The National Oncologic PET Registry (NOPR) was developed in response to the Centers for Medicare and Medicaid Services (CMS) proposal to expand coverage for FDG-PET to include cancers and indications not presently eligible for Medicare reimbursement. Medicare reimbursement for these cancers will be available if the patient's referring physician and the provider submit data to a clinical registry to assess the impact of PET on cancer patient management. The NOPR is implementing this registry for CMS. The NOPR is sponsored by the Academy of Molecular Imaging (AMI) and is managed by the American College of Radiology (ACR) through the American College of Radiology Imaging Network (ACRIN). The NOPR is endorsed by the American College of Radiology (ACR), the American Society for Clinical Oncology (ASCO), and the Society for Nuclear Medicine (SNM).

Any PET facility that is approved to bill CMS for either technical or global PET charges can apply to participate in the NOPR. Sites are not required to have ACR or ICANL accreditation to participate. When a registered PET facility enters a patient on the NOPR, the patient's referring physician will be asked to complete both pre- and post-PET data collection forms that ask several questions regarding the patient's planned management. The PET Facility will enter this information and a copy of the PET scan report into the NOPR database via a Web form. If the PET facility completes the data collection process in a timely fashion, the facility can bill for the Medicare procedure.

Below are several helpful links:

Starting December 5, 2005 visit the NOPR Web site.

The American College of Radiology Information Network (ACRIN) website has posted some early details of the expected process.

How the National PET Data Registry will Work - The Application Process

The CMS Decision Memorandum

The objectives and goals of this data collection are as follows:

• Primary objective: To assess the effect of FDG PET on referring physicians’ plans of intended patient management across the spectrum of the expanded cancer indications for FDG-PET.
• Secondary objective: To assess the effect of FDG-PET on referring physician’ plans of intended management in relation to cancer-type, indication, performance status, physicians role in management, and type of PET.
• First goal: To acquire data that can be used to evaluate PET and PET/CT in a manner that does not interfere with the clinical care of the patient.
• Second goal: To minimize hassle to patients, PET centers and referring clinicians while acquiring the data.

Facility Registration

NOPR will launch PET facility registration on November 27, 2005 at the annual meeting of the Radiological Society of North America (RSNA) in Chicago. Physicians and administrators attending the conference can complete the pre-registration form at the ACR Booth (#3950 South Building, Hall A) and have the balance of the registration materials emailed to their facility's designated contact. Booth visitors also can sign up to receive PET Registry updates and preview the NOPR Web site. The NOPR Web site will be activated on December 5, 2005 and will provide access to facility registration forms, sample data collection forms, information for clinicians and more.

Patient Registration

Although the NOPR will begin the PET facility registration process at RSNA, PET centers cannot enter patients into the Registry until final approval is received from the Centers for Medicare and Medicaid Services (CMS). It is hoped that this approval will be awarded by the end of 2005.

What data can we expect to provide?

Details of the Registry are being finalized, and more information will be posted, as it is available. The following information is based on informal discussions with CMS and other sources we have consulted, but this information is not official or final. We will post more information to this section, the Registry Forms section and the News section as it becomes available.

Below are examples of data that may be required before the PET scan concerning demographics:

• Specific reason for PET
• Cancer type and working stage
• Patient performance status
• Intended management
• Cancer care provider

Under "specific reason for PET", one of the following reasons would be selected:

• Diagnosis: To determine if a suspicious lesion is cancer
• Diagnosis: To detect an unknown primary tumor site in a patient with a confirmed metastatic lesion
• Diagnosis: To detect a primary tumor site in a patient with a presumed paraneoplastic syndrome
• Initial Staging of histologically confirmed, newly diagnosed cancer
• Monitoring treatment response during chemoRx, radiation therapy or combined modality therapy
• Restaging after completion of therapy
• Suspected recurrence of a previously treated cancer

Below are questions concerning the primary study endpoint on planned management of the patients may be asked and answered both before and after the study:

• If PET were not available, what would your current management strategy be? (Check one)
  • Observation (with close follow-up)
  • Additional imaging (CT, MRI) or other non-invasive diagnostic tests
  • Tissue biopsy (surgical, percutaneous, or endoscopic)
• What treatment and type? (Check all that apply)
  • Surgical
  • Chemotherapy
  • Radiation
  • Other
  • Supportive care only
• What is the treatment goal?
  • Curative
  • Palliative

Anticipate that there will be 5-6 questions total after the scan has been performed. Three to four questions are customized by PET indication, mostly requiring Yes/No answers, and two questions that are common to both the Pre-PET Form and the Post-PET Form concerning intended management and cancer care provider information.

Getting Paid

After the pre-scan data has been submitted; the registered facility performs, reviews and reports the scan; then the post-scan data is submitted and if the data is collectled in a timely fashion the facility can bill Medicare for the procedure.