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Positron Emission Tomography (PET) Markets

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Publication Date:
July 2011; Pages: 225
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Positron Emission Tomography Sample

The medical imaging segments are poised for a major new phase of growth fueled by the availability of new technology coming out of the computer and digital information technology segment. Continuous improvements in technology are resulting in a growing number of new imaging tests that combine high levels of accuracy with rapid, easy-to-use product formats. Part of that medical imaging improvement is coming from positron emission tomography (PET). PET is a scanning technique used in combination with small amounts of radio-labeled compounds to visualize the anatomy and function of the brain. The purpose of this TriMark Publications report is to describe the specific market segment of the diagnostics medical imaging market called PET scanning. This sector includes all of the generally accepted imaging activities that are currently used in PET, including equipment for PET, PET/CT, SPECT and the use of radiopharmaceuticals for imaging. It examines these clinical measurement devices and their reagents and supplies as used in hospitals and clinics. It also reviews associated clinical market segments in which PET scanning has taken a prominent role including cancer treatment, cardiology, and neurology imaging markets.

 

TABLE OF CONTENTS

1. Overview 12
1.1 Scope of This Report 12
1.2 Methodology 14
1.3 Executive Summary 15

2. PET Technology: An Overview 18
2.1 History and Development of PET 18
2.1.1 Early Beginnings 18
2.1.2 The 1950s: Pioneering Ideas for PET 18
2.1.3 The 1960s and 1970s: The Development of PET 18
2.1.4 The 1980s: PET's Advancement and Performance in Research Sector 19
2.1.5 The 1990s: PET's Progression in the Clinical Sector 20
2.1.5.1 PET Advancements of the 1990s 20
2.1.5.2 PETS Ability to Identify Pathophysiology 20
2.1.5.3 Insurance Coverage for PET 21
2.1.5.4 Availability of FDG 21
2.1.6 The 2000s: PET/CT Scanner 21
2.1.7 The Working of PET 22
2.1.8 Coincidence Detection 23
2.1.9 Coincidence Imaging 24
2.1.10 PET Modes 25
2.1.11 Obstacles to Widespread Use of PET 25
2.1.12 Dedicated PET Equipment 26
2.2 PET's Comparison with Other Conventional Imaging Procedures 27
2.3 Trends in PET Instrumentation 29
2.3.1 Advances in PET/CT Imaging 29
2.3.2 Promise of PET/MR Imaging 30
2.4 Cost Considerations in PET Scanners 32
2.5 Economics of Hybrid Systems 32
2.5.1 Hybrid Optimization 33
2.5.2 Image Quality and Hybrids 33

3. PET Applications: An Overview 34
3.1 Applications of PET and PET/CT in Oncology 34
3.1.1 PET/CT's Growth in Clinical Oncology in the U.S. and Europe 35
3.1.2 Cancer: Global Incidence and Mortality 36
3.1.3 PET: The Most Powerful Imaging Tool in Cancer Management 36
3.1.4 Increases in Cancer Imaging Costs 37
3.1.5 New Criteria for Diagnosing Alzheimer's disease 37
3.1.6 Expanded Applications for PET in Oncology 37
3.1.6.1 PET Scanning for Prostate Cancer 38
3.1.6.2 PET/CT in Radiation Treatment Planning for Cancer Patient Treatment 38
3.1.6.3 PET in Radiation Therapy Planning 38
3.1.6.4 Imaging Protocols for PET in Radiation Therapy Planning 39
3.2 Applications of PET in Cardiology 39
3.2.1 Cost of Cardiovascular Disease 40
3.2.2 CVD: The Single Largest Killer in Adults 41
3.2.3 Prevalence of CVD in the U.S. 42
3.2.4 Economic Cost of CVD in the U.S. 43
3.2.5 PET: The Established Diagnostic Tool in Cardiology 44
3.2.6 PET and Heart Disease Diagnosis 44
3.2.7 PET/CT's Suitability in Cardiac Imaging 45
3.2.8 Need for Dedicated PET Devices for Cardiac Imaging 46
3.2.9 Impact of PET in Reducing Biopsies 46
3.2.10 Current Status of Nuclear Medicine in Cardiology 46
3.2.10.1 Current Status of Cardiac Nuclear Medicine in Asia 47
3.2.10.2 Current Status of Cardiac Nuclear Medicine in Europe 47
3.2.10.3 Current Status of Cardiac Nuclear Medicine in Latin America 48
3.2.10.4 Current Status of Cardiac Nuclear Medicine in North America 48
3.2.11 SPECT vs. PET in Cardiology 49
3.3 Application of PET in Neurology 50
3.3.1 PET's Promising Role in Diagnosing Migraines and schizophrenia 51
3.3.2 PET's key role in Parkinson's research 51
3.3.3 PET's Prediction on Surgical Outcome in Refractory Epilepsy Patients 51
3.3.4 Disease-Specific Applications of PET and PET/CT in Neurology 52
3.3.4.1 PET Imaging of Brain Tumors 52
3.3.4.2 PET and Brain Metastases 53
3.3.4.3 PET in Dementia 53
3.3.4.4 PET in Epilepsy 53

