Different techniques of administering FDG for clinical PET imaging

Objectives To administer FDG to patients undergoing clinical PET exams in such a way that is appropriate to the patient and does not negatively impact the overall quality of the study.

Methods In our years of acquiring PET studies we have found that the administration of FDG must sometimes be altered to accomodate patient situations. Each of the unique situations comes with its own set of problems, and artifacts which must be taken into consideration before deciding to use that technique. The most common and accepted way of administering FDG is intravenously through a patent established upper extremity arm vein. This involves an i.v. established with normal saline running for 5-10 minutes before the injection of FDG. Alternative methods we use include a temporary small gauge butterfly needle, administration of FDG through an indwelling catheter (Port, Hickman etc) and oral administration of FDG.

Results The following problems and possible artificats should be taken into consideration for each of the our techniques: Standard i.v.: infiltrated dose which can affect SUV values and injection site in the field of view resulting in a hot spot on the images. Temporary butterfly injection: infiltrated dose, tracking or sticking of the FDG in the superficial vein often caused by not being able to follow injection with significant flush, size of the vein and poor circulation. Indwelling catheters: FDG adhering to the catheter, introduction of clots at time of injection, and infiltrated dose. Oral administration of FDG changes the biodistribution pattern of the FDG, SUV values for this adminstration technique are not established, care should be taken to avoid this technique in known or suspected cases of head and neck, abdominal and pelvic disease.

Conclusions Having multiple techniques available for the administration of FDG can allow a site to tailor the study to the patient's needs and still provide a high quality, diagnostic exam to the referring physicain