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Access to PET/CT scans

Key findings

In 2016, 146 integrated positron emission tomography-computed tomography (PET/CT) scans per 1000 total cancer incidence were performed in Ontario. The volume of PET/CT scans performed has steadily increased since 2011, although significant regional variation continues to exist across Ontario. This variation is likely driven by differences in referral patterns among physicians and their awareness of the PET/CT program.

With point-in-time sample data, self-reported by the PET/CT centres, wait times are typically less than 10 days in Ontario, with the monthly median ranging from 3 to 11 days. Despite an increase in scanning volume, PET/CT wait times have remained consistent over time.

What are PET/CT scans?

  • Medical imaging, such as CT scans and magnetic resonance imaging (MRI), is routinely used to provide information about anatomical structures within the body. This information is used to diagnose illnesses (such as cancer) and make decisions about treatment.
  • PET scans are a type of nuclear medicine imaging exam. A PET scan provides pictures of what is happening inside the body at the molecular and cellular level; in some situations, it has the potential to identify areas of disease (such as cancer) before other imaging techniques. PET imaging is typically performed on a combined PET/CT scanner to help localize the information from the PET scan to the patient’s anatomy.
  • PET/CT imaging has clinical utility (i.e. the results may affect how a patient is managed) for some cancers as well as other conditions (such as cardiovascular disease and epilepsy).

PET/CT scanning in Ontario

  • PET Scans Ontario, which is operated by Cancer Care Ontario, collaborates with the Ministry of Health and Long-Term Care to coordinate PET/CT scan services and to ensure access to PET/CT services that are supported by evidence. This evidence-based approach ensures that patients receive the right test at the right time; this, in turn, helps to avoid the use of tests that are not of clinical benefit to the patient. The program also aims to improve transparency, accountability and equity for PET/CT scan services across Ontario.
  • In Ontario, patients can receive a PET/CT scan through 4 streams of access[1]:
    • services insured under the Ontario Health Insurance Plan (OHIP), where there is sufficient evidence that a PET/CT scan will benefit the patient and that it has advantages over other testing tools;
    • the Ontario PET Registry, which makes PET/CT scans available to patients in cases where there is some evidence to support the benefit of PET/CT scanning, but where additional evidence is needed before funding through OHIP can be recommended;
    • provincial clinical trials, which determine whether a PET/CT scan improves patient management or outcomes when there is little (or no) published evidence; and
    • the Ontario PET Access Program, which considers physician requests on a case-by-case basis in instances where patients may benefit from a PET/CT scan but do not meet the eligibility criteria under one of the other categories.
  • In Ontario, a PET/CT scan is recommended only in situations where (according to available evidence) it improves patient care and outcomes. The primary use of PET/CT scans in the province is for certain cancers, but some PET/CT scanning is performed for cardiology and other emerging areas.
  • To ensure patients are receiving their PET/CT scan in a timely fashion, PET Scans Ontario tracks wait times for the 12 PET/CT centres in the province (see Figure 1 for locations).

Figure 1. PET/CT centre locations across Ontario

 

Figure 2. The number of oncology PET/CT scans per 1000 total cancer incidence, by Local Health Integration Network (LHIN) of patient residence, Ontario, 2012 to 2016

More information regarding the methodology is available.

Report date: June 2017

Data source: PET/CT Scans Database, Cancer Care Ontario; Insured PET/CT Scans Database, OHIP; Cancer Incidence Estimates, Surveillance at Cancer Care Ontario

Prepared by: System and Infrastructure Planning and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

Figure 3. Percentage of non-small cell lung cancer NSCLC patients (diagnosed 2012 to 2016) who had a PET/CT scan prior to radical treatment, by Local Health Integration Network (LHIN) of patient residence

More information regarding the methodology is available.

Report date: December 2017

Data source: OCR, RPDB, ALR, CIHI-DAD, CIHI-NACRS, OHIP, PET Scan

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

Figure 4. Percentage of esophageal cancer patients (diagnosed 2012 to 2016) who had a PET/CT scan prior to radical treatment

More information regarding the methodology is available.

