Q&A: Refurbished PET scanners offer economic alternative to new systems
John Rebok, director of operations, Austin Heart, Texas
Advancements in PET and PET/CT continue to accelerate at a rapid pace, bringing doctors to consider investing in these technologies to keep their practices equipped with the latest solutions to meet their patients' needs. However, when battling a recession, it may seem difficult to consider purchasing technology that requires a hefty monetary investment. To avoid the high price tag and still invest in the most advanced technology, some administrators are now purchasing refurbished PET cameras.

Cardiovascular Business News asked John Rebok, director of operations of Austin Heart, a cardiac and vascular care practice based in Austin, Texas, to discuss the topic.

Cardiovascular Business (CVB) News: Why did your practice choose to implement a cardiac PET program?

John Rebok: One of our cardiologists had performed a fellowship with Dr. Tim Bateman, MD, at the Mid-America Heart Institute in Kansas City, Mo. Subsequently, our doctors investigated cardiac PET imaging with rubidium-82 and felt that it would provide a number of clinical advantages, including significantly improved image quality, especially for challenging patients. I then evaluated the operational efficiencies and financial aspects of this modality. Based upon our evaluation of the benefits that cardiac PET would provide to our practice, we made a decision to incorporate this technology into our cardiac imaging program.

CVB News: Why did you elect to purchase a refurbished PET scanner instead of new equipment? Did you have any concerns about purchasing refurbished equipment?

Rebok: During the time of our evaluation, new dedicated PET scanners were not being produced in the market because the major camera manufacturers offered only hybrid PET/CT systems. Our group did not think there was a need for a hybrid system since we already had a partnership with the hospital for performing CT. When looking at cost, the difference was $500,000 for a refurbished, dedicated PET camera versus around $2 million for a new 64-slice PET/CT. Most of the refurbished PET cameras available today are about as good as they were the day they rolled off of the assembly line. After looking into the refurbished options, we selected a vendor with a good reputation that offered a high quality product along with a service agreement. Consequently, we felt very comfortable with our decision.

CVB News: How economically feasible is it for a private practice cardiology group to initiate a cardiac PET program?

Rebok: Medicare reimbursement in our area is approximately $1,400 per scan for the PET scan, tracer, stress test and physician interpretation fee. We performed a detailed financial analysis and determined that based upon our practice's costs, our breakeven point was estimated to be three patients per day to support a cardiac PET program, which included the cost of the refurbished PET scanner, radiopharmaceutical (rubidium-82) and accessories. Therefore, if a cardiology practice can support a patient volume of three or more PET patients daily, this would be a technology worth investigating. Within the first week, we were performing an average of six PET scans per day and were very pleased with the results.

CVB News: Did you have any concerns about investing in new technology during these challenging economic times?

Rebok: I think that during these times, practices need to make informed decisions about investing in new technologies and they need to perform their due diligence. However, for a business to continue growing, there needs to be ongoing investments. Practices need to be sure they are making the right investments. We felt that cardiac PET would help us better differentiate our service offering and further expand our patient base.

CVB News: What advantages does PET offer over SPECT?

Rebok: From a clinical perspective, cardiac PET with rubidium-82 offers greater diagnostic accuracy, yielding a much more definitive study for the interpreting physician. We think that PET offers our patients better outcomes. The test also has enhanced our patient satisfaction because the entire protocol can be completed in less than an hour versus three to four hours for SPECT. Therefore, patients do not have to plan to be here for an entire morning or afternoon anymore. Patients who require pharmacologic stress testing, diabetics, obese patients (BMI, more than 30) and large breasted women can often present imaging challenges for SPECT. These patients are ideally suited for PET.

Rebok can be reached at jrebok@austinheart.com.