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Cancer imaging/screening in clinical
practice
Thomas F. Hany MD
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Cancer
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Diagnostic imaging
X-ray– Breast cancer (-screening)
Computer tomography- based on x-raxs
- Lung Cancer (-screening)
Magnetic resonance imaging– Imaging of hydrogen atoms in a magnetic field
Positron emission tomography/CT - MRI
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Chest x-ray
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Bronchial carcinoma- chest x-ray
Accuracy of detecting lung cancer by chest x-ray is 70-80% (low!)
Evaluating older chest x-rays are as important as reviewing current films
Older films to determine whether an abnormality is new, old, or has changed.
No change in 2 or more years or show benign calcification pattern are classified as benign
In terms of staging, the chest x-ray is poor at defining T status (29% accurate) and N status, identifying less than 10% of abnormal lymph nodes.
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Cause ...
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Screening by low-dose CT
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Chest CT vs. conventional Rx
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Lung cancer screening US
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Recommendations
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Screening mammography
– Screening mammography is an x-ray examination of the breasts in a woman who is asymptomatic (has no complaints or symptoms of breast cancer).
– The goal of screening mammography is to detect cancer when it is still too small to be felt by a woman or her physician.
– Screening mammography is recommended each year for women once they reach 40 years of age.
– In some instances, physicians may recommend beginning screening mammography before age 40 (i.e. if the woman has a strong family history of breast cancer
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Mammography
Mammography is the only exam approved by
the FDA to screen for breast cancer in
women who do not show any signs or
symptoms of the disease.
Mammography can detected approximately
85% of breast cancers.
The average cost for screening mammography
in the U.S. is about $100.
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What is PET/CT ?
Kinahan PE, Townsend DW, Beyer T, Sashin D. Attenuation correction for a combined 3D PET/CT scanner.
Med Phys. 1998 Oct;25(10):2046-53.
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4 – 128 slice MSCT
fullring-detector PETLutetium- or Germanium based crystal material
Most used tracer: Fluor-18 – deoxyglucose = FDG
In-Line PET-CT system
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Contralateral mediastinal
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50 patients prospectively evaluated
PET/CT additional information in 41% over PET + CT
T stage Paired Sign Test P-value
PET/CT vs. CT 0.001*
PET/CT vs. PET <0.001*
PET/CT vs. PET+CT 0.013*
N stage Paired Sign Test P-Value
PET/CT vs. CT 0.12
PET/CT vs. PET 0.013*
___________ PET/CT vs. PET+CT 0.021*significant after Bonferroni correction
T staging in NSCL with PET/CT vs. PET+CTLardinois, Weder, Hany, Steinert HC et al., N Engl J Med 2003;348:2500-7
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Today – insert vs. rail-way vs. full
integration
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PET Radiotracers
Body/oncology
- F-18-FDG
- F-18-DOPA
- Ga-68-DOTATOC
- Ga-68-PMSA
- F-18 Fluoride
- F-18 Choline
- F-18 Ethyl-Tyrosine (FET); Methyl-Tyrosin (FMT)
Neuro
- F-18 FDG (Dementia)
- F-18 Flobetapir (Alzheimer)
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Work horse – FDG – not to be replaced so
fast….
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Don`t forget...
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Basic Copyright Notice & Disclaimer
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