Report date: December 2017

Data source: OCR, RPDB, ALR, CIHI-DAD, CIHI-NACRS, OHIP, PET Scan

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

Figure 5. Percentage of esophageal cancer patients (diagnosed 2012-2016) who had a PET/CT scan prior to radical treatment, by Local Health Integration Network (LHIN) of patient residence

More information regarding the methodology is available.

Report date: December 2017

Data source: OCR, RPDB, ALR, CIHI-DAD, CIHI-NACRS, OHIP, PET Scan

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

Figure 6. Percentage of PET/CT scans performed for staging of aggressive lymphoma, by lymphoma incidence, 2013 to 2016, by Local Health Integration Network (LHIN) of patient residence

More information regarding the methodology is available.

Report date: August 2017

Data source: PET/CT Scans Database, Cancer Care Ontario; Cancer Incidence Estimates, Surveillance at Cancer Care Ontario

Prepared by: System and Infrastructure Planning and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions
  2. † Values have been suppressed due to small cell counts

Figure 7. Median number of business days between referral date and first available appointment, 2013 to 2017

More information regarding the methodology is available.

Report date: January 2018

Data source: Internal (self-reported data collected via Imaging Program)

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

Data Table 1. PET/CT centre locations across Ontario

LHIN Erie St Clair Erie St Clair South West South West Hamilton Niagara Haldimand Brant Hamilton Niagara Haldimand Brant Hamilton Niagara Haldimand Brant Hamilton Niagara Haldimand Brant Mississauga Halton/ Central West Mississauga Halton/ Central West Mississauga/ Halton/ Central West Mississauga/ Halton/ Central West Toronto Central Toronto Central Toronto Central Toronto Central Toronto Central Toronto Central Champlain Champlain Champlain Champlain North West North West
Centres Precision Diagnostic Imaging Precision Diagnostic Imaging St. Joseph's Health Care London St. Joseph's Health Care London Hamilton Health Sciences - McMaster University Medical Centre (MUMC) Hamilton Health Sciences - McMaster University Medical Centre (MUMC) St. Joseph's Healthcare Hamilton Charlton Campus St. Joseph's Healthcare Hamilton Charlton Campus KMH Cardiology and Diagnostic Centre KMH Cardiology and Diagnostic Centre MyHealth Partners Inc. MyHealth Partners Inc. University Health Network (Princess Margaret Hospital) University Health Network (Princess Margaret Hospital) Sunnybrook Odette Cancer Centre Sunnybrook Odette Cancer Centre Hospital For Sick Children Hospital For Sick Children The Ottawa Hospital General Campus Nuclear Medicine The Ottawa Hospital General Campus Nuclear Medicine University of Ottawa Heart Institute University of Ottawa Heart Institute Thunder Bay Regional Health Sciences Centre Thunder Bay Regional Health Sciences Centre
Address 2462 Howard Ave. Unit 136 Windsor ON N8X 3V6 268 Grosvenor Street London ON N6A 4V2 1200 Main St. West Hamilton ON L8N 3Z5 50 Charlton Avenue East Hamilton ON L8N 4A6 2075 Hadwen Road Mississauga ON L5K 2L3 6870 Goreway Drive Mississauga ON L4 1P1 610 University Ave. Toronto ON M5G 2M9 2075 Bayview Avenue Toronto ON M4N 3M5 555 University Avenue Toronto ON M5G 1X8 501 Smyth Road Ottawa ON K1H 8L6 40 Ruskin Street Ottawa ON K1Y 4W7 980 Oliver Road Thunder Bay ON P7B 6V4

 

Data Table 2. The number of oncology PET/CT scans per 1000 total cancer incidence, by Local Health Integration Network (LHIN) of patient residence, Ontario, 2012 to 2016

