18F-FDG PET-CT scan for cardiac sarcoidosis

What is a PET-CT scan?

PET-CT (Positron Emission Tomography and Computed Tomography) is a scanning method that allows us to see how organs are working. PET-CT helps us identify organs or tissues that are not working normally. The body is imaged following the injection of a radioactive tracer. The most commonly used pharmaceutical in PET is Fluorine-18 fluorodeoxyglucose (FDG), a slightly radioactive form of sugar. This provides important information about many conditions affecting different organs and the images allow your doctor to plan your treatment more effectively.

How long will I be in the department?

You should expect to be with us approximately two hours in total. This includes explanation, preparation and scanning time. The scan itself lasts roughly 10-20 minutes.

What to do when you arrive

Please report to reception and take a seat in the waiting area.

Staff you are likely to meet

Our department consists of radiographers, nuclear medicine technologists, radiologists, clinical support workers and administrative staff.

Preparation for procedure/examination

You must:

• adhere to a high-fat, high protein, low-carbohydrate diet from the morning before to the day of your scan. You will then need to fast for 18 hours prior to your appointment time. This may sound like a very long time, but will basically mean that you will stick to the diet the day prior to your scan, with an early dinner, and then simply skip breakfast on the morning of your PET scan. During this whole period we would like you to keep well hydrated. Please see the Dietary Instructions at the end of this leaflet.
• take all prescribed medications on the day of your scan as usual, unless otherwise instructed on your appointment letter.
• avoid strenuous exercise for 24 hours prior to your scan appointment, e.g. running, cycling, horse riding or gym exercise.

Please consider leaving all jewellery at home as we need to remove metallic objects for the scan if possible. We suggest wearing something loose and comfortable with no metal buttons, zips or fastenings. If required, a hospital gown can be provided for the scan.

Please contact us in advance on 01223 349222 if you:

• have had or are expecting chemotherapy within three weeks of your appointment
• have had radiotherapy within the last three months
• have had surgery within the last three months
• are taking oral steroids
• have had a recent infection
• are pregnant, breast feeding, or have young children at home
• are diabetic
• have any disability or special needs requiring ramp access
• have been told that you have difficult veins to cannulate
• weigh over 150kg (23 stone)
• are claustrophobic
• have any difficulty lying flat for 20 minutes
• have any other appointments on the same day
• require a specific appointment time due to taking time sensitive medication (e.g. medicines for Parkinson’s disease).

Please note that appointment timings may be limited due to specific tracer availability.

Benefits

PET-CT combines two types of imaging in one scan. Your doctors get functional information from the PET scan as well as organ anatomy from the CT scan to check if your organs and tissues are functioning normally. A PET-CT scan may help to confirm or rule out a suspected diagnosis.

Risks

The scan involves an injection of a small amount of a radioactive tracer which will remain in your body for a few hours. This radiation can cause cell damage that can, after many years or decades, contribute to the development of cancerous cells. This procedure carries only a very small chance of this happening to you.

Your doctor will have considered the risks and benefits of having this test before referring you to us. The benefits of the test outweighs the potential risks.

Please discuss this with the staff on the day of your appointment if you have any concerns.

What will happen on the day of my procedure/examination?

Once you arrive for your appointment you will be taken into the interview room and the procedure will be fully explained by one of our radiographers/technologists who will also take a brief clinical history. If you have any questions, this is a good opportunity to ask them.

A small needle will be inserted into a vein in your arm or hand, and your blood glucose will be checked. We need your blood sugar to be at a fairly low level, which is the reason for the diet. If high blood sugar levels are detected, your scan will need to be rescheduled.

A small amount of a radioactive tracer will be injected through this needle. You will then sit and relax quietly for 60 to 90 minutes before having the scan.

Just before your scan, you will be asked to empty your bladder and to remove all jewellery and metallic objects. We will then ask you to lie on your back on the scanner bed with your arms placed above your head if possible, otherwise arms down by your side. Most scans last between 10 and 20 minutes.

Please note that due to the complex processes involved in the manufacture of these tracers, there may be delays and on occasion there may be failures in the production or quality control testing of the tracers which may lead to the cancellation of your appointment. We will keep you updated of any delays.

Accessibility requirements

If you require support for your appointment, e.g. if you find it hard to hear, see or be understood by others, please let the receptionist or healthcare professional know on arrival or contact us: by Email or telephone: 01223 256998.

