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The PET/CT Field Guide

What nobody taught you before they put you on the scanner. A practitioner's guide to FDG PET/CT for cross-trained nuclear medicine technologists, travel techs, and anyone starting on a new camera, by Daniel Joseph, ARRT(R), NMTCB(NM), retired U.S. Air Force.

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PET/CT Rapid Review

A 54-question practice check built from the Field Guide: prep, glucose, diabetes and insulin, uptake timing, QC, CT for PET, positioning, biodistribution, artifacts and troubleshooting. Every answer shows its source.

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Free PET/CT Practice Check
5 questions from the PET/CT Field Guide
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Read this first

Informational use only. This is a practice check for the PET/CT Field Guide. It is not registry or board-exam preparation, not medical advice, and not a substitute for your facility's protocols, physician orders, manufacturer instructions, or state requirements.

When anything here conflicts with your site's policy, your site's policy wins. Scope of practice varies by state and employer — confirm yours.

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PET/CT Rapid Review
Companion to The PET/CT Field Guide

© 2026 Opes Supremae LLC · Daniel Joseph, ARRT(R) NMTCB(NM)
Guideline items summarized from EANM FDG PET/CT guideline v3.0 (2025), CC BY 4.0. Not reviewed or endorsed by EANM.

(function(){ const QS=[{"s":"Patient Prep","q":"Per the EANM v3.0 guideline, how long should a non-diabetic patient fast (plain water only) before FDG injection?","o":["At least 2 hours","At least 4 hours, ideally 6","At least 12 hours","Overnight, minimum 10 hours"],"a":1,"e":"The guideline calls for at least 4 hours of fasting, ideally 6, with plain water only. Your site protocol governs.","src":"Section 4 — guideline (S1 §9.3)"},{"s":"Patient Prep","q":"A patient asks if black coffee with no sugar is OK before the scan. What does published guidance say?","o":["Fine, it has no sugar","Fine if more than 2 hours before injection","Not recommended, even sugarless","Only decaf is allowed"],"a":2,"e":"Coffee and caffeinated drinks are not recommended, even sugarless.","src":"Section 4 — guideline (S1 §9.3)"},{"s":"Patient Prep","q":"How long should strenuous exercise be avoided before an FDG study, per the guideline?","o":["At least 1 hour","At least 6 hours, preferably 24","At least 48 hours","Exercise doesn't matter for FDG"],"a":1,"e":"At least 6 hours, preferably 24. Exercise raises skeletal muscle uptake.","src":"Section 4 — guideline (S1 §9.3)"},{"s":"Patient Prep","q":"What hydration does the guideline suggest before injection?","o":["Nothing by mouth at all","About 1 L of plain water in the 2 hours before injection, and void right before the scan","Sports drinks to keep electrolytes up","Juice to avoid low glucose"],"a":1,"e":"About 1 L of plain water in the 2 hours before injection, and void right before the scan. Hydration and voiding reduce urinary-tract problems.","src":"Section 4 — guideline (S1 §9.3)"},{"s":"Patient Prep","q":"To reduce brown fat uptake, when should the patient be kept warm?","o":["Only during the scan","Starting 30–60 minutes before injection and through the uptake period","Only after injection","Room temperature doesn't matter"],"a":1,"e":"Keep the patient warm from 30–60 minutes before injection through uptake, seated or lying and silent.","src":"Section 4 — guideline (S1 §9.3)"},{"s":"Patient Prep","q":"During uptake, the patient wants to chat on the phone. Why should you discourage it?","o":["It's rude to other patients","Talking can increase muscle uptake; the guideline says seated or lying silent","Phones interfere with the PET detector","It isn't a problem"],"a":1,"e":"The guideline says the patient should be seated or lying silent during uptake. Talking and movement raise muscle