Positron Emission Tomography - Computed Tomography (PET/CT)

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Positron Emission Tomography - Computed

Tomography (PET/CT)
Positron emission tomography (PET) uses
small amounts of radioactive materials called
radiotracers, a special camera and a computer
to help evaluate your organ and tissue
functions. By identifying body changes at the
cellular level, PET may detect the early onset
of disease before it is evident on other
imaging tests.
Tell your doctor if theres a possibility you are
pregnant or if you are breastfeeding. Your
doctor will instruct you based on the type of
exam to be performed. Discuss any recent
illnesses, medical conditions, medications
youre taking and allergies especially to contrast material. You will likely be told not to eat anything
and to drink only water several hours before your scan. Leave jewelry at home and wear loose,
comfortable clothing. You may be asked to wear a gown.
What is Positron Emission Tomography Computed Tomography

(PET/CT) Scanning?
Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine
imaging.
Nuclear medicine is a branch of medical imaging that uses small amounts of radioactive material to
diagnose and determine the severity of or treat a variety of diseases, including many types of cancers,
heart disease, gastrointestinal, endocrine, neurological disorders and other abnormalities within the body.
Because nuclear medicine procedures are able to pinpoint molecular activity within the body, they offer
the potential to identify disease in its earliest stages as well as a patients immediate response to
therapeutic interventions.
Nuclear medicine imaging procedures are noninvasive and, with the exception of intravenous injections,
are usually painless medical tests that help physicians diagnose and evaluate medical conditions. These
imaging scans use radioactive materials called radiopharmaceuticalsor radiotracers.
Positron Emission Tomography - Computed Tomography (PET/CT)

Copyright 2016, RadiologyInfo.org
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Reviewed: Jun-11-2015
Depending on the type of nuclear medicine exam, the radiotracer is either injected into the body,
swallowed or inhaled as a gas and eventually accumulates in the organ or area of the body being
examined. Radioactive emissions from the radiotracer are detected by a special camera or imaging device
that produces pictures and provides molecular information.
In many centers, nuclear medicine images can be superimposed with computed tomography (CT) or
magnetic resonance imaging (MRI) to produce special views, a practice known as image fusion or
co-registration. These views allow the information from two different exams to be correlated and
interpreted on one image, leading to more precise information and accurate diagnoses. In addition,
manufacturers are now making single photon emission computed tomography/computed tomography
(SPECT/CT) and positron emission tomography/computed tomography (PET/CT) units that are able to
perform both imaging exams at the same time. An emerging imaging technology, but not readily available
at this time is PET/MRI.
A PET scan measures important body functions, such as blood flow, oxygen use, and sugar (glucose)
metabolism, to help doctors evaluate how well organs and tissues are functioning.
CT imaging uses special x-ray equipment, and in some cases a contrast material, to produce multiple
images or pictures of the inside of the body. These images can then be interpreted by a radiologist on a
computer monitor. CT imaging provides excellent anatomic information.
Today, almost all PET scans are performed on instruments that are combined PET and CT scanners. The
combined PET/CT scans provide images that pinpoint the anatomic location of abnormal metabolic
activity within the body. The combined scans have been shown to provide more accurate diagnoses than
the two scans performed separately.
What are some common uses of the procedure?

PET and PET/CT scans are performed to:
detect cancer.
determine whether a cancer has spread in the body.
assess the effectiveness of a treatment plan, such as cancer therapy.
determine if a cancer has returned after treatment.
determine blood flow to the heart muscle.
determine the effects of a heart attack, or myocardial infarction, on areas of the heart.
identify areas of the heart muscle that would benefit from a procedure such as angioplasty or
coronary artery bypass surgery (in combination with a myocardial perfusion scan).
evaluate brain abnormalities, such as tumors, memory disorders, seizures and other central nervous
system disorders.
map normal human brain and heart function.
How should I prepare for a PET and PET/CT scan?

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You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing.
Women should always inform their physician or technologist if there is any possibility that they are
pregnant or if they are breastfeeding. See the Safety page for more information about pregnancy and
breastfeeding related to nuclear medicine imaging.
You should inform your physician and the technologist performing your exam of any medications you
are taking, including vitamins and herbal supplements. You should also inform them if you have any
allergies and about recent illnesses or other medical conditions.
You will receive specific instructions based on the type of PET scan you are undergoing. Diabetic
patients will receive special instructions to prepare for this exam.
If you are breastfeeding at the time of the exam, you should ask your radiologist or the doctor ordering
the exam how to proceed. It may help to pump breast milk ahead of time and keep it on hand for use after
the PET radiopharmaceutical and CT contrast material are no longer in your body.
Metal objects including jewelry, eyeglasses, dentures and hairpins may affect the CT images and should
be left at home or removed prior to your exam. You may also be asked to remove hearing aids and
removable dental work.
Generally, you will be asked not to eat anything for several hours before a whole body PET/CT scan since
eating may alter the distribution of the PET tracer in your body and can lead to a suboptimal scan. This
could require the scan to be repeated on another day, so following instructions regarding eating is very
important. You should not drink any liquids containing sugars or calories for several hours before the
scan. Instead, you are encouraged to drink water. If you are diabetic, you may be given special
instructions. You should inform your physician of any medications you are taking and if you have any
allergies, especially to contrast materials, iodine, or seafood.
You will be asked and checked for any conditions that you may have that may increase the risk of
receiving intravenous contrast material.
What does the equipment look like?

