Abstract
Background
Novel therapies for Alzheimer's disease are expected to increase the demand for biomarkers. PET will likely play a central role in patient selection and treatment monitoring, requiring adequate infrastructure and trained professionals.
Objective
To assess the current status of Nuclear Medicine departments in Spain regarding organization, expertise, and available infrastructure.
Methods
We conducted a nationwide survey among Nuclear Medicine departments in Spain.
Results
Respondents averaged 19.8 years of professional experience; 62.0% had specific neuroimaging training and 76.0% reported high confidence in amyloid PET interpretation. Hospitals were mainly public (70.6%) and widely distributed geographically, and 73.0% reported having cognitive impairment units. Following the INVEAT plan, Spain currently has 147 PET scanners, although capacity varies: most centers operate one scanner and five reported having none. Amyloid PET is available in 77.0% of departments, with annual volumes ranging from fewer than 10 to more than 100 studies; 15.0% cannot perform amyloid PET due to regional limitations. Quantification tools are available in 41.3% of centers, although only 15.5% include quantitative metrics in reports, while 66.7% support the use of centiloid standardization. Nearly all respondents anticipate increased indications for amyloid PET (screening 83.7%; monitoring 68.5%) and support multidisciplinary collaboration (89.1% favor Neuroimaging Committees). About half report workforce needs, mainly nuclear medicine physicians (46.2%). Research activity in Alzheimer's disease is expected to increase (95.6%).
Conclusions
Most departments recognize the key role of amyloid PET for anti-amyloid therapy implementation and anticipate increased demand, highlighting the need to expand availability, implement quantification tools, and strengthen multidisciplinary collaboration.
Introduction
Alzheimer's disease (AD) is the leading cause of dementia and the most common neurodegenerative disorder. In recent years, diagnostic accuracy has improved significantly with the development of neuroimaging and fluid biomarkers. 1 The relevance of biomarkers is increasingly acknowledged in successive updates of AD research criteria. 2 Notably, two anti-amyloid monoclonal antibodies have demonstrated positive results in phase 3 trials and have been approved by the U.S. Food and Drug Administration.3,4 Lately lecanemab and donanemab have also been approved by the European Medicines Agency (EMA). The approval of these therapies represents a major milestone in the AD field, as they are the first therapies aimed at modifying underlying pathology. Moreover, additional therapies aimed at reducing neurodegeneration are currently under investigation. 5
Nuclear medicine plays a key role in the diagnostic pathway of patients with AD and related disorders. In this context, 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging serves as a reliable marker of synaptic dysfunction and can delineate the regional extent of neurodegeneration. Brain perfusion SPECT, although less sensitive than 18F-FDG-PET, is also a marker of neurodegeneration. Amyloid PET enables the detection of fibrillar amyloid deposition with high sensitivity and specificity, as validated against pathological studies. Tau PET is a marker of tau pathology, exhibiting high affinity for aggregated tau proteins in neurofibrillary tangles. Finally, presynaptic dopaminergic imaging is recognized in the diagnostic criteria for dementia with Lewy bodies and is useful in the differential diagnosis from AD.6–9
Amyloid PET has played a central role in clinical trials of both lecanemab and donanemab, demonstrating the effectiveness of these agents in clearing amyloid plaques in vivo. Furthermore, changes in amyloid PET signal (quantified using centiloid scales) have been correlated with clinical outcomes across different trial designs targeting amyloid clearance. Because of these developments and new requirements, appropriate use criteria for brain PET have been recently updated. 10
Amyloid PET is one of the standard techniques used to confirm amyloid deposition prior to initiating anti-amyloid therapy. Additionally, it may serve a role in monitoring treatment response and in making decisions about treatment discontinuation, as in the case of donanemab. Furthermore, the recent approval of the first tau tracer, 18F-flortaucipir, provides a valuable new tool for disease staging. 11 However, the implementation of anti-amyloid therapies also poses significant challenges for healthcare systems.12,13 Achieving successful and equitable access to these drugs will likely require careful planning and reorganization of available resources to enable early identification of eligible patients and ensure appropriate delivery of therapy. For this reason, a thorough understanding of each country's specific capabilities and infrastructure has been strongly encouraged. 14
This study aimed to assess the status of Nuclear Medicine departments in Spain, focusing on their organization, capabilities, and available infrastructure. Additionally, we sought to understand the anticipated changes in clinical practice following the introduction of anti-amyloid therapies. We conducted a survey to 158 departments of Nuclear Medicine distributed across Spain to evaluate whether the capacity of the Spanish Nuclear Medicine is sufficient to meet a potential increasing demand in the nuclear medicine neuroimaging with the introduction of anti-amyloid therapies.
