Podcast
Questions and Answers
Which type of leukemia is primarily diagnosed in adults?
Which type of leukemia is primarily diagnosed in adults?
- Chronic myeloid leukemia (CML) (correct)
- Acute lymphocytic leukemia (ALL)
- Chronic lymphocytic leukemia (CLL) (correct)
- Acute myeloid leukemia (AML)
What is the primary population affected by hepatocellular carcinoma?
What is the primary population affected by hepatocellular carcinoma?
- Children under 12 years old
- Women of all ages
- Men and individuals over age 65 (correct)
- Persons diagnosed with thyroid cancer
What imaging procedure is recommended for thyroid cancer assessment?
What imaging procedure is recommended for thyroid cancer assessment?
- CT scan of the abdomen and pelvis
- Ultrasound focused on head and neck
- Routine PET/CT from chest to pubic symphysis (correct)
- Routine MRI from neck to pelvis
What type of lung cancer is specifically associated with solitary pulmonary nodule imaging approval?
What type of lung cancer is specifically associated with solitary pulmonary nodule imaging approval?
Which imaging position is recommended for patients during lung cancer assessment?
Which imaging position is recommended for patients during lung cancer assessment?
What receptors does 18F Fluroestradiol bind to for breast cancer imaging?
What receptors does 18F Fluroestradiol bind to for breast cancer imaging?
Which imaging agent is recommended for evaluating prostate cancer and metastasis?
Which imaging agent is recommended for evaluating prostate cancer and metastasis?
What is the recommended wait time after injecting GA-68 Gozetotide before performing a scan?
What is the recommended wait time after injecting GA-68 Gozetotide before performing a scan?
Which term describes the method used to process 18F Florataucipir?
Which term describes the method used to process 18F Florataucipir?
What is the primary use of 18F Florataucipir?
What is the primary use of 18F Florataucipir?
What type of cancer is most commonly associated with the female reproductive organs?
What type of cancer is most commonly associated with the female reproductive organs?
Which type of renal cancer is the most common?
Which type of renal cancer is the most common?
Which cancer type is most closely linked to HPV infection and affects predominantly women younger than 55 years old?
Which cancer type is most closely linked to HPV infection and affects predominantly women younger than 55 years old?
What age group is most commonly affected by prostate cancer?
What age group is most commonly affected by prostate cancer?
What imaging technique is critical to ensure accuracy in detecting cancer spread in the pelvis and other organs?
What imaging technique is critical to ensure accuracy in detecting cancer spread in the pelvis and other organs?
What is the peak time for the formation of metastases in melanoma after its initial diagnosis?
What is the peak time for the formation of metastases in melanoma after its initial diagnosis?
Which imaging method is recommended for detecting sarcomas?
Which imaging method is recommended for detecting sarcomas?
In imaging protocols for melanoma, what is the recommended patient positioning?
In imaging protocols for melanoma, what is the recommended patient positioning?
What is the primary tumor type of prostate cancer?
What is the primary tumor type of prostate cancer?
Which PET radiopharmaceutical is used to evaluate hypoxia?
Which PET radiopharmaceutical is used to evaluate hypoxia?
Which of the following cancers accounts for around 2 to 4% of all cancers in the U.S. and is more common in men than women?
Which of the following cancers accounts for around 2 to 4% of all cancers in the U.S. and is more common in men than women?
What is the mechanism by which 18F-FLT uptakes in cancer cells?
What is the mechanism by which 18F-FLT uptakes in cancer cells?
What factor is NOT used to classify myeloma into its stages?
What factor is NOT used to classify myeloma into its stages?
What characteristic is associated with neuroendocrine prostate cancer?
What characteristic is associated with neuroendocrine prostate cancer?
What type of carcinoma is commonly associated with esophageal cancer?
What type of carcinoma is commonly associated with esophageal cancer?
What imaging procedure is generally NOT covered for staging cervical cancer?
What imaging procedure is generally NOT covered for staging cervical cancer?
Which of the following procedures involves using 18F-FDG?
Which of the following procedures involves using 18F-FDG?
Which of the following is NOT a stage classification for esophageal cancer?
Which of the following is NOT a stage classification for esophageal cancer?
What age demographic has a higher risk of developing sarcomas?
What age demographic has a higher risk of developing sarcomas?
What is the use of 18F-Fluciclovine in medical imaging?
What is the use of 18F-Fluciclovine in medical imaging?
What patient preparation is necessary before PET/CT imaging for gastric cancer?
What patient preparation is necessary before PET/CT imaging for gastric cancer?
How is melanoma generally recognized in terms of its pathology?
How is melanoma generally recognized in terms of its pathology?
Which radiopharmaceutical possesses a blood flow mechanism primarily used in cardiology?
Which radiopharmaceutical possesses a blood flow mechanism primarily used in cardiology?
What is a crucial aspect of imaging for myeloma to include?
What is a crucial aspect of imaging for myeloma to include?
What process is involved in the production of 11C-Sodium acetate?
What process is involved in the production of 11C-Sodium acetate?
What is the coverage status of metastatic cancer of unknown primary origin for initial treatment strategy?
What is the coverage status of metastatic cancer of unknown primary origin for initial treatment strategy?
What kind of images are typically acquired after injecting 18F-Flurpiridaz?
What kind of images are typically acquired after injecting 18F-Flurpiridaz?
What type of cancer is primarily associated with seminomas and nonseminoma germ cell tumors?
What type of cancer is primarily associated with seminomas and nonseminoma germ cell tumors?
Which positioning is specified for imaging in lymphoma cases?
Which positioning is specified for imaging in lymphoma cases?
Which type of imaging is approved for breast cancer according to CMS?
Which type of imaging is approved for breast cancer according to CMS?
What age group is primarily affected by thymomas?
What age group is primarily affected by thymomas?
What is a common imaging practice for the evaluation of breast cancer?
What is a common imaging practice for the evaluation of breast cancer?
Which of the following cancers was one of the first indications approved for PET imaging?
Which of the following cancers was one of the first indications approved for PET imaging?
What is a significant risk factor for head and neck cancers?
What is a significant risk factor for head and neck cancers?
Which cancer type is characterized by tumors that are often slow-growing and treatable with radiation therapy?
Which cancer type is characterized by tumors that are often slow-growing and treatable with radiation therapy?
What is typically included in imaging for colorectal cancer?
What is typically included in imaging for colorectal cancer?
Which type of pancreatic cancer is specified for CMS approval under ICD-9 code 157?
