BlueCross BlueShield of Tennessee Medical Policy Manual

Positron Emission Tomography (PET) for Cardiac Applications

DESCRIPTION

Positron emission tomography (PET) images biochemical reactions and physiological functions by measuring concentrations of radioactive chemicals that are partially metabolized in the body region of interest. Radiopharmaceuticals or tracers used for PET are introduced into the body by intravenous injection or by respiration.

The scanners used for PET imaging are very similar to those used for radiograph computed tomography, but PET requires more complicated technology and computerized mathematical models of physiologic functions and tracer kinetics for the generation of images. When assessing myocardial perfusion in individuals with suspected coronary artery disease, PET has slightly higher resolution than the less costly more readily available single photon emission computed tomography (SPECT) test.

Note: For a single photon emission computed tomography (SPECT) test refer to MCG Care Guideline for Myocardial Perfusion Stress Imaging (A-0078).

POLICY

See also: 

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES

Einstein, A., Moser, K., Thompson, R., et al. (2007). Radiation dose to patients from cardiac diagnostic imaging. Circulation, 116, 1290-1305. (Level 5 evidence)

Okumura, W., Iwasaki, T., Toyama, T., et al. (2004). Usefulness of fasting F-FDG PET in identification of cardiac sarcoidosis. Journal of Nuclear Medicine, 45 (12), 1989-1998. (Level 3 evidence)

Yoshinaga, K., Chow, B., Williams, K., Chen, L., deKemp, R., Garrard, L., et. al. (2006) What is the Prognostic Value of Myocardial Perfusion Imaging Using Rubidium-82 Positron Emission Tomography? Journal of the American College of Cardiology. 48 (5), 1029-1039. (Level 4 evidence)

ORIGINAL EFFECTIVE DATE:  3/9/2017

MOST RECENT REVIEW DATE:  11/9/2017

ID_EC

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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