Society of Nuclear Medicine Procedure Guideline for FDG PET Brain Imaging
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Procedure Guideline for FDG-PET Brain Imaging v1.0 1
Society of Nuclear Medicine Procedure Guideline for
FDG PET Brain Imaging
Version 1.0, approved February 8, 2009
Authors: Alan D. Waxman, MD; Karl Herholz, MD; David H. Lewis, MD; Peter Herscovitch, MD; Satoshi
Minoshima, MD; PhD, Masanori Ichise, MD; Alexander E. Drzezga, MD; Michael D. Devous, Sr., PhD;
James M. Mountz, MD, PhD
I. Purpose function. Under physiological conditions
glucose metabolism is tightly connected to
The purpose of this guideline is to assist nuclear neuronal activity. [18F]FDG is suitable for
medicine practitioners in recommending, imaging regional cerebral glucose
performing, interpreting, and reporting the results of consumption with PET since it accumulates
F-18FDG brain metabolic imaging. in neuronal tissue depending on facilitated
transport of glucose and hexokinase
II. Background information and definitions mediated phosphorylation. Therefore
changes in neuronal activity induced by
A. The document considers the work of disease are reflected in an alteration of
previous guideline organizations such as the glucose metabolism. [18F]FDG-PET is
German Inter Disciplinary Consensus currently the most accurate in-vivo method
Conference on Clinical Brain PET, The for the investigation of regional human
Austrian Guideline for the Use of FDG-PET brain metabolism in health and disease
in Neurology and Psychiatry, The Society states.
of Nuclear Medicine Procedure Guidelines C. The clinical use of [18F]FDG can be
for Tumor Imaging Using F-18 FDG, The regarded as established for a number of
Society of Nuclear Medicine Brain Imaging diagnostic questions in neurology,
Council and by individual experts neurosurgery and psychiatry. This
throughout the world. information is often complementary to the
B. In the brain, glucose metabolism provides anatomic detail provided by structural
approximately 95% of adenosine imaging techniques such as CT or MRI.
triphosphate (ATP) required for brain However, functional impairment often
The Society of Nuclear Medicine (SNM) has written and approved these guidelines as an educational tool
designed to promote the cost-effective use of high-quality nuclear medicine procedures or in the conduct of
research and to assist practitioners in providing appropriate care for patients. The guidelines should not be
deemed inclusive of all proper procedures nor exclusive of other procedures reasonably directed to obtaining the
same results. They are neither inflexible rules nor requirements of practice and are not intended nor should they
be used to establish a legal standard of care. For these reasons, SNM cautions against the use of these guidelines
in litigation in which the clinical decisions of a practitioner are called into question.
The ultimate judgment about the propriety of any specific procedure or course of action must be made by the
physician when considering the circumstances presented. Thus, an approach that differs from the guidelines is
not necessarily below the standard of care. A conscientious practitioner may responsibly adopt a course of action
different from that set forth in the guidelines when, in his or her reasonable judgment, such course of action is
indicated by the condition of the patient, limitations on available resources, or advances in knowledge or
technology subsequent to publication of the guidelines.
All that should be expected is that the practitioner will follow a reasonable course of action based on current
knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole
purpose of these guidelines is to assist practitioners in achieving this objective.
Advances in medicine occur at a rapid rate. The date of a guideline should always be considered in determining
its current applicability.
1Procedure Guideline for FDG-PET Brain Imaging v1.0 2
precedes structural changes, and may also injection.
exist alone. Thus PET imaging provides b. Blood Glucose - Should be checked
unique information that is often prior to FDG administration.
complementary to anatomic imaging (1) If greater than 150 - 200 mg/dL,
information. most institutions reschedule the
patient. When hyperglycemia is
III. Procedure present, there is increased
competition of elevated plasma
A. Patient Preparation glucose with FDG at the carrier
1. Pre-arrival (Patient Instruction) enzyme and is often usually
a. Patient should be fasting for 4 - 6 associated with high
hours. intracellular glucose and
b. Oral hydration with water is circulating insulin levels
encouraged. driving FDG into muscle
c. Avoid caffeine, alcohol, or drugs resulting in reduced uptake in
that may affect cerebral glucose the brain.
