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Practical Approach to Diagnostic CT Combined with PET

¹ All authors: Department of Radiology, Duke University Medical Center, Box 3949 Duke University Medical Center, Durham, NC 27710.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Schemas for CT and PET examination of oncology patients. Serial study approach. CT scan is obtained first, and then PET is performed if needed. Coregistered PET and CT images can be obtained with fusion software.

View larger version (6K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Schemas for CT and PET examination of oncology patients. Combined study approach. Hybrid PET/CT scanners allow acquisition of diagnostic-quality CT (DCT) scans and PET images in one imaging session.

View larger version (32K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —PET/CT request form. Referring physicians choose one of four types of PET/CT studies and whether routine or whole-body imaging is desired. This form has greatly facilitated communication among referring physicians, technical staff, and interpreting physicians.

View larger version (21K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Graph shows monthly volume of various types of PET/CT and PET/diagnostic CT (DCT) studies performed from January 2004 to March 2006. Proportion of PET/diagnostic CT studies has grown and accounts for approximately 30% of all PET studies at Duke. + = contrast material used, - = contrast material not used, Ch = chest.

View larger version (67K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —53-year-old man with lymphoma (not shown). CT-based attenuation-correction PET images (B, D) and CT scans (A, C) obtained without (A, B) and with (C, D) IV contrast material. Even in regions of very high density in right subclavian vein, presence of IV contrast material has no noticeable effect on attenuation-corrected images. Newer attenuation-correction algorithms have reduced or eliminated problem of artifactually increased activity that previously occurred in regions of high contrast enhancement.

View larger version (51K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —53-year-old man with lymphoma (not shown). CT-based attenuation-correction PET images (B, D) and CT scans (A, C) obtained without (A, B) and with (C, D) IV contrast material. Even in regions of very high density in right subclavian vein, presence of IV contrast material has no noticeable effect on attenuation-corrected images. Newer attenuation-correction algorithms have reduced or eliminated problem of artifactually increased activity that previously occurred in regions of high contrast enhancement.

View larger version (69K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —53-year-old man with lymphoma (not shown). CT-based attenuation-correction PET images (B, D) and CT scans (A, C) obtained without (A, B) and with (C, D) IV contrast material. Even in regions of very high density in right subclavian vein, presence of IV contrast material has no noticeable effect on attenuation-corrected images. Newer attenuation-correction algorithms have reduced or eliminated problem of artifactually increased activity that previously occurred in regions of high contrast enhancement.

View larger version (53K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —53-year-old man with lymphoma (not shown). CT-based attenuation-correction PET images (B, D) and CT scans (A, C) obtained without (A, B) and with (C, D) IV contrast material. Even in regions of very high density in right subclavian vein, presence of IV contrast material has no noticeable effect on attenuation-corrected images. Newer attenuation-correction algorithms have reduced or eliminated problem of artifactually increased activity that previously occurred in regions of high contrast enhancement.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Volunteer showing upper body immobilization technique with arms-up positioning. Patients are supported securely on scanner table with straps, and towels or sheets are used to maintain patient comfort. Board has hand grips for helping patient comfortably raise arms during scans.

View larger version (96K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —54-year-old woman with progressive systemic sclerosis. Conventional diagnostic thoracic CT scan obtained 10 days before CT at end-tidal volume as part of PET/CT study. Area of left lower lobe fibrosis is evident.

View larger version (108K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —54-year-old woman with progressive systemic sclerosis. CT scan at end-tidal volume from PET/CT shows lower lung volumes result in mild dependent atelectasis and minimal ground-glass opacity. These effects are more profound at lung bases.

View larger version (62K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —29-year-old woman with breast cancer. Example of CT tube current modulation along z-axis with automated CT tube current modulation. Image quality is maintained by use of higher tube current in pelvis. Lower tube current is needed in neck and thorax, reducing radiation dose to patient.

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