Have Nuclear Medicine, Will Travel: Taking PET/CT on the Road

When mobile diagnostic imaging first rolled onto the scene—some 20 years ago now—it often was assumed to be substandard to stationary systems operating in hospitals and freestanding centers. But thanks to technology’s advancements constantly shrinking in size and some custom-built trailers, those times are long gone. Housed in high-tech trailers, today’s portable PET/CT units bring with them the same quality of system and images as any in-house scanner.

“There are absolutely no limitations to the exams that can be done on the mobile units,” said Randy W. Skiles, president and CEO of Shared PET Imaging LLC, Canton, Ohio. The company operates a fleet of full-service mobile PET and PET/CT trailers, each of which is outfitted with a scanner manufactured by either GE Healthcare, Waukesha, Wis, or Siemens Medical Solutions, Malvern, Pa. “The equipment—and, more important, the image quality—are exactly the same as what a hospital offers.”

Just as in any fixed scanning suite, the transportable systems must comply with all regulatory guidelines, including those set by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the American College of Radiology (ACR), the Nuclear Regulatory Commission (NRC), and state departments overseeing health and transportation. Also, technologists are highly trained and monitored to ensure they maintain the necessary credentials.

“We follow the same manufacturer guidelines for QA and maintenance as stationary units, and our technologists are Certified Nuclear Medicine Technologist [CNMT]-certified, with additional training required for PET/CT,” said Traci Hollingshead, CNMT, corporate radiation safety officer at DMS Health Group, Fargo, ND. DMS Imaging, a member of the DMS Health Group, offers PET/CT and nuclear medicine SPECT systems nationwide as part of its mobile diagnostic services. The company works with PET/CT systems from Philips Medical Systems, Andover, Mass, Siemens Medical, and GE Healthcare, as well as SPECT systems made by GE Healthcare and Siemens Medical.

	Once thought of as inferior to stationary scanners, mobile PET/CT services function identically and provide the same level of diagnostic quality. Mobile coaches have allowed the technology to reach out-of-the-way locations that might not otherwise have access to the capability.

Radiologists and referring physicians aren’t the only ones who won’t know the difference. Great pains are taken to ensure that the patient experience is as smooth as possible, with the traveling suites designed specifically to mirror those of their permanent counterparts.

“The inside of our mobile coaches is designed to resemble the look and feel of an in-house exam room,” Hollingshead said. “The patient registers and uses the restroom inside the hospital or clinic; all other aspects of the exam take place onboard the mobile coach.”

The same approach is used by Shared PET Imaging. Each of the company’s 48-foot coaches is divided into three rooms. First is a patient prep room, where the patient is injected and rests prior to the exam. Next, the technologist works in the console room, which houses the computer, acquisition station, and other controls essential to performing the scan. And finally, of course, the scanning room is where the actual system resides.

Expanding Horizons

Although the benefits of PET/CT are well established, the cost of installing and maintaining the equipment and staff required can keep the technology from being purchased by all but the largest medical centers.

“Mobile technology can be a good fit for any medical facility that has a need for services without the impact of a capital purchase,” said Lynn Speral, marketing director of DMS Health Group. DMS Interim Solutions offers both short- and long-term rental options. “This may help a facility determine the actual need they have for a particular service.”

Many facilities are avoiding the costs altogether by contracting the procedure out to companies offering these mobile services. This option allows the facility to provide the modality to their patients and physicians without a major capital investment.

“In this day and age, CEOs have become very attuned to the financial decision-making process and they really have to weigh all factors in order to determine what is best for their facility,” Skiles said. “Gone are the days when you can put in a piece of equipment and hope to build your volume; people want to test the water, see where the volume will go, and then be able to sit down and intelligently decide if this is something they want to purchase.”

Many administrators employ the mobile systems to resolve the access problems, though sometimes other factors—such as market forces and physicians insisting on permanent access to the equipment—can force the decision. Even then, however, they often appreciate the opportunity to cover the gap between demand for the scanner and the actual PET/CT purchase.

A 48-foot coach is divided into three areas: A patient prep room, a control room for the technician, and a room housing the scanner.

When the time comes that a hospital believes the volume is sufficient to warrant the investment, mobile providers also can share their experience as a way to ease the transition to a fixed scanner.

“Because this is all we do, we are experts in this particular modality,” Skiles said. “We also go to a great deal of effort and expense to keep our staff highly trained, so when hospitals want to go in-house, they often look to us to make that happen.” In many cases, Shared PET Imaging enters into a joint venture with the medical center. “We can get the system installed, provide staff, and manage it on a day-to-day basis, ensuring that everything runs properly,” he said.

Having an entire fleet of technologists helps in these scenarios as well. “If anybody is sick or goes on vacation, we can always pull someone from the mobile fleet who can temporarily fill in for them,” Skiles said. “We also will train the staff on the system, if that is [the hospital’s] preference.”

Moving Pictures

Wireless communications play a major role with this type of on-the-go technology. Every mobile unit run by Shared PET Imaging is linked to the main network through wireless technology.

This makes it possible not only to locate any truck at any given time, but also to determine the operational condition of the onboard scanner. Systems can be updated or maintained remotely through this capability as well. Similarly, the team in the mobile units is able to connect with the hospital’s PACS.

“We send all of the information to both the PACS and a reading workstation we supply in the facility,” Skiles said. “If it is on the PACS, [the radiologists] can combine it with prior CTs or other diagnostic studies, or they can use the workstation to immediately begin interpretation.”

Choose Wisely

Often, services offered by various mobile imaging companies are very similar in nature. When searching for the best on-site PET/CT service, Skiles recommended paying close attention to the details to avoid getting “nickeled-and-dimed.” Every fee should be considered, not just the one charged for each scan.

“Much of the cost is in the supplies—the isotopesand all of the injection material, for example—that really add up,” he said. “You want to be able to provide the service to your patients without any surprises at the end of the billing period.”

One often-overlooked expense is coverage for lost isotopes. Some mobile imagers charge the hospital if the patient doesn’t show up or when the scan cannot be completed for any reason.

“We offer 100% coverage, so in those cases, the hospital does not get billed,” Skiles said. “We also supply all of the injections, so they don’t have to pay for the patient kits for injections.”

Companies like Shared PET Imaging and DMS Imaging satisfy another recommendation: having a significant number of scanners, so an immediate replacement can be dispatched should one unit stop functioning.

“We offer what we believe is the most up-to-date technology in the mobile market,” Speral said. “The company is careful in selecting equipment that best meets the needs of our customers and is complementary to our existing fleet.”

Providing the Best to the Most

Today’s mobile PET/CT providers are doing their part to bring the latest in diagnostic imaging to the people who need it most.

“Our mission statement challenges us to want to make a difference in the lives of our patients, customers, and employees,” Speral said. “Without mobile services, many facilities would be unable to offer diagnostic imaging services, and many patients would need to travel great distances for procedures.”

Furthermore, these organizations are making it happen with a commitment to maintaining the highest level of quality. Said Skiles, “In today’s health care environment, we must be able to serve an ever-increasing population in a very economical manner.”

Dana Hinesly is a contributing writer for  Medical Imaging. For more information, contact .