When we founded Nuclivision three years ago, we pitched it as a win-win for patients and hospitals. Scanning with less tracer cuts patients' radiation exposure and lowers hospital costs. Faster scanning lets centers do more scans on the same equipment, often raising total reimbursement, while patients spend half the time under the scanner.

But that's not the whole picture. The real gain for patients lies in something literature rarely discusses. While countless studies focus on endpoints like overall or progression-free survival, time to treatment gets far less attention. As PET scans become central to treatment decisions, time to PET scan matters more than ever.

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Why PET imaging is important for improving treatment decisions?

PET scans improve cancer care not just by detecting disease more accurately, but by fundamentally changing what clinicians do next. In lung cancer, PET-CT identifies nodal involvement that CT alone misses and disease staging based on the PET image, determines whether a patient goes to surgery or receives chemoradiation instead [1]. In lymphoma, interim PET after the first chemotherapy cycles reveals whether a tumor is responding metabolically, allowing oncologists to de-escalate or intensify treatment early [2]. Across these two indications, PET alters management in up to 40% of cases. The same principle is extending to newer indications. In high-risk prostate cancer, PSMA-targeted PET detects metastatic lesions invisible on CT, shifting treatment intent from curative to systemic or confirming localized disease and sparing unnecessary treatment [3]. PSMA PET is also now a prerequisite for radioligand therapy (RLT) eligibility, making it a literal gatekeeper to an entirely new treatment modality. Despite its cost, more accurate staging means fewer patients overtreated, fewer undertreated, and - in the case of RLT - access to therapies that would otherwise never be considered.

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What is the impact of delayed access to treatment?

To assess the impact of treatment delays, the strongest source is the meta-analysis by Hanna et al., which found that a four-week delay can raise mortality by over 10%, depending on indication and therapy type [4]. Other studies corroborate this, and for some indications the figures are no exaggeration. A recent simulation confirms that delay leads to larger tumor size and thus higher metastatic risk, estimating that an eight-week delay raises that risk by 2.25% to 4.79%, depending on hormone status [5]. Colorectal cancer is grimmer still: mortality rises 12% at four weeks and up to 39% at twelve [6]. Ovarian and uterine cancers show the same pattern, with longer delays consistently tied to poorer outcomes and progression [7].  Perhaps the largest body of evidence comes from the COVID pandemic, where the effect of lag times was plainly visible[8].

There are caveats. In low-risk prostate and endometrial cancers, delays often matter little, though they remain a concern in higher-risk disease [8]. More important is the "waiting time paradox," in which lag time is inversely correlated with outcome [9], [10]: the sickest patients move through urgent pathways yet still have low survival, so studies must account for these shifting pathways. Even so, the consensus holds that for most cancers and treatments, lag times are strongly associated with increased mortality, and the evidence is growing fast.

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Enabling faster treatments

The numbers from Hanna et al. and others are sobering, and the authors themselves note that faster access to diagnostics may yield a greater survival benefit than many of the new, often costly therapies now reaching the clinic. Professor Clare Turnbull put it pointedly in response to their publication: "Timely diagnosis and treatment of cancer is key, and it is important to note that the benefit of reducing systematic delays in cancer pathways is greater than the survival benefit afforded by most emerging therapies."

This reveals a striking imbalance. Billions flow into new treatments and technologies, while the clinical infrastructure that delivers them is systematically underfunded. The spotlight falls on the next breakthrough therapy, but almost no one talks about the workflows and people who make these technologies work. PET-CT will clearly be central to early diagnosis across a growing list of indications, yet significant delays already stand between patients and a scan. In most Western countries, that means easily preventable lag times quietly cancel out the gains of expensive new treatments. In developing countries, the picture is even starker as limited access to advanced diagnostics like PET-CT drives systemic delays that weigh heavily on public health [11].

This is where Nuclarity comes in: our software aims to put faster PET access within reach, since PET scans increasingly sit on the critical path to treatment. But technology will only take us so far. What must change first is the mindset of policymakers, who can no longer afford to overlook the evidence. The path forward is clear: educate patients about the urgency of timely diagnosis, ensure there are enough professionals to carry it out, and equip them with the right tools to do so.

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References

_{[1] Khan IS, et al., Cureus (2025), doi: 10.7759/CUREUS.77880.
[2] Johnson P, et al., N Engl J Med. (2016), doi: 10.1056/NEJMoa1510093.
[3] Hofman MS et al., The Lancet (2020), doi: 10.1016/S0140-6736(20)30314-7.
[4] Hanna TP et al., BMJ (2020), doi: 10.1136/BMJ.M4087.
[5] Hölzel D, et al., Breast Cancer Research and Treatment (2025), doi: 10.1007/S10549-025-07630-9.
[6] Ungvari Z, et al., Geroscience (2025), doi: 10.1007/S11357-025-01648-Z.
[7] Zouzoulas D, et al., Cancers (2025), doi: 10.3390/CANCERS17132076.
[8] Tope P, et al., Elife, (2023), doi: 10.7554/ELIFE.81354.
[9] Neal RD, et al., Br. J. Cancer (2015), doi: 10.1038/BJC.2015.48.
[10] Crawford SC, et al., BMJ (2002), doi: 10.1136/BMJ.325.7357.196.
[11] Puente-Vallejo R, et al., Ecancermedicalscience, (2025), doi: 10.3332/ECANCER.2025.2039.}

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