About Saral

We started in 1984 under professional guidance of Dr. Ravi Gupta, MD Radio diagnosis from Delhi University with a vision and motto to serve and provide latest medical investigations.

We are a multimodality Diagnostic centre to serve all your diagnostic need under one roof. At Delhi we are spread over more than 25000 sq. ft. and at Noida we are spread over more than 11,000 sq. ft.We are the first NABH Accredited Diagnostic centre in the country. We have all the major government panels.

What is PET-CT

Positron emission tomography–computed tomography (PET-CT) is a nuclear medicine technique which combines, in a single gantry, a positron emission tomography scanner and an x-ray computed tomography scanner, to acquire sequential images from both devices in the same session, which are combined into a single superposed image.

Principle of PET CT (How PET-CT works)

Tumour cells take up glucose under aerobic conditions constitutes the basis for the detection and staging of human cancers with 18F-fluorodeoxyglucose (FDG) and positron emission tomography (PET). 18F-FDG is a structural analogue of 2-deoxyglucose and is used as a tracer of glucose metabolism.Positron Emission Tomography (PET) detects and measures glucose metabolism within the body. In cancers and certain diseases of the heart and brain, the metabolism of glucose may be abnormal.

What is Digital PET-CT

Digital PET-CT imaging is the latest advancement in PET- CT (providing high definition PET images and offering higher sensitivity and higher diagnostic performance). Digital PET-CT imaging is transforming cancer diagnostics with precision, detecting even the smallest lesions missed by conventional imaging techniques, including the analogue PET CT, leading to personalized treatment options and improved patient outcomes. Smallest lesion detectability can change the patient management and improving outcomes in oncological and non-oncological diseases. AI Based reconstruction gives best image quality in lesser injected dose leading to significantly less radiation burden to the patient.

Advantages of digital PET-CT

Better - image quality, Industries’ best clinical reolution of 1.4 mm.
Clearer - Crystal clear image quality, Sharper, superior images for accurate disease diagnosis and staging
Faster - Whole body scanning in just 6-8 min vs. 15-20 min
Safer - Significantly less radiation to the patient, Digital technology, AI Based reconstruction, Digital Motion correction & Digital Self gating feature avoid repetition of scan leading to less radiation to the patient
Comfortable - Accommodates patients of all sizes (Upto 250 kg body weight), Compact Gantry Width , Unique in-bore light feature leading to less claustrophobia
Inclusive - Beyond cancer, digital PET-CT proves valuable in neurology and cardiology, offering precise diagnosis, staging, and treatment evaluation, particularly in early-stage cancer, where tumor size matters most.

Advantages of PET-CT over other imaging modalities

EARLY detection of disease before appearance of anatomical changes.
ACCURATE staging and restating of cancers.
SIMULTANEOUS contrast enhanced CT with metabolic information - cost effective way of imaging the whole body in one sitting.
QUANTIFICATION of tumor metabolism (SUV) before and after treatment.
Metabolic GRADING of tumors possible - Impacts treatment decisions.
SAFE for use in patients with chronic kidney disease, metallic implants, pacemakers, etc.

Test details

Whole body FDG PET-CT Scan

Oncology:

To diagnose primary malignancy : early detection (Because PET images biochemical activity, it can accurately characterize a tumor as benign or malignant, thereby avoiding surgical biopsy when the PET scan is negative)

Initial staging of known malignancy : PET-CT is extremely sensitive in determining the full extent of disease, because of whlie body combined functional and anatomical imaging. Confirmation of metastatic disease allows the physician and patient to more accurately decide how to proceed with the patient's management.

Treatment response evaluation : The level of tumor metabliism (SUV) is compared on PET scans taken before and after a chemotherapy cycle. A successful response seen on a PET scan frequently precedes alterations in anatomy and would therefore be an earlier indicator of tumor response than that seen with other diagnostic modalities.

