Giraldes Maria Rosário
Administração Central do Sistema da Saúde, Ministério da Saúde, Lisboa.
Acta Med Port. 2010 Mar-Apr;23(2):291-310. Epub 2010 Apr 14.
Nuclear imaging has used initially anatomic and volumetric technologies as CT or MRI. In recent years new dimensions of non invasive studies, as PET, have shown a higher utility in the effectiveness of the treatment. The evaluation of need must be done according to a principle of Horizontal Equity, equal treatment for equal need and of a principle of Vertical Equity, Different treatment, at regional level, according to each hospital level. The evaluation of need has been made according to the Potential Demand by Potential User Groups: diabetes, type 2, (50 years and more); screening colorectal (50 years and more); morbidity by cancer; surgery of lung cancer; cardiology; heart surgery; acute chest pain in the emergency department. In a Macro Perspective need has been evaluated using the Population Estimations for 2007, at municipality level. Relatively to Lisbon and Porto data at locality level has been used, from the 2001 Census. According to Campos, J.R. (2007), in 2006, it existed 1 PET by 1 million inhabitants and after that date 2 more were created (Quadrantes and Hospital ad Luz), belonging to the private sector. Mores 15 PET are needed in the NHS, 1 PET for about 504128 inhabitants. According to The Potential Demand perspective 18 new PET are needed, 15 from the public sector. The private sector will cover progressively the demand. Dorado and Albertino (2002), in Spain, mention that the introduction of this new technique in our Health System must be done slowly due to the cost and complexity. In Portugal exists already 6 PET and this applies also. As a first priority the intervention in Oncology in the IPO (Coimbra). A priority must be given to the University Hospitals of Santa Maria and São João. The Central Hospitals of Viseu and VilaReal/Régua must have also 1 PET. A priority must be given to the interior in order to avoid transports of patients and families. In fourth place the HC Central Lisbon must have also 1 PET, which will go to the New Hospital of Todos-os-Santos. The Hospital Garcia de Orta must have also 1 PET, what will avoid the patients from the Setúbal district to come to Lisbon. The HC of Coimbra and the HC of Ocidental Lisbon must have 1 PET in order to cover the population of the Centre Region and of Lisbon Region. The HC of VN de Gaia, the Hospital Pedro Hispano, Matosinhos, and the Hospital of Guimarães, must have 1 PET due to the population density of the North Region. The New Central Hospitals of Evora and Faro must also have 1 PET and the New Hospital of Braga. The estimation of diabetes, type 2, has been made using the minimum prevalence of 3%. The prevention of cardiac illness in the population of 50 years need with diabetes, type 2, must be done with PET annual examinations in the Hospital, referred by the family doctor in the health centre. The screening colorectal has not a tradition in Portugal. Sun L et al (2008) mention that according to criteria of specificity, sensibility and precision PET/CT presents higher advantages in the colorectal screening. It has been estimated that it must be done in 10% of the adults of 50 years and more with annual examinations in the Hospital, referred by the family doctor in the health centre. The use of PET in cancer treatment must be done only in the cancer of mama; cáncer colorectal; cancer of esofagus; cancer of head and neck; lung cancer; linfoma; melanoma; and Solitary Pulmonary Nodules; cancer of thyroid; cancer cervical . Those types of cancer are 46,7 % of total cancer mortality. The use of PET in cardiology in CAD is also important. If the prevalence of CAD is less than 70% PET has a lower value per QALY. The number foreseen of examinations is of about 3114 examinations/ year. The application of Pet in acute chest pain makes that the localization of PET must be done near the Emergency Department. Mowatt, G. et al. (2008) conclude that, based in some studies of Acute Chest Pain there is an evidence of prognostic that the use of 64-slice CT has influence in the way as patients are treated, what gives origin to a reduction in some inpatient care and avoids the development of invasive CAD.
核成像最初采用的是如CT或MRI等解剖学和容积技术。近年来，正电子发射断层显像（PET）等无创研究的新维度在治疗效果方面显示出更高的效用。需求评估必须依据横向公平原则，即同等需求给予同等治疗，以及纵向公平原则，即在区域层面根据各医院级别进行差别治疗。需求评估是根据潜在用户群体的潜在需求进行的：2型糖尿病（50岁及以上）；结直肠癌筛查（50岁及以上）；癌症发病率；肺癌手术；心脏病学；心脏手术；急诊科急性胸痛。从宏观角度来看，需求评估是利用2007年的人口估计数，在市一级进行的。对于里斯本和波尔图，使用的是2001年人口普查在当地层面的数据。根据坎波斯，J.R.（2007年）的说法，2006年，每100万居民中有1台PET，此后又新增了2台（夸德兰蒂斯和卢斯医院），属于私营部门。国民保健服务体系（NHS）还需要15台PET，即每约504128名居民需要1台PET。从潜在需求角度来看，需要新增18台PET，其中15台来自公共部门。私营部门将逐步满足需求。多拉多和阿尔贝蒂诺（2002年）在西班牙提到，由于成本和复杂性，在我们的医疗系统中引入这项新技术必须循序渐进。在葡萄牙已经有6台PET，情况也是如此。首先要优先干预科英布拉肿瘤研究所（IPO）的肿瘤学。必须优先考虑圣玛丽亚和圣若昂大学医院。维塞乌和维拉雷亚尔/雷瓜中央医院也必须有1台PET。必须优先考虑内陆地区，以避免患者及其家属的转运。第四，里斯本中央医院也必须有1台PET，将用于托多斯-桑托斯新医院。加西亚·德奥尔塔医院也必须有1台PET，这将避免塞图巴尔地区的患者前往里斯本。科英布拉医院和西里斯本医院必须有1台PET，以覆盖中部地区和里斯本地区的人口。由于北部地区人口密度大，盖亚新城医院、佩德罗·希斯帕诺医院（马托西纽什）和吉马良斯医院必须有1台PET。埃武拉和法鲁的新中央医院以及布拉加新医院也必须有1台PET。2型糖尿病的估计是使用3%的最低患病率。对于50岁患有2型糖尿病的人群，必须在医院进行PET年度检查以预防心脏病，由健康中心的家庭医生转诊。在葡萄牙，结直肠癌筛查没有传统。孙L等人（2008年）提到，根据特异性、敏感性和精确度标准，PET/CT在结直肠癌筛查中具有更高的优势。据估计，必须对10%的50岁及以上成年人进行年度检查，由健康中心的家庭医生转诊到医院进行。PET在癌症治疗中的应用必须仅用于乳腺癌；结直肠癌；食管癌；头颈癌；肺癌；淋巴瘤；黑色素瘤；孤立性肺结节；甲状腺癌；宫颈癌。这些癌症类型占癌症总死亡率的46.7%。PET在冠心病心脏病学中的应用也很重要。如果冠心病的患病率低于70%，PET每质量调整生命年（QALY）的价值较低。预计每年的检查次数约为3114次。PET在急性胸痛中的应用使得PET的设置必须靠近急诊科。莫瓦特，G.等人（2008年）得出结论，基于一些急性胸痛研究，有预后证据表明64层CT成像的使用会影响患者的治疗方式，这会减少一些住院护理，并避免侵入性冠心病的发展。