Methods
Study design and participants
The survey was developed by the Neuroimaging Group of the Spanish Society of Nuclear Medicine (SEMNIM), conducted between March and May 2025 and was directed to all public and private hospitals in Spain with a Nuclear Medicine department (158 centers, 76 of them belonging to the public healthcare system). Invitations were sent via email (only one survey per department) and SEMNIM helped with its dissemination. Participation was voluntary, with no incentives offered. Each center designated one representative (preferably the head of the department or a specialist in neuroimaging) to complete the survey. The questionnaire was administered through Google Forms, and responses were securely stored in a dedicated database.
A total of 58 questions were included in the questionnaire, divided into the following sections (Table 1):
Questions about professional aspects of survey responders and hospital organization. General questions about resources and availability of PET devices and cyclotrons in Spain. Questions about frequency of brain perfusion SPECT and brain 18F-FDG-PET studies in Nuclear medicine Departments. Questions about availability and frequency of amyloid PET in Nuclear Medicine departments. Questions about the use of amyloid PET quantification tools. Questions about use of diagnostic techniques for patient selection and monitoring anti-amyloid therapies. Questions about organization of multidisciplinary dementia teams. Questions about the resources that are necessary for the departments of Nuclear Medicine. Questions about research.
Questions included in the survey.
The first items (A-E) asked for general questions about professional aspects of responders, hospital organization, resources and availability of PET equipment, amyloid tracers, cyclotrons, availability of amyloid doses, number of nuclear medicine physicians, etc.
Items F-I included a statement (e.g., “I believe that, due to the introduction of anti-amyloid drugs for Alzheimer's disease, the following changes will occur in diagnostic techniques…” and below several options, among which doctor answering the survey had to mark all the statements regarding this with which they agreed).
The main responses of the survey are summarized in Table 2 and Figures 1–5.
Map of PET devices in all Autonomous Communities in Spain (A). Blue circles represent PET/CT devices of Public Healthcare system, red circles represent PET/CT devices of Private Healthcare system and red triangle a PET/MRI device in Private Healthcare System. Density rate of PET/CT devices per 100,000 inhabitants is represented in orange scale; B) Average density of PET/CT devices per 100,000 inhabitants is represented in vertical bar chart: blue for Public healthcare system and mauve for global healthcare system (public and private); C) Representation de distribution of cyclotrons in Spain (green rhombuses). Information was collected based on data from the Spanish Nuclear Medicine Society and responders to the questionnaire.
Pie charts showing proportion of patients with cognitive impairment derived for perfusion brain SPECT and 18F-FDG PET/CT studies in Nuclear Medicine Departments.
Pie charts showing number of annual amyloid PET/CT in Nuclear Medicine Departments.
Summary of the survey: level of agreement in questions regarding the use of diagnostic techniques for patient selection and monitoring of antiamyloid therapies, and organization of multidisciplinary teams.
Summary of the survey: level of agreement in questions regarding the resources necessary in the departments of nuclear and in questions regarding the research.
Main sociodemographic and main characteristics of the responders.
Statistical analysis
Data analysis was conducted using IBM® SPSS Statistics version 26.0. Descriptive statistics and frequencies were calculated. For questions evaluating the level of agreement, statements reaching 75% or greater agreement were accepted as positive or negative consensus.
