by: Wayne Webster
The 2011 SNM annual meeting was held this year in Salt Lake City. Not the best venue for a meeting but the SNM has never been about location. Last year the meeting was a victim of the Swine Flu scare and attendance was down. This year attendance was about the same at least that was the take by most of the exhibitors I spoke with.
As I perused the exhibit hall there was the usual cadre of exhibitors. GE, Siemens and Philips were all showing their SPECT and PET hybrids. Interestingly the “Image of the Year was a SPECT/CT image from a group in Japan. This was different from the last several years when PET and PET/CT images were chosen.
The radiopharmaceutical sellers and distributors were taking questions about the potential for a fix in the Moly-99 supply. The two reactors programs that supply most of the Moly for production of Tc-99m generators were leaking information that the crisis may be nearing an end. Within two weeks of the meeting both Chalk River and Petten announced that their reactors were repaired and ready for restart. It appears that in July/August we will see a resumption of the local supply of Moly-99. Most agree that with the return of the Tc-99m supply a lot of the anxiety in the market will be removed.
After many years of attending the SNM, this year met my expectations. Not a lot new or exciting. Lantheus had a lot of papers and posters showing the results of the 18F derivative for PET Myocardial Perfusion Imaging. The expectation is that the kit for production of the radiopharmaceutical will be approved and available in about 18-months.
One company, Sophie Biosciences, which apparently was a product of the UCLA PET imaging program was showing a new and somewhat different animal PET scanner, for mice. It had some unique abilities at about a third of the cost of the other animal PET scanners. The staff was young and ready to do some good things. It wasn’t obvious to me but I don’t think they’d shipped the first commercial unit. The scanner was a large cube that fit into a fume hood and had some useful loading devices making it easier to anesthetize and monitor the mouse.
For some reason which no one understood there were several companies entering the cyclotron marketplace. Best Medical was touting a single design that could be expanded from a smaller 14 MeV PET cyclotron up to a 70 MeV unit. The first unit will be ready for inspection at the end of the year for anyone out there who cares. Sumitomo was back after a decade away. They were exhibiting their smaller cyclotron. A new company called ABT from Knoxville displayed a “Table-Top” cyclotron. This machine runs at 7 MeV and can produce a dose of FDG about every 20 minutes. This is a ready to inject dose with somewhere between 10-14 mCi’s. This 19-ton machine is a positive ion, shelf-shielded, internal target machine with an attached automated processing and dispensing system. The company claims that the production process is FDA GMP compliant. I couldn’t get my arms around this part and how they could validate the process from ion source to dose dispensing. The cost for the three-dose an hour machine is about $1.3 million plus the cost of disposables which appeared to be about $100/production run. Like all cyclotrons the use of electricity for operation is pretty inefficient. There’s no real way to change this but it is a substantial use and will be a substantial cost for those considering their own production. Another company from South Korea, Unitech, was also showing a new line of cyclotrons.
With GE and Siemens continuing their cyclotron programs the new cyclotron companies were a big surprise to me. There seemed to be little interest in adding a cyclotron to facilities with PET or PET/CT cameras. The price of FDG has been coming down as the demand for tracer has flattened. What all of these companies see as a market is a mystery.
Everyone is concerned about reimbursement and health care reform. Most seem to understand that the many regulations to come from Meaningful Use and the potential for further reductions in reimbursement which may substantially change the face of nuclear medicine.
What is interesting about nuclear medicine is that through its history this specialty has been driven by hospital based systems. PET and PET/CT changed some of that but overall it still is largely a hospital based modality. Because of this there was not the anxiety over the push to move imaging back to the hospital that’s being orchestrated by the Feds.
Maybe it was the venue, the lack of new and exciting equipment and applications or the fact that nuclear medicine is a mature diagnostic modality that kept the meeting from braking attendance records. I don’t know. But one can say that other than the 18F derivative for PET MPI research there was not a lot at the meeting to get the base excited.