Which type of pancreatic cancer is specified for CMS approval under ICD-9 code 157?
Which age group is at higher risk for developing non-Hodgkin's lymphoma?
Which age group is at higher risk for developing non-Hodgkin's lymphoma?
What is the primary classification of breast cancer?
What is the primary classification of breast cancer?
What is the primary group affected by Hodgkin's lymphoma?
What is the primary group affected by Hodgkin's lymphoma?
How should patients be positioned during the imaging for thymomas?
How should patients be positioned during the imaging for thymomas?
How many new cases of cancer are diagnosed each year in the United States?
How many new cases of cancer are diagnosed each year in the United States?
What significant advancement is mentioned regarding PET imaging in oncology?
What significant advancement is mentioned regarding PET imaging in oncology?
What was one of the first clinical investigations for PET in the late 1970s?
What was one of the first clinical investigations for PET in the late 1970s?
In what decade did investigators begin to demonstrate the value of PET technology in cancer detection?
In what decade did investigators begin to demonstrate the value of PET technology in cancer detection?
Which feature enhances the confidence of identifying areas of hypermetabolism in PET imaging?
Which feature enhances the confidence of identifying areas of hypermetabolism in PET imaging?
What did cost analyses indicate regarding PET technology in relation to unnecessary tests?
What did cost analyses indicate regarding PET technology in relation to unnecessary tests?
What is a key concern that remains despite advances in oncology?
What is a key concern that remains despite advances in oncology?
Which of the following best describes the role of positron-emitting radionuclides in PET imaging?
Which of the following best describes the role of positron-emitting radionuclides in PET imaging?
What positioning may alleviate pressure on specific pain areas during imaging?
What positioning may alleviate pressure on specific pain areas during imaging?
What is critical to manage for patient comfort when using immobilization devices during PET/CT imaging?
What is critical to manage for patient comfort when using immobilization devices during PET/CT imaging?
Why is it important for patients to void before undergoing imaging?
Why is it important for patients to void before undergoing imaging?
What arms positioning is commonly recommended for average patients during PET scans?
What arms positioning is commonly recommended for average patients during PET scans?
How can patient movement affect the quality of PET/CT images?
How can patient movement affect the quality of PET/CT images?
For patients with specific malignant conditions, what may be necessary regarding arm positioning?
For patients with specific malignant conditions, what may be necessary regarding arm positioning?
What is advisable to avoid artifacts from patients with higher body weight during acquisitions?
What is advisable to avoid artifacts from patients with higher body weight during acquisitions?
Why is it recommended to acquire head and neck imaging in two parts?
Why is it recommended to acquire head and neck imaging in two parts?
What is one of the main reasons for using overlapping data in large patients?
What is one of the main reasons for using overlapping data in large patients?
What does the acquisition mode for PET scans depend on?
What does the acquisition mode for PET scans depend on?
Why is patient cooperation emphasized during PET imaging procedures?
Why is patient cooperation emphasized during PET imaging procedures?
What is often necessary to check before starting a PET/CT scanning protocol?
What is often necessary to check before starting a PET/CT scanning protocol?
What is a common reason for falsely increased FDG uptake in PET imaging?
What is a common reason for falsely increased FDG uptake in PET imaging?
What normal variation is often observed in myocardial FDG imaging for fasting patients?
What normal variation is often observed in myocardial FDG imaging for fasting patients?
What factor complicates thyroid evaluations in FDG PET imaging?
What factor complicates thyroid evaluations in FDG PET imaging?
Which condition is usually suspected if there is intense symmetrical uptake in the thyroid gland?
Which condition is usually suspected if there is intense symmetrical uptake in the thyroid gland?
Which area is known to present diagnostic challenges due to muscular or brown fat activity?
Which area is known to present diagnostic challenges due to muscular or brown fat activity?
What can increase FDG uptake in patients, possibly leading to misdiagnosis?
What can increase FDG uptake in patients, possibly leading to misdiagnosis?
In which circumstance may additional imaging help resolve diagnostic uncertainties?
In which circumstance may additional imaging help resolve diagnostic uncertainties?
What are glucose clamp protocols used for in FDG PET imaging?
What are glucose clamp protocols used for in FDG PET imaging?
How does FDG uptake vary in patients with a history of muscle grinding or chewing?
How does FDG uptake vary in patients with a history of muscle grinding or chewing?
What normal variation occurs frequently in diabetic patients on FDG PET imaging?
What normal variation occurs frequently in diabetic patients on FDG PET imaging?
What was the first cancer for which Medicare approved FDG PET scan reimbursement in 1998?
What was the first cancer for which Medicare approved FDG PET scan reimbursement in 1998?
Which of the following cancers was added to CMS coverage for FDG PET scans in 2002?
Which of the following cancers was added to CMS coverage for FDG PET scans in 2002?
What should patients with diabetes mellitus do before undergoing an FDG PET scan?
What should patients with diabetes mellitus do before undergoing an FDG PET scan?
What characteristic of cancer cells contributes to increased FDG uptake compared to normal cells?
What characteristic of cancer cells contributes to increased FDG uptake compared to normal cells?
Which factor can lead to inadequate tissue activity in FDG PET scans for diabetic patients?
Which factor can lead to inadequate tissue activity in FDG PET scans for diabetic patients?
What is a primary concern when using FDG PET as a screening tool for cancer?
What is a primary concern when using FDG PET as a screening tool for cancer?
What happens to FDG once it enters the cancer cell?
What happens to FDG once it enters the cancer cell?
What is the main reason for patients to fast for 4 to 6 hours before FDG administration?
What is the main reason for patients to fast for 4 to 6 hours before FDG administration?
Which enzyme is primarily responsible for the phosphorylation of glucose in the first step of glycolysis?
Which enzyme is primarily responsible for the phosphorylation of glucose in the first step of glycolysis?
What condition may cause complications during FDG PET studies in hospitalized patients?
What condition may cause complications during FDG PET studies in hospitalized patients?
In which year did CMS release a decision to cover FDG PET scans for solid tumors for subsequent treatment strategies?
In which year did CMS release a decision to cover FDG PET scans for solid tumors for subsequent treatment strategies?
What is the purpose of injecting a saline flush after FDG administration?
What is the purpose of injecting a saline flush after FDG administration?
Which of the following is TRUE about FDG PET imaging in cancer diagnostics?
Which of the following is TRUE about FDG PET imaging in cancer diagnostics?
