PET/CT FDG (Whole Body) — Dictation, Appropriateness, and Dose for Residents

1. The Attending-Ready PET/CT Read

It’s 3 PM. You have a newly diagnosed esophageal cancer on your list for initial staging. The PET/CT is complex — there’s the primary tumor, a few borderline nodes, and some weird symmetric uptake in the neck. Your attending expects a perfect report: staging, SUVmax on the key lesions, a Deauville or PERCIST-ready baseline, and a clear-eyed take on that supraclavicular activity. You know it’s probably brown fat, but you need to sound confident and rule out metastatic disease definitively. This is where a solid framework isn’t just helpful; it’s essential for getting the read right and getting it done efficiently. For more tools like this, check out the residents and fellows resource hub.

2. What a Whole Body PET/CT with FDG Covers and What Attendings Look For

A Positron Emission Tomography/Computed Tomography (PET/CT) scan using 18F-fluorodeoxyglucose (FDG) is the workhorse of metabolic imaging in oncology. It provides a whole-body map of glucose metabolism, highlighting tissues with high uptake — a hallmark of most malignancies, but also of inflammation and infection.

This study is designed to answer critical clinical questions:

• Initial Staging: Is there distant metastatic disease that would change a surgical plan to a systemic one?
• Treatment Response: Is the tumor responding to chemotherapy or radiation? This is where frameworks like Deauville for lymphoma and PERCIST for solid tumors come in.
• Recurrence Detection: Can we find recurrent disease, often before it’s visible on anatomic imaging alone?
• Problem Solving: Is that post-treatment scar just fibrosis, or is it residual tumor? Is an indeterminate lung nodule metabolically active?

Your attending expects a report that systematically addresses these points. They’re looking for a clear description of physiologic versus pathologic uptake, precise anatomic localization of suspicious findings, and semi-quantitative analysis (like SUVmax) for key lesions. Most importantly, they want a confident, clinically relevant impression that synthesizes the findings into actionable information for the referring oncologist.

3. Radiology Report Template for PET/CT FDG (Whole Body)

This template provides a solid starting point. Adapt it based on your institution’s specific requirements and the clinical context.

Technique

WHOLE BODY PET/CT was performed from the skull base to the mid-thighs 60 minutes after the intravenous administration of [XX] mCi of F-18 FDG. A low-dose, non-contrast CT was performed for attenuation correction and anatomic localization.

Blood glucose at the time of injection was [XX] mg/dL.

(Modify if contrast was given: A diagnostic quality contrast-enhanced CT of the [chest/abdomen/pelvis] was performed following the administration of [XX] mL of [contrast agent]…)

Findings

Comparison is made to the prior study from [DATE].

PHYSIOLOGIC DISTRIBUTION: Normal physiologic FDG uptake is seen in the brain, myocardium, liver, spleen, gastrointestinal tract, kidneys, and bladder. No unusual muscle or brown fat uptake is noted. (Or, if present: Symmetric FDG uptake is noted in the supraclavicular and paraspinal brown adipose tissue, consistent with physiologic brown fat.)

HEAD AND NECK: No focal hypermetabolic lesion identified. The visualized portions of the brain demonstrate symmetric physiologic uptake. No hypermetabolic cervical or supraclavicular lymphadenopathy.

CHEST: No hypermetabolic pulmonary nodules, masses, or consolidation. No hypermetabolic mediastinal or hilar lymphadenopathy. No hypermetabolic pleural or pericardial disease.

ABDOMEN AND PELVIS: The liver, spleen, pancreas, adrenal glands, and kidneys are unremarkable without focal hypermetabolic lesions. No hypermetabolic lymphadenopathy. No evidence of hypermetabolic peritoneal disease.

MUSCULOSKELETAL: No suspicious hypermetabolic osseous or soft tissue lesions.