The number of PET scans on each autonomous community was also registered, and number of PET/100,000 inhabitants was calculated following the data from the National Statistics Institute (www.ine.es). To determine the PET equipment availability in Spain, the average density rate of PET-CT per 100,000 inhabitants, and the distribution of cyclotrons, not only the survey data were taken into account, but all were included on the map using data from the SEMNIM and the INVEAT plan data.
Results
Professional aspects of survey responders and hospital organization
Of the 158 Nuclear Medicine departments to which the survey was sent, ninety-two nuclear medicine physicians responded to the survey, 52 men (56.5%) and 40 women (43.5%). Of them, 57 were chairs of Nuclear Medicine Departments, 2 were chairs of Nuclear Medicine Sections and 33 were nuclear medicine physicians with expertise in Neuroimaging. The average years of experience as specialists among the responders was 19.84 (range 1–42; 9.9 SD). Furthermore, 57/92 (62.0%) of the responders reported having specific training in Neuroimaging. Regarding the level of confidence in interpreting amyloid PET studies, 76.0% consider it high, 20.0% intermediate, and 4.0% low. Regarding the level of confidence in interpreting FDG-PET brain studies, 65.0% consider it high, 34.0% intermediate, and 1.0% low (Table 2).
The responders gave information about the Nuclear Medicine departments belonging to the public healthcare system (65; 70.6%), private healthcare (16.3%) or had mixed public-private funding models (13.0%). Completion rate was 97.5% for hospitals of the public healthcare system (74/76 departments). The hospitals were distributed throughout the Spanish geography and included all the autonomous regions: Madrid (n = 19), Andalucia (n = 15), Catalonia (n = 13), Community of Valencia (n = 10), Galicia and Castilla y León (n = 5), Basque Country, Castilla La Mancha and Canary Islands (n = 4), Murcia, Aragon, Balearic Islands and Navarra, (n = 2), La Rioja, Asturias, Extremadura and Cantabria (n = 1). According to the responders, 73.0% of the hospitals has a specific unit of cognitive impairment, whereas did not have or was unaware of this information (18 and 9%, respectively).
Availability of PET devices and cyclotrons in Spain
It is worth noting the profound technological changes brought about by the INVEAT plan for investment in high-technology healthcare equipment within the National Health System (SNS). Thanks to the High-End Technology Equipment Investment Plan (INVEAT) plan, Spain has made significant improvements in the level of technological obsolescence in the SNS, as well as in the density rate of PET/CT scanners per 100,000 inhabitants. 15 After the renovation and expansion carried out under the INVEAT plan, Spain now has 147 scanners (both public and private), shown in Figure 1, along with the equipment density in each autonomous community per 100,000 inhabitants, placing Navarre, Madrid, Catalonia, Cantabria and the Basque Country as the best equipped (density > 0.3/100,000 inhabitants).
To create the PET map of Spain (Figure 1), the information provided by the physicians who responded to the survey was used, along with data from the INVEAT plan and from the website of the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM). A map of cyclotrons and their distribution across the different autonomous communities is also represented.
Among the hospitals that responded to the survey, most hospitals have one PET scanner (n = 65), 17 have two scanners, 4 have three scanners, and one has four PET scanners. Five centers do not have PET scanners.
There is a highly variable number of nuclear medicine physicians in the surveyed centers, ranging from 1 to 18, with an average of 6.2 [range 1–18; 3.2 SD]. 78.4% of the departments report having nuclear medicine physicians with special dedication to neuroimaging.
38.7% of the responders report having a cyclotron in their city, and 65.6% in their autonomous community; however, amyloid doses are distributed from Madrid (Ajalvir), Seville, Barcelona, and Murcia, which leads to greater variability in availability across different autonomous communities. Cantabria has its own cyclotron and production of 11C-PIB.
Regarding the availability of amyloid doses in different hospitals, it ranges from 0 to 6 days of weekly production, with an average of 2.3 (1.9 SD), and the number of doses per day ranges from 0 to 9. The question with the greatest discrepancy was the total number of amyloid studies each center could perform per week, considering the technological resources, personnel, and availability of amyloid doses, with a median of 4.44 studies/week (range 0–12; 3.2 SD).