Which patient condition requires careful management before a PET/CT examination?
Which patient condition requires careful management before a PET/CT examination?
What type of facility's increase has been necessary for expanding PET services?
What type of facility's increase has been necessary for expanding PET services?
What is a recommended preparation for patients prior to undergoing FDG PET scans?
What is a recommended preparation for patients prior to undergoing FDG PET scans?
What should be ensured regarding the patient before FDG administration?
What should be ensured regarding the patient before FDG administration?
What is a potential advantage of using FDG as a radiopharmaceutical?
What is a potential advantage of using FDG as a radiopharmaceutical?
What is the advised approach for type I diabetic patients before an FDG PET scan?
What is the advised approach for type I diabetic patients before an FDG PET scan?
Which cancer types were covered by Medicare for FDG PET scans immediately following lung cancer?
Which cancer types were covered by Medicare for FDG PET scans immediately following lung cancer?
Why is it advisable to advocate for preauthorization with private insurance for FDG PET scans?
Why is it advisable to advocate for preauthorization with private insurance for FDG PET scans?
How long should a patient with diabetes avoid dextrose solutions before an FDG PET scan?
How long should a patient with diabetes avoid dextrose solutions before an FDG PET scan?
What role do membrane transport proteins play in FDG uptake by cancerous cells?
What role do membrane transport proteins play in FDG uptake by cancerous cells?
What activity should be avoided by patients 24 hours prior to an FDG PET scan?
What activity should be avoided by patients 24 hours prior to an FDG PET scan?
What are patients advised to do with their bladder before a PET imaging sequence?
What are patients advised to do with their bladder before a PET imaging sequence?
What is the most common adult dose of FDG administered to reduce radiation exposure?
What is the most common adult dose of FDG administered to reduce radiation exposure?
What is a potential consequence of retention in the reservoirs and catheter line tips during imaging evaluation?
What is a potential consequence of retention in the reservoirs and catheter line tips during imaging evaluation?
What is a standard protocol for hydration before an FDG PET scan?
What is a standard protocol for hydration before an FDG PET scan?
Which imaging technique is commonly used for evaluating specific areas in oncology?
Which imaging technique is commonly used for evaluating specific areas in oncology?
Which contrast media is commonly used to enhance radiographic visualization of low-contrast tissues?
Which contrast media is commonly used to enhance radiographic visualization of low-contrast tissues?
What is the recommended procedure regarding the bladder immediately before imaging?
What is the recommended procedure regarding the bladder immediately before imaging?
In the case of suspected cancer in the pelvis, which intervention is mentioned but may be counterproductive?
In the case of suspected cancer in the pelvis, which intervention is mentioned but may be counterproductive?
What method is commonly employed to enhance the excretion of FDG?
What method is commonly employed to enhance the excretion of FDG?
Which scan type requires patients to be still for the entirety of the imaging sequence?
Which scan type requires patients to be still for the entirety of the imaging sequence?
What is the recommended patient positioning during PET scans to minimize artifacts?
What is the recommended patient positioning during PET scans to minimize artifacts?
What key factor must be accounted for in imaging protocols regarding patient movements?
What key factor must be accounted for in imaging protocols regarding patient movements?
What is the purpose of incremental administration of oral contrast before imaging?
What is the purpose of incremental administration of oral contrast before imaging?
Which imaging procedure may involve a combination of PET with CT for optimal results?
Which imaging procedure may involve a combination of PET with CT for optimal results?
What is often done to improve tumor to soft tissue contrast over time during imaging?
What is often done to improve tumor to soft tissue contrast over time during imaging?
What is the primary reason FDG accumulates in cancer cells?
What is the primary reason FDG accumulates in cancer cells?
What should patients do to ensure low peripheral blood glucose levels before an FDG PET scan?
What should patients do to ensure low peripheral blood glucose levels before an FDG PET scan?
What is a potential effect of elevated peripheral blood glucose levels on FDG PET imaging?
What is a potential effect of elevated peripheral blood glucose levels on FDG PET imaging?
Which of the following situations requires additional consideration when preparing a patient for a PET scan?
Which of the following situations requires additional consideration when preparing a patient for a PET scan?
What role does hexokinase play in FDG metabolism in cancer cells?
What role does hexokinase play in FDG metabolism in cancer cells?
What is the recommended action if a patient has elevated glucose levels before a PET scan?
What is the recommended action if a patient has elevated glucose levels before a PET scan?
How should communication be tailored for patients with language barriers before a PET scan?
How should communication be tailored for patients with language barriers before a PET scan?
What is a key consideration during patient preparation to prevent FDG uptake in muscles?
What is a key consideration during patient preparation to prevent FDG uptake in muscles?
What precaution should be taken with diabetic patients before their PET scan?
What precaution should be taken with diabetic patients before their PET scan?
What effect does FDG-6-P have on cancer cells after uptake?
What effect does FDG-6-P have on cancer cells after uptake?
Why is patient positioning important during imaging?
Why is patient positioning important during imaging?
What might be necessary if a patient cannot comply with procedural instructions due to hearing impairment?
What might be necessary if a patient cannot comply with procedural instructions due to hearing impairment?
What is a common misunderstanding regarding fasting periods before a PET scan?
What is a common misunderstanding regarding fasting periods before a PET scan?
Why does the presence of inflammation around a gastrostomy tube show elevated FDG activity on a PET scan?
Why does the presence of inflammation around a gastrostomy tube show elevated FDG activity on a PET scan?
What is the recommended order for performing emission and transmission scans to minimize patient motion misalignments?
What is the recommended order for performing emission and transmission scans to minimize patient motion misalignments?
How does the CT scan in PET/CT scanners contribute to the imaging process?
How does the CT scan in PET/CT scanners contribute to the imaging process?
What duration is typically required for each transmission scan at a bed position using radioactive rod sources?
What duration is typically required for each transmission scan at a bed position using radioactive rod sources?
What factor should be monitored throughout the PET/CT imaging to ensure patient safety and protocol adherence?
What factor should be monitored throughout the PET/CT imaging to ensure patient safety and protocol adherence?
What is usually the best practice for patient positioning when preparing for a PET/CT procedure?
What is usually the best practice for patient positioning when preparing for a PET/CT procedure?
What is the typical time interval recommended after injecting 18F-FDG before beginning imaging?
What is the typical time interval recommended after injecting 18F-FDG before beginning imaging?
Which organs demonstrate consistent intense activity in normal FDG distribution during PET imaging?
