Download PET- CT Imaging - Diagnostic Radiology, HKU

PET- CT Imaging
The University of Hong Kong
Operations Manual
香港大學診斷影像中心
正電子-電腦掃描部
Ground Floor ․ New Wing D ․ Queen Mary Hospital ․
瑪麗醫院․ 新 D 翼․地下
Tel : 2855 5914
Fax: 2817 5391
Website: www.hku.hk/diaradio
PET- CT Imaging
The University of Hong Kong
Department of Diagnostic Radiology
The University of Hong Kong
Director
Dr. P. L. Khong
Location
K4-07
Radiologists
Dr. P. L. Khong
Dr. Clara Pang
Dr. Sonny Chiu
K4-07
K4-08
K4-05
3306
3309
4499
Department Secretaries
Ms. Irene Leung
Ms. Alice Lau
K4-06
K4-06
3307
3307
Senior Radiographer
Mr. Stephen Kwok
DG
5914
Radiographers
Mr. Ken Liu
Ms. Winnie Chan
DG
DG
5914
5914
Unit Receptionist
Ms. Janet Wan
DG
5914
General Enquiry &
Appointment Booking
PET-CT Imaging Unit
New Wing D, Grd Floor
Tel : 2855 5914
Fax : 2817 5391
HKU PET-CT Imaging Operations Manual.doc
Page 1 of 18
Extn
3306
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Content
Page
1.
Guiding Principles of Operation
3
2.
Clinical Services and Scope of Work
3
3.
Specialty Service Scope
4
4.
Examination Booking
- Request Form
5-6
7
5.
Instructions to Ward Staff
8
6.
Report and Images
9
7.
Work Flow at Unit
10-11
8.
Price List
12-13
9.
PET-CT Frequently Asked Questions
Patient Preparation
14
15
16
17
17
17
18
18
18
18
What happens when I arrive for my scan?
What is a PET-CT?
What is a radiopharmaceutical?
What is FDG?
Is a PET-CT scan painless?
Is PET-CT safe?
How long is the procedure?
HKU PET-CT Imaging Operations Manual.doc
Page 2 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Guiding Principles of Operation
•
•
•
•
•
The Unit is established with a charitable capital donation but the running
of the Unit has been agreed to be based on financial self-sustainability
basis (self-financing program).
The Unit is managed by the Faculty of Medicine, HKU, and located in QMH.
The Unit will serve mainly patients from HA hospitals, and also outside
referrals.
Referrals will be made according to individual clinical needs, in accordance
with HA referral guidelines, and will be up to the patient’s choice. The Unit
merely provides another option to patients.
Collaborative research activities will be supported, on a cost-recovery basis,
and as far as possible.
Clinical Services and Scope of Work
Operation Hours:
The Unit will provide PET-CT and CT scan services to patients from Mondays to
Fridays, 9am - 5pm and CT scan services only on Saturdays, 9am - 1pm.
For the time being, the Unit will not provide out-of-hours emergency services.
Service Schedule:
Monday Tuesday
Wednesday
Thursday
Friday
6-8 cases
6-8 cases
6-8 cases
6-8 cases
6-8 cases
3pm-5pm 6-8 cases 6-8 cases
CT only
6-8 cases
6-8 cases
6-8 cases
9am-3pm
PET-CT
HKU PET-CT Imaging Operations Manual.doc
Page 3 of 18
Saturday
9am-1pm
12-15 cases of
CT
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Specialty Service Scope
(For detailed services, please refer to the list of examinations and pricing)
PET-CT applications:
•
•
•
•
•
Oncology: cancer detection, staging and therapy monitoring
Cardiology: myocardial viability
Neurology and Psychiatry: dementia, epilepsy, Alzheimer’s disease
Radiotherapy planning (to acquire images for the oncology department for RT
planning)
Infection and Inflammation
CT applications:
The whole gamut of Diagnostic CT scan services (interventional radiology
excepted) will be provided. We hope to maximise on the advantages of this 64slice Volume CT scanner by performing those examinations which will especially
benefit from this new technology e.g. cardiac CT scans.
HKU PET-CT Imaging Operations Manual.doc
Page 4 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
PET-CT Scan Booking
Telephone call/Fax request form
for appointment booking
(Tel.: 2855 5914; Fax: 2817 5391)
Refer to senior radiographer
(Radiologist if necessary) for
special requests or queries
Unit receptionist
(DG/Main Block)
1.
2.
3.
4.
5.
