mounted Back-to-Back for Sequential Acquisition 31
Figure 2.10: Full Integration of a Whole-Body PET/MRI System 31
Figure 3.1: Projection for Global Cancer Deaths, 2010-2030 36
Figure 3.2: Projected Cost of Cardiovascular Disease, 2010-2030 41
Figure 3.3: CVD: The Single Largest Killer in Adults 41
Figure 3.4: Prevalence of CVD in Four of the Ethnic Groups in the U.S. 42
Figure 3.5: Percentage Breakdown of Deaths from CVD in the U.S. 43
Figure 3.6: Costs of Major CVD Types in the U.S. 43
Figure 3.7: Increasing Number of Heart Failures in Europe, 2010-2020 47
Figure 3.8: CVD in Middle Income Countries 48
Figure 3.9: CVD in Developed Countries 49
Figure 5.1: Global Market for Medical Imaging Equipment by Geography, 2010 67
Figure 5.2: Global Medical Imaging Market Share by Modality, 2010 68
Figure 5.3: Global Cancer Cases, 2009-2020 69
Figure 5.4: U.S. Spending on Cancer, 2010-2020 70
Figure 5.5: Spending on Cancer in U.K., 2010-2020 71
Figure 5.6: Percent Comparison of Spending on Cancer, 2010 72
Figure 5.7: Volume Distribution in Cancer Imaging in the U.S. 73
Figure 5.8: Distribution of Outpatient Cancer Services in the U.S. 74
Figure 5.9: Global Market for Diagnostic Imaging Equipment for Oncology, 2010-2017 74
Figure 5.10: PET/CT's Share in Oncology Imaging Market, 2010-2017 75
Figure 5.11: Percent PET/CT Imaging by Cancer Type 76
Figure 5.12: Percent Share of Oncology, Cardiology and Neurology in PET/CT Scanning 77
Figure 5.13: Nuclear Cardiology Procedures for 100,000 of Population per Year for Developing vs. Developed Countries 84
Figure 5.14: Future of Nuclear Cardiology in 2014 85
Figure 5.15: Approximate Use of Cardiac Diagnostic Testing, U.S. 86
Figure 5.16: Utilization of Nuclear Cardiology in Developed Countries 86
Figure 5.17: Utilization of Nuclear Cardiology in Latin America 87
Figure 5.18: Utilization of Nuclear Cardiology Procedures in Asia/Oceania 88
Figure 5.19: Utilization of Nuclear Cardiology in Africa 89
Figure 5.20: Global Market for PET Services, 2010-2017 92
Figure 5.21: Projected Market Share of PET and SPECT in 2020 93
Figure 5.22: Growth Rate for SPECT and PET, 2011-2014 93
Figure 5.23: Number of Cameras: SPECT Switching to PET, 2011-2014 94
Figure 5.24: Top Ten Body Sites of Cancer for Men in the U.S. 96
Figure 5.25: Top Ten Body Sites of Cancer in U.S. Women 96
Figure 5.26: U.S. PET and PET/CT Patient Studies in Oncology, 2001-2008 97
Figure 5.27: U.S. PET and PET/CT Patient Studies in Cardiology, 2001-2008 98
Figure 5.28: U.S. PET and PET/CT Patient Studies in Neurology, 2001-2008 99
Figure 5.29: PET-Only Sites/Studies vs. PET/CT Sites/Studies 99
Figure 5.30: Trends in PET Procedure Volume in Finger Lakes Region, 2003-2009 100
Figure 5.31: U.S. PET Utilization by Body Site, 2009 101
Figure 5.32: U.S. PET Utilization Rate, 2003-2009 102
Figure 5.33: Approximate U.S. Sales of SPECT & SPECT/CT and PET & PET/CT, 2005-2009 103
Figure 5.34: Cardiac PET HOPPS payments, 2008-2011 104
Figure 5.35: U.S. Market for PET, 2010-2017 110
Figure 5.36: Percent Self-Reported Heart Disease By Age Group 118
Figure 5.37: Installed Units of PET in E.U, 2002-2013 119
Figure 5.38: Installed Units of PET/CT in E.U., 2002-2013 120
Figure 5.39: Growth of PET and PET/CT Examinations in E.U., 2002-2013 120
Figure 5.40: Location of PET Centers in Europe 121
Figure 5.42: PET Studies per Million Populations in Europe 122
Figure 5.41: Evolution of Cyclotron in Europe 123
Figure 5.43: Location of PET Cameras in Europe 124
Figure 5.44: Growth of Cyclotron Units in Europe, 2000-2010 125
Figure 5.45: European Nuclear Imaging Market Share by Geography, 2010 125