Which organs demonstrate consistent intense activity in normal FDG distribution during PET imaging?
How does immobilization contribute to the PET/CT imaging process for radiation therapy candidates?
How does immobilization contribute to the PET/CT imaging process for radiation therapy candidates?
What should be done if a patient's blood glucose level is greater than 200 mg/dl before FDG injection?
What should be done if a patient's blood glucose level is greater than 200 mg/dl before FDG injection?
What is typically the first step in the PET/CT procedure for oncology?
What is typically the first step in the PET/CT procedure for oncology?
What is the consequence of patient movement during PET imaging?
What is the consequence of patient movement during PET imaging?
What method is used to reconstruct images after PET acquisition?
What method is used to reconstruct images after PET acquisition?
What must be done to the patient prior to injecting FDG?
What must be done to the patient prior to injecting FDG?
During a PET/CT procedure, which parameter relates to the timing of the imaging sequence?
During a PET/CT procedure, which parameter relates to the timing of the imaging sequence?
What is estimated to be the total number of new cancer cases diagnosed in the United States each year?
What is estimated to be the total number of new cancer cases diagnosed in the United States each year?
Which imaging technology represents one of the most effective diagnostic tools in nuclear medicine?
Which imaging technology represents one of the most effective diagnostic tools in nuclear medicine?
What significant benefit has been demonstrated through the use of PET technology in medical imaging?
What significant benefit has been demonstrated through the use of PET technology in medical imaging?
During what decade did PET technology begin to show value in cancer detection?
During what decade did PET technology begin to show value in cancer detection?
Which of the following has significantly improved confidence in identifying areas of hypermetabolism in PET imaging?
Which of the following has significantly improved confidence in identifying areas of hypermetabolism in PET imaging?
What aspect of oncology continues to face significant questions despite advancements in research and treatment?
What aspect of oncology continues to face significant questions despite advancements in research and treatment?
What was one of the primary focuses of initial PET development in the late 1970s?
What was one of the primary focuses of initial PET development in the late 1970s?
The increased use of PET technology has provided significant savings by avoiding which of the following?
The increased use of PET technology has provided significant savings by avoiding which of the following?
What is the typical dose range for injected FDG in adults during imaging?
What is the typical dose range for injected FDG in adults during imaging?
Which imaging technique is often used when a solitary pulmonary nodule is detected?
Which imaging technique is often used when a solitary pulmonary nodule is detected?
What is the primary purpose of administering a three-way stopcock in FDG injection?
What is the primary purpose of administering a three-way stopcock in FDG injection?
In what scenario might urinary catheters be used during PET scanning?
In what scenario might urinary catheters be used during PET scanning?
What is the recommended wait time after injecting FDG before imaging?
What is the recommended wait time after injecting FDG before imaging?
What is the effect of contrast media on the heart and renal system?
What is the effect of contrast media on the heart and renal system?
Which imaging method is typically used to achieve better lesion detection?
Which imaging method is typically used to achieve better lesion detection?
What positioning is recommended to alleviate pressure during imaging?
What positioning is recommended to alleviate pressure during imaging?
What should be checked before commencing a PET scan on a potentially claustrophobic patient?
What should be checked before commencing a PET scan on a potentially claustrophobic patient?
What is the purpose of dual time point imaging in PET scans?
What is the purpose of dual time point imaging in PET scans?
What range of body weight is used to calculate pediatric doses of FDG?
What range of body weight is used to calculate pediatric doses of FDG?
Why is patient cooperation critical during a PET scan?
Why is patient cooperation critical during a PET scan?
What is a recommended action for patients before the imaging procedure?
What is a recommended action for patients before the imaging procedure?
Which protocol is essential for managing patients with significantly low or high glucose levels?
Which protocol is essential for managing patients with significantly low or high glucose levels?
What role do immobilization devices play in PET/CT imaging?
What role do immobilization devices play in PET/CT imaging?
What can cause errors in the evaluation of the chest wall during imaging?
What can cause errors in the evaluation of the chest wall during imaging?
What factor can significantly impact imaging quality in heavier patients?
What factor can significantly impact imaging quality in heavier patients?
When undergoing PET imaging, why is it beneficial to void the bladder immediately before the procedure?
When undergoing PET imaging, why is it beneficial to void the bladder immediately before the procedure?
Which imaging technique requires continuous imaging in a single position?
Which imaging technique requires continuous imaging in a single position?
Which scanning protocol is commonly recommended for typical patients during PET scans?
Which scanning protocol is commonly recommended for typical patients during PET scans?
What imaging method is recommended for gaining a comprehensive view of suspected malignancies throughout the entire body?
What imaging method is recommended for gaining a comprehensive view of suspected malignancies throughout the entire body?
What is the minimum imaging matrix recommended for PET scanners?
What is the minimum imaging matrix recommended for PET scanners?
What should be done to ensure patient safety before the scanning protocol begins?
What should be done to ensure patient safety before the scanning protocol begins?
What acquisition mode might be used in PET imaging depending on scanner capabilities?
What acquisition mode might be used in PET imaging depending on scanner capabilities?
Why might the arms be positioned at the sides during head and neck imaging?
Why might the arms be positioned at the sides during head and neck imaging?
How can larger patients affect PET imaging acquisition times?
How can larger patients affect PET imaging acquisition times?
What should be adjusted in the CT parameters when scanning the head and neck region?
What should be adjusted in the CT parameters when scanning the head and neck region?
What issue can arise from motion artifacts during the CT and PET acquisitions?
What issue can arise from motion artifacts during the CT and PET acquisitions?
What is a common reason for increased FDG uptake in diabetic patients during myocardial PET imaging?
What is a common reason for increased FDG uptake in diabetic patients during myocardial PET imaging?
Which pattern of FDG uptake in the thyroid is commonly associated with autoimmune disorders?
Which pattern of FDG uptake in the thyroid is commonly associated with autoimmune disorders?
What is a significant factor that can complicate FDG imaging results in the neck and shoulder regions?
What is a significant factor that can complicate FDG imaging results in the neck and shoulder regions?
Which of the following describes a normal variation of FDG accumulation around the mouth?
Which of the following describes a normal variation of FDG accumulation around the mouth?
What imaging studies are essential for confirming the presence or absence of a malignancy in cases of notable FDG uptake?
What imaging studies are essential for confirming the presence or absence of a malignancy in cases of notable FDG uptake?
