Long-axial field-of-view (LAFOV) systems have changed the field of molecular imaging. Since their introduction, many PET centres have installed these next-generation digital systems to provide more detailed imaging and acquire PET images in a single bed position. Indeed, vertex to thigh imaging for oncological indications can be obtained in most of the population with the currently available LAFOV systems. Moreover, Total Body (TB) PET, a subtype of LAFOV, enables imaging the entire patient—from vertex through the toes—with one bed-position for most of the population. This review aims to identify possible challenges and opportunities for PET-centres working with TB and LAFOV systems. Emphasis is placed on the strength and weaknesses in clinical routine of currently available and upcoming TB and LAFOV PET systems.
Why are these next generation LAFOV machines important?
Short answer – faster, higher quality. Long answer below. The long answer is based on interpretation of a recent article entitled Total-Body PET/CT: Challenges and Opportunities (those who like the detail should read this). They describe the clinical opportunities but they also quite rightly looked at the challenges. I assessed these two categories and put a NET spin on them. See below.
🌟 Clinical Opportunities (What This Could Mean for NET Patients)
1. Low‑dose PET/CT scans
NET patients often need multiple scans over many years. Lower radiation from total‑body PET means:
- safer long‑term monitoring
- less cumulative exposure
- more flexibility to scan when clinically needed
This is especially reassuring for younger patients or those with slow‑growing disease.
2. Short acquisition times
Faster scans mean:
- less time lying still
- easier breathing during the scan
- fewer motion artefacts (important for liver and lung NETs)
This can improve comfort and image quality, especially for patients with pain, anxiety, or carcinoid‑related symptoms.
3. Delayed imaging
NET tumours sometimes take longer for tracers to “settle” into. With LAFOV PET, delayed imaging can:
- improve detection of small liver lesions
- help distinguish tumour from normal bowel uptake
- give clearer results in patients with borderline SSTR expression
This can reduce uncertainty and improve staging accuracy.
4. Dual‑tracer protocols (SSTR + FDG on the same day)
This is a major opportunity for NET patients, especially:
- Grade 3 NET
- High‑grade Grade 2
- Lung NETs
- Mixed SSTR/FDG‑avid disease
Dual‑tracer imaging can:
- reduce the number of hospital visits
- give a complete picture of tumour biology in one session
- help identify aggressive areas that may need different treatment
- support better PRRT decision‑making
This is one of the most exciting NET‑specific benefits of total‑body PET.
5. Dynamic imaging and kinetic modelling
Total‑body PET can watch how tracers move through your body in real time. For NET patients, this may help:
- predict how well PRRT and other radioligand based targets will work
- understand how quickly tumours take up SSTR and other tracers
- personalise treatment planning
- support research into new NET tracers
This could eventually lead to more tailored therapy and better outcomes.
⚠️ Challenges for Imaging Centres (and What They Mean for NET Patients)
1. Clinical pitfalls with LAFOV and total‑body PET
This is particularly relevant for NETs because of physiological uptake in various sites including but not limited to:
- pancreas
- spleen
- liver
- adrenal glands
- bones
These areas can mimic tumour or hide small lesions. With more sensitive scanners, radiologists may see:
- tiny “hot spots” that are not cancer
- normal SSTR expression that looks abnormal
- artefacts from breathing or bowel movement
What this might mean for NET patients:
- results may take longer to interpret
- expert NET radiology review becomes even more important
- some findings may still require correlation with MRI or follow‑up scans
This is a real challenge, but one that can be managed with experience and protocols.
2. Technical challenges of data handling
Total‑body PET produces huge amounts of data, which means:
- not all hospitals can offer it yet
- early access may be limited to research centres
- scheduling may be restricted while systems mature
For NET patients:
- availability may depend on where you live
- research participation may be the first route to access
- clinical rollout may take time (years)
What are where are these new capabilities?
You guys got quite excited by my post on Australia’s whole body fast PET scan, it made me dig deeper to see what else is happening out there. In my general scan blog “If you can see it, you can detect it” I did include an interest point about a total body fast PET installed in USA in Mason/UC Davis California. So we have all know for some time, industry and healthcare facilities are actively working on the next generation PETs, bigger, better, more expensive and with more quality of the images – I must add that comes with some risk because we are already challenged by the need of our physicians to carefully assess each abnormality because many findings will continue to be physiologic uptake in some way, probably more so on bigger faster clearer PETs …… not a new issue.
I must also constrain you by saying that these total body PET scans are mainly being deployed for research purposes rather than solely for surveillance of those diagnosed with illnesses. That’s not to say you won’t get one, just that it might need to be part of a research programme in some cases. You may get lucky that single healthcare institution may purchase one for their own research and use surveillance within that research. I’m also going to assume that these PETs will all have the capability of utilising SSTR tracers – I know the Melbourne initiative has already used this radionuclide based target but as part of their formal clinical trial. During my research for this article, I discovered quite a few locations across the world now experimenting with these new capabilities mainly provided by 3 manufacturers supplying the equipment. A short summary of global efforts will be posted below.
Three overviews of Long-axial field-of-view (LAFOV) systems – one from each manufacturer above
I’m starting with 3 initiatives currently ongoing.
