While the use of positron emission tomography–computed tomography (PET–CT) is a standard of care in oncological practice in many developed countries, it is still limited in many low to middle income nations. To make reliable information more widely available, the IAEA convened an expert consultant group to review, based on the most recent developments of PET radiopharmaceuticals, Human Health Series No. 9, Appropriate Use of FDG-PET for the Management of Cancer Patients. This, the resulting publication, provides up to date recommendations on the optimal use of PET–CT imaging procedures in oncology. It is written for policy makers and decision makers who allocate resources dedicated to the health care system, a critical issue in the development of nuclear medicine in low and middle income countries. It will also benefit medical imaging practitioners as well as referring physicians.

• 1. INTRODUCTION
  • 1.1. Background
  • 1.2. Objective
  • 1.3. Scope
  • 1.4. Structure
• 2. CLINICAL SCENARIOS FOR PET–CT INDICATIONS
  • 2.1. Search strategy
  • 2.2. List of included radiopharmaceuticals
    • 2.2.1. Acetate: [11C]acetate
    • 2.2.2. Choline: [11C]choline chloride, [18F]fluoroethylcholine or [18F]fluoromethylcholine
    • 2.2.3. Somatostatin analogues such as [68Ga]DOTA-NOC, -TOC or -TATE
    • 2.2.4. FDOPA: 6-[18F]fluoro-L-DOPA
    • 2.2.5. FDG: [18F]fluorodeoxyglucose
    • 2.2.6. FES: [18F]fluoroestradiol
    • 2.2.7. FET: [18F]fluoroethyltyrosine
    • 2.2.8. Fluoride: [18F]sodium fluoride
    • 2.2.9. Methionine: [11C]methionine
    • 2.2.10. PSMA: [68Ga]-ligand for the prostate specific membrane antigen
  • 2.3. Definitions
    • 2.3.1. Recommendation criteria for the use of PET
    • 2.3.2. Indications for PET
  • 2.4. Summary of results
• 3. PRIMARY TUMOURS OF THE CENTRAL NERVOUS SYSTEM
  • 3.1. Diagnosis
  • 3.2. Staging
  • 3.3. Response evaluation
  • 3.4. Recurrence
    • 3.4.1. Suspected recurrence
    • 3.4.2. Confirmed recurrence
  • 3.5. Follow-up
  • 3.6. Radiation therapy planning
• 4. HEAD AND NECK CANCERS
  • 4.1. Diagnosis
  • 4.2. Staging
  • 4.3. Response evaluation
  • 4.4. Recurrence
  • 4.5. Follow-up
  • 4.6. Radiation therapy planning
• 5. NON-SMALL CELL LUNG CANCER (NSCLC)
  • 5.1. Diagnosis (characterization of solitary pulmonary nodules)
  • 5.2. Staging
  • 5.3. Response evaluation
  • 5.4. Recurrence
  • 5.5. Follow-up
  • 5.6. Radiation therapy planning
• 6. SMALL CELL LUNG CANCER (SCLC)
  • 6.1. Diagnosis
  • 6.2. Staging
  • 6.3. Response evaluation
  • 6.4. Suspected recurrence
  • 6.5. Follow-up
  • 6.6. Radiation therapy planning
• 7. MESOTHELIOMA
  • 7.1. Diagnosis
  • 7.2. Staging
  • 7.3. Response evaluation
  • 7.4. Recurrence
  • 7.5. Follow-up
  • 7.6. Radiation therapy planning
• 8. BREAST CANCER
  • 8.1. Diagnosis
  • 8.2. Staging
  • 8.3. Response evaluation
  • 8.4. Recurrence
  • 8.5. Follow-up
  • 8.6. Radiation therapy planning
• 9. OESOPHAGEAL CANCER
  • 9.1. Diagnosis
  • 9.2. Staging
  • 9.3. Response evaluation
  • 9.4. Recurrence
  • 9.5. Follow-up
  • 9.6. Radiation therapy planning
• 10. GASTRIC CANCER
  • 10.1. Diagnosis
  • 10.2. Staging
  • 10.3. Response evaluation
  • 10.4. Recurrence
  • 10.5. Follow-up
  • 10.6. Radiation therapy planning
• 11. COLORECTAL CANCER
  • 11.1. Diagnosis
  • 11.2. Staging
  • 11.3. Response evaluation
  • 11.4. Recurrence
  • 11.5. Follow-up
  • 11.6. Radiation therapy planning
• 12. ANAL CANCER
  • 12.1. Diagnosis
  • 12.2. Staging
  • 12.3. Response evaluation
  • 12.4. Recurrence
  • 12.5. Follow-up
  • 12.6. Radiation therapy planning
• 13. PANCREATIC ADENOCARCINOMA
  • 13.1. Diagnosis
  • 13.2. Staging
  • 13.3. Response evaluation
  • 13.4. Recurrence
  • 13.5. Follow-up
  • 13.6. Radiation therapy planning
• 14. HEPATOCELLULAR CARCINOMA
  • 14.1. Diagnosis
  • 14.2. Staging
  • 14.3. Response evaluation
  • 14.4. Recurrence
