Whole-body PET/CT studies with lowered 18F-FDG doses: The influence of body mass index in dose reduction

Abstract

The administered dose of 18F-FDG can be greatly reduced using body mass index (BMI) instead of the patient's weight, without diminishing image quality. We have focused on reducing the administered dose while maintaining the acquisition time and have developed dosing-based algorithms using BMI. We conducted a prospective dose-adjustment research study with more than 1,800 patients undergoing time-of-flight PET/CT. Methods: From January 2009 to October 2010 we recruited 1,000 patients, of whom 180 were randomly selected to create the control group. The treatment group was created by selecting 180 new subjects from a total of 800 recruited from January to December 2011. The control group was administered a body weight-calculated dose of 5.55-7.4 MBq/kg. The treatment group was administered a BMI-calculated dose of 6.85-11.1 MBq/BMI. Each group was divided into 5 subgroups according to BMI classification (underweight, normal weight, overweight, obese, and morbidly obese). All scans were acquired with a time-of-flight PET/CT scanner and were evaluated in a masked manner by 2 nuclear medicine physicians. Evaluation of images was purely qualitative, with visual scoring of image quality from 1 to 3 (high to low). These data were analyzed for statistical significance. Dosimetric measures of patients' emitted radiation were taken at the surface and at a distance of 0.5 m and 1 m to compare the groups. The readings of PET staff dosimeters were evaluated during this period and analyzed. Results: A reduction of between 9% and 22% in administered dose per patient was achieved for the BMI-derived dose group with respect to the body weight-calculated dose group. In addition, an effective dose reduction of 56% and 12.5% for patients and staff, respectively, was achieved. The cost per study was therefore reduced while diagnostic image quality was maintained or even improved in most cases. Conclusion: BMI-calculated doses, which are often lower than strictly weight-based doses, can be administered while maintaining acquisition times. This dose reduction is not only consistent with the as-low-as-reasonablyachievable principle but can be performed without diminishing diagnostic accuracy and should lead to lower dose to staff and potential economic savings. © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.