Fludeoxyglucose (18F) Sahlgrenska
Radiopharmaceutical diagnostic agent for PET imaging
Fludeoxyglucose (18F) Sahlgrenska is a radiopharmaceutical containing the radioactive isotope fluorine-18 attached to a glucose molecule. It is used as a diagnostic tracer in positron emission tomography (PET) scans to detect areas of abnormal metabolic activity in the body. This medication is administered exclusively in hospital nuclear medicine departments and plays a critical role in diagnosing and monitoring cancers, assessing heart muscle viability, and evaluating neurological conditions. FDG is the most widely used PET tracer worldwide and forms the backbone of modern molecular imaging.
Quick Facts
Key Takeaways
- Fludeoxyglucose (18F) is a radioactive glucose analog used exclusively for PET diagnostic imaging in hospital settings, not a therapeutic medication.
- The radioactive half-life is approximately 110 minutes, meaning the radioactivity decreases by half every two hours and is essentially gone within 10–12 hours.
- It is the gold standard PET tracer for cancer detection, staging, and treatment response monitoring across virtually all tumor types.
- Patients must fast for 4–6 hours before the scan and maintain blood glucose below 11 mmol/L (200 mg/dL) for optimal image quality.
- Side effects are very rare; the main consideration is the low-level radiation exposure, which is carefully justified against diagnostic benefit by the treating physician.
What Is Fludeoxyglucose (18F) Sahlgrenska and What Is It Used For?
Fludeoxyglucose (18F), commonly abbreviated as FDG or 18F-FDG, is a radioactive tracer used in positron emission tomography (PET) imaging. It consists of a glucose molecule where one hydroxyl group has been replaced by the radioactive isotope fluorine-18. When injected intravenously, FDG behaves similarly to natural glucose: it is transported into cells by glucose transporter proteins (primarily GLUT-1 and GLUT-3) and phosphorylated by the enzyme hexokinase. However, unlike glucose, the phosphorylated form (FDG-6-phosphate) cannot be further metabolized and becomes trapped inside the cell. This intracellular trapping allows the PET scanner to detect the gamma rays emitted by the decaying fluorine-18 and create detailed images of glucose metabolism throughout the body.
The Sahlgrenska designation refers to the production site at Sahlgrenska University Hospital in Gothenburg, Sweden. Due to the very short half-life of fluorine-18 (approximately 110 minutes), FDG must be produced at or near the facility where it will be used. Multiple manufacturing sites across Europe and the world produce their own FDG formulations, all following the same pharmacopoeial standards. The active substance and clinical application are identical regardless of the production site.
Oncology (Cancer Diagnostics)
Oncology represents the most common indication for FDG PET imaging, accounting for approximately 90% of all clinical FDG PET scans worldwide. Cancer cells typically exhibit significantly increased glucose metabolism compared to normal tissue — a phenomenon first described by Otto Warburg in the 1920s and known as the Warburg effect. This metabolic hyperactivity makes tumors appear as bright “hot spots” on PET images. FDG PET/CT is used for initial diagnosis and characterization of suspicious lesions, staging to determine the extent and spread of known cancers, detection of cancer recurrence after treatment, monitoring treatment response during and after chemotherapy, radiation therapy, or immunotherapy, and guiding biopsy to the most metabolically active tumor region.
FDG PET/CT has proven particularly valuable in lymphoma, lung cancer, colorectal cancer, melanoma, head and neck cancers, esophageal cancer, breast cancer, and many other malignancies. The European Association of Nuclear Medicine (EANM) and the Society of Nuclear Medicine and Molecular Imaging (SNMMI) have published extensive guidelines for FDG PET/CT use in oncology, which continue to expand as evidence accumulates.
Cardiology (Heart Imaging)
In cardiology, FDG PET is used to assess myocardial viability — determining whether heart muscle that has been damaged by a heart attack (myocardial infarction) or chronic coronary artery disease is still alive but hibernating, or permanently scarred. Viable myocardium that still takes up FDG may recover function after revascularization procedures such as coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). This distinction has significant implications for treatment planning. FDG PET is also increasingly used to detect cardiac sarcoidosis and infective endocarditis, including prosthetic valve infections.
