As its name implies, surgeons cut patients open and tried to find evidence of cancer or other ailments. Aside from being risky, the method wasn't always that good at detecting cancer.
Today, Dr. Church and some of his colleagues in northwest Ohio are using what they say is a powerful tool in detecting cancer: positron emission tomography, or "PET."
In the procedure, cancer patients are injected with a liquid sugar solution that is radioactive, but safe for the patient. The solution is taken up by the body's cells and cancer tumors, if they are present.
Tumors take up the sugar solution at a higher rate than normal cells. That's because tumors grow faster than normal cells; cancer is basically the rapid and uncontrolled growth of cells.
A PET machine can pick up the energy given off by the radioactive sugar solution and because tumors absorb a high level of solution, the machine pinpoints where - and how large - tumors are.
The procedure isn't usually used to diagnose cancer but "it's a quantum leap in our ability to determine if cancer is present or has spread," Dr. Church said. "It determines the course of treatment."
The information is invaluable because it tells physicians whether chemotherapy or surgery is needed, or if a treatment has succeeded in getting rid of cancer. The procedure also tells doctors if no treatment is necessary.
"It has already spared patients unnecessary operations," Dr. Church said.
PET technology has been around for about 25 years, but it's only now showing up in northwest Ohio. Until recently, offering the procedure was not feasible for most health-care sites because the technology was expensive.
A unit can cost anywhere from $1.5 million to $3 million. That's about the same as a computed tomography unit or magnetic resonance imaging unit, but unlike those technologies, PET was not covered by insurance or Medicare.
As a result, PET has traditionally only been offered in large academic-type medical centers, such as the Cleveland Clinic.
However, private insurers have begun to cover some PET services. Last month, Medicare began covering the services for several types of cancer, which health officials say will greatly increase using the procedure across the country.
There are now about 200 sites that offer the services, according to Dr. Val Lowe, who oversees the services for the Mayo Clinic in Rochester, Minn. Dr. Lowe said the improvements in reimbursement should mean the procedure will soon become common in more places across the country.
Dr. Church agreed.
He is the medical director for the MRI Center of Toledo, which is managed by all of the Toledo metro area hospitals, except for Medical College of Ohio Hospitals. The Center has offered outpatient MRI services since 1987, but in April started offering PET services.
The Center is leasing a mobile PET unit from Cleveland-based Neo Pet. Neo Pet owns the unit, which is housed in a semi-trailer and moved to various locations throughout northern Ohio. The unit is at the MRI Center three times a week and 112 patients had been scanned as of early last week.
Larry Humelsine, a Neo Pet technologist who operates the unit that comes to Toledo, said business is booming for PET services. He said his company owns three mobile units (all housed in semi-trailers) and is purchasing four more. The company serves Ohio and Pennsylvania.
The MRI Center was the first health-care site in the Toledo area to offer PET services, but Medical College of Ohio began offering PET services one day a week last month. Medical College of Ohio is offering the procedure through a similar arrangement; it leases the services of a mobile unit.
While the procedure is invaluable in some cases, Dr. Lowe cautions that it is not a candidate for widespread use in the healthy population. For example, other scanning technology like CT (or CAT) scans are now being touted as screening tools to pick up early signs of cancer.
CT scans are now commonplace in medicine and are used to detect internal injuries. They have replaced conventional X-rays in many instances.
However, while the use of CTs for cancer screening may have some potential, some physicians are skeptical because of scant scientific evidence to back it up.
Dr. Lowe said PET is strictly for use in patients where doctors already know a problem exists, or suspect a problem may exist.
"It's more in the realm of deciding how to treat a patient with cancer," he said. "You're not going to find cancer any earlier with this test, and it hasn't been shown to be of any use in screening patients. What it's good at is defining the extent of cancer once you know it's there, and that's an important issue. It determines whether you get a $60,000 operation or go on to chemotherapy."
While the procedure is used mostly on cancer patients, it has also been useful in evaluating damage to the heart, according to Dr. Donald Neumann, who oversees PET services for the Cleveland Clinic.
Dr. Neumann said when a heart becomes damaged because of blockage, physicians often want to know now how badly harmed blood-starved areas of the heart have become. PET can be useful for diagnosing heart damage because damaged areas of the heart take up less sugar solution than normal tissue.
Knowing that information helps guide physicians when they consider whether to perform a heart bypass or angioplasty, he said. Cleveland Clinic is unique in that it performs almost half of its PET procedures on heart patients, Dr. Neumann said, while other center focus primarily on cancer patients.
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