What factor must be considered to achieve accurate results during myocardial PET imaging in fasting patients?
What factor must be considered to achieve accurate results during myocardial PET imaging in fasting patients?
Why is activity in the supraclavicular region potentially misleading in FDG PET imaging?
Why is activity in the supraclavicular region potentially misleading in FDG PET imaging?
What normal variation may occur in the hearts of fasting patients during FDG PET scans?
What normal variation may occur in the hearts of fasting patients during FDG PET scans?
Which condition is suggested by intense focal uptake of FDG in the thyroid?
Which condition is suggested by intense focal uptake of FDG in the thyroid?
What common imaging study complements PET imaging for accurate diagnosis in ambiguous cases of FDG uptake?
What common imaging study complements PET imaging for accurate diagnosis in ambiguous cases of FDG uptake?
What is an important dietary recommendation for patients before fasting for FDG administration?
What is an important dietary recommendation for patients before fasting for FDG administration?
Which factor may lead to inadequate tissue activity in patients with diabetes during FDG PET scans?
Which factor may lead to inadequate tissue activity in patients with diabetes during FDG PET scans?
What is the recommended fasting period before the administration of FDG?
What is the recommended fasting period before the administration of FDG?
When preparing a diabetic patient for an FDG PET scan, what should be avoided in terms of insulin administration for type I patients?
When preparing a diabetic patient for an FDG PET scan, what should be avoided in terms of insulin administration for type I patients?
What is the primary reason for assessing whether a patient is an inpatient or outpatient before a PET scan?
What is the primary reason for assessing whether a patient is an inpatient or outpatient before a PET scan?
What should be done with IV lines used for FDG injection if iodinated contrast will also be administered?
What should be done with IV lines used for FDG injection if iodinated contrast will also be administered?
Which of the following is not advisable for inpatient preparation before a FDG PET scan?
Which of the following is not advisable for inpatient preparation before a FDG PET scan?
What effect does ingestion of high carbohydrates have on FDG PET imaging results?
What effect does ingestion of high carbohydrates have on FDG PET imaging results?
What is the impact of muscle exercise on FDG uptake?
What is the impact of muscle exercise on FDG uptake?
What additional steps should breast-feeding mothers take before FDG administration?
What additional steps should breast-feeding mothers take before FDG administration?
How long after FDG administration is localization typically recommended?
How long after FDG administration is localization typically recommended?
What should be monitored in patients with diabetes during the preparation for FDG imaging?
What should be monitored in patients with diabetes during the preparation for FDG imaging?
In cases of patients undergoing PET scans, what should be documented accurately to prepare for their appointment?
In cases of patients undergoing PET scans, what should be documented accurately to prepare for their appointment?
What is a key advantage of FDG in cancer imaging?
What is a key advantage of FDG in cancer imaging?
What preparation should a patient undergo before an FDG PET scan?
What preparation should a patient undergo before an FDG PET scan?
What is a reason that FDG PET scans may yield inconclusive results in some cases?
What is a reason that FDG PET scans may yield inconclusive results in some cases?
Which characteristic enables cancer cells to take up FDG more effectively than normal cells?
Which characteristic enables cancer cells to take up FDG more effectively than normal cells?
What patient factors should be assessed before an FDG PET scan?
What patient factors should be assessed before an FDG PET scan?
What can occur if a patient has elevated blood glucose levels before an FDG PET scan?
What can occur if a patient has elevated blood glucose levels before an FDG PET scan?
How should a patient be positioned during brain imaging for a PET scan?
How should a patient be positioned during brain imaging for a PET scan?
What factor does NOT affect the image quality in FDG PET scanning?
What factor does NOT affect the image quality in FDG PET scanning?
What can happen if insulin is administered within 2 hours of FDG injection?
What can happen if insulin is administered within 2 hours of FDG injection?
What could potentially enhance patient cooperation during PET imaging?
What could potentially enhance patient cooperation during PET imaging?
What is one of the main disadvantages of using FDG as a PET imaging agent?
What is one of the main disadvantages of using FDG as a PET imaging agent?
What is the purpose of interlacing emission and transmission scans in PET imaging?
What is the purpose of interlacing emission and transmission scans in PET imaging?
What role do hexokinase enzymes play in cancer cell FDG metabolism?
What role do hexokinase enzymes play in cancer cell FDG metabolism?
What is the typical duration of a transmission scan at each bed position?
What is the typical duration of a transmission scan at each bed position?
In what year did CMS first approve reimbursement for FDG PET scans in patients with solitary pulmonary nodules or non–small-cell lung carcinoma?
In what year did CMS first approve reimbursement for FDG PET scans in patients with solitary pulmonary nodules or non–small-cell lung carcinoma?
How do PET/CT scanners differ from traditional PET scanners in terms of transmission scans?
How do PET/CT scanners differ from traditional PET scanners in terms of transmission scans?
What is a necessary step to verify before starting a PET/CT procedure?
What is a necessary step to verify before starting a PET/CT procedure?
Which cancers were covered by Medicare after their initial approval for FDG PET scans in 1999?
Which cancers were covered by Medicare after their initial approval for FDG PET scans in 1999?
Why is it recommended to wait approximately 90 to 120 minutes after the injection of FDG before imaging?
Why is it recommended to wait approximately 90 to 120 minutes after the injection of FDG before imaging?
What is the first intracellular enzyme involved in the breakdown of glucose?
What is the first intracellular enzyme involved in the breakdown of glucose?
What is the primary reason that FDG cannot be transformed into fructose-6-phosphate?
What is the primary reason that FDG cannot be transformed into fructose-6-phosphate?
What should be done if a patient's blood glucose level exceeds 200 mg/dl before a PET scan?
What should be done if a patient's blood glucose level exceeds 200 mg/dl before a PET scan?
Which factor is essential for determining the success of the PET/CT imaging procedure?
Which factor is essential for determining the success of the PET/CT imaging procedure?
What factor is primarily increased in malignant tumors that makes FDG PET imaging effective?
What factor is primarily increased in malignant tumors that makes FDG PET imaging effective?
Which circumstance may lead to false positives in FDG PET scans?
Which circumstance may lead to false positives in FDG PET scans?
Why might immobilization devices be used during a PET/CT examination?
Why might immobilization devices be used during a PET/CT examination?
What does the CT scan provide during a PET/CT procedure in comparison to using radioactive sources for transmission scans?
What does the CT scan provide during a PET/CT procedure in comparison to using radioactive sources for transmission scans?