Frequency of PET studies
19.6% of responders routinely and 21.7% occasionally perform SPECT perfusion studies in neurodegenerative processes brain perfusion studies. Fifty-eight per cent of respondents no longer perform cerebral perfusion studies, having replaced them with brain studies using 18F-FDG-PET. The approximate percentage of patients with cognitive impairment under evaluation who undergo SPECT perfusion is: 0–5% (13%), 5–10% (10%), 10–25% (2.0%), 25–50% (4.0%), 50–75% (6.0%), >75% (7%).
76.1% of responders routinely and 18.5% occasionally perform brain 18F-FDG-PET studies in neurodegenerative processes. 6% of the responders do not perform brain 18F-FDG-PET studies. The approximate percentage of patients with cognitive impairment under evaluation who undergo 18F-FDG-PET is: 0–5% (10%), 5–10% (4.0%), 10–25% (9%), 25–50% (14.0%), 50–75% (15.0%), >75% (42.0%) (Figure 2).
Availability of amyloid PET in nuclear medicine departments
77% (71/92) of the Nuclear Medicine departments have amyloid PET included in their service portfolio, with the annual number of studies performed in these services of: 0–10 studies (n = 16), 10–25 (n = 17), 25–50 (n = 11), 50–75 (n = 7); 75–10 (n = 10), >100 (n = 10). 15% of Nuclear Medicine Departments are not in a position to perform amyloid PET because it is not included in the service portfolio of their autonomous community (Galicia, Canarias, Extremadura, Basque Country); nevertheless, 10 (10.8%) hospitals are currently undergoing the necessary procedures to incorporate amyloid PET, and 6 (6.5%) believe it could be incorporated in the near future. 12% of the surveyed services conduct amyloid PET as part of clinical trials, and 14.1% perform tau PET in clinical trials. Eight (8.7%) of the hospitals that do not currently have availability have no plans for the upcoming incorporation of amyloid PET (Figure 3).
Amyloid PET quantification tools
Less than half of the Nuclear Medicine departments in Spain have quantification tools for amyloid PET quantification available (41.3%). However, only 15.5% of them currently include quantification in the reports in addition to the visual assessment (11.1% SUVR scale, 3.3% centiloid scale, and 1.1% both SUVR and centiloid scale). Nonetheless, although the majority of responders do not use these tools, 66.7% believe that quantification (specifically, the centiloid scale) should be included in the report. Only 6.5% of participants generally use PET/MRI fusion for evaluation.
Use of diagnostic techniques for patient selection and monitoring of anti-amyloid therapies
The majority of respondents (97.8%) agreed that the indications for diagnostic tests would change with the implementation of anti-amyloid therapies. All the nuclear medicine physicians strongly agreed that the indication for CT will not increase (100% of agreement), most of them think there will be an increase in the indication for amyloid PET scans (96.7% of agreement), but only 23.9% think there will be an increase in the indication for MRI; 65.2% of them believe that the indication for 18F-FDG-PET scans will not increase. Most responders think that amyloid PET will be a key technique for screening patients eligible for therapy (83.7% of agreement) and for monitoring patients undergoing anti-amyloid therapies (68.5% of agreement). The vast majority of respondents believe that radiation exposure would not be a concern for using PET in the diagnosis and monitoring of patients receiving anti-amyloid therapies (98.9% of agreement); there is no consensus on whether the development of blood-based biomarkers will reduce the use of amyloid PET (45.5% of agreement) and whether the approval for clinical use and introduction of tau PET scans will be accelerated with the introduction of anti-amyloid therapy (52.2% of agreement).
