Fludeoxyglucose (18F) Akademiska sjukhuset
Radioactive diagnostic agent for PET imaging
Fludeoxyglucose (18F), commonly known as FDG, is a radioactive glucose analogue used as a diagnostic tracer in positron emission tomography (PET) scans. It is the most widely used radiopharmaceutical in the world, playing a critical role in the detection, staging, and monitoring of cancer, as well as in the evaluation of cardiac viability and neurological conditions. This preparation is manufactured by Akademiska sjukhuset (Uppsala University Hospital).
Quick Facts
Key Takeaways
- Fludeoxyglucose (18F) is the world's most commonly used PET imaging tracer, essential for cancer detection, cardiac assessment, and neurological evaluation.
- It works by mimicking glucose: cells with high metabolic activity (such as cancer cells) absorb more FDG, making them visible on PET scans.
- The radioactive fluorine-18 isotope has a short half-life of approximately 110 minutes, meaning radiation exposure is limited and temporary.
- Patients must fast for at least 4–6 hours before the scan, and blood glucose levels should be well controlled for optimal image quality.
- Side effects are very rare; the main consideration is the ionizing radiation dose, which is carefully justified by the clinical benefit of the diagnostic information obtained.
What Is Fludeoxyglucose (18F) and What Is It Used For?
Fludeoxyglucose (18F) is a radiopharmaceutical diagnostic agent classified as a radioactive medicinal product. Its chemical name is 2-deoxy-2-[18F]fluoro-D-glucose, and it is the most widely used positron emission tomography (PET) tracer in clinical medicine worldwide. The compound was first synthesized in the 1970s and has since revolutionized medical imaging by enabling physicians to visualize metabolic activity in living tissues with remarkable precision.
The fundamental principle behind FDG-PET imaging is elegantly simple: FDG is structurally similar to glucose, the body's primary energy source. When injected intravenously, FDG is transported into cells through the same glucose transporter proteins (GLUT) that normally carry glucose. Once inside the cell, it undergoes phosphorylation by the enzyme hexokinase to become FDG-6-phosphate. However, unlike normal glucose-6-phosphate, FDG-6-phosphate cannot be further metabolized and becomes effectively trapped within the cell. This metabolic trapping allows the radioactive signal to accumulate in metabolically active tissues.
The fluorine-18 isotope in FDG decays by emitting positrons, which are antimatter counterparts of electrons. When a positron encounters an electron in surrounding tissue, the two particles annihilate each other, producing two gamma photons that travel in exactly opposite directions. The PET scanner detects these coincident photon pairs to create detailed three-dimensional images of FDG distribution throughout the body, effectively providing a map of metabolic activity.
Oncology Applications
The primary clinical application of FDG-PET is in oncology, where it serves several crucial roles. Cancer cells typically exhibit markedly increased glucose metabolism compared to normal tissue — a phenomenon known as the Warburg effect, first described by Nobel laureate Otto Warburg in the 1920s. This metabolic hyperactivity makes tumors stand out prominently on FDG-PET images. In oncology, FDG-PET is used for initial diagnosis and characterization of suspicious lesions, staging of known malignancies to determine disease extent, monitoring treatment response during and after chemotherapy or radiation therapy, detecting recurrent disease during follow-up surveillance, and guiding biopsy and radiation treatment planning.
FDG-PET has proven particularly valuable for lymphomas, lung cancer, colorectal cancer, head and neck cancers, melanoma, esophageal cancer, and breast cancer. According to the European Association of Nuclear Medicine (EANM), FDG-PET/CT has become the standard of care for staging and response assessment in many malignancies, with demonstrated improvements in patient management and outcomes.
Cardiology Applications
In cardiology, FDG-PET is used to assess myocardial viability — that is, to determine whether heart muscle that appears damaged or non-functional after a heart attack still contains living cells that could recover function if blood flow is restored through revascularization procedures such as coronary artery bypass grafting or percutaneous coronary intervention. Viable but hibernating myocardium will take up FDG, while truly scarred tissue will not. This distinction is critically important for clinical decision-making, as revascularization of viable myocardium can significantly improve cardiac function and patient survival. FDG-PET is also increasingly used to detect cardiac sarcoidosis and prosthetic valve endocarditis.