Collect patient details and check contraindications.
Offer appointment date and time.
Quote examination fee.
Request for request form to be faxed to Unit if not done.
Fax appointment and preparation instruction to the
referring doctors/organization.
(Appointment and preparation instruction to be delivered to
patient by the referring doctor/ organization).
Unit receptionist re-confirms appointments with patients by
telephone call at 4pm on the day prior to scheduled booking
No
Appointment re-confirmed with patient
Appointment
cancelled or
rescheduled
Yes
Radiopharmaceuticals ordered at 4:30 pm
by Senior Radiographer according to the
confirmed appointment list
HKU PET-CT Imaging Operations Manual.doc
Page 5 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
CT Scan Booking
Telephone call/fax request form
for appointment booking
(Tel.: 2855 5914; Fax: 2817 5391)
Unit receptionist
(DG/Main Block)
1. Collect patient details and check
contraindications.
2. Offer appointment date and time.
3. Quote examination fee.
4. Request for request form to be faxed to
the Unit if not done.
5. Fax appointment and preparation
instruction to the referring doctors /
organization.
(Appointment and preparation
instruction to be delivered to patient
by the referring doctor/ organization).
Refer to senior radiographer
(radiologist if necessary) for
special requests or queries
** Cancellation of PET-CT examination appointment:
For cancellation of appointments, the PET-CT Imaging Unit should be
informed as soon as possible by phone/fax. PET-CT appointments cancelled
after 4:30 pm on the working day prior to the scheduled examinations will
incur a charge of $3000 to the patient for the cost of the ordered FDG
radiopharmaceutical .
HKU PET-CT Imaging Operations Manual.doc
Page 6 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
PET-CT SCAN & CT SCAN REQUEST FORM 正電子及電腦掃描申請表
PET Examination Requested
FDG PET-CT without IV contrast
(from base of skull to upper ⅓ of thigh)
FDG PET-CT with IV contrast
(from base of skull to upper ⅓ of thigh)
FDG PET-CT with IV contrast including
brain
CT Examination Requested
Head & Neck:
Brain
Head and neck
Orbits
Nasopharynx
Paranasal sinus
Skull base
FDG myocardial viability
FDG myocardial viability with
CT coronary angiography
Other requests (please specify):
Non-contrast
FDG brain without IV
contrast
FDG brain with IV
contrast
Non-contrast & Contrast
Body:
Thorax
Thorax high resolution CT (HRCT)
Abdomen (from diaphragm to iliac crest)
Pelvis (from iliac crest to symphysis pubis)
CT urogram
CT colonoscopy
Optional Contrast
Cardiovascular:
Calcium score for coronary arteries
Coronary angiogram
Angiogram of (please specify):
Other requests (please specify):
Clinical Information
Clinical History:
Previous history of pulmonary TB
Yes
No
Previous surgery
(If yes, please specify Date, Type & Site):
Yes
No
Previous radiation therapy
(If yes, please specify Date & Site):
Yes
No
Previous chemotherapy / Steroid therapy
(If yes, please specify Date & Type):
Yes
No
Is the patient a known diabetic?
Yes
Yes
No
No
Yes
Yes
No
No
Yes
Yes
Yes
Yes
No
No
No
No
If yes, on metformin?
Allergic history:
Previous reaction to IV iodinated contrast injection?
Previous adverse drug reaction?
(If yes, please specify Drug Name):
History of asthma / angioneurotic oedema?
Allergy to seafood, alcohol, etc.?
Urticaria?
Clinical Question:
Does the patient have raised serum creatinine?
(If yes, please provide the following information)
Serum creatinine level:_________ μmol/L
Date of measurement :_______________
Referring Doctor’s Information
Doctor’s Name (Block Letter):
Signature
Pager/Mobile:
Hospital:
Date:
Tel:
Dept.
HKU PET-CT Imaging Operations Manual.doc
Page 7 of 18
Films & report delivery:
Collect by patient
Send to address (specify):
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Instructions to Ward Staff
PET-CT Scan:
Patients need to be well fasted for at least 6 hours before the scheduled PETCT scan to ensure a low blood sugar level at the time of the scan. This
includes abstaining from sweets, flavoured/sugared drinks etc and if patient
is on i/v dextrose drips to turn off the drip for at least 6 hours prior to the
scan. Patients should be encouraged to drink plain water.
If the patient is diabetic, please keep the patient fasted and withhold the last
dose of oral medication or insulin. Patients on insulin will be scheduled for
an early morning appointment. Any queries, please contact the Unit for
further instructions.
