Patient History

The patient is a 57 year old white female with a previous history of lung cancer. She previously had a CT scan on 10/1/03 which was used in fusing with her PET scan which was performed on 2/3/04.  Is there any significant impact to such a lapse of time between the CT and P.E.T. procedure?

Radiopharmacy

11.78 mCi of F-18 FDG was injected via catheter in right antecubital vein.

Procedure

  After the injection the patient was reclined back and asked to sit still and relax. What happens if the patient is uncomfortable and wants to get up and walk around or use the rest room?  After 30 minutes a technologist went into the room to remove the catheter. After another 20 minutes the patient was sat up and asked to empty her bladder before the scan to reduce her exposure and improve the images to come.  How does the bladder relate to the normal biodistribution of FDG-18 in the human body?

Positioning

  The patient positioned supine on the table with a Velcro strap around her torso and her hands above her head. The table was then elevated and moved forward into the gantry. Using lasers, the patient was marked from her eyebrows and again at her upper thigh (“Eyes to thighs”). The result was 6 bed lengths.  What is a bed length?  Is this a universal standard?

Findings

  The images were reviewed by a radiologist in parasagittal, transaxial, and transcoronal planes. As noted on the patient’s previous CT exam there is a very large mass identified within the left upper lung. There is associated central photopenia (what does this mean?) which is consistent with necrosis. The standard uptake value (SUV) associated with the mass is markedly elevated at 9.225 grams/ml. How are these units significant? The also is a nodule identified in the left lower lobe with another nodule being identified in the right middle lobe. These both have elevated SUV levels and are consistent with metastatic lesions. What factors make this consistent with metastatic lesions?  Does this mean for sure that the patient is positive for lung cancer doesn’t have to have a biopsy? There is also increased activity identified within multiple mediastinal lymph nodes.

Discussion

Technologist's Concerns