PET/CT And Lung Cancer Overview - University Of California .
PET/CT and Lung CancerOverview What is PET/CT What to expect if you were a patientcoming to our clinic Notes on Radiation exposure PET/CT for Lung CancerMartin Allen-Auerbach, MDDepartment of Molecular and Medical Pharmacology, UCLAWhat is PET/CT?– Staging– Surveillance– Treatment MonitoringThe tracer: FDG FDG is an accurate tracer forevaluating metabolism of mostcancers. FDG uptake can occur in noncancerous conditions such asinfection or inflammation. FDG does not have any sideeffects nor does it cause allergicreactions1
SUV: Standardized Uptake Valuec (t)(D)activity concentration in the tissueinjected doseCommon Errors affecting Measurement of SUVsErrorEffect on tumor SUVBlood glucose levelsLower values with increasing bloodglucose levelsRegion-of-interest definitionLower mean uptake for larger regionsof interest; larger random errors forsmall regions of interestParavenous 18F-FDG injection,residual activity in syringeIncorrectly low SUVNo decay correction of injectedactivityIncorrectly low SUVIncorrect cross-calibration ofscanner and dose calibratorIncorrectly low or high SUV, dependingon error of calibration factorVariable uptake period (timebetween injection and imaging)Higher SUV with longer uptake periodWeber, W.A.,. J Nucl Med, 2005. 46(6): p. 983-95.(IV and PO contrast do not affectSUV significantly)Standardized Uptake Value (SUV)Yau et al. J Nucl Med. 2005 Feb;46(2):283-91Ditzendorf et al J Nucl Med. 2003 May;44(5):732-8In the Clinic Brain 8-10Mediastinal Blood Pool 2Malignancy 2-3Myocardium 2-7Liver 2-3Urine 15-502
What to expect when you cometo the Nuclear Medicine ClinicHow to prepare for a PET/CT On the day of the scan take your regularly prescribedmedications with water only. Do not eat or drink anything except water for 4 to 6 hoursbefore the scan. Refrain from heavy exercise for 12 hours prior to thescan. Drink at least two glasses of water one hour before thescanDoes the PET/CT Scan haveSide Effects? Your blood sugar will be checkedAn IV catheter will be placedFDG will be injectedYou might be asked to drink oral contrastYou will rest comfortably for 45 minutesYou will receive IV contrastCT images will be obtained first (less than 1 minute)PET images will be obtained (about 25 minutes)You should be in and out of the clinic in less than 2 hours.Frequent Patient Concerns after PET/CTThe PET component Am I radioactive? No, not dangerous IV placement Claustrophobia FDG has no side effects Can I be around children or pregnantwomen? YesThe CT Component IV contrast can cause an allergic response;cautious use in patients with kidney problems Oral contrast can cause abdominal discomfortRadiation Exposure Can I eat anything I want? Yes (and youare encouraged to drink more than usual)Relative Risk of developing a fatalcancer from Radiation (1PET/CT 3 rem)DOSERISK25 rem10 rem1 rem0.1 rem1 in 1001 in 2501 in 25001 in 25000Annual dose limit for radiation workers: 5 remAnnual background radiation: 0.72 rem3
PET/CT: the Scanning ProcedureCTFDGLifetime risk of dying in a car accident: 1 in 84Lifetime risk of developing a fatal cancer: 1 in eath-Hold vs. Shallow Breathing CTnumber of nodules 1cmn 142200180160140120100806040200285shallow ow Breathingbreath hold160breath holdmissedIn 13% of patients nodules were only detected on breath-hold images.Allen-Auerbach et al, J Nucl Med. 2006 47:298-3014
Where’s Waldo?PET/CT for Staging of Lung CancerEarly “Imaging” Application of PET5
PET/CT for Detection 3/25/109/28/103/14/113/25/106
Why is Treatment Monitoring important? Some patients benefit from a particular therapy whereas others (despitewhat seems to look like the same type of cancer) do not.PET/CT for Treatment Monitoring Current therapies can have a lot of side effects. Doctors want to know asearly as possible whether a treatment is working. The definitive proof of whether a therapy is working is if a patient feels betterand lives longer. Looking at the cancer with scans is generally used to measure the effects ofa treatment earlier. Current response assessment is based primarily on changes in tumor sizeas measured by CT (RECIST).History of Response CriteriaRECIST16 oncologists determinedthe diameter of 12differently sized woodenspheres hidden under arubber foam.Response Evaluation Criteria in Solid TumorsRubber FoamMoertel and Hanley,Cancer (1976) 38:388-394European Journal of Cancer, January 2009Two different Patients each 2 weeks after the start ofTreatmentTreatment affects Metabolism of the Cancerbefore Changes in Size are seenAfterBeforePatient 1Baseline24 hours7 days2 months5.5Patient 27
