PET SCAN

Positron emission tomography, also called PET imaging or a PET scan, is a type of nuclear medicine
imaging.

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.

What to do before PET / CT scan?

Women should always inform their physician or technologist if there is any possibility that they are
pregnant or if they are breastfeeding.

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

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.

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.

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.

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.

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.

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 send 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?

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 pregnancy,
breastfeeding and nuclear medicine exams.