Neurology Applications
In neurology, FDG-PET provides valuable information about regional brain glucose metabolism. The brain is the body's most metabolically active organ, consuming approximately 20% of total glucose despite representing only 2% of body weight. FDG-PET can identify areas of reduced or increased brain metabolism, making it useful for presurgical evaluation of medically refractory epilepsy to localize seizure foci, early diagnosis and differential diagnosis of neurodegenerative dementias including Alzheimer's disease, evaluation of brain tumors, and assessment of patients with suspected central nervous system infections or inflammation.
Infection and Inflammation
Activated inflammatory cells, particularly macrophages and neutrophils, also exhibit increased glucose metabolism. This property makes FDG-PET useful for identifying sites of infection and inflammation, including fever of unknown origin, vascular graft infections, spondylodiscitis, and large vessel vasculitis. The European Association of Nuclear Medicine has published specific guidelines supporting the use of FDG-PET/CT in the diagnostic workup of these conditions.
What Should You Know Before Receiving Fludeoxyglucose (18F)?
Although Fludeoxyglucose (18F) is a diagnostic agent rather than a therapeutic drug, several important considerations and precautions apply before its administration. Because it is a radioactive substance, its use involves exposure to ionizing radiation, and every administration must be justified by the expected diagnostic benefit. The "as low as reasonably achievable" (ALARA) principle governs all aspects of radiopharmaceutical use, ensuring that radiation exposure is minimized while maintaining diagnostic image quality.
Contraindications
There are no absolute contraindications to FDG in the traditional pharmacological sense, as the mass dose of the compound is extremely small (in the nanogram to microgram range) and has no pharmacological effect. However, the following situations require careful consideration:
- Known hypersensitivity to fludeoxyglucose (18F) or any of the excipients (extremely rare)
- Pregnancy — Ionizing radiation poses a risk to the developing fetus. FDG-PET should only be performed during pregnancy when the potential clinical benefit clearly outweighs the radiation risk to the unborn child.
- Uncontrolled diabetes — Significantly elevated blood glucose levels (above 11 mmol/L or 200 mg/dL) compete with FDG for cellular uptake, resulting in poor image quality and potentially misleading results.
Warnings and Precautions
Healthcare professionals administering FDG must observe several important precautions. First, proper patient preparation is essential for optimal image quality. Patients should fast for at least 4–6 hours before the examination, consuming only water during this period. Strenuous physical exercise should be avoided for at least 24 hours before the scan, as muscular FDG uptake can interfere with image interpretation. Blood glucose levels should be measured before injection and ideally should be below 8 mmol/L (150 mg/dL) for oncological indications, though scans are generally considered acceptable up to 11 mmol/L (200 mg/dL).
After the injection, patients should rest quietly in a warm, dimly lit room for 45–60 minutes to allow optimal FDG distribution. Speaking, chewing, and movement should be minimized during this uptake period to avoid physiological uptake in muscles, including the laryngeal muscles and muscles of mastication, which could create artifacts on the images.
Adequate hydration and frequent bladder voiding are recommended before and after the procedure to reduce radiation dose to the bladder wall, as FDG is primarily excreted through the kidneys. Patients should be encouraged to drink water and empty their bladder immediately before the scan begins.
FDG is a radioactive medicinal product. It must only be received, handled, and administered by authorized personnel in designated clinical settings equipped with appropriate radiation shielding. Patients are temporarily radioactive after injection and should limit close contact with pregnant women and young children for several hours after the procedure.
Pregnancy and Breastfeeding
The use of FDG during pregnancy requires particularly careful justification due to the radiation dose to the fetus. Nuclear medicine examinations on pregnant women also deliver a radiation dose to the fetus. According to the International Commission on Radiological Protection (ICRP), the estimated fetal dose from a standard FDG-PET examination is approximately 1–4 mSv, depending on gestational age and maternal dose. When a PET scan is deemed clinically essential during pregnancy, the activity administered should be kept as low as possible while maintaining diagnostic image quality.
For breastfeeding mothers, the European Association of Nuclear Medicine recommends a temporary interruption of breastfeeding for at least 12 hours after FDG administration. Breast milk expressed during this period should be discarded. This recommendation is based on the small amount of FDG that is secreted in breast milk and the need to minimize the infant's radiation exposure. Some guidelines suggest pumping and storing breast milk before the procedure so that the infant can be fed during the interruption period.
Pediatric Considerations
FDG-PET is performed in pediatric patients for many of the same indications as in adults, particularly for staging and monitoring of childhood cancers such as lymphoma, neuroblastoma, and sarcomas. The administered activity in children is reduced according to body weight, following the EANM pediatric dosage card recommendations. Special attention must be given to minimizing radiation exposure in children, who are more radiosensitive than adults and have a longer remaining lifetime for potential radiation effects to manifest.
