Strategic Healthcare Planning - Healthcare consultancy company, supporting the NHS

Projects: Acute Services: PET Scanner

Cancer, Renal and Cardiac Service expansion on track

Many parts of the NHS are expanding Cancer, Renal, and Cardiac services to keep pace with increasing local demands and national access targets. SHP has been supporting a number of NHS Trusts with these specific plans, one of which has been the development of a PET scanner for the North West Midlands Cancer network, as detailed below:

PET/CT Scanner Strategic Outline Case

Introduction
The central aim of the Strategic Outline Case was to set out the arguments and evidence, to gain support for North West Midlands Cancer Network plans to invest in a Positron Emission Tomography (PET) Scanning Service.

The development of the Strategic Outline Case was led by Strategic Healthcare Planning with the full involvement of representatives from all the key service providers:

Mid Staffordshire General Hospitals NHS Trust;

University Hospital of North Staffordshire NHS Trust;

Shrewsbury and Telford Hospital NHS Trust.

The objectives of the new service were to meet the identified need by:

	A service model which will sit within the wider strategy for provision of cancer services;
	Providing new opportunities to improve efficiency, patient pathway, quality, clinical effectiveness, patient and carer involvement;
	Providing PET/CT scanning services co-located with other cancer treatment capacity that will provide an integrated service;
	Providing sufficient capacity for PET/CT scanning growth in-line with current workload predictions;
	Ensuring all cancer service resources are utilised to maximum benefit for patients and cost effectiveness;
	Enhancing and improving existing opportunities for recruitment, retention, training and development for this specialist staff group.

What is PET/CT
PET stands for Positron Emission Tomography and is a type of scan developed in the 1970s the use of which is being broadened and extended within the NHS. Its clinical usage is continuing to develop and expand.

It can show how body tissues are working, as well as what they look like. PET/CT scans can therefore diagnose and stage many types of cancer. Evidence is growing to indicate that a significant number of patients receive alternative treatment plans following PET/CT scanning. Strategic Healthcare Planning and the clinical representatives investigated and reviewed the available research in order to draw conclusions about which cancer patients would most benefit from PET/CT scanning.

The most common drug used in PET/CT scanning is fluorine 18, also known as ¹⁸FDG. This is a radioactive version of glucose. ¹⁸FDG is produced in cyclotron and has a half-life of 110 minutes.
When ¹⁸FDG is injected into the body it travels to places where glucose is used for energy. Cancer cells have increased glucose uptake and changes in this process can be detected before corresponding structural changes in tissue anatomy, ¹⁸FDG-PET has the following properties and advantages for imaging malignant disease, compared to other radiological techniques such as CT, MRI and ultrasound:
Tumours may be detected earlier and with a greater sensitivity;
A malignant lesion can be discriminated from a benign nodule;
Lymph node involvement can be detected before it becomes enlarged;
Tumour recurrence can be distinguished from post-treatment scar tissue or necrosis;
Whole body images are obtained for no additional radiation dose which allows detection of metastatic disease, or of the primary tumour site (for biopsy or therapy) in patients where there are clinical indications of malignant disease (e.g. increasing tumour markers);
An earlier assessment can be provided of the response to chemotherapy and radiotherapy.

As well as its use in Cancer Services PET/CT scanning is also used for conditions such as heart disease, epilepsy, Alzheimer's disease.

SHP undertook a finite analysis of the international use of PET/CT and found that whilst PET/CT scanning is relatively new and limited in the UK many European counties and the USA have recognised the clinical benefits of PET/CT scanning and have developed a much greater capacity per head of population.

Why it is needed
The diagnoses and treatment of cancer, heart disease and mental health disorders have been identified in the NHS Plan as clinical priorities, and significant resources are being invested in modernising diagnostic and treatment equipment. PET is a functional imaging technique that can be used in all three clinical areas mentioned above. However its widest and most valuable application has been found to be the management of cancer. The National Cancer Plan recognised that decades of under-investment in equipment has resulted in an inability to deliver state-of-the-art procedures for diagnosis and treatment.

What is needed
SHP undertook an analysis of the population of the North West Midlands Cancer network, cancer incidence rates and the recommendations regarding particular uses of PET/CT in cancer diagnosis. The chart below shows the outcome of this work:

SHP reviewed the capacity of different manufacturers PET/CT scanners and the recommendations within a report of the Intercollegiate Standing Committee on Nuclear Medicine, 2003 and determined that the North West Midlands Cancer Network required 1 PET/CT scanner.
SHP worked with clinical representatives to establish the accommodation required for delivering a PET/CT scanning services and the diagram below shows the optimum configuration of this accommodation to provide an efficient, patient-focussed service:

Deciding On the Best Location
One of the practical restrictions to the development of PET/CT services is the location of ¹⁸FDG production facilities. The production of ¹⁸FDG requires a particle accelerator, called a cyclotron, and a dedicated radiopharmacy with purpose-built handling equipment. The half-life of 18F (110 min) is long enough to allow a remote cyclotron and radiopharmacy to act as the source of a "hub-and-spoke" supply of ¹⁸FDG to a number of hospitals, as long they are not separated by a distance of more than the equivalent of about 3 hours travelling time. Keele University, near Stoke has a cyclotron.

SHP led a non-financial option appraisal with representatives from all service providers to determine the best location for PET/CT scanning. A financial appraisal was also undertaken comparing both the initial capital outlay and the ongoing revenue costs for each option. The results of both the non-financial and financial appraisals determined that the optimum location of a PET/CT scanning service for the North West Midlands Cancer Network was University Hospital of North Staffordshire NHS Trust.

Conclusions
The Strategic Outline Case set out the arguments for investment in a PET/CT scanning service within the North West Midlands Cancer Network. The costs of the preferred option, locating a PET/CT scanning service at University Hospital of North Staffordshire NHS Trust were identified and an initial project timetable established.