Radiation Dose Savings Associated with Personalized CT Scan Range in ¹⁸F-NaF Bone PET/CT

A disadvantage of ¹⁸F-NaF PET/CT compared with other types of bone scintigraphy is the additional radiation dose from the standard whole-body CT scan for lesion localization and characterization (L/C). This study investigated whether the L/C CT region can be personalized to reduce CT radiation dose, according to uptake in the PET images. Methods: Attenuation-corrected ¹⁸F-NaF PET images were reviewed for the clinically required L/C CT range by 1 medical observer and 1 technologist observer in 25 patients with breast cancer scanned before neoadjuvant chemotherapy. For each patient, effective doses were estimated for whole-body L/C CT, personalized L/C CT, and whole-body CT for attenuation correction only. Dose savings for the personalized method incorporating both whole-body CT for attenuation correction and personalized L/C CT were expressed relative to standard whole-body L/C CT. The clinical impact of the personalized method was determined by evaluating whether lesions clinically requiring coverage had been missed from the L/C CT region. Results: Potential dose savings of 43%-54% were estimated for the personalized CT method, according to the observers. From the 25 patients reviewed, the medical observer did not miss any clinically significant lesions from the L/C CT region, whereas the technologist observer missed 2 clinically significant lesions of 61 suggestive lesions identified by medical observer follow-up. Conclusion: Mean CT dose could be reduced by around half in this patient group with personalized CT. Future work should further evaluate whether this method can be implemented in clinical practice without compromising clinical image evaluation.