How Does Fludeoxyglucose (18F) Interact with Other Drugs?
Fludeoxyglucose (18F) is unique among diagnostic agents in that its diagnostic value depends entirely on its metabolic behavior rather than any pharmacological action. The extremely small mass of FDG administered (typically nanograms) means it has no pharmacological effect and does not interact with other drugs in the conventional sense. However, many medications and medical interventions can alter glucose metabolism and thereby affect FDG biodistribution, potentially compromising diagnostic accuracy. Understanding these interactions is essential for proper patient preparation and scan interpretation.
| Factor | Effect on FDG Uptake | Recommendation |
|---|---|---|
| Insulin | Increases muscular and adipose tissue uptake, reduces tumor uptake | Do not administer insulin within 4 hours before FDG injection |
| Corticosteroids | Elevate blood glucose; may reduce inflammatory FDG uptake | Note steroid use; may affect infection/inflammation imaging |
| Chemotherapy | Transient increase in inflammatory uptake (flare); reduced tumor uptake if effective | Wait at least 2–3 weeks after chemotherapy cycle |
| Radiation therapy | Causes inflammatory FDG uptake in irradiated tissues | Wait at least 3 months after radiation therapy completion |
| G-CSF (filgrastim) | Markedly increases bone marrow and splenic uptake | Wait at least 5 days after G-CSF administration |
| Metformin | Increases intestinal FDG uptake, potentially obscuring abdominal pathology | Consider temporary discontinuation 48 hours before scan if abdominal assessment needed |
| Recent surgery | Wound healing and post-surgical inflammation increase local FDG uptake | Wait at least 4–6 weeks after major surgery |
| Parenteral nutrition (TPN) | Elevates blood glucose and insulin, alters biodistribution | Discontinue TPN at least 4–6 hours before FDG injection |
Blood Glucose and Insulin Effects
The most clinically significant interaction affecting FDG-PET image quality involves blood glucose and insulin levels. Insulin stimulates glucose transporter (GLUT4) expression on muscle and fat cells, dramatically increasing FDG uptake in these tissues while correspondingly reducing uptake in tumors and other target tissues. This effect can render a PET scan non-diagnostic. For this reason, patients should fast for 4–6 hours before the scan, and insulin should not be administered within 4 hours of FDG injection. Diabetic patients require special scheduling protocols that vary by institution.
Chemotherapy and Immunotherapy Timing
The timing of FDG-PET relative to chemotherapy and immunotherapy treatments is critical for accurate response assessment. International guidelines, including those from the EANM, Society of Nuclear Medicine and Molecular Imaging (SNMMI), and Response Evaluation Criteria in Lymphoma (RECIL), recommend specific waiting periods between treatment and imaging. Imaging too soon after chemotherapy can lead to false-negative results (if treatment has been effective but residual FDG uptake from inflammation is present) or false-positive results (from treatment-related inflammation). For interim response assessment, a minimum interval of 10–14 days after the last chemotherapy cycle is generally recommended, while end-of-treatment scans should be delayed at least 3 weeks.
What Is the Correct Dosage of Fludeoxyglucose (18F)?
Fludeoxyglucose (18F) dosing differs fundamentally from conventional drug dosing because the administered amount is expressed in units of radioactivity (becquerels) rather than mass (milligrams). The actual mass of FDG injected is vanishingly small — typically in the nanogram to microgram range — far below any pharmacologically active threshold. The radioactivity concentration of this preparation ranges from 0.9 GBq/mL to 4.5 GBq/mL at the time of calibration, and the injected volume is typically 1–10 mL depending on the required activity and the time elapsed since calibration (due to radioactive decay).
Adults
Standard Adult Dosage
For oncological and most other indications in adults, the recommended administered activity is 200–400 MBq (approximately 5–10 mCi), administered as a single intravenous injection. The European Association of Nuclear Medicine recommends a standard activity of approximately 3 MBq/kg body weight for 3D PET scanners, with adjustments based on scanner sensitivity, patient body habitus, and acquisition protocol. For modern digital PET/CT scanners with higher sensitivity, lower activities (2–2.5 MBq/kg) may be sufficient while maintaining diagnostic image quality. Obese patients may require activities at the higher end of the range to ensure adequate count statistics.