What happens to FDG-6-P once it has entered the cytosol of a cell?
What happens to FDG-6-P once it has entered the cytosol of a cell?
In normal FDG distribution, which organ is known to have moderate activity?
In normal FDG distribution, which organ is known to have moderate activity?
What is the significance of FDG PET scans expanding in various cancer treatment centers?
What is the significance of FDG PET scans expanding in various cancer treatment centers?
What happens to the soft tissue concentration of FDG over time following its injection?
What happens to the soft tissue concentration of FDG over time following its injection?
Which of the following is a limitation identified in the use of FDG PET for cancer screening?
Which of the following is a limitation identified in the use of FDG PET for cancer screening?
What method allows FDG to enter cells for imaging applications?
What method allows FDG to enter cells for imaging applications?
Which method facilitates the best understanding of variations in FDG localization?
Which method facilitates the best understanding of variations in FDG localization?
Which type of cancer was not initially approved for FDG PET scan reimbursement in 2002?
Which type of cancer was not initially approved for FDG PET scan reimbursement in 2002?
What aspect of tumor biology correlates with increased intracellular FDG uptake?
What aspect of tumor biology correlates with increased intracellular FDG uptake?
What is a critical aspect for patients regarding FDG PET imaging coverage by insurance?
What is a critical aspect for patients regarding FDG PET imaging coverage by insurance?
Which of the following conditions is NOT typically associated with increased FDG uptake?
Which of the following conditions is NOT typically associated with increased FDG uptake?
Flashcards
Leukemia Types
Leukemia Types
Cancers of blood cells, categorized as chronic or acute, and lymphocytic or myeloid.
Thyroid Cancer Types
Thyroid Cancer Types
Different types of thyroid cancer include papillary, follicular, Hurthle, medullary, and anaplastic.
Lung Cancer Types
Lung Cancer Types
Lung cancer can be non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC), further divided into subtypes like squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.
Hepatocellular Carcinoma
Hepatocellular Carcinoma
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PET Imaging Protocol
PET Imaging Protocol
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Alpha-fetoprotein (AFT) test
Alpha-fetoprotein (AFT) test
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Colorectal cancer
Colorectal cancer
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Colorectal cancer risk factors
Colorectal cancer risk factors
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PET imaging approval (Colorectal)
PET imaging approval (Colorectal)
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Testicular cancer
Testicular cancer
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Testicular cancer types
Testicular cancer types
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Seminoma (testicular cancer)
Seminoma (testicular cancer)
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Non-seminoma (testicular cancer)
Non-seminoma (testicular cancer)
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Lymphoma
Lymphoma
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Hodgkin's Lymphoma Population
Hodgkin's Lymphoma Population
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Non-Hodgkin's Lymphoma Population
Non-Hodgkin's Lymphoma Population
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Head and Neck Cancer Imaging
Head and Neck Cancer Imaging
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Breast Cancer Types
Breast Cancer Types
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Breast Cancer Population
Breast Cancer Population
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Endometrial Cancer
Endometrial Cancer
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Cervical Cancer
Cervical Cancer
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PET for Cervical Cancer
PET for Cervical Cancer
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Ovarian Cancer Imaging
Ovarian Cancer Imaging
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Melanoma
Melanoma
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Melanoma Stages
Melanoma Stages
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Melanoma Imaging
Melanoma Imaging
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Myeloma
Myeloma
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Myeloma Staging
Myeloma Staging
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Myeloma Demographics
Myeloma Demographics
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UPT/CUP
UPT/CUP
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Esophageal Cancer
Esophageal Cancer
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Esophageal Cancer Stages
Esophageal Cancer Stages
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Gastric Cancer
Gastric Cancer
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[18F]Flortaucipir
[18F]Flortaucipir
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18F Piflufolastat (Pylarify)
18F Piflufolastat (Pylarify)
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18F Fluroestradiol (Cerianna)
18F Fluroestradiol (Cerianna)
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GA-68 Gozetotide (IIICCIX, Locametz)
GA-68 Gozetotide (IIICCIX, Locametz)
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What are the common steps involved in using radioactive tracers for imaging?
What are the common steps involved in using radioactive tracers for imaging?
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Renal Cancer
Renal Cancer
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Prostate Cancer
Prostate Cancer
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TNM Staging
TNM Staging
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Sarcomas
Sarcomas
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18F-FLT
18F-FLT
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18F-FMISO
18F-FMISO
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13NH3
13NH3
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15O2
15O2
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15O-water
15O-water
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82Rb-Chloride
82Rb-Chloride
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Amyloid Plaque Imaging
Amyloid Plaque Imaging
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Neuroendocrine Tumor Imaging
Neuroendocrine Tumor Imaging
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18F-Flurpiridaz
18F-Flurpiridaz
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11C-Sodium Acetate
11C-Sodium Acetate
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18F-Fluciclovine (Axumin)
18F-Fluciclovine (Axumin)
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PET Imaging in Oncology
PET Imaging in Oncology
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PET Imaging Accuracy
PET Imaging Accuracy
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PET Imaging Applications
PET Imaging Applications
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PET Imaging Advantages
PET Imaging Advantages
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Early PET Development
Early PET Development
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PET Imaging Cost-Effectiveness
PET Imaging Cost-Effectiveness
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PET Imaging Technology
PET Imaging Technology
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PET Imaging Future
PET Imaging Future
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FDG PET for Cancer
FDG PET for Cancer
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What is FDG?
What is FDG?
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Why does FDG accumulate in cancer cells?
Why does FDG accumulate in cancer cells?
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FDG PET Applications
FDG PET Applications
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FDG PET Limitations
FDG PET Limitations
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Hexokinase
Hexokinase
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Facilitated Diffusion
Facilitated Diffusion
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FDG-6-P
FDG-6-P
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FDG PET & Malignant Tumors
FDG PET & Malignant Tumors
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FDG PET & Treatment Strategy
FDG PET & Treatment Strategy
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Benefits of Medicare Coverage for FDG PET
Benefits of Medicare Coverage for FDG PET
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Impact of Payer Reimbursement
Impact of Payer Reimbursement
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FDG PET & Private Insurance
FDG PET & Private Insurance
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FDG PET: A Screening Tool
FDG PET: A Screening Tool
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FDG PET
FDG PET
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FDG Accumulation in Cancer Cells
FDG Accumulation in Cancer Cells
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Why is patient preparation important for FDG PET?
Why is patient preparation important for FDG PET?