- The US Mason initiative called EXPLORER mentioned above.
- The UK’s NPIP’s First Total-Body PET Scanner
- The Melbourne Australia one I posted previously
Mason EXPLORER total body PET scanner
This was the first one I found way back in 2020. The uEXPLORER scanner is the first clinically approved total-body PET system in the World You can read about their efforts by clicking here. When you look at LAFOV systems, an indicator of its power can be enhanced by the Axial Field‑of‑View and you can see from the diagram above, the uEXPLORER is the highest quality.
United Kingdom – National PET Imaging Platform (NPIP)
This is a fairly recent investment programme funded by the UK government. Through NPIP, the nation will have a richer picture of human health for clinical research, helping us to develop drugs and diagnostics more effectively and bring them to market quicker. Two cutting-edge total-body PET scanners, provided by “Siemens Healthineers”, will deliver outstanding image clarity of a patient’s entire body in near real-time. These state-of-the-art facilities will be sited in Scotland and London and will serve the length and breadth of the UK. Each location will be jointly managed by the Universities of Edinburgh and Glasgow in Scotland and by Imperial College London and King’s College London. You can read more about their efforts by clicking here. Note: This is an excellent initiative for the future but its core purpose is national research coordination and it’s funded as such. NPIP was created to support multi‑centre research, standardised protocols, and large‑scale datasets. That’s fundamentally different from a clinical PET service, which exists to scan patients as part of routine care. The scanners are embedded in academic environments inside university‑led imaging hubs, not NHS diagnostic centres. But see global map because Royal Free London has the same equipment embedded in an NHS institution. I do not know if this is available for surveillance purposes but I’ll update when I know more.
Melbourne Australia
This project is what got you guys excited so if you missed it – click here
Here is my research of global efforts, I’ll add more as I find it
Please note that the global table map below has indicated which locations might be research only, clinical use only or both. This is the interpretation of my own research and it may not be accurate. I’m hoping to build on that from feedback from patients over the coming months.
🌍 Global Total‑Body PET / LAFOV PET Map (2026)
United States
California
- UC Davis Health (Sacramento) uEXPLORER — United Imaging Healthcare (UIH) Status: Hybrid (Clinical + Research)
- United Imaging R&D Center (Mason) uEXPLORER — United Imaging Healthcare (UIH) Status: Research
Texas
- MD Anderson Cancer Center (Houston) Siemens Biograph Vision Quadra — Siemens Healthineers Status: Hybrid
Minnesota
- Mayo Clinic (Rochester) Siemens Biograph Vision Quadra — Siemens Healthineers Status: Hybrid
United Kingdom
London
- Royal Free Hospital Siemens Quadra — Siemens Healthineers Status: Hybrid (Clinical + Research)
- King’s College London / Guy’s & St Thomas’ Siemens Quadra + Siemens Vision 600 — Siemens Healthineers Status: Hybrid (Clinical + Research)
- St Thomas’ Hospital (NPIP) Siemens Quadra — Siemens Healthineers Status: Research Platform
Cambridge
- Addenbrooke’s Hospital (CUH) Siemens Quadra — Siemens Healthineers Status: Research‑dominant hybrid
Scotland
- Edinburgh / Glasgow (NPIP expansion) Siemens Quadra (planned) Status: Research
Australia
Melbourne
- Peter MacCallum Cancer Centre GE Omni Total Body — GE HealthCare Status: Clinical Evaluation + Research
Switzerland
Bern
- Inselspital, Bern University Hospital Siemens Quadra ×2 — Siemens Healthineers Status: Hybrid (Clinical + Research)
Germany
- University Hospital Essen — Siemens Quadra — Hybrid
- University Hospital Tübingen — Siemens Quadra — Research‑heavy
- University Hospital Freiburg — Siemens Quadra — Hybrid
- LMU Klinikum Munich — Siemens Quadra — Hybrid
- Heidelberg University Hospital — Siemens Quadra — Research
- University Hospital Würzburg — Siemens Quadra — Hybrid
Netherlands
- UMC Groningen Siemens Quadra — Siemens Healthineers Status: Research‑heavy
France
- CEA / Inserm collaborations Siemens Quadra — Siemens Healthineers Status: Research
China
Scanner: uEXPLORER Manufacturer: United Imaging Healthcare (UIH) Status: Hybrid (Clinical + Research) Listing: Multiple academic hospitals Note: China has the largest number of uEXPLORER systems worldwide, with installations across several major university hospitals and research centres.
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- Next Generation Total-Body PET/CT: Challenges and Opportunities
Long-axial field-of-view (LAFOV) systems have changed the field of molecular imaging. Since their introduction, many PET centres have installed these next-generation digital systems to provide more detailed imaging and acquire PET images in a single bed position. Indeed, vertex to thigh imaging for oncological indications can be obtained in most of the population with the… Read more: Next Generation Total-Body PET/CT: Challenges and Opportunities - Phase 1/2 Trial Evaluating CRN09682 for the Treatment of Neuroendocrine Tumors and Other Somatostatin Receptor 2-Expressing Tumors
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