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FDG PET is able to detect bone marrow involvement in patients with multiple myeloma. FDG PET is useful in assessing extent of disease at time of initial diagnosis, contributing to staging that is more accurate. FDG PET is also useful for evaluating therapy response.

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CT and PET are widely used to characterize solitary pulmonary nodules (SPNs). However, most CT accuracy studies have been performed with outdated technology and methods, and previous PET studies have been limited by small sample sizes and incomplete masking. Our objective was to compare CT and PET accuracy in veterans with SPN. Methods: Between January 1999 and June 2001, we recruited 532 participants with SPNs newly diagnosed on radiography and untreated. The SPNs were 7-30 mm. All patients underwent 18 F-FDG PET and CT. A masked panel of 3 PET and 3 CT experts rated the studies on a 5-point scale. SPN tissue diagnosis or 2-y follow-up established the final diagnosis. Results: A definitive diagnosis was established for 344 participants. The prevalence of malignancy was 53%. The average size was 16 mm. Likelihood ratios (LRs) for PET and CT results for combined ratings of either definitely benign (33% and 9% of patients, respectively) or probably benign (27% and 12%) were 0.10 and 0.11, respectively. LRs for PET and CT results for combined ratings of indeterminate (1% and 25%), probably malignant (21% and 39%), or definitely malignant (35% and 15%) were 5.18 and 1.61, respectively. Area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.90-0.95) for PET and 0.82 (95% confidence interval, 0.77-0.86) for CT (P , 0.0001 for the difference). PET inter-and intraobserver reliability was superior to CT. Conclusion: Definitely and probably benign results on PET and CT strongly predict benign SPN. However, such results were 3 times more common with PET. Definitely malignant results on PET were much more predictive of malignancy than were these results on CT. A malignant final diagnosis was approximately 10 times more likely than a benign final diagnosis in participants with PET results rated definitely malignant.

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For staging purposes, PET is limited by its lack of anatomic detail. However, PET compares favorably with CT and MRI in detecting recurrent/residual cancers. PET imaging complements the more traditional imaging modalities (CT or MRI), especially for an unknown primary cancer.

PET is more sensitive and specific than CT for detection of melanoma metastasis and should be considered the primary staging study for recurrent disease. PET shows greater ability to detect soft tissue, small-bowel, and lymph node metastasis that do not meet criteria designated as abnormal by CT. PET is superior to CT even when sites not routinely evaluated by CT are excluded from comparative analysis.

Nuclear medicine in the United States has grown because of advances in technology, including hybrid imaging, the introduction of new radiopharmaceuticals for diagnosis and therapy, and the development of molecular imaging based on the tracer principle, which is not based on radioisotopes. Continued growth of the field will require cost-effectiveness data and evidence that nuclear medicine procedures affect patients' outcomes. Nuclear medicine physicians and radiologists will need more training in anatomic and molecular imaging. New educational models are being developed to ensure that future physicians will be adequately prepared.Key Words: nuclear medicine; statistics; status; trends J Nucl Med 2011; 52:24S-28S DOI: 10.2967/jnumed.110.085688Nucl ear medicine has a history of decades of strong growth, particularly in nuclear cardiology and PET/CT. In the United States, the number of nuclear medicine procedures has grown from approximately 14 million in 1999 to almost 20 million in 2005 (1). After 2005, however, it dropped to about 17 million. Most nuclear medicine procedures are performed in hospital-based settings, but the number performed in nonhospital settings has grown over time to one third of all nuclear medicine procedures in 2008.In the United States, the growth of nuclear medicine procedures is due primarily to nuclear cardiology, which has grown from about 7 million procedures in 1999 to about 11 million in 2005 (1). Nuclear cardiology represents more than 50% of the nuclear medicine procedures done in the United States but represents only 14% of those done in Europe. A study performed in 2007 investigated the worldwide use of nuclear cardiology (2). The study findings indicated that nuclear cardiology procedures were used most extensively in the United States, with 1,000 or more procedures performed per 100,000 people (Fig. 1).Bone scintigraphy is the next most common nuclear medicine procedure performed in the United States, but it represents only 17% of procedures (1). Bone scintigraphy represented 36% of procedures performed in Europe in 2008.The volume of PET procedures in the United States is approximately 1.5 million per year (3). Oncology accounts for more than 90% of the PET and PET/CT procedures performed, whereas cardiology and neurology account for about 4% each (3). According to the National Oncology PET Registry, about 84% of the slightly more than 1,600 PET facilities in the United States have PET/CT systems (4). The emergence of molecular imaging with new radiopharmaceuticals and new technologies is likely to result in continued growth in the coming decades.Efforts to control spiraling health care costs have resulted in decreased reimbursement for medical imaging and the need to provide evidence that patients' outcomes are improved by diagnostic tests and therapies. Radiology benefit managers have become gatekeepers for insurance plans, but without evidence to ensure the appropriate use of medical imaging, coverage decisions are frequently based on cost. Downward pressure on nuclear me...