LHIN of patient residence Oncology scans per 1,000 total cancer incidence in 2012 Number PET/CT scans in 2012 Total cancer incidence in 2012 Oncology scans per 1,000 total cancer incidence in 2013 Number PET/CT scans in 2013 Total cancer incidence in 2013 Oncology scans per 1,000 total cancer incidence in 2014 Number PET/CT scans in 2014 Total cancer incidence in 2014 Oncology scans per 1,000 total cancer incidence in 2015 Number PET/CT scans in 2015 Total cancer incidence in 2015 Oncology scans per 1,000 total cancer incidence in 2016 Number PET/CT scans in 2016 Total cancer incidence in 2016
Ontario 108.0     120.0     134.0     142.8     146.3    
Erie St. Clair 121.3 518 4,270 114.1 477 4,179 143.5 614 4,280 174.0 763 4,384 173.6 779 4,488
South West 104.0 637 6,126 122.8 765 6,228 149.9 958 6,391 175.7 1,153 6,561 190.6 1,282 6,726
Waterloo Wellington 83.7 416 4,969 102.8 426 4,144 109.4 469 4,288 108.2 481 4,446 112.6 517 4,593
Hmltn-Ngr-Hldmnd-Brnt 126.0 1,170 9,286 133.7 1,250 9,346 142.7 1,366 9,574 153.4 1,509 9,837 166.0 1,673 10,079
Central West 85.6 318 3,716 89.6 342 3,815 119.4 476 3,986 133.9 560 4,182 117.4 513 4,368
Mississauga Halton 83.1 472 5,677 86.4 509 5,894 105.1 641 6,098 103.1 652 6,326 102.0 668 6,549
Toronto Central 96.6 616 6,379 106.1 695 6,549 110.2 740 6,714 125.7 864 6,876 132.7 934 7,040
Central 79.7 723 9,074 92.5 856 9,255 110.2 1,051 9,535 114.6 1,126 9,826 121.3 1,230 10,137
Central East 96.5 901 9,334 101.5 951 9,372 115.3 1,113 9,654 119.5 1,190 9,954 136.8 1,400 10,234
South East 123.8 477 3,853 128.2 476 3,714 136.0 518 3,810 151.5 593 3,915 151.6 608 4,011
Champlain 158.7 1,169 7,366 198.1 1,443 7,284 219.1 1,642 7,496 226.0 1,745 7,722 207.7 1,650 7,943
North Simcoe Muskoka 116.4 375 3,221 122.9 387 3,149 129.8 420 3,235 132.6 442 3,333 138.3 473 3,419
North East 110.1 479 4,349 123.1 524 4,255 118.8 515 4,335 105.8 468 4,422 114.1 513 4,498
North West 126.3 170 1,346 158.2 228 1,441 167.1 245 1,466 175.1 263 1,502 183.5 281 1,531

Report date: June 2017

Data source: PET/CT Scans Database, Cancer Care Ontario; Insured PET/CT Scans Database, OHIP; Cancer Incidence Estimates, Surveillance at Cancer Care Ontario

Prepared by: System and Infrastructure Planning and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 3. Percentage of non-small cell lung cancer NSCLC patients (diagnosed 2012 to 2016) who had a PET/CT scan prior to radical treatment, by Local Health Integration Network (LHIN) of patient residence