A PET scanner is a large machine with a round, doughnut shaped hole in the middle, similar to a CT or
MRI unit. Within this machine are multiple rings of detectors that record the emission of energy from the
radiotracer in your body.
The CT scanner is typically a large, box-like machine with a hole, or short tunnel, in the center. You will
lie on a narrow examination table that slides into and out of this tunnel. Rotating around you, the x-ray
tube and electronic x-ray detectors are located opposite each other in a ring, called a gantry. The
computer workstation that processes the imaging information is located in a separate control room, where
the technologist operates the scanner and monitors your examination in direct visual contact and usually
with the ability to hear and talk to you with the use of a speaker and microphone.
Combined PET/CT scanners are combinations of both scanners and look similar to both the PET and CT
scanners.

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A computer aids in creating the images from the data obtained by the gamma camera.
How does the procedure work?

With ordinary x-ray examinations, an image is made by passing x-rays through the patient's body. In
contrast, nuclear medicine procedures use a radioactive material, called a radiopharmaceutical or
radiotracer, which is injected into the bloodstream, swallowed or inhaled as a gas. This radioactive
material accumulates in the organ or area of your body being examined, where it gives off a small amount
of energy in the form of gamma rays. Special cameras detect this energy, and with the help of a computer,
create pictures offering details on both the structure and function of organs and tissues in your body.
Unlike other imaging techniques, nuclear medicine imaging exams focus on depicting physiologic
processes within the body, such as rates of metabolism or levels of various other chemical activity,
instead of showing anatomy and structure. Areas of greater intensity, called "hot spots," indicate where
large amounts of the radiotracer have accumulated and where there is a high level of chemical or
metabolic activity. Less intense areas, or "cold spots," indicate a smaller concentration of radiotracer and
less chemical activity.
For more information on how a CT scan works, see Computed Tomography.
How is the procedure performed?

Nuclear medicine imaging is usually performed on an outpatient basis, but is often performed on
hospitalized patients as well.
You will be positioned on an examination table. If necessary, a nurse or technologist will insert an
intravenous (IV) catheter into a vein in your hand or arm.
Depending on the type of nuclear medicine exam you are undergoing, the dose of radiotracer is then
injected intravenously, swallowed or inhaled as a gas.
Typically, it will take approximately 60 minutes for the radiotracer to travel through your body and to be
absorbed by the organ or tissue being studied. You will be asked to rest quietly, avoiding movement and
talking.
You may be asked to drink some contrast material that will localize in the intestines and help the
radiologist interpreting the study.
You will then be moved into the PET/CT scanner and the imaging will begin. You will need to remain
still during imaging. The CT exam will be done first, followed by the PET scan. On occasion, a second
CT scan with intravenous contrast will follow the PET scan. For more information on how a CT scan is
performed, see Computed Tomography. The actual CT scanning takes less than two minutes. The PET
scan takes 20-30 minutes.
Total scanning time is approximately 30 minutes.

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Depending on which organ or tissue is being examined, additional tests involving other tracers or drugs
may be used, which could lengthen the procedure time to three hours. For example, if you are being
examined for heart disease, you may undergo a PET scan both before and after exercising or before and
after receiving intravenous medication that increases blood flow to the heart.
When the examination is completed, you may be asked to wait until the technologist checks the images in
case additional images are needed. Occasionally, more images are obtained for clarification or better
visualization of certain areas or structures. The need for additional images does not necessarily mean
there was a problem with the exam or that something abnormal was found, and should not be a cause of
concern for you.
If you had an intravenous line inserted for the procedure, it will usually be removed unless you are
scheduled for an additional procedure that same day that requires an intravenous line.
What will I experience during and after the procedure?

Except for intravenous injections, most nuclear medicine procedures are painless and are rarely
associated with significant discomfort or side effects.
When the radiotracer is given intravenously, you will feel a slight pin prick when the needle is inserted
into your vein for the intravenous line. When the radioactive material is injected into your arm, you may
feel a cold sensation moving up your arm, but there are generally no other side effects.
When swallowed, the radiotracer has little or no taste. When inhaled, you should feel no differently than
when breathing room air or holding your breath.
With some procedures, a catheter may be placed into your bladder, which may cause temporary
discomfort.
It is important that you remain still while the images are being recorded. Though nuclear imaging itself
causes no pain, there may be some discomfort from having to remain still or to stay in one particular
position during imaging.
If you are claustrophobic, you may feel some anxiety while you are being scanned.
Unless your physician tells you otherwise, you may resume your normal activities after your nuclear
medicine scan. If any special instructions are necessary, you will be informed by a technologist, nurse or
physician before you leave the nuclear medicine department.
Through the natural process of radioactive decay, the small amount of radiotracer in your body will lose
its radioactivity over time. It may also pass out of your body through your urine or stool during the first
few hours or days following the test. You should also drink plenty of water to help flush the radioactive
material out of your body as instructed by the nuclear medicine personnel.
For more information on what you will experience during and after a CT scan, see Computed
Tomography.

