Table 7.

Checklist of patient preparation to ensure good PET image quality

Preparation	Action
Diet and glucose administration	Patients should fast for 4–6 h before FDG-PET/CT is performed. This includes cessation of parenteral and enteral nutrition All parenteral administration of glucose should be stopped as well. This includes (medication dissolved in) intravenous glucose When a cardiac infection focus is suspected, patients should be kept on a low carbohydrate diet for 24 h before FDG-PET/CT and should fast 6 h before FDG-PET/CT. Otherwise, physiologic myocardial FDG uptake may obscure cardiac infections such as endocarditis
Hydration	Patients should drink 1 L of water (or receive non-glucose containing fluid intravenously) in the 2 h before FDG-PET/CT to increase renal excretion of FDG, which subsequently increases the lesion-to-background ratio and decreases FDG concentration in the urine
Glucose regulating drugs	Patients with diabetes should not receive rapid-acting insulin within 4 h of FDG-PET/CT, short-acting insulin within 6 h of FDG-PET/CT, and no intermediate or long-acting insulin on the day FDG-PET/CT is performed Use of metformin may increase FDG uptake of the gastrointestinal tract but does not necessarily have to be stopped before FDG-PET/CT
Exercise	Patients should avoid (strenuous) exercise 24 h prior to FDG-PET/CT as exercise increases FDG uptake of skeletal muscle
Temperature	Patients should not be subjected to cold 1 h before FDG-PET/CT to minimize FDG accumulation in brown fat

The described recommendations for adequate patient preparation are based on European Association of Nuclear Medicine guidelines [14]