LHIN of patient residence Acronym Percentage of NSCLC patients with PET scans prior to radical treatment in 2012 Number of NSCLC patients receiving a PET prior to radical treatment in 2012 Number of NSCLC patients with radical treatment in 2012 Lower confidence interval in 2012 Upper confidence interval in 2012 Percentage of NSCLC patients with PET scans prior to radical treatment in 2013 Number of NSCLC patients receiving a PET prior to radical treatment in 2013 Number of NSCLC patients with radical treatment in 2013 Lower confidence interval in 2013 Upper confidence interval in 2013 Percentage of NSCLC patients with PET scans prior to radical treatment in 2014 Number of NSCLC patients receiving a PET prior to radical treatment in 2014 Number of NSCLC patients with radical treatment in 2014 Lower confidence interval in 2014 Upper confidence interval in 2014 Percentage of NSCLC patients with PET scans prior to radical treatment in 2015 Number of NSCLC patients receiving a PET prior to radical treatment in 2015 Number of NSCLC patients with radical treatment in 2015 Lower confidence interval in 2015 Upper confidence interval in 2015 Percentage of NSCLC patients with PET scans prior to radical treatment in 2016 Number of NSCLC patients receiving a PET prior to radical treatment in 2016 Number of NSCLC patients with radical treatment in 2016 Lower confidence interval in 2016 Upper confidence interval in 2016
Ontario ON 78.1 2,035 2,606 76.5 79.7 81.8 2,118 2,590 80.3 83.3 83.9 2,325 2,770 82.6 85.3 83.9 2,429 2,894 82.6 85.3 85.2 2,593 3,044 83.9 86.5
Erie St. Clair ESC 76.4 107 140 69.0 83.8 79.8 103 129 72.5 87.2 81.8 130 159 75.4 88.1 79.4 127 160 72.8 86.0 78.3 123 157 71.6 85.1
South West SW 74.4 169 227 68.6 80.3 68.4 160 234 62.2 74.6 84.0 205 244 79.2 88.8 83.8 202 241 79.0 88.7 84.4 221 262 79.8 88.9
Waterloo Wellington WW 80.7 96 119 73.2 88.2 82.6 100 121 75.5 89.8 82.1 101 123 74.9 89.3 85.2 115 135 78.8 91.6 83.8 114 136 77.3 90.4
Hmltn-Ngr-Hldmnd-Brnt HNHB 86.5 283 327 82.7 90.4 89.3 293 328 85.8 92.8 86.7 293 338 82.9 90.5 85.9 335 390 82.3 89.5 87.5 336 384 84.1 90.9
Central West CW 75.0 78 104 66.2 83.8 80.2 101 126 72.8 87.5 88.3 91 103 81.7 95.0 82.1 110 134 75.2 89.0 78.6 92 117 70.8 86.5
Mississauga Halton MH 75.5 105 139 68.0 83.1 79.5 93 117 71.7 87.2 80.9 131 162 74.5 87.2 84.6 110 130 78.0 91.2 82.0 114 139 75.3 88.8
Toronto Central TC 75.3 171 227 69.5 81.2 80.3 151 188 74.4 86.3 83.4 146 175 77.6 89.2 84.7 183 216 79.7 89.8 83.3 195 234 78.3 88.3
Central Cen 66.8 175 262 60.9 72.7 75.7 181 239 70.1 81.4 76.3 219 287 71.2 81.4 78.7 211 268 73.7 83.8 84.1 238 283 79.7 88.5
Central East CE 80.6 232 288 75.8 85.3 81.9 227 277 77.2 86.7 86.3 276 320 82.3 90.2 86.5 283 327 82.7 90.4 89.8 299 333 86.4 93.2
South East SE 89.4 101 113 83.3 95.5 95.8 92 96 91.3 100.0 83.2 84 101 75.4 91.0 91.1 112 123 85.6 96.5 85.6 143 167 80.0 91.3
Champlain Ch 89.3 258 289 85.5 93.0 93.8 301 321 91.0 96.6 92.9 301 324 90.0 95.9 91.3 327 358 88.3 94.4 94.8 343 362 92.3 97.2
North Simcoe Muskoka NSM 62.2 79 127 53.4 71.0 71.6 96 134 63.6 79.7 77.3 119 154 70.3 84.2 76.2 109 143 68.9 83.6 83.8 134 160 77.7 89.8
North East NE 72.4 147 203 66.0 78.8 76.0 165 217 70.1 82.0 80.6 166 206 74.9 86.2 71.4 147 206 64.9 77.8 74.5 181 243 68.8 80.2
North West NW 82.9 34 41 70.2 95.7 87.3 55 63 78.3 96.3 85.1 63 74 76.4 93.9 92.1 58 63 84.6 99.5 89.6 60 67 81.5 97.6

Report date: December 2017

Data source: OCR, RPDB, ALR, CIHI-DAD, CIHI-NACRS, OHIP, PET Scan

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 4. Percentage of esophageal cancer patients (diagnosed 2012 to 2016) who had a PET/CT scan prior to radical treatment

Diagnosis year Percentage of esophageal cancer patients with PET scans prior to radical treatment Number of esophageal cancer patients receiving a PET prior to radical treatment Number of esophageal cancer patients with radical treatment Lower confidence interval Upper confidence interval
2012 79.8 166 208 79.3 80.4
2013 76.2 163 214 75.6 76.7
2014 83.5 172 206 83.0 84.0
2015 78.6 184 234 78.1 79.2
2016 68.5 178 260 67.9 69.0

