title: Introduction of positron emission tomography into the Western Norwegian Health Region: Regional balance in resource utilization from 2009 to 2014.
abstract: BACKGROUND
  The aim was to compare resource utilization across the four health trusts within the Western Norway Regional Health Authority since the establishment of positron emission tomography (PET) at Haukeland University Hospital in Bergen in 2009.
  
  
  METHODS
  Metadata from all PET examinations from 2009 to 2014 were automatically imported from the PET centre's central production database into a custom-developed database system, MDCake. A PET examination was defined as a procedure based on a single injection of radioactive tracer. The patients' place of residence and tentative diagnosis were coded based on the available clinical information.
  
  
  RESULTS
  The total number of PET examinations increased from 293 in 2009 to 1616 in 2014. The number of PET examinations per year increased across all diagnostic groups, but plateaued for lung cancer, gastrointestinal cancer and malignant melanoma since 2013. The number of examinations per capita was evenly distributed between the three northern health trusts with an average of 1260 PET studies per million inhabitants in 2014. However, patients residing in the most southerly health trust received between 44% (2010) and 27% (2014; P<0·001, repeated measures ANOVA) fewer examinations per capita per year.
  
  
  CONCLUSIONS
  Centralized PET in the Western Norwegian health region meets the current clinical demand for patients residing in the three northern health trusts while patients from the most southern health trust receive approximately 30% fewer PET examinations. Access to specialized health care should be monitored routinely in order to identify inequalities in referral patterns and resource utilization.
authors.affiliation: Nuclear Medicine/PET-centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.|Department of Radiology and Nuclear Medicine, Oslo University Hospital, University of Bergen, Bergen, Norway.
authors.forename: Henning Langen
authors.initials: HL
authors.lastname: Stokmo
authors.affiliation: Nuclear Medicine/PET-centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Bernt Christian
authors.initials: BC
authors.lastname: Reitan
authors.affiliation: Nuclear Medicine/PET-centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Boel
authors.initials: B
authors.lastname: Johnsen
authors.affiliation: Nuclear Medicine/PET-centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Ankush
authors.initials: A
authors.lastname: Gulati
authors.affiliation: Nuclear Medicine/PET-centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
authors.forename: Nina
authors.initials: N
authors.lastname: Kleven-Madsen
authors.affiliation: Nuclear Medicine/PET-centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.|Department of Chemistry, University of Bergen, Bergen, Norway.
authors.forename: Tom Christian Holm
authors.initials: TCH
authors.lastname: Adamsen
authors.affiliation: Nuclear Medicine/PET-centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine, University of Bergen, Bergen, Norway.
authors.forename: Martin
authors.identifier: http://orcid.org/0000-0002-5550-1035
authors.initials: M
authors.lastname: Biermann
mesh_terms: D002391:Catchment Area, Health; D002497:Centralized Hospital Services / Q000706:statistics & numerical data*; D016208:Databases, Factual; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D006295:Health Resources / Q000706:statistics & numerical data*; D006302:Health Services Research; D054625:Healthcare Disparities; D006785:Hospitals, University; D006801:Humans; D000071253:Metadata; D009664:Norway; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians'; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals / Q000008:administration & dosage; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012040:Regional Health Planning; D013997:Time Factors
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Fluordeoxyglucose; PET/CT; health services; health technology; positron emission tomography