Methods:
Three patients were diagnosed with Neuroblastoma since the beginning of the COVID 19 pandemic in March 2020.
MIBG scintigraphy had to be cancelled for patient 1 due to radiopharmaceutical not arriving on the scheduled date as a result of the cancellation of flights. In discussion with the clinical team, we decided to carry out 68Ga-DOTATATE PET/CT imaging as an alternative. For both the subsequent patients,68Ga- DOTATATE PET/CT was done electively to avoid delay and hazard during the pandemic.
A 68Germanium/68Gallium generator was used to produce 68Ga locally, which was radiolabeled with DOTATATE. Required quality control tests were performed prior to injecting the patient in accordance with good manufacturing practices (GMP). Following radiopharmaceutical injection an uptake phase of 45-60 minutes took place prior to scanning the patient. All 3 patients were scanned on a GE Discovery 690 PET-CT scanner with an axial field of view of 15.7 cm. A low dose CT scan (80 kVP, mA dose modulation, ASIR, 0.5 s rotation time, 40-mm collimation), was performed for attenuation correction and anatomical localization followed by a whole body PET at 4 min per bed acquisition with an 11 slice overlap. All data corrections for scatter, randoms and attenuation were employed as implemented on the scanner front end. Images were reconstructed with time of flight iterative reconstruction algorithm with a correction for point spread function (VPFX - 2 iterations, 28 subsets), and a 3.4 mm post reconstruction Gaussian filter. The final pixel sizes were 1.56 x 1.56 mm with a slice thickness of 3.27 mm. All 3 patients were scanned under general anesthesia (GA). The need for sedation was independent of the type of study, as they would have required GA for MIBG as well. There were no complications.