metabolism. (2) Lowering serum glucose by
d. Required medications should be administration of insulin can be
taken with water. considered, but the
e. Intravenous fluid containing administration of FDG should
dextrose or parenteral feeding be delayed following insulin
should be withheld for 4 – 6 hours. administration (with the
f. Pregnancy and breastfeeding – See duration of the delay dependent
Society of Nuclear Medicine on the type and route of
procedure Guidelines for general administration of insulin),
imaging. probably because the correction
2. Pre-injection of increased intracellular
a. Environment – Should be stable for glucose levels lags behind the
at least 30 minutes prior to FDG correction of the plasma
injection and in the subsequent glucose level.
uptake phase (at least 30 minutes). (3) Best results for clinical FDG
(1) The patient should be placed in imaging of the brain in
a quiet, dimly-lit room. diabetics can be achieved in a
(2) Background noise is acceptable euglycemic situation during
with eyes open. stable therapeutic management.
(3) Alternatively, studies can be c. Bladder
performed with eyes closed if (1) Before the scanning procedure
this is being done consistently is started, the patient should
across comparable scans. void the bladder for maximum
(4) The patient should be seated or comfort during the study.
reclining comfortably. (2) Advise the patient to void again
(5) Place intravenous access at after the scanning session to
least 10 minutes prior to minimize radiation exposure.
injection to permit d. EEG
accommodation. (1) For preoperative evaluation of
(6) Instruct the patient to relax, not epilepsy, continuous EEG
to speak or read and to avoid recording is recommended.
major movements. (2) Monitoring should start ideally
(7) Minimize interaction with the 2 hours before injection in order
patient prior to, during, and up to ensure that FDG is not
to at least 30 minutes post administered in a post-ictal
2Procedure Guideline for FDG-PET Brain Imaging v1.0 3
state and should be maintained influence regional metabolic rate of
at least until 20 minutes post- glucose. If possible, centrally acting
injection. For adequate image pharmaceuticals should be
interpretation, it is important to discontinued.
be aware if seizures occurred d. History of diabetes, and knowledge
prior to imaging. of patient’s fasting state.
B. Information Pertinent to Performing the e. Patient’s ability to lie still for the
Procedure duration of the acquisition (30
1. History minutes to 1 hour). If sedation is
a. A focused history should be required (e.g. patients with
obtained including any past or Dementia or children), it should be
current drug use or head trauma, performed after the uptake period
neurological examination, prior to imaging.
psychiatric exam, mental status f. If sedation is necessary, it should be
exam (e.g. Folstein mini-mental performed as late as possible
examination or other following administration of FDG.
neuropsychological test), memory C. Precautions
impairment, stroke, TIA or epilepsy 1. Supervision
(type, location). History of brain a. Continuous supervision of patients
tumor (type and location), prior during the procedure is important.
brain operations including shunt b. Actual interaction should be kept at
procedures should also be noted. a minimum to avoid the effects of
b. Recent morphologic imaging functional activation on glucose
studies (e.g. CT, MRI or prior PET metabolism.
or SPECT brain studies). c. Deviation from resting state during
c. Current medications and when last the uptake period and scanning
taken. These would include anti- needs to be recorded and considered
seizure medication, chemotherapy when interpreting scans.
for brain tumors, anticholinesterase 2. Pregnancy is a relative contraindication
drugs for memory impairment in especially during the first trimester.
addition to psychotropic 3. Refrain from breastfeeding for 24 hours.
pharmaceuticals. These may
D. Radiopharmaceuticals
Radiation Dosimetry in Adults
Radiopharmaceuticals Administered * Organ Receiving the Largest Effective Dose **
Activity Radiation Dose **
mGy per MBq
MBq (rad per mCi) mSv per MBq
(mCi) (rem per mCi)
[F-18]-2-fluoro-2-deoxy- 185 - 740 0.16 0.019
D-glucose (5 – 20) Urinary Bladder (0.070)
(0.59)
* Depends on equipment limitations, specific application and patient compliance.
3Procedure Guideline for FDG-PET Brain Imaging v1.0 4
Radiation Dosimetry in Children
Wt adjust
Radiopharmaceuticals Administered Organ Receiving the Largest Effective Dose **
Activity Radiation Dose **
mGy per MBq
MBq/ Kg (rad per mCi) mSv per MBq
(mCi)/Kg (rem per mCi)
[F-18]-2-fluoro-2-deoxy- 5.18 – 7.4 0.32 0.050
D-glucose (0.14 – 0.20) Urinary Bladder (0.18)
(1.2)
* International Commission on Radiation Protection; Elsevier; 2000:49, ICRP Publication 80.
