Dabbling with the Dark SideDabbling with the Dark Side

Birmingham experience of an Birmingham experience of an on-site Private Sector PET/CT on-site Private Sector PET/CT

facilityfacility

Chris BoivinChris BoivinHead of Nuclear Medicine, University Hospital Head of Nuclear Medicine, University Hospital

BirminghamBirmingham

Birmingham PET CentreBirmingham PET Centre

BackgroundBackground

How service worksHow service works

Lessons learnedLessons learned

BackgroundBackground

1997 – Gamma Camera PET1997 – Gamma Camera PET

Really wanted proper PET ASAPReally wanted proper PET ASAP

DH funding? DH funding? – Always about 2 years awayAlways about 2 years away

Local business case?Local business case?– Non-starter since no guaranteed incomeNon-starter since no guaranteed income

Independent sector?Independent sector?– Began to show interest 2001Began to show interest 2001

2001: PET scanners per 10m2001: PET scanners per 10m

‘‘Procurement’Procurement’

Independent sector managed facilityIndependent sector managed facility

On-site PET/CT facility at no cost to TrustOn-site PET/CT facility at no cost to Trust

Alliance Medical preferred provider 2003Alliance Medical preferred provider 2003

Lengthy contract negotiationsLengthy contract negotiations– Freedom to negotiate our own contract, but Freedom to negotiate our own contract, but

also freedom to cock it upalso freedom to cock it up

Time lineTime line

Oct 2003:Oct 2003: Mobile PETMobile PET

July 2004:July 2004: Mobile PET/CTMobile PET/CT

July 2005:July 2005: PET Centre opensPET Centre opens

Jan 2006:Jan 2006: 10001000thth scan scan

0

50

100

150

200

250

300

350

400

450

500

Oct-Dec2003

Jan-Mar

2004

Apr-Jun

2004

Jul-Sep2004

Oct-Dec2004

Jan-Mar

2005

Apr-Jun

2005

Jul-Sep2005

Oct-Dec2005

Jan-Mar

2006

Apr-Jun

2006

Jul-Sep2006

Oct-Dec2006

PET scans per quarterPET scans per quarter

Our RequirementsOur Requirements

Partnership – integration with Trust Partnership – integration with Trust Imaging servicesImaging servicesInvolvement in choice of PET/CT camera Involvement in choice of PET/CT camera & centre design& centre designBells & whistlesBells & whistles– Radiotherapy treatment planningRadiotherapy treatment planning– Respiratory gatingRespiratory gating

Low-cost research accessLow-cost research accessInvolvement of Nuclear Med staffInvolvement of Nuclear Med staff

PET Centre OperationPET Centre Operation

Staffed by AllianceStaffed by Alliance– Manager/operator, operator, helper, 2 x clericalManager/operator, operator, helper, 2 x clerical

FDG shipped inFDG shipped inIRR99 & RSA93 – AllianceIRR99 & RSA93 – AllianceIRMER – Trust (control over procedures)IRMER – Trust (control over procedures)ARSAC & reporting – Trust radiologistsARSAC & reporting – Trust radiologistsMPE – St George’s, shortly to be transferred to MPE – St George’s, shortly to be transferred to Trust physicistsTrust physicistsRPA – Trust physicistsRPA – Trust physicistsTrust authorised officer – contract monitoringTrust authorised officer – contract monitoringMonthly service meetings Trust & AllianceMonthly service meetings Trust & Alliance

IT IntegrationIT Integration

Probably the most complicated bitProbably the most complicated bit

Alliance private network with firewalls to Alliance private network with firewalls to Trust networkTrust network

All patients registered on Trust PAS & RISAll patients registered on Trust PAS & RIS

DICOM worklist RIS to PET/CTDICOM worklist RIS to PET/CT

Images pushed to Trust PACSImages pushed to Trust PACS

Scan reporting on Trust RIS, access to Scan reporting on Trust RIS, access to Trust PACS in PET CentreTrust PACS in PET Centre

Trust Staff IntegrationTrust Staff Integration

Radiologists – ARSAC, reporting, trainingRadiologists – ARSAC, reporting, training

Physicists – report checking, IRMER, Physicists – report checking, IRMER, RPA, incident investigation, audit & RPA, incident investigation, audit & contract monitoring, RIS & IT support contract monitoring, RIS & IT support (bubbling under – MPE, R&D)(bubbling under – MPE, R&D)

Technologists – injection assistance Technologists – injection assistance (future – supernumerary rotation, (future – supernumerary rotation, permanent staffing?)permanent staffing?)

Service IntegrationService Integration

Emergency medical coverEmergency medical coverMedical & consumable suppliesMedical & consumable suppliesInfection controlInfection controlWaste disposalWaste disposalCleaningCleaningPorteringPorteringFire alarmsFire alarmsUtilities infrastructureUtilities infrastructure

Lessons learnedLessons learned

Their targets are not necessarily our Their targets are not necessarily our targets (eg 31 & 62 day cancer waits)targets (eg 31 & 62 day cancer waits)

IT links and data sharing are a challenge IT links and data sharing are a challenge to seamless integrationto seamless integration

Useful to transfer risk of spiralling costsUseful to transfer risk of spiralling costs

Glossy literature & service marketingGlossy literature & service marketing

ConclusionConclusion

High-quality PET/CT service establishedHigh-quality PET/CT service established

From user point of view, day-to-day From user point of view, day-to-day function similar to other Trust imaging function similar to other Trust imaging modalities modalities – radiologists, IT integration, MDTs etcradiologists, IT integration, MDTs etc

Goodwill & good communication essentialGoodwill & good communication essential– overcame initial teething troubles, everyone overcame initial teething troubles, everyone

working well togetherworking well together