Organization of multidisciplinary dementia teams
85.9% of the responders believe that imaging departments (Radiology and Nuclear Medicine) should strengthen their collaboration with Neurology departments, and concurred that it would be advisable to create dedicated committees to discuss cases in a multidisciplinary manner (89.1% of agreement). There is less consensus on whether Nuclear Medicine departments should have a designated specialist responsible for the care of patients with neurodegenerative diseases (67.4% of agreement). 59.8% of responders believe that Nuclear Medicine services will become more expensive due to the cost of amyloid tracers and the necessary complementary scans; however, these same doctors believe that amyloid PET is cost-effective, given that anti-amyloid drugs are expensive.
78.3% of responders consider that Dementia Units should incorporate clinical pathways specific to anti-amyloid therapies.
A small percentage of patients believe that for the implementation of anti-amyloid therapies, it would be better to centralize patients in centers/units with greater expertise in the field (27.2% of responders) (items F and G are summarized in Figure 4).
Need of resources
A 50% of responders considered it is necessary to hire more personnel (physicians, nurses or technicians). Specifically, 43 (46.2%) consider that it is necessary a greater number of nuclear medicine physicians to implement the use of amyloid PET. Similarly, approximately a 20% of responders consider they would be a greater number of Nuclear Medicine technologists (19; 20.4%) or nurses (20;21.5%).
Neuroimaging research
Almost all responders agreed that research in clinical trials will increase with the introduction of anti-amyloid drugs (95.6% of agreement) and disagreed with the decrease in research in clinical trials in AD (100% of disagreement). There was a 98.9% agreement that it will not increase the research in clinical trials in other dementias. In addition, they also reached a moderate consensus that there will be an increase in neuroimaging (78.3%) and biomarkers research (76.9%). A majority agreed that basic research will not increase (75.8%), and most saw no further issues with recruiting clinical trial patients (93.4%).
No consensus was reached on whether specific databases will be established due to the implementation of anti-amyloid drugs (47.4% of agreement), and whether there will be greater resources for research (41.8% of agreement), but a moderate consensus was obtained about the promotion of publication in high-impact journals (67.0% of agreement). (items H and I are summarized in Figure 5).
Discussion
In this study, we conducted a survey about the status of the Departments of Nuclear Medicine in Spain, especially focused on neuroimaging and the diagnosis and treatment of patients with AD. Almost all public and private departments across Spain's regions were included in the study. These findings are of interest in preparing the health system for the implementation of anti-amyloid therapies, considering that the feasibility of implementing these new drugs in healthcare systems has been considered challenging.16,17 Additionally, nuclear medicine departments face challenges due to the arrival of new tracers and indications over the last few years.
In this regard, we found that a large part of the departments has access to amyloid PET, although it was not included in the service portfolio in some cases. However, the number of amyloid PET studies seems low, considering that over 60% only performs less than 50 studies per year. This suggests a relatively restricted use. The greater use of 18F-FDG-PET indicates that departments can often perform PET scans for cognitive disorders, but factors like cost, limited amyloid treatments, and availability of CSF biomarkers likely contribute to the lower use of amyloid PET. These findings are consistent with a recent survey conducted in Germany, in which 18F-FDG-PET is performed five times more frequently than amyloid PET. 18
The surveyed experts reached a consensus on a change in the indications and frequency of use of the diagnostic techniques, especially emphasizing an increase in the use of amyloid PET, a key tool to select candidate patients. 19 The consensus was low in terms of the use of amyloid PET in monitoring, although the fact that 68.5% considered the use in these indications suggests a potential use in many cases. Amyloid PET imaging may be important for monitoring the efficacy of anti-amyloid treatment and, in some cases, indicating its discontinuation, and for this purpose a baseline study could be recommended. There was no consensus regarding the impact of blood biomarkers in changing the use of amyloid PET. Plasma amyloid biomarkers could play a broad screening role in selecting patients for amyloid PET scans, 20 but their use could also likely complement rather than replace PET imaging. In this regard, they could help screen more patients and, at the same time, increase the use of amyloid PET as a confirmatory test. There was no consensus regarding the acceleration of the implementation of tau PET. This is consistent with the fact that, although a good tool for staging, anti-amyloid drugs have demonstrated positive findings in both high and low tau load. 21
The Centiloid Project has enabled standardization of amyloid plaque quantification in amyloid PET, through a process that allows converting the cortical uptake scale (SUVR) to a scale that permits harmonization across centers and tracers . Centiloid scale has emerged an essential tool approved by EMA for the accurate measurement of amyloid-β in AD patients. With high certainty, a CL value below 10 excludes the presence of Aβ pathology, while a value above 30 corresponds well with pathological deposits. In fact, in clinical trials, amyloid PET measured with the Centiloid scale was the tool used for patient selection, and in the Donanemab guidelines, it is considered the ideal technique, performed between 12 and 18 months, to reliably discontinue therapy when it is negative.22,23 In fact, the EMA concludes that the ‘Centiloid unit’ can be considered a validated measure of global brain amyloid burden, regardless of the PET tracer used, as a selection criterion (‘enrichment’) in clinical trials. In this regard, it should be noted that currently, most services in Spain do not include the centiloid measurement in the report, although 66.7% consider its inclusion essential in the context of anti-amyloid therapies.
