Nuclear Medicine Gamma Cameras

     
PET/CT Philips Axis Philips Forte
     
     
 Siemans E. Cam  Siemens Symbia SPECT/CT  Philips Precedence SPECT/CT

 

POSITRON EMISSION TOMOGRAPHY (PET)/COMPUTED TOMOGRAPHY (CT)

Positron Emission Tomography (PET) is a non-invasive, diagnostic imaging technique for measuring the metabolic activity of cells in the human body. It is useful clinically in patients with certain conditions affecting the brain and the heart, as well as in patients with certain types of cancer. The agent used for this exam is FDG or Flourine-18 Deoxyglucose.

The newest technology in PET scanning is the addition of Computed Tomography (CT) to the PET scan. Computed Tomography provides the reading physician with an accurate structural map of the body. Using the structural map from CT and overlaying the PET images, the reading physician can now determine the exact location of abnormal uptake.

What is PET/CT?

Positron Emission Tomography (PET) is a non-invasive, diagnostic imaging technique for measuring the metabolic activity of cells in the human body.

It involves the use of a small amount of a radioactive material, similar to what is used in other nuclear medicine procedures. The radioactivity is attached or tagged to a compound that is familiar to your body. Compounds similar to glucose, water, ammonia, and certain drugs may be used. The radioactive drug is administered to the patient, usually by injection and a specially designed PET scanner images how the body processes the drug.

PET is unique because it produces images of the body's basic biochemistry or function. Traditional diagnostic techniques, such as x-rays, CT scans or MRI, produce images of the body's anatomy or structure.

The detailed anatomy provided by the CT portion of the scan allows for precise localization of areas of abnormal uptake seen on the PET portion of the scan.

The combination of PET and CT into one imaging session is a very useful addition to the clinician's diagnostic toolbox, providing significant advantages over traditional, stand-alone diagnostic methods. The information provided from a PET/CT can also be used in planning for Radiation Therapy treatment.

It is useful clinically in patients with cancer, as well as conditions affecting the brain and the heart.

In diseases such as Alzheimer's disease, where there is no gross structural abnormality, PET is able to show a biochemical change.

The field of PET has been emerging into clinical diagnostic medicine since the the late 1980's and is approved by many insurance carriers, including Medicare, for coverage.

A specially trained technologist will perform the exam, and will explain the entire procedure. If you have any questions, do not hesitate to ask the technologist, as he/she will be happy to answer them for you.

For additional information or if you have any further questions, please call the Nuclear Medicine Department at 715-387-5394.

Benefits of a PET/CT scan

  • Earlier Diagnosis
  • Efficiently monitors the effectiveness of treatment
  • May eliminate the necessity of invasive procedures such as biopsies
  • Can be use for pre-treatment planning (whether a person is a surgical candidate)
  • Can be used to locate other sites of metastasis within the body
  • This can help distinguish between several neurological diseases (such as Alzheimers and Dementia)
  • Helps in determining if patients with uncontrolled seizures might benefit from surgery
  • Evaluation of coronary artery disease-blockages in the arteries of the heart
  • Assess the metabolic activity of the heart muscle (helps to determine whether a person would benefit from Coronary Bypass Grafting or a heart transplant)

Description of PET/CT procedures

Oncology Exams

  • An IV is placed in the patient's arm or hand
  • The blood glucose level is tested by the technologist
  • Patient lays quiet and still for 15 minutes
  • After the 15 minute waiting period, the patient receives an injection of FDG (Flourine-18 Deoxyglucose)
  • Patient will then lay quiet and still for another 60-90 minutes
  • Patient is then taken to the PET Scanner
  • Scan may take anywhere from 20-40 minutes
  • After the scan, the images are reviewed by our Nuclear Medicine Physician
  • If no additional images are needed, the patient is free to leave
  • Total test time will take two to three hours

Myocardial Perfusion Imaging using Rubidium-82 (Rb-82)