4. PET Radioisotopes and Radiopharmaceuticals 55
4.1 Types of Radiopharmaceuticals 56
4.1.1 Diagnostic Radiopharmaceuticals 57
4.1.2 Suppliers of Radiopharmaceuticals 57
4.1.3 Radioisotopes Used in Medicine 58
4.1.4 Cyclotron Radioisotopes 59
4.1.5 FDA-Approved Radiopharmaceuticals 61
4.1.6 Some Common Radiopharmaceuticals in PET Imaging 63
4.1.6.1 Nitrogen-13 Ammonia 65
4.1.6.2 Rubidium-82 65
4.1.6.3 Oxygen-15 Water 65
4.1.6.4 Flourine-18 fluorodeoxyglucose (FDG) 65
4.1.7 Generator-Produced PET Radiopharmaceuticals 66
4.1.8 New PET Agents for Cardiology 66
4.1.8.1 New Neuronal Imaging Agents 66

5. Market Analysis 67
5.1 Global Market for Medical Imaging Modalities 67
5.1.1 Global Medical Imaging Market Share by Modality, 2010 67
5.2 PET and PET/CT Market 68
5.2.1 Pet and PET/CT's Application Areas 69
5.2.1.1 Global Spending on Cancer 69
5.2.1.2 U.S. Spending on Cancer and Cancer Imaging 70
5.2.1.3 U.K. Spending on Cancer 71
5.2.2 Global Market for Diagnostic Imaging Equipment for Oncology 72
5.2.2.1 Improved Diagnosis and Staging by Technological Advances 72
5.2.2.2 Importance of Imaging to Cancer Treatment 73
5.2.2.3 PET/CT Market in Oncology Sector 75
5.2.2.4 Percent Share of PET/CT Utilization by Type of Cancer 76
5.2.2.5 The Lion's Share of PET/CT Imaging in Oncology 76
5.2.3 Economic Evaluation of PET and PET/CT in Oncology 77
5.2.3.1 Costs for PET and PET/CT in Oncology 77
5.2.3.2 Cost Effectiveness of PET and PET/CT in Selected Cancer Types 78
5.2.3.3 Cost Effectiveness in the diagnosis of Solitary Pulmonary Nodules 78
5.2.3.4 Cost Effectiveness in the Detection of Non-Small Lung Cancer 78
5.2.3.5 Cost Effectiveness in the Detection of Colorectal Cancer 78
5.2.3.6 Cost Effectiveness in the Detection of Head and Neck Cancers 79
5.2.3.7 Cost Effectiveness in the Detection of Malignant Lymphoma 79
5.2.3.8 Cost Effectiveness in the Detection of Pancreatic cancer 79
5.2.3.9 Cost Effectiveness in the Detection of Other Solid Neoplasms 79
5.2.4 PET/CT: Business Models 80
5.2.4.1 The Models 80
5.2.4.2 Market Forces 80
5.2.5 Rising Demand for PET 81
5.2.5.1 Changes in PET Reimbursement 81
5.2.5.2 Initial Results from the National Oncologic PET Registry (NOPR) 81
5.2.5.3 The Road toward Open Coverage for PET 82
5.2.6 Future of SPECT and PET 82
5.3 Imaging Markets in Cardiology 83
5.3.1 Nuclear Imaging of Heart 83
5.3.2 Global Utilization of Nuclear Imaging in Cardiology 84
5.3.2.1 Future of Global Nuclear Cardiology Utilization 85
5.3.2.2 Utilization of Nuclear Cardiology Procedures in Developed Countries 85