Post treatment restaging : Once the desired treatment is completed, PET scan is done to check to find any residual cancer cells in the body, if found immediate second line treatment is started.

Follow up to check recurrences : PET is considered to be the most accurate diagnostic procedure to differentiate tumor recurrences from radiation necrosis or post-surgical changes.

Infections:

In PUO - to localise site of occult infection / inflammation.

Tuberculosis - to assess multi focal involvement and response to treatment

Infected Implants/ grafts

Osteomyelitis

Sarcoidosis

Vasculitis

Irritable bowel disease/ syndrome (IBS)

F18 - DOPA PET-CT Scan

Will help to differentiate tremors of parkinson Vs non parkinson disorder - help in deciding line of management.

Dementia

Neuroendocrine tumours

Epilepsy

Brain tumours

FDG Brain PET Scan

Dementia - PET will help to differentiate different types of dementias - Alzheimer, Fronto temporal, senile dementia - helps in decision making on line of management of dementia

Seizure- To look for epileptic focus

Brain tumor recurrence vs radiation necrosis, differentiate benign to malignant tumour.

FDG PET-CT with Triple phase CT

Hepatocellular carcinoma - in cases of raised alphafetoproein with suspicious USG/ CT imaging for HCC.

For better diagnosis of liver, adrenal and pancreatic lesions

F18 PSMA PET-CT Scan

PSMA PET-CT is indicated

(1) in men with newly diagnosed prostate cancer who are at risk for metastatic disease, and

(2) men who have previously been treated for their prostate cancer with curative intent (e.g. with surgery and/or radiation) and now have suspected persistent or recurrent disease based on a rising prostate specific antigen (PSA) level in their blood.

F18-NOTANOC PET-CT Scan

F-18 NOTANOC PET-CT scan is a whole-body examination which gives information regarding the site and extent of primary NET and distant metastasis.

A. Common NETs

(i) Pheochromocytoma

(ii) Medullary Ca thyroid

(iii) Insulinoma

B. Other NETs

Carcinoid, neuroblastoma, Gastrinoma, Merkel Cell Carcinoma, Gatric and Large bowel NET, Somatostatinoma, Pancreatic polypeptidoma, Paraganglioma, Gluganoma, Lung NET, MEN, NET of Pitutary etc.

FDG Cardiac PET Scan

Myocardial viability assessment, to detect hibernating myocardium in post MI patients- help plan treatment protocol - revasularise / medical management

Cardiac sarcoidosis, Myocarditis and infective endocarditis

F18-Choline PET-CT Scan

Most sensitive investigation to localise parathyroid adenoma in case of Primary hyperparathyroidism

More Sensitive than MIBI Parathyroid scan

Better localization of lesion/ multiple lesions

Instructions for PET-CT patients (Pre Requisites)

Prior appointment is mandatory/ preferable.

One attendant is desirable.

Patients are requested to report for their scan, 30 minutes before their appointment time.

Pregnancy is a contra-indication. Please inform if there is any chance of pregnancy or history of missed period. Please inform if the patient is a nursing mother (breast-feeding).

Overnight or minimum 4 - 6 hours fasting is required prior to appointment time (except diabetic, diabetic patients please read special instructions below). Drinking of water is allowed but no other liquid. No need to hold urine.

Parentral feeding (IV dextrose drip) should also be withheld for 4-6 hours (Tube feeding).

Intravenous fluid containing dextrose should be withheld for 12 hours (for admitted patients).

Patients are requested to remove all the ornaments before coming for the scan.

PET-CT scans are completely painless.

Dress comfortably and warmly, as scanner rooms are cool.

If you need pain medication, please bring it with you.

Patients should avoid alcohol, sweets and strenuous exercise at least two days prior to the PET-CT study.

Pregnant women / children should not accompany the patient

Patients are instructed to bring their Recent Blood sugar, Blood Urea and S. Creatinine reports – maximum one month old, if not done than these tests can be done here on the same day prior to the PET-CT scan.

