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Principles and Practice of PET/CT EANMEANM® Eu ne rope edici an Association of Nuclear M Publications · Brochures Principles and Practice of PET/CT Part 1 A Technologist‘s Guide Produced with the kind Support of Editors Peter Hogg Giorgio Testanera Head of Diagnostic Imaging Research Istituto Clinico Humanitas University of Salford Department of Nuclear Medicine Salford, UK Rozzano, Italy Contributors Suzanne Dennan Ann Heathcote Department of Diagnostic Imaging Regional Manger St. James Hospital, Dublin, Ireland Alliance Medical Limited Warwick, UK Thomas Kane Consultant in Radiology & Nuclear Medicine Amy Wareing Victoria Hospital, Blackpool Senior PET CT Technologist and Lancashire PETCT Centre, Preston, UK Preston PET CT Centre Royal Preston Hospital Jean-Marc Vrigneaud Lancashire Teaching Hospitals, UK Medical Physicist Nuclear Medicine Department Peter Julyan Centre Georges-François Leclerc Clinical Scientist Dijon, France North Western Medical Physics The Christie NHS Foundation Trust, UK Sylvianne Prevot Radiation Safety O#cer Katy Szczepura Centre Georges-Francois Leclerc Medical Physics Lecturer Dijon, France Department of Diagnostic Radiography University of Salford Angela Meadows Greater Manchester, UK Unit Manager Preston PET/CT Centre Simona Cola Alliance Medical Technologist of the Department of Nuclear Royal Preston Hospital Medicine Lancashire Teaching Hospitals NHS Trust, UK S. Maria Nuova Hospital Reggio Emilia, Italy Ronald Boellaard Associate Professor and Head of Physics Department of Nuclear Medicine and PET Research VU University Medical Centre Amsterdam, The Netherlands 2 Contents Foreword Suzanne Dennan . ......................................4 Preface and Glossary of Terms and Abbreviations Peter Hogg and Giorgio Testanera . ..........................5 Chapter 1: The value and limitations of PET-CT in routine clinical practice: a UK radiologist’s perspective Thomas Kane and Peter Hogg . ............................7 Chapter 2: Practical radiation protection in PET-CT Jean-Marc Vrigneaud, Sylvianne Prévot, Angela Meadows and Peter Hogg . .16 EANM Chapter 3: PET imaging instrumentation and principles of PET protocol optimisation Ronald Boellaard. .37 Chapter 4: CT instrumentation and principles of CT protocol optimisation Ann Heathcote, Amy Wareing and Angela Meadows . ..........54 Chapter 5: Quality assurance and quality control for PET-CT Peter Julyan . ...........................................69 Chapter 6: PET isotope production Katy Szczepura . ..........................................76 Chapter 7: Patient care in PET-CT Simona Cola and Peter Hogg . ...........................81 Chapter 8: Radiographer and technologist competencies – education and training in PET-CT Peter Hogg and Angela Meadows . .......................88 Imprint . 99 3 Foreword Suzanne Dennan The EANM Technologist Committee was I am grateful for the e(orts and hard work of the established in 1996 to represent European authors, who have ensured the educational val- nuclear medicine technologists and radiogra- ue and quality of this guide. Special thanks are phers within the EANM. Key aims of the Tech- extended to the editors, Professor Peter Hogg nologist Committee include the promotion and Mr. Giorgio Testanera, for their dedication of high professional standards and participa- to the success of this publication. In particular, tion in EANM education and continuing edu- many thanks are due to Siemens Medical for cation initiatives. During the lifetime of the their support and generous sponsorship. committee, the %eld of nuclear medicine has undergone considerable change, particularly It is hoped that this PET-CT book will serve as with the advent of hybrid PET-CT imaging. an invaluable educational tool for all profes- sionals working in PET-CT departments and Since 2004, an annual “Technologists’ Guide” that it will contribute to the quality of their has been produced by the EANM Technolo- daily work. I also hope that this book will ben- gist Committee. This successful series aims e%t those with no or limited PET-CT experi- to develop expertise in key areas of nuclear ence, helping them to start to develop their medicine and to assist with the development understanding of the %eld. I look forward to of high standards of professional practice. the next two books in 2011 and 2012. The current book is dedicated to PET-CT and will be the %rst of a comprehensive three-part Suzanne Dennan series devoted to this important topic. Chair, EANM Technologist Committee 4 Preface and Glossary of Terms and Abbreviations Peter Hogg and Giorgio Testanera PET-CT is expanding rapidly in many coun- dionuclide production equipment work and tries and has quickly established its place in also they explain what quality checks might the diagnosis and management of several be conducted to ensure optimal performance. prominent diseases. This has come about Given that PET-CT radiation protection re- through a growing and convincing evidence quirements are complex, we have included base in regard to its e#cacy, combined with a substantial chapter on this. This comprises