  • The patient will be asked to undress from the waist up and put on a gown
  • They will be instructed to remove any metal objects from the chest area (jewelry)
  • An IV is placed in a vein in the patient's arm
  • EKG patches are put on the chest to monitor the patient's heart rate and rhythm
  • The patient is placed on the PET/CT imaging table
  • The patient will be asked to place their arms behind their head
  • A CT will be done to correlate the patient's position on the table for the Rubidium imaging
  • The patient then receives an infusion of the radiopharmaceutical (Rb-82), while a 6 minute set of resting images are obtained
  • After the resting images are completed, the stress portion of the test will be performed using a pharmaceutical called Adenosine
  • The pharmaceutical stress occurs for a 7 minute infusion period
  • During the 7 minute stress, the Rb-82 is also being infused and another 6 minute set of images are obtained
  • The technologist and nurse will assist you throughout the entire procedure
  • The images are checked for quality and then the patient is allowed to leave
  • Total Test time is 60 to 90 minutes

Myocardial Viability

  • An IV is placed in a vein in the patient's arm
  • Blood Glucose level is initially checked
  • The patient will be given a bottle of Dexicola to drink, this will cause an increase in the blood glucose levels. At that point, diabetic patients will be instructed to take their diabetic medication
  • The patient's blood glucose will be monitored until the glucose levels begin to come back down
  • An injection of FDG (Flourine-18 Deoxyglucose) will be administered to the patient
  • Images will begin 30-60 minutes after the injection of FDG
  • The images take approximately 15 minutes
  • Total Test time is 1-2 hours

Brain Imaging

  • An IV is placed in a vein in the patient's arm
  • After resting quietly for 30 minutes, an injection of FDG (Flourine-18 Deoxyglucose) will be administered to the patient
  • Patient will need to rest quietly until imaging
  • Imaging will begin 30-60 minutes after the injection of the FDG
  • The imaging will take approximately 20 minutes
  • Total test time is 1-2 hours

Frequently Asked Questions (FAQs)

 

HOW LONG WILL THE TEST TAKE?

The scan will take approximately 2-3 hours.

 

WHEN WILL I GET THE RESULTS?

Following the exam, a Nuclear Medicine physician will review and evaluate your images. These results will be made available to the ordering physician, who will then explain the results to you. The results should be available to you within 24 to 48 hours after the exam.

 

WHAT SHOULD I WEAR TO THE APPOINTMENT?

You will be laying for the better portion of the test so you want to wear comfortable clothing. You will be asked to remove any metal from the clothing you are wearing.  Often you will be asked to put on a pair of hospital pants and a hospital gown.  If you seem to be cold most of the time, it is suggested that you bring a sweatshirt or sweater (without any metal on) with you.

 

WILL I NEED SOMEONE TO DRIVE ME TO AND FROM THE PET/CT SCAN APPOINTMENT?

There are no side effects from the PET scan, so you will be able to drive yourself to and from the appointment.

 

WHAT WILL I EXPERIENCE DURING THE EXAM?

After lying for 15 minutes, a small injection of a radioactive glucose(sugar), will be injected into an IV that had been started into a hand or arm. After lying quietly for another hour, you will be taken to the PET/CT scanner and images will take 20-40 minutes.

 

IS A PET/CT SCAN PAINLESS?

Yes, other than starting the IV, there is no pain involved in a PET/CT scan.

 

WHAT DO I NEED TO DO TO PREPARE FOR THE EXAM?

We would like your blood sugar less than 200 mg/dl. If you are not a diabetic, you will be asked to fast for 8 hours prior to your appointment. If you are a diabetic, you will be asked to fast for only 4 hours prior to your appointment. Instructions will be given to what foods you can have with your insulin.  You will also be asked not to do any form of strenuous activity for 24 hours prior to the appointment time.

ALTHOUGH YOU NEED TO FAST YOU ARE ABLE TO DRINK WATER.

 

IS PET/CT SAFE?

The risks associated with a PET/CT scan are very minimal. The injection is made up of radioactive glucose (sugar). The radiation exposure associated with a PET/CT scan is approximately the same as a CT scan.

 

HOW DOES A PET SCAN DIFFER FROM CT OR MRI SCANS?

CT and MRI scans look at the size and shape of organs and body structures. A PET scan looks at the metabolic activity of the body. The information received from a PET scan is different from any other test that is available.

 

WHEN CAN A PET/CT SCAN BE SCHEDULED?

PET is offered at Ministry Saint Joseph's Hospital Monday through Friday.

