Our institute has been performing PET/CT examinations since 2014, which are also available as privately financed examinations. PET/CT examinations can generally detect malignant tumorous diseases earlier than conventional imaging procedures, and can provide information about pathological lesions that helps in planning the necessary therapy and making it more effective. The radiopharmaceuticals used for the examination are produced on-site in our own radiochemistry laboratory.

What you need to know about PET/CT examination

PET: positron emission tomography

CT: computed tomography, a computer-based imaging method

During a CT examination, anatomical and structural information about the body is obtained from cross-sectional images, which involves radiation exposure.

A PET/CT examination combines the high sensitivity of PET imaging for functional abnormalities with the excellent anatomical resolution of CT imaging.

The radiopharmaceuticals used for the procedure are taken up by cells depending on the level of their metabolism. The more intense a cell’s metabolism is, the more radiopharmaceutical it uses. Most malignant tumors grow rapidly; therefore, their cellular metabolism is increased, and they take up more of the given radiopharmaceutical than the surrounding healthy tissues. Metabolic changes in malignant tumors typically precede anatomical abnormalities.

With the PET/CT method, malignant tumorous lesions can in many cases be detected earlier than with other conventional examinations such as ultrasound, CT, or MRI. With this procedure, we can map important characteristics of lesions that are relevant for therapy and may remain hidden from other examination methods. PET/CT examination can also detect small tumors that do not yet cause symptoms, enabling faster and more effective care.

No allergic reactions related to the radiopharmaceuticals used for PET examinations have been reported in the literature. The painless PET/CT examination involves a radiation exposure of approximately 4–10 mSv.

Who we recommend PET/CT examination for

PET/CT examination provides diagnostic information about primary tumors, regional metastatic lymph nodes, and distant metastases. The examination can be an effective aid in selecting the optimal therapy, assessing the extent of the disease, planning radiation therapy, evaluating the effectiveness of the applied anti-cancer treatment, characterizing residual lesions after therapeutic interventions, and in the follow-up of the disease. The examination can help determine the optimal site for histological sampling and assist in surgical planning.

What is needed for the PET/CT examination

Referral

Referral process for privately financed PET/CT examinations:

If you would like to request a PET/CT examination for a disease category that is not supported by OEP, or if the patient undertakes the examination at their own expense, please call our customer service at our central telephone number. There you will receive information about the process of the PET/CT examination, its fee, and the possible methods of payment. A privately financed PET/CT examination can be initiated by completing and returning our examination request form.

How to prepare for the PET/CT examination

In general:

• do not eat during the 6 hours before the examination, but drink plenty of sugar-free and sweetener-free fluids, such as still mineral water
• you may take your medications as usual; during consultation, make sure to clarify with our staff which medications you take

In case of diabetes:

If you have diabetes, please make sure to inform our staff when booking your appointment!

• In the case of an examination performed with FDG radiopharmaceutical, it is important to keep blood glucose levels between 4 and 11 mmol/L, because high blood glucose levels alter the distribution of the radiopharmaceutical, its uptake by different tissues, and its utilization in organs/tissues. In case of high blood glucose levels, it may become necessary to reschedule the examination for another date.
• In case of insulin-treated diabetes, you may administer insulin in the usual way and you may eat. You must appear for the examination within 3 hours after administering insulin (the radiopharmaceutical can be administered after 4 hours). If you need to administer insulin several times a day, please bring your injector and insulin with you, and also bring food.
• In case of diabetes treated with tablets, you may take your medications as usual, but you must not eat during the 6 hours before the examination.

In case of pregnancy:

• in case of pregnancy or suspected pregnancy, the examination cannot be performed, except where a prior consultation with the specialist medical team results in a decision to allow it

In the 48 hours before the examination:

• physical activity, active sports, or heavy physical work must be avoided

On the day of the examination:

• wearing layered clothing is recommended
• metal objects on clothing may cause artifacts on the images, so please avoid wearing clothes containing metal elements such as zippers, buckles, sequins, hooks, or metal buttons
• do NOT bring jewelry or valuables with you; remove piercings and body jewelry
• if your removable dentures contain metal, they must be removed for the examination, so please do NOT glue them in
• avoid smoking
• in case of claustrophobia, a mild sedative may be used before the examination
• breastfeeding mothers should collect enough milk for one day before the examination, because breastfeeding must be suspended for 24 hours after the examination and the expressed breast milk must be discarded
• if you have a stoma, and the stoma bag is full, it must be emptied immediately before the examination. Please bring a spare stoma bag in case replacement is needed
• if you have urinary problems, such as a catheter with a urine bag, or if you wear a diaper or pad, please empty or replace it with a clean one immediately before the examination, and bring spare equipment with you

Risks and possible side effects of the PET/CT examination:

• The PET/CT examination itself is completely painless.
• The radiopharmaceutical used for the examination has no pharmacological effect on the body, and the procedure is safe with regard to allergic reactions.
• The radiation exposure to the body, with the activity usually applied, is similar to the radiation exposure of a contrast-enhanced diagnostic CT examination performed on the same body regions.
• After consuming the oral CT contrast agent diluted with water, which is used for more accurate visualization of the intestinal tract, looser stools or diarrhea may occur as a very rare side effect. Please drink the liquid slowly, in small portions.