Please advise the patient not to do repetitive activities prior to the scan.
Excessive muscular activity may interfere with the scan quality.
For re-scheduling or cancellation of appointments, please inform the Unit as
early as possible.
Patient Escort:
Agreement has been sought from the Central Portering Team/QMH to provide
patient escort service for walking, wheelchair and stretcher patients coming
for the scheduled scans and return to their respective QMH’s wards thereafter.
Iodinated intravenous contrast CT Scan:
For patients scheduled for intravenous contrast-enhanced CT scans, an
Allergy data form and checklist has to be completed by the referring clinician.
Steroid cover may be necessary.
HKU PET-CT Imaging Operations Manual.doc
Page 8 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Report and Images
Reports will be accessible to QMH and HA referring clinicians through the HA
RIS system when ready.
All hard copies of reports (4 copies) and images (1 copy of colour print, 1 copy
of film and 2 copies of CD-ROM) will be delivered to the referring clinician on
the following day after the scan. If the patient opts to collect the report
directly from the Unit, he/she should inform the Unit’s Receptionist to
arrange for it to be collected on the day after the scan. Otherwise, the
referring clinician is requested to deliver three copies of report, 1 copy of
colour print, film and CD-ROM to the patient when the patient attends the
coming appointment.
.
All images will be digitally archived in the PET-CT Unit at Ground floor, New
Wing Block D, QMH. Hard copies will not be kept by the PET-CT Unit and
therefore, it will not be available at the Unit unless prior arrangement has
been made with the Unit to duplicate the films. Requests for extra hard
copies may be made by the patient to the PET-CT Unit at the quoted charges.
HKU PET-CT Imaging Operations Manual.doc
Page 9 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Work Flow for PET-CT Studies
Patient arrival
Registration & payment at PET-CT Unit
Procedure explained by radiographer
Checklist of clinical history
Is steroid cover indicated ?
Yes
No
Formal consent obtained from
patient. IV line access set up by
radiographer and oral contrast
given
Handled by Nurse to determine
whether the patient has steroid
cover according to protocol
Yes
Blood glucose within normal
No
FDG injection then uptake for 1
hour in patient preparation room
Insulin prescribed by radiologist
on duty to bring down the blood
glucose.
Close monitoring of blood glucose
by nurse after insulin injection.
Scan (15-20min)
Image checked by radiologist or
senior radiographer
Delayed scan or additional scan
Yes
HKU PET-CT Imaging Operations Manual.doc
No
Patient discharged from PET-CT
Unit
Page 10 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Work Flow for CT Studies
Patient arrival
Registration & payment at PET-CT Unit
Procedure explained by radiographer
Checklist of clinical history
Is steroid cover indicated ?
Yes
No
Handled by Nurse to determine
whether the patient has steroid
cover according to protocol
Formal consent obtained from
patient. IV line access set up by
radiographer and oral contrast
given
Scan (15-20min)
Image checked by radiologist or
senior radiographer
Yes
Additional scan
No
Patient discharged from PET-CT
Unit
HKU PET-CT Imaging Operations Manual.doc
Page 11 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Pricing Notice
1.
Please note that the services provided by the PET-CT Imaging Unit are
operated by the University of Hong Kong. According to CSB and HA policy,
scans will not be reimbursable by CSB to civil servants, pensioners and
their eligible dependents; or by the Hospital Authority to HA staff, retirees
and their eligible dependents.
CSSA cardholders and financially needy public patients will not be granted
subsidy by the Samaritan fund.
Fee collection will be handled by HKU. Thus, payment is to be made
directly at the Unit when the patient comes for the scan and receipt will be
issued upon payment.
2.
3.
