Intro to PET/CT Imaging at the

Gordon Center for Medical Imaging

Put together for you by:

Julia Kaiser
Nicole DaSilva
Meredith Minns
 SPECT

MEDICAL IMAGING MODALITIES

1. X-ray
2. CT – Computed Tomography PET/CT
3. MRI – Magnetic Resonance Imaging
(also called MR)
C
4. Ultrasound T
5. General Nuclear Medicine
MRI
a) Gamma Cameras
b) Cardiac Cameras
c) SPECT – Single Photon Emission
Computed Tomography
6. PET – Positron Emission Tomography
DIFFERENCES BETWEEN IMAGING
MODALITIES 1. X-ray: Uses x-rays from a stationary source to create 2D
image
2. CT: Uses x-rays in a circular source to create 3D images in
slices
3. MRI: Uses changes in magnetic fields to create 3D images
4. Ultrasound: Uses sound waves to create 2D& 3D images
5. Nuclear Medicine: Uses radiation from gamma ray emitting
radioisotopes injected into patient to generate 2D and 3D
pictures
a) Gamma Camera: Generates 2D pictures
b) Cardiac Cameras: Specifically designed for generating 3D
pictures of the heart
c) SPECT: Generates 3D pictures
6. PET: Uses radiation from positron emitting radioisotopes
injected into the patient to generate 3D pictures
 PET-MR

MULTI-MODALITY SCANNERS
• Some scanners use 2 different modalities in the
same scanner.
• PET/CT
• PET-MR
• SPECT/CT
• These take 2 images either sequentially (PET/CT
& SPECT/CT) or simultaneously (PET-MR) and
fuse the images together
AT GCMI WE PERFORM RESEARCH SCANS ON:

• Siemens HR+ PET only – White 224

• GE Discovery MI PET/CT – Edwards Basement 003
• Siemens Biograph 64 PET/CT– Blake 262 (Clinical)
• PDS NeuroPET/CT – White 224
• Coming Soon!
• CareMiBrain – dedicated PET only brain scanner in Bulfinch
Basement 051
• GE PET-MR – Blake 2 across from PET/CT area CareMiBrain
STEPS TO PERFORM A PET/CT SCAN PART 1

1. Radiotracer production
a. Can be done in-house by Gordon PET Pharmacy or by
external pharmacy, i.e. Sophie, Cardinal Health, etc.
b. Transport dose from pharmacy to imaging suite
2. Participant arrival & check-in
1. Verify identity, consent & screening
3. Explain study to participant & answer questions
4. Place IV for injection
5. Have participant use restroom to empty bladder
STEPS TO PERFORM A PET/CT SCAN PART 2

• Radiotracer is measured before injecting.

• IV is used for injection and then flushed with saline.
• Perform radiotracer injection
• Can be done on the scanner for full dynamic imaging, starting
simultaneously with the PET scan.
OR
• Can be done prior to scanning; participant will wait the
appropriate uptake time, and then be positioned on the scanner.
• Radiotracer residual activity is measured after the injection to
calculate the exact injected dose.
 STEPS TO PERFORM A PET/CT SCAN PART 3
• Position participant on the scanner
• Can be head-first or feet-first depending on type of imaging
• Cover with blanket if needed
• Use straps & cushions for comfort and to immobilize region
of interest
• Remind participant they need to hold very still
• There is a microphone in the scanner for communication
with Technologist while scanning
• Perform CT scan or transmission image (PET only
scanners) for attenuation correction
• Perform PET emission scan
STEPS TO PERFORM A PET/CT SCAN PART 4

• Once scan is complete participant is taken out of the

scanner and is free to go
• Images are reviewed for quality and motion
• If tracer injection was simultaneous with the start of
the scan, then the tracer information is added
• Images are reconstructed and processed, and
transferred to study staff or uploaded per protocol
requirements
TYPES OF PET SCANS
• Dynamic Imaging (1 bed position)
• Whole Body Imaging (multi-bed positions)
• Inject radiotracer simultaneously with starting the
PET scan • Inject prior to scan and wait appropriate uptake
time
• Can also be done with injection prior to scanning
and waiting an appropriate uptake time before • Multiple images (bed positions) are taken
beginning scan sequentially while the bed moves through the
scanner and then combined to make one image of
• Participant stays in the same position throughout
the total field of view.
imaging procedure
• Multiple images (frames) acquired of the same
field of view over time
PET ISOTOPES
• This is the radioactive component
of a Radiotracer
• Emit positrons which are detected
by the scanner
• Have short half-lives
• Most common isotopes:
• Flourine-18

• Carbon-11
• Nitrogen-13
• Gallium-68
PET RADIOTRACERS

• A Radiotracer combines the radioactive

component with a chemical component which
determines where in the body the tracer is taken
up
• Usually injected intravenously but can also be
ingested or via other routes
• Grouped by target areas/diseases
• We use both FDA approved tracers and ones
that are covered under IND (FDA) or RDRC
(MGH RSC) for research only
ANCILLARY PROCEDURES WITH A PET SCAN

• Additional procedures may be

required with a PET scan including:
• Pregnancy test (for all women of
child-bearing potential)
• Arterial blood sampling
• Venous blood sampling
• Measuring vitals
• Gated imaging (respiratory or
cardiac)
COMMON PET PROTOCOLS
PiB/T807 Combo
• 11C-PiB inject 15 mCi & scan
from 0-60 or 0-70 mins
• 18F-T807 inject 10 mCi,
uptake of 75 min & scan for
30 mins.
Whole-body FDG
• Test blood glucose
• 18F-FDG inject 10-20 mCi,
uptake of 60 mins & whole-
body scan (eyes to thighs),
image 5 mins per bed position.
MK6240 (2 options)
• 18F-MK6240 inject 5 mCi & scan
0-120 mins with possible break
from 65-80 min
• 18F-MK6240 inject 5 mCi, uptake
of 90 min & scan for 30 mins.
Brain FDG
• Test blood glucose
• 18F-FDG inject 5 mCi, uptake of
30-45 mins & scan for 15-30 mins
Florbetaben
• 18F-FBB inject 8 mCi, uptake
of 90 mins & scan for 20 mins
mins with possible break from
65-80 min
MENER
• 11C-MENER inject 15 mCi &
scan 0-120 mins with possible
break from 45-60 min
IMPORTANT THINGS TO TELL PARTICIPANTS
BEFORE THEIR SCANS:

• There is often a lot of waiting involved, bring something to do!

• Wear comfortable clothing and not a lot of jewelry
• If fasting is required, or not for their scan, and how long
• Don’t hesitate to ask questions!
• The full duration of the entire imaging procedure is often several hours, they should
know both the arrival time and estimated completion time
• Give a brief description of the PET procedure, based on the specific protocol, so
they know what to expect (repetition helps them be prepared!)
 We are always happy to answer
questions and assist in any way we
can with making the scanning
process smooth and worry-free for
participants!

THANK YOU!