HighQualityPETCTReportElements.ppt

High Quality PET/CT Report Elements And PET/CT team steps learning 2010 4.7 高價健檢篩癌 沒必要! 沒必要!那我們這些儀器與人如何? Don’t worry, be happy. We have our knowledge and confidence! We fight for and service for our patients as well as for our clinical doctors. Don’t be afraid! 其實早在二年前核醫月會 tumor scan演講中我已提到: 先做低階檢查再做高階正子檢查 ex. GI tumor: occult blood ;tumor marker; sonography; endoscopic biopsy and even CT, MRI, coloscopy are firstly chosen before doing PET scan or tumor scan because the problem of FDG uptake, for lymph node metastases it is not bad study. PET/CT風險:隨時間久我們愈知愈多其偽陽性與偽陰性愈知不可膨風 Low to intermediate pt FDG avid Exposure to high dose radiation Suggestion of biopsy or others. High price study in normal pt. Misleading clinician wrong direction. Even suggest surgery; biopsy but exposure pt to near unrecovery situation. Non FDG avid tumor: prostate;BAC hepatoma, GIST,NET,teratoma… (for C11-Acetate PET has advantage over F18-DG in false negative studies). For normal and healthy patient, PET/CT? Shin Kon hospital PET/CT 1.1% screening rate for cancer 5% false positive rate annually. 0.5 cm tumor about 10 mSv. MRI is good at no radiation but poor detection in lung, GI and colon cancer. Family history is important. False positive findings Inflammation Lymphadenopathy. Ovulation Brown fat Post radiotherapy in oral cancer. Fibrosis or any increased metabolic activity non cancer situation. 醫病新觀念:人不是物體,醫生不能只考慮修復身體,不同人對自己的身體有不同的感受,醫師必需了解進而尊重這些不同的觀念進而將之放進醫病關係中.醫療勢必要從一種權威的命令,控制朝雙向協商,理解的服務本質調整,使病人相信與安心,試想若我們的報告作到連病人都瞭解那麼更何況臨床醫師!(quality). According to PET PROS (professional resources and outreach source) guideline(SNM) 高價健檢,身體擔風險. 美國多年來一直不贊成健檢用PET/CT原因就在此. 尚未克服false positive and false negative problem in FDG. 但是既然經已經做了我們應該給病人與醫師最盡心適合的報告! Elements of PET/CT report: Clinical history(3+5) Procedure(7+3+2) Comparison(2) Findings(3) Impression Sample normal reports Clinical history(3+5) Indication for study: tumor type ;abnormality to be evaluated,