This document in pdf at: https://bit.ly/2ZLJTPx

On Facebook at: https://www.facebook.com/permalink.php?story_fbid=4636682303034336&id=114803041888974

Dear member of the BECA committee,

It is illogical to plan to spend billions of EURO of taxpayer money funding proposals and strategies claiming to Beat Cancer without asking for a plan estimating the efficacy of each proposal and strategy in reducing cancer deaths and healthcare costs and, after funding a plan to measure such efficacy on a sample population in a specific location showing significant reduction in cancer deaths and costs compare to the years before in the same location and compared to other locations where such plan is not implemented.

The European Beating Cancer Committee (BECA) original DRAFT report “Strengthening Europe in the fight against cancer – towards a comprehensive and coordinated strategy” (https://www.europarl.europa.eu/doceo/document/BECA-PR-693752_EN.pdf)  presented by Veronique Trillet-Lenoire on July 15th 2021, and the 1,537 amendments considered on October 14^th, 2021, https://www.europarl.europa.eu/committees/en/strengthening-europe-in-the-fight-agains/product-details/20211008CAN63623 do not ask for a plan estimating the efficacy of each proposal and strategy in reducing cancer deaths and healthcare costs.

On behalf of taxpayers and cancer patients I respectfully request to address the following issues and those described in my previous emails reported below and I respectfully request to include them within the amendments to maximize benefits to humanity.

It is urgent for BECA Committee to provide logical and scientific consideration to the following issues:

On September 27th, 2021, I provided:

1. line-by-line questions/comments to items 31-41 of the “Chapter II of your BECA DRAFT 2020/2267(INI) (https://www.europarl.europa.eu/doceo/document/BECA-PR-693752_EN.pdf). My questions/comments can be found in the pdf document at: https://bit.ly/2Y4lCU3 or below in an image document

2. irrefutable references that ITALY has a cancer cost of €20 billion per year, while the population is constant and the number of cancer deaths per year are slightly increasing instead of decreasing. This proves that the €20 billion per year are not spent effectively to reduce cancer deaths and costs. 

3. I am providing a detailed strategic plan that can be tested with existing, very expensive devices at a very high cost of $10,000 per examination, which are copies of my 3D-CBS invention. However, funding my 3D-CBS invention then will cost only $200 per screening test, my claims of the lives and money saved can be verified experimentally on 0.02% of the European population (90,000 people per year) and then extend it to the 450 million population.

4. I am providing the summary of the strategic plan to save from cancer over 2.6 million lives and over €355 billion in ITALY in 30 years by building 450 units 3D-CBS in 8 years and additional 100 units in the following 22 years to replace the old machines. 

5. I am providing the summary of the strategic plan to save from cancer over 20 million lives and over €2 trillion in EUROPE in 30 years by building 4000 units 3D-CBS in 11 years and additional 800 units in the following 19 years to replace the old machines.

On September 8th, 2021, before your meeting Chaired by Honorable Batosz ARLUKOWICZ, for the creation pf the European Health Data Space and the Chemical Strategy for Sustainability, I sent you the letter which is also available:

• In pdf at: https://bit.ly/3njgGoq
• On Facebook at: https://www.facebook.com/permalink.php?story_fbid=4470048669697701&id=114803041888974
• On the Blog at: https://crosettofoundation.org/letter-to-the-members-of-the-eu-beca-committee-in-regard-to-the-objectives-of-the-beca-meeting-9-september-european-health-data-space-chemicals-strategy/

On July 15th, 2021, before your meeting, when BECA Rapporteur Véronique Trillet-Lenoir presented her draft report “Strengthening Europe in the fight against cancer – towards a comprehensive and coordinated strategy” (https://www.europarl.europa.eu/doceo/document/BECA-PR-693752_EN.pdf) to the Members of the Beating Cancer Committee and with John-F Ryan, Director Public Health, DG SANTE. The meeting will be live streamed, I sent you the letter which is also available:

• In pdf at: https://bit.ly/2TigQ2W
• On Facebook at: https://www.facebook.com/permalink.php?story_fbid=4306891836013386&id=114803041888974
• On the Blog at: https://crosettofoundation.org/european-parliamentary-question-related-to-eu-beca-and-to-chapter-ii-of-beca-draft-2020-2267ini/

Following I am providing the result of the Dialogue at the most important international conference in the world in this field with scientists who have the responsibility to determine scientifically what works best in reducing cancer deaths and costs.