11/5/09Baseline3 weeks14 weeks11/20/09(note BAT activity H/N,supraclavicular and paravertebral)11/5/0911/5/0911/20/0911/20/09What is missing? A decrease in FDG uptake on a PET scan likely means that thecancer is responding to the treatment. There have been many PET studies, but the definition of aresponse and how the scans were done have been quitevariable. As of now there is no agreement of when treatment monitoringshould be performed or how much FDG uptake has to go downto call it a good response to treatment. Ongoing trials are trying to answer these questions.Rodney J. Hicks, Journal of Nuclear Medicine, 20098
Summary FDG PET/CT is a safe test PET/CT is useful for Staging of Lung Cancer PET/CT is useful for Detection of Recurrence PET/CT is useful for Treatment Monitoring9
Where’s Waldo? Early “Imaging”Application of PET PET/CT for Staging of Lung Cancer. 6 PET/CT for Detection of Recurrence 2007 2009 2007 20092009 2007 3/25/10 9/28/10 3/14/11 3/25/10 9/28/10 3/14/11. 7 PET/CT for Treatment Monitoring Why is
11/15/2011 4 Lung Cancer Facts Lung cancer accounts for more deaths than any other cancer in both men and women. Since 1987, more women have died each year from lung cancer than from breast cancer. Lung cancer causes more deaths than the next three common cancers combined (colon, breast, prostate). Smoking contributes to 80% and 90% of lung cancer deaths in
Lung cancer screening: the cost of inaction 2 Table of contents Executive summary 3 1 Introduction 7 2 Lung cancer: a public health priority 9 3 Earlier detection: the key to reducing the burden of lung cancer 12 4 LDCT screening for lung cancer: the next big opportunity in cancer detection 18 5 An investment in health system sustainability 21 6 Ensuring successful implementation of lung cancer
Lung Cancer Canada is a national charitable organization that serves as Canada's leading resource for lung cancer education, patient support, research and advocacy. Based in Toronto, Ontario, Lung Cancer Canada has a wide reach that includes both regional and pan-Canadian initiatives. Lung Cancer Canada is a member of the Global Lung Cancer
Primary lung cancer remains the most common malignancy after non-melanocytic skin cancer, and deaths from lung cancer exceed those from any other malignancy worldwide [1]. In 2012, lung cancer was the most frequently diagnosed cancer in males with an estimated 1.2 million incident cases worldwide. Among females, lung cancer was the leading
Non-small cell lung cancer is the most common type of lung cancer and accounts for 84% of cases. There are different types of non-small cell lung cancer, including: Adenocarcinoma - a cancer that forms in the outer parts of the lung. Squamous cell carcinoma - a cancer that forms from a cell lining the airway.
Non Small Cell Lung Cancer (NSCLC) Lung cancer is responsible for 1 in 7 new cases of cancer and is responsible for 22% of all cancer deaths. Approximately 80% of patients have non-small cell lung cancer (NSCLC), of whom about 20% have early-stage disease (AJCC Stage I, TNM Stage T1-2N0M0) which is associated with the best chance of cure. Lung
lung cancer spreads to bones, it is still termed as lung cancer and not bone cancer. In that case, it may be said that the person has "lung cancer with bone metastases". 10 It is important to realise that cancer is not a single disease with a single type of treatment. There are more than 200 different kinds of cancer, each with its own name
Reasons for Lung Surgery Lung surgery is used to diagnose and sometimes treat many different lung problems. Some reasons for lung surgery include: Lung Abscess: This is an area of pus that has formed in the lung. If the abscess does not go away with antibiotics, surgery may be needed to remove the infected part of the lung.