Report date: December 2017

Data source: OCR, RPDB, ALR, CIHI-DAD, CIHI-NACRS, OHIP, PET Scan

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 5. Percentage of esophageal cancer patients (diagnosed 2012-2016) who had a PET/CT scan prior to radical treatment, by Local Health Integration Network (LHIN) of patient residence

LHIN of patient residence Acronym Percentage of esophageal cancer patients receiving PET scans prior to radical treatment Number of esophageal cancer patients with a PET prior to radical treatment Number of esophageal cancer patients with radical treatment Lower confidence interval Upper confidence interval
Ontario ON 76.9 863 1,122 76.7 77.2
Erie St. Clair ESC 87.9 58 66 87.1 88.7
South West SW 88.4 99 112 87.8 89.0
Waterloo Wellington WW 69.5 41 59 68.3 70.7
Hmltn-Ngr-Hldmnd-Brnt HNHB 63.6 103 162 62.8 64.3
Central West CW 68.3 28 41 66.9 69.7
Mississauga Halton MH 76.0 38 50 74.8 77.2
Toronto Central TC 78.7 59 75 77.7 79.6
Central Cen 64.9 61 94 63.9 65.9
Central East CE 81.8 108 132 81.2 82.5
South East SE 83.1 59 71 82.2 84.0
Champlain Ch 84.4 92 109 83.7 85.1
North Simcoe Muskoka NSM 78.8 41 52 77.7 80.0
North East NE 78.1 50 64 77.1 79.2
North West NW 74.3 26 35 72.8 75.8

Report date: December 2017

Data source: OCR, RPDB, ALR, CIHI-DAD, CIHI-NACRS, OHIP, PET Scan

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

Data Table 6. Percentage of PET/CT scans performed for staging of aggressive lymphoma, by lymphoma incidence, 2013 to 2016, by Local Health Integration Network (LHIN) of patient residence

LHIN of patient residence PET/CT scans per first systemic consult in 2013 Number of PET/CT scans in 2013 Total first systemic consults in 2013 PET/CT scans per first systemic consult in 2014 Number of PET/CT scans in 2014 Total first systemic consults in 2014 PET/CT scans per first systemic consult in 2015 Number of PET/CT scans in 2015 Total first systemic consults in 2015 PET/CT scans per first systemic consult in 2016 Number of PET/CT scans in 2016 Total first systemic consults in 2016
Ontario 3.7 39 1,059 11.0 157 1,434 22.0 331 1,502 23.5 355 1,511
Erie St. Clair 12.2 9 74 23.7 18 76 43.3 45 104 28.9 26 90
South West 1.7 21.0 22 105 43.6 54 124 45.4 49 108
Waterloo Wellington 2.0 3.6 17.7 14 79 15.1 14 93
Hmltn-Ngr-Hldmnd-Brnt 0.0 6.4 9 140 14.9 26 175 17.9 34 190
Central West 0.0 22.7 17 75 9.9 7 71 24.1 20 83
Mississauga Halton 0.0 9.3 10 108 15.9 18 113 21.8 22 101
Toronto Central 2.2 11.9 14 118 27.0 34 126 23.1 28 121
Central 2.6 10.6 20 189 20.6 34 165 25.4 49 193
Central East 3.3 5.7 9 158 11.6 17 147 12.7 21 165
South East 3.8 8.1 7 86 15.1 14 93 28.2 22 78
Champlain 9.9 11 111 12.3 18 146 34.9 51 146 38.5 55 143
North Simcoe Muskoka 4.0 8.0 7.4 4.4
North East 0.0 3.3 5.6 8.3 8 97
North West 20.8 14.7 23.3 10 43 23.1

Report date: August 2017

Data source: PET/CT Scans Database, Cancer Care Ontario; Cancer Incidence Estimates, Surveillance at Cancer Care Ontario

Prepared by: System and Infrastructure Planning and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions
  2. † Values have been suppressed due to small cell counts

 

Data Table 7. Median number of business days between referral date and first available appointment, 2013 to 2017