Neurology (Brain Imaging)
The brain is one of the most metabolically active organs, consuming approximately 20% of the body's glucose despite representing only about 2% of body weight. FDG PET brain imaging can identify regions of decreased glucose metabolism (hypometabolism) characteristic of neurodegenerative diseases, and regions of increased metabolism seen in epileptic foci during seizures. Specific patterns of hypometabolism help differentiate between Alzheimer's disease, frontotemporal dementia, Lewy body dementia, and other neurodegenerative conditions. In epilepsy, FDG PET performed between seizures (interictal) can localize the seizure focus as an area of reduced metabolism, aiding presurgical planning for patients with drug-resistant epilepsy.
Infection and Inflammation Imaging
Activated inflammatory cells and immune cells also demonstrate increased glucose uptake, making FDG PET useful for evaluating infectious and inflammatory conditions. Clinical applications include fever of unknown origin (FUO), vascular graft infections, spondylodiscitis, large-vessel vasculitis such as giant cell arteritis and Takayasu arteritis, and sarcoidosis. The EANM and SNMMI have published joint procedure guidelines for the use of FDG PET/CT in inflammation and infection imaging.
What Should You Know Before Receiving Fludeoxyglucose (18F)?
Because Fludeoxyglucose (18F) involves exposure to ionizing radiation, its use must always be justified by the expected diagnostic benefit. The referring physician and nuclear medicine specialist together evaluate whether the information obtained from the PET scan will meaningfully influence patient management. This is a fundamental principle of radiation protection known as justification, established by the International Commission on Radiological Protection (ICRP).
Contraindications
There are no absolute contraindications to FDG PET imaging apart from known hypersensitivity to the active substance or any of the excipients. However, true allergic reactions to FDG are exceptionally rare, with only isolated case reports in the medical literature. The following situations require careful consideration and may lead to postponement or cancellation of the examination:
- Uncontrolled blood glucose: Blood glucose levels above 11 mmol/L (200 mg/dL) significantly reduce FDG uptake in target tissues while increasing background uptake, leading to poor image quality and potentially false-negative results. In diabetic patients, blood glucose should be optimized before the scan.
- Pregnancy: FDG PET should be avoided during pregnancy unless the clinical benefit clearly outweighs the potential radiation risk to the fetus. The radiation dose to the uterus from a standard FDG PET scan is approximately 4–8 mGy, depending on the administered activity and gestational stage.
- Acute illness: Patients with acute infections, recent surgery, or active inflammatory conditions may demonstrate increased non-specific FDG uptake that can complicate interpretation.
Warnings and Precautions
Fludeoxyglucose (18F) is a radioactive medicinal product. It must only be received, used, and administered by authorized personnel in designated clinical settings equipped for safe handling of radioactive materials. All radiation protection regulations must be observed. The lowest activity consistent with diagnostic quality should be administered (ALARA principle — As Low As Reasonably Achievable).
Several clinical situations require specific precautions to ensure diagnostic accuracy and patient safety:
- Diabetes mellitus: Patients with diabetes require careful glucose management before the scan. Insulin should generally not be administered within 4 hours of FDG injection, as insulin increases glucose uptake in skeletal muscle while potentially reducing uptake in tumors. Specific protocols vary by institution but typically involve morning appointments after an overnight fast for insulin-dependent patients.
- Renal impairment: FDG is primarily excreted through the kidneys. Patients with significantly reduced kidney function may have slower clearance, but dose adjustment is generally not required as the scan is performed at a fixed time point after injection.
- Pediatric patients: Children have a higher radiation sensitivity per unit dose. The administered activity should be adjusted according to body weight, following the EANM pediatric dosage card recommendations. The indication should be carefully justified.
- Strenuous exercise: Physical exercise in the 24 hours before the scan can increase FDG uptake in skeletal muscles, reducing contrast between tumor and background tissue and potentially mimicking or masking pathology.
Pregnancy and Breastfeeding
Pregnancy: Nuclear medicine procedures on pregnant women involve radiation dose to the fetus. The European Pharmacopoeia and all international guidelines advise that FDG PET should only be performed during pregnancy when the expected diagnostic information is essential and no non-irradiating alternative is available. If FDG PET is clinically indispensable, the administered activity should be minimized while maintaining diagnostic adequacy.
