Since 2014, our institute has been performing PET/CT examinations financed by NEAK (National Health Insurance Fund) and offering the possibility of privately financed examinations. The PET/CT examination allows for the early detection of malignant cancerous diseases in general, compared to traditional procedures, and provides information about pathological abnormalities that can aid in planning necessary therapies and making them more effective. The radioactive isotope-labeled glucose molecules (18F-FDG) used for the examination are produced in our radiopharmacy laboratory using a Siemens Eclipse cyclotron.

What you need to know about PET/CT examination:

PET:Positron Emission Tomography

CT: Computed Tomography

During a CT examination, cross-sectional images are obtained to provide anatomical and structural information about the body. This also involves radiation exposure, but it is much lower than in diagnostic CT scans.

The PET CT scan combines the high sensitivity of the PET scan to functional abnormalities and the excellent anatomical resolution of the CT scan.

The cells take up the injected sugar-like substance depending on the intensity of their metabolism. The more intense the cell metabolism, the more sugar it consumes. Most malignant tumors grow rapidly, leading to increased cell metabolism and thus increased sugar consumption. Therefore, PET/CT is suitable for detecting tumors. Metabolic changes in malignant tumors typically precede anatomical abnormalities.

The PET/CT method can often detect malignant tumors at an earlier stage than other traditional diagnostic methods such as ultrasound, CT, or MRI. With this procedure, important characteristics of the abnormalities can be mapped out, which are crucial for therapy but may remain hidden from other imaging techniques. PET/CT can identify even small tumors that do not yet cause symptoms, making treatment faster and more effective.

There have been no reported cases of allergic reactions related to radiopharmaceutical (isotope) in the literature. The painless PET/CT examination is associated with a radiation exposure of approximately 7-10 mSv.

Who is PET/CT imaging recommended for?

The PET/CT imaging provides diagnosis of primary tumors, regional lymph node involvement, distant metastases, etc. The significance of the examination lies in guiding therapy choices, assessing disease extent, planning radiation therapy, monitoring disease progression, and evaluating therapeutic response. The examination assists in determining the site of tissue sampling and aids in surgical planning.

What is needed for the PET/CT examination

Referral

There are two ways to obtain a referral, depending on whether you are a private patient or a patient financed by the National Health Insurance Fund (OEP) in accessing our services:

Referral process for examinations financed by OEP:

• The referring physician uploads the request for the examination electronically to the central waiting list operated by the National Health Insurance Fund Administration (NEAK).
• The requests on the waiting list are evaluated online by a designated team according to centrally determined criteria.
• When requesting the examination, the treating physician suggests to the patient which healthcare facility the examination should take place at. The distribution takes into account the territorial obligations of care, but the patient's preferences should also be taken into consideration as much as possible.
• In case of a positive evaluation, the approved examination request appears at Medicopus Nonprofit Ltd., and our staff immediately begins coordinating the examination appointment with the patient over the phone.

For privately financed PET/CT examinations, the referral process is as follows:

If you would like to request a PET/CT examination for a disease category that is not supported by the National Health Insurance Fund (OEP) and you are willing to pay for the examination out of pocket, please contact our customer service at the central phone number, where you will receive information about the process, fees, and payment options for the PET/CT examination.

How to prepare for the PET/CT examination

In general:

• Do not eat anything in the 6 hours prior to the examination, but feel free to consume plenty of sugar-free and sweetener-free liquids (such as non-carbonated mineral water).
• You can take your medications as usual. Make sure to clarify with our staff what they are during your consultation.

In case of diabetes:

If you have diabetes, please inform our staff upon registration!

• It is important to maintain blood sugar levels between 4 - 11 mmol/L, as high blood sugar levels can alter the uptake and utilization of isotopically labeled sugars in organs/tissues/cells. If your blood sugar level measured right before the examination is above 8 mmol/L (144 mg/dl), due to the altered glucose metabolism pattern, it might be necessary to postpone the examination to another day.
• In the case of IDDM (insulin-dependent diabetes mellitus), you can administer insulin in the usual way, you can eat (you can eat foods with a reduced carbohydrate content, which means half the usual amount of carbohydrates). You must appear for the examination within 3 hours after the administration of the insulin (the radiopharmaceutical can be administered 4 hours later). If you need to inject insulin several times a day, take the injector and insulin with you with food.
• In case of NIDDM (non-insulin-dependent - "pill" diabetes mellitus), do not take metformin-containing medicines (Adimet, Avandamet, Competact, Eucreas, Gluformin, Janumet, Maformin, Meforal, Meglucon, Merkformin, Metfogamma, Metformin, Metrivin, Stadamet, Velmetia) 48 hours before the examination. Other oral antidiabetic medication should be taken, but food should be avoided! Please always bring your diabetes medication with you.

In case of pregnancy::

• In case of pregnancy or suspicion of pregnancy, the examination cannot be performed (except based on prior consultation with the medical team).

72 hours before the examination::

• Avoid heavy physical activities (exercise, gardening, horseback riding, sports, skiing, physical labor, etc.).
• Avoid consumption of high-carbohydrate foods and beverages (DO NOT consume: bread, pastries, sugary drinks, sweets, candies, chewing gum).