E. Image Acquisition (2) Variations on the basic design
1. Depending on the clinical question and include the partial ring BGO
type of equipment available, FDG dedicated PET scanner and the
imaging may include: dedicated PET scanner with six
a. Static limited field tomographic position-sensitive sodium
images. iodide detectors.
b. Dynamic tomographic images. b. Alternatives to dedicated PET
(1) Multiple sequential images in a scanners
field of view, usually covering (1) Gamma camera with 511 keV
the whole brain. collimators imaging single
(2) May be used when absolute scintillations. (not
quantification of regional recommended)
metabolic rates of glucose is (2) Dual-head gamma camera for
needed. coincidence imaging (no
c. 2D Mode - Coincidence detection collimators). Extremely limited
only between adjacent detector performance characteristics.
rings. Septa usually separate small (3) CT-PET scanner: In this system
groups of rings. a CT scanner is combined with
d. 3D-acquisition mode - Coincidence the PET components of a full
detection using all detector rings. ring BGO/LSO/GSO/LYSO
No septa between rings. scanner. This makes it possible
e. For other dedicated PET-systems to have PET images corrected
(i.e. sector tomographs), not based by CT attenuation data and
on full detector rings, equivalent concomitant co-registration of
acquisition modes are existent. functional images from PET
2. Scanners and morphological images from
a. State-of-the-art dedicated PET CT. This system is becoming
scanner the dominant choice due to
(1) A state-of-the art whole-body manufacturing trends.
PET scanner consists of several (4) Dedicated brain PET
full rings detectors BGO scanners – These specialized
(Bismuth Germanate machines may have superior
Orthosilicate) or LSO performance parameters
(Lutetium Orthosilicate) or
when compared to full-body
GSO (Gadolinium
Orthosilicate) or LYSO
scanners and are mainly used
(Lutetium Yttrium for research applications.
Orthosilicate).
4Procedure Guideline for FDG-PET Brain Imaging v1.0 5
Comparison of scanners is beyond the adequate count density.
scope of this document. The (c) Scatter correction can be
performance of the coincidence scanner obtained by removal of
systems has been the subject of debate, non-coincidence events
especially with regard to their costs and from the emission data.
diagnostic accuracy compared to (2) Transmission scan -
dedicated PET scanners. Limitations Transmission imaging (images
include sensitivity, count rate, activity acquired with an external
outside the field of view. At present the source):
general opinion is that their clinical (a) Cold transmission - the
reliability is lower than that of full ring standard procedure for
BGO/LSO/GSO/LYSO scanners. There older generation full ring
is general agreement in the international PET systems is the
nuclear medicine community that the measurement of attenuation
standard for PET is the dedicated prior to FDG-injection. A
scanner with a full ring of Ge-68/68-Ga source is
BGO/LSO/GSO/LYSO detectors on the commonly used as an
basis of its excellent physical and external source of radiation
clinical performance and the extensive and serves to correct the
clinical experience in its application in subsequent emission scan
brain studies worldwide. For this reason for attenuation.
this procedure guideline will focus on (b) Hot transmission -
these systems. transmission imaging
following FDG injection is
3. Limited-field tomographic images. less favorable with Ge-
a. This static scan consists of an 68/68-Ga because of the
emission scan and a transmission potential underestimation of
scan. attenuation of structures
(1) Emission scan with high uptake, especially
(a) The emission acquisition in sub-cortical regions.
typically begins 30-60 4. Pre-Emission Attenuation Correction
minutes post injection and a. The sequence of the two scans
lasts between 5 and 60 (scanning protocols) and the
minutes depending on the techniques for performing
injected activity, the type of transmission scans vary according
scanner and acquisition to the tomographic system available
protocol used (2D or 3D). and be extremely time consuming.
