Total Body PET-CT Protocols in Oncology

Recently developed long axial field of view (LAFOV) PET-CT scanners, including total body scanners, are already in use in a few centers worldwide. These systems have some major advantages over standard axial field of view (SAFOV) PET-CT scanners, mainly due to up to 20 times higher sensitivity and therefore improved lesion detectability. Other advantages are the reduction of the PET acquisition time for a static whole-body measurement, the reduction of the administered radiotracer dose, and the ability to perform delayed scans with good image quality, which is important for imaging radionuclides with long half-lives and pharmaceuticals with long biodistribution times, such as ⁸⁹Zr-labeled antibodies. The reduction of the applied tracer dose leads to less radiation exposure and may facilitate longitudinal studies, especially in oncological patients, for the evaluation of therapy. The reduction in acquisition time for a static whole body (WB) study allows a markedly higher patient throughput. Furthermore, LAFOV PET-CT scanners enable for the first-time WB dynamic PET scanning and WB parametric imaging with an improved image quality due to increased sensitivity and time resolution. WB tracer kinetics is of particular interest for the characterization of novel radiopharmaceuticals and for a better biological characterization of cancer diseases, as well as for a more accurate assessment of the response to new targeted therapies. Further technological developments based on artificial intelligence (AI) approaches are underway and may in the future allow CT-less attenuation correction or ultralow dose CT for attenuation correction as well as segmentation algorithms for the evaluation of total metabolic tumor volume. The aim of this review is to present dedicated PET acquisition protocols for oncological studies with LAFOV scanners, including static and dynamic acquisition as well as parametric scans, and to present literature data to date on this topic.