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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