5.3.2.3 Utilization of Nuclear Cardiology Procedures in Latin America 86
5.3.2.4 Utilization of Nuclear Cardiology Procedures in Asia/Oceania 87
5.3.2.5 Utilization of Nuclear Cardiology in Africa 88
5.3.2.6 Utilization of Nuclear Cardiology and Mortality Rate 89
5.3.2.7 Cost-Effectiveness in Nuclear Cardiology 89
5.3.2.8 Epidemiology of Cardiovascular Diseases in Developing Countries 89
5.3.3 Global Opportunities for Nuclear Cardiology Products 90
5.3.3.1 Competition in Nuclear Cardiology Market 90
5.3.4 Need for Dedicated PET Imaging in Cardiology 90
5.3.5 Market for PET Imaging Systems 91
5.3.5.1 Growth Rate for PET Cameras 92
5.3.5.2 The Decline of SPECT and the Rise of PET 93
5.3.5.3 Dedicated PET vs. Hybrid PET 94
5.3.5.4 The Different Paths of SPECT/CT and PET/CT 94
5.3.6 U.S. PET Landscape 95
5.3.6.1 PET and PET/Studies in the U.S. for Oncology 97
5.3.6.2 PET/CT Studies in the U.S. for Cardiology 98
5.3.6.3 PET/CT Studies in the U.S. for Neurologic Studies 98
5.3.6.4 U.S. Growth Rate for PET Procedure Volume 99
5.3.7 Utilization of PET Scanners in the U.S. Finger Lakes Region 100
5.3.7.1 U.S. PET Utilization by Body Site 101
5.3.7.2 PET Utilization by Payment Type 101
5.3.7.3 U.S. PET Utilization Rates 102
5.3.7.4 U.S. Demand for SPECT, SPECT/CT, PET and PET/CT 102
5.3.8 U.S: Cardiac PET Payments 103
5.3.8.1 Opposition for Reduction 103
5.3.8.2 Breakeven Point 104
5.3.9 CMS Coverage for Cancer Patients and PET/CT Growth 104
5.3.9.1 Opportunities for the Providers of PET and PET/CT 106
5.3.10 Medicare Reimbursement for PET Procedures 107
5.3.10.1 Coding 107
5.3.10.2 Reimbursement 108
5.3.10.3 Payment for Diagnostic Radiopharmaceuticals 108
5.3.11 U.S. Market for PET 110
5.3.12 PET Landscape across Canada 110
5.3.13 PET scanning in Canada 115
5.3.13.1 Publicly Funded PET Scanning in Canada 116
5.3.13.2 Privately Funded PET Scanning in Canada 117
5.3.13.3 Utilization of PET in Ontario 117
5.3.13.4 CVD: Number One Killer in Canada 118
5.3.14 PET Landscape in Europe 118
5.3.14.1 PET Installations in Europe 119
5.3.14.2 Growth of PET/CT in the E.U. Market 119
5.3.14.3 PET/CT Procedures in Europe 120
5.3.14.4 Locations of PET Centers in Europe 121
5.3.14.5 PET Studies per Million Population in Europe 121
5.3.14.6 The Commercial Isotope Market in Europe 122
5.3.15 Availability of PET in U.K 123
5.3.15.1 PET Units in Europe 124
5.3.15.2 Cyclotron-Based Isotopes 124
5.3.15.3 Nuclear Imaging Leaders in Europe 125
5.3.15.4 European Market for PET/CT 126
5.3.15.5 Nuclear Imaging System Market in Germany 127
5.3.15.6 Nuclear Imaging Market in France 127