Categories:
•
•
HA patients, both public and private HA patients pay the same price
Outside private patients
Price includes:
•
•
•
•
Radiologist’s report X 4 (3 copies to patient, 1 copy to referring clinician)
CD ROM of images X 2 (1 disc to patient, 1 disc to referring clinician)
Colour print copy of PET-CT images X 1 (1 copy to patient)
Film copy of CT images X 1 (1 copy to patient)
HA
public &
private
Outside
private
patient
FDG Whole Body + CT Plain
$12,000
$15,700
FDG Whole Body + CT Contrast
$14,000
$18,600
FDG Whole Body and Brain + CT Contrast
$16,000
$21,400
FDG Brain + CT Plain
$8,500
$11,000
FDG Brain + CT Contrast
$9,500
$12,500
FDG Cardiac Viability
$8,000
$10,000
$14,000
$18,000
PET-CT
Examination
FDG Cardiac Viability + CT Coronary Angiography
HKU PET-CT Imaging Operations Manual.doc
Page 12 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Head & Neck
Body
Cardiovascular
Spine &
Musculoskeletal
Processing &
Special
procedures
CT Examination
Brain
Perfusion Brain
Pituitary Fossa
Orbits
Temporal Bone
Face
Nasopharynx
Nose and Paranasal Sinuses
Neck
High Resolution CT Thorax
Thorax or Abdomen or Pelvis
Staging (2 parts): Thorax/ Abdomen /Pelvis
Staging: Thorax & Abdomen & Pelvis
Staging: Brain & Thorax & Abdomen & Pelvis
Liver, pre-transplant with volume
measurements
CT Colonoscopy
CT Urogram
Coronary Calcium Scoring
Plain
$1,500
$1,800
$1,800
$1,800
$2,800
$1,900
$2,300
$2,800
$2,500
$2,000
Contrast
$2,000
$4,000
$2,200
$2,200
$2,200
$4,200
$2,800
$3,300
$4,200
$3,500
$6,500
$8,000
$9,500
$4,500
$4,000
$6,000
$5,500
$3,000
Coronary Angiogram (include Calcium Scoring)
$6,000
Cervical Spine
$2,500 $4,000
Thoracic / Lumbar / LS/ Sacrum Spine
$3,000 $4,500
Upper extremity
$2,000 $3,500
Lower extremity
$2,500 $4,000
CT Angiogram processing
add $2,000
3D CT
add $2,000
CT Virtual Endoscopy (except colonscopy)
add $2,000
CT Organ Volume Measurement (except Liver)
add $2,000
add $2,000
Radiotherapy Planning
Extra Reports/Films for both public and private
Radiologist's report
$1,000
CD Rom
$250
Colour printout
$500
Film copy of images
HKU PET-CT Imaging Operations Manual.doc
$100/film
Page 13 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
PET –CT FAQ
Patient Preparation
What happens when I arrive for my scan?
What is a PET-CT?
What is a radiopharmaceutical?
What is FDG?
Is a PET-CT scan painless?
Is PET-CT safe?
How long is the procedure?
HKU PET-CT Imaging Operations Manual.doc
Page 14 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
Patient Preparation
1.
Bring recent examination films or studies (such as CT, MRI, ultrasound,
PET) for the radiologist to compare directly to your PET-CT scan
2.
Do not eat or drink anything for 6 hours before your procedure, with the
exception of water, Black coffee or tea, both without sugar or cream/milk.
Do NOT take any sweets, flavoured/sugared drinks, mints, coffee
with cream or milk, chewing gum etc., as it may interfere with the results.
3.
Avoid strenuous/repetitive physical activities or exercise on the day before
and day of your PET/CT exam. Excessive muscular activity may interfere
with the interpretation of your exam.
4.
Be well hydrated. Take plenty of water before your examination.
5.
You may continue to take prescribed medications with water, but avoid over
the counter medications that contain sugar like cough syrup.
6.
If you are a diabetic, please notify our staff to obtain special instructions. If
you take insulin to control your diabetes, you will be scheduled for an early
morning appointment since you must withhold your insulin prior to the
exam.
7.
If you have any allergic history or have had an allergic reaction to
intravenous contrast agent during your previous CT or X-Ray examinations,
please notify our staff before your appointment.
8.
Females who are pregnant or breast feeding should not undergo the PET-CT
exam.
9.
If you have any other special conditions or illness, make sure our staff is
aware of that ahead of time.
10. Plan to arrive a little early. Allow 2-3 hours for the PET-CT procedure. The
actual scan time (lying on the imaging table) will be less than 30 minutes.
The standard exam varies depending on the type of study.
Note:
A very expensive FDG radiopharmaceutical has to be prepared specifically
for your exam procedure. If you cannot keep your appointment, please
notify us at least the day before the scan, otherwise you would be
charged $3,000 for the cost of the ordered FDG radiopharmaceutical.
HKU PET-CT Imaging Operations Manual.doc
Page 15 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
What happens when I arrive for my scan?
At Queen Mary Hospital
1.
Come to the University of Hong Kong’s PET-CT Imaging Unit reception
area located on the Ground floor of New Wing D, Main Building of Queen
Mary Hospital.
At PET-CT Imaging Unit
2.