Date Jan. 13 Feb. 13 Mar. 13 Apr. 13 May 13 Jun. 13 Jul. 13 Aug. 13 Sep. 13 Oct. 13 Nov. 13 Dec. 13 Jan. 14 Feb. 14 Mar. 14 Apr. 14 May 14 Jun. 14 Jul. 14 Aug. 14 Sep. 14 Oct. 14 Nov. 14 Dec. 14 Jan. 15 Feb. 15 Mar. 15 Apr. 15 May 15 Jun. 15 Jul. 15 Aug. 15 Sep. 15 Oct. 15 Nov. 15 Dec. 15 Jan. 16 Feb. 16 Mar. 16 Apr. 16 May 16 Jun. 16 Jul. 16 Aug. 16 Sep. 16 Oct. 16 Nov. 16 Dec. 16 Jan. 17 Feb. 17 Mar. 17 Apr. 17 May 17 Jun. 17 Jul. 17 Aug. 17 Sep. 17 Oct. 17 Nov. 17 Dec. 17
Median 3.0 5.5 5.5 4.0 6.5 7.5 6.0 9.0 7.0 7.0 6.0 5.0 4.0 7.0 5.0 4.0 6.0 5.0 5.0 4.0 4.0 7.0 4.0 4.0 4.0 6.0 6.0 6.0 6.0 5.0 5.0 6.0 8.0 8.0 8.0 6.0 9.0 6.0 7.0 6.0 10.0 10.0 10.0 8.0 9.0 7.0 8.0 9.0 5.0 6.0 7.0 7.0 9.0 10.0 11.0 10.0 10.0 10.0 10.0 9.0

Report date: January 2018

Data source: Internal (self-reported data collected via Imaging Program)

Prepared by: Analytics and Informatics, Cancer Care Ontario

Note:

  1. See technical notes for detailed methodology and inclusions/exclusions

 

What do the results show?

The number of PET/CT scans performed continues to increase, but regional variations persist (Figure 2)

Measure:  PET/CT scan utilization

 

Desired Direction:

 

An image of an arrow pointing upwards. This indicates that desired direction for this action is upwards.

 

As of this Report:

 

An image of an arrow pointing upwards in a yellow box. This indicates that there has been an increase in performance over the previous periods identified and this action is below but approaching target or has notable regional variation.

  • Overall PET/CT utilization is being reported per 1000 total cancer incidence, which helps account for different rates of cancer diagnoses between regions. Although PET/CT scanning is not used for all cancers, it does play a role for many common cancers (e.g. lung and colorectal cancers, and lymphoma).
  • The number of PET/CT scans across the province in 2016 increased relative to the previous year. The number of completed cancer-related PET/CT scans per 1000 total cancer incidence increased from 108 in 2012 to 146 in 2016, which may be a result of an increase in awareness of both the availability of PET/CT scanning and its utility in some clinical scenarios.
  • Differences in utilization are likely in part related to physician referral patterns and their awareness of the PET/CT program.
  • PET/CT centre location relative to patient Local Health Integration Network (LHIN) of residence does not appear to be a primary driver of the variation: utilization rates are, in some cases, comparable or higher for LHINs that do not have a PET/CT scanner than for those that do.
  • Cancer Care Ontario has continued to provide support to the regional PET/CT centres through education and support for quality improvement initiatives.

PET/CT scans prior to radical treatment for Non-Small Cell Lung Cancer (NSCLC) (Figure 3)

Measure:  Percentage of NSCLC patients who had PET/CT scan prior to radical treatment

 

Desired Direction:

 

An image of an arrow pointing upwards. This indicates that desired direction for this action is upwards.

 

As of this Report:

 

An image of an arrow pointing straight in a yellow box. This indicates that there has been no increase or decrease in performance over the previous periods identified and this action is below but approaching target or has notable regional variation.