5.3.15.7 U.K. Nuclear Imaging System Market 128
5.3.15.8 Nuclear Imaging System Market in Italy 128
5.3.15.9 PET Services in Europe 129
5.3.15.10 PET Services in England 130
5.3.15.11 Availability of PET in U.K 131
5.3.16 Costs of Setting up a PET Center in U.K. with a Distant Supply of Tracer 131
5.3.16.1 Capital Costs 131
5.3.16.2 Operating Costs 132
5.3.16.3 Fixed Costs 133
5.3.16.4 Variable Costs 133
5.3.16.5 Costs of Setting up a PET Center in U.K. with Full Production of Tracer 133
5.3.16.6 Operating Costs 134
5.3.16.7 Staff Costs 136
5.3.16.8 Radiotracer Production 136
5.3.16.9 Fixed Costs 137
5.3.16.10 Variable Costs 137
5.3.16.1 Radiotracer Production 138
5.3.17 Nuclear Medicine Equipment and Consumables in India 138
5.3.17.1 Market Trends 138
5.3.17.2 Key Market Drivers 138
5.3.18 Status of PET in India 139
5.3.18.1 Historic Perspective 139
5.3.18.2 The Isotope 139
5.3.18.3 FDG Supply 139
5.3.18.4 Ownership of Cyclotron 139
5.3.18.5 Issues of the Cyclotron 140
5.3.18.6 Regulation for Cyclotron and Isotope Supply 140
5.3.18.7 Cyclotron Supply Issue 140
5.3.18.8 Isotope within the End User Site 141
5.3.18.9 Hardware Issues 141
5.3.18.10 Indications for PET Studies in India 142
5.3.18.11 Indian Nuclear Medicine Equipment Market 142
5.4 Nuclear Medicine 144
5.4.1 Shortage of Isotopes for Medical Imaging 144
5.4.2 The Supply of Medical Radioisotopes 145
5.4.3 Isotopes Used in PET Imaging 145
5.4.4 Isotopes Used in SPECT Imaging 146
5.4.5 Rapid Growth of Radiotracers 146
5.4.6 Global Market for Mo-99/Tc-99m 147
5.4.6.1 Global Market for Mo-99 by Geography 147
5.4.6.2 Global demand for Tc-99m 148
5.4.6.3 Market Trends for Tc-99m 148
5.4.6.4 Supply Uncertainties 149
5.4.6.5 Pricing 149
5.4.6.6 Impact of Tc-99m Pricing on Health Care Budgets 150
5.4.7 Impact of Technetium Shortage 150
5.4.7.1 Global Impact 150
5.4.7.2 Popular Medical Uses of Tc-99m 154
5.4.7.3 Market Trends for Tc-99m 155
5.4.7.4 Supply Uncertainties 155
5.4.7.5 Pricing 155
5.4.7.6 Impact of Tc-99m Pricing on Health Care Budgets 156
5.4.8 18F-fluorodeoxyglucose (FDG) Positron Emission tomography (PET) 156
5.4.9 FDG Utilization in Europe 157
5.4.10 Future of Radiopharmaceuticals 157
5.4.11 U.S. Radioisotopes Industry 158
5.4.11.1 Industry Trends and Developments 159
5.4.11.2 Market Trends for Radiopharmaceuticals and Brachytherapy 159
5.4.11.3 Supply Disruptions 161
5.4.11.4 U.S. Shipments, Consumption and Trade 161
5.4.11.5 U.S. Trade of Radioisotopes 162
5.4.11.6 U.S. Exports of Radioisotopes 162
5.4.11.7 U.S. Imports of Radioisotopes 164

