Patient name:

PET "Metabolic Flare" Scheduling Instructions
(also see flow chart on page 2)
PET estradiol stimulation testing is performed to see if a patient's breast cancer has active functional estrogen receptors and may benefit from hormonal therapy. Prior to scheduling confirm that the patient has disease that is likely to be detectable by FDG-PET imaging. The patient will have a baseline FDG-PET/CT study per standard clinical procedures. On the following day or another day in the near future (within a week), the patient will be scheduled to return for the "flare" FDG- PET/CT. Scheduling should be done so that all imaging parameters can remain as consistent as possible (same time of day to ensure similar fasting times, uptake time, etc.). Patient will be given a prescription for 3 estradiol 2 mg tablets (total of 6 mg) by the treating physician. The patient will be instructed to take one 2 mg tablet every 8 hours with the last dose of estradiol occurring approximately 1 hour before the scheduled injection of Be sure to schedule based on patient's normal sleeping habits and/or confirm that the patient will be compliant and set an alarm clock to wake up at odd hours of the night or early morning to stay on the 8-hour dosing Flow Chart for PET flare study
Call from oncologist (his/her office) to the reading room
Nuclear Medicine attending should talk to the oncologist and make sure that based on the
available data the lesions will be evaluable by FDG-PET/CT and then ask the oncologist to give
estradiol prescription to the patient (2 mg estradiol x 3)
Nuclear Medicine attending/fellow will schedule the study with PET technologists and
Cheryl/Clara (make sure that the first and second PET studies can be done at the same time of
the day with approximately 60 min uptake time)
Then the Nuclear Medicine attending/fellow tentatively selects the times for the patient to take
estradiol
Nuclear Medicine attending/fellow informs the Dr.'s office and makes sure that the time is
convenient for the patient and then confirms the appointment with Cheryl/Clara
Nuclear Medicine attending/fellow should fill out the estradiol form and discuss it with the
patient after the first PET study is done and gives her the instructions
There should be one report for each PET study. The lesions to be analyzed are selected on the
first day PET study (typically up to 6 most intense lesions). The SUVmax of the lesion(s) is
measured on both PET studies. The average SUVmax of the lesions on each day will be
calculated and the percent change in FDG uptake will be determined. ≥ 12% increase in FDG
uptake on the second day PET in comparison to the first day PET is indicative of "metabolic
flare" and thus, the likelihood of response to hormonal therapy
Call Dr. Dehdashti (362-7027) with any questions
"ESTRADIOL CHALLENGE" PET Scan
Instructions for taking of estradiol prior to "estradiol challenge" PET scan: 1. To determine if you have active estrogen receptors, you will need to take a total of 6 mg of estradiol (an oral form of estrogen) before your second PET scan. 2. You will take one (2-mg) pill three times according to schedule below. REMEMBER: Nothing to eat for at least 6 hours prior to your appointment. You may drink as much water as
you would like before the appointment. Please report to the Clinical PET Facility located on the second floor of the Center for Advanced Medicine Building approximately 30 minutes before your scheduled appointment

Source: http://gamma.wustl.edu/docs/PET%20Flare%20Estradiol%20Scheduling%20instructions%2004-10-09.pdf