Figure 5.46: European Market for PET/CT, 2010-2017 126
Figure 5.47: Nuclear Imaging Market in Germany, 2010-2017 127
Figure 5.48: Nuclear Imaging System Market in France, 2010-2017 127
Figure 5.49: Nuclear Imaging System Market in U.K., 2010-2017 128
Figure 5.50: Nuclear Imaging System Market in Italy, 2010-2017 128
Figure 5.51: Number of Installed Bases in Nuclear Medicine in India 142
Figure 5.52: Nuclear Medicine Equipment Market in India 143
Figure 5.53: Indian Nuclear Medicine Equipment Market by Application 143
Figure 5.54: Global Demand Trend for Mo-99/Tc-99m 147
Figure 5.55: Global Market for Mo-99 by Geography/Country, 2009 148
Figure 5.56: Global Demand for Tc-99m (48 Million Doses/Year), 2009 148
Figure 5.57: Composition of Nuclear Medicine Procedures Utilizing Tc-99m 152
Figure 5.58: Global Demand for Mo-99 and Tc-99 153
Figure 5.59: U.S. FDG Sales, 2010-2017 156
Figure 5.60: U.S. Sales of Diagnostic Radiopharmaceuticals, 2007-2014 159
Figure 5.61: U.S. PET Procedure Volume Increase, 2007-2015 160
Figure 5.62: U.S. Sales of Fluorodeoxyglucose (FDG), 2007-2015 160
Figure 5.63: U.S. Export Share in Radioisotopes by Major Markets, 2007 162
Figure App. 2.1: Number of Global Nuclear Medicine Procedures Using for 99mTC/99Mo, 1990-2020 199
Figure App. 2.2: Growth of 99Mo Requirements, 1990-2020 199
Figure App. 2.7: Quantity of 99Mo Delivered to End-Users by Geography, 2007 200
Figure App. 2.8: Regional Shares of Reactor Production of 99Mo, 2007 200
Figure App. 2.9: Regional Shares of Reactor Production and Requirements of 99Mo, 2007 201
Figure App. 2.10: Regional Shares of Reactor Production and Requirements of 99Mo, 2007 202
Figure App. 5.1: Types of Nuclear Medicine Procedures that Can be Done Using Tc-99m 211
Figure App. 5.2: The basic linear supply chain for Tc-99m 212
Figure App. 5.3: North American Supply Chain for Tc-99m 213
Figure App. 5.4: Global Supply Chains for Tc-99m 214
Figure App. 5.5: Global Market Share by Reactor for Tc-99m 214
Figure App. 6.1: Growth in Allowed Services and Allowed Charges for Advanced Imaging Paid Under the MPFS, 1995 to 2005 217
Figure App. 6.2: Percentage of Total Growth in Allowed Services by Imaging Modality, 1995 to 2005 218
Figure App. 6.3: Percentage of Total Growth in Allowed Charges by Imaging Modality, 1995 to 2005 218
Figure App. 6.4: Growth in Advanced Imaging Utilization Rates, 1995 to 2005 219
INDEX OF TABLES
Table 2.1: Comparison of PET with Other Imaging Modalities 27
Table 2.3: Average Adult PET and PET/CT Scan Times 33
Table 2.4: Applications of PET in Oncology 35
Table 3.1: Applications of PET in Cardiology 40
Table 3.2: Characteristics of SPECT vs. PET in Cardiac Imaging 45
Table 3.3: List of Common PET Tracers Used in the Evaluation of Neurological Disorders 52
Table 4.1: Common PET Radioisotopes 55
Table 4.2: Examples of PET Radiopharmaceuticals 55
Table 4.3: Estimated Radiation Dose with Intravenous Administration of FDG in a 70-kg Patient 56
Table 4.4: PET Radiopharmaceuticals: Their Applications, Mechanisms of Uptake and Localizations 59
Table 4.5: FDA-Approved Radiopharmaceuticals as of August 3, 2010 61
Table 5.1: U.S. PET Locations and Exams 97
Table 5.2: Utilization by Payment Type in Finger Lake Region, 2009 101
Table 5.3: Effect of Coverage Changes on Oncologic Uses of FDG PET 105
Table 5.4: Volume Outlook for Outpatient Imaging, 2005-2015 107
Table 5.5: Medicare Reimbursement for PET Procedures 109
Table 5.6: Publicly Funded PET Scanners in Canada, 2009 111
Table 5.7: Funding for PET Scans (Period prior to October 1, 2009) 112
Table 5.8: Alberta Indications 113
Table 5.9: Estimated Ontario New Cancer Cases, 2009 114