6. Company Profiles 165
6.1 Actinium Pharmaceuticals, Inc. 165
6.2 Advanced Medical Isotope Corporation 165
6.2.1 AMIC's Medical Isotope Products 165
6.3 Bio-Nucleonics 166
6.3.1 Strontium Chloride Sr89 166
6.3.2 Rubigen 166
6.4 Bracco Diagnostics, Inc. 166
6.4.1 CardioGen-82 167
6.5 Covidien, PLC 167
6.5.1 Covidien's Nuclear Medicine Products 167
6.5.1.1 Duosafe 167
6.5.1.2 Indium In-111 chloride sterile solution 168
6.5.1.3 Octreoscan 168
6.5.1.4 Sodium Iodide I-131 Capsules 168
6.5.1.5 Technescan HDP 169
6.5.1.6 Thallous Chloride Tl 200 169
6.5.1.7 Ultra-Technekow Dry-Top Eluting (DTE) 169
6.5.1.8 Gallium Citrate Ga-67 Injection 170
6.5.1.9 Tc 99m Sestamibi 170
6.5.1.10 Sodium iodide I-123 170
6.5.1.11 Technescan MAG3 171
6.5.1.12 Technescan PYP 171
6.5.1.13 Ultratag RBC 171
6.6 DRAXIMAGE, Inc. 172
6.7 FluoroPharma, Inc. 172
6.7.1 FluoroPharma's technology 173
6.7.1.1 CardioPET 173
6.7.1.2 BFPET 173
6.7.1.3 VasoPET 173
6.8 GE Healthcare 174
6.8.1 GE's PET and PET-Related Products 174
6.8.1.1 CardIQ Fusion 174
6.8.1.2 CardIQ Physio 174
6.8.1.3 Dynamic VUE 175
6.8.1.4 MINItrace 175
6.8.1.5 PETtrace 175
6.8.1.6 Discovery PET/CT 600 176
6.8.1.7 Discovery PET/CT 690 176
6.8.1.8 Discovery VCT 176
6.8.1.9 Discovery STE 177
6.8.1.10 Discovery ST 177
6.8.1.11 Optima PET/CT 560 177
6.9 Lantheus Medical Imaging, Inc. 178
6.9.1 Selected Products from Lantheus 178
6.9.1.1 Cardiolite (Kit for Technetium Tc99m Sestamibi for Injection) 178
6.9.1.2 Technetium Tc 99m Generator 178
6.10 MIM Software Inc. 178
6.10.1 MIMfusion 179
6.10.2 MIMcardiac 179
6.10.3 MIMviewer 179
6.10.4 MIM Storage Server 180
6.11 Neusoft Medical Systems Co., Ltd. 180
6.11.1 Truesight PET 181
6.11.2 BeyondImage Workstation (BW) 181
6.11.3 CardioCARE 181
6.11.4 PETCare 182
6.12 Nordion Inc. 182
6.12.1 Nordion's Business Strategy 182
6.12.2 Nordion's Medical Isotope Business Priorities 182
6.12.3 Nordion's Sterilization Technologies Business Priorities 183
6.12.4 Nordion's Medical Isotopes 183
6.13 Numa, Inc. 183
6.13.1 NumaLink 183
6.13.2 NumaList 184
6.13.3 NumaList Plus 184
6.13.4 NumaStore 185
6.13.5 NumaRead 185
6.13.6 NumaServer 186
6.13.7 NumaManage 186
6.13.8 Numa's Core Lab system 187
6.14 Philips Healthcare 187
6.14.1 Ingenuity TF PET/CT 187
6.14.2 GEMINI TF Big Bore PET/CT 188
6.14.3 GEMINI TF PET/CT 188
6.14.4 GEMINI TF Ready PET/CT 189
6.14.5 GEMINI LXL 189
6.15 Positron Corporation 190
6.15.1 Attrius 190
6.15.2 Cardio-Assist 190
6.15.3 Radiopharmaceuticals 190
6.15.4 Tech-Assist 191
6.16 Siemens Healthcare 191
6.16.1 Biograph TruePoint (16-slice PET/CT) 191
6.16.2 Syngo.via 191
6.17 Thinking Systems Corporation 192
6.17.1 MDStation 192
6.17.2 MDStation for PET and PET/CT 192


