Research ArticleSpecial Contribution

Variations in PET/CT Methodology for Oncologic Imaging at U.S. Academic Medical Centers: An Imaging Response Assessment Team Survey

Michael M. Graham, Ramsey D. Badawi and Richard L. Wahl
Journal of Nuclear Medicine February 2011, 52 (2) 311-317; DOI: https://doi.org/10.2967/jnumed.109.074104

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  • TABLE 1.

    Summary of Survey Questions

    CategoryQuestion
    Patient dose and preparation1. Administered dose of 18F-FDG:
    2. Uptake period in minutes:
    3. Is CT contrast used during the transmission scan?
    4. Fraction of patients who have a separate diagnostic CT acquisition:
    5. How often bladder catheterization is performed:
    6. How often sedation is used:
    7. Percentage of cases with intravenous contrast:
    8. Minimum duration of fasting before 18F-FDG injection:
    9. Is a low-carbohydrate diet recommended one or more days before PET study?
    10. Estimated frequency of different strategies used for preparation of diabetic patients:
    11. Is the blood glucose measured before 18F-FDG injection?
    12. Blood glucose cutoff:
    Scanner, acquisition, and reconstruction parameters13. PET scanner manufacturer and model: 14. PET scanner software version number:
    15. Emission scan acquisition mode (2D vs. 3D for whole body and brain):
    16. Scan extent (top of head to toes, base of brain to thighs, arms up, arms down, etc.):
    17. For whole-body scan, duration of emission scan per bed position:
    18. Nature of transmission scan (CT, 68Ge rod source, 133Cs):
    Display, review, and archiving19. CT technique used for the average adult patient:
    20. PET reconstruction algorithm used:
    21. Postreconstruction filter(s) used for reconstruction:
    22. PET voxel dimensions:
    23. Software used for image interpretation by radiologist/nuclear medicine physician:
    24. Are PET/CT images archived to PACS and available for viewing?
    25. Can PET/CT images on PACs be viewed as fused images?
    26. Quality of PACS PET/CT image display capability:
    27. Name of PACS software used by referring physicians for PET/CT:
    28. Do you make digital images available on compact disk for referring physicians or patients?
    29. Type of display software included on the compact disks you provide:
    30. Procedure for reviewing outside images:
  • TABLE 2.

    Comparison of IRAT Survey Results with Recommendations of NCI, European Group, and ACRIN

    ParameterNCIEuropean groupACRINIRAT survey
    Administered dose370–740 MBq (10–20 mCi)5 mBq/kg for 2D, 2.5 MBq for 3D (370 MBq [10 mCi] for 2D, 185 MBq [5 mCi] for 3D for 70-kg patient)Dose is specific to each trial259–740 MBq (7–20 mCi)
    Uptake time50–70 min55–65 min50–70 min45–90 min
    Duration of fastingMinimum of 4 h4 h, prefer 6Minimum of 4 h4 or 6 h (evenly split)
    Recommendation for low-carbohydrate dietRecommend for 24 h beforeNot mentionedRecommend for 24 h beforeHalf the sites recommend
    Blood glucose cutoff<120 mg/dL for nondiabetic patients; 150–200 mg/dL for diabetic patientsReschedule if more than 126 mg/dLReschedule if more than 150–200 mg/dLReschedule if more than 200 mg/dL
    Duration of emission scan per bed positionNot mentionedTypically 5 min per bed positionUse manufacturer recommendations2–7 min
    CT techniqueNot mentioned30 mAs or lessTechnique is specific to each trialVariable and center-specific
    Reconstruction algorithmsNo specific recommendationsSpecific for GE, Siemens, and PhillipsUse manufacturer recommendations2D OSEM, 2 iterations. 20–30 subsets
    How to handle diabetic patientsScan in morning after overnight fast and before first use of medicationSpecific recommendations for type I and type II *Scheduled in morning with instructions provided in consultation with primary physicianWide variation, as described in text

    • ↵* Type I: Study will be scheduled preferably at end of morning; patient will have normal breakfast at 7:00 AM and use regular dose of insulin, followed by fasting for at least 4 h. Type II: Study will be scheduled preferably at end of morning; patient needs to have fasted for at least 4 h; intake of water is recommended; oral antidiabetic drugs should be continued.

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