Breastfeeding: Fluorine-18 is excreted in small amounts in breast milk. To limit radiation exposure to the nursing infant, breastfeeding should be interrupted for at least 12 hours after FDG injection. Expressed breast milk during this period should be discarded. It is advisable to express and store breast milk before the procedure if the mother wishes to resume breastfeeding promptly after the waiting period.
How Does Fludeoxyglucose (18F) Interact with Other Drugs?
Unlike most conventional drugs, FDG interactions are not pharmacokinetic (affecting drug levels) but rather biodistribution-altering — they change where FDG accumulates in the body, potentially producing false-positive or false-negative results. Understanding these interactions is essential for accurate scan interpretation and appropriate scheduling of imaging relative to other treatments.
Major Interactions
| Interacting Drug/Substance | Effect on FDG PET | Recommended Action |
|---|---|---|
| Insulin | Increases skeletal muscle uptake; decreases tumor and brain uptake; may cause false-negative results | Do not administer insulin within 4 hours before FDG injection |
| IV Glucose solutions | Elevated blood glucose competes with FDG for cellular uptake, reducing image quality | Avoid glucose-containing infusions for at least 4 hours before the scan |
| Corticosteroids | Increase blood glucose; may alter FDG biodistribution and reduce tumor uptake | Document steroid use; consider timing and dose when interpreting results |
| G-CSF / GM-CSF | Markedly increases FDG uptake in bone marrow and spleen for several days; may mimic bone marrow involvement | Wait at least 5 days (ideally 2 weeks) after G-CSF before FDG PET |
| Chemotherapy | May cause false-negative results due to reduced tumor metabolic activity; inflammatory changes can cause false positives | Perform FDG PET at least 2–4 weeks after last chemotherapy cycle (6 weeks for immunotherapy) |
| Radiotherapy | Post-radiation inflammatory changes can cause false-positive FDG uptake in irradiated areas | Wait at least 8–12 weeks after completing radiotherapy |
Minor Interactions
Metformin can cause diffusely increased FDG uptake in the intestinal wall, particularly in the colon, which may complicate interpretation of abdominal findings. While discontinuation is not always necessary, the interpreting physician should be aware if the patient is taking metformin. Some protocols recommend discontinuing metformin 48 hours before the scan for abdominal or pelvic indications.
Benzodiazepines and sedatives reduce cerebral glucose metabolism globally. If brain FDG PET is being performed, these medications should ideally be avoided before the scan unless clinically contraindicated. For body imaging, their effect is generally not clinically significant.
Total parenteral nutrition (TPN) containing glucose should be stopped at least 4–6 hours before the examination, as the glucose load will compete with FDG for cellular uptake and significantly degrade image quality.
What Is the Correct Dosage of Fludeoxyglucose (18F)?
Fludeoxyglucose (18F) is administered as a single intravenous injection. The exact activity (dose) depends on the type of PET scanner (PET/CT vs. PET/MRI, time-of-flight capability, detector sensitivity), the patient's body weight, the clinical indication, and the imaging protocol. The treating nuclear medicine physician determines the appropriate activity for each individual patient, following the principle of administering the lowest activity that provides diagnostically adequate images (ALARA principle).
Adults
Standard Adult Dosing
Oncology (whole-body PET/CT): 200–400 MBq (typically 3–5 MBq/kg body weight). Modern digital PET/CT scanners with silicon photomultiplier detectors may allow lower activities of 1.5–3 MBq/kg while maintaining image quality.
Cardiology (myocardial viability): 200–400 MBq, administered after glucose loading protocol to enhance myocardial FDG uptake. Insulin clamp or oral glucose loading may be used depending on institutional protocol.
Neurology (brain PET): 150–250 MBq. Lower activities are often sufficient because the brain has very high baseline FDG uptake and modern scanners provide excellent resolution for brain imaging.
Imaging time: The scan is typically performed 60 minutes after injection (uptake period), during which the patient rests quietly in a warm room. The actual scan acquisition takes approximately 15–30 minutes depending on the protocol.
Children
Pediatric Dosing
Pediatric activity is calculated based on body weight using the EANM pediatric dosage card, with a recommended baseline activity of approximately 25.9 MBq (for a reference 3 kg child), scaled according to the child's weight. The minimum recommended activity is typically 26 MBq to ensure diagnostic image quality. Pediatric-specific protocols may employ longer acquisition times or specialized reconstruction algorithms to compensate for lower administered activities. Sedation may be required for very young children who cannot remain still during the scan.