uptake.","src":"Section 4 — guideline (S1 §9.3)"},{"s":"Patient Prep","q":"Which items do patients most often forget to mention when asked about eating?","o":["Breakfast and lunch","Candy, drinks and gum","Vitamins","Plain water"],"a":1,"e":"Be absolutely clear and name everything: candy, drinks and gum. Ask before you inject and document anything new.","src":"Section 4 — author's experience"},{"s":"Patient Prep","q":"When is the guideline's recommended bathroom timing during uptake?","o":["Immediately after injection","Preferably more than 30 minutes after injection, emptying the bladder about 5 minutes before the scan","Never during uptake","Only after the scan"],"a":1,"e":"Bathroom visit preferably more than 30 minutes after injection; bladder emptied about 5 minutes before the scan.","src":"Tool Pack — guideline (S1 Supp 3)"},{"s":"Glucose","q":"Per EANM v3.0, a study can proceed when plasma glucose is below about:","o":["120 mg/dL","150 mg/dL","200 mg/dL (11 mmol/L)","300 mg/dL"],"a":2,"e":"Below about 200 mg/dL (11 mmol/L). At or above, ideally reschedule, considering the patient's circumstances. Other guidelines and facilities use other thresholds — your protocol governs.","src":"Section 4 — guideline (S1 §9.4)"},{"s":"Glucose","q":"The guideline advises checking glucose on arrival so it is not too high or too low. Roughly what low value should be avoided?","o":["Below about 70 mg/dL","Below about 100 mg/dL","Below about 40 mg/dL","There is no lower concern"],"a":0,"e":"Avoid below about 70 mg/dL. (The author's sites used 60 as a site rule — follow your own protocol.)","src":"Section 4 — guideline (S1 §9.4)"},{"s":"Glucose","q":"A patient's glucose is just over your limit. What does the guideline describe as an option?","o":["Give insulin to bring it down","Hydrate while walking and recheck","Inject anyway and double the uptake time","Send the patient home immediately"],"a":1,"e":"Hydrate while walking and recheck until acceptable. Never give insulin to lower glucose — it raises muscle uptake.","src":"Section 4 — guideline (S1 §9.4)"},{"s":"Glucose","q":"Why should insulin NOT be given to lower glucose before an FDG scan?","o":["It's against HIPAA","It raises muscle uptake","It changes the CT dose","It slows the scanner"],"a":1,"e":"Insulin drives FDG into muscle, degrading the study.","src":"Section 4 — guideline (S1 §9.4)"},{"s":"Glucose","q":"If the glucose value will be used for SUV glucose correction, what does the guideline caution?","o":["Any bedside meter is fine","Many bedside meters aren't precise enough; a validated method is needed","Glucose correction is never done","Use the patient's home reading"],"a":1,"e":"Many bedside meters are not precise enough for SUV glucose correction; use a validated method.","src":"Section 4 — guideline (S1 Supp 3)"},{"s":"Glucose","q":"Is hyperglycemia an absolute contraindication in poorly controlled diabetics, per EANM v3.0?","o":["Yes, always cancel","No — it's not an absolute contraindication; record the value","Only for brain scans","Only if above 150"],"a":1,"e":"Not an absolute contraindication in poorly controlled diabetes; record the value. Your protocol governs.","src":"Section 4 — guideline (S1 §9.4)"},{"s":"Diabetes & Insulin","q":"Under the 2025 EANM guideline, when is short-acting insulin given on the morning of the scan?","o":["2 hours before injection","4 hours before injection","Not given that morning until after the scan","With the FDG injection"],"a":2,"e":"Short-acting insulin is not given the morning of the scan until the scan is completed. (This replaced the 2015 4 h/6 h option.) Medication decisions belong to the diabetes team and your protocol.","src":"Section 4 — guideline (S1 Supp 1)"},{"s":"Diabetes & Insulin","q":"A type 2 diabetic on metformin is scheduled. What does the guideline say about metformin?","o":["Always stop 48 h before","Can continue (withheld 48 h only if IV iodinated contrast is planned and eGFR is below 30)","Double