National Oncologic PET/CT registry

Recently, the Center for Medicare and Medicaid Services (CMS) announced a broad expansion of coverage for positron emission tomography (PET) scans for virtually all types of cancers. As part of this new reimbursement structure, CMS is asking that referring physicians and a registered facility, in this case Ministry Saint Joseph's Hospital in Marshfield, submit data to a clinical registry to assess the impact of PET on cancer patient management.

This is exciting news for patients. PET scans for all cancer indications will now be covered under the Medicare program if all the proper forms are filled out by the referring physician and the PET facility. There are no additional charges for patients to participate in the PET Registry program. The PET scan will be covered just like any other covered service under the Medicare plan, so any deductibles or gap payments may apply.

Patients will need to give their consent to participate in the research component of the PET Registry program. This consent will be asked for when the PET scan is performed. If a patient declines to participate in the research component of the program, the coverage by Medicare does not change and the patient will still be able to have the PET scan.

For More Information please call the Nuclear Medicine Department at 715-387-7787 or visit www.cancerpetregistry.org.

Patient Preparation

Oncology Studies

  • Wear comfortable clothing
  • You need to be fasting for 8 hours prior to your appointment. If you have diabetes then you are required to fast for 4 hours
  • ALTHOUGH YOU NEED TO FAST, YOU ARE STILL ABLE TO DRINK WATER
  • NO strenuous activity for 24 hours prior to the PET/CT scan appointment
  • Please notify your physician if there is a possibility that you may be claustrophobic.
  • Please notify your physician immediately if you are pregnant, suspect you may be, or are a nursing mother. You will need further evaluation before the PET/CT exam can be conducted.

Cardiac Imaging

DIABETIC PATIENTS

  • Patient must fast for 4 hours prior to the appointment
  • No strenuous exercise 24 hours prior
  • The patient should bring along their insulin or oral diabetic medication

NON-DIABETIC PATIENTS

  • Patient must fast for 4 hours prior to the appointment
  • no strenuous exercise 24 hours prior

RUBIDIUM-82 FOR MYOCARDIAL PERFUSION

  • NO caffeine products after midnight the day of the exam
  • Nothing to eat or drink 1 hour prior to the appointment
  • Discontinue asthma medications for 48 hours prior to the appointment
  • Discontinue nitroglycerin patch for 20 minutes prior to the appointment

Neurological Imaging

  • No patient preparation

PET/CT Reimbursement

Ministry Saint Joseph's Hospital follows the requirements for reimbursement set by Medicare and Medicaid.  Although most insurance companies follow these same guidelines, it is recommended that people contact their private insurance companies with any concerns or questions regarding PET scan reimbursement requirements.

PET REIMBURSEMENT SUMMARY
As of April 2004
Select for an easy to print table

 

Clinical 
Conditions
Reimbursement
(with limitations)
Clinical Indication
Breast Cancer[i] Staging, restaging, & monitoring of treatment
  • Staging of patients with metastasis outside a localized region
  • Restaging localized region for metastasis
  • Evaluation of effectiveness of treatment
 Colorectal Cancer  Diagnosis, Staging, and Restaging
  • Indications for staging and restaging include rising CEA marker.
  • Stage of cancer remains in doubt after completion of a standard diagnostic work up Restaging after completion of treatment.
  • Clinical management would change, depending on the stage of the cancer identified
 Esophageal Cancer  Diagnosis, Staging, and Restaging
  • Pre-surgical staging to assess the extent of the disease
  • Stage of cancer remains in doubt after completion of a standard diagnostic work up
  • Restaging after completion of treatment.
  • Clinical management would change, depending on the stage of the cancer identified
 Head and Neck Cancer
 (excludes CNS and thyroid carcinoma)
 Diagnosis, Staging, and Restaging
  • Reveal the site of the primary tumor to prevent unnecessary random biopsies or unneeded radiation
  • Stage of cancer remains in doubt after completion of a standard diagnostic work up.
  • Restaging after completion of treatment.
  • Clinical management would change, depending on the stage of the cancer identified.
Lung Cancer
(Non-Small Cell)
Diagnosis, Staging, and Restaging
  • There must be evidence of a primary tumor which is pathologically confirmed
  • Evidence of a tumor on a current thoracic CT scan
  • Stage of cancer remains in doubt after completion of a standard diagnostic work up.
  • Restaging after completion of treatment.
  • Clinical management would change, depending on the stage of the cancer identified
Lymphoma Diagnosis, Staging, and Restaging [ii]
  • Can take the place of a Gallium scan
  • Stage of cancer remains in doubt after completion of a standard diagnostic work up
  • Restaging after completion of treatment.
  • Clinical management would change, depending on the stage of the cancer identified
Melanoma