(b) Adequate scans including b. Exact positioning of the patient’s
attenuation correction can head is attempted by external
be completed in 5 minutes markers, e.g. with the cross-
on a state of art PET/CT shaped laser marking system
with 740 MBq FDG lower
available in some scanners.
dose (185 MBq) slower
(1) Patient cooperation is important
systems may require
(ability to lie still for approx. 30
additional time to acquire
minutes).
sufficient count density;
(2) If necessary, tools to aid
most systems today use 3D
immobilization (e.g. head elastic
acquisition. IF 2D
bands) may be used.
acquisition is used, longer
5. Post Emission attenuation correction
acquisition times are
a. If a Cesium 133 or CT x-ray source
required to achieve
5Procedure Guideline for FDG-PET Brain Imaging v1.0 6
is used, the attenuation may be done (2) Contours should be defined for
following FDG injection due to a each individual transaxial slice.
high photon flux relative to (3) Correct shape and position of
emission data. the contours should be
b. Correction factors are obtained by reviewed prior to calculation of
measuring the ratio between a blank the corrected slices.
scan (performed without patient in d. It is important to note that the
scanner) and a transmission scan different mathematical correction
(performed with an external source procedures lead to systematic
when the patient is in position). differences in the resulting images,
Positional differences will result in making images obtained with
major artifacts. different correction procedures not
6. If repositioning of the patient is directly comparable (e.g. with
necessary, great care should be taken to statistical subtraction analyses on a
minimize positional differences. voxelwise basis).
7. Hybrid attenuation correction e. Differences may appear especially
(attenuation map calculated from a in the occipital and cerebellar
transmission measurement followed by regions.
a segmentation image): These methods f. Measured attenuation correction is
calculate an attenuation image based on preferable to calculated specially if
a short transmission measurement post emission techniques used.
followed by image segmentation. 10. Dynamic studies
8. CT-based attenuation correction of the a. Dynamic studies consist of a
brain in PET/CT-scanners. sequence of serial images in a
a. In CT-PET systems the photon limited field, starting at the time of
attenuation correction is obtained FDG administration and continuing
by means of a measured correction for 60-90 minutes.
matrix from a simultaneously (1) The acquisition modalities for
assessed CT scan in line with PET dynamic studies are only briefly
b. The CT map has to be transformed mentioned here because they
into a 511keV attenuation map by are not commonly used in
segmentation and absorption clinical routine.
correction and forward projection of (2) This type of acquisition is used
the data for use as attenuation to quantitatively assess the
correction data. regional rates of FDG
9. Mathematical attenuation correction - metabolism by determining
estimated attenuation correction based appropriate kinetic rate or
on the emission data: Not commonly influx constants.
performed since post emission (3) Determination of arterial input
attenuation systems now commonly function is needed.
available. (4) Measurements of FDG and
a. Correction procedures estimating glucose plasma levels are
the attenuation based on the required.
estimation of organ density from (5) A calibration factor between the
emission data (i.e. according to scanner events and in vitro
Chang). activity is needed and can be
b. Accurate skull attenuation lacking. attained by phantom imaging.
c. Shape contouring should be used if (6) Simplified methods for
available. calculation of regional
(1) Contours should include scalp metabolic rates of FDG using
and not just grey matter.
6Procedure Guideline for FDG-PET Brain Imaging v1.0 7
static scanning and 4. Re-slicing of reconstructed images
arteriolized venous blood helps achieve consistent orientation of
sampling provides a the images for interpretation. Sagittal
compromise between full and coronal views along with axial
projections are important in
metabolic quantitation and
characterizing specific anatomic sites.
quantitation of FDG uptake 5. Volume rendering may be helpful for
relative to a reference region more accurate topographic orientation
in the brain. in some clinical applications. However,
F. Image Processing such display may also be subject to
1. Images are reconstructed in the form of artifacts and must be used with caution.
transaxial 128 x 128 or 256 x 256 6. 3D coregistration with MR structural
matrix size.
data can facilitate anatomically
2. Typical pixel size is 2-4 mm.
3. Depending on the resolution of the PET
accurate reporting.
H. Image Interpretation
system, a final image resolution may
1. The extent of normal variability must be
vary between 2.5 -10 mm FWHM. This
appreciated during scan interpretation.
typically yields adequate image
Substantial variability may be noted
resolution and signal to noise ratios.
between normal individuals and
4. For reconstruction using filtered back
between scans of a single subject
projection, commonly used filters are
obtained at different times.
Hanning or Shepp-Logan.
2. Individual clinics should obtain or be
5. Iterative reconstruction is increasingly
familiar with an appropriate normal
being employed.
database to best interpret patient
6. Processing of gamma camera
studies.
coincidence detection data generally
3. Unprocessed projection images should
employs iterative reconstruction
be reviewed in cinematic display prior
techniques.
to viewing of tomographic sections.
