High Quality PET/CT
Report Elements
And PET/CT team steps learning
2010 4.7 高價健檢篩癌 沒必要!
和信醫院二十週年黃達夫院長說例行性篩檢更可靠不承擔風險!
沒必要!那我們這些儀器與人如何?
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Don’t worry, be happy.
We have our knowledge and
confidence!
We fight for and service for our
patients as well as for our
clinical doctors. Don’t be afraid!
其實早在二年前核醫月會
tumor scan演講中我已提到:
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先做低階檢查再做高階正子檢查
ex. GI tumor: occult blood ;tumor
marker; sonography; endoscopic
biopsy and even CT, MRI, coloscopy
are firstly chosen before doing PET
scan or tumor scan because the
problem of FDG uptake, for lymph
node metastases it is not bad study.
PET/CT風險:隨時間久我們愈知愈
多其偽陽性與偽陰性愈知不可膨風
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Low to intermediate pt FDG avid
Exposure to high dose radiation
Suggestion of biopsy or others.
High price study in normal pt.
Misleading clinician wrong direction.
Even suggest surgery; biopsy but
exposure pt to near unrecovery situation.
Non FDG avid tumor: prostate;BAC
hepatoma, GIST,NET,teratoma…
(for C11-Acetate PET has advantage over
F18-DG in false negative studies).
For normal and healthy patient, PET/CT?
Shin Kon hospital PET/CT
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1.1% screening rate for cancer
5% false positive rate annually.
>0.5 cm tumor about 10 mSv.
MRI is good at no radiation but
poor detection in lung, GI and
colon cancer.
Family history is important.
False positive findings
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Inflammation
Lymphadenopathy.
Ovulation
Brown fat
Post radiotherapy in oral cancer.
Fibrosis or any increased
metabolic activity non cancer
situation.
醫病新觀念:人不是物體,醫生不能
只考慮修復身體,不同人對自己的身
體有不同的感受,醫師必需了解進而
尊重這些不同的觀念進而將之放進
醫病關係中.醫療勢必要從一種權威
的命令,控制朝雙向協商,理解的服
務本質調整,使病人相信與安心,試
想若我們的報告作到連病人都瞭解
那麼更何況臨床醫師!(quality).
According to PET PROS
(professional resources and
outreach source) guideline(SNM)
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高價健檢,身體擔風險.
美國多年來一直不贊成健檢用
PET/CT原因就在此.
尚未克服false positive and false
negative problem in FDG.
但是既然經已經做了我們應該給
病人與醫師最盡心適合的報告!
Elements of PET/CT report:
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Clinical history(3+5)
Procedure(7+3+2)
Comparison(2)
Findings(3)
Impression
Sample normal reports
Clinical history(3+5)
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Indication for study: tumor
type ;abnormality to be evaluated,
and specific clinical question: (For
diagnosis,staging,restaging,respons
e to therapy).
Relevant history: biopsy results,
chemotherapy,radiotherapy, other
treatment; medical/surgery history.
Information needed for billing:ex.
Indeterminate nodule found on chest
CT, PET/CT for solitary pulm. nodule
Procedure(7+3+2)
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PET/CT radiopharmaceutical; dose;
route and injection site; scan
coverage;uptake time; serum blood
sugar level; medication
CT noncontrast, iodinated iv
contrast type and amount,oral
contrast type and amount.
Notes: explanation for deviation
from standart protocol; special tx
like O2 supplement, treatment of
contrast reaction.
For PET/CT procedure
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Scan field for reginal or whole body
scan should describe beginning and
ending anatomic region. A range of 60
to 90 mins is between injection to
scanning. Localization time shorter or
longer than ususal should be
mentioned.
Blood sugar level should be comply
with ACR guidelines. For interpretation
of current study, we can also have this
at delayed scan
For medication and
intervention
Protocol like anxiolytics and
fusosemide the type, dose, and
route administration should be
noted. Any iv as procedure should
be described, like urinary catheter.
Any oral premedication
regimen should be noted.