See also in pdf at: https://bit.ly/2ZoGUw7 Screenshots at: https://bit.ly/3GhYMcU, in-depth dialogue at: https://bit.ly/2X4XVuc

450 million Europeans want to know from scientists what works best
in reducing suffering, deaths and costs of cancer

 EUROPEAN PARLIAMENT – Parliamentary questions

21 June 2021 (Translated in 24 languages) https://www.europarl.europa.eu/doceo/document/E-9-2021-003244_EN.html

The answer is provided through the Dialogue

Dialogue between Dario Crosetto and IEEE at the Workshop:

“Challenges moving from the lab bench to clinical practice for nuclear medicine”

held online from Japan on 23 October 2021

 9:37 – From Dario Crosetto to Everyone:

David Townsend in your review paper with Terry Jones “History and future technical innovation in positron emission tomography” at p. 14 (or cited at p. 21 of http://bit.ly/2QdgdTx) you stated “…Attaining a 10-ps timing would open up an entirely new concept of static partial ring scanner...” which is not logical, because fewer detectors reduce sensitivity, it is opposite the request by Iwao Kanno, it is incorrect, misleading and driving researchers in the wrong direction. Would you correct it?

10:02 – From Dario Crosetto to Everyone:

Could you please read my question as it is done for all questions?

10:31 – From Dario Crosetto to Everyone:

Craig Levin, last video from GE advertising their PET/CT do not mention spatial resolution only sensitivity 7.5 cps/MBq for 15 cm FOV PET and the square for a detector length increase of 30 cps/MBq for a 30 cm FOV. Iwao Kanno states at the beginning and end of his talk “The Goal of PET is to measure biophysiology, not to take a beautiful picture”. Why you continue to drive researchers in the wrong direction of high PET spatial resolution?

10:34 – From Reinhard Schulte to Everyone:

@Dario: Not quite, for PET/CT based radiation therapy planning and image guidance we need high spatial resolution; 1 mm is perfect

10:35 – From Dario Crosetto to Everyone:

What is the PET/CT market for radiation therapy and for all other applications? Are you countering Prof. Iwao Kanno assessment?

10:37 – From Reinhard Schulte to Everyone:

More than 50% of all cancer patients receive RT and PET/CT is now integral part of RT planning

10:39 – From Dario Crosetto to Everyone:

Then you should counter Prof. Iwao Kanno. I do not think that you have a good point.

10:41 – From Craig Levin to Everyone:

Hi Dario: Whether one does or does not need high resolution for cancer imaging (in addition to, not instead of high sensitivity) depends on the clinical question you are asking. In our case, the hear/neck and breast cancer physicians, they drove this clinical interest of 1 mm^3 resolution, not me. If they were not interested, we would not have worked on the project. Of course we still have to demonstrate that 1 mm resolution has clinical impact, and that is precisely why we are trying to translate the technology to the clinical.

[Dario Crosetto did not see the above message from Craig Levin during the workshop, therefore he answers now to his comment]

From Dario Crosetto to Craig Levin after the workshop

Hi Craig:

• In regard to your first comment “(in addition to, not instead of high sensitivity)”, I answered at 11:45 during the workshop that high spatial resolution goes to the detriment of sensitivity and low cost. This is proven by calculating the cost of the components when using the approach to build PET with long FOV of 150 cm such as the EXPLORER, Siemens Biograph Vision Quadra, UPENN-EXPLORER or your submillimeter detector module for breast, compare to the cost of less than $2 million for the components used in my 3D-CBS device offering higher sensitivity.

• In regard to your second statement “…cancer physicians, they drove this clinical interest of 1 mm^3 resolution, not me”. I think you should not blame the physicians, oncologists, etc., but is your responsibility to understand the principle of operation of an instrument and tell users how to use it appropriately. You are not telling a physician to use a ruler to measure the weight or the scale to measure the heigh of the patient. PET is counting all possible valid signals received from a cluster of body cells emitting tumor markers within a time unit, is not measuring a dimension.

• In regard to your statement: “If they were not interested, we would not have worked on the project”: As a scientist, you should follow the logic of the laws of nature and not to please a physician. Ultimately you have to satisfy the laws of nature (science) and not pleasing a doctor who does not understand them, even if he/she asks you to do so. When you will test both devices on a sample population, would a PET with high spatial resolution or a PET with high sensitivity save more lives and reduce healthcare costs? The logic should tell you that a more sensitive PET capturing more signals from the tumor markers at a lower cost would save more lives and reduce costs instead of building a PET with high spatial resolution, wasting money, time and get experimental results confirming it.

• In regard to your statement: “…we still have to demonstrate that 1 mm resolution has clinical impact…”: Now we have your submillimeter PET for breast cancer and a few expensive PET with a FOV longer than 1m (EXPLORER, Siemens Biograph Vision Quadra, PENN-EXPLORER), which are less efficient and more expensive than my 3D-CBS. You can first estimate with calculations (e.g. by filling the table https://bit.ly/3zZQgMj with the parameters of the above mentioned existing devices) how many lives and costs will save (or if it will increase healthcare cost?). Having built those devices, mostly spending taxpayer money, you can verify your estimates with screening tests on a sample population as described on page 97 of http://ly/2QdgdTx. Next you need to compare the calculations based on your device with those based on my 3D-CBS device, which uses 30 mm thick BGO crystals on a 150cm FOV detector that no one could invalidate that each 3D-CBS unit at $200 per screening test, can save over 260 lives per year reducing to 1/80 the cost per life saved. Funding my 3D-CBS will prove its benefits by performing the same screening test as described on page 114 of http://bit.ly/2QdgdTx.