On the day of the examination:

• Wearing warm clothing is recommended - shivering can affect the results.
• Metal objects on clothing interfere with image quality, so please avoid wearing clothing with metal elements (zippers, clasps, sequins, hooks, metal buttons).
• Do not bring jewelry or valuables with you, remove piercings and body jewelry.
• If you have removable dentures containing metal, they must be removed for the examination, so please DO NOT glue them in.
• Avoid smoking.
• If you experience claustrophobia, you can bring a mild sedative with you to take before the examination.
• Breastfeeding mothers should collect enough breast milk for one day, as breastfeeding should be suspended for 24 hours after the examination, and expressed breast milk should be discarded.
• If you have a stoma, if it becomes full, the stoma bag should be emptied immediately before the examination. Please bring spare stoma bags in case of replacement.
• If you have urinary elimination issues (catheter - urinary bag or wearing diapers, pads), please empty and, if needed, replace them just before the examination. Please also bring spare equipment for replacements.

Risks and possible side effects of the PET/CT examination:

• The PET/CT examination itself is completely painless.
• The administered substance has no medicinal effect on the body, the procedure is harmless from the point of view of an allergic reaction.
• The radiation exposure to the body is similar to the radiation exposure of a contrast-enhanced CT scan performed on the same areas of the body in addition to the usual activity.
• Rarely, mild side effects such as nausea, vomiting, or diarrhea may occur after consuming oral contrast material diluted to provide a more accurate image of the gastrointestinal tract. We recommend that you consume the liquid in small quantities and slowly.

During the PET/CT Examination

Upon arrival, check in at the reception for data verification, registration, and filling out and signing the 'CT Consent Form.' Adhere to your appointment time, as failure to do so may result in the inability to conduct the examination.

Bring the following documents with you:

• Personal identification (ID) card
• Address card
• National Health Insurance Card (Taj kártya)
• Your previous medical records (in hard copy or electronic format)

The assessment of its current condition is carried out in a specially designated area. During this, a qualified staff member will review the documentation you have brought, make copies as necessary, and take your medical history based on the questions on the evaluation form. They will measure your weight and height and make sure there are no exclusion criteria for the study. After that, you will receive information about the further course of the investigation. Before administering the radiopharmaceutical, we always check your blood sugar level. If it exceeds 11 mmol/l, we cannot continue the test.

After the evaluation, the radiopharmaceutical (medicine) is injected.

If you have any questions, please address them to our colleagues before the administration of the radiopharmaceutical. After the injection, our colleagues will minimize close contact with you for their own radiation protection, although necessary assistance will still be provided.

After the injection, you will need to wait in complete rest for 45-60 minutes (time for the radiopharmaceutical to accumulate in cells). It is important that you avoid any physical or mental activity during this time, which means no talking, reading, walking, etc.

During the waiting period, you are allowed to empty your bladder, but once the waiting time is over, our qualified staff will ask you to go to a designated restroom to empty your bladder, change your pad, and, if needed, empty your stoma bag. This is necessary because the administered radiopharmaceutical is excreted through the kidneys into the bladder, and a full bladder hinders the assessment of pelvic abnormalities.

Please pay special attention not to contaminate the environment or yourself with urine. This is important both from a radiation protection perspective and for the interpretability of the images obtained during the examination.

During the examination (typically lasting 25-40 minutes), you will need to lie still on the examination bed while the bed moves horizontally along with you inside the imaging device. Depending on the nature of the examination, you may need to keep your arms extended alongside your body or interlace them above your head. Even slight movement can degrade image quality. There are microphones and speakers installed in the examination room and imaging device through which you can communicate with our staff.

Post-PET/CT Examination Instructions

In the 24 hours following the examination:

• We kindly ask you to avoid close physical contact during the 24 hours after the examination, such as hugging, sleeping together, using public transportation, and participating in communal events (e.g., cinema, theater).
• Take particular care to protect small children and pregnant women, keep them as far away as possible and stay in one place for the shortest time, if absolutely necessary.
• If you are breastfeeding, you must discard expressed breast milk in the 24 hours following the examination.
• It is recommended to drink plenty of fluids, which should be at least 2-3 liters.
• During a restroom use, please take care not to contaminate your surroundings or yourself with urine.
• Until the day following the examination, avoid close contact with pregnant women and young children.

PET/CT examination results, findings:

• The completed findings, signed by specialists, and the associated DVD with the images will be posted to your home address and sent electronically to your treating physician.
• If you would like to personally pick up the examination results, please make sure to inform our staff.
• With a written authorization, the examination results can be collected by a legal representative or a designated individual on behalf of the patient.
• Please make sure to keep a copy of your examination results for your own records. It is recommended to bring them with you in case of any future medical appointments or follow-up examinations.

Risks and possible side effects of the PET/CT examination

• The PET/CT examination itself is completely painless.
• The administered tracer does not have any pharmacological effects on the body, and the procedure is considered safe regarding the risk of allergic reactions.
• The radiation exposure to the body during a PET/CT examination, using the standard activity, is lower than the radiation exposure from a contrast-enhanced CT examination of the same body region.
• To achieve a more accurate depiction of the gastrointestinal system, it is sometimes necessary to consume an oral contrast agent mixed with water before the examination. Very rarely, this can cause side effects such as nausea, vomiting, or diarrhea. We recommend consuming the liquid in small amounts and at a slow pace to minimize any discomfort.