the dose","Take it with the FDG"],"a":1,"e":"Metformin can continue. If IV iodinated contrast is planned and eGFR < 30, it can be stopped at the procedure and withheld 48 hours. Metformin can also increase bowel uptake.","src":"Section 4 — guideline (S1 Supp 1)"},{"s":"Diabetes & Insulin","q":"Which scan timing does the guideline prefer for a type 1 diabetic on intermediate-acting or premixed insulin?","o":["Late afternoon","Early, before 10 a.m., with the dose change arranged in advance","Any time","After lunch"],"a":1,"e":"Type 1: scan early (before 10 a.m.) with the dose change arranged in advance by the diabetes team.","src":"Section 4 — guideline (S1 Supp 1)"},{"s":"Diabetes & Insulin","q":"A patient uses weekly basal insulin. When does the guideline suggest scanning?","o":["The day after the dose","Day 6, 7 or 8 after the last dose","Same day as the dose","Weekly insulin patients can't be scanned"],"a":1,"e":"Scan on day 6, 7 or 8 after the last dose.","src":"Section 4 — guideline (S1 Supp 1)"},{"s":"Diabetes & Insulin","q":"Who makes medication-change decisions for a diabetic PET patient?","o":["The technologist","The patient's treating/diabetes team and your protocol","The front desk","The patient alone"],"a":1,"e":"Medication decisions belong to the patient's treating team and your protocol, not the technologist.","src":"Section 4"},{"s":"Uptake & Timing","q":"What uptake time does the guideline recommend between injection and start of acquisition?","o":["30 minutes (20–40 acceptable)","60 minutes (55–75 acceptable)","90 minutes (80–120 acceptable)","Whatever fits the schedule"],"a":1,"e":"60 minutes, acceptable range 55–75. Record the actual interval. Consistent timing keeps SUV comparisons meaningful.","src":"Section 6 — guideline (S1 Supp 3)"},{"s":"Uptake & Timing","q":"For a follow-up study on the same patient, how closely should uptake time match the prior study?","o":["Within 10 minutes","Within 30 minutes","Within 1 hour","It doesn't matter"],"a":0,"e":"Repeat studies should match within 10 minutes so SUVs stay comparable.","src":"Section 6 — guideline (S1 Supp 3)"},{"s":"Uptake & Timing","q":"The schedule is running behind and someone suggests scanning a patient early. What sets the uptake window?","o":["The schedule","The protocol","The patient's preference","The front desk"],"a":1,"e":"Camera-time pressure always pushes toward scanning earlier. Your protocol sets the window, not the schedule.","src":"Section 6"},{"s":"Console & QC","q":"Which entries does published guidance list for the console?","o":["Name and room number only","Height, weight, net activity administered, and injection time","Insurance information","Only the patient's weight"],"a":1,"e":"Height, weight, net activity administered and injection time. Weight is measured before every exam because it changes.","src":"Section 2 — guideline (S1 Supp 4, §8.2)"},{"s":"Console & QC","q":"How closely should the scanner clock and dose calibrator clock be synchronized?","o":["Within 1 minute","Within 10 minutes","Within 1 hour","They don't need to match"],"a":0,"e":"Within one minute. Clock mismatch corrupts decay correction and SUV.","src":"Section 2 — guideline (S1 §12)"},{"s":"Console & QC","q":"For patients over about 90 kg, what does the guideline recommend?","o":["Inject more activity","Longer time per bed position rather than more activity","Skip attenuation correction","Use a smaller FOV"],"a":1,"e":"Longer time per bed rather than more activity. Newer high-sensitivity systems point to the EARL procedure. Your protocol sets the numbers.","src":"Section 1 — guideline (S1 §10–11, Supp 2)"},{"s":"Console & QC","q":"What QC does published guidance list in the minimum daily set?","o":["CT only","PET only","Daily QC of both PET and CT, per manufacturer specs","QC is optional"],"a":2,"e":"Daily QC of both PET and CT, plus cross-calibration with the dose calibrator at least quarterly, and PET/CT alignment on the manufacturer's