Diagnosis, Staging, and Restaging

  • Cannot be used for the regional evaluation of nodes
  • Stage of cancer remains in doubt after completion of a standard diagnostic work up
  • Restaging after completion of treatment.
  • Clinical management would change, depending on the stage of the cancer identified
Cardiac Viability Primary or Initial diagnostic evaluation
  • Can be used as a primary or initial diagnostic exam prior to revascularization.
Seizure Disorders Pre-surgical Evaluation
  • Only for pre-surgical evaluation of seizure localization
Single Pulmonary Nodule (SPN) Single Nodule within the Lung
  • Purpose is to examine a single lung nodule and determine the likelihood of malignancy. [iii]
  • Stage of cancer remains in doubt after completion of a standard diagnostic work up
  • Restaging after completion of treatment.
  • Clinical management would change, depending on the stage of the cancer identified

Thyroid Cancer

Restaging
  • Recurrent or residual thyroid carcinoma of follicular cell orgin.[iv]

Medicare Definitions:

Diagnosis:

PET is covered only in clinical situations in which the PET results may assist in avoiding an invasive diagnostic procedure, or in which the PET results may assist in determining the optimal anatomical location to perform an invasive diagnostic procedure. In general, for most solid tumors, a tissue diagnosis is made prior to the performance of PET scanning. PET scans following a tissue diagnosis are performed for the purpose of staging, not diagnosis. Therefore, the use of PET in the diagnosis of lymphoma, esophageal, and colorectal cancers as well as in melanoma should be rare. PET is not covered for other diagnostic uses, and is not covered for screening (testing of patients without specific signs and symptoms of disease).

Staging and Restaging:

PET is covered in clinical situations in which 1) (a) the stage of the cancer remains in doubt after completion of a standard diagnostic work up, including conventional imaging (computed tomography, magnetic resonance imaging, or ultrasound) or (b) the use of PET would also be considered reasonable and necessary if it could potentially replace one or more conventional imaging studies when it is expected that conventional study information is insufficient for the clinical management of the patient and 2) clinical management of the patient would differ depending on the stage of the cancer identified. PET will be covered for restaging after the completion of treatment for the purpose of detecting residual disease, for detecting suspected recurrence or to determine the extent of a known recurrence. Use of PET would also be considered reasonable and necessary if it could potentially replace one or more conventional imaging studies when it is expected that conventional study information is insufficient for the clinical management of the patient.

Monitoring:

Use of PET to monitor tumor response during the planned course of therapy (i.e., when no change in therapy is being contemplated) is not covered except for breast cancer. Restaging only occurs after a course of treatment is completed, and this is covered, subject to the conditions above.

[i] Medicare continues to have a national non coverage determination for initial diagnosis and staging of axillary lymph nodes.Medicare covers FDG PET as an adjunct to other imaging modalities for staging patients with distant metastasis, or restaging patients with locoregional recurrence or metastasis. Monitoring treatment of a breast cancer tumor when a change in therapy is contemplated is also covered as an adjunct to other imaging modalities.

[ii] A PET scan will be allowed for restaging no sooner than 50 days following the last staging PET scan or Gallium scan, unless sufficient evidence is presented to the Medicare contractor that the restaging at an earlier date is medically necessary

[iii] When evaluation of a SPN using both CT and regional PET chest scanning, PET scans will not be covered if repeated within 90 days following a negative PET scan.

[iv] Patient must have treated by a thyroidectomy and radioiodine ablation.Must also have a serum thyroglobulin > 10 ng/ml and a negative I-131 wholebody.All other uses of PET is not covered

Reasons for a PET/CT scan

  • For people with certain types of cancer
  • For people with Coronary Artery Disease
  • For people with uncontrolled seizures
  • For people with Alzheimer's Disease

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