  • Cancer Care Ontario measures access to PET/CT scans across the province generally, and for lung (NSCLC), esophageal and lymphoma cancers specifically.
  • In 2016, 85% of NSCLC patients had a PET/CT scan prior to radical treatment, which continues to remain relatively consistent since 2013 (82%).
  • It is worth noting that some regions without local access to PET/CT scanners actually had higher performance for this metric than regions that do. Thus, it is likely that reasons for regional performance are multifaceted, potentially including both proximity to a PET/CT scanner and local referral patterns or practice.
  • The Canadian Partnership Against Cancer’s 2015 Cancer System Performance Report measured the percentage of all NSCLC patients who received a PET scan (versus the indicator in this section, which measures only the percentage who had a PET scan prior to radical treatment). Compared to 5 other provinces, Ontario had the highest percentage of all NSCLC patients who received a PET scan at 38% [2].

PET/CT scan prior to radical treatment for esophageal cancers (Figures 4 and 5)

  • In 2016, 69% of patients received a PET/CT scan prior to radical treatment for esophageal cancer, which is a decrease from 79% in 2015.

Measure:  Percentage of esophageal patients who had PET/CT scan prior to radical treatment

 

Desired Direction:

 

An image of an arrow pointing upwards. This indicates that desired direction for this action is upwards.

 

As of this Report:

 

An image of an arrow pointing downwards in a red box. This indicates that there has been a decrease in performance over the previous periods identified and this action is well below target.

  • The highest percentage of performed PET/CT scans was reported in 2014 with a rate of 84%.
  • There is some regional variation among the Local Health Integration Network (LHIN) of patient residence. However, given the low incidence of esophageal cancer, it is unclear whether this variation is significant or a result of low numbers.

PET/CT use for the staging of aggressive lymphoma is far from reaching the Cancer Care Ontario range of 50% to 65% (Figure 6)

  • In May 2013, PET Scans Ontario launched a Registry to assess the impact of PET/CT scans on the management of patients with early stage aggressive lymphoma. The goal was to strengthen preliminary evidence of clinical utility determined through a systematic evidentiary review [3].
  • In August 2014, international guidance was released recommending PET/CT scans for the staging of aggressive lymphomas [4].
  • In 2016, 23% of patients who fit the criteria for PET/CT scan for staging aggressive lymphoma received the scan, which was below Cancer Care Ontario’s range of 50% to 65%.
  • Since launch of the PET Registry, the rate of PET/CT scans for lymphoma staging has continually increased, increasing sharply from the time of the release of international guidance (data not shown). It is expected that uptake will continue towards the clinically recommended rate over time.

Measure: Percentage of PET/CT scans performed for staging of aggressive lymphoma

 

Desired Direction:

 

An image of an arrow pointing upwards. This indicates that desired direction for this action is upwards.

 

As of this Report:

 

An image of an arrow pointing upwards in a grey box. This indicates that there has been an increase in performance over the previous periods identified and this action does not have identified targets.

On average, wait times are typically less than 2 weeks (10 business days) at each PET/CT centre (Figure 7)

  • The monthly median wait time across all centres from 2013 to 2017 ranged from 3 to 11 business days.
  • In previous years, the PET/CT centres reporting the maximum wait times varied from month to month (no consistent outliers were present). Some PET/CT centres have recently experienced increased demand for services, which has led to consistently longer wait times for these locations.
  • The volume of PET/CT scans performed in Ontario for all oncology and non-oncology indications has increased year over year, with 6,995 scans in 2011, 8,223 in 2012, 10,355 in 2013, 11,854 in 2014, 12,893 in 2015, 14,200 in 2016 and 15,946 in 2017. The data, however, show that median wait times have not been significantly affected.

Why is this important for patient care?

  • PET/CT scanning typically occurs at a decision point for a patient’s treatment. For example, in patients with NSCLC, a PET/CT scan helps to determine whether radical treatment (i.e. treatment with curative intent) is appropriate. If it is determined not to be beneficial, then the patient is prevented from undergoing a significant procedure and the associated recovery.

Measure: Median number of business days between referral date and first available appointment (point-in-time sampling)

 

Desired Direction:

 

An image of an arrow pointing downwards. This indicates that desired direction for this action is downwards.

 

As of this Report:

 

An image of an arrow pointing straight in a yellow box. This indicates that there has been no increase or decrease in performance over the previous periods identified and this action is below but approaching target or has notable regional variation.

