Operational considerations in expanding a PET-CT service to include PET-MR

Objectives: PET/CT has been available clinically for over a decade and provides high quality imaging with a relatively short scan time. As vendors begin to offer PET-MR in addition to PET-CT, institutions are evaluating the timing and goals in investing in PET/MR in lieu of, or in addition to, PET/CT. We aim to highlight some of the operational considerations that were taken into account as we expand our clinical services at a large multi-specialty clinic to include PET-MR.

Methods: A hierarchical and timeline based overview is used to briefly summarize the reasons for considering a PET-MR expansion, followed by a detailed analysis of the individual issues such as personnel, technology, and financial aspects that were vital to developing an operational plan for starting a PET-MR service. The operational design was preceded by team selection, in this case a group of radiologists, technologists, and physicists, who worked together to tackle specific targets. The experience of PET-MR acquisition lends itself to a typical project management implementation in healthcare technology acquisition. Each of the steps is demonstrated as a module that must reach a certain level of completeness before the team is ready for the next step. Some of the discrete issues addressed include: vendor choice for PET-MR, utilization goals for the device, assessment of staffing needs, training needs for the entire team, development of new workflows, and methods of marketing to the referring clinician.

Results: The unique experience of our team is presented with incorporation of pre-existing experience of another installation, at a different site, in our organization. The stepwise approach to this project served us well, allowing for natural milestones to be created using a project management algorithm. Once the ‘go/no-go’ threshold was crossed by answering the issues highlighted above, and a decision to acquire a PET-MR was made, the operational aspects were addressed. Additional staff was hired across the team spectrum- nuclear medicine technologist, MRI technologist, and a physicist. Specific indications and orders were created. Education modules were implemented for MRI and radiation safety training. Interpreting and reporting methods were implemented. Finally, a plan was put in action to reach out to the referring clinicians during the scanner validation period to ensure a smooth rollout at the initiation of the clinical service.

Conclusion: The process of acquiring and placing a new healthcare technology into clinical practice involves constant communication and coordinated teamwork, which is facilitated by identifying and involving the correct stakeholders early in the project. Having the team built at the outset allows for a more efficient evaluation of the pros and cons of each decision. By putting together a PET/MR working group and establishing guidelines to be followed, PET/MR can be incorporated and turned into a viable practice.