10:51 – From Reinhard Schulte to Dario Crosetto (Direct Message):

Hi Dario, I don’t want to counter Prof Kanno, just wanted to point out needs in radiation oncology (I am a RadOnc). This conference is certainly dominated by nuclear medicine from the diagnostic point of view.

11:02 – From Dario Crosetto to Reinhard Schulte (Direct Message):

Reinhard Schulte, please study the principle of operation of PET and you will realize that is counting valid signals from tumor markers withing a time unit, is not measuring a spatial resolution. Would you take a high resolution picture of the water to measure its consumption or would you build a water meter measuring liters/minute?

11:04 – From Reinhard Schulte to Dario Crosetto (Direct Message):

Yes Dario I get that, but detection limit depends on spatial resolution, doesn’t it?

11:08 – From Dario Crosetto to Reinhard Schulte (Direct Message):

No, EXPLORER team have measured on a block detector with 18.1 mm thick LYSO crystal being able to detect 10 Bq (signal from second) in air, in a human body could be expected 100 Bq. This is the precious information we can provide doctors from PET.

11:13 – From Reinhard Schulte to Dario Crosetto (Direct Message):

This is interesting, thanks for pointing out

11:20 – From Reinhard Schulte to Dario Crosetto (Direct Message):

Is this the team? https://explorer.ucdavis.edu/our-team?

11:23 – From Dario Crosetto to Reinhard Schulte (Direct Message):

Sorry, I missed the word “cluster”. Here is the correct statement: EXPLORER Team have measured on a block detector using 18.1 mm LYSO crystals being able to detect clusters (small tumors) emitting only 10 Bq (signals per second), which in human body could be expected 100 Bq. This is the precious information we can provide doctors from PET.

11:33 – From Dario Crosetto to Reinhard Schulte (Direct Message):

To Reinhard Schulte: Yes, but on the list of the members of the Team on their website is not shown the name of Qian Wang who made the measurements presented by Simon Cherry at the 2019 IEEE-MIC conference in Manchester that were confirmed by Qian Wang in emails exchanged I had with her that I reported at page 120 of http://bit.ly/2QdgdTx

11:34 – From Dario Crosetto to Reinhard Schulte (Direct Message):

I would appreciate the answer from David Townsend to my first question, thanks, Regards, Dario

11:35 – From Reinhard Schulte to Everyone:

@Dr. Miwako: high grade gliomas are driven by a small population of stem-like cells. Any PET tracer in sight that would be taken up specifically be glioma stem cells?

11:37 – From Dario Crosetto to Everyone:

I would appreciate the answer from David Townsend to my first question, thanks, Regards, Dario

11:38 – From Dario Crosetto to Everyone:

David Townsend in your review paper with Terry Jones “History and future technical innovation in positron emission tomography” at p. 14 (or cited at p. 21 of http://bit.ly/2QdgdTx) you stated “…Attaining a 10-ps timing would open up an entirely new concept of static partial ring scanner…” which is not logical, because fewer detectors reduce sensitivity, it is opposite the request by Iwao Kanno, it is incorrect, misleading and driving researchers in the wrong direction. Would you correct it?

11:41 – From Dario Crosetto to David Townsend (Direct Message):

David Townsend in your review paper with Terry Jones “History and future technical innovation in positron emission tomography” at p. 14 (or cited at p. 21 of http://bit.ly/2QdgdTx) you stated “…Attaining a 10-ps timing would open up an entirely new concept of static partial ring scanner…” which is not logical, because fewer detectors reduce sensitivity, it is opposite the request by Iwao Kanno, it is incorrect, misleading and driving researchers in the wrong direction. Would you correct it?

[Dario Crosetto answers with a chat to statements made from the panelist stating that spatial resolution is in addition to sensitivity]

11:45 – From Dario Crosetto to Everyone:

High Spatial resolution goes to the detriment of sensitivity.

High spatial resolution goes to the detriment of sensitivity and low cost

11:59 – From Dario Crosetto to Everyone:

Our goal should be providing instrumentation that saves more lives and reduces healthcare costs. To resolve our disagreements I should be allowed to present my 3D-CBS system based on 30 mm thick BGO crystals, 150 cm FOV, funding should be approved for a prototype from colleagues as they approve $15.5 million for the EXPLORER then test the efficacy of both systems on a sample population and leave the judgement to experimental results.

12:04 – From Paul Rene Michel Lecoq to Everyone:

I cannot agree more with what S^David just said

If technology proves to produce a significant prohress, its costs will decrease

12:09 – From Dario Crosetto to Everyone:

Yes, but it should show to be cost-effective compared to alternative approaches that should not be suppressed