XXX Nuclear Facility 6021 University Blvd., Suite 500 Ellicott City, MD 21043 Phone (123)123-1234 Fax (123)123-1234 Patient Name: Doe, Jane ID Number: 123456 Date of Birth: 4-2-63 Sex: Female Referring Physician: Dr. Jones Date of the Exam: 4-1-12 Clinical Indications: Evaluate treatment response for breast carcinoma Radiopharmaceutical: 10.4 mCi FDG IV Whole Body PET/CT Study CLINICAL HISTORY: Evaluate treatment response to breast cancer. PROCEDURE: Following the IV administration of 10.4 mCi FDG, image acquisition on a dedicated PET CT unit was obtained one hour post injection. A preliminary CT study at the site of the neck, chest, abdomen, pelvis and proximal thighs was obtained for attenuation correction and anatomic localization. The serum glucose level at the time of injection was 129 mg/dl. FINDINGS: Neck: There are no abnormal areas of uptake to suggest the presence of metastatic disease. Chest: An Infusaport catheter is seen in the anterior right subcutaneous fat. Normal uptake within the thyroid gland is seen. The patient has had a prior left mastectomy. There are post surgical changes involving the operative site and skin. This expands to the pectoralis muscles. However, in the high left axilla, there are nodular areas of increased uptake adjacent to surgical clips. This extends along the axillary vessels toward the subclavian vessels. Soft tissue fullness is seen without discrete nodularity. However, I would regard the findings as being suspicious for nodal metastatic disease. Calcified lymph nodes are seen in the right subcarinal region and right hilum. There is no evidence of a pleural or pericardial effusion. A tiny non-FDG avid nodule seen in the right upper lobe anterior segment subpleural region on image #124. This is too small to characterize with certainty. There is a small dense nodule in the superior segment of the right lower lobe on image #139. It has markedly increased in attenuation values and this is compatible with a calcified granuloma. The remainder of the lungs appears to be clear. Abdomen: Calcified splenic granulomas are present. There are no abnormal areas of uptake within the liver or spleen to suggest metastases. The patient has had a prior cholecystectomy. The adrenal glands are normal. There are no pancreatic abnormalities. The kidneys are unremarkable. There is no evidence of lymphadenopathy or ascites. Normal physiologic uptake in bowel is seen. There is a small moderate size paraumbillical hernia. Pelvis: There are no abnormal areas of uptake to suggest the presence of metastatic disease. The inguinal and gluteal regions are unremarkable. The proximal thighs are normal. There is no evidence of abnormal bone marrow uptake. IMPRESSION: 1. 2. Patient is status post left mastectomy. Post surgical changes are seen involving the skin, subcutaneous tissues and adjacent pectoralis major and minor muscles. There are surgical clips in the left axilla. There are focal nodular areas of increased uptake within the high left axilla deep to the pectoralis minor muscle. This extends along the axillary and proximal subclavian vessels. The maximum SUV in these regions is roughly 5.5-6. The findings are suspicious for high left axillary nodal metastasis with possible extension into the subclavian-axillary region. Mary Beth Farrell, MD (electronically signed) Date of interpretation: 4-2-12 Date of final report: 4-3-12 PET-CT Whole Body Colorectal Restaging Report (SAMPLE) 1 NOTE: This is a SAMPLE only. Protocols submitted with the application MUST be customized to reflect current practices of the facility.