ABSTRACT
Positron emission tomography (PET)-computed tomography (CT) has become a routine imaging modality in body oncology and is particularly well suited for the management of patients with lung cancer. Current clinical applications of PET-CT in patients with lung cancer include evaluation of indeterminate pulmonary nodules, initial staging of lung cancer, restaging of lung cancer following treatment, and radiation therapy planning. Contemporary PET-CT scanners allow comprehensive diagnostic PET and CT imaging in a single imaging session. Interpretation and reporting of PET-CT examinations of patients with lung cancer require a thorough and integrated approach taking advantage of the anatomic and metabolic information.
Subject(s)
Lung Neoplasms/diagnostic imaging , Multimodal Imaging , Fluorodeoxyglucose F18 , Humans , Lung Neoplasms/pathology , Neoplasm Staging , Patient Care Planning , Radionuclide Imaging , RadiopharmaceuticalsSubject(s)
Heart/diagnostic imaging , Multimodal Imaging/methods , Nuclear Medicine , Positron-Emission Tomography , Societies, Scientific , Tomography, X-Ray Computed , Documentation , Female , Health Knowledge, Attitudes, Practice , Humans , Image Processing, Computer-Assisted , Infection Control , Multimodal Imaging/adverse effects , Multimodal Imaging/instrumentation , Multimodal Imaging/standards , Patient Selection , Physicians , Physics , Pregnancy , Quality Control , Radiation Dosage , Radiopharmaceuticals/adverse effects , SafetyABSTRACT
This article covers positron emission tomography-computed tomography (PET-CT) scan protocols for radiation therapy planning purposes and therapy response assessment. For radiation therapy planning PET-CT scans, protocols used will depend on the intended use of the PET-CT images in the radiation therapy planning. In general scans are performed on a flat radiation therapy pallet with the patient in the treatment position or closely approximating the treatment position. PET-CT protocols used in radiation therapy planning are typically otherwise very similar to diagnostic protocols. An important component in PET-CT imaging performed for therapy monitoring and assessment is consistency in patient preparation, image acquisition, and imaging processing of the baseline scan and subsequent therapy assessment scans.
Subject(s)
Neoplasms/radiotherapy , Positron-Emission Tomography/methods , Radiotherapy Planning, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Fluorodeoxyglucose F18 , Four-Dimensional Computed Tomography/methods , Humans , Image Processing, Computer-Assisted/methods , Neoplasms/diagnostic imaging , Prognosis , Radiopharmaceuticals , Respiratory-Gated Imaging Techniques/methods , Treatment OutcomeABSTRACT
This article provides an overview of the primary considerations of positron emission tomography-computed tomographic (PET-CT) workflows specifically related to patient and image data management in radiation therapy (RT) planning and therapy response assessment. PET-CT has become increasingly integral to the RT planning and therapy response assessment. There are numerous workflow challenges related to integrating PET-CT in the framework of RT planning and therapy assessment. For PET-CT scan used for RT planning, accurate patient positioning and scan registration with the simulation is critical. For therapy assessment PET-CT scans, consistency in patient preparation, scanning and image reconstruction parameters, and image analysis are critical.
Subject(s)
Image Processing, Computer-Assisted/methods , Neoplasms/radiotherapy , Patient Positioning/methods , Positron-Emission Tomography/methods , Radiotherapy Planning, Computer-Assisted/methods , Tomography, X-Ray Computed/methods , Humans , Neoplasms/diagnostic imaging , Quality Assurance, Health Care/methods , Radiology Information Systems , Respiratory-Gated Imaging Techniques/methods , Safety , Treatment OutcomeABSTRACT
New developments in positron emission tomography-computed tomography (PET-CT) have included the introduction of scanners with multidetector 16- to 64-row CT that allow thin-section essentially isotropic imaging datasets to be acquired rapidly in multiple time phases. "Diagnostic quality" CT with both oral and intravenous enhancement is now routinely possible in PET-CT and allows greater potential for the accurate diagnosis and staging of the full range of cancers involving the abdomen and pelvis. This article explores the considerations for more tailored, specific tumor-related protocols for PET-CT in the abdomen and pelvis, with emphasis on the use and value of fully optimized CT as part of an integrated PET-CT examination.
