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Semin Nucl Med. May;47(3) doi: /wesatimunogo.cflmed Epub Feb Optimization of Pediatric PET/CT. Parisi MT(1), Bermo.
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Arrows d show the junction between low dose AC CT and diagnostic portions of the exam. The merged CT data used to attenuation correct the PET data is displayed as a separate series at the workstation. One result of implementing our multi-series acquisition technique has been a reduction in radiation dose at our institution. In phantom experiments, Fahey et al. In addition to reducing unnecessary radiation dose, having diagnostic quality CT data for image co-registration and fusion can also improve the diagnostic accuracy of the PET examination and provide anatomic correlation for lesions that would have been difficult to discern on a low dose attenuation correction CT.
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In all cases, the CT used for attenuation correction, whether low dose or of diagnostic quality, should be acquired with the same patient positioning and the same quiet breathing used for the PET acquisition. This is particularly important for lesions in the chest and upper abdomen, where large differences in patterns of breathing e. Sedated patients will have similar quiet breathing patterns for both the CT and PET acquisitions and co-registered images can usually be accurately generated without difficulty.
PET imaging is performed using standard techniques in accordance with the North American and EANM consensus guidelines and the update of the North American guidelines [ 28 , 29 ], using administered activities of 3. Lower administered activities have also been used in an effort to generate sub-mSv PET examinations [ 30 ], however these usually require longer acquisition times and have not been rigorously validated to ensure sensitivities and specificities that are comparable with the existing techniques.
In our experience, proper patient preparation, with instructions to avoid cold exposure and dress warmly even during warm summer months, ambient temperatures in air conditioned cars and hospitals may be quite cold for a lightly dressed child , followed by warming of the patient prior to, and during the uptake period, can substantially eliminate brown fat uptake in most patients. During the uptake period patients are also instructed to minimize repetitive muscle activity in an effort to reduce background muscle uptake, although in practice the patterns of muscle uptake in children related to, for example, inconsolable crying, use of a pacifier, or use of electronic devices such as cell phones, can usually be readily recognized and interpreted.
Reversing the direction of the PET acquisition, moving from feet to head, may be indicated, particularly for bladder and pelvic neoplasms where excreted tracer in the bladder can obscure tumor uptake, although as noted earlier, placement of a bladder catheter could be considered in such circumstances. Head and neck tumors are best imaged with the arms down to minimize CT beam-hardening artifacts in the neck. However, the reconstruction of the 3D PET data will require either a 3D reconstruction algorithm or rebinning of the data into a 2D set prior to reconstruction.
Many sites utilize ordered subset expectation maximization OSEM iterative reconstruction leading to a reduction in reconstruction time. Lastly, we routinely use iterative reconstruction with resolution recovery which has improved the imaging of small structures, particularly in our younger patients. Inclusion of the uncorrected PET data is important to allow apparent focal areas of FDG uptake that are related to attenuation correction artifacts, rather than disease, to be evaluated.
This is best accomplished using either a dedicated nuclear medicine processing and viewing workstation or a PACS-integrated nuclear medicine viewing functionality. Regardless of the viewing environment chosen, it is essential that PET image thresholds be scalable and adjustable. The fusion workstation should have the capability of displaying fused images with different percentages of PET and CT blending, and should have the capability of measuring SUV, including use of volumetric ROI.
We generally review the PET component of the exam first, using the greyscale images on an appropriately calibrated monitor. Beneath the PET images, the fused images are displayed, which allows for convenient anatomic co-localization of any PET abnormalities. The fused images are then separately reviewed in all three planes, followed by a dedicated review of the CT images in all three planes whether low dose attenuation correction CT, diagnostic CT or merged hybrid CT images. Although is it not standard practice in most institutions, we issue a separate report for the attenuation correction CT portion of the exam, making reference to any pertinent findings on the accompanying PET examination, and ensuring a thorough and comprehensive review of all the available imaging data.
Optimization of Pediatric PET/CT - ScienceDirect
In general, three reports are provided for each examination: In accordance with ACR and SNMMI practice guidelines, the PET report should contain a description of the radiopharmaceutical used, the administered activity and route of administration, serum glucose level, patient weight and time of injection. Since this will be the primary report reviewed by the referring clinician, any additional information, such as need for sedation or contrast reactions, should be noted.
Description of any areas of abnormal FDG uptake should be noted, with relation made to any correlative findings on the CT images and with provision of any quantitative or semi-quantitative measures of FDG accumulation SUV. Any image artifacts or technical problems that could lead to image misinterpretation should also be noted.
Although not standard practice or required by the guidelines, it is our practice to review the attenuation correction CT images with the same rigor used for reviewing a diagnostic CT. A standardized reporting template is used, with brief descriptions of any CT findings that correlate with PET abnormalities, and note made of any pertinent incidental or unexpected findings e.
This is reported by the covering body radiologist using standard dictation templates, in a similar fashion to a Dx CT being obtained without an accompanying PET examination. In most cases the radiologist reviews the Dx CT together with the individual interpreting the PET examination, which insures a comprehensive review and allows both the PET and Dx CT reports to convey uniform information.
Where indicated strategies for minimizing specific artifacts or physiologic variants i. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study. All authors contributed to preparation, editing, and final approval of the submitted manuscript.
Positron emission tomography
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Journal List Cancer Imaging v. Published online Nov 7. Grant , Laura Drubach , Michael J. Callahan , Robert D. MacDougall , Frederic H. Fahey , and Stephan D. Finally, we will discuss measures to improve the patient experience, the resource use, the departmental workflow, and the diagnostic performance of the study through the use of appropriate technology, all in the context of minimizing procedure-related risks.
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