Elderly
Elderly Patient Dosing
No specific dose adjustment is required for elderly patients based on age alone. The standard weight-based dosing applies. However, elderly patients may have reduced renal function, which can slow urinary excretion of FDG and its metabolites. The nuclear medicine physician considers the patient's overall clinical status, mobility, and ability to maintain the required position during the scan. Additional hydration may be recommended to facilitate renal clearance and reduce radiation dose to the bladder wall.
Preparation and Administration
- Fast for at least 4–6 hours (water is permitted and encouraged)
- Avoid strenuous exercise for 24 hours before the scan
- Blood glucose checked before injection (must be below 11 mmol/L / 200 mg/dL)
- Remove metal objects and change into a hospital gown if required
- Empty the bladder before the scan to reduce pelvic background activity
- Rest quietly during the 60-minute uptake period (minimize talking and movement)
- Stay warm during the uptake period (cold activates brown fat, which takes up FDG)
Missed Dose
The concept of a “missed dose” does not apply to FDG in the conventional sense. FDG is administered as a single diagnostic injection during a scheduled appointment. If the procedure is cancelled or rescheduled, a new dose is prepared for the new appointment. Due to its short half-life (approximately 110 minutes), FDG cannot be stored for later use — each dose is produced specifically for the scheduled examination.
Overdose
Pharmacological overdose in the traditional sense is not applicable to FDG, as it is not a therapeutic agent. However, accidental administration of a higher-than-intended radioactivity could increase radiation exposure. In such cases, the radiation dose to the patient should be calculated and documented. Encouraging oral hydration and frequent voiding can help reduce the absorbed radiation dose to the bladder and other organs by accelerating urinary excretion. The effective half-life of FDG is approximately 110 minutes, so the excess radioactivity will decay relatively quickly.
What Are the Side Effects of Fludeoxyglucose (18F)?
Fludeoxyglucose (18F) has an excellent safety profile. At the sub-pharmacological doses used for diagnostic imaging, the FDG molecule itself has no known pharmacological effects. The quantities injected are measured in nanomoles — far below any threshold for pharmacological activity of glucose. The main safety consideration is the radiation exposure from the radioactive fluorine-18, which is inherent to the diagnostic purpose of the product.
The following side effects have been reported in post-marketing surveillance and clinical literature. Due to the nature of radiopharmaceutical use (supervised hospital administration, single-dose), comprehensive incidence data are limited compared to conventional medications.
Uncommon (1/100 to 1/1,000)
- Injection site pain or irritation
- Injection site redness (erythema)
- Transient warmth or flushing sensation during injection
Rare (less than 1/1,000)
- Nausea
- Headache
- Mild dizziness
- Rash or urticaria (hives)
- Hypersensitivity reactions (extremely rare; isolated case reports)
Radiation Exposure Considerations
The effective radiation dose from a standard FDG PET scan (without CT) is approximately 3–7 mSv for a typical adult dose. When combined with a diagnostic CT scan (PET/CT), the total effective dose is approximately 5–25 mSv, depending on the CT protocol (low-dose CT for attenuation correction only vs. full diagnostic CT). For context, the average annual background radiation exposure from natural sources is approximately 2.4 mSv globally.
Specific organ radiation doses from FDG administration include higher doses to the bladder wall (due to urinary excretion), brain, and heart. Frequent voiding after the scan and adequate hydration help reduce the bladder wall dose. The ICRP publishes detailed dosimetry data for all radiopharmaceuticals, which nuclear medicine physicians use for dose calculations and patient counseling.
Contact your healthcare provider if you experience any unusual symptoms after the FDG PET scan, including persistent redness or swelling at the injection site, signs of allergic reaction (difficulty breathing, skin rash, swelling of face or throat), or any other unexpected symptoms. While reactions are extremely rare, prompt reporting ensures appropriate medical documentation and care.
Long-Term Considerations
The theoretical long-term risk from a single FDG PET scan is related to the stochastic (probabilistic) effects of ionizing radiation, primarily a small increase in lifetime cancer risk. This risk is very small and is estimated to be well below 1% for a single diagnostic scan. For patients undergoing multiple PET scans (e.g., for cancer treatment monitoring), the cumulative radiation dose should be documented and considered when planning further imaging studies. The principle of justification requires that each scan provides sufficient clinical benefit to outweigh this small additional risk.