Subject(s)
Abdominal Neoplasms/diagnosis , Pelvic Neoplasms/diagnosis , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Colorectal Neoplasms/diagnosis , Contrast Media , Female , Fluorodeoxyglucose F18 , Gastrointestinal Stromal Tumors/diagnosis , Genital Neoplasms, Female/diagnosis , Humans , Lymphoma/diagnosis , Lymphoproliferative Disorders/diagnosis , Pancreatic Neoplasms/diagnosis , Sarcoma/diagnosis , Stomach Neoplasms/diagnosisABSTRACT
This article reviews the major considerations involved in optimizing positron emission tomography-computed tomographic (PET-CT) workflows including patient management and specific acquisition, processing, and archiving procedures. Due to the dual modality nature of PET-CT and the needs of the patients typically undergoing these examinations, there is a high level of patient contact and interaction with the technologists and ancillary personnel. Each PET-CT scan itself generates a considerable volume of raw image data which must be reconstructed, and the reconstructed images distributed and archived without impeding overall workflow. PET-CT facility design and layout, the procedures for sequencing patients through each phase of the exam, and adequate staffing are important considerations for an efficient and high-quality service.
Subject(s)
Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Electronic Data Processing , Humans , PatientsABSTRACT
Body oncology positron emission tomography-computed tomographic (PET-CT) exams are particularly complex and time-consuming studies to interpret and report. An integrated approach is required to provide the referring physician with the full clinical value of this combined modality. Special attention to the Positron Emission Tomography-Computed Tomographic Report Findings section and Impression section is necessary to insure all the information relevant to the patient's care are clearly communicated to the referring physicians.
Subject(s)
Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Electronic Data Processing , Humans , Image Interpretation, Computer-Assisted , Neoplasms/diagnosisABSTRACT
This consensus statement from the members of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine recommends a standardized method for measuring gastric emptying (GE) by scintigraphy. A low-fat, egg-white meal with imaging at 0, 1, 2, and 4 h after meal ingestion, as described by a published multicenter protocol, provides standardized information about normal and delayed GE. Adoption of this standardized protocol will resolve the lack of uniformity of testing, add reliability and credibility to the results, and improve the clinical utility of the GE test.
ABSTRACT
This consensus statement from the members of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine recommends a standardized method for measuring gastric emptying (GE) by scintigraphy. A low-fat, egg-white meal with imaging at 0, 1, 2, and 4 h after meal ingestion, as described by a published multicenter protocol, provides standardized information about normal and delayed GE. Adoption of this standardized protocol will resolve the lack of uniformity of testing, add reliability and credibility to the results, and improve the clinical utility of the GE test.
Subject(s)
Gastric Emptying , Stomach/diagnostic imaging , Diagnostic Techniques, Digestive System , Diagnostic Techniques, Radioisotope , Dumping Syndrome/diagnostic imaging , Gastroparesis/diagnostic imaging , Humans , Radionuclide ImagingABSTRACT
OBJECTIVE: This chapter discusses the differences in the operation of dual-technique PET/CT compared with conventional PET tomography in clinical practice. CONCLUSION: Although PET/CT still is a relatively new medical imaging technique, it is becoming the preferred method for body oncology imaging and will play an increasingly important role in molecular imaging in clinical practice. Therefore, it is imperative that facilities learn how to establish a successful PET/CT practice.
