Best practices in NaF-PET/CT bone imaging in oncology

Objectives PET/CT bone imaging with 18F-NaF is currently covered by Medicare through a Coverage with Evidence Development (CED) program. The objective was to determine the added value of utilizing 18F-NaF alongside new imaging technologies for castrate resistant prostate cancer patients that qualified for the 18F-NaF NOPR program.

Methods The patient experience was reviewed from ordering of exam to image interpretation, focusing on enhancing patient satisfaction and incorporating new imaging technologies to current clinical practices. Current radiotracer availability was analyzed along with new emerging lines of therapy to assess demand moving forward.

Results Total study time for the patient decreased from 3.5-4hrs (typical study duration using methylene diphosphonate (MDP)) to 1.5 hours by using 18F-NaF. Additionally, the use of continuous bed motion (CBM) acquisition, coupled with a time-of-flight (TOF) + point-spread-function (PSF) reconstruction, has decreased imaging time from 45 minutes to 28 minutes; resulting in an increase in patient satisfaction. Even though total radiation dose to the patient is higher with 18F-NaF (24.7 mSv) when compared to MDP (8.05 mSv), the enhanced spatial resolution and sensitivity of 18F-NaF has led to more accurate image interpretation and more complete staging of the patient's disease process. Finally, recent global shortages of Tc-99m have caused alterations to clinical practices, increasing the demand for the more available 18F-NaF radiotracer.

Conclusions By utilizing 18F-NaF instead of the less dependable MDP for skeletal imaging, we have saved our patients over 2 hours of time in the clinic. Incorporating CBM with TOF+PSF has decreased our imaging time to 28 minutes and vastly increased our patient satisfaction. Finally, higher spatial resolution has increased the accuracy of image interpretation and disease staging.