Saving lives through early cancer detection: Breaking the current PET efficiency barrier with the 3D-CBS

An innovative, low-radiation 3-D Complete-Body-Scan (3D-CBS) medical imaging device is presented, combining the benefits of the functional imaging capability of the Positron Emission Tomography (PET) with those of the anatomical imaging capability of the Computed Tomography (CT). Until now, the greatest impediment to extending the axial field of view (FOV, the length of the detector) has been the electronics of current PET, which could not efficiently capture the photons. The unique architecture of the 3D-CBS electronics allows for the extension, in a cost-effective manner, of the FOV to over one meter in length. The 3D-CBS captures about 1,000 out of 10,000 photons in time coincidence, compared with only 2 out of 10,000 captured by current PET. In addition, the overall architecture of the 3D-CBS permits the use of a single detection apparatus acquiring PET and CT data concurrently without moving the patient or the detector. This uniquely provides functional and anatomical whole-body three-dimensional dynamic imaging and also allows real-time tracking of moving tumors during radiation therapy. The 3DCBS features significant improvements in the scanning speed by providing PET and CT exams combined in two to four minutes. It achieves increased resolution and accuracy, providing better imaging with a reduction in "false positives" and "false negatives," and allows for the radiation dosage to the patient be reduced to 1/30th of the dose required by existing PETs. The faster scanning time allows for at least six times as many PET examinations per day with a five-fold increase in net revenues or an examination cost floor as low as $300; currently the price of a PET scan is $2,000-$4,000. The lower examination cost and higher imaging quality of the 3D-CBS will compete with the cost and quality of current diagnostic workups of CT and PET. The low radiation dosage requirements will open the door to new applications by permitting annual whole-body screening for early detection of cancer and other systemic anomalies (heart functions, blood flow, brain activity, metabolic activity). This will replace most other current procedures for partial cancer screening (prostate, lung, breast, uterus, colon, etc.) because it is faster, less expensive, more accurate, and less invasive. The proposed 3DCBS device makes it possible to achieve improved performance now, while using cheaper, slower BGO, CsI crystals, currently available in abundance, unlike the nearly ideal fast LSO crystals, which have limited production capabilities. Comparisons are made of the superior cost effectiveness of the 3D-CBS versus both the current PETs that use the ideal crystal (LSO) and those with the highest spatial resolution (300 m). The need for the 3D-CBS is apparent after analyzing the number of people in a high-deathrate group (i.e., from 45-64 years old, which is still below general life expectancy) who are lost, not because the drugs to cure the disease do not exist, but because low radiation, and high sensitivity instrumentation for early detection of the disease does not exist. Cancer and heart disease are responsible for 60% of the deaths in the 45-64 age range. Clearly, a great proportion of these deaths could be avoided through early detection and treatment. Current expenditures for prescription drugs in the U.S. (excluding those used in hospitals, nursing homes, and by health care practitioners) are $116.9 billion per year and are projected by the Health Care Financing Administration (HCFA) to increase to over $360 billion per year by 2010, whereas expenditures for electromedical, diagnostic and irradiation equipment total only $13 billion per year. It is obvious that the impact of early detection with improved diagnostic imaging, in terms of both reduced mortality and increased global heath care savings, would be immense. Global health care costs will be reduced by helping hospitals and physicians select the most effective drugs and monitor their effects and by reducing costs related to morbidity. The 3D-CBS will also facilitate the development and testing of new drugs. Comparisons of the U.S. national health care expenditures (NHE) as a share of the gross domestic product (GDP) and the NHE/GDP of other countries are provided. Currently, PET imaging efficiency improves 2to 3fold every 5 years; a careful analysis of the 3D-CBS project, which increases efficiency over 400-fold compared to current technology, will show that all parties (investors, hospitals, physicians, drug researchers, insurance companies, the government, and patients) will benefit from the implementation of this technology as soon as possible. TABLE I. COMPARISON OF THE OPERATING COSTS10 PER SCANNER PER YEAR WHEN USED FOR THE SAME NUMBER OF HOURS PER DAY, AT THEIR HIGH THROUGHPUT AT A PRICE OF $400/EXAM. (SOURCE: RADIOISOTOPE MANUFACTURERS, HOSPITALS ADMINISTRATION FOR USA AND TABLE 5-1 OF [29] FOR EUROPEAN COSTS). Figure 1. Differences between the current PETs and 3D-CBS. If you are interested in this proposal but don’t have time to review it in depth, please see summary of advantages of the 3D-CBS on Table XV on page 34. Also see Section 17.2, for a request for comment and collaboration, and an opportunity for you to contribute and hasten the benefits of the 3D-CBS. FOV 15-25 cm Almost all photons are lost Photons lost FOV 120-160 cm Fewer photons lost HEAD RING TORSO RING Open for claustrophobic or overweight Close top for NON claustrophobic Current PET devices Capture only ~ 2 out of 10,000 photons Require ~ 55 min. to scan 90 cm of the body Low data quality and low resolution image High radiation dosage, high examination cost Annual examinations are hazardous ! The 3-D Complete Body Scan 3D-CBS Captures ~ 1,000 out of 10,000 photons Only ~ 4 minutes to scan 150 cm FOV Good image quality (avoids “false positives”) Only 1/30 the radiation dosage, low exam cost Permits annual examinations ! -$1.4 -$1.0 -$0.6 -$0.2 $0.2 O peating csts & pofits or loses) Capital amortiz. (8yr) -$0.125 -$0.275 -$0.750 Capital cost (5%) -$0.050 -$0.110 -$0.300 Service contract -$0.060 -$0.100 -$0.200 Upgrading -$0.060 -$0.100 -$0.150 Building -$0.090 -$0.090 -$0.090 Personnel -$0.200 -$0.250 -$0.350 Radioisotope FDG -$0.850 -$0.850 -$0.850 Revenues $0.400 $0.500 $3.000 Profit (or loss) -$1.035 -$1.275 $0.310 Current PET <14 cm FOV [millions $] Current PET ~25 cm FOV [millions $] 3D-CBS ~150 cm FOV [millions $] [millions] Revenues: $400 x 1,000 exams Revenues: $400 x 1,250 exams Revenues: $400 x 7,500 exams er scnner, er year L o s s L o s s Dario B. Crosetto / July 30, 2001. Saving lives through early cancer detection: Breaking the current PET efficiency barrier with the 3D-CBS