Ga68 PET SCAN

The Gallium 68 scan, used with functional PET imaging, is another nuclear medicine scan that relies on the over-expression of somatostatin receptors to visualize tumours. NETs typically express several somatostatin receptor subtypes in a unique pattern based on tumour type, origin and grade of differentiation. Ga68 scans offer the advantages of improved image resolution and higher sensitivity.

Tumours that may be visualized with a Ga68 scan include: gastroenteropancreatic (GEP) tumours; pheochromocytoma, paraganglioma, neuroblastoma, medullary thyroid carcinoma and others.

Prior to receiving a Ga68 scan ask your doctor whether or not you should discontinue somatostatin analog therapy. The radiopharmaceutical will be administered intravenously and the scan will be performed. The substances used to perform the Ga68 scan are rapidly cleared from the blood; therefore, no radioactivity is detectable in the blood or urine within four hours.

Why Ga68 PET Scan for Neuroendocrine Cancer Patients?

Ga-68-labeled somatostatin analogs are important imaging agents to detect and manage neuroendocrine tumors (NETs).  The Gallium 68 scan, used with functional PET imaging, is a nuclear medicine scan that relies on the over-expression of somatostatin receptors to visualize tumours. NETs typically express several somatostatin receptor subtypes in a unique pattern based on tumour type, origin and grade of differentiation. Ga68 scans offer the advantages of improved image resolution and higher sensitivity.

Ga68 PET:

  • Offers high quality images that provide information that exceeds what is available from conventional imaging (111In-Octreotide, contrast enhanced CT).
  • Can detect tumors as small as 4 millimeters.
  • Has different roles depending on what the tumour is doing.
  • May be used for diagnosis, staging and restaging, deciding best form of treatment and monitoring the effect of treatment.
  • Identifies patients who are viable candidates for PRRT therapy.
  • Cost of scan is currently comparable to Octreotide and therefore no further burden on provincial funding agencies.

Change in Patient Management:

Ga68 has the potential to delineate the extent of disease accurately for proper management:

  • Different studies found that Ga68 PET led to change in management in 36% to 56% of patients.
  • Could spare patients from invasive futile surgery.
  • Offers the ability to tailor treatments for patients based on a more accurate assessment of tumor burden.
  • Potential to find unknown primary. Important for NET patients who have had surgery to remove metastases but have an unknown primary tumor.
  • Earlier diagnosis for symptomatic patients.
  • May also provide additional information, such as if a tumor is well or poorly differentiated.  Poorly differentiated tumors are more aggressive and with the GA-68 scan the likelihood of a tumor’s growth may be determined.
  • In one trial, patients who were previously considered to be inoperable went on to have surgery, and patients with previously unknown and extensive cancer who were originally slated for surgery were found to be inoperable.

Patient Convenience:

  • No significant toxicity
  • Lower radiation exposure
  • Shorter examination time
  • Fewer visits to hospital with scan completed in one day as opposed to multiple days for Octreoscan

Access to Ga68 PET Scan in Canada

From the BC Ministry of Health

Requests for elective medical services such as PET scans, provided in other provinces and territories that are not covered under the Interprovincial Reciprocal Billing Agreements, require prior approval by the British Columbia Ministry of Health. The Ministry requires and relies on the referring specialists and the appropriate authorities at various agencies and health authorities to confirm that an application for funding is appropriate.

If a specialist wants to refer a patient to Sherbrooke for a PET scan, the appropriateness of the request based on the established criteria for approving funding requests.

A referring specialist who is seeking pre-approval to send a patient to Sherbrooke for a PET scan, can submit their request to PCR@gov.bc.ca, and it will be considered for pre-approval.

Awaiting Response
Provide the medical reasons for the scan for prior approval (by letter) & faxed or mailed to:
Dr. Zeljko Bolesnikov
Medical Consultant
Medicare
PO Box 5100
Fredericton, NB E3B 5G8
Fax: (506) 457-7671
Not covered
Awaiting Response
Provide the medical reasons for the scan and submit for prior approval (by letter) to MSI at
Fax # 902-490-2275.

Further Contact Info for MSI (Medical Services Insurance)
P: 902-496-7008, 1-800-563-8880
msi@medavie.ca

https://novascotia.ca/DHW/msi/moving_travel.asp

Awaiting Response

Physicians can obtain the appropriate form for requesting the Ga68: https://www.ccohealth.ca/en/what-we-do/general-health/pet-scans-ontario/refer-a-patient

University Health Network, Princess Margaret Cancer Centre,
Contact: Ur Metser, M.D., Phone: 416-946-4501 ext 4394, Email: ur.metser@uhn.ca
68Ga-DOTATATE PET for Management of Neuroendocrine Tumors

Covered under Quebec Health Insurance Plan. No need for pre-approval.
Centre de recherche du Centre hospitalier universitaire de Sherbrooke
Contact: Helena Senta, PhD 819-346-1110 ext 13660 helena.senta@usherbrooke.ca
Contact: Éric Lavallée, TIM 819-346-1110 ext 12887 eric.lavallee2@usherbrooke.ca
Jewish General Hospital, Montreal Quebec
Written (letter) request with patient history and the reason (diagnosis) for the request to be directed to Arlene Powers for pre-approval by fax to 902-569-0581.
A letter, which will serve as an application for prior approval, must be submitted in writing by an appropriate Saskatchewan specialist and include:

  • The patient’s name, address and valid Health Services Number;
  • All pertinent clinical details and diagnosis;
  • The nature of the service required and confirmation by the specialist that, to the best of their knowledge, the service(s) being requested are not obtainable within Saskatchewan; and
  • When possible, the cost of the service and the name and location of the physician who is to provide the service.

The letter is to be submitted to Medical Services Branch, TC Douglas Building 3475 Albert Street REGINA, SK S4S 6X6  Fax: (306) 787-3761.