PET Scans Ontario
PET Access Policy
 

The Ontario PET Access Program* considers, on a case-by-case basis, requests from physicians for access to PET scans for patients who may benefit, but who do not fit the criteria to receive PET scans under one of these categories: insured services, clinical trials or the PET Registry. A panel of experts considers each request and makes recommendations about funding.

The program is not intended to bypass the review process for diagnostic scans that would normally be considered under other Ministry of Health and Long-Term Care or PET Scans Ontario programs. Such requests will be redirected.

Ontario PET Access Program Review Policy Criteria

Requests submitted by a patient's physician will be evaluated against the following criteria:

Evidence

  • Some literature supports the use of PET scans under these clinical circumstances.
  • There is demonstration of improved test performance (i.e., greater sensitivity and specificity) than standard anatomical imaging, OR identification of disease beyond the extent that is defined by anatomical imaging.
    Note: No consideration will be given for an indication where the Ministry has decided not to fund due to lack of evidence, unless new evidence is presented that supports the use of PET under these clinical circumstances.

Diagnostic Alternatives

  • There are inconclusive results from standard diagnostic tests.

Funding Alternatives

Clinical Impact

  • The use of a PET scan may result in avoidance of unnecessary invasive interventions (e.g. exploratory surgery) or treatment; AND/OR
  • The clinical management may change based on the PET scan results.
    • The clinical impact and implications on clinical management must be described by the referring physician.

Assessment

(Applicable criteria must be met before assessment review)

  • Requests will normally be considered on a case‐by‐case basis by a three‐person expert panel that will typically consist of a radiologist, a nuclear medicine physician, and a disease specialist (e.g., usually an oncologist).
    • If a decision cannot be reached by the panel, the request will automatically be sent to an alternate panel for consideration.
  • Some requests will be adjudicated by PET Scans Ontario staff on a case‐by‐case basis:
    • Requests for indications that have been approved by the Ministry of Health and Long‐Term Care but have not yet been implemented; OR
    • Requests for indications that were originally part of a Ministry funded PET Registry or clinical trial that has closed and are pending a formal Ministry review

Outcomes

  • Follow‐up data on the outcomes of approved PET scans under PET Scans Ontario is required. This data will be collected and assessed routinely for purposes of planning and program management.

Request for a Repeat PET Scan

  • Requests for repeat scans must continue to meet the criteria above (i.e., the PET scan is expected to change clinical management; not intended for surveillance).

Resubmissions, Reassessments and Appeals

  • In the event that the request for a PET scan is not approved, PET Scans Ontario will accept a request for a resubmission, reassessment or an appeal, which will be considered on a case-by-case basis. Information on the eligibility criteria, filing process, and review process are detailed in the PET Access Program Resubmission, Reassessment and Appeals Policy.

* Referring physicians must obtain expressed consent from their patients prior to making an application to the Ontario PET Access Program.