As imaging technology continues to advance, Cardiac PET MPI is gaining more awareness in today’s clinical market. In recent years, the modality has seen growth and is generating interest among cardiologists.
While the diagnostic benefits of Cardiac PET are clear, it’s important to understand the financials and investments needed to offer the service before making a commitment. In this post we’ll explore five aspects to consider as you evaluate Cardiac PET.
1. Equipment Requirements
If you decide to offer PET imaging, you’ll need to choose between the purchase of a new imaging system, or refurbished. It’s common for pre-owned options to be 8-10 year-old traditional PET cameras that have been refurbished to factory standards for technology and performance.
Many of these older cameras use line sources to perform attenuation correction. Generally, the camera and attenuation correction sources are considered the acquisition component. It’s often bundled with a new processing workstation that employs some of the latest cardiac processing features, including coronary flow information.
Depending upon the manufacturer, a refurbished system can cost between $350,000 and $450,000, but because there is limited availability in the secondary market, they’re also subject to the law of supply and demand.
An additional factor in the equipment equation should be your maintenance and repair costs, which, for a pre-owned system, will typically range from $80,000 -$85,000 annually.
If you’re considering a refurbished model, it’s important to do business with a reputable company. Keeping quality and service in mind, a trustworthy organization will help you find the best fit for your investment.
The alternative option is to purchase a new PET MPI camera. Most modern PET imagers include a CT component that provides attenuation correction. Most new PET/CT imagers cost over $1,500,000 and are a significantly higher investment than the cost of a refurbished model.
New cameras come with various levels of CT sophistication, some of which can perform calcium scoring and coronary vessel imaging. If you’re contemplating the larger investment, you might want to consider purchasing the most sophisticated camera your budget can afford, and offset the cost by the additional tests you can offer your patients.
It’s important to remember that regardless of which new PET/CT model you choose, you’ll need to spend 10-12% of the purchase price for annual repair and maintenance costs.
Many cardiology practices choose the refurbished route. When you do the math, depreciating $350,000 over 72 months is a lot easier to digest than $1,500,000 over the same time period. The sticker shock alone prevents some practices from considering the more sophisticated tests.
2. Radiopharmaceutical Expenses
The radiopharmaceuticals used with PET MPI are a significant component of the monthly cost in offering the modality. If you’re using the Rubidium-82 radiotracer, you can expect to pay between $40,000 and $45,000 each month, depending upon your study volume, the size of your generator, and the length of your contract. Supply contracts are generally a minimum of 1 year but are typically negotiated for 3-year terms.
13n-ammonia is an alternative radiotracer, but its practicality and cost make it prohibitive. A unit dose solution, however, is known to be in clinical trials, which may or may not lead to commercial availability within 3-5 years.
3. Staffing Considerations
If your practice is offering SPECT imaging in-house, your current nuclear technologist should have the educational background and licensing required to perform PET studies as well. While they may not have direct PET/CT expertise, your technologists can easily be trained. The only procedural difference between SPECT and PET MPI is the type of stress imposed on the patient. SPECT imaging includes both chemical and mechanical while PET includes only chemical stress. It does not require the use of a treadmill.
When you purchase a PET camera, the manufacturer will include applications training, as will the generator or cyclotron company.
Depending upon your volume, one technologist may be able to manage the workflow. You might also consider adding an assistant if an additional technologist isn’t warranted. Generally, adding PET MPI to your services should not affect your staffing, unless, of course, your volume is such that both your SPECT and PET imaging are significant enough to require an additional team member.
4. Facility Requirements
Adding a PET camera to your office may require some site planning considerations. The PET camera is significantly larger than the typical SPECT camera. Since you’ll be keeping your SPECT camera, you’ll not only need additional space, it will also have to be larger than what you have allotted for your SPECT camera. A 15’x20’ – 20’x30’ room could accommodate a PET camera, depending on the manufacturer. The space will also need to be lead-lined for radiation shielding. If your office square footage is tight, consider building an addition or even acquiring other real estate either in your current building or at another location.
5. Regulatory Expenses
Some states in the U.S. require physicians to apply for a Certificate of Need (CON)to install a PET camera. The goal of the CONprogram is to control health care facility costs and facilitate the coordinated planning of new services. Approval is not guaranteed as they reserve the right to determine the necessity of an additional PET camera in a particular area. If you live in one of these states, be sure to factor in the cost and time of submitting your application.
There may also be additional taxes or fees assessed by some states for high-end imaging. In that case, a percentage of the revenue from your PET studies may be payable to the state government.