CACA guidelines for holistic integrative management of PET imaging

The CACA guidelines standardize the clinical application of positron emission tomography (PET) for holistic and integrative tumor management. It systematically introduces the technical evolution of PET/CT and PET/MR, imaging principles, standardized procedures, and clinical indications. The guidelines specify the use of 18 F-FDG as the fundamental metabolic tracer and the rational application of targeted probes, including 68 Ga-PSMA, 68 Ga-FAPI, somatostatin receptor, and estrogen receptor tracers, along with quantitative parameters such as SUV, MTV, and TLG. It unifies patient preparation, radiopharmaceutical injection, scanning protocols, and report writing to ensure a consistent quality. PET is indicated for pretreatment staging, efficacy evaluation, recurrence detection, prognostic assessment, and radiotherapy target delineation in patients with major cancers. However, its limitations include false negatives in low-metabolism tumors, tumor heterogeneity, and resolution constraints. Multimodal imaging, combined tracers, and advanced equipment are recommended to improve the accuracy. This guideline promotes standardized and precise PET applications in the whole-course management of tumors in China.