7. Refer to camera manufacturer’s 4. Projection data should be assessed for
recommendations for best choices of the presence and degree of patient
iterations, subsets, and smoothness. motion, target-to-background ratio and
G. Data Display other potential artifacts.
1. Reconstructed transverse images can be 5. Inspection of the projection data in
displayed for quality control and sinogram form may also be useful.
interpretation. 6. Images should be viewed on a computer
2. Additional re-sliced images in coronal screen rather than from film or paper
and sagittal sections should be copy to permit interactive adjustment of
displayed routinely, which often helps contrast, background subtraction and
better delineation of lesions. color table.
3. Using volume re-slicing software, 7. Caution must be used in selecting levels
transverse slices are most commonly re- of contrast and background subtraction.
sliced to fit the bi-commissural line (the 8. Non-continuous color scales may be
line passing through the anterior and confusing or misleading if abrupt color
posterior commissures, which can be changes occur in the range of expected
approximated by the line passing gray matter activity.
through the anterior and posterior poles 9. Thresholding, if used, should be based
of the brain). Re-slicing along the upon knowledge of a normal database
hippocampal axis (parallel to the for FDG and instruments used in
temporal lobe) is preferred for acquiring the study. Artifacts can be
evaluation of suspected temporal lobe created when inappropriate thresholding
epilepsy.**
7Procedure Guideline for FDG-PET Brain Imaging v1.0 8
is performed. by compartmental modeling, or
10. Comparison of serial images to assess influx constants by graphical
worsening or improvement requires analytic approaches.
appropriate normalization techniques to d. Correction factors, including the so
avoid artificially created differences. called ”lumped constant” (LC =
Differences in threshold settings, color 0.42 – 0.82), can be used to convert
or Grey scale windowing, SUVs of the FDG values to values reflecting
reference areas need to be minimized. glucose metabolism. In this way
11. Three-dimensional renderings may be glucose metabolic rate can be
useful in appreciating overall patterns of measured in absolute units (e.g. in
disease. mol min-1 g-1).
12. Images should be evaluated with e. For clinical purposes absolute
reference to recent anatomic brain quantification approaches are
images (CT or MRI). Specific typically not necessary, particularly
attention should be paid to the extent when considering the high inter-
individual fluctuation of absolute
of metabolic abnormalities relative
cerebral glucose metabolism. In
to underlying morphologic defects addition, most diagnostic
as well as to the possible effects of applications depend on patterns of
atrophy and partial volume effect. relative regional abnormalities, not
Interpreters should be familiar with on quantitative metabolic rate of
the document “Ethical Clinical glucose.
Practice of Functional Brain 1. Observer Independent Analysis
Imaging” issued by the Ethical a. Owing to advancements in image
Subcommittee for Functional Brain processing technology developed in
Imaging, a subcommittee of the brain mapping research, automated
SNM Brain Imaging Council. or semi-automated brain mapping
I. Quantitative Interpretation techniques can be applied to routine
1. Absolute Glucose Metabolism clinical studies.
b. In conjunction with pixel-wise
a. A quantitative analysis can be
comparison to normal control data
performed when it is possible to or database, individual statistical
calculate the curve of the arterial maps (such as Z score maps) may
FDG concentration against time be used to provide additional
(arterial input function). It information to conventional image
requires direct sampling of interpretation.
arterial blood (serial (1) The techniques are usually
measurements). It is often based on slice display
combined with dynamic data (customarily axial) or
acquisition, but can also be stereotactic surface projection
combined with static scanning. displays.
b. Some non-invasive alternatives to (2) These methods commonly
arterial blood sampling have been involve automated image
studied: realignment in the bi-
(1) Arterialized venous blood commissural stereotactic
sampling system and anatomic
(2) The input function can be standardization.
retrieved from the PET images (3) When employing this type of
using the aorta, or left ventricle. analyses for image
c. Rate constants can then be estimated interpretation, it is critical to
use methods validated and
8Procedure Guideline for FDG-PET Brain Imaging v1.0 9
published in scientific (3) Instrumentation used i.e. PET
literature. with measured attenuation
(4) The diagnostic accuracy may correction, PET with
also be affected by differences transmission correction,
in image characteristics attenuation correction with
between individual cases and CT
cases included in the normal h. Assessment of the technical quality
database. of the study (good, adequate, poor).
