Society of Nuclear Medicine Procedure Guideline for Tumor Imaging Using F-18 FDG

There is a growing body of evidence for the use of FDG in the differentiation of malignant from benign disease, staging and grading of malignant disease, differentiating recurrent or residual disease from therapy induced changes, and monitoring the response to therapy. Depending on the clinical question and type of equipment available, the FDG imaging procedure may include: A. Limited Field Tomographic Images: usually performed when critical abnormalities are likely to be localized in a known region of the body (e.g. probable lung carcinoma, evaluation of hilar lymph node involvement). B. Dynamic Tomographic Images: consist of multiple sequential three dimensional images in a limited field. This type of acquisition is often used when quantitation of regional metabolic rates is needed. C. Whole Body Tomographic Images: usually performed to survey the entire body in the search for areas of abnormal FDG accumulation. D. Attenuation Correction: the method for correcting emission photon attenuation by either: 1. Transmission Imaging: A set of corresponding images are acquired with an external source of radiation. Typically, these images are acquired with PET. 2. Mathematical Attenuation Correction: typically used in brain imaging, where an estimated attenuation correction based on the emission data may be used instead of actually acquiring transmission data. 3. Hybrid Attenuation Correction: This method consists of a short (approximately 2 min) transmission measurement, followed by an image segmentation to generate a calculated attenuation map.