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Patient Fasting Before FDG PET
Patient Fasting Before FDG PET
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High Blood Glucose Levels and FDG PET
High Blood Glucose Levels and FDG PET
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Managing Diabetes and FDG PET
Managing Diabetes and FDG PET
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Insulin and FDG PET
Insulin and FDG PET
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PET Radiotracers
PET Radiotracers
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Sensitivity of PET Radiotracers
Sensitivity of PET Radiotracers
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PET/CT Scan
PET/CT Scan
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Limitations of FDG PET
Limitations of FDG PET
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New PET Radiotracers
New PET Radiotracers
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Importance of History Before FDG PET
Importance of History Before FDG PET
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Language Barriers and FDG PET
Language Barriers and FDG PET
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FDG Dose
FDG Dose
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FDG Uptake
FDG Uptake
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Limited-Area PET Scan
Limited-Area PET Scan
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Dynamic PET Scan
Dynamic PET Scan
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Whole-Body PET Scan
Whole-Body PET Scan
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Total-Body PET Scan
Total-Body PET Scan
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PET Scan for Pelvic Cancer
PET Scan for Pelvic Cancer
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PET Scan and Motion
PET Scan and Motion
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Radiopaque Contrast Media (ROCM)
Radiopaque Contrast Media (ROCM)
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ROCM Administration
ROCM Administration
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ROCM Adverse Effects
ROCM Adverse Effects
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Contraindications for ROCM
Contraindications for ROCM
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PET Imaging with Contrast
PET Imaging with Contrast
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Importance of Imaging Professional's Knowledge
Importance of Imaging Professional's Knowledge
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PET Scan Timing
PET Scan Timing
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FDG Uptake in Normal Tissues
FDG Uptake in Normal Tissues
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Factors Affecting FDG Uptake
Factors Affecting FDG Uptake
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Diabetic Patients & FDG
Diabetic Patients & FDG
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Preparing Diabetic Patients
Preparing Diabetic Patients
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Patient Preparation for FDG PET
Patient Preparation for FDG PET
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FDG Administration Technique
FDG Administration Technique
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Timing of FDG Administration
Timing of FDG Administration
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Caloric Intake Before FDG
Caloric Intake Before FDG
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Assessing Patient Tolerance for FDG PET
Assessing Patient Tolerance for FDG PET
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FDG Uptake in Cancer Cells
FDG Uptake in Cancer Cells
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Hexokinase and FDG Uptake
Hexokinase and FDG Uptake
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Facilitated Diffusion of FDG
Facilitated Diffusion of FDG
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Trapped FDG in Cells
Trapped FDG in Cells
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Interlaced Acquisition
Interlaced Acquisition
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Transmission Scan
Transmission Scan
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Emission Scan
Emission Scan
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ET/TE Acquisition
ET/TE Acquisition
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FDG
FDG
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Normal FDG Distribution
Normal FDG Distribution
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PET/CT Procedure
PET/CT Procedure
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Patient Preparation for PET/CT
Patient Preparation for PET/CT
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Radioactive Tracer
Radioactive Tracer
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PET/CT in Oncology
PET/CT in Oncology
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PET/CT Advantages
PET/CT Advantages
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FDG Uptake in Inflammation
FDG Uptake in Inflammation
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Normal Variations in FDG Localization
Normal Variations in FDG Localization
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Myocardial Activity Variations
Myocardial Activity Variations
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Thyroid Activity Variations
Thyroid Activity Variations
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Normal Variations Around the Mouth
Normal Variations Around the Mouth
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Muscular Activity in the Neck and Shoulders
Muscular Activity in the Neck and Shoulders
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Gastrointestinal Tract Activity Variations
Gastrointestinal Tract Activity Variations
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Importance of Accurate History
Importance of Accurate History
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Correlative Imaging Studies
Correlative Imaging Studies
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Role of Biopsy
Role of Biopsy
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Patient Positioning: Arms Up
Patient Positioning: Arms Up
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Patient Positioning: Arms Down
Patient Positioning: Arms Down
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PET Scan Duration
PET Scan Duration
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Weight Limit: PET Scanners
Weight Limit: PET Scanners
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Head and Neck PET: Arms Down
Head and Neck PET: Arms Down
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PET Scan Acquisition Time (Lesions)
PET Scan Acquisition Time (Lesions)
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PET Scan Acquisition Mode
PET Scan Acquisition Mode
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PET Scan Resolution: High
PET Scan Resolution: High
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Transmission Attenuation Correction
Transmission Attenuation Correction
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Overlapping Bed Positions
Overlapping Bed Positions
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3D Whole-Body Acquisition
3D Whole-Body Acquisition
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Random and Scatter Events in 3D Mode
Random and Scatter Events in 3D Mode
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Manufacturer's Recommendations for Acquisition Protocols
Manufacturer's Recommendations for Acquisition Protocols
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Patient Safety: Before Scan Start
Patient Safety: Before Scan Start
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PET Scan Resolution: High (Compared to SPECT)
PET Scan Resolution: High (Compared to SPECT)
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PET Imaging
PET Imaging
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Why does FDG accumulate?
Why does FDG accumulate?
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Why Fast Before FDG PET?
Why Fast Before FDG PET?
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High Blood Glucose & FDG PET
High Blood Glucose & FDG PET
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Insulin & FDG PET Timing
Insulin & FDG PET Timing
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FDG PET Scan
FDG PET Scan
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Patient Positioning
Patient Positioning
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Why raise arms during a PET scan?
Why raise arms during a PET scan?
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What are motion artifacts?
What are motion artifacts?
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Dual Time Point Imaging
Dual Time Point Imaging
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Importance of patient cooperation
Importance of patient cooperation
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Why is head holder sometimes used?
Why is head holder sometimes used?
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PET scan resolution
PET scan resolution
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Acquisition modes: 2D vs. 3D
Acquisition modes: 2D vs. 3D
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Overlap in PET scan acquisition
Overlap in PET scan acquisition
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Interpretation of PET images
Interpretation of PET images
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New developments in PET imaging
New developments in PET imaging
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Normal Myocardial Activity in FDG PET
Normal Myocardial Activity in FDG PET
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Thyroid Activity in FDG PET
Thyroid Activity in FDG PET
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FDG Accumulation in Salivary Glands and Muscles
FDG Accumulation in Salivary Glands and Muscles
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Exercise, Shivering, and FDG Uptake
Exercise, Shivering, and FDG Uptake
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Gastrointestinal Tract Activity in FDG PET
Gastrointestinal Tract Activity in FDG PET
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Impact of Patient History and Additional Imaging
Impact of Patient History and Additional Imaging
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FDG PET and False Positives
FDG PET and False Positives
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FDG PET and Diabetes Management
FDG PET and Diabetes Management
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Interlacing Scans
Interlacing Scans
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Why are transmission scans important in PET/CT?