Report to the staff at Reception Counter. You would be shown to a change
room where a locker has been reserved for you to place you belongings.
3.
After changing, you will be waiting in a private Patient Preparation Room,
where our Radiographers will discuss the procedure with you and answer
any queries.
4.
You will have an intravenous catheter placed into a vein in your arm for
ease of injection.
5.
Your blood sugar will be tested and if the levels are acceptable, the
procedure will begin.
6.
We will be injecting a small amount of a radioactive glucose or sugar
known as FDG through this intravenous catheter.
7.
Wait quietly in this private room for 45 minutes to 1 hour . It is important
that you relax and rest and refrain from too much movement, talking or
reading during this time to allow the FDG to properly distribute
throughout your body.
In the Scan Room
8.
After the FDG uptake procedure, you will proceed with the scan, which
will take 15 to 30 minutes.
9.
You will be brought to the scan room and asked to lie down on a
comfortable scanner bed. The scanner bed will move slowly through the
donut-shaped PET-CT scanner to acquire the information needed to
generate diagnostic images.
10. You will be asked to lie still and breathe normally during the scan
because movement can interfere with results.
After the Scan
11. You will be asked to wait at the Patient Waiting Area when your PET-CT
will be reviewed to make certain that all images are complete and no
further imaging is required. You may then check out with the receptionist.
HKU PET-CT Imaging Operations Manual.doc
Page 16 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
12.
Unless you've received special instructions, you can eat and drink
immediately. Increasing your fluid intake soon after the exam will assist
in removing any residual radiopharmaceutical in your system. The
radiopharmaceuticals used during your scan do not remain in your
system for long, so there is no need to avoid contact with others. However,
we advise that you wait for a few hours before getting too close to an
infant or anyone who is pregnant.
Reports and result
13. Results will be sent to your referring physician.
14. You physician will explain the findings of your PET-CT exam and submit
the following to you on behalf of our PET-CT Imaging Unit at your next
scheduled appointment:
a. 3 copies of the PET-CT exam report;
b. 1 copy of colour print;
c. 1 copy of film; and
d. 1 copy of CD-ROM.
What is a PET-CT?
PET stands for Positron Emission Tomography, and PET-CT is the combination
of two imaging techniques in one exam – a PET scan and a CT scan. The PET
scan provides unique information about your body on a cellular level while the
CT scan offers excellent anatomic information. Overall, the PET-CT scan helps
physicians diagnose disease and better understand the exact location and
extent of disease. That information allows physicians to develop the best
treatment plan for the patient.
What is a radiopharmaceutical?
A radiopharmaceutical is a radioactive drug. The most commonly used PET-CT
radiopharmaceutical is FDG, which is a radioactive form of glucose (sugar).
Radiopharmaceuticals are produced in very specific cyclotrons by physicists and
chemists.
HKU PET-CT Imaging Operations Manual.doc
Page 17 of 18
Created April, 2007
PET- CT Imaging
The University of Hong Kong
What is FDG?
2-Deoxy-2-[18F]fluoro-D-Glucose, or FDG, is a type of glucose (sugar) and is the
most common radiopharmaceutical used in PET. To begin the PET procedure, a
small amount of FDG is injected into your bloodstream through an intravenous
catheter. Glucose is a common substance that every cell in your body needs in
order to function and therefore will be taken up by cells. Diabetic patients do
not need to worry; it would take 4,000 doses of FDG to equal the glucose in 1
teaspoon of sugar. FDG has a half-life of approximately 110 minutes, so it is
quickly expelled from your body. FDG must pass multiple quality control
measures before it is used for any patient injection.
Is a PET-CT scan painless?
The only pain involved is the needle prick when a small intravenous catheter is
set up for you to receive the radiopharmaceutical injection.
Is PET-CT safe?
The risks associated with a PET-CT scan are very minimal. The quantity of
radiation is low (10-25mSv) and the radiopharmaceutical (FDG) degrades
quickly so that no detectable radioactivity is present after several hours. In
addition to the radioactive decomposition, the remaining FDG is eliminated from
the body through urine. Family members are not at risk of significant exposure
since greater than 60% of the radioactivity has left the body or is decomposed
before the patient has left the center.
How long is the procedure?
It depends on the type of PET-CT scan your doctor ordered. In general please
allow 2-3 hours for the entire visit. This includes time to prepare you for the
scan and time in the scanner.
HKU PET-CT Imaging Operations Manual.doc
Page 18 of 18
Created April, 2007