From guidelines to bedside: a practical tool for ¹⁸F-FDG PET/CT patient preparation in endocarditis and other cardiac diseases

In the diagnostic workup of inflammatory, infective, and infiltrative cardiac diseases such as endocarditis or cardiac sarcoidosis, ¹⁸F-FDG PET/CT requires adequate suppression of physiological myocardial glucose uptake. Current international guidelines provide general dietary principles but fail to adequately address complex clinical scenarios encountered in the inpatient setting. We developed a structured operational algorithm through multidisciplinary collaboration between Nuclear Medicine, Clinical Dietetics and Diabetology specialists, presented as a single-page reference table combining three patient categories (non-diabetic, diabetic on oral therapy, insulin-dependent diabetic) with three nutritional modalities (oral, enteral, parenteral). For each combination, clear, time-referenced instructions are provided. The protocol was formally adopted and shared with all referring wards of our hospital through a dedicated educational program; these preliminary findings warrant formal prospective validation. The practical tool presented here addresses a concrete gap not covered by current international guidelines and may serve as a reference for other Nuclear Medicine centers facing similar challenges in the inpatient setting.