(For positive findings, describe them systematically with anatomic location, size on CT, and SUVmax. Example: “In the right upper lobe, there is a 2.1 cm spiculated nodule corresponding to the known primary malignancy, demonstrating intense hypermetabolism with an SUVmax of 12.5.”)

Impression

1. Evidence of a hypermetabolic [LOCATION] mass, consistent with the patient’s known primary malignancy. The maximum standardized uptake value (SUVmax) is [X.X].
2. Hypermetabolic [LOCATION] lymph nodes, suspicious for metastatic disease. The largest measures [SIZE] with an SUVmax of [X.X].
3. No evidence of distant metastatic disease elsewhere in the chest, abdomen, or pelvis.
4. (If for response assessment): Deauville Score [1-5]. Findings are consistent with a [complete/partial] metabolic response to therapy.

4. Free Template Sources for Your On-Call Toolkit

Building a personal library of templates is a rite of passage. Before you build everything from scratch, know that two great free repositories exist, curated by major radiology organizations. They are excellent starting points for common and uncommon studies alike.

• RadReport.org: Maintained by the RSNA, this is a comprehensive library of peer-reviewed templates covering nearly every modality and subspecialty.
• Radiology Templates (AU): An excellent resource maintained by Australian radiologists, offering a clean interface and practical, well-structured templates.

These are fantastic for grabbing a solid structure when you’re faced with an unfamiliar study.

5. The Next-Level Move: Free-Form Dictation to Structured Report

The real bottleneck isn’t finding a template; it’s populating it accurately and efficiently under pressure. You see the positive findings, but dictating them into the right sections, adding the measurements, and remembering the specific classification language for a Deauville score or PERCIST criteria takes time and cognitive load.

This is the workflow that AI-powered dictation tools are designed to streamline. Instead of meticulously navigating a template, you can dictate the positive findings in free form—”hypermetabolic 2 cm right upper lobe mass with SUV of 12, plus a 1.5 cm subcarinal node with SUV of 8″—and the software handles the rest. The GigHz Precision AI reporting assistant parses your natural language and generates a complete, structured report using pre-loaded templates from governing bodies like the ACR. It helps ensure every key element is in the right place, making your reports clearer for clinicians and more impressive to your attendings.

6. When Should You Order a Whole Body PET/CT FDG? ACR Appropriateness Criteria

Knowing when a PET/CT is the *right* test is as important as reading it correctly. The American College of Radiology (ACR) Appropriateness Criteria provide evidence-based guidelines.

For newly diagnosed esophageal cancer, a PET/CT for initial pretreatment clinical staging is rated “Usually Appropriate” (ACR Staging and Follow-up of Esophageal Cancer). It’s considered the standard of care for detecting nodal and distant metastatic disease.

For invasive breast cancer, the role of PET/CT depends on the stage (ACR Imaging of Invasive Breast Cancer).

• For early-stage (I-IIA) disease, PET/CT is “Usually Not Appropriate” for evaluating distant disease, as the yield is low.
• For late-stage (IIB-III) disease, PET/CT becomes “Usually Appropriate” for the evaluation of distant metastatic disease, as the pretest probability is much higher.
• For suspected recurrence of breast cancer based on symptoms or rising tumor markers, PET/CT is also “Usually Appropriate” for identifying the site of disease.

PET/CT is also “Usually Appropriate” for staging most non-small-cell lung cancers, lymphomas, and melanomas, as well as for characterizing indeterminate pulmonary nodules greater than 8 mm.

