Practices and barriers in PET/CT use for critically ill patients: an international survey.

Abstract

2-deoxy-2-[18F] fluoro-D-glucose (FDG) Positron Emission Tomography/Computed Tomography ([18F]-FDG-PET/CT) offers high diagnostic sensitivity for occult infection, malignancy and inflammatory processes - conditions that frequently complicate critical‑care patients. Despite this potential, routine use of [18F]-FDG-PET/CT in the intensive care unit (ICU) remains sporadic and there are no formal guidelines to direct its application. The objective of the study is to describe current international practice, identify barriers to implementation, and provide a data‑driven foundation for future consensus recommendations on [18F]-FDG-PET/CT use in ICU patients. An electronic questionnaire was disseminated worldwide through the European Society of Intensive Care Medicine (ESICM) and the European Association of Nuclear Medicine (EANM). The survey collected demographic information, hospital characteristics, availability and location of nuclear‑medicine services, clinical indications for [18F]-FDG-PET/CT in critically ill patients, frequency of use, workflow organization, and perceived obstacles. Forty‑one respondents from 16 countries completed the survey. Most participants worked in university hospitals (63%) and specialised either in ICU care (71%) or nuclear imaging (29%). A nuclear‑medicine department (NMD) was available in 78% of centres, but only 60% were co‑located with the ICU. [18F]-FDG-PET/CT was performed infrequently: 43% of users performed 1-5 scans per year and a fourth performed 1-2 scans per month. The use of PET/CT as primary diagnostic technique was infection (74%), followed by malignancy (57%) and fever of unknown origin (49%). Radiotracer administration occurred mainly in the NMD (77%) and specific dietary preparation protocols were present in only 50% of sites. Reported barriers included lack of standardised protocols, prolonged procedure duration, limited imaging slots, ambiguous indications, insufficient staff expertise, and logistical difficulties transporting unstable ICU patients. This international survey reveals marked heterogeneity in [18F]-FDG-PET/CT utilisation and significant practical obstacles in the ICU setting. The data highlight an unmet need for consensus guidelines and streamlined workflows to optimise the diagnostic value of [18F]-FDG-PET/CT in critical‑care patients. Findings will inform forthcoming joint recommendations by ESICM and EANM, ultimately aiming to enhance patient outcomes through evidence‑based imaging protocols.