Another interesting result was the consensus regarding the need to establish AD committees to evaluate and discuss the cases in multidisciplinary teams. The consensus was lower in terms of designating neuroimaging specialists for AD and related dementias in nuclear medicine, although a large percentage of departments already have at least one. In this regard, it is worth mentioning the situation regarding PET scans and personnel. The fact that 71% of hospitals had only one PET scan (for all indications) could be a bottleneck in the use of amyloid PET, given the high incidence of the disease, even if candidates for therapy remain under 10% of recent estimates. 24 The recent INVEAT plan allowed for the renewal of equipment and the expansion of PET-CT scanners in various autonomous communities in 2023, covering the renewal of 15 scanners and the implementation of 32 new ones. Despite this, the availability seems heterogeneous across the country, and the increase in the indications of PET imaging in many other diseases in recent years could be a challenge. 25 Acquisition of new scanners or event recent developments of brain dedicated PET scans could be a measure to mitigate this issue. 26 Similarly, the fact that there are only 3 cyclotrons distributing amyloid tracers seems an important aspect to improve.
Regarding the need for more personnel, there was no high consensus, but 50% recognized the need to hire more professionals in the departments, especially nuclear medicine physicians in 46% of the departments. It is especially interesting that a significant percentage of cases considered that nuclear medicine departments were not well prepared to perform amyloid PET for patients undergoing anti-amyloid drugs. Considering that several important points lacked high consensus (e.g., the need for specific personnel), this finding suggests that the reasons underlying this apparently incomplete preparation may be heterogeneous across departments. Overall, this suggests the need for a detailed analysis in each center. This contrasts with a recent survey in the departments of neurology, in which many different issues reached a high consensus 13 .
Concerning research, there was consensus that the introduction of anti-amyloid therapies will increase the number of clinical trials and further research, which at the same time could be a challenge for the departments, considering that most of them combine research with assistance duties. Thus, this should also be considered in future resource plans.
Our study has some limitations. First, we used an ad hoc questionnaire that had not been previously validated. Second, due to heterogeneity in healthcare management across regions and between public and private systems, we were unable to evaluate potential differences between regions and hospital types adequately. In this regard, our findings should be interpreted within a Spanish context, as differences in reimbursement policies, regulatory timelines, and health system organization across countries are likely to influence amyloid PET adoption in the different European countries; thus, the challenges identified in Spain may serve as an example but specific studies on each country are required. Third, it is worth noting that part of our study is based on plausible projections informed by the opinions of nuclear medicine physicians. Thus, they should be regarded as hypotheses rather than expectations. In this regard, it is important to integrate the multiple disciplines involved in the management of AD patients to optimize the patient pathway, integrating PET imaging with the other diagnostic tools (e.g., cognitive assessments, fluid biomarkers). Furthermore, while the availability of amyloid PET is an important step for the therapy, readiness for anti-amyloid therapy implementation is multidimensional and also depends on operational capacity, clinical pathways, and integration with neurology services; for instance, the mismatch between technical availability and actual use in amyloid PET imaging or quantification metrics suggests the presence of organizational and policy barriers that should also be taken into account. Fourth, an important part of the study is focused on amyloid PET, because it is one of the requirements for the new treatments. However, amyloid PET should not be considered a substitute for established imaging modalities such as structural MRI or FDG PET. Rather, its use should be contextualized within a multimodal diagnostic framework in which structural, functional, and molecular information provide complementary insights into neurodegenerative processes.