What happens during the PET/CT examination

Upon arrival, you must check in at reception for data verification, registration, and for completing and signing the PET/CT consent form. Please make sure to keep your appointment time, because otherwise it may happen that we cannot perform your examination.

Please make sure to bring the following documents with you:

• Personal identification card
• Address card
• TAJ card
• Your previous medical records (in printed or electronic form)
• Images from previous imaging examinations (CD/DVD) and their reports

The assessment of your current condition and confirmation that you are suitable for the examination takes place in a specially designated area. During this process, our qualified staff member reviews the documentation you have brought, makes copies of it, takes your medical history based on the questions on the assessment form, measures your weight and height, and makes sure that there is no reason that would exclude the examination. After this, you will be informed about the further course of the examination. Before administering the radiopharmaceutical, we always check your blood glucose level. If its value exceeds 11 mmol/L, it may become necessary to reschedule the examination for another date.

After the assessment, the radiopharmaceutical required for the PET examination is injected.

If you have any questions, please ask our colleagues before the radiopharmaceutical is administered. After administration of the radiopharmaceutical, our colleagues will minimize close contact with you for their own radiation protection, but this does not exclude the provision of any necessary assistance.

After the injection, you will need to wait in complete rest for 10–120 minutes, while the radiopharmaceutical is distributed in the body. It is important that you do not perform either physical or mental activity during this time, meaning that you must not talk, read, or walk.

During the waiting period, you may use the designated restroom at any time. However, after the waiting period has elapsed, our qualified staff member will ask you to go to a separately designated restroom and to empty your bladder, change your pad, and, if overfilled, empty your stoma bag. This is necessary because the administered radiopharmaceutical leaves the body through the kidneys into the bladder, and a full bladder may limit the accurate assessment of the pelvic region.

Please take special care not to contaminate either your environment or yourself with urine, as this is important both from a radiation protection perspective and for the interpretability of the images obtained during the examination.

During the examination, which takes an average of 10–15 minutes, you must lie still on the examination bed while the bed moves horizontally with you inside the imaging device. Depending on the nature of the examination, you may need to keep your arms stretched alongside your body or clasped above your head. Even slight movement can impair image quality and may make it necessary to repeat part or all of the examination. Microphones and speakers are installed in the examination room and in the equipment, through which you can communicate with our staff.

Instructions after the PET/CT examination

In the 24 hours following the examination:

• Please avoid close physical contact with pregnant persons or children during the 24 hours following the examination, and avoid participating in community events such as cinema or theater.
• Pay particular attention to the protection of small children and pregnant women; if it is absolutely necessary, stay as far away from them as possible and spend the shortest possible time in the same place.
• If you are breastfeeding, the expressed breast milk must be discarded during the 24 hours following the examination.
• Drinking plenty of fluids is recommended, at least 2–3 liters, as well as frequent bladder emptying.
• When using the toilet, please make sure not to contaminate either your environment or yourself with urine.
• The radiopharmaceutical used for the examination completely decays and is eliminated from the patient’s body within 24 hours.

PET/CT examination result and reporting:

• The completed reports signed by specialists, together with the accompanying DVD containing the image material, will be mailed to your home address.
• It is also possible to collect the report in person; please make sure to indicate this request to our staff at the time of the examination.
• Upon special request, with written authorization, the examination result may also be collected in person by a relative or legal representative.
• Please keep your report for your own benefit and bring it with you in case of any future examination.

Risks and possible side effects of the PET/CT examination

• The PET/CT examination itself is completely painless.
• The administered radiopharmaceutical has no pharmacological effect on the body, and the procedure is safe with regard to allergic reactions.
• The radiation exposure to the body, with the activity usually applied, does not exceed the radiation exposure of a contrast-enhanced CT examination performed on the same body regions.
• Before the examination, it may be necessary to consume an oral contrast agent diluted with water for more accurate visualization of the intestinal tract. Very rarely, looser stools or diarrhea may occur as a side effect. Please drink the liquid slowly, in small portions.