However, it’s not the first choice for every malignancy. Key alternatives for specific cancers include:

• Prostate Cancer: PSMA PET/CT
• Neuroendocrine Tumors: Ga-68 DOTATATE PET/CT
• Hepatocellular Carcinoma: Contrast-enhanced MRI with a hepatobiliary agent
• Renal Cell Carcinoma: Contrast-enhanced CT or MRI

7. PET/CT FDG (Whole Body) Imaging Protocol — Phases, Contrast, and Key Parameters

The PET/CT protocol is a two-part study combining metabolic and anatomic imaging. The key is careful patient preparation to ensure the FDG tracer goes to the tumor, not to skeletal muscle or brown fat. Prep includes fasting for 4-6 hours, a pre-injection glucose check (<200 mg/dL), and a 60-minute quiet uptake period in a warm room.The scan itself involves a low-dose CT for localization and attenuation correction, followed by the PET acquisition. A diagnostic, contrast-enhanced CT can be performed instead of the low-dose CT if detailed anatomic information is required for initial staging.

Common protocol pitfalls:

• High Blood Glucose: If the patient’s glucose is >200 mg/dL, endogenous glucose will compete with FDG, leading to poor tumor uptake and a non-diagnostic scan. The study should be rescheduled.
• Patient Motion: Movement between the CT and PET acquisitions can cause misregistration artifacts, making it difficult to localize metabolic activity.
• Brown Fat Activation: If the patient is cold or anxious, symmetric uptake in the neck, supraclavicular, and paraspinal regions can mimic malignant lymphadenopathy. Keeping the patient warm is critical.

8. The 3-Months-Free Offer for Radiology Residents and Fellows

3+ months free for radiology residents and fellows

Look like a rockstar on your reports. The biggest gap between a junior resident and a senior isn’t just knowledge—it’s speed and confidence in reporting. We want to help you bridge that gap. Dictate your positive findings in free form, and let the AI generate a perfectly structured report using ACR and SIR templates. The appropriate clinical decision support fires automatically, guiding you to the right classification every time.

All we ask in return is your feedback so we can keep improving the product for trainees.

To sign up, just let us know:

1. Your PGY year (e.g., PGY-2, PGY-4)
2. Your training type (radiology residency or fellowship specialty)
3. Your training program / hospital name

There’s no credit card required and no long forms to fill out. To get started, apply for the residents free-access program.

9. Frequently Asked Questions

Is it HIPAA-compliant?

Yes. The platform is designed for de-identified workflows. No protected health information (PHI) is required to use the tool to structure your report findings.

Do I need my hospital’s IT department to set it up?

No. The tool is browser-based and requires no local installation or special permissions. It works on any modern computer, including the call-room PC or your personal iPad.

Does it work with PowerScribe or other dictation systems?

Yes. It works alongside your existing dictation system. You can generate the structured report and then copy-paste it directly into your PACS/RIS environment. It’s a workflow enhancement, not a replacement.

Can I use it on my phone or iPad?

Absolutely. It’s a web-based application, so it’s accessible from any device with a browser, which is perfect for reviewing a case or prepping a report away from your primary workstation.

Can I customize the templates?

Yes. While the system comes pre-loaded with ACR and other society-endorsed templates, you can create, modify, and save your own templates to match your personal style or your institution’s specific formatting requirements.

What happens after I finish residency or fellowship?

The free access program is specifically for trainees. After you graduate, you can transition to a standard plan. We offer discounts for recent graduates to help you get started in your practice.

Free GigHz Tools That Pair With This Article

Three free tools that complement the material above:

• ACR Appropriateness Criteria Lookup — Type an indication or clinical scenario in plain language and get the imaging studies the ACR rates for it, with adult and pediatric radiation levels. Built directly from 297 ACR topics, 1,336 clinical variants, and 15,823 procedure ratings.
• GigHz Imaging Protocol Library — A searchable library of 131 imaging protocols with the physics specs surfaced and the matching ACR Appropriateness Criteria alongside. Plain-English narratives readable in 60 seconds, organized by modality.
• GigHz Radiation Dose Calculator — Pick the imaging studies a patient has had and see total dose in millisieverts (mSv) with comparisons to natural background radiation, transatlantic flights, and chest X-rays. Useful for shared decision-making.

Reviewed by Pouyan Golshani, MD, Interventional Radiologist — May 7, 2026