Why are transmission scans important in PET/CT?
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PET/CT Scanners and Transmission
PET/CT Scanners and Transmission
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Importance of Patient Evaluation during Imaging
Importance of Patient Evaluation during Imaging
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PET/CT Protocol for Radiation Therapy Candidates
PET/CT Protocol for Radiation Therapy Candidates
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How does PET help in radiation therapy?
How does PET help in radiation therapy?
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Normal FDG Distribution in the Body
Normal FDG Distribution in the Body
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FDG Uptake in Malignant Tissues
FDG Uptake in Malignant Tissues
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Why is waiting for a long time interval before PET imaging beneficial?
Why is waiting for a long time interval before PET imaging beneficial?
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What is the optimal imaging time for FDG PET?
What is the optimal imaging time for FDG PET?
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Why is fasting important for FDG PET?
Why is fasting important for FDG PET?
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How do high blood glucose levels affect FDG PET?
How do high blood glucose levels affect FDG PET?
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Study Notes
Cancer Types and Imaging
-
Leukemia: Cancers originating in blood cells. Subtypes include Chronic Lymphocytic Leukemia (CLL), Chronic Myeloid Leukemia (CML), Acute Lymphocytic Leukemia (ALL), and Acute Myeloid Leukemia (AML). CLL and CML primarily affect adults, while ALL and AML can affect both adults and children.
-
Thyroid Cancer: Common in women, including subtypes like papillary, follicular, Hurthle cell, medullary, and anaplastic. Approved for PET imaging since late 2003, similar imaging protocols are used as for head and neck cancers.
-
Lung Cancer: Includes Non-small cell lung cancer (NSCLC), small cell lung cancer (SCLC), squamous cell carcinoma, adenocarcinoma, large cell carcinoma, BAC. NSCLC is approved for solitary pulmonary nodule imaging since 1998. Imaging typically encompasses the neck to pelvis.
-
Hepatocellular Carcinoma: Cancer starting in the liver, affecting mainly men and those over 65. PET imaging can aid in staging and evaluating disease spread. Alphafetoprotein (AFP) blood tests can be used to assess disease.
-
Colorectal Cancer: Cancer in the colon/rectum. Approved for PET imaging in 1999 for staging, restaging, and diagnosis as well as reimbursement in 2009. Important to image rectum, lymph nodes for accurate evaluation.
-
Testicular Cancer: Rare but common solid tumor in young males (15-40). Includes seminomas (50%) and nonseminomas (50%). Seminomas are slow-growing, treatable with radiation; nonseminomas are faster-growing. FDG PET may help in staging and treatment response evaluations but large studies are limited compared to other cancer subtypes.
-
Lymphoma: Cancer in lymphatic system (lymphocytes, vessels, nodes). Includes Hodgkin lymphoma (primarily adolescents/young adults) and non-Hodgkin lymphoma (primarily adults). Approved for PET since 1999 for improved treatment evaluations. Lymph node involvement is critical to image.
-
Head and Neck Cancer: Affecting oral cavity, sinuses, larynx, etc. Often squamous cell carcinomas. Associated risk factors include tobacco and alcohol use. Approved for PET imaging in 2001 for diagnosis, staging, and treatment planning. Double scan protocol exists for comprehensive examination.
-
Thymomas: Rare thymic tumors (90% of thymic tumors are thymomas). Mostly affecting adults aged 40-60. PET may be used for staging and recurrence evaluation, but is optional for some initial assessment.
-
Breast Cancer: Cancer in breast cells, most frequently affecting females. Ductal and lobular subtypes exist. FDG/PET imaging approved in 2002. Imaging is performed with arms raised.
-
Pancreatic Cancer: Cancer in pancreas ducts. PET approved under CMS NCD and imaging includes neck to pelvis with arms held above the head.
-
Gynecological Cancers: Includes uterine (endometrial) cancer, often adenocarcinomas, and cervical cancer (often slow-growing, HPV-linked). PET coverage varies by cancer type, important to encompass all lymph nodes and organs within field of view, with arms raised.
-
Melanoma: Skin cancer that can arise in pigmented tissues. Diagnosed in stages 0-IV. FDG/PET imaging generally approved for general staging and treatment response evaluation, but some indications, such as in regional lymph nodes, remain uncovered. Total body imaging is crucial.
-
Myeloma: Cancer in bone marrow, diagnosed based on M protein levels, bony lesions, hemoglobin, and calcium. More frequent in men and rarely affecting under 50 year-olds
-
Unknown Primary Tumor (UPT/CUP): Metastatic cancer with unknown origin. CMS approval covers initial staging, typically with imaging from skull base to mid-thigh with arms raised.
-
Esophageal Cancer: Cancer of the esophagus, with squamous cell carcinoma and adenocarcinoma being common subtypes. Approved for PET imaging since 2001 and staging is important. Patients should fast and have blood glucose checked before imaging. Imaging is best done with arms above the patient's head.
-
Gastric Cancer: Stomach cancer, typically adenocarcinomas. It is important to evaluate for distant metastasis using PET imaging. Patients should fast and have blood glucose checked before imaging. Imaging is best done with arms above the patient's head.
-
Renal Cancer: Kidney cancer, most frequently renal cell carcinoma. Staging is an important use of PET imaging for this malignancy, ideally performed with arms held overhead.
-
Prostate Cancer: Prostate cancer, predominantly adenocarcinomas. PET imaging is less often covered for diagnosis but is useful for evaluating recurrence or metastatic spread. Recent agents may become important later.
-
Sarcoma: Cancer of connective tissues (bone, muscle, fat). Imaging from head to feet, arms by side.
PET Radiopharmaceuticals
- Numerous radiopharmaceuticals exist that target specific metabolic or biological processes.
- Specific examples include: 18F-FLT, 18F-FMISO, 13NH3, 15O2, 82Rb-Chloride, 18F-Amyloid Florbetapir (Amyvid™) etc.
- Each radiopharmaceutical has its specifics in terms of clinical applications, uptake mechanisms, production, procedure, and imaging parameters.
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