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Who interprets the results and how do I get them?

A radiologist or other physician who has specialized training in nuclear medicine will interpret the
images and forward a report to your referring physician.
If your physician has ordered a diagnostic CT, a radiologist with specialized training in interpreting CT
exams will report the findings of the CT and forward a report to your referring physician.
What are the benefits vs. risks?

Benefits
Nuclear medicine examinations provide unique informationincluding details on both function
and anatomic structure of the body that is often unattainable using other imaging procedures.
For many diseases, nuclear medicine scans yield the most useful information needed to make a
diagnosis or to determine appropriate treatment, if any.
Nuclear medicine is less expensive and may yield more precise information than exploratory
surgery.
By identifying changes in the body at the cellular level, PET imaging may detect the early onset of
disease before it is evident on other imaging tests such as CT or MRI.
For additional benefits of CT exams, see Computed Tomography (CT).
The benefits of a combined PET/CT scanner include:
greater detail with a higher level of accuracy; because both scans are performed at one time without
the patient having to change positions, there is less room for error.
greater convenience for the patient who undergoes two exams (CT & PET) at one sitting, rather
than at two different times.
Risks
Because the doses of radiotracer administered are small, diagnostic nuclear medicine procedures
result in relatively low radiation exposure to the patient, acceptable for diagnostic exams. Thus, the
radiation risk is very low compared with the potential benefits.
Nuclear medicine diagnostic procedures have been used for more than five decades, and there are
no known long-term adverse effects from such low-dose exposure.
The risks of the treatment are always weighed against the potential benefits for nuclear medicine
therapeutic procedures. You will be informed of all significant risks prior to the treatment and have
an opportunity to ask questions.
Allergic reactions to radiopharmaceuticals may occur but are extremely rare and are usually mild.
Nevertheless, you should inform the nuclear medicine personnel of any allergies you may have or
other problems that may have occurred during a previous nuclear medicine exam.
Injection of the radiotracer may cause slight pain and redness which should rapidly resolve.
Women should always inform their physician or radiology technologist if there is any possibility
that they are pregnant or if they are breastfeeding. See the Safety page for more information about

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pregnancy, breastfeeding and nuclear medicine exams.

For risks of CT exams, see Computed Tomography (CT).
What are the limitations of Positron Emission Tomography

Computed Tomography (PET/CT)?
Nuclear medicine procedures can be time consuming. It can take several hours to days for the radiotracer
to accumulate in the body part of interest and imaging may take up to several hours to perform, though in
some cases, newer equipment is available that can substantially shorten the procedure time.
The resolution of structures of the body with nuclear medicine may not be as high as with other imaging
techniques, such as CT or MRI. However, nuclear medicine scans are more sensitive than other
techniques for a variety of indications, and the functional information gained from nuclear medicine
exams is often unobtainable by other imaging techniques.
Test results of diabetic patients or patients who have eaten within a few hours prior to the examination
can be adversely affected because of altered blood sugar or blood insulin levels.
Because the radioactive substance decays quickly and is effective for only a short period of time, it is
important for the patient to be on time for the appointment and to receive the radioactive material at the
scheduled time. Thus, late arrival for an appointment may require rescheduling the procedure for another
day.
A person who is very obese may not fit into the opening of a conventional PET/CT unit.
Disclaimer
This information is copied from the RadiologyInfo Web site (http://www.radiologyinfo.org) which is dedicated to
providing the highest quality information. To ensure that, each section is reviewed by a physician with expertise in
the area presented. All information contained in the Web site is further reviewed by an ACR (American College of
Radiology) - RSNA (Radiological Society of North America) committee, comprising physicians with expertise in
several radiologic areas.
However, it is not possible to assure that this Web site contains complete, up-to-date information on any particular
subject. Therefore, ACR and RSNA make no representations or warranties about the suitability of this information
for use for any particular purpose. All information is provided "as is" without express or implied warranty.
Please visit the RadiologyInfo Web site at http://www.radiologyinfo.org to view or download the latest
information.
Note: Images may be shown for illustrative purposes. Do not attempt to draw conclusions or make diagnoses by
comparing these images to other medical images, particularly your own. Only qualified physicians should interpret
images; the radiologist is the physician expert trained in medical imaging.
Copyright
This material is copyrighted by either the Radiological Society of North America (RSNA), 820 Jorie Boulevard, Oak
Brook, IL 60523-2251 or the American College of Radiology (ACR), 1891 Preston White Drive, Reston, VA

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20191-4397. Commercial reproduction or multiple distribution by any traditional or electronically based

reproduction/publication method is prohibited.
Copyright 2016 Radiological Society of North America, Inc.

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