schedule.","src":"Section 7 — guideline (S1 Supp 6)"},{"s":"Console & QC","q":"You inherit a site that skips PET QC. What's the right move?","o":["Skip it too — they know the site","Take it to your supervisor; don't decide alone","Run it secretly once a month","Stop scanning patients"],"a":1,"e":"When you inherit a site that skips a QC, take it to your supervisor. Do not decide alone to skip it.","src":"Section 7"},{"s":"Console & QC","q":"How accurate should the scale be, per the guideline?","o":["Within 5 kg","Accurate to 1 kg and checked annually","Any home scale is fine","Patient-reported weight is acceptable"],"a":1,"e":"Scales accurate to 1 kg and checked annually; height gauge to 0.5 cm.","src":"Source Ledger — guideline (S1 Supp 3)"},{"s":"CT for PET","q":"What separates a low-dose CT for attenuation correction from a diagnostic CT?","o":["Nothing — they're the same","Low-dose CT is for attenuation correction and localization; diagnostic CT follows local/national protocols and may use contrast","Diagnostic CT is always done without the PET","Low-dose CT always uses contrast"],"a":1,"e":"Know which one your order is asking for.","src":"Section 3 — guideline (S1 §4, Supp 4)"},{"s":"CT for PET","q":"An order says 'CT chest' but the patient was booked on the PET schedule. What do you do?","o":["Run a PET/CT anyway","Run a diagnostic CT","Treat it as ambiguous and verify with the ordering physician before proceeding","Ask the patient what they want"],"a":2,"e":"If the order doesn't specifically say PET/CT, or could be mistaken for a regular CT, question it and verify. Don't guess.","src":"Section 3"},{"s":"CT for PET","q":"Who decides whether IV contrast is used on a PET/CT?","o":["The technologist","A qualified physician, per protocol","The patient","The scheduler"],"a":1,"e":"A qualified physician assesses indications and contraindications. Contrast is a protocol and physician decision, never a tech decision.","src":"Section 3 — guideline (S1 §9.4.1)"},{"s":"CT for PET","q":"If IV contrast is used, which phase does the guideline say to time it to?","o":["Arterial phase","Portovenous phase, avoiding arterial","Delayed phase only","Timing doesn't matter"],"a":1,"e":"Portovenous phase, avoiding the arterial phase.","src":"Section 3 — guideline (S1 §9.4.1, Supp 4)"},{"s":"CT for PET","q":"When quantification matters and contrast CT is planned, what strategy does the guideline recommend?","o":["Use the contrast CT for attenuation correction","A separate low-dose CT for correction, with the contrast CT afterward","Skip attenuation correction","Inject contrast during the PET"],"a":1,"e":"Contrast-enhanced CT for AC may change SUV by under 10% on average; when quantifying, do a separate low-dose CT for correction first.","src":"Section 3 — guideline (S1 Supp 4)"},{"s":"CT for PET","q":"During which breathing state should the CT for attenuation correction be acquired?","o":["Deep inspiration breath-hold","Tidal or shallow breathing","Full expiration breath-hold","Breathing doesn't matter"],"a":1,"e":"Tidal or shallow breathing. A deep-inspiration chest CT causes large PET/CT misregistration.","src":"Section 3 — guideline (S1 Supp 4)"},{"s":"Positioning","q":"For a standard body PET/CT, where should the arms be if possible?","o":["At the sides","Above the head","Crossed on the chest","Under the back"],"a":1,"e":"Arms above the head if possible, to avoid beam-hardening and truncation artifacts — except dedicated head and neck imaging.","src":"Section 3 — guideline (S1 §9.3)"},{"s":"Positioning","q":"For a dedicated brain PET, where do the arms go?","o":["Above the head","Alongside the body","One up, one down","Behind the head"],"a":1,"e":"Dedicated brain scans are done with the arms alongside the body.","src":"Section 3 — guideline (S1 §9.4.1)"},{"s":"Positioning","q":"A body patient can't raise their arms. What should you do?","o":["Cancel the scan","Use an alternative position avoiding truncation, and document