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The ICON clinical team recommends the PET-CT

The ICON clinical team recommends the PET-CT (positron emission tomography/computed tomography) guidelines from the College of Nuclear Physicians of South Africa in the January 2016 SAMJ, pages 105 to 122.

This is a comprehensive and well referenced document with guidelines on the appropriate use of 18F-fluorodeoxyglucose (18F- FDG) and non-18F-FDG positron emission tomography/computed tomography. These documents will be used by the ICON clinical team to advise network colleagues and the medical schemes on the use of PET-CT scans in the ICON setting.

Reference: M Vorster, A Doruyter, A Brink, S Mkhize, J Holness, N Malan, N Nyakale, JM Warwick, M Sathekge, on behalf of the College of Nuclear Physicians of South Africa. RECOMMENDATIONS. Appropriate indications for positron emission tomography/computed tomography, 2015. S Afr Med J 2016;106(1): 105-122

Link: http://www.samj.org.za/index.php/samj/article/view/10181

A summary of the process and recommendations on pages 894 to 896 of the November 2015 SAMJ is a useful quick guide.

Reference: M Sathekge, JM Warwick, A Doruyter, M Vorster. Appropriate indications for positron emission tomography/computed tomography: College of Nuclear Physicians of the Colleges of Medicine of South Africa. S Afr Med J 2015;105(11):894-896.  DOI:10.7196/SAMJ.2015.v105i11.10180

Link: http://repository.up.ac.za/bitstream/handle/2263/50504/Sathekge_Appropriate_2015.pdf?sequence=1&isAllowed=y

The points made in the circular on ICON PET-CT Guidelines sent out to the ICON Network in 2013 stand:

Appropriate radiology in oncology means:

  1. The most useful investigation is done at the most helpful time.
  2. An investigation that will provide sufficient information in order to make good clinical decisions.
  3. The most cost-effective investigation.
  4. An investigation done only if it will determine or alter future treatment.
  5. Investigations done in an appropriate manner in appropriate facilities by the appropriate radiologists/nuclear medicine specialists.
  6. Reports that offer relevant information using recognised reporting criteria that will assist in clinical decision-making.

The above presupposes that:

  1. Careful thought is given when determining both the appropriate investigation and the appropriate timing of the investigation.
  2. Prior radiologic investigations accompany the patient and are reviewed when the new investigation is done.
  3. Sufficient clinical history is provided to the radiologist/nuclear medicine physician in order to facilitate a comprehensive report.
  4. Restrictions and contra-indications to imaging are considered prior to the investigation.

We would recommend that these documents are used to guide you in deciding on the appropriate use of PET-CT scans in the management of your patients. If there is reason to go outside of these guidelines. a detailed letter of motivation with clear reasons will help in the evaluation of the request by the ICON clinical team.

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