Table 5.10: Publicly Funded PET Scanners in Ontario 2009 115
Table 5.11: Approved International Indications for Clinical Use of 18F-FDG 116
Table 5.12: Availability of Publicly Funded Clinical PET Scanning in Canada 116
Table 5.13: European PET, PET/CT, PET/NM Installations 119
Table 5.14: Typical Radiation Doses 123
Table 5.15: PET Scanning Facilities in Europe 129
Table 5.16: PET Scanning Facilities in England 130
Table 5.17: Typical Radiation Doses 131
Table 5.18: Capital Costs for a PET Center with a Distant Supply of Tracer 132
Table 5.19: Staff Costs per Annum for Imaging with a Distant Supply of Tracer 132
Table 5.20: Fixed Costs per Annum for Imaging with a Distant Supply of Tracer 133
Table 5.21: Variable Costs per Annum for Imaging with a Distant Supply of Tracer 133
Table 5.22: Total Capital Scanning Costs for Imaging and Radiotracer Production Facility 134
Table 5.23: Capital Costs for Full Production of Radiotracer within an Imaging and Full Production of Tracer Facility 134
Table 5.24: Staff Costs per Annum for an Imaging and Full Production of Tracer Facility 136
Table 5.25: Staff Costs for the Cyclotron and Radiochemistry Within an Imaging and Full Production of Tracer Unit 137
Table 5.26: Fixed Radiotracer Production Costs 137
Table 5.27: Variable Scanning Costs 137
Table 5.28: Radiotracer Production Variable Costs 138
Table 5.29: Medical Cyclotrons in India 140
Table 5.30: PET/CT Scanner Profile in India 141
Table 5.31: PET/CT Scanners by Number of Slices in India 141
Table 5.32: Major current 99Mo producing reactors 145
Table 5.33: Characteristics of Positron Emitting Tracers Used in PET Perfusion Imaging 146
Table 5.34: Worldwide Production Capacity of 99Mo, 2009 151
Table 5.35: Small Scale Production of 99Mo, 2010 151
Table 5.36: Nuclear Medicine Procedures that Use Tc-99m 154
Table 5.37: Radiopharmaceuticals of Clinical Use in Europe 157
Table 5.38: Useful Radionuclides for Molecular Imaging 158
Table 5.39: U.S. Shipments, Consumption and Trade of Radioisotopes 161
Table 5.40: U.S. Exports, Imports and Trade Balance by Selected Countries, 2003-2007 163
Table 5.41: U.S. Imports of Radioisotopes for Consumption, 2003-2007 164
Table 6.1: Actinium's Product Pipeline 165
Table App. 1.1: Global Reactor Landscape 194
Table App. 1.2: Global Share of Nuclear Medicine by Reactor, 2009 195
Table App. 2.1: Radionuclides for Which Supply is Believed to be in Jeopardy in 2010-2020 198
Table App. 3.1: Imaging Properties of PET Crystals 203
Table App. 3.2: Average adult PET and PET/CT Scan Times 204
Table App. 3.3: Common PET Radioisotopes 205
Table App.3.4: Examples of PET Radiopharmaceuticals 205
Table App. 4.1: Research Reactors Producing Radioisotopes 207
Table App. 4.2: Estimated Worldwide Value of Radioisotope Production 210
Table App. 6.1: Ten Most Frequently Billed Advanced Imaging Procedure Codes, 2005 220
Table App. 6.2: Growth in Allowed Charges for Advanced Imaging Under the MPFS by Year, 1995-2005 220
Table App. 6.3: CT Services Billed Under the MPFS by Provider Specialty, 1995-2005 220
Table App. 6.4: PET Services Billed Under the MPFS by Provider Specialty, 1995-2005 222
- Actinium Pharmaceuticals, Inc.
- Advanced Medical Isotope Corporation
- Bio-Nucleonics
- Bracco Diagnostics, Inc.
- Covidien, PLC
- DRAXIMAGE, Inc.
- FluoroPharma, Inc.
- GE Healthcare
- Lantheus Medical Imaging, Inc.
- MIM Software Inc.
- Neusoft Medical Systems Co., Ltd.
- Nordion Inc.
- Numa, Inc.
- Philips Healthcare
- Positron Corporation
- Siemens Healthcare
- Thinking Systems Corporation
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