INDEX OF FIGURES

Figure 2.1: Illustration of the SMART Scanner 22
Figure 2.2: Illustrations of PET, CT and Fused PET/CT Scans 22
Figure 2.3: Collision of a Positron and Electron and the Creation of Two Resultant Gamma Rays 23
Figure 2.4: Discharge of Two Gamma Rays at 180 Degrees 24
Figure 2.5: A Sinogram with Coincidence Lines 24
Figure 2.6: PET Images Viewed in Axial, Coronal and Sagittal Planes 25
Figure 2.7: Block Diagram of PET Scanner 26
Figure 2.8: Principles of Operation of a Combined PET/CT Scanner 30
Figure 2.9: Two Scanners Mounted Back-to-Back for Sequential Acquisition 31
Figure 2.10: Full Integration of a Whole-Body PET/MRI System 31
Figure 3.1: Projection for Global Cancer Deaths, 2010-2030 36
Figure 3.2: Projected Cost of Cardiovascular Disease, 2010-2030 41
Figure 3.3: CVD: The Single Largest Killer in Adults 41
Figure 3.4: Prevalence of CVD in Four of the Ethnic Groups in the U.S. 42
Figure 3.5: Percentage Breakdown of Deaths from CVD in the U.S. 43
Figure 3.6: Costs of Major CVD Types in the U.S. 43
Figure 3.7: Increasing Number of Heart Failures in Europe, 2010-2020 47
Figure 3.8: CVD in Middle Income Countries 48
Figure 3.9: CVD in Developed Countries 49
Figure 5.1: Global Market for Medical Imaging Equipment by Geography, 2010 67
Figure 5.2: Global Medical Imaging Market Share by Modality, 2010 68
Figure 5.3: Global Cancer Cases, 2009-2020 69
Figure 5.4: U.S. Spending on Cancer, 2010-2020 70
Figure 5.5: Spending on Cancer in U.K., 2010-2020 71
Figure 5.6: Percent Comparison of Spending on Cancer, 2010 72
Figure 5.7: Volume Distribution in Cancer Imaging in the U.S. 73
Figure 5.8: Distribution of Outpatient Cancer Services in the U.S. 74
Figure 5.9: Global Market for Diagnostic Imaging Equipment for Oncology, 2010-2017 74
Figure 5.10: PET/CT's Share in Oncology Imaging Market, 2010-2017 75
Figure 5.11: Percent PET/CT Imaging by Cancer Type 76
Figure 5.12: Percent Share of Oncology, Cardiology and Neurology in PET/CT Scanning 77
Figure 5.13: Nuclear Cardiology Procedures for 100,000 of Population per Year for Developing vs. Developed Countries 84
Figure 5.14: Future of Nuclear Cardiology in 2014 85
Figure 5.15: Approximate Use of Cardiac Diagnostic Testing, U.S. 86
Figure 5.16: Utilization of Nuclear Cardiology in Developed Countries 86
Figure 5.17: Utilization of Nuclear Cardiology in Latin America 87
Figure 5.18: Utilization of Nuclear Cardiology Procedures in Asia/Oceania 88
Figure 5.19: Utilization of Nuclear Cardiology in Africa 89
Figure 5.20: Global Market for PET Services, 2010-2017 92
Figure 5.21: Projected Market Share of PET and SPECT in 2020 93
Figure 5.22: Growth Rate for SPECT and PET, 2011-2014 93
Figure 5.23: Number of Cameras: SPECT Switching to PET, 2011-2014 94
Figure 5.24: Top Ten Body Sites of Cancer for Men in the U.S. 96
Figure 5.25: Top Ten Body Sites of Cancer in U.S. Women 96
Figure 5.26: U.S. PET and PET/CT Patient Studies in Oncology, 2001-2008 97
Figure 5.27: U.S. PET and PET/CT Patient Studies in Cardiology, 2001-2008 98
Figure 5.28: U.S. PET and PET/CT Patient Studies in Neurology, 2001-2008 99
Figure 5.29: PET-Only Sites/Studies vs. PET/CT Sites/Studies 99
Figure 5.30: Trends in PET Procedure Volume in Finger Lakes Region, 2003-2009 100
Figure 5.31: U.S. PET Utilization by Body Site, 2009 101