For cardiac viability assessment, a typical dose of 200–400 MBq is administered under specific metabolic conditions. An oral glucose load (50–75 g) is given approximately 60–90 minutes before FDG injection to stimulate insulin secretion and promote myocardial glucose uptake. In diabetic patients, insulin clamping protocols may be employed.
For neurological indications, activities of 150–300 MBq are typically used, as brain imaging can be performed with lower count rates due to the limited field of view and high brain metabolic activity.
Children
Pediatric Dosage
The activity administered to children is calculated based on body weight according to the EANM Paediatric Dosage Card, which uses a baseline activity of 25.9 MBq multiplied by a weight-based multiplication factor. The minimum recommended activity for pediatric FDG-PET is 26 MBq (0.7 mCi) to ensure adequate image quality. For a child weighing 20 kg, the typical administered activity would be approximately 70–100 MBq. The ALARA principle is particularly important in pediatric nuclear medicine, and modern PET scanners with time-of-flight technology allow diagnostic-quality images with reduced activities.
Elderly
Elderly Dosage
No specific dose adjustment is required for elderly patients based on age alone. However, the same weight-based dosing approach applies, and consideration should be given to renal function, as reduced glomerular filtration rate may slow FDG clearance. In practice, standard adult dosing protocols are used for elderly patients, with the activity adjusted according to body weight using the same MBq/kg calculation as for younger adults.
Administration Procedure
FDG is administered as a single intravenous injection, typically into an antecubital vein (in the arm). The injection should be given slowly over 1–2 minutes, and the intravenous line should be flushed with normal saline (0.9% sodium chloride) after injection to ensure complete delivery of the dose. The injection site should preferably be in the arm contralateral to any known pathology to avoid potential artifacts from FDG extravasation. After injection, patients rest quietly for 45–60 minutes (the "uptake period") before scanning begins.
Overdose
Pharmacological overdose is not a concern with FDG due to the negligible mass administered. However, accidental administration of a higher radioactivity than intended will result in a proportionally higher radiation dose to the patient. In such cases, the absorbed radiation dose should be calculated and documented. The patient should be encouraged to drink large volumes of fluids and void frequently to increase renal excretion of FDG and reduce the radiation dose, particularly to the bladder wall. There is no specific antidote for radiation overexposure from FDG; management is supportive and based on general principles of radiation protection.
What Are the Side Effects of Fludeoxyglucose (18F)?
Fludeoxyglucose (18F) has an excellent safety profile that distinguishes it from most other pharmaceutical products. Because the mass of FDG administered is in the nanogram to microgram range — orders of magnitude below any pharmacologically active dose — conventional side effects related to drug action are essentially non-existent. The glucose analogue itself has no physiological or pharmacological effect at the doses used for diagnostic imaging.
The principal safety consideration with FDG-PET is the exposure to ionizing radiation. A standard adult dose of approximately 370 MBq delivers an effective radiation dose of approximately 7 mSv. For context, this is comparable to the radiation dose from a conventional CT scan of the chest and approximately 2–3 times the average annual background radiation dose (2.4 mSv globally according to the United Nations Scientific Committee on the Effects of Atomic Radiation, UNSCEAR). When FDG-PET is combined with a diagnostic CT scan (PET/CT), the total effective dose may range from 10 to 25 mSv depending on the CT acquisition parameters used.
The theoretical risk of radiation-induced adverse effects, including carcinogenesis, is estimated using the linear no-threshold (LNT) model, which assumes that any dose of ionizing radiation, no matter how small, carries some risk. However, at the dose levels used in diagnostic PET imaging, the absolute risk is very small and is considered to be far outweighed by the diagnostic benefit in appropriately selected patients.
Rare (<1/1,000)
- Injection site reactions (mild pain, redness, or swelling)
- Transient flushing or warmth at injection site
- Mild nausea
Very Rare (<1/10,000) or Isolated Reports
- Allergic or hypersensitivity reactions (rash, urticaria, pruritus)
- Anaphylactoid reactions (extremely rare; isolated case reports in literature)
- Vasovagal reactions (fainting, light-headedness — often related to anxiety or fasting rather than FDG itself)
Delayed/Long-term Considerations
- Small theoretical increase in lifetime cancer risk from ionizing radiation
- Risk is dose-dependent and cumulative across multiple examinations
- Risk is higher in younger patients and children due to greater radiosensitivity and longer remaining lifespan
- Genetic effects are theoretically possible but have not been demonstrated at diagnostic dose levels
A single FDG-PET scan delivers approximately 7 mSv of effective dose. For comparison: a chest X-ray delivers about 0.02 mSv, a transatlantic flight about 0.08 mSv, annual background radiation is about 2.4 mSv, and a diagnostic abdominal CT scan delivers about 8–10 mSv. The radiation dose from FDG-PET is considered low and is always weighed against the substantial diagnostic benefit.