How Should You Store Fludeoxyglucose (18F)?
Fludeoxyglucose (18F) Sahlgrenska is not a medication that patients handle or store at home. It is produced at a cyclotron facility, transported in radiation-shielded containers, and stored within the radiopharmacy department of the nuclear medicine facility until use. The following storage requirements apply to healthcare professionals handling the product:
- Temperature: Store below 25°C. Do not freeze.
- Container: Store in the original lead or tungsten shielded container to minimize radiation exposure to personnel.
- Shelf life: Due to the short half-life of fluorine-18 (109.8 minutes), FDG has an extremely limited shelf life. The expiry time is typically 10–12 hours from the end of synthesis, or as specified on the product label. The actual usable window depends on the starting activity and the minimum activity required for diagnostic quality.
- Quality control: Each batch undergoes quality control testing for radiochemical purity, radionuclidic purity, pH, sterility, and endotoxin levels before release for patient use, in accordance with the European Pharmacopoeia and Good Radiopharmacy Practice (GRPh) guidelines.
- Disposal: Any unused product or waste material must be disposed of in accordance with local requirements for radioactive waste. The short half-life means that most radioactive waste from FDG can be stored for decay (typically 10 half-lives, approximately 18 hours) before disposal as non-radioactive waste.
What Does Fludeoxyglucose (18F) Sahlgrenska Contain?
Active substance: Fludeoxyglucose (18F), also known as 2-[18F]fluoro-2-deoxy-D-glucose (2-[18F]FDG). The chemical formula is C6H1118FO5. At the time of calibration, each vial contains 1 to 110 GBq of fludeoxyglucose (18F) in a volume that varies depending on the production parameters. The concentration of FDG molecules in the injection solution is extremely low (nanomolar range), meaning the total mass of FDG administered is negligible from a pharmacological standpoint.
Excipients (inactive ingredients):
- Sodium chloride: Used to adjust the tonicity of the solution to make it isotonic with blood, ensuring comfort during injection.
- Sodium citrate dihydrate: Acts as a pH buffer to maintain the solution within the acceptable pH range (4.5–8.5).
- Citric acid monohydrate: Additional pH buffering agent.
- Water for injections: Pharmaceutical-grade water serving as the solvent.
Physical characteristics of fluorine-18: Fluorine-18 decays by positron emission (97%) and electron capture (3%) with a half-life of 109.77 minutes. The emitted positrons travel a short distance (maximum range approximately 2.4 mm in tissue) before annihilating with an electron, producing two 511 keV gamma photons emitted at approximately 180 degrees to each other. These coincident gamma photons are detected by the PET scanner's ring of detectors, enabling precise localization of the FDG accumulation through a process called coincidence detection. This physical principle provides PET imaging with superior spatial resolution compared to conventional nuclear medicine (SPECT) imaging.
Frequently Asked Questions About Fludeoxyglucose (18F)
Fludeoxyglucose (18F), commonly known as FDG, is a radiopharmaceutical used as a diagnostic tracer in positron emission tomography (PET) imaging. Its primary clinical uses include cancer diagnosis, staging, and treatment monitoring across virtually all tumor types; assessment of myocardial viability in patients with coronary artery disease or after myocardial infarction; evaluation of neurological conditions such as epilepsy and dementias including Alzheimer's disease; and investigation of infections and inflammatory conditions such as fever of unknown origin and vasculitis. It is the most widely used PET tracer in clinical medicine worldwide.
FDG PET scans are generally considered very safe. The radiation dose from a typical FDG PET/CT scan is comparable to or slightly higher than a standard diagnostic CT scan, typically around 5–14 mSv total (PET plus low-dose CT). The radioisotope fluorine-18 has a short half-life of approximately 110 minutes, meaning it decays rapidly and is essentially gone from the body within 10–12 hours. Allergic reactions to FDG are extremely rare, with only isolated cases reported worldwide. The diagnostic benefit of the scan is always weighed against the small radiation risk, a decision made by the referring physician and nuclear medicine specialist for each individual patient.
