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
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
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:
- The most useful investigation is done at the most helpful time.
- An investigation that will provide sufficient information in order to make good clinical decisions.
- The most cost-effective investigation.
- An investigation done only if it will determine or alter future treatment.
- Investigations done in an appropriate manner in appropriate facilities by the appropriate radiologists/nuclear medicine specialists.
- Reports that offer relevant information using recognised reporting criteria that will assist in clinical decision-making.
The above presupposes that:
- Careful thought is given when determining both the appropriate investigation and the appropriate timing of the investigation.
- Prior radiologic investigations accompany the patient and are reviewed when the new investigation is done.
- Sufficient clinical history is provided to the radiologist/nuclear medicine physician in order to facilitate a comprehensive report.
- 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.