Appropriate use criteria for FDG PET/CT imaging of cancer patients by SNMMI

The Society of Nuclear Medicine and Molecular Imaging (SNMMI) has published appropriate use criteria (AUC) for FDG PET/CT in Restaging and Treatment Response Assessment of Malignant Disease. As cancer patients move through therapy, FDG PET/CT has proven an effective tool for assessing treatment response and updating the stage of malignancy. This AUC aims to improve utilization and guide providers across specialties in its use.

This is the fourth in a series of new AUC developed by SNMMI in its role as a qualified provider-led entity (PLE) under the Medicare Appropriate Use Criteria Program for Advanced Diagnostic Imaging. The society's other recently released AUC are for bone scintigraphy in prostate and breast cancer; ventilation/perfusion (V/Q) imaging in pulmonary embolism, which is endorsed by the American College of Emergency Physicians; and hepatobiliary scintigraphy in abdominal pain.

The new AUC are intended to assist referring physicians and ordering professionals in fulfilling the requirements of the 2014 Protecting Access to Medicare Act (PAMA). Current regulations call for PAMA to require referring physicians to consult AUC developed by a PLE beginning January 1, 2018, to ensure cost-effective and appropriate utilization of advanced diagnostic imaging services. However, the Centers for Medicare & Medicaid Services has proposed pushing back the start date for when providers will be required to consult AUC to January 2019.

The FDG PET/CT Workgroup consisted of expert representatives from SNMMI, the European Association of Nuclear Medicine (EANM) and the American Society of Clinical Oncology (ASCO). They reviewed the scientific literature and developed consensus recommendations for the clinical use of this technology. The Oregon Health Science University's (OHSU) Evidence-based Practice Center conducted a systematic review of existing evidence based on the scope and parameters the PET/CT Workgroup put together, which they used to make their recommendations for clinical use.

The SNMMI Guidance Oversight Committee is also developing AUC for gastrointestinal transit, infection imaging, PET myocardial perfusion imaging, prostate cancer imaging, somatostatin imaging, and thyroid imaging and therapy.