0:00

The second part in this section is all about the patient's

0:03

preparation before arrival.

0:05

And the first thing to note here is

0:07

that there actually aren't any general contraindications

0:09

to the PSMA PET tracer.

0:11

Um, but there are considerations when a patient is being

0:14

booked in for a PET scan, namely whether

0:17

or not they can tolerate the examination safely.

0:20

They need to be able to be in a room

0:22

for approximately 60 minutes

0:23

after they've been injected with the radio tracer.

0:25

You know, be able to manage bladder

0:27

and bowel to the point that you're not having

0:29

radioactive urine, um, in places it shouldn't be.

0:33

And then also be able to lie flat.

0:35

Um, in the case of a total body PET scanner,

0:37

you're looking at being on the scanning bed for five

0:39

to 10 minutes, but for a more conventional pet scanner,

0:41

digital or time of flight,

0:43

then you may have the patient on the bed

0:45

for 20 to 30 minutes.

0:46

So making sure that they can tolerate

0:48

that scan is really important.

0:51

There's no need for fasting, there's no need

0:52

for blood sugar control, and that is in conjunction, in, um,

0:55

comparison rather to FDG pet, which is a glucose analog,

0:59

which is why you need to fast and maintain glucose levels.

1:02

So there's no such requirement.

1:03

So no fasting patients can just turn up.

1:05

Medications generally can pretty much continue as directed.

1:08

There's no need to pause any medications.

1:11

There is some, um, talk in the literature about the impact

1:13

of a DT therapy on patients results.

1:17

Um, but really that should just continue

1:18

if it's already commenced.

1:19

If it is being started as a new line of therapy, you know,

1:22

it potentially there's some benefit to doing the scan

1:24

before the therapy is, um, started to allow that baseline.

1:28

One thing that we do ask patients

1:29

to do is keep well hydrated

1:31

because it is, um, excreted through the urine.

1:33

Um, we want our patients to be well hydrated

1:35

so they can get rid of that tracer over time.

1:37

Um, and also not have a really high concentration

1:40

of radio urine in the bladder, which can cause artifacts.

1:43

The patients should be well hydrated on their arrival,

1:45

but we will also provide oral hydration

1:46

during the uptake period between, you know, 900 mls

1:49

to a liter of water, which we encourage them to drink in

1:53

during that waiting time between when the tracer is injected

1:55

and when the patient is scanned.

1:58

In terms of blood tests, um,

1:59

we'll see in an upcoming section about the use

2:01

of intravenous contrast.

2:02

So a renal function measurement is useful to screen, um,

2:05

for safety for using the iv I donated contrast.

2:09

Um, and it's also really useful to have a recent PSA

2:12

as well, um, which really helps us

2:14

with our imaging interpretation.

2:17

And so what the patient can expect on the day is they'll

2:20

arrive and they'll check in with the front

2:21

desk at our institution.

2:23

They're guided down the corridor, they're met by our nurse

2:25

who, um, does some basic observations including weight

2:27

and we'll cite the cannula.

2:29

And somewhere in that my registrars, um,

2:31

will come in and have a chat with them.

2:32

I'll pop him in if I need to.

2:34

Um, they'll also be seen by our radiation technologists

2:37

who are responsible for the handling

2:38

of the radiopharmaceutical and injection.

2:40

Um, and as you say, there's a cannula cited.

2:42

Height and weight are recorded, which allows us to do, um,

2:45

SUV measurements and semi-quantitative analysis.

2:47

On the examination, the patient is injected

2:50

with radiotracer in an uptake room, so a room

2:52

that they have, um, on their own,

2:54

which is lead lined for radiation safety.

2:56

Um, and I pop a little asterisk there because

2:58

Some patients will be injected on the scanning bed.

3:02

Um, and that's if they are having an initial dynamic phase

3:05

at the beginning of their examination.

3:07

For patients who are injected in the uptake rooms,

3:09

they're just having a single acquisition, um, 50

3:11

to 60 minutes post injection.

3:12

They'll wait that time in their room in a comfy recliner

3:16

or a bed, and then their scan will take place

3:19

before they go into the scanning room, they will need to go

3:22

to the bathroom, empty their bladder,

3:24

and during that uptake period they'll also be drinking

3:26

and hydrating as well.

3:28

The scan will last about 10 to 30 minutes,

3:30

depending on the camera as we discussed.

3:32

Um, then images are checked by our technologists

3:34

and the doctors if there is any concerns.

3:36

And then provided that's okay, the patient is then able

3:39

to depart.