Figure 5.32: U.S. PET Utilization Rate, 2003-2009 102
Figure 5.33: Approximate U.S. Sales of SPECT & SPECT/CT and PET & PET/CT, 2005-2009 103
Figure 5.34: Cardiac PET HOPPS payments, 2008-2011 104
Figure 5.35: U.S. Market for PET, 2010-2017 110
Figure 5.36: Percent Self-Reported Heart Disease By Age Group 118
Figure 5.37: Installed Units of PET in E.U, 2002-2013 119
Figure 5.38: Installed Units of PET/CT in E.U., 2002-2013 120
Figure 5.39: Growth of PET and PET/CT Examinations in E.U., 2002-2013 120
Figure 5.40: Location of PET Centers in Europe 121
Figure 5.42: PET Studies per Million Populations in Europe 122
Figure 5.41: Evolution of Cyclotron in Europe 123
Figure 5.43: Location of PET Cameras in Europe 124
Figure 5.44: Growth of Cyclotron Units in Europe, 2000-2010 125
Figure 5.45: European Nuclear Imaging Market Share by Geography, 2010 125
Figure 5.46: European Market for PET/CT, 2010-2017 126
Figure 5.47: Nuclear Imaging Market in Germany, 2010-2017 127
Figure 5.48: Nuclear Imaging System Market in France, 2010-2017 127
Figure 5.49: Nuclear Imaging System Market in U.K., 2010-2017 128
Figure 5.50: Nuclear Imaging System Market in Italy, 2010-2017 128
Figure 5.51: Number of Installed Bases in Nuclear Medicine in India 142
Figure 5.52: Nuclear Medicine Equipment Market in India 143
Figure 5.53: Indian Nuclear Medicine Equipment Market by Application 143
Figure 5.54: Global Demand Trend for Mo-99/Tc-99m 147
Figure 5.55: Global Market for Mo-99 by Geography/Country, 2009 148
Figure 5.56: Global Demand for Tc-99m (48 Million Doses/Year), 2009 148
Figure 5.57: Composition of Nuclear Medicine Procedures Utilizing Tc-99m 152
Figure 5.58: Global Demand for Mo-99 and Tc-99 153
Figure 5.59: U.S. FDG Sales, 2010-2017 156
Figure 5.60: U.S. Sales of Diagnostic Radiopharmaceuticals, 2007-2014 159
Figure 5.61: U.S. PET Procedure Volume Increase, 2007-2015 160
Figure 5.62: U.S. Sales of Fluorodeoxyglucose (FDG), 2007-2015 160
Figure 5.63: U.S. Export Share in Radioisotopes by Major Markets, 2007 162
Figure App. 2.1: Number of Global Nuclear Medicine Procedures Using for 99mTC/99Mo, 1990-2020 199
Figure App. 2.2: Growth of 99Mo Requirements, 1990-2020 199
Figure App. 2.7: Quantity of 99Mo Delivered to End-Users by Geography, 2007 200
Figure App. 2.8: Regional Shares of Reactor Production of 99Mo, 2007 200
Figure App. 2.9: Regional Shares of Reactor Production and Requirements of 99Mo, 2007 201
Figure App. 2.10: Regional Shares of Reactor Production and Requirements of 99Mo, 2007 202
Figure App. 5.1: Types of Nuclear Medicine Procedures that Can be Done Using Tc-99m 211
Figure App. 5.2: The basic linear supply chain for Tc-99m 212
Figure App. 5.3: North American Supply Chain for Tc-99m 213
Figure App. 5.4: Global Supply Chains for Tc-99m 214
Figure App. 5.5: Global Market Share by Reactor for Tc-99m 214
Figure App. 6.1: Growth in Allowed Services and Allowed Charges for Advanced Imaging Paid Under the MPFS, 1995 to 2005 217
Figure App. 6.2: Percentage of Total Growth in Allowed Services by Imaging Modality, 1995 to 2005 218
Figure App. 6.3: Percentage of Total Growth in Allowed Charges by Imaging Modality, 1995 to 2005 218
Figure App. 6.4: Growth in Advanced Imaging Utilization Rates, 1995 to 2005 219


