Considerations in Setting Up a Positron Emission Tomography Center Mathis P. Frick, Naresh C. Gupta, John J. Sunderland, Michael A. Best, Joseph A. Rysavy, and Chyng-Yann Shiue Clinically oriented imaging with position emission tomography (PET) has come of age, Given an adequate referral base and physician interest, a compelling argument can be made at all levels of the review process for setting up a PET program in a clinical setting. PET is expensive. It is obvious that the cost of running a PET service depends heavily on an institu- tion's ability to obtain reasonable financing. Educa- tional institutions have the opportunity to acquire special funding through a variety of sources. On the other hand, money can be expensive for private entre- preneurs. It appears that in the near future PET centers will probably remain at educational institutions or large well-financed community hospitals able to raise money at reasonable rates until reimbursement issues are better resolved. Finally, the future of clinical PET may hinge significantly on the ability of commercial radiopharmaceutical suppliers to provide regional flu- orodeoxyglucose distribution. As an institutional pro- gram development, PET offers opportunities by provid- ing unique clinical data aiding the referral pattern. PET may serve as a magnet for recruitment in many areas and may promote interdisciplinary cooperation. A clin- ical PET center serves both as a model for future and more widespread use of PET and as a training ground for medical personnel. Finally, the unique capabilities of PET may facilitate grant opportunities. Copyright 9 1992 by W,B. Saunders Company LARGE NUMBER of human studies have een safely conducted with positron emis- sion tomography (PET). For many years, PET has been exclusively a university-based research modality. Development of clinical uses for PET Ihas lagged behind those of other modalities. However, PET can provide unique clinical infor- mation in a viable manner with high diagnostic accuracy that affects patient management. Equipment has improved markedly over the last few years. Manufacturers provide user-friendly cyclotrons, radiopharmaceutical delivery sys- tems, and scanners. Even though the term turnkey PET center seems optimistic, personnel and maintenance requirements have been dras- tically reduced. Automated synthesis modules for key radiopharmaceuticals such as F-18- fluorodeoxyglucose (FDG) and N-13 ammonia are available. Improved scanners provide bio- chemical information with sufficient morpholog- ical detail (resolution of 3 to 7 mm) to be used with computed tomography (CT) and magnetic resonance imaging. These modalities provide structural information that complements PET data. With enhanced equipment and controlled From the Center for Metabolic Imaging, Department of Radiology, Creighton University School of Medicine, Omaha, NE. Address reprint requests to Mathis P. Frick, MD, Creighton University Medical Center, Department of Radiology, 601 N 30th St, Omaha, NE 68131. Copyright 9 1992 by W.B. Saunders Company 0001-2998/92/2203-0004505.00/0 personnel costs, PET studies are not dissimilar to other high-technology studies. This scenario makes it possible for PET to develop a clinical track record. The clinical setting is the only way to realize the medical potential of PET and to benefit from its large research data base. To project the complete realm of appropriate PET applications, the advantages of PET must be considered in relation to those of other modali- ties. Each new diagnostic test carves out its specific niche, resulting in some adjustment in other areas. This should reduce use of lower- yielding studies. The overall effect is that each modality is used more efficiently in the area in which it performs best. PET is accurate in identifying patients with coronary artery disease and myocardial infarction. Cardiac PET studies pinpoint patients who will benefit from revascu- larization procedures. In patients with partial complex epilepsy being considered for surgery, PET usually locates the abnormal focus before surgical removal. PET studies yield important diagnostic and prognostic information in the management of patients with brain and other tumors. Such studies can also detect recurrence of tumor often difficult to differentiate from treatment-induced abnormalities. PET may help in differentiating the various forms of dementia, such as Alzheimer's disease, multi-infarct de- mentia, pseudodementia, Huntington's disease, and Parkinson's disease. In the clinical realm, PET studies have to provide routine answers to important diagnostic questions. Clinical PET 182 Seminars in Nuclear Medicine. Vol XXII, No 3 (July), 1992: pp 182-188