Subject(s)
Positron-Emission Tomography , Practice Management, Medical/organization & administration , Tomography, X-Ray Computed , Facility Design and Construction , HumansABSTRACT
OBJECTIVE: To determine the incidence of chest neoplasms detected by FDG PET in patients with previously treated squamous cell head and neck cancer (HNC), being evaluated for possible recurrent disease. METHODS: This is a retrospective review of 41 patients (M = 29, F = 12: average age = 58 years) with previously treated HNC who underwent FDG PET of the neck and chest as part of routine evaluation for locoregional and/or distant recurrence. Thirty-four of 41 patients had advanced stage III or IV HNC. All FDG PET studies were reviewed by dedicated nuclear medicine physicians, including evaluation for abnormal uptake in the chest. The chest FDG findings were correlated with serial chest radiographs or chest CT. The occurrence rate of incidental chest malignancy was determined and based on characteristic imaging findings, biopsy, and/or clinical course. RESULTS: Twelve of 41 patients had abnormal FDG uptake in the lungs and/or mediastinum. Ten of 12 patients were found to have neoplasms that could represent either metastases or a new lung primary. Five of these 10 were unsuspected neoplasms prior to FDG PET. The other 2/12 FDG PET scans in the chest were false positive. There was one false-negative FDG PET, with subsequent PET and CT demonstrating pulmonary metastases. Overall, there was a 27% incidence of chest malignancies in patients with advanced HNC being evaluated for possible recurrence. CONCLUSION: Our study demonstrated a chest malignancy in 1 out of 4 patients with advanced HNC being evaluated for locoregional and/or distant spread. Fifty percent were unsuspected prior to FDG PET. This result suggests that FDG PET of the lungs should be routinely included in the evaluation of high-risk patients.
Subject(s)
Carcinoma, Squamous Cell/diagnostic imaging , Carcinoma, Squamous Cell/epidemiology , Head and Neck Neoplasms/diagnostic imaging , Head and Neck Neoplasms/epidemiology , Neoplasm Recurrence, Local/diagnostic imaging , Neoplasm Recurrence, Local/epidemiology , Positron-Emission Tomography , Adult , Aged , Aged, 80 and over , False Positive Reactions , Female , Fluorodeoxyglucose F18 , Follow-Up Studies , Humans , Incidence , Male , Middle Aged , Neoplasm Staging , Positron-Emission Tomography/methods , Predictive Value of Tests , Radiopharmaceuticals , Sensitivity and SpecificityABSTRACT
PURPOSE: To evaluate the diagnostic accuracy of 2-[fluorine-18]fluro-2-deoxy-D-glucose positron emission tomography (FDG-PET) for detecting nonsquamous tumors of the extracranial head and neck (NSTHN). MATERIALS AND METHODS: The records of all patients with suspected or proven NSTHN undergoing PET imaging in our institution over a 12-year period were reviewed. Forty-four patients (24 males and 20 females; age range, 6-81 years; mean age, 51.2 years) were classified into 3 main groups: thyroid tumors (n = 19), salivary gland tumors (n = 7), and miscellaneous lesions (n = 18). The PET findings for each individual group with respect to the primary site, cervical nodal and distant metastases, were correlated with histopathology or follow-up (2-year minimum) RESULTS: The overall diagnostic accuracy of FDG-PET for all NSTHN was 86%, However, the diagnostic accuracy varied for the histologic subtype (thyroid, salivary, miscellaneous) and the area being evaluated (primary site, nodal metastases, distant metastases). CONCLUSION: There is variable diagnostic accuracy of FDG-PET in detecting different histologic subtypes of NSTHN. This information should be taken into consideration when considering PET for evaluation of NSTHN.
Subject(s)
Fluorodeoxyglucose F18 , Head and Neck Neoplasms/diagnostic imaging , Tomography, Emission-Computed , Adolescent , Adult , Aged , Aged, 80 and over , Carcinoma, Medullary/diagnostic imaging , Carcinoma, Papillary/diagnostic imaging , Child , Female , Humans , Lymphatic Metastasis/diagnostic imaging , Male , Middle Aged , Neoplasm Metastasis/diagnostic imaging , Salivary Gland Neoplasms/diagnostic imaging , Thyroid Neoplasms/diagnostic imagingABSTRACT
With the advent of the Clinical Positron Imaging journal, a new vehicle has been created to facilitate the dissemination of information relevant to the clinical positron imaging community. In addition to providing technical, scientific, and medical information, this journal will also be used to address financial, regulatory, and legislative issues in clinical positron imaging. Since this is the journal of the Institute for Clinical PET (ICP), all of its members will receive it as an added service of ICP.