It is worth mentioning that the use of amyloid PET in AD has been questioned in several studies. Some authors have raised concerns regarding its use as a primary surrogate endpoint in immunotherapy trials, highlighting potential methodological limitations 27 . In addition, systematic analyses of anti-amyloid monoclonal antibodies have suggested that although reductions in amyloid burden measured by PET can be demonstrated, the associated clinical benefits remain modest, and the overall risk-benefit balance continues to be debated 28 . Similarly, the appropriateness, prioritization or complementary role of PET versus alternative approaches based on fluid biomarkers is currently under debate 29 . Furthermore, comparative imaging studies have reported that other PET tracers, such as 18F-FDG, show stronger correlations with cognitive performance30,31. However, the aim of this study was not to evaluate the therapies or the superiority of amyloid PET over other imaging biomarkers. Rather, our objective was to assess the current infrastructure, availability and preparedness of Nuclear Medicine departments in Spain in anticipation of potential changes in clinical demand. In this context, and independently of the ongoing scientific debate, PET tracers are relevant in the study of AD and other neurodegenerative disorders, and amyloid PET is currently an approved biomarker and is increasingly incorporated into the diagnostic frameworks and clinical trials in AD. Therefore, evaluating the capacity of the healthcare systems to provide this imaging modality remains relevant from an organizational and healthcare planning perspective.
In conclusion, our study has provided an analysis of the current situation of nuclear medicine departments, both in public and private settings, across different regions of Spain. Most nuclear medicine physicians recognized the relevant role of PET imaging, especially amyloid tracers, in selecting patients as candidates for therapy, and predicted an increase in the number of studies. Many of the departments already use amyloid PET, and nuclear medicine physicians are confident with the interpretation of the technique, although the number of studies seems low. Expanding the number of PET scans equitably, incorporating amyloid PET into the service portfolio in all hospitals, and hiring more personnel across the departments were some of the main actions identified in the survey. The identification of challenges and proposed actions is important for healthcare planning and to enable an adequate, timely, and equitable use of PET imaging across Spanish regions, which will result in the successful implementation of anti-amyloid drugs in AD patients. The present study constitutes an initial investigation into the present status quo with regard to the implementation of nuclear neuroimaging technology within the Spanish healthcare infrastructure. The findings of this study may be utilized as a foundation for future updates and longitudinal comparisons. In addition, the information from this study may be helpful to determine the specific use of PET imaging and other complementary biomarkers (e.g., plasma and cerebrospinal fluid biomarkers) in clinical practice. Beyond the available scientific evidence, it is also necessary to consider contextual factors such as local availability, infrastructure, expertise, and healthcare system organization. For this reason, the information provided in this study may be useful to support the evaluation of cost-effectiveness, resource allocation, and health system capacity when planning the integration of PET imaging and other biomarkers (FDG-PET, MRI, fluid biomarkers) into structured AD care pathways.
