Patients undergoing multiple 18F-FDG PET/CT exams: Assessment of frequency, dose and disease classification

Objective: To analyse the frequency, demographics, primary disease and cumulative effective dose of patients undergoing two or more F-18-FDG PET/CT examinations in a year. Methods: In a retrospective study performed at a tertiary-care hospital, patients who underwent >= 2 F-18-FDG PET/CT scans in a calendar year were identified for two consecutive years. The CT radiation dose was calculated using dose-length-product and sex-specific conversion factors. The primary malignancy of patients was retrieved from electronic medical records. Results: 10,714 F-18-FDG PET/CT exams were performed for 6,831 unique patients in 2 years, yielding an average of 1.6 exams per patient. The maximum number of F-18-FDG PET/CT examinations any patient underwent in a single year was seven. 20.9% patients had >= 2 F-18-FDG PET/CT exams in any single year. Thirty nine percent patients in the cohort were below 60 years age. The median dose for F-18-FDG PET/CT examination was 25.1 mSv and maximum value reaching 1.7 to 2.9 times the median value. Cumulative effective dose (CED) was >= 100 mSv in 12-13% of the patients. The cumulative dose for both years combined demonstrated the 25(th) percentile, 50(th) percentile and 75(th) percentile as well as the mean to be over 100 mSv, with the 25(th) percentile being 109 mSv. The dominant primary malignancies contributing to serial F-18-FDG PET/CTs in decreasing frequency were melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma. Conclusions: A sizeable number of patients undergo >= 2 F-18-FDG PET/CT exams with one out of every eight patients receiving cumulative dose >= 100 mSv and that includes patients with long--life expectancy. Advances in knowledge: The study found that one of five patients had >= 2 F-18-FDG PET/CT exams in a calendar year, one of four patients in two years and one of eight patients received cumulative dose >= 100 mSv. Top malignancies associated with serial imaging in decreasing order of frequency included melanoma, non-Hodgkin's lymphoma (NHL), gastrointestinal cancer, breast cancer and Hodgkin's lymphoma.