Practical approach to diagnostic CT combined with PET

Protocols for PET/CT are not yet standardized. In particular, image quality, utilization, and reporting of the findings of the CT component of PET/CT can vary widely, making it complicated for physicians to request the appropriate information. In an effort to address this problem, we describe a set of four PET/CT protocols that satisfy a broad range of clinical needs among oncology patients. Current technology allows acquisition of diagnostic-quality CT scans as part of PET/CT examinations, and referring physicians are given the option of requesting formal interpretation of the CT findings. In this case, the PET and CT images are interpreted by the corresponding specialists, and equivocal or discordant findings are adjudicated through joint review of the PET/CT images.

The menu of PET/CT imaging protocols has gained wide acceptance by our referring physicians and have been used successfully in more than 6,000 PET/CT studies. Newer PET/CT protocols will be developed as technology advances. Continued collaboration among oncologists, CT specialists, and nuclear medicine specialists is essential for deriving the maximum clinical benefit from combined PET/CT. Standardization of imaging protocols will become increasingly important as multiple-institution trials are developed for evaluation of present and future applications of PET/CT.