A healthy person who has tried PET-CT physical examination said, “It’s worth it to check the whole body in one PET-CT examination.” Because of its unique advantages in tumor diagnosis, this expensive test is used for diagnosis and treatment, but also for physical examinations of healthy people, and is increasingly sought after. At some medical checkups, PET-CT exams can be booked with just one phone call, with prices ranging from 7,000 to 14,000 yuan. One doctor said, “Some PET-CT medical checkup centers even have people waiting in line all year round.” But not long ago, Dr. Lin Hongwei, an oncology surgeon at the People’s Liberation Army’s 306th Hospital, posted a microblog criticizing PET-CT as “abusive”. He called out, “PET-CT is not for medical checkups!” When Caixin New Century visited a private cancer detection and physical therapy center in Finland in late October, it was also told that PET-CT would not be used casually for medical examinations. “It’s useless even if you have money, you have to have it done after other instruments are checked and the doctor thinks it’s necessary.” The hospital director said. With clinical value “Patient number three, please drink one-third of the liquid in your hand; patient number eight, please go to the injection room to inject the drug.” On Nov. 15, at the PET-CT center of a tertiary oncology hospital, a radiologist was giving different instructions to different patients. “The liquid here refers to the contrast agent, and the ‘drug’ that needs to be injected is the contrast agent containing radioactive elements.” The doctor told Caixin’s New Century. PET-CT is the highest medical anatomy today yet rich in physiological and biochemical functional information, which can provide the basis for determining and finding the precise location of tumors and other lesions for quantitative and qualitative diagnosis. However, PET imaging requires radioactive elements. The most commonly used imaging agent, 18F-FDG, is a glucose analogue containing the radioactive fluorine element 18F. PET-CT detects the radioactive distribution of 18F-FDG in the body and looks for malignant tumors with particularly high glucose metabolism. “For the treatment of tumors, PET-CT can better provide dynamic monitoring of clinical treatment.” The doctor of PET-CT center of the aforementioned tertiary cancer hospital told Caixin “New Century”. Take lymphoma as an example. At present, the treatment of lymphoma is still tentative. In the past, after four cycles of first-line chemotherapy, CT was needed to determine whether the first-line treatment was effective, and thereafter further treatment options were selected. “But lymphoma patients have only eight tolerated cycles of chemotherapy, and if those four cycles of treatment are shown to be ineffective, there is very little time left to make up for it.” But with the advent of PET-CT, he says, “some studies have concluded that it is possible to determine whether treatment is working in as little as 24 hours. And in practice, we are usually more conservative and can tell if the treatment is working after two cycles of treatment. For young lymphoma patients, this is a significant saving in treatment time, which is significant for their lives.” In addition to its significant role in evaluating and monitoring the treatment effect of tumors and assisting clinical formulation and adjustment of treatment plans, PET-CT is also important in finding the primary foci of tumors, early detection of tumor metastases, identifying recurrence, residual or post-treatment changes of tumors, identifying biological target areas of tumors, guiding precise radiotherapy, and guiding tumor biopsy and interventional treatment. Lin Hongwei said that PET-CT is mostly used for the confirmation and localization of advanced tumor recurrence, or the diagnosis of tumors of unknown origin. However, he expressed strong doubts about its use for medical checkups: “PET-CT is never used for routine medical checkups! It requires a drug to be injected into the body, which has radiation. It is arguably harmful to the body!” The controversy thus began. Some radiologists countered that “PET-CT is safe”; “In China, where cancer is highly prevalent, it is worth considering PET-CT for medical checkups as long as it is financially affordable.” So, can PET-CT be used for physical examinations of healthy people or not? Risks and Benefits There is a consensus in the industry about the role of PET-CT for cancer treatment. Currently, the U.S. and European countries have included certain cost-effective PET-CT therapeutic examinations in their health insurance reimbursement. “Statistics from the U.S. in 2007 showed that non-small cell lung cancer alone saved the U.S. government$1.9 billion in federal health insurance due to the use of PET-CT, which is only one of many types of insurance in the United States.” Tian Jiahe, director of the Department of Nuclear Medicine at the PLA General Hospital, told Caixin’s New Century. At the recent “Yanjing Conference on Clinical Oncology and PET/CT Applications” hosted by Peking University Cancer Hospital, several Chinese oncologists and radiologists called for the inclusion of PET-CT for certain diseases in health insurance after limiting the indications. However, compared to the active support of PET-CT for clinical treatment in many countries’ health insurance, the majority of countries do not include PET-CT medical examinations in their reimbursement. “It’s not because of the price, it’s because of the risk.” Cornelis Hofnagel, a specialist in the Department of Nuclear Medicine at the Netherlands Cancer Institute. Cornelis A. Hoefnagel told Caixin New Century, “A PET-CT checkup like the one in Japan may only check 5 people out of 100. It’s not worth putting the other 95 people at risk of radiation for the sake of 5 people.” The safety of PET-CT has always been questioned, and in April 2009, “Imaging is advancing rapidly, but judging whether it is a malignant tumor still follows only one “gold standard”, that is, the image of the diseased tissue is becoming clearer and clearer, but must it be a good thing?” Another radiologist at Peking Union Medical College Hospital has the opposite view: “Many people come for PET-CT examination either because they are uncomfortable or because of psychological anxiety. Nowadays, the incidence of tumor is so high, he always suspects he has cancer, if the examination can relieve his anxiety, do you think it is worth it?” However, Professor Qiao Youlin, a tumor epidemiologist from Chinese Academy of Medical Sciences and Peking Union Medical College, also has a negative attitude towards PET-CT for general population medical checkups. He pointed out that there are mature, easy and cheap detection methods for many cancers, while PET-CT examinations are too expensive and risky, and “do not have the value to be promoted to the whole population.” Tian Jiahe also admits that the use of PET-CT as a routine medical examination does require guidelines. “A deterrent approach should be established as to what circumstances should be used and what should not be used.” He said, “I advocate that PET-CT can be used for physical examination for high-risk groups, that is, those with family history of tumor, smoking, drinking and other bad lifestyle habits.” “The existing data accumulation is not enough.” The aforementioned doctor from a tertiary cancer hospital said, “It is a more appropriate practice if we can conduct preliminary screening first and then conduct PET-CT examination after finding abnormal tumor markers.”