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South Island PET Scan Variance

Background

Positron Emission Tomography PET is an imaging tool to support clinical decision-making on the appropriate treatment for some patients with cancer and can be used to more accurately plan treatment for patients.

The Minister of Health has agreed to $1million sustainable funding per annum nationally to boost funding for PET Scans based on nationally agreed clinical indications. This funding will supplement (not replace) existing DHB spending on PET scans.

From 1 July 2010 Canterbury DHB, working with the other SI DHBs and the Southern Cancer Network (SCN), is required to ensure that PET Scan services are available for all South Island DHBs. Canterbury DHB as lead DHB is responsible for funding and reporting processes on behalf of SI DHBs and the SCN for the establishment and secretariat for the Regional Variance Committee.

Clinical Indications for PET Scanning

The following table outlines the Ministry of Health Clinical Indications for PET scanning.

Cancer	Clinical Indication
Colorectal	Pre-operative evaluation for patients considered for resection of hepatic/lung metastases in colorectal carcinoma (CRC) Evaluation of residual structural abnormality on diagnostic imaging following definitive treatments for colorectal carcinoma (CRC)
Lung	Staging of proven non-small cell lung cancer (NSLC) prior to curative surgery or radiotherapy Solitary pulmonary nodules not amenable to fine needle aspiration (FNA) or which have failed pathological characterisation
Lymphoma	Restaging of residual mass for non-Hodgkin's Lymphoma following definitive treatment Staging of early stage low-grade non-Hodgkin's Lymphoma Staging of Hodgkin's Disease
Head and Neck	Restaging of residual neck masses in head and neck cancers following radiotherapy/chemotherapy Staging for metastatic squamous carcinoma in cervical lymph nodes from unknown primary
Oesophagus	Staging of gastric/oesophageal cancer for curative treatment
Malignant Melanoma	Patients considered for definitive or adjuvant treatment of oligo-metastatic or regional melanoma
Cervical	Staging of locally advanced cervical cancer for curative radiation treatment
Ovarian	Restaging of recurrent ovarian carcinoma being considered for cytoreductive surgery

South Island PET Scan Variance Committee

The role of the committee is to consider PET scan requests that do not meet the nationally approved clinical indications for PET scan.

The Secretariat for the South Island PET Scan Variance Committee is managed by Canterbury DHB.

Process

Requests for Variant PET scans will be considered by the committee on an as needs basis (the greatest frequency will be weekly).

For variant requests, the referring clinician is asked to attend the South Island PET Scan Variance Committee meeting by videoconference if unable to attend in person.

1. The clinician is asked to present the supporting material using a Powerpoint presentation or similar

2. The presentation time should be up to and no more than ten minutes with a further ten to 15 minutes for discussion

3. A copy of the presentation is kept by the South Island PET Scan Variance Committee for use in meeting minutes and subsequent reference / auditing processes

4.The contents of the clinician's supporting information should include:

a. Clinical details around the particular case, including relevant imaging and other laboratory data

b. Rationale behind the PET referral in this particular case

c. Literature review around the use of PET for this indication, including a discussion on the level of evidence