Preparation typically involves fasting for 4–6 hours before the scan to ensure low blood glucose levels, which improves image quality. You should drink plenty of water (but no juice, soft drinks, or other caloric beverages) and avoid strenuous physical exercise for 24 hours before the procedure. Your blood glucose will be checked before injection; levels above 11 mmol/L (200 mg/dL) may lead to rescheduling of the scan. Inform your doctor about all medications you are taking, especially insulin, metformin, and corticosteroids, as these can affect scan results. Wear comfortable, warm clothing without metal fasteners. You will be asked to rest quietly and stay warm during the 60-minute uptake period after injection.
Fluorine-18, the radioactive component of FDG, has a physical half-life of approximately 109.8 minutes (about 2 hours). This means that every 2 hours, the radioactivity decreases by half. Within 10–12 hours (approximately 6 half-lives), the radioactivity has decreased to less than 2% of the original dose. Additionally, FDG is cleared from the body through urinary excretion, which further reduces the radiation burden. You may be advised to drink extra fluids and urinate frequently after the scan to help speed up this process. Most patients can safely be around others, including children, shortly after the scan, though your nuclear medicine department will provide specific guidance.
Yes, FDG PET scans can be performed on children when clinically indicated. The administered radioactivity is adjusted according to the child's body weight following the EANM pediatric dosage card guidelines, ensuring the lowest effective dose. Common pediatric indications include staging of lymphomas, evaluation of neuroblastoma, assessment of epileptic foci for presurgical planning, and monitoring of various childhood cancers. The decision is made carefully, weighing diagnostic benefit against radiation exposure, with particular consideration given to children's higher radiation sensitivity. Sedation or general anesthesia may be necessary for very young or uncooperative children to ensure the patient remains still during the acquisition.
CT (computed tomography) provides detailed anatomical images based on X-ray absorption, showing the structure and shape of organs and tissues. PET (positron emission tomography) with FDG provides functional or metabolic information, showing how actively cells are using glucose. Most modern scanners combine both technologies (PET/CT or PET/MRI), providing both metabolic and anatomical information in a single examination. This combination is particularly valuable in oncology, as cancer cells often have increased glucose metabolism that PET can detect even before structural changes become visible on CT alone. PET/CT has become the standard of care for staging and restaging of many cancers.
References
This article is based on the following peer-reviewed sources and international medical guidelines:
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- Delbeke D, et al. “Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0.” Journal of Nuclear Medicine (SNMMI). 2006;47(5):885–895.
- European Medicines Agency (EMA). Summary of Product Characteristics: Fludeoxyglucose (18F). Accessed February 2026.
- European Pharmacopoeia. Monograph: Fludeoxyglucose (18F) Injection. 11th Edition, 2023.
- Jamar F, et al. “EANM/SNMMI guideline for 18F-FDG use in inflammation and infection.” Journal of Nuclear Medicine. 2013;54(4):647–658. doi:10.2967/jnumed.112.112524
- Lassmann M, et al. “The new EANM paediatric dosage card.” European Journal of Nuclear Medicine and Molecular Imaging. 2008;35(9):1748–1751. doi:10.1007/s00259-007-0700-9
- International Commission on Radiological Protection (ICRP). Publication 128: Radiation Dose to Patients from Radiopharmaceuticals. 2015.
- Varrone A, et al. “EANM procedure guidelines for PET brain imaging using [18F]FDG, version 2.” European Journal of Nuclear Medicine and Molecular Imaging. 2009;36(12):2103–2110. doi:10.1007/s00259-009-1264-0
- Dilsizian V, et al. “ASNC/SNMMI guideline for clinical cardiac PET.” Journal of Nuclear Cardiology. 2016;23(5):1187–1226. doi:10.1007/s12350-016-0522-3
- World Health Organization (WHO). WHO Model List of Essential Medicines – Companion Diagnostics. 23rd List, 2023.
Editorial Team
This article was written and reviewed by the iMedic Medical Editorial Team, comprising licensed specialist physicians in nuclear medicine, radiology, and oncology. Our editorial process follows the iMedic Editorial Standards, which require evidence-based sourcing, medical peer review, and regular content updates.
Content authored by physicians specializing in nuclear medicine and diagnostic radiology, with expertise in PET imaging and radiopharmaceuticals.
Independently reviewed by the iMedic Medical Review Board according to EANM, SNMMI, and WHO guidelines. Evidence level: 1A.
Conflict of Interest: The iMedic editorial team has no financial relationships with pharmaceutical or radiopharmaceutical companies. All content is produced independently without commercial funding.