From: PET probe-guided surgery: applications and clinical protocol
FDG-positive Tumor/Lesion Localization Protocol | |
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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 |