Reporting Adverse Reactions
Although adverse reactions to FDG are exceedingly rare, healthcare professionals should report any suspected adverse reactions through their national pharmacovigilance reporting system. In the European Union, this is typically done through the national competent authority or through the EudraVigilance system. In the United States, adverse events should be reported to the FDA MedWatch program. Comprehensive post-marketing surveillance helps to maintain an accurate safety profile for all medicinal products, including radiopharmaceuticals.
How Should Fludeoxyglucose (18F) Be Stored?
The storage requirements for Fludeoxyglucose (18F) are fundamentally different from those of conventional pharmaceutical products due to its radioactive nature and short physical half-life. FDG is not stored or handled by patients; it is exclusively managed by trained nuclear medicine professionals in authorized facilities that comply with national radiation protection regulations.
FDG must be stored below 25°C (77°F) unless otherwise specified by the manufacturer. The product must be kept in its original shielded container, which is typically a lead or tungsten vial shield designed to attenuate the 511 keV gamma radiation emitted during positron annihilation. Adequate shielding is essential to protect healthcare workers from unnecessary radiation exposure during storage and handling.
The radiological shelf life is critically limited by the 109.77-minute half-life of fluorine-18. After approximately 10 half-lives (roughly 18 hours), the remaining radioactivity is negligible (less than 0.1% of the original activity). In practice, FDG must typically be used within 8–12 hours of production, depending on the initial activity concentration and the time of calibration. The expiry time for each batch is specified on the label and must be strictly observed.
Storage and disposal of radioactive waste from FDG must comply with local and national regulations for radioactive materials. Unused product or waste material should be disposed of in accordance with institutional radioactive waste procedures. Due to the short half-life of fluorine-18, waste can often be stored for decay (approximately 10 half-lives, or 18–20 hours) before disposal as non-radioactive waste, subject to regulatory requirements.
FDG should be kept out of sight and reach of unauthorized persons at all times. Radioactive materials must be stored in designated, clearly labeled, and access-controlled areas within the nuclear medicine department. The storage area should be surveyed regularly for radiation levels, and inventory records must be maintained as required by national radiation regulatory authorities.
What Does Fludeoxyglucose (18F) Contain?
Fludeoxyglucose (18F) injection is a clear, colorless to slightly yellow, sterile, pyrogen-free, isotonic solution intended for intravenous administration. The product is manufactured under strict good manufacturing practice (GMP) conditions in a specialized radiopharmaceutical production facility, typically using an automated synthesis module connected to a medical cyclotron.
Active Ingredient
The active substance is fludeoxyglucose (18F), also known by its chemical name 2-deoxy-2-[18F]fluoro-D-glucose. The radioactivity concentration at the time of calibration ranges from 0.9 GBq/mL to 4.5 GBq/mL. The chemical and radiochemical purity of the product must meet stringent quality specifications before each batch is released for clinical use, with radiochemical purity typically exceeding 95%. The specific activity is extremely high, meaning that the mass of FDG per unit of radioactivity is very small, resulting in a total injected mass in the nanogram range.
Excipients
The typical excipients in FDG injection include:
- Sodium chloride — to make the solution isotonic with blood plasma
- Sodium citrate dihydrate (or sodium acetate trihydrate) — as a buffer to maintain appropriate pH
- Citric acid monohydrate (or acetic acid) — for pH adjustment
- Water for injections — as the solvent
The solution pH is typically adjusted to between 4.5 and 8.5, and the product is made isotonic to ensure compatibility with intravenous administration. The product does not contain any preservatives, antimicrobial agents, or stabilizers. Each vial is for single or multiple patient use within the validated shelf life, depending on the manufacturer's specifications and local regulatory requirements.
Production Process
Fluorine-18 is produced in a medical cyclotron by bombardment of oxygen-18 enriched water with protons. The 18F fluoride produced is then used in an automated nucleophilic substitution reaction with a mannose triflate precursor to yield the protected FDG intermediate, which is subsequently deprotected by acid or base hydrolysis to give the final product. The entire synthesis, purification, quality control, and release process typically takes 60–90 minutes, which is significant given the 110-minute half-life of the isotope. This time-critical manufacturing process is one reason why FDG is produced in regional radiopharmacies close to PET imaging centers.