Footnotes
Acknowledgements
We would like to thank all participants of the survey for their valued contribution, including Andrés Achury, Juan Carlos Alonso-Farto, Alejandro Andrés, Stela Asadurova, Luis Bañuelos Andrío, Elisa Caballero-Calabuig, José Reinaldo Chícharo de Freitas, Ioana Cillero Etxebeste, Montserrat Cortés Romera, Pascual de la Cruz García, Leticia de la Cueva, Luis Domínguez-Gadea, Ángela Esteban Hurtado, Iratxe Fernández, José Ferrer Rebolleda, Belén Finat de Codes, Daniel Flores Couce, Marta Gallego Peinado, María Pilar García-Alonso, Lina García-Cañamaque, David García-Solís, Laura García-Zoghby, Puy Garrastachu Zumarán, Manuel Gómez-Río, Pedro González, Blanca González-Gaggero, Ana Isabel González García, Elena Goñi Gironés, Manuel Guerrero-Ortiz, Ramón Guitián Iglesia, Antonio Luis Gutiérrez-Cardo, Ceferino Gutiérrez Mendiguchia, María Concepción Isla Gallego, Darío Lisei, Isabel López-Villar, Carles Lorenzo Bosquet, Antonio Maldonado, Jesús Maraña, Francisco Martín, Sara Martín, Ana María Martín-García, Begoña Martínez, Francisco Medina Romero, Mercedes Mitjavila Casanova, Gloria Moragas Freixa, José Manuel Nogueiras Alonso, Edel Noriega Álvarez, María del Prado Orduña Díez, Simeón Ortega Lozano, Virginia Peiró, Francisco José Pena-Pardo, Andrea Carolina Peñaherrera Cepeda, Berta Pérez-López, Pedro Plaza-López, Juan Carlos Prieto Prieto, Virginia Pubul, Liliana Quintero, Mamen Redal Peña, Eduard Riera Gil, Pablo de la Riva, Antonio Rodríguez-Fernández, Omar Darío Rodríguez-Fonseca, Ato Antonio Rodríguez-Revuelto, Julio Rodríguez-Rubio, Patricia Romero-Fernández, Ricardo Ruano-Pérez, Sebastiá Rubí-Sureda, Antonio Rubio-Rodríguez, Laroussi Mohamed Salem, María Sánchez-García, Salomé Sanz, Marta Leticia de Sequera Rahola, Rafael Serrano-Nieto, Antonio Serrano-Palacio, Justo Serrano-Vicente, Antonio Eloy Seva-Delgado, María José Tabuenca-Mateo, Marcos Tajahuerce, Ana Tembl Ferrairó, Bernard Theillac, Ignacio Tobalina Larrea, Javier Travieso Betancor, Lourdes Urquía, Marta Valero Camps, Juan Antonio Vallejo-Casas, José Verdú, Carmen Vigil-Díaz, who agreed to be listed in this manuscript.
We thank Society of Nuclear medicine and Molecular Imaging (SEMNIM) for their help in disseminating the survey.
ORCID iD
Ethical considerations
The study protocol was approved by the institutional ethics committee from the Hospital Clinico San Carlos.
Consent to participate
Participation was voluntary, informed consent was obtained from all participants.
Consent for publication
Not applicable
Author contribution(s)
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Jordi A Matias-Guiu is supported by Instituto de Salud Carlos III through the projects INT20/00079 and INT23/00017 (co-funded by European Regional Development Fund “A way to make Europe”).
Instituto de Salud Carlos III, (grant number INT20/00079 , INT23/00017 ).
Declaration of conflicting interests
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dra. María Nieves Cabrera Martín has received honoraria as speaker/professor from Lilly, Curium Pharma S.A, KRKA Farmaceútica S.L., Advanced Accelarator Applications Iberica, S.L.U., Dr Jordi A Matias-Guiu has received honoraria as advisor and speaker from Almirall, Alter, Araclon Biotech, Bial, Eisai, Esteve, and KRKA; Dr. Edgar F. Guillén Valderrama has received honoraria as board consultant from Telix Pharmaceuticals; Dr. Javier Arbizu has received research funding from Siemens Healthineers, Life Molecular Imaging (Lantheus), and honoraria from Lilly, Advanced Accelerator Applications (Novartis), Novo-Nordisk, Siemens Healthineers, Biogen, Zambon and General Electric Healthcare. No industry sponsor had any role in the conception, design, analysis, or interpretation of the data; in the preparation or review of the manuscript; or in the decision to submit the manuscript for publication. There was no influence on the content of the work.
Data availability statement
The dataset is available from the corresponding author upon reasonable request.