Pregnancy status

We have a legal responsibility to enquire if you are pregnant. Any patient aged between 12-55 years will be asked if there is a possibility they could be pregnant. This is important for us to know before you have your examination involving ionising radiation.

You can discuss this with a healthcare professional in private if you wish.

Medication

Please bring a list of your medications to your appointment, particularly any antibiotics or steroids you are taking.

Can I bring someone with me?

Any friends or relatives bringing you to your appointment will not be allowed to stay in the unit due to limited waiting room space. Only an essential carer or interpreter is permitted. Please note that during your scan, they will be asked to wait outside the scan room due to the limited space.

Please do not bring children or pregnant friends or relatives with you.

Personal belongings

Your personal belongings will remain with you throughout the whole process. Please refrain from wearing any jewellery as this will have to be removed for the scan.

Please feel free to bring some reading material with you to read during the 60 minute uptake time as you will be required to stay in the department during this time.

What happens after my procedure/examination?

You are free to go home. You may eat and drink as normal. Continue to drink plenty of fluids for the remainder of the day and empty your bladder frequently.

Please avoid close contact with pregnant women and young children for six hours after your scan.

If you are breastfeeding, we recommend that you:

• Express and appropriately store at least one feed before your appointment
• Breastfeed your child before your appointment
• Express as much milk as you can in the 2 hours after your scan and discard the milk
• Ideally, have someone else bottle feed the stored milk to your child until the end of your six-hour contact restriction

Possible side effects and additional aftercare

Very rarely there may be bruising at the site of the injection. This will resolve itself within a few days.

How, when and by whom will my results be communicated?

Imaging examinations are reported in order of clinical priority to ensure those with the highest urgency are reported first.

Your referring team or clinician will be responsible for communicating reports back to you. Results are usually with your doctor within a week or two, often much sooner.

If you have a further appointment with your doctor, please let us know the date when you attend for your scan.

Test results are made available via MyChart but there is 3 week delay from when an examination has been reported to when it is available on MyChart, in order to allow time for your clinical team to be able to see and action the results prior to them being released to the individual patient.

Are there any alternative tests?

This scan forms part of a series of investigations your doctor will be undertaking. There is no equivalent scan we can use.

Contacts/Further information

The tracer we use will be ordered for you and cannot be used for any other patient. It is important you inform the department if you are unable to attend your appointment. Please help us to conserve valuable NHS resources.

Your scan will take place in the PET-CT department of Addenbrooke’s Hospital. It is vital that you arrive on time for your appointment as the radioactivity has a very short shelf life. If you are late for your appointment we may not be able to proceed with your scan.

Please also be aware that the tracer is produced off-site and delivery can sometimes be delayed because of production or transportation issues.

For further information, you can contact the PET-CT team on 01223 349222

Facilities available

Our department is equipped with toilets and changing rooms. You will wait in one of our bays after you have had your injection until it is time for your scan. These bays have call bells, so you can get the attention of the team should you require anything. They also have adjustable chairs.

Directions to the department

The PET-CT department is between the outpatients and oncology departments on the ground floor (level 2). If you enter through the outpatients entrance, turn right at the shop and follow the corridor to oncology, CT and PET imaging corridor on the left. PET-CT is on the right. If you enter through oncology, go through the waiting room and turn right onto the corridor. PET-CT is on the left before you reach the main corridor. There is an app available on your phone called CUH Directions if you need help finding the department. It is marked as CT/PET on the app.

Parking at CUH is limited. Please use public transport if possible, there is parking available at Trumpington and Babraham Park & Rides with frequent buses to the hospital. If you do need to bring your car then we have two patient and visitor car parks.

All parking is pay on foot. This means you pay at a pay station when you are ready to leave for the period of time you have parked. Please get your ticket stamped at reception in the PET-CT department as this offers you a subsidised rate.

The pay stations take credit cards, notes or coins and are located on the ground floor in both car parks 1 and 2, in the lift and stair lobbies on each floor and in the main concourse.

Parking spaces may be limited during peak times. Please allow enough time to park and make your way to your appointment.

Question, concern or complaint?

Firstly speak to your nurse, doctor or other staff member as soon as you can so they can do their best to put things right straight away.

If you don’t feel able to speak directly to the people caring for you, contact the patient advice and liaison service (PALS). Please call 01223 216756 9am to 4pm Monday to Friday, by Email, or via a form available via link on the CUH PALS webpage.

PALS is open every weekday, and you can leave a message in the evenings and weekends.

MyChart

We would encourage you to sign up for My Chart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device More information is available on our website: MyChart