  • 14.5. Follow-up
  • 14.6. Radiation therapy planning
• 15. CHOLANGIO- AND GALLBLADDER CARCINOMAS
  • 15.1. Diagnosis
  • 15.2. Staging
  • 15.3. Response evaluation
  • 15.4. Recurrence
  • 15.5. Follow-up
  • 15.6. Radiation therapy planning
• 16. RENAL CANCER
• 17. UROTHELIAL AND BLADDER CANCERS
  • 17.1. Diagnosis
  • 17.2. Staging
  • 17.3. Response evaluation
  • 17.4. Recurrence
  • 17.5. Follow-up
  • 17.6. Radiation therapy planning
• 18. GERMINAL TUMOUR
  • 18.1. Diagnosis
  • 18.2. Staging
  • 18.3. Response evaluation
  • 18.4. Recurrence
  • 18.5. Follow-up
  • 18.6. Radiation therapy planning
• 19. PROSTATE CANCER
  • 19.1. Diagnosis
  • 19.2. Staging
  • 19.3. Response evaluation
  • 19.4. Recurrence
  • 19.5. Follow-up
  • 19.6. Radiation therapy planning
  • 19.7. Theranostic planning
• 20. OVARIAN CANCER
  • 20.1. Diagnosis
  • 20.2. Staging
  • 20.3. Response evaluation
  • 20.4. Recurrence
  • 20.5. Follow-up
  • 20.6. Radiation therapy planning
• 21. ENDOMETRIAL CANCER
  • 21.1. Diagnosis
  • 21.2. Staging
  • 21.3. Response evaluation
  • 21.4. Recurrence
  • 21.5. Follow-up
  • 21.6. Radiation therapy planning
• 22. CERVICAL CANCER
  • 22.1. Diagnosis
  • 22.2. Staging
  • 22.3. Response evaluation
  • 22.4. Recurrence
  • 22.5. Follow-up
  • 22.6. Radiation therapy planning
• 23. VULVAR CANCER
  • 23.1. Diagnosis
  • 23.2. Staging
  • 23.3. Response evaluation
  • 23.4. Recurrence
  • 23.5. Follow-up
  • 23.6. Radiation therapy planning
• 24. BONE AND SOFT TISSUE SARCOMAS
  • 24.1. Diagnosis
  • 24.2. Staging
  • 24.3. Response evaluation
  • 24.4. Recurrence
  • 24.5. Follow-up
  • 24.6. Radiation therapy planning
• 25. MELANOMA
  • 25.1. Diagnosis
  • 25.2. Staging
    • 25.2.1. Stages I and II: Low pre-test probability of metastases
    • 25.2.2. Stages I and II: High pre-test probability of metastases
    • 25.2.3. Stage III or potential stage IV
  • 25.3. Response evaluation
  • 25.4. Recurrence
  • 25.5. Follow-up
  • 25.6. Radiation therapy planning
• 26. LYMPHOMA
  • 26.1. Diagnosis
  • 26.2. Staging
  • 26.3. Response evaluation
  • 26.4. Recurrence
  • 26.5. Follow-up
  • 26.6. Radiation therapy planning
• 27. MYELOMA
  • 27.1. Diagnosis
  • 27.2. Staging
  • 27.3. Response evaluation
  • 27.4. Recurrence
  • 27.5. Follow-up
  • 27.6. Radiation therapy planning
• 28. THYROID CANCER
  • 28.1. Diagnosis
  • 28.2. Staging
  • 28.3. Response evaluation
  • 28.4. Restaging and suspected recurrence
  • 28.5. Follow-up
  • 28.6. Radiation therapy planning
• 29. ADRENOCORTICAL CARCINOMAS
  • 29.1. Diagnosis
  • 29.2. Staging
  • 29.3. Response evaluation
  • 29.4. Recurrence
  • 29.5. Follow-up
  • 29.6. Radiation therapy planning
• 30. BRONCHIAL CARCINOID
  • 30.1. Diagnosis
  • 30.2. Staging
  • 30.3. Response evaluation
  • 30.4. Recurrence
  • 30.5. Follow-up
  • 30.6. Radiation therapy planning
  • 30.7. Theranostic planning
• 31. GASTROINTESTINAL AND PANCREATIC NEUROENDOCRINE TUMOURS (GEP-NETs)
  • 31.1. Diagnosis
  • 31.2. Staging
  • 31.3. Response evaluation
  • 31.4. Recurrence
  • 31.5. Follow-up
  • 31.6. Radiation therapy planning
  • 31.7. Theranostic planning
• 32. PARAGANGLIOMA, PHAEOCHROMOCYTOMA AND NEUROBLASTOMA
  • 32.1. Diagnosis
  • 32.2. Staging
  • 32.3. Response evaluation
  • 32.4. Recurrence
  • 32.5. Follow-up
  • 32.6. Radiation therapy planning
  • 32.7. Theranostic planning
• 33. MEDULLARY THYROID CARCINOMA
  • 33.1. Diagnosis
  • 33.2. Staging
  • 33.3. Response evaluation
  • 33.4. Recurrence
  • 33.5. Follow-up
  • 33.6. Radiation therapy planning
• 34. CANCER OF UNKNOWN PRIMARY
  • 34.1. Diagnosis
    • 34.1.1. Cervical adenopathy with occult primary
    • 34.1.2. Other metastases of unknown origin
  • 34.2. Staging
  • 34.3. Response evaluation
  • 34.4. Follow-up
  • 34.5. Radiation therapy planning
• REFERENCES
• ABBREVIATIONS
• CONTRIBUTORS TO DRAFTING AND review