0:01

So let's talk about quality control.

0:04

I always start every case looking at the MIP images

0:08

because it gives me a lot of information about

0:12

the distribution of the tracer, which would be my first

0:16

thing to check has the patient gotten the tracer

0:21

that was requested or has there been an issue.

0:24

And even though this might be, uh, an uncommon

0:29

problem, it happens.

0:31

So it is important for you to understand

0:34

and be comfortable with how each tracer looks

0:39

and just, uh, make sure

0:40

that everything matches when you're reading the case.

0:45

The other thing that is important is

0:46

that in this MIP I will be able

0:49

to see if there are other issues related to,

0:53

for instance, injection.

0:55

Like in this case, there's an extravasation in the anti

1:00

cubital region where the patient was injected.

1:04

Other things that can happen is the misregistration,

1:08

which sometimes it's easily identified on the mip,

1:13

but often it will be once you start reading the case

1:16

that you realize that there are issues

1:19

with the misregistration between the CT and the PET portion.

1:22

And here I'm, I'm showing you an example.

1:26

You can see that the head on the C is facing, uh,

1:31

one direction, whereas the PET portion, the road data

1:35

of the pet shows

1:36

that the head is facing a different direction.

1:40

What these results in is

1:42

that your corrected images will look blurry.

1:46

Sometimes these might require to repeat the study,

1:49

and sometimes, depending on the case, if you see

1:53

that there's no abnormality, you might not need to repeat.

1:57

But this is something that the technologist should review

2:00

before sending the patient off,

2:02

and you should always mention in your report.

2:06

Another issue with misregistration

2:09

that we often run into is misregistration

2:15

from tidal breathing.

2:16

As I mentioned earlier in the introduction,

2:20

patients don't hold their breath during the PET imaging,

2:23

and this can limit our ability to detect lesions

2:27

or also could show us that in, like in this case, the area

2:31

of pet uptake is higher

2:35

and you can see it better on the F images,

2:37

but the area of uptake is higher than the abnormality.

2:41

So knowing how the PET CT has been acquired

2:46

allows you to understand these possible limitations.

2:51

This is another example of breathing motion

2:54

that we often encounter. In the ME

2:58

Imaging, we see that there's multiple hepatic lesions

3:02

that show intense FDG uptake,

3:04

and there are some areas of FO focal uptake

3:07

that project over the right lung base.

3:10

The coronal plane is very useful to

3:13

evaluate the distribution of the lesions in the liver versus

3:16

lung, uh,

3:17

and it might help you decide if these areas of uptake belong

3:22

to the lung or to the liver.

3:25

The other thing to do, obviously, is to go

3:29

and see if there are abnormalities in the lung

3:32

or in the liver that correspond

3:35

to these areas of focal uptake.

3:37

In this case, I do not see nodules at the right lung

3:41

base, but I don't see a specific correlate

3:46

for all the areas of focal uptake on the liver.

3:50

However, the distribution of these tells me

3:55

that this is most likely liver lesions

3:59

that are mis registered due to motion.