  • PET/CT scan utilization provides a way of assessing whether patients are receiving an appropriate scan as part of their care. The regional data can be used to identify where physician outreach and education may improve equity of use.
  • A PET/CT scan is one part of the diagnostic phase of the patient journey, since patients typically have a number of tests before treatment. The time a patient waits for a PET/CT scan contributes to the overall time between diagnosis and treatment. By monitoring wait times, we can ensure access to PET/CT scans is timely and that any delay is minimal.

How does Ontario compare with other jurisdictions?

  • Other jurisdictions have taken different approaches to the introduction, use and monitoring of PET/CT scans. As a result, differences in utilization cannot be interpreted as differences in appropriate care.
    • The 2015 Canadian Agency for Drugs and Technologies in Health (CADTH) report on the publicly funded uses of PET scans in Canada provides provincial-level information regarding annual volumes, PET/CT locations and indications across Canada [5].
    • A 2004 survey of 14 members of the International Networks of Agencies for Health Technology Assessment (INAHTA) identified the number of PET scanners per million ranging from 0.25 in the Netherlands to 1.26 in Belgium. Australia had 0.65 per million, the United States had 0.83 and Canada had 0.39 [6].
      • The Canadian Partnership Against Cancer’s 2015 Cancer System Performance Report showed data that identified significant variability across Canada in the availability and use of PET scanners. Quebec reported the maximum availability with 16 publicly funded PET scanners, while some provinces, including Prince Edward Island, did not have a PET scanner [7].
      • The Canadian Partnership Against Cancer’s 2015 Cancer System Performance Report showed the percentage of NSCLC patients who received a PET scan. Compared to 5 other provinces, Ontario had the highest percentage of patients at 38% [7].
    • The Organisation for Economic Co-operation and Development (OECD) presented data on the number of PET scanners available per thousand population for several countries, including Canada. Of those reporting data for 2015 (the most recent year for all countries listed), Denmark had the highest number of PET scans per thousand population (7.4), with Israel (5.7) and United States (5.4) having the second and third highest, respectively [8].

Find out more

  • Oversight for the PET Scans Ontario program is through Cancer Care Ontario’s Cancer Imaging Program. Other areas of focus for the Cancer Imaging Program include the appropriateness of cancer imaging use, timely access, development of an imaging community of practice and synoptic radiology reporting. To find out more, visit the Cancer Imaging Program.
  • Ontario also reports wait times for CT and MRI scans for all disease types. Find reports through the Health Quality Ontario site.

Notes

  1. Cancer Care Ontario [Internet]. Toronto: Cancer Care Ontario. PET scans Ontario: PET scanner primer; [cited 2016 Feb 24]. Available from here.
  2. Canadian Partnership Against Cancer. The 2015 cancer system performance report [Internet]. Toronto: Canadian Partnership against Cancer; 2015 [cited 2016 Feb 23]. Available from here.
  3. Kouroukis CT, Cheung M, Sussan J, Hodgson D, Freeman M and Kellett S. The Clinical Utility of Positron Emission Tomography in the Diagnosis, Staging, and Clinical Management of Patients with Lymphoma: Recommendation Report. [Internet]. Toronto: Cancer Care Ontario; 2015 [cited 2016 Mar 1]. Available from here.
  4. Barrington S, Mikhael NG, Kostakoglu L, Meignan M, Hutchings M, Müeller SP, et al. Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol. 2014; 32(27):3048–3058.
  5. CADTH [Internet]. Canadian Agency for Drugs and Technologies in Health; c2016. Positron emission tomography in Canada 2015; 2015 Sep 29 [cited 2016 Mar 3]. Available from here.
  6. Hastings J, Adams EJ. Joint project of the international network of agencies for health technology assessment—Part 1: survey results on diffusion, assessment, and clinical use of positron emission tomography. Int J Technol Assess. 2006; 22(2):143–148.
  7. Canadian Partnership Against Cancer. The 2015 cancer system performance report [Internet]. Toronto: Canadian Partnership against Cancer; 2015 [cited 2018 Jan 25]. Available from here.
  8. OECD.Stat [Internet]. The Organisation for Economic Co-operation and Development (OECD); c2018. Health status; 2018 Jan 25 [cited 2018 Jan 25]. Available from here.