title: Impact of fluorine-18 fluorodeoxyglucose positron emission tomography on patient management: first year's experience in a clinical center.
abstract: OBJECTIVE
  To measure the impact of whole-body fluorodeoxyglucose (FDG) positron emission tomography (PET) on patient management during its first year of use in a community hospital.
  
  
  METHODS
  First-year FDG-PET impact was determined from 463 referring physicians' evaluations of their patients' PET imaging results using two surveys. Survey 1 was given to all physicians referring patients to PET to discover whether PET changed patient management or had decision-making value in the patient's clinical algorithm. Survey 2 was given to one surgeon and one pulmonologist after therapy to determine how PET affected the surgical, chemotherapeutic, and/or radiotherapeutic treatment for the 53 cancer patients they referred.
  
  
  RESULTS
  The 463 responses to survey 1 described 23 different PET indications. Lung (40%), head and neck (18%), and colorectal cancers (11%) were the three leading causes of referral. PET changed patient management/therapy in 45% of all patients referred and had inferential/decision-making value in another 44%. Overall, PET had some type of positive influence in 412 (89%) of the patients. Survey 2 provided a more detailed assessment of 53 referrals from two specialists. PET positively affected surgery in 31 patients (58%), prompted the addition of chemotherapy or radiation therapy in nine patients (17%), and eliminated chemotherapy or radiation therapy in four cases (8%). Overall, PET affected patient management/therapy in 70% of the cases and had some decision-making value in another 26%, for a combined PET impact on patient management of 96%.
  
  
  CONCLUSIONS
  FDG-PET can be valuable for physicians in clinical practice. Its sensitivity and specificity in metabolic imaging, when combined with complementary anatomic imaging techniques, contribute significantly to the clinical treatment of cancer patients. In addition, the high accuracy of FDG-PET makes it a cost-effective radiologic procedure in the work-up of all suspected and/or recurrent cancer patients. Further research is needed to link this demonstrated impact on patient management to cost-effectiveness.
authors.affiliation: Hamamatsu/Queen's Positron Emission Tomography Imaging Center, Queen's Medical Center, Honolulu, HI 96813, USA. trobertv@aol.com
authors.forename: R
authors.initials: R
authors.lastname: Tucker
authors.forename: M
authors.initials: M
authors.lastname: Coel
authors.forename: J
authors.initials: J
authors.lastname: Ko
authors.forename: P
authors.initials: P
authors.lastname: Morris
authors.forename: G
authors.initials: G
authors.lastname: Druger
authors.forename: P
authors.initials: P
authors.lastname: McGuigan
mesh_terms: D019788:Fluorodeoxyglucose F18; D006801:Humans; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000628:therapy; D014055:Tomography, Emission-Computed
chemical_list: D019788:Fluorodeoxyglucose F18