(5) The quality of the normal i. Potential artifacts such as
database may affect diagnostic (1) Patient movement
accuracy. Morphing artifacts (2) Medications which affect
due to faulty alignment between cerebral metabolism
individual subjects and a (a) These medications are
composite normal database may listed explicitly under
occur. Point L.1
(6) Quality control of such analyses (3) Observed seizure activity
is essential for proper diagnosis j. Describe abnormalities including:
given that these complex
analyses are prone to errors and (1) Location
artifacts. (2) Extent
(7) Fully automated diagnostic (3) Symmetry or asymmetry
systems are under development. (4) Reference to a normal
These methods should be used database if quantitation is
with caution until they are employed. Normalization to
scientifically validated and a specific reference site in
approved for clinical use and brain i.e. cerebellum, total
pitfalls and artifacts are fully brain, pons, basal ganglia, or
understood by potential users. thalamus.
k. If study limitations are encountered,
J. Reporting they should be described in the
report. This would include:
1. Clinical reports for brain PET or PET- (1) Protocol deviations such as
CT imaging should include the shortened data acquisition
following clinical information time, changes in time
including: following injection
a. Indications for the study. (2) Other deviations which would
b. Brief history emphasizing the main impact the FDG uptake and
reason for the study e.g. memory distribution pattern.
loss. 1. Interpretation and Conclusions
c. Duration of the problem. a. Provide a reasonable differential
d. Other essential clinical information diagnosis of the findings based on
including medications. peer reviewed and generally
e. Recent findings on prior nuclear accepted disease specific patterns.
medicine studies. b. Integrate all other pertinent facts
f. Findings on other imaging including historical information,
modalities such as MRI laboratory information, co-morbid
g. Study technique conditions, medications, any recent
(1) Dose and route of therapy including surgery or
radiopharmaceutical and uptake radiation therapy, additional
period diagnostic studies such as CT, MRI
(2) Blood glucose level or EEG.
9Procedure Guideline for FDG-PET Brain Imaging v1.0 10
c. Consider the impact of atrophy or (1) The blank scan also serves for
structural lesions as well as partial attenuation correction.
volume effects. (2) This test takes a short time (30
d. If relevant clinical or additional minutes) and can be performed
testing results are not available for daily.
review, state the limitation of the d. Since many studies are performed
conclusions and recommend using CT for morphologic
additional test as indicated. comparison and fusion as well as
e. When studies are difficult to attenuation correction CT quality
interpret due to a pattern not control should be performed by a
commonly described using well- trained CT technologist and
accepted criteria, the report should physicist.
contain statements, which would 2. Performance tests can be usually
aid the referring physician to better carried out according to the
understand why a specific international recommendations
diagnostic entity could not be according to:
ascribed to the pattern noted. a. American guidelines are published
f. Caution should be mentioned in by NEMA (National Electrical
the reporting of quantitative Manufacturer Association).
information as limitations of the b. European guidelines are published
quantitative technique need to be by IEC (International Electrotechnical
clearly understood by the Committee).
interpreting physician before
issuing a report as normal or L. Pitfalls, Artifacts, Sources of Error
abnormal based on quantitative
findings.
1. Medications altering cerebral
K. PET scanner quality control
metabolism including
a. Sedatives
1. Clinical scanning should be
b. Drugs such as amphetamines,
accompanied by a strict quality control
cocaine
program consisting of specific
c. Narcotics
performance tests including:
d. Anti-psychotic medications
a. Normalization procedure: to ensure
e. Corticosteroids
the existence of an adequate
correction of the changes in
Most medications predominantly alter
efficiency among the crystals of the
global metabolism with modest effects on
detectors. This procedure takes
regional distribution.
several hours and can be performed
every month, providing that there
2. Hyperglycemia
are no detector failures.
3. Patient motion during the data
b. Setup scan: to ensure that all
acquisition may result in image artifacts
detectors are working properly.
and render the study non-interpretable.
(1) The setup scan changes the
4. Misregistration between the emission
detect gains to modify any
and transmission scans.
possible drifts.
5. Calculated attenuation using a per file
(2) This takes about two hours and
calculation may result in falsely
can be done weekly
increased activity in the superior aspect
c. Blank scan: to ensure that the
of the brain.
detectors have not drifted since the
6. Calculated attenuation does not correct
last normalization.
10Procedure Guideline for FDG-PET Brain Imaging v1.0 11
for variations of skull thickness. 2. Chugani HA, Functional brain
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1. What constitutes a “normal” database man: the effect of insulin. J Cereb
a. How many subjects Blood Flow Metab 1998; 18: 130-40
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