Procedure volume in the PET market is continuing to grow at about 6% per year in the United States since 2013, reaching its highest level ever in the U.S. in 2019.
An estimated 2,200,800 clinical PET scans were performed in U.S. hospital and non-hospital sites using fixed PET imaging systems or mobile PET services, according to IMV’s newly published “2020 PET Imaging Market Summary Report.” Compared to an estimated 2,086,000 PET scans performed in 2018, total PET scans increased about 6% to 2,200,800 in 2019, representing the highest level of PET scan volume to date in the U.S. Moreover, based on estimates for the next twelve months provided by the survey respondents, total PET scans will continue the single-digit growth trend of a 6-7% increase in PET scans in 2020.
PET has been an exciting medical imaging technology since its inception, due to its ability to detect organ function on a cellular and molecular level using radiotracers that the PET technology detects. With the development of PET/CT — which fuses PET metabolic images with CT anatomic images, enhancing the ability to locate specific areas of abnormal cell activity — came a rapid adoption of PET/CT scanners in the U.S. since the early 2000s.
The primary use of PET imaging has been for cancer patients, with oncology procedures consistently comprising about 90% of the clinical PET scans. For oncology patients, FDG is used as the radiotracer to identify active cancer cells, as FDG is a compound similar to sugar, which cancer cells metabolize at high rates. For PET imaging sites, oncology scans have been a stable source of patients, as it has been used to diagnose the extent of cancer and ongoing patient management, particularly for patients with lung, Hodgkins/lymphoma, and breast cancer.
However, although the use of PET imaging is at its highest point, total PET scan volume represents only 2% of the 91.4 million CT scans performed on CT-only scanners in the U.S. (as estimated in IMV’s “2019 CT Market Outlook Report”). PET imaging is not a “primary care” modality, as patients are typically referred to PET after the patients are suspected as having cancer using other tests, with the top three sources of physician referrals being medical oncologists, radiation oncologists, and pulmonologists.
IMV estimates that 2,370 sites are performing PET scans in the U.S., with 60% of the PET imaging sites using fixed PET imaging units installed on site, including PET-only, PET/CT, and PET/MR scanners. The other 40% of the sites are using mobile PET services that stop at their facilities for several days per month. IMV finds that the sites using mobile PET services are not quick to adopt their own fixed units yet, likely due to reimbursements as well as the relatively “stable” market for oncology scans. The addition of new PET scanners in an area is more likely to steal volume from other providers rather than increasing the total pie.
Researchers and early adopters are excited about the potential of using PET technology for cardiac imaging and neurology applications. IMV estimates that the volume of PET cardiology scans has more than doubled in the five years from 2014 to 2019 but observes that cardiology-related PET scans are only 8% of the total PET scans performed in 2019. A relatively low 11% of the PET sites currently perform cardiology PET scans, which primarily consists of myocardial perfusion scans using Rb82 or N13 ammonia. Neurology scans currently constitute only 3% of the total PET scan volume in 2019, but a higher 38% of the PET sites perform some type of neurology-related scans, such as for patients suspected of having Alzheimer’s disease or dementia.
Faster growth of PET imaging since 2013 may have been inhibited due to the adoption of “appropriate use” criteria by the American College of Radiology (ACR), the Society of Nuclear Medicine and Molecular Imaging (SNMMI) and related associations. Furthermore, the usage of appropriate use criteria in ordering PET scans has been reinforced by the change in reporting policy from the CMS, mandating that under the Protecting Access to Medicare Act of 2014 (PAMA). In this CMS policy, physicians are to utilize a clinical decision support system for ordering imaging studies (CT, MR, PET, and NM only) to assure appropriate use of imaging resources and to minimize over-utilization. Third-party insurers have also been active in limiting reimbursement approvals through their use of their pre-authorization processes.
For the future, clinical research in both PET imaging technology and radiotracers is continuing to identify growth opportunities for new clinical applications and to improve productivity. In addition to cardiology applications, potential areas of growth for PET imaging include prostate cancer, neuroendocrine tumors, bone studies using sodium fluoride (NaF18), neuroimaging agents to detect beta-amyloid plaque for Alzheimer’s disease, and simulation for radiation therapy treatment planning.
Lorna Young is senior director of market research at IMV Medical Information Division, part of Science and Medicine Group.
IMV’s 2020 PET Imaging Market Summary Report explores trends in PET scan volume, the installed base of fixed PET imaging systems, PET scanner replacement cycles, mobile PET users, purchase plans for fixed PET systems (including PET-only, PET/CT, and PET/MR scanners), manufacturer installed base share and brand loyalty, radiopharmaceutical use and manufacturer share, and PET site operations characteristics. Manufacturers covered in this report include Bracco, Canon, Cardinal, GE, Hitachi, Jubilant, Philips, Positron, Siemens, SOFIE, and United Imaging, who provide PET imaging systems and/or radiopharmaceuticals.
The data source for this report is IMV’s PET Census Database of hospital and non-hospital facilities performing PET imaging in the United States, which is based on telephone interviews conducted by IMV from February 2019 through January 2020 with over 500 respondents in hospital and non-hospital sites. To provide nationwide estimates, their responses have been projected to the IMV-identified universe of sites in the United States that perform PET imaging using fixed PET imaging units or mobile PET services. While the 2020 PET Imaging Market Summary Report provides an overview of key trends, IMV clients may also license IMV’s PET Imaging Census Database so that they can conduct their own specific areas of inquiry. The IMV PET Census Database is a valuable dataset that can be queried directly to answer specific questions and to target specific sites.
For information about purchasing IMV’s 2020 PET Imaging Market Summary Report and/or IMV’s PET Census Database, visit the corporate website at https://www.imvinfo.com or call 773-778-3080 to speak with a representative.