INDEX OF TABLES

Table 2.1: Comparison of PET with Other Imaging Modalities 27
Table 2.3: Average Adult PET and PET/CT Scan Times 33
Table 2.4: Applications of PET in Oncology 35
Table 3.1: Applications of PET in Cardiology 40
Table 3.2: Characteristics of SPECT vs. PET in Cardiac Imaging 45
Table 3.3: List of Common PET Tracers Used in the Evaluation of Neurological Disorders 52
Table 4.1: Common PET Radioisotopes 55
Table 4.2: Examples of PET Radiopharmaceuticals 55
Table 4.3: Estimated Radiation Dose with Intravenous Administration of FDG in a 70-kg Patient 56
Table 4.4: PET Radiopharmaceuticals: Their Applications, Mechanisms of Uptake and Localizations 59
Table 4.5: FDA-Approved Radiopharmaceuticals as of August 3, 2010 61
Table 5.1: U.S. PET Locations and Exams 97
Table 5.2: Utilization by Payment Type in Finger Lake Region, 2009 101
Table 5.3: Effect of Coverage Changes on Oncologic Uses of FDG PET 105
Table 5.4: Volume Outlook for Outpatient Imaging, 2005-2015 107
Table 5.5: Medicare Reimbursement for PET Procedures 109
Table 5.6: Publicly Funded PET Scanners in Canada, 2009 111
Table 5.7: Funding for PET Scans (Period prior to October 1, 2009) 112
Table 5.8: Alberta Indications 113
Table 5.9: Estimated Ontario New Cancer Cases, 2009 114
Table 5.10: Publicly Funded PET Scanners in Ontario 2009 115
Table 5.11: Approved International Indications for Clinical Use of 18F-FDG 116
Table 5.12: Availability of Publicly Funded Clinical PET Scanning in Canada 116
Table 5.13: European PET, PET/CT, PET/NM Installations 119
Table 5.14: Typical Radiation Doses 123
Table 5.15: PET Scanning Facilities in Europe 129
Table 5.16: PET Scanning Facilities in England 130
Table 5.17: Typical Radiation Doses 131
Table 5.18: Capital Costs for a PET Center with a Distant Supply of Tracer 132
Table 5.19: Staff Costs per Annum for Imaging with a Distant Supply of Tracer 132
Table 5.20: Fixed Costs per Annum for Imaging with a Distant Supply of Tracer 133
Table 5.21: Variable Costs per Annum for Imaging with a Distant Supply of Tracer 133
Table 5.22: Total Capital Scanning Costs for Imaging and Radiotracer Production Facility 134
Table 5.23: Capital Costs for Full Production of Radiotracer within an Imaging and Full Production of Tracer Facility 134
Table 5.24: Staff Costs per Annum for an Imaging and Full Production of Tracer Facility 136
Table 5.25: Staff Costs for the Cyclotron and Radiochemistry Within an Imaging and Full Production of Tracer Unit 137
Table 5.26: Fixed Radiotracer Production Costs 137
Table 5.27: Variable Scanning Costs 137
Table 5.28: Radiotracer Production Variable Costs 138
Table 5.29: Medical Cyclotrons in India 140
Table 5.30: PET/CT Scanner Profile in India 141
Table 5.31: PET/CT Scanners by Number of Slices in India 141
Table 5.32: Major current 99Mo producing reactors 145
Table 5.33: Characteristics of Positron Emitting Tracers Used in PET Perfusion Imaging 146
Table 5.34: Worldwide Production Capacity of 99Mo, 2009 151
Table 5.35: Small Scale Production of 99Mo, 2010 151
Table 5.36: Nuclear Medicine Procedures that Use Tc-99m 154
Table 5.37: Radiopharmaceuticals of Clinical Use in Europe 157
Table 5.38: Useful Radionuclides for Molecular Imaging 158
Table 5.39: U.S. Shipments, Consumption and Trade of Radioisotopes 161
Table 5.40: U.S. Exports, Imports and Trade Balance by Selected Countries, 2003-2007 163
Table 5.41: U.S. Imports of Radioisotopes for Consumption, 2003-2007 164
Table 6.1: Actinium's Product Pipeline 165
Table App. 1.1: Global Reactor Landscape 194
Table App. 1.2: Global Share of Nuclear Medicine by Reactor, 2009 195
Table App. 2.1: Radionuclides for Which Supply is Believed to be in Jeopardy in 2010-2020 198
Table App. 3.1: Imaging Properties of PET Crystals 203
Table App. 3.2: Average adult PET and PET/CT Scan Times 204
Table App. 3.3: Common PET Radioisotopes 205
Table App.3.4: Examples of PET Radiopharmaceuticals 205
Table App. 4.1: Research Reactors Producing Radioisotopes 207
Table App. 4.2: Estimated Worldwide Value of Radioisotope Production 210
Table App. 6.1: Ten Most Frequently Billed Advanced Imaging Procedure Codes, 2005 220
Table App. 6.2: Growth in Allowed Charges for Advanced Imaging Under the MPFS by Year, 1995-2005 220
Table App. 6.3: CT Services Billed Under the MPFS by Provider Specialty, 1995-2005 220
Table App. 6.4: PET Services Billed Under the MPFS by Provider Specialty, 1995-2005 222

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