BC Chapter – Canadian Association of Nuclear Medicine

Special Thanks to Evan Revie and Kavita Uttam for stepping up very late in the game to help with this talk after the excellent Dr. Tarzwell had to drop out.

We were given one week’s notice to put this together and pulled from some prior material.

Evan also had last minute commitments so one of our dedicated technologists, Kavita Uttam stepped into his slides with only TWO DAYS notice.

We are very lucky to have such a deep bench of talent and knowledge to pull from among our many awesome nuclear medicine technologists in Island Health and at BCCA Victoria.

A recorded version of the National livestream is on the CAMRT website.

The Million Dollar Question

What do technologists see as the top priority for sustaining the future of Nuclear Medicine and Theranostics?

So what will likely be a controversial poll question was asked at the talk. This is a question mostly asked to health economists, but I thought it would be interesting to get a perspective of on the ground current needs in our field and in medicine, and the perceived value of healthcare priorities among frontline staff and local leaders from 5 different provinces.

And the answer is…..

1. Fair wages for technologists is the NUMBER ONE PRIORITY.
   • Nuclear Medicine Technologists struggle with pay equity gaps with other MRT classifications
   • There was excellent discussion about some of the disparities between provinces and equity issues relative to other technologists with Alex Fontana who was present in the audience and has recently authored a report on technologist workforce issues
2. Technologists are concerned about WAIT TIMES and IMAGING ACCESS
   • Prioritizing faster equipment to shorten wait times for imaging tests was felt to be more important than funding Pluvicto
   • This makes sense, as technologists understand the value of the many other services they help provide to a broad patient population
   • FASTER CAMERAS CAN INCREASE THROUGHPUT*
     • There was post talk discussion about infrastructure renewal and 3D CZT SPECT-CT cameras (Starguide from GE and Veriton from Spectrum Dynamics). We were able to share our positive local experiences with this technology increasing throughput in Victoria
     • *CAUTION: Don’t buy a pricey fast PET or SPECT if you can’t run an efficient department! Expert technologists from different sites across the country discussed this after the talk. While total body or long FOV PET cameras like Quadra (Siemens), or OMNI legend (GE) can be an excellent boon to patient access by increasing throughput, some sites struggle to achieve throughput advantages due to administrative roadblocks.
     • If the fastest you can drive in your town is 60km/h, don’t buy an expensive sports car, buy a cheap economy model (or learn to drive faster, we need to).
3. Mixed opinions exist about the value of Pluvicto relative to other medical priorities for patients.
   • The example of lecanemab was selected because patient selection and follow up both involve Amyloid PET. There is no plan in British Columbia yet to addressed unmet needs for PET for Dementia
   • Interestingly, despite appearing to have more perceived value than Pluvicto among a small non-expert audience, CDA recommended against funding this drug publicly
   • The poll respondents were not qualified or informed enough to pick between these two priorities, however low technologist perception of the value of Pluvicto may influence the enthusiasm of smaller departments making local efforts towards theranostics expansion.
   • I was very pleased to talk with some of the audience members afterwards, and found even some from small peripheral sites were still enthusiastic to get local programs up and running, they would just like to be better resourced to do so.
4. Rubidium PET ranked lowest among priorities
   • This is likely reflective of a lack of discussion on the topic in the presentation and the perceived reasonable access to alternatives (i.e. coronary CTA and MIBI/tetrofosmin).
   • Had there been more discussion on the incremental value of this test compared to other tests, I suspect we may have seen Pluvicto in last place. We will cover more on Cardiac PET at another date
   • Read more about PET for Heart Disease here , or recent UBC grand rounds talks on the economics of Cardiac PET (not yet posted online).

Identifying key priorities to move forward together on theranostics

This talk highlights how effectively Regional Health Authorities are working to deliver this service, and how collaborative our colleagues at BC Cancer have been in building a logistical rear guard support system for the frontline care technologists and treating nuclear medicine physicians provide to patients in the community in Island Health and other regional health authorities.

Without our referring provider medical oncologists at BCCA strongly advocating to the Ministry for funding for this radiopharmaceutical therapy, none of this would exist!

Delivering this therapy using existing infrastructure and expertise is a lesson to other provinces we were happy to share. As we work together to build capacity to drive patient access and build economic investments in BC through clinical trials, we have to be cautious we don’t lose sight of our broader mandate to other patients as well.

Special Thanks and Acknowledgements

Thank you to Andrew Maciag from GE for reaching out to the local guy at the last minute to see if he could put something together at this wonderful conference.

Also quick shout out to Novartis for their wonderful collaborative support in building our theranostics program.

Thanks to our other partners in Industry at Isologic who sponsored this session, including Frank Maiorino who introduced me at the live version.

Thanks to the team at CAMRT for putting on a wonderful conference. It was great to meet more technologists from Fraser Health and Providence Health who gave other excellent sessions. Also special thanks to my new friend Alex Fontana from CANM national, who took the time to engage with technologists in Victoria and across the rest of the country at this wonderful event.

You be the judge…

Members will be given access to an internal poll on ranking strategic priorities that includes a version of the million dollar question.

This will help us better align our organization with the values of our membership.

Still a work in progress… Coming soon.

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