Feasibility study on the implementation of a mobile high-resolution PET/CT scanner for surgical specimens: exploring clinical applications and practical considerations.

Abstract

In this trial we explore potential indications of an intra-operative mobile PET/CT camera. The tested device is designed to acquire high quality images of resected tissue specimens from patients who were administered a PET-tracer, shortly before resection. Besides clinical experiences, we will also comment on the practical aspects of the implementation of a safe workflow for intra-operative PET/CT-imaging. This investigator driven study involved a 12-month evaluation of the AURA 10 PET/CT camera (XEOS Medical, Belgium). Depending on the tumour type, [¹⁸F]FDG, [18F]JK-PSMA-7, [^18F]PSMA-1007 or [¹⁸F]Choline was injected intravenously 60-90 min prior to the removal of the tumour. The tissue was scanned in the mobile PET/CT-device and 12 min later the surgeon could review the images. Specimen PET/CT-images were confronted with pathology findings. Dose rates were monitored around the patient throughout the procedure. The technique was tested in 32 surgeries for thyroid carcinomas (n = 5), transitional cell carcinomas (n = 2,) renal cell carcinoma (n = 1), prostate cancer (n = 5), breast carcinoma (n = 7), skin cancer (n = 3), nodal or bone biopsy for oncology work up (n = 6) and parathyroid adenoma (n = 3). Normalized to an injected activity of 1 MBq/kg the estimated median absorbed doses per procedure were 15.6 µSv (range 0,7-140,8) and 14,1 µSv (0,5-46,2) for respectively the surgeons and instrumenting nurses. The overall experience of intra-operative PET/CT-imaging of surgical specimens was promising in our hospital, with particular added value in case of (para)thyroid, urological surgeries, and oncological work-ups. High quality images were obtained with low activity of tracers, enabling a safe implementation. BUN: B0172022000009 (NCT retrospectively submitted).