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Table 2 PET probe-guided surgery protocol for F-18 FDG

From: PET probe-guided surgery: applications and clinical protocol

FDG-positive Tumor/Lesion Localization Protocol

Radiopharmaceutical

• F-18-FDG

Activity/Administration

• 5–15 mCi/IV injection (Use higher doses if the operation is scheduled more than 4 h post-injection)

Standard Imaging Protocol

• Performed using standard clinical protocol

Timing of Surgical Exploration

• 2–6 h post-injection

Patient Preparation

• NPO × 6 hours

 

• Blood glucose control in diabetics (Blood glucose ≤ 140 at the time of FDG injection)

 

• 1 hour quiet time

 

• Hydration with Normal Saline @ 100–150 cc/h (No glucose containing fluids)

 

• Consider β-blockers ± Diazepam for head and neck cases

Gamma Probe

• PET probe (High-energy gamma probe with photopeak detection capability over at 511 keV)

System set-up

• Analyzer Settings: Photopeak: 511 keV, Window: 20%, Threshold: 490 keV (In commercial systems this is obtained by switching the isotope selection to PET (FDG) setting)

 

• Verify calibration and settings of the system

 

• Cover the probe with sterile plastic sleeve

Intra-operative Use

• Point probe tip away from physiologic sites of uptake/accumulation (Foley catheter avoids bladder background)

 

• Probe survey at counts- per-second mode (Dynamic pitch range feed-back helpful)

 

• Hot-spot confirmation with TBR > 1.5 at 10-second count mode (TBR ratio feed-back helpful)

 

• Avoid simultaneous electrocautery use