Patients are instructed to bring all their previous investigations reports and films (MRI and CT reports, histopathogy reports), discharge summaries and doctor’s prescription. Please must carry previous PET-CT (CD/ DICOM images) with report and doctor’s prescription for PET-CT on the day of test.

Additional instructions for diabetic patients

Diabetic patients should inform us about their blood sugar report in advance.

Blood glucose level should ideally be less than 200mg/dl, if it is more then we might have to delay or postponed the test.

Patients should take a light breakfast along with their anti-diabetic medicines between 5- 6 am or 4-6 hours prior to the scheduled time and come for scan at least 2 hours before the scheduled time.

Patients should bring all the diabetic medicines along with him / her.

PET-CT procedure (How PET-CT is done)

Upon arriving at the PET-CT department, you will receive an IV-injection of radioactive glucose like FDG/ PSMA, following which you shall rest for approximately 30-90 minutes in isolation to allow FDG/ PSMA to distribute throughout your body.

Then you will be asked to empty your bladder and change clothes, then lie down on the PET-CT machine.

The scan takes approximately 6-8 minutes, depending upon the type of scan you are undergoing. It is important that you lie still during this process.

It is not noisy and there is no tunnel-like feeling as in an MRI.

The gantry is well lit.

You should plan on being at the center for approximately 2-3 hours. In case a delayed scan is needed, then there may be additional stay.

Discharge Advise

Once the PET scan is complete, you will be able to leave the center. Make sure you drink plenty of water or other fluids throughout the day to flush the FDG from the body, unless regulated by your doctor.

You should avoid close contact with other people, especially children below 5 years of age and pregnant females during the next 24 hours.

A senior nuclear medicine physician and a radiologist interpret the PET-CT scan, and the results will be ready within 24-48 hours depending upon the test. You should contact your referring doctor to discuss the results.

Risk associated with PET-CT

For your PET scan, a radioactive drug called a tracer will be injected into a vein. CT scan also uses some radiation from x-rays. Because the amount of radiation you're exposed to in the tracer is small, the risk of negative effects from the radiation is low. But the tracer might expose your unborn baby to radiation if you are pregnant, so please inform the technologist/ doctor if there is any chance of pregnancy.

Our's Vs. Other's

Digital PET	Analogue PET
Latest advancement in PET-CT (provide high definition PET images and offer higher sensitivity and higher diagnostic performance)	Existing most PET-CT machines
Highest Resolution -- 1.4 mm (Smallest lesion detectability)	Resolution > 2 mm
Smallest lesion detectability can change the patient management and improving outcomes in oncological and non-oncological diseases	Can miss small lesions which can affect Staging of disease
Shorter scan time 8 min (increases the comfort level of elderly, children & sick patients)	Longer scan time 15-20 min
Less radiation burden to the patient	More radiation burden to the patient
Al Based reconstruction gives best image quality in lesser injected dose (Crystal Clear Image Quality)	Not so sharp images
Reporting by Senior Nuclear Medicine Physician as well as radiologist for better diagnosis (Experience of more than 20 years)	Only reported by Nuclear Medicine Physicain
All investigations under one roof- MRI, CT, USG, Path Lab, Dexa, Mammography, Fibroscan, Echo, Stress Echo, ECG, TMT, EPS, CBCT	Refer to other centres for other tests
Wide Gantry (70 cms) Accommodates larger patients	Smaller Gantry
Compact Gantry Width reduces the Claustrophobia.	Heavy Gantry - more Claustrophobia
Unique in-bore light feature - less claustrophobia	No in bore light - more Claustrophobia
Highest Weight wearing capacity of table i.e. 250 KG	Weight wearing capacity of table - Not suitable for overweight patients
Digital Motion correction & Digital Self gating feature avoid repetition of scan	No such features - Repeat the scan - increases radiation burden to patient

PET-CT