it so the reader knows","Force the arms up","Don't mention it"],"a":1,"e":"One arm up/one alongside, or both alongside or across, avoiding truncation. The report should state a nonstandard arm position.","src":"Section 3 — guideline (S1 Supp 4, Supp 5)"},{"s":"Positioning","q":"What two-step option does the guideline describe for head and neck tumours?","o":["Head and neck with arms down, then lung apex to mid-thigh with arms up, with overlap","Two separate injections","Brain first, then legs","Prone then supine"],"a":0,"e":"Head and neck with arms down, then lung apex to mid-thigh with arms up, with enough overlap to avoid missing anatomy.","src":"Section 3 — guideline (S1 Supp 4)"},{"s":"Biodistribution","q":"Heavy myocardial uptake on a fasting study most often suggests:","o":["Normal finding every time","The patient may have eaten or had a glucose load","Scanner malfunction","Too much FDG"],"a":1,"e":"Fasting myocardial uptake is low but variable; after a glucose load the heart uses glucose. Re-question the patient.","src":"Section 5 — guideline (S1 §14.1)"},{"s":"Biodistribution","q":"High brain FDG uptake on a body scan is:","o":["A prep failure","Expected normal biodistribution","A sign of infiltration","An artifact from metal"],"a":1,"e":"Brain uptake is high normally (about 7% of injected activity). Not a prep failure.","src":"Section 5 — guideline (S1 §14.1)"},{"s":"Biodistribution","q":"Brown fat uptake is more common in which patients?","o":["Older, heavier patients","Young, thin patients and when the room is cold","Diabetics only","Patients who drank water"],"a":1,"e":"More common in young, thin patients and cold rooms. Keep the uptake room warm and quiet.","src":"Section 5 — guideline (S1 §14.1)"},{"s":"Biodistribution","q":"Increased bowel uptake can be associated with which medication?","o":["Metformin","Aspirin","Antihistamines","Insulin"],"a":0,"e":"Bowel uptake varies and is increased with metformin — ask about medications.","src":"Section 5 — guideline (S1 §14.1)"},{"s":"Biodistribution","q":"Uptake in the throat ring (lymphoid tissue) on a routine scan is usually:","o":["Always cancer","Common and usually normal — know it so you don't over-flag it","A breathing artifact","A sign the patient talked"],"a":1,"e":"Lymphoid tissue (throat ring, terminal ileum, cecum) uptake is common and usually normal.","src":"Section 5 — guideline (S1 §14.1)"},{"s":"Artifacts","q":"Streaks across the torso with inaccurate quantification most likely come from:","o":["Infiltration","CT truncation and arms-down beam hardening","Patient talking","Fasting too long"],"a":1,"e":"Arms up for body scans when possible; avoid truncation; document position.","src":"Section 5 — guideline"},{"s":"Artifacts","q":"There's hot uptake next to a hip implant. How should you check whether it's real?","o":["Ignore anything near metal","Confirm on the non-attenuation-corrected images","Rescan with arms down","Increase the CT dose"],"a":1,"e":"Metal reduces image quality and quantification near it; confirm uptake on the non-corrected images.","src":"Section 5 — guideline (S1 §12)"},{"s":"Artifacts","q":"Why should both attenuation-corrected and non-corrected images be available?","o":["Billing requires both","Non-corrected images help show motion, misalignment, contrast and metal artifacts","Corrected images are always wrong","It's only for research"],"a":1,"e":"The non-corrected set helps reveal artifacts from motion, misalignment, contrast and metal.","src":"Section 5 — guideline (S1 §13.1, §14)"},{"s":"Artifacts","q":"When should images be reviewed, per the guideline?","o":["The next day","Before the patient leaves the department","Only if the physician asks","Never by the tech"],"a":1,"e":"Before the patient leaves, to confirm the study is technically satisfactory and decide whether more imaging or an urgent call is needed.","src":"Section 5 — guideline (S1 Supp 4)"},{"s":"Troubleshooting","q":"You see a hot spot at the