Technologist’s Guide

Principles and Practice of PET/CT Part 2

October 2011

Owing primarily to the wide availability of 18F-FDG, PET/CT has established its place in the diagnosis and management of several prominent diseases, especially in the field of oncology. In recent years, an increasing number of alternative new PET radiopharmaceuticals have become commercially available, opening the way to new applications of PET/CT imaging. Since a greater variety of biological functions can be visualised by PET/ CT with these new positron radiopharmaceuticals, the number of PET/CT applications will increase in cardiology and neurology as well as in oncology.

This second PET/CT Technologist’s Guide will be of value not only for nuclear medicine technologists but also for other professionals working with PET/CT. As the first book covered instrumentation, protocol optimisation, radiation protection and patient care issues, this book provides the reader with information on the principles of PET radiochemistry and the current state of clinical applications of PET/CT in the fields of oncology, cardiology, infection and inflammation and neurology. The first chapter covers the principles of PET radiochemistry. In addition to presenting the basic knowledge on PET chemistry, it also discusses the regulatory rules which require increasing awareness of the challenges involved in the production and quality assurance of PET radiopharmaceuticals. This chapter offers the reader an excellent overview of all the issues and aspects related to the preparation of PET tracers. Chapter 2 presents the clinical applications of PET/CT in oncology, with a review of the strengths, weaknesses, current evidence and future directions of this imaging technique over a wide range of tumours. PET/CT applications in the detection and follow-up of infection and inflammatory disease are rather new and still unrecognised by some. Chapter 3 reviews the main indications for 18F-FDG PET/CT in this field and discusses the advantages and pitfalls compared with imaging using labelled white blood cells. The introduction of new PET tracers such as 82Rb and the increasing availability of PET devices in combination with high-end CT scanners is opening the way for increasing use of PET/CT in cardiology. Chapter 4 discusses the clinical applications in the field and covers patient preparation and PET/CT protocols. Imaging of the brain with PET/CT is still an open field with many possibilities. Thanks to the large number of PET tracers for brain imaging that are either already available or expected to become available. This final chapter offers an overview of the current applications of PET/CT imaging in different brain diseases.

After the broad view offered by the first two volumes on technology, radiation protection, patient care and clinical applications of PET/CT, the third book in this series, to be published in 2012, will address the great challenge posed by multimodality approaches involving PET/CT. In particular, it will consider the radiotherapy applications of PET/CT imaging. The ultimate quality of PET/CT imaging depends on the expert input of a number of professionals, including physicians, physicists, chemists, pharmacists and technologists. Only good teamwork between the professionals working in the area of PET/CT imaging will ultimately ensure high-quality diagnosis of disease. The importance of such collaboration also applies to this booklet, in which the good quality reflects the excellent teamwork between the EANM Radiopharmacy, Oncology, Cardiovascular and Neurology Committees and Task Group on Infection and Inflammation and the EANM Technologist Committee. We hope that you enjoy reading this book and that it will prove a valuable resource for all professionals who work in the area of PET/CT or are interested in this topic.

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