Other details.4D R/T; dedicated brain
imaging, or any delayed additional
acquisitions. Or immobilization
devices should be mentioned.
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For CT procedure
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For low dose CT(non diagnostic
CT) should mentioned the details
to the technique used 40 mAs,120
kVp.
For anatomical localization for non
FDG avid site like soft tissue
mass or cystic lesions, the tissue
of characterization by density, or
pattern of enhancement should be
metioned at compasion with PET.
Additional notes.
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Any adverse reation and treatment
should be noted. Any deviation
from standard protocol should be
included in the official report.
Detail of such interventions are
also typically kept in a separate
nurse’s note or incident report.
Comparison(2)
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Prior PET or PET/CT studies.
Dates should be described for
comparison
Other studies: CT;MRI;
mammography and nuclear
medicine.or even plain film…
Findings(3)
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Order of importance format
Anatomic site format
Hybrid format
According to priority and anatomic site for
dominant findings (TNM or primary lesion
or recurrent disease); metastases (nodal
or extranodal site of metastases) and
other abnormal PET findings (like second
primary tumors or diffuse thyroid activity).
Incidental CT findings: lung nodule w/o
FDG uptake, renal mass
Normal physiologic FDG uptake: brown
fat; prominent muscle or intestinal uptake.
Anatomic site format
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Begin with significant PET and CT
findings and follow by relevant CT
only
findings and incidental observations.
For
each Head and neck; chest;
abdomen and pelvis;
musculoskeletal.
Synthesis of priority and anatomic
site(combination:assures of overall
structure and consistency) and
general report notes(RADLEX).
General reporting notes.
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Or RECIST: size measurements
in 2 or 3 orthogonal directions, a
statement that it is in the short or long
axis. Do not let your report led to
confusion and frustration of the
clinicians by different measurement of
PET or CT in tumor size, especially.
Assure a consistency message.
PET and CT report are read
independently!
Impression
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It is most important because most
clinician start to read your report only
at this! It is essential
that all the important information
discovered in the study is presented
here in a clear and succinct way.
Brief with concise; answer clinical
question; give a precise diagnosis;
when it is not possible, a clear and
organized differential diagnosis
should be given. It may be
appropriate to discuss the use of
additional imaging study or follow up.
colloquial
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Definite evidence of malignancy
Probable malignancy in …
without evidence of metastases.
For follow up scans after therapy,
both metabolic response and
anatomic response should be
commented.
If appear benign, Negative study
for malignancy is better than no
evidence for active malignancy
because can be misinterpreted
by the referring physician.
Certain terminology: must
care be exercised…
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Absent; excludes; unlikely, probable,
certain and definite are common used in
referring physician, but other terms are
understood quite differently like
:unlikely, highly suggestive, compatible
with or worrisome or
suspicious. Clinician most like:
definitely benign; probably benign
equivocal, probably malignant or
almost certainly malignant or definitely
malignant.
Vague language only confuses the
referring physician and can result
in sub-optimal patient care.
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Definite finding use right and specific
words. Uncertainty should also
essential that the uncertainty be
clearly communicated..knowing this
limitation of imaging studies and
result must be taken in context of
each situation, help clinician convey
the necessary information and
without causing unnecessary anxiety
to the patient.
Sample normal reports:1+1
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Synthesis of priority and anotomic
site styles,
Even neither pt had PET findings
suggesting disease recurrency, there
is still a number of relevant positive
and negative findings conveyed in
each report. case 1:negative have to
do with lymph nodes and spleen.
Case 2: SPN though negative on
PET, there is still TNM to chest
subsection framed in context.
Sample normal reports:1+1
Sample normal reports:1+1
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PET CT Reporting Form
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Famous center PET CT
Reporting Form
doctor introduction
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Report accuracy rate list below:
論PET/CT center 之團
隊合作與醫病新關係
How to reconstruction your gr?
Team work for PET/CT center
Assessment what?
Many things you can guess!
Persistent monitoring for:
Delegation are sharing order.
Open mind and feedback in
time. Solve problems.
Routine and daily life.