injection site. What should you do?","o":["Nothing — it's normal","Notify the physician, image the injection area if suspected, and document per protocol","Inject a second dose","Delete those images"],"a":1,"e":"Report administration problems, image the injection area if extravasation is suspected, and record the injection site. A dose sitting fully in the arm means reschedule.","src":"Section 6 — guideline (S1 Supp 3, Supp 5)"},{"s":"Troubleshooting","q":"The scanner stalls after the acquisition was already complete. What's often possible?","o":["A restart may save the study without a full rescan","Always rescan from scratch","Always reinject","Cancel and reschedule"],"a":0,"e":"If the image was complete, a restart can sometimes save it. If not complete, expect a full rescan.","src":"Section 6 — author's experience"},{"s":"Troubleshooting","q":"The table stops moving mid-procedure. What's the first priority?","o":["Restart the computer","Call the service contractor","Patient first — get the patient off safely, manually if needed","Finish the scan"],"a":2,"e":"Patient first, then troubleshooting. Then notify the ordering physician if the exam is affected, restart, and escalate.","src":"Section 7 / Tool Pack — author's experience"},{"s":"Troubleshooting","q":"When should claustrophobia be asked about, per the guideline?","o":["On the scanner table","At scheduling","After injection","Never — it upsets patients"],"a":1,"e":"Asking at scheduling cuts cancellations and allows premedication planning.","src":"Section 6 — guideline (S1 §9.3)"},{"s":"Troubleshooting","q":"A patient on a lung study had coffee an hour ago. The author's sites:","o":["Proceeded anyway","Rescheduled, because heart uptake interferes with the area of interest","Gave insulin","Doubled the uptake time"],"a":1,"e":"The region of interest decides it, and the physician signs off on any exception. Brain and prostate studies proceeded with physician clearance.","src":"Section 4 / Field Notes — author's experience"},{"s":"Scope & Judgment","q":"When anything in a reference guide conflicts with your site's policy, what wins?","o":["The guide","Your site's policy","Whichever is newer","The patient's preference"],"a":1,"e":"Your site's policy wins. Your protocol is the authority; when it doesn't cover a situation, escalate — don't improvise.","src":"Read This First / Section 3"},{"s":"Scope & Judgment","q":"Who should be on the CT protocol review team, per AAPM guidance?","o":["Any available tech","At least a lead CT radiologist, the lead CT technologist, and a qualified medical physicist","The hospital administrator","The vendor only"],"a":1,"e":"AAPM: lead CT radiologist, lead CT technologist and a qualified medical physicist.","src":"Section 3 — guideline (S3)"}],NS='opesRR',SAMPLE=false; const root=document.getElementById(NS),app=root.querySelector('.app'),st=root.querySelector('.stat'); const S=k=>{try{return JSON.parse(localStorage.getItem(NS+'_'+k))}catch(e){return null}}; const W=(k,v)=>{try{localStorage.setItem(NS+'_'+k,JSON.stringify(v))}catch(e){}}; let deck=[],i=0,score=0,missed=[],answered=false; const shuffle=a=>{a=a.slice();for(let j=a.length-1;j>0;j--){const k=Math.floor(Math.random()*(j+1));[a[j],a[k]]=[a[k],a[j]]}return a}; const idx=q=>QS.findIndex(x=>x.q===q.q); const A={};window[NS]=A; const C=f=>`${NS}.${f}`; function stat(){const b=S('best');st.textContent=b?('Best: '+b+'%'):''} A.ack=()=>{W('ack',1);A.home()}; A.home=()=>{stat(); if(!S('ack')){app.innerHTML=`
Read this first

Informational use only. This is a practice check for the PET/CT Field Guide. It is not registry or board-exam preparation, not medical advice, and not a substitute for your facility's protocols, physician orders, manufacturer instructions, or state requirements.

When anything here conflicts with your site's policy, your site's policy wins. Scope of practice varies by state and employer — confirm yours.

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