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400+ Times Improved PET Efficiency for Lower-Dose Radiation, Lower-Cost Cancer Screening

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Oncologists and others interested in cancer screening: Pay attention to Dario Crosetto's book on cancer screening by PET. This is an important work. Positron Emission Tomography (PET) has been around for some time as a tool for imaging active cancer within the body and for research on the brain. PET shows regions of high metabolism, a characteristic of cancerous tumors. However, many oncologists dismiss PET. They are unfamiliar with its use and with interpretation of PET images compared to MRI or CT; the cost is high; the radiation dose is large; and until recently, insurance companies would not pay for a PET scan.

Crosetto's book describes how this situation can be improved by increasing PET scanning efficiency by a remarkable 40,000%. He focuses on improvements to detector geometry, as well as innovative data processing techniques that make better use of the raw detector data. Cost, time and radiation dose could be dramatically reduced, allowing PET scans to be widely used. No longer would anxious patients and their loved ones have to wait a few more months for another CT scan to see if that dreaded spot has gotten bigger, meanwhile possibly spreading cancer cells throughout the body. Also, a single screening PET scan per year could replace multiple cancer screening tests (mammograms, colonoscopy, lung x-rays, etc), and even circulatory system and coronary screening, for much less cost and more complete coverage.

The book's preface and several other sections describe the basics of PET, its promise and current limitations, and the main ideas of Crosetto's improvements, in relatively non-technical language. For those interested in early cancer detection or brain research by PET, it is a worthwhile introduction. The rest of the book is a detailed exposition of current PET equipment, technology and limitations, and a design recipe for an improved PET/SPECT/CT multimodal system. Ample technical information, detailed physics and logic flow explanations, and an extensive reference bibliography allow one to check the author's claims and evaluate the advantages of the proposed new system.

The book has minor flaws such as insufficient explanation of some factors and lack of units in a few formulas and equations, and missing references for some data, but these omissions are either unimportant or easily checked with a little research on the Internet.

This book presents a proposal for a novel scanner design based on knowledge gained from the author's experience in the field of high energy physics that should allow faster data acquisition with less cost to health care organisations and radiation dose to the patient for cancer screening purposes. The use of the 3D-flow electronics system which proved to be very useful in other areas and constitutes one of the major contributions of the author might be a sensitive solution for hardware design of medical imaging systems.

The book is generally well written, unique ... useful ... brings together the essential elements of state of the art PET technology ... contains many chapters... very detailed information about ... methodology ... helpful discussion of ... underlying science and technology ... good breadth of applications and approaches ... a resource for the scientist ... valuable reference ... for the research student ... postgraduate courses could usefully use this as a recommended text. ... chapters ... grouped to emphasize the aims of the book . ... amply illustrated with relevant and helpful diagrams as well as extensive bibliographies ... should be on the bookshelves of both researchers and students of nuclear medical imaging.

During the last decade, a considerable number of articles and reports have been published reporting innovative designs of PET scanner's components, but only a few books are available and none of them has been published in the specific area of PET scanners design. The content covers very well the field as a book mainly intended for researchers working in the area of nuclear medicine physics and related fields, as well as for many of the physicians working in this specialty. Some of the proposed topics have high impact and many readers would welcome such good reviews that would alleviate the need for consulting many isolated references. There are, however, some minor mistakes due, in my opinion, mainly to the fact that the author belongs to the particle rather than the medical physics community.

It is amazing how revolutionary inventions come from the capacity of putting together technological progress in different fields and a few simple but smart ideas. The final result looks "simple", "evident", but only "after". This is the case of Crosetto's invention which is in my view a real a revolution: the possibility of transforming a PET scanner into a one year check-up tool is a real breakthrough in the battle again cancer and I wish it will be a reality as soon as possible.

Improving detector dimension and efficiency has been impossible up to now because of the bottleneck of the electronic system which should be capable of doing too many calculations in a short time: Crosetto's smart idea in coincidence detection is replacing the need of executing 26 thousands trillion comparisons per second and sending the results of these comparisons to a single channel, what it would have been required to increase the dimension of a PET from about 20 cm to over 150 cm. The implementation of his innovative algorithm, requiring only 12 million comparisons per second, is only made possible thanks to his innovative parallel hardware architecture. These innovations, allowing also the elimination of the boundaries between the elements of the PET detector (the book describes this problem in chapter 13), increase the overall efficiency of over 400 times: in practice they allow to capture 10 photons out of 100, instead of 2 out of 10,000 captured by the best PET currently in use. This results into a 1/30 reduction in the dose to the patient with a substantial improvement in image quality. This is really something!

I really hope that this device could be developed as soon as possible regardless of the current economical practice in the industry of delaying the introduction of innovative tools to absorb investment costs. Our health is much more important !