sound %nancial reasons. Taken together, these three elements – ‘sta(’, ‘patient’ and ‘depart- provide a %rm argument for routine use of ment design’. There is also a chapter on pa- PET-CT in certain disease processes. With this tient care, and, as with radiation protection, in mind, this book, the %rst in a series of three we have anticipated an existing level of gen- about PET-CT, comes at a timely moment. The eral knowledge about these particular issues. next two books in this series will be published The %nal chapter presents arguments on how EANM in 2011 and 2012. Each chapter has a reference competence to practice could be achieved list, though we have tried to keep these lists to and what considerations should be borne in essential references only. Finally, most chap- mind when designing educational curricula. ters also have a short reading list, which seeks either to develop fundamental background Building on this book, the second in the series knowledge that should be present prior to will explore some more fundamental issues reading the chapter or to give direction on (such as radiochemistry QC) before progress- how to extend your knowledge after reading ing to the detail of how PET-CT procedures are the chapter. conducted. We hope that you enjoy reading this book and the two related ones. More im- This book covers some fundamental aspects portantly, we hope that this book will serve as of PET-CT in preparation for the two subse- a valuable resource when conducting PET-CT quent books. It commences with a chapter on procedures and also designing educational a radionuclide radiologist’s perspective about processes that seek to ensure sta( are com- the use of PET-CT in his medical practice. This petent in their roles. is an important starting point because it makes a clear statement about how PET-CT Finally, as part of this preface, we have includ- is evolving in a particular country with a view ed below a concise glossary of terms and ab- to providing a routine service. Having intro- breviations that aim to give a simple insight duced this perspective, the book progresses before you begin reading this book. to a number of equipment-related chapters. These outline how PET-CT imaging and ra- Peter Hogg and Giorgio Testanera 5 Glossary of terms and abbreviation PET imaging devices and consequently in recent Positron emission tomography (PET) is a to- times there has been a move towards the fu- mographic imaging technique which allows sion of the two medical imaging devices into non-invasive quantitative assessment of bio- one physical unit. The use of one imaging unit chemical and functional processes. A range of to produce two di(erent image datasets has positron emitters are available for use but 18 F become known as hybrid imaging. Examples (combined with FDG – +uorodeoxyglucose) of hybrid imaging devices include SPECT/CT, is the most commonly used. PET-CT has par- PET-CT and PET/MR. ticular value in cancer diagnosis and manage- ment but it does have value in many other Molecular imaging pathologies, too. Molecular imaging can be broadly de%ned as the in vivo characterisation and measurement CT of biological processes at the cellular and mo- Computed tomography (CT) is a technique lecular level. Molecular imaging di(ers from that uses an x-ray beam to generate images traditional imaging in that probes (known as that have a very good resolution to demon- biomarkers) are used to help image particu- strate anatomy. lar targets or pathways. Biomarkers interact chemically with their surroundings and in turn PET-CT alter the image according to molecular chang- Integrated PET with CT in a single unit (PET- es occurring within the area of interest. PET CT) has become an established and valued is an excellent molecular imaging modality. imaging modality in clinical routine. Inte- grated PET-CT has been shown to be more Cyclotron accurate for lesion localisation and characteri- A cyclotron is required to generate the pos- sation than either PET or CT alone. PET-CT is itron-emitting radionuclides that are used in an example of hybrid imaging. PET imaging. Ideally cyclotrons are located as close as possible to the PET scanner because Image fusion and hybrid imaging the positron-emitting radionuclides tend to Image fusion involves the bringing together have short half-lives. of two image datasets with the intention of registering them as closely as possible. Gener- ally the two image datasets would have been produced on di(erent types of medical imag- ing device. Various problems have been in- curred when using two geographically remote 6 Chapter 1: The value and limitations of PET-CT in routine clinical practice: a UK radiologist’s perspective Thomas Kane and Peter Hogg Introduction The Preston PET Centre, established in 2007, When considering the value and limitations of houses a General Electric 64-slice CVT system PET-CT in routine clinical practice it is important to with cardiac and respiratory gating capabili- set the context as there can be marked variations ties. The majority of its workload is focussed both between and within countries.
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