MCCCD Official Course Competencies:

DMI287  2008 Fall – 2009 Summer II

Nuclear Medicine PET and PET/CT

1.

Discuss basic designs and principles that enable the construction of images using PET, and/or Integrated PET/CT imaging systems. (I)

2.

Describe the Quality Control necessary for PET and PET/CT. (I)

3.

Give a step-by-step explanation of the back projection method of reconstruction, and interactive reconstruction. (I)

4.

Discuss the selection criteria related to the open frame and axial collimators used in positron imaging, and 511 keV collimators used in Single Photon Emission Computed Tomography (SPECT) systems. (I)

5.

Describe the components of PET, integrated PET/CT and Positron Coincidence Detection (PCD) systems. (I)

6.

List conditions or pathologies for which tomographic imaging procedures are advantageous over SPECT and planar imaging. (I)

7.

State radiopharmaceutical requirements that must be satisfied in order to perform a PET, PCD, or PET/CT studies. (I)

8.

Discuss the activity limitations related to open frame and axial collimators. (I)

9.

Describe the factors the must be considered when selecting a filter. (I)

10.

Describe how annihilation allows for PET, PET/CT and PCD imaging. (I)

11.

Compare the sensitivity, resolution, and signal-to-noise ratio for the three methods of imaging with 511 keV photons. (I)

12.

List the studies that can be performed satisfactorily using each method of imaging. (I)

13.

Discuss the physical and chemical characteristics of positron emitters that make them appropriate for nuclear medicine procedures and how they are produced. (II)

14.

Describe the methods and radiation protection procedures necessary for preparing and administering positron emitters. (II)

15.

Describe the allowable dose ranges and calibration requirements according the Nuclear Regulatory Commission (NRC) regulations. (III)

16.

Use decay formulas and decay factor tables to account for radioactive decay. (III)

17.

Discuss the different methods used to calculate adult and pediatric dose ranges, the advantages and disadvantages of each method including the importance of utilizing minimum and maximum dose limits and resulting radiation dose to various organs and tissues. (III)

18.

Describe the radiopharmaceuticals used for positron imaging including the physical and chemical properties, biorouting, dose preparation, and route and method of administration for radiopharmaceuticals used in PET and PET/CT. (IV)

19.

Discuss the physical or pathological conditions or medications that could contraindicate or interfere with positron imaging. (IV)

20.

Describe precautions and potential adverse reactions to radiopharmaceuticals. (IV)

21.

In reference to the indications for positron imaging, discuss why this type of nuclear medicine study would be preferable to, or complement other nuclear medicine procedures or diagnostic modalities in various cases. (IV, IX)

22.

Describe the procedures for positron imaging including equipment, patient preparation, protocol, dose and administration technique, administration-to-acquisition times, acquisition parameters, standard positioning and views, and special imaging adaptations. (V, VI)

23.

Describe the procedure for data processing and image formatting. (VI)

24.

Identify and potential pitfalls with basic procedure and processing. (VI)

25.

Compare and contrast selected interventions and procedures including vasodilators, psychological stress studies, and sensory stimulation studies. (VII)

26.

Describe the normal distribution and normal variants seen in positron imaging as recognized on printed images. (VIII)

27.

Describe various artifacts that can occur during positron imaging as identified on printed images. (VIII)

28.

Discuss common causes of false-negative and false positive positron imaging. (VIII)

29.

Discuss the diagnostic and prognostic value of positron imaging. (IX)

MCCCD Official Course Outline:

DMI287  2008 Fall – 2009 Summer II

Nuclear Medicine PET and PET/CT

I. Positron imaging systems

A. Dedicated PET

1. Basic principles of operation

2. Sensitivity/deadtime

3. Spatial resolution

4. System configurations

5. Time of flight (TOF)

6. Annihilation coincidence detectors

7. Crystal characteristics

8. Signal-to-noise ratio (SNR)

9. Quantitation

10. Attenuation correction

11. Suitable studies

12. Quality control for PET

B. Integrated PET/CT

1. Basic principles of operation

2. Sensitivity/deadtime

3. Spatial resolution

4. System configuration

5. TOF

6. Annihilation coincidence software

7. Crystal characteristics

8. Signal-to-noise ratio

9. Attenuation correction

10. Collimators

a. Open frame

b. Axial

11. Dose range limitations

12. Mode acquisition

13. AIterative reconstruction

14. Attenuation correction

15. Coincidence timing unit

16. Angle of acceptance

17. Rebinding of data

18. Crystal thickness

19. Limitations

20. Suitable studies

21. Quality control for integrated PET/CT

C. Positron imaging using gamma camera and high energy collimators PCD

1. Basic principles of operation

2. Sensitivity/deadtime

3. Spatial resolution

4. System configuration

a. Collimator design

b. Camera head adaptation

5. Signal-to-noise ratio

6. Limitations

7. Suitable studies

D. Positron imaging systems

1. PET

2. PCD

3. Integrated PET/CT

II. Preparing positron-emitters

A. Production

1. Generator systems

2. Cyclotron systems

B. Characteristics of positron emitters

1. Physical

2. Chemical

C. Biochemical characteristics

1. 11C

2. 15O

3. 13N

4. 18F

5. Rb-82

6. NaFBone scanning with PET

7. Other

D. Synthesis of radiopharmaceuticals

E. Quality control of radiopharmaceuticals

F. Administration

1. Intravenous

2. Gaseous

III. Dose determination

A. Dose range

1. Factors affecting dose determination

a. Organ or system size

b. Photon flux

c. Radiation dose

2. NRC acceptable ranges

3. NRC calibration requirements

B. Calculation of dose to be administered

1. Specific concentration

2. Volume to be administered

3. Dilution of doses

4. Adjusting unit doses

5. Accounting for decay

a. Decay calculation

b. Decay factor tables

IV. Position imaging

A. Indications

B. Radiopharmaceuticals

1. Tracers

a. Fluorine-18 Fluorodeoxyglucose (FDG)

b. Oxygen-15 water

c. Nitrogen-13 ammonia

d. F-18 Sodium Fluoride

e. C-11-Chloride

f. Rb-82

g. NaF Sodium Fluoride

h. Other

2. Physical and chemical characteristics

3. Preparation

a. Dose range and route of administration

b. Biorouting

c. Dosimetry

4. Contraindications and adverse reactions

a. Physical condition

b. Interfering studies

c. Interfering drugs

d. Precautions

e. Adverse reactions

V. Preparation

A. Patient preparation

B. Consent

C. Equipment

1. Cameras and collimators

a. Dedicated PET

b. Integrated PET/CT

2. Ancillary equipment

3. Monitoring devices

4. Computers

VI. Basic procedure and processing

A. Protocols

B. Dose administration and technique

C. Acquisition parameters

D. Positioning and views, including adaptations

E. Data processing, including co-registration and 3-dimensional volumetric display

1. Dedicated PET and Integrated PET/CT

2. Iterative reconstruction and attenuation correction

F. Image formatting

G. Pitfalls

VII. Interventions and procedures

A. Vasodilators (acetazolamide)

B. Psychological stress studies

C. Sensory stimulation studies

D. Others

VIII. Image and data interpretation

A. Normal

B. Normal variants

C. Abnormal

D. Artifacts

IX. Diagnostic/prognostic value of study

A. Outcomes

B. Treatment decision

C. Prognostic risk factors based on diagnosis