0:04

The last case is a melanoma case, right?

0:08

So go from the top because it's Oma.

0:12

Look at this big melanoma, right?

0:16

You guys, you guys remember the melanoma?

0:17

Melanoma has pre thickness or clark, right?

0:21

Levels, prest, low thickness,

0:24

less than one millimeter thickness.

0:26

They just like do wide local excision

0:28

and follow the, follow the melanoma up clinically, right?

0:32

One to four millimeter.

0:33

We do the sentinel node

0:35

and depending on the sentin node in the

0:37

or if it's metastatic, then they do know the dissection

0:41

and do pet for staging.

0:42

If it's not metastatic, they just close the patient

0:46

and follow the patient up, right?

0:47

They don stage it after the,

0:50

if the crystal sickness is more than four, four millimeter,

0:54

then they do know the dissection

0:56

and they send the patient for, for staging, for PET staging

0:58

because they know that this, this is a higher risk,

1:00

this patient, right?

1:02

But look at this one. This is big,

1:04

big melanoma stick melanoma.

1:06

It's even um, exo melanoma in the scap,

1:11

the frontal scap, right?

1:13

And then I'll go down

1:19

and there is metastatic lymph node,

1:23

obvious metastatic lymph node.

1:24

It's rounded, it's hypermetabolic, it's ugly,

1:29

it's an ugly, um, lymph node.

1:31

It's obviously the static lymph node, right?

1:42

This patient can progress quickly, right?

1:47

Sure. There's another file. What is it?

1:51

There's a pacemaker in this patient, right? Yeah.

1:53

And there's pacemaker, dual chamber peacemaker.

1:55

There's, and by the way, we read the, the ct.

1:59

So it's not that you read the PET

2:00

and the C for ian correction.

2:02

No, you read the, the CT

2:04

and it's a non unconscious ct,

2:05

so it's like not the easiest to read.

2:07

So we look at everything, injection site infiltration.

2:10

You look at the whole, the whole body.

2:13

One thing that is important about the melanoma patient is

2:17

you look at, it's one of the situation

2:20

where the non corrected image is important.

2:23

So, um, oh, we have a head and neck because it's a,

2:27

because it has a head and neck.

2:28

Melanoma we usually do, um, a head

2:33

and neck, a zoom neck,

2:46

just magnified more time over the head and neck.

2:50

See how much better is the

3:01

here look how much better it is.

3:05

Look, look how much better it's here.

3:07

Looking at the me side

3:10

and looking at the metastatic lymph node,

3:18

it's much better.

3:20

So we do, because it's a me of the head and neck.

3:22

We do also an extra zoom neck, which is extra position,

3:25

pet position on the head and neck.

3:28

Extended time, more time per uh, develop, uh, position

3:33

to get a better look at the head and neck.

3:35

'cause it's the primary side, right?

3:39

The other thing I was telling you is that

3:42

when it is a melanoma, what we do with

3:45

what you should do is you should, um,

3:49

pull the non corrected image.

3:53

Why? Because I'm sure, yeah,

3:57

this is the non corrected image.

3:59

How do you know it's the non corrected damage?

4:02

Because multiple things,

4:07

one of the things is that, see the, how the lung is darker

4:12

and then the skin, it's like you hold the marker

4:15

and go around the patient skin is hot, right?

4:19

This, this is not corrected damage.

4:21

So this photons coming from the skin doesn't

4:25

have any attenuation.

4:27

It makes, makes it right away to the detector.

4:29

So they are really hot, right?

4:33

Lung because it's a lot of air, no attenuation again,

4:36

so the lung are usually hot, right?

4:41

So why do I look at the non attrition

4:43

corrected in melanoma patient?

4:45

Because it exaggerate activity from the skin.

4:49

So, and melanoma sometime tends to send meds

4:54

to other side of the skin.

4:55

So I have to scan the, the whole skin carefully.

4:59

So I go slowly in the non attenuation corrected to see any,

5:03

any subtle activity that I can miss in the corrected image.

5:07

So the corrected image tweaked down the activity on the skin

5:10

because the skin activity is

5:11

exaggerated in an uncorrected image.

5:14

But here it's exaggerated.

5:16

I want it to be exaggerated

5:17

because I wanna see any sort of activity

5:19

and see if this is really something that I care about

5:22

or this is, um, just inflammation or an artifact

5:27

and I wanna mention it anyway.

5:28

So I go slowly through the whole scan

5:32

and make sure there's no sort activity that I am, i,

5:37

I didn't see in the, in the corrected image

5:41

in the melanoma case.

5:42

See? And then I come here

5:46

is the decrease the intent still,

5:48

but this is the map of the non corrected image

5:52

and I look, is there anything focal I can see on the skin?

5:56

Not really. This is just joint here.

6:01

Not really. This is the, this is the primary side.

6:04

This is the metastatic lymph node. There's nothing really.

6:08

Then I'll go back to your corrected image

6:13

and nothing else you need to see it.

6:15

So this case have the primary site

6:17

and the scalp have the metastatic lymph node,

6:19

no distant meds and nothing else to worry about.

6:24

I.