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Gus Iversen, Editor in Chief | May 08, 2026
A shift from older imaging agents to newer PET-based radiotracers for neuroendocrine tumors has been associated with uneven access to care, particularly for patients in rural areas, according to a study published in the Journal of the American College of Radiology.
Researchers from the Harvey L. Neiman Health Policy Institute reviewed 3,365 claims and found that the rollout of Gallium-68 DOTATATE and DOTATOC beginning in 2017 coincided with increased travel distances for patients seeking diagnostic imaging. Those in small towns and rural areas traveled an average of 134.9 additional miles compared with earlier standards, while patients in metropolitan and micropolitan areas traveled 26.7 additional miles.
Prior to 2017, imaging for neuroendocrine tumors relied on Indium-111 pentetreotide, a SPECT-based agent with a longer half-life that supported wider distribution. The introduction of Gallium-68 radiotracers marked a transition to PET-based imaging, offering improved diagnostic performance but requiring on-site or nearby production due to a 68-minute half-life.
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“PET/CT-based imaging with gallium-68 can only be performed when the radiotracer is produced locally due to its extremely short half-life. For this reason, patients living in small towns and rural areas had to travel long distances,” said Cindy Yuan, M.D., assistant professor of clinical radiology at the Indiana University School of Medicine, and the study’s lead author.
The study focused on the diagnostic phase of theranostics, where imaging identifies targets for subsequent radioligand therapy. Investigators noted that disparities in diagnostic access likely extend to treatment access as well.
In 2021, the introduction of Copper-64 DOTATATE, which has a longer half-life of 12.7 hours, appeared to reduce geographic disparities. “Importantly, the introduction of Copper-64 DOTATATE in 2021 largely eliminated the metropolitan-micropolitan versus small-rural differences in access to PET-based radiotracers,” Yuan said.
Utilization trends shifted quickly. Gallium-68 agents accounted for 33.8% of use in 2017 and grew to 90.9% by 2020. After Copper-64 DOTATATE entered the market, it reached 40.6% share by 2023, while use of Indium-111 pentetreotide declined to 2%.
Senior author Eric Christensen, Ph.D., said logistical factors may influence future adoption patterns, particularly in smaller markets where distribution challenges remain.
