AYUMI NAKANISHI / ANAKANISHI@ STARBULLETIN.COM D. "Rick" Rickenbacher and Eric Hannum demonstrated the use of the P.E.T. scanner.

Mobile unit widens
reach of health care

A PET scanner aids in the diagnosis
and treatment of cancer and other diseases

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By Helen Altonn
haltonn@starbulletin.com

IT looks like a large moving van, but malignant tumors and diseases can be identified with the technology inside to help doctors with diagnosis and treatment.

The coach, as it's called, houses a mobile Positron Emission Tomography (PET) scanner, a powerful imaging procedure available here until now only at the Queen's Medical Center.

The unit goes to St. Francis Medical Center Liliha on Mondays and Tuesdays, and St. Francis West on Wednesdays.

Dr. Marc Coel, chief of Queen's Nuclear Medicine Department, was recruited as medical director for the traveling van. His department operates the PET scanner, donated to Queen's by Hamamatsu Photonics K.K. of Japan in 1998.

"I really believe the more visible PET is, the better the care will be of patients," he said, adding that he hopes it will eventually go to Castle Medical Center and other island hospitals to care for people reluctant to make the trip to Queen's.

AYUMI NAKANISHI / ANAKANISHI@ STARBULLETIN.COM Cynthia L. Okinaka, left is president of Hawaii P.E.T. Imaging.

Coel said he just finished a PET scan for a doctor he has been following with lymphoma.

"We picked up the earliest sign of recurrence," he said. "We did him a year ago and he was negative. Now, they can treat him earlier rather than waiting for him to be clinically negative.

"I really love doing it," Coel said. "I think this is going to revolutionize how we take good care of patients."

Nervous patients showing up at the unit while at St. Francis Liliha are soon put at ease by D. "Rick" Rickenbacher, affable chief technologist and operations manager.

"The patients are under a lot of stress. I try to put them in a different mind," he said.

"I have a lot of fun with my patients."

The PET is a camera that detects differences in metabolism between different types of cells after a small amount of radioactive glucose or sugar is injected into the body.

Cells with increased metabolism, such as cancer cells, use more glucose than other cells so a malignant tumor "lights up" in the PET scan, Rickenbacher said.

It shows all organ systems in one image, diagnosing early stages and progress of a disease and results of treatment. Unnecessary surgical or medical treatments can be ruled out.

Images taken in the mobile unit are interpreted by Coel and his team of radiologists, including Drs. Peter Ko, Roy Bejhati and Sandi Kwee, a University of Washington-trained Fellow doing PET research.

Benefits for patients and doctors are "astronomical," Rickenbacher said.

"We can give them information they don't get now," he said, such as whether chemotherapy is working in early stages or if a tumor is changing in size.

The mobile unit is operated by Hawaii P.E.T. Imaging, Inc., headed by Cindy Okinaka, who left St. Francis last year in July after 10 years, five of which she spent as hospital administrator. The company uses periods in "P.E.T." to educate the public that "it isn't animal-related, that the initials mean something," Okinaka said.

She said the mobile unit was prompted by advances in technology that made it more cost-effective, and expanded Medi- care and Hawaii Medical Service Association coverage for PET scans.

One of the major goals is to educate the community about PET, she said. Like the St. Francis hospitals, Castle Medical Center and Wahiawa General Hospital are equipped to provide electricity and transmit images to Queen's, she said.

Medicare's coverage of PET scans for women with breast cancer, starting Oct. 1, will greatly impact care of women, Okinaka said.

"We have in this state 800 to 900 new cases a year," she said, not counting women who have breast cancer that could be tracked with the scanner.

Coel said Medicare caused "a real headache" by approving PET scanning for breast cancer, diagnosis and treatment, but not paying for it until October.

"We're getting referrals for women wanting follow-up, but we can't do it," he said.

Prior approval also is required for some PET tests or treatment, "and we believe it should be as routine as any other (procedure)," he said.

The mobile operation began July 1 with a two-week shakedown and volunteer patients, Coel said. 

"People don't realize how much work is involved before we even do a patient," Rickenbacher said.

He said the patient's weight determines the amount of radioactive glucose injected, and the time on the scanning table to get all views ranges from 50 minutes to 1.5 hours, depending on the patient's height.

He turns down the lights, plays music, and talks and jokes with patients during the scanning.

"A lot of things are going through their mind," he said. "I try to relax them."

He said he tries to get all the information to Coel so the images can be read the same day and reported to the patient's doctor.

"It's a tool you really can't live without," he said.

Certain PET scans covered by HMSA The Hawaii Medical Service Association, Hawaii's largest health carrier, covers Positron Emission Tomography (PET) scans for 12 types of cancer and other conditions, with pre-authorization required in some cases. "The critical part here is what information from the PET scan is going to change the treatment decision by a physician," said Dr. William Osheroff, head of HMSA's Office of Medical Directors. Esophageal cancer and some cases of breast cancer involving reoccurrence, not initial diagnosis, were the most recent ones added to PET scan coverage, he said. Epileptic seizures and coronary artery disease also are covered under certain circumstances, Osheroff said. He said HMSA's coverage is consistent with conditions listed for Medicare payments starting Oct. 1. Medicare also requires pre-authorization in many cases.