Patient Questionnaire
PET/CT Patient Instructions and General Information
Insurance and Privacy Form
BEFORE THE EXAM: It is important that you not eat or drink anything for six hours prior to your exam.
We do need for you to drink 24 to 36 ounces of water the night before your procedure. You may take any
prescribed medications with water the day of your exam unless instructed by your physician not to do so.
We would like for you to abstain from any form of exercise for forty-eight hours prior to your exam. If you
are an insulin-dependent diabetic, you cannot take your insulin the day of your procedure. Oral diabetic
medication should be taken as usual. Please wear comfortable clothes and arrive on time.
THE EXAM: During the exam, you will be asked to drink two cups of liquid material at different
intervals, plus, you will be injected with a radioactive tracer. This tracer is a compound of complex sugars
labeled with a short-lived radioisotope. The radiation exposure associated with this procedure is safe. You
will be placed in a quiet room by yourself for approximately 60 minutes while the radioactive compound
travels throughout your body. Once you have completed the incubation period, a technologist will place
you on a scan table, which will slowly pass through the scanner. Please plan on being at our facility for
approximately two-three hours.
AFTER THE EXAM: You should feel fine as there are no side effects resulting from the injected tracer
or ingested liquid material. Please contact your referring physician for your test results.
MISCELLANEOUS INFORMATION: The following items may exclude you from having your
PET/CT exam. Please call our office at 317-715-9999 of any of these apply to you or if you have any
questions.
Weight over 350 pounds
Pregnant
Diabetic with uncontrolled blood sugar > 180
Please fill out the enclosed registration and PET/CT questionnaire; this will expedite processes while you
are on site. You will also need to bring all of your insurance information.
An appointment time has been reserved especially for you. Please arrive on time to allow for
registration, consultation, glucose reading, administration of the oral liquid material if applicable, and
the injection of the radioactive isotope. If you cannot make your appointment, please notify us as soon
as possible so we can cancel the radioisotope that was created specifically for you. Thank you for your
cooperation in the above matters.
For more information please visit our website at www.northwestradiology.com
Glossary