Frequently Asked Questions
Fludeoxyglucose (18F), commonly known as FDG, is a radioactive diagnostic agent used in PET (positron emission tomography) scans. It is primarily used in oncology to detect and monitor cancer, in cardiology to assess heart muscle viability, and in neurology to evaluate conditions such as epilepsy and dementia. It is the most widely used radiopharmaceutical in PET imaging worldwide, with millions of scans performed annually.
Yes, FDG-PET scans are generally considered very safe. The radiation dose from a typical FDG-PET scan is approximately 7 mSv, comparable to the natural background radiation a person receives over 2–3 years. Side effects from the FDG injection itself are extremely rare. The diagnostic benefit of the scan far outweighs the very small radiation risk in most clinical scenarios.
After the FDG injection, you typically wait 45–60 minutes in a quiet room for the tracer to distribute throughout your body. The actual PET scan itself usually takes 20–30 minutes. Including preparation time, the entire appointment typically lasts approximately 2–3 hours. You should plan to be at the hospital for the full duration.
Fasting for at least 4–6 hours before an FDG-PET scan is essential because FDG competes with normal glucose for cellular uptake. If blood glucose levels are elevated from recent eating, the body's insulin response will direct FDG into muscles and fat tissue instead of the target areas (such as tumors), significantly reducing image quality and diagnostic accuracy. Water consumption is permitted and encouraged during the fasting period.
Yes, diabetic patients can have FDG-PET scans, but special preparation protocols are required. Blood glucose must be below 11 mmol/L (200 mg/dL) before the injection. The nuclear medicine department will provide specific instructions about medication adjustments, timing of meals, and insulin management based on your diabetes type and current treatment regimen. Morning appointments are generally preferred for diabetic patients.
A typical FDG-PET scan delivers an effective radiation dose of approximately 5–7 mSv for a standard adult injection of 370 MBq. When combined with a diagnostic CT scan (PET/CT), the total dose ranges from 10–25 mSv depending on the CT protocol. For comparison, the average annual background radiation dose is about 2.4 mSv, and a single chest X-ray delivers about 0.02 mSv.
References
- Boellaard R, Delgado-Bolton R, Oyen WJG, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. European Journal of Nuclear Medicine and Molecular Imaging. 2015;42(2):328-354. doi:10.1007/s00259-014-2961-x
- Delbeke D, Coleman RE, Guiberteau MJ, et al. Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0. Journal of Nuclear Medicine. 2006;47(5):885-895.
- European Medicines Agency. Summary of Product Characteristics: Fludeoxyglucose (18F). EMA/H/A-31/1222. European Medicines Agency; 2017.
- Jadvar H, Colletti PM, Delgado-Bolton R, et al. Appropriate Use Criteria for 18F-FDG PET/CT in Restaging and Treatment Response Assessment of Malignant Disease. Journal of Nuclear Medicine. 2017;58(12):2026-2037. doi:10.2967/jnumed.117.197988
- International Commission on Radiological Protection (ICRP). Radiation Dose to Patients from Radiopharmaceuticals. ICRP Publication 128. Annals of the ICRP. 2015;44(2S).
- Lassmann M, Treves ST. Paediatric Radiopharmaceutical Administration: harmonization of the 2007 EANM paediatric dosage card and the 2010 North American consensus guidelines. European Journal of Nuclear Medicine and Molecular Imaging. 2014;41(5):1036-1041.
- United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR). Sources and Effects of Ionizing Radiation: UNSCEAR 2008 Report. United Nations; 2010.
- Warburg O. On the origin of cancer cells. Science. 1956;123(3191):309-314.
- World Health Organization. WHO Model List of Essential Medicines. 23rd List. Geneva: World Health Organization; 2023.
- Stable-Siemeling P, et al. Clinical safety of fludeoxyglucose F18: analysis of adverse events reported to the FDA Adverse Event Reporting System. Nuclear Medicine Communications. 2019;40(6):613-618.
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, comprising licensed physicians and specialists in nuclear medicine, radiology, and oncology. All content follows international medical guidelines and the GRADE evidence framework.
iMedic Medical Editorial Team — Nuclear Medicine and Radiology Specialists
iMedic Medical Review Board — Independent expert panel following EMA, FDA, and EANM guidelines
Level 1A — Based on systematic reviews, international guidelines, and peer-reviewed clinical evidence
No commercial funding or pharmaceutical company sponsorship. Fully independent editorial content.