Determining and updating PET/CT and SPECT/CT diagnostic reference levels: A systematic review

Abstract

The aim of this systematic review is to investigate the national diagnostic reference level (NDRL) methods for positron emission tomography/computed tomography (PET/CT) and single photon emission tomography/computed tomography (SPECT/CT) procedures. A search strategy was based on the preferred, reporting items for systematic review and meta-analysis (PRISMA). Relevant articles retrieved from Medline, Scopus, Web of Science, Embase, Cinahl, and Google Scholar published up to October 2017. The search yielded 1057 articles. Fourteen articles were included in the review after a screening process. Relevant information from the selected articles were summarised and analysed. Discrepancies were found between the methodologies utilised to establish and report both PET/CT and SPECT/CT NDRLs, e.g. patient sampling and administered activity. Further research should focus on reporting more NDRLs for hybrid PET/CT and SPECT/CT examinations, and establish a robust NDRL standard for the CT portion associated with PET/CT and SPECT/CT examinations. This review provides updated NDRL reommndations to deliver more comparable international radation doses for administered activity and CT dose across PET/CT and SPECT/CT clinics.

Diagnostic reference levels for 18F‐FDG whole body PET/CT procedures: Results from a survey of 12 centres in Australia and New Zealand

“…Although effective dose is not appropriate unit for a DRL, effective dose is the only convenient unit that enables combined radiation doses and the conversion of the value into one unit (mSv). 7,10 The total effective dose delivered from additional CTs delivered from some AU QLD PET/CT centres were higher than delivered from a breath-hold CT acquisition protocol from three NZ PET/CT clinical centres. The values presented in this study reveal the total effective dose of a standard 18 F-FDG PET/CT examination, from AU QLD/WA PET/CT centres, and NZ centres with additional CT acquisition protocols, which are higher than the existing published effective dose data shown in Table 6.…”

“…Thus, reporting effective dose values is important to reflect the actual radiation doses delivered from PET/CT acquisition protocols. Although effective dose is not appropriate unit for a DRL, effective dose is the only convenient unit that enables combined radiation doses and the conversion of the value into one unit (mSv) . The total effective dose delivered from additional CTs delivered from some AU QLD PET/CT centres were higher than delivered from a breath‐hold CT acquisition protocol from three NZ PET/CT clinical centres.…”

“…Inevitably, a concern with 18 F‐FDG whole‐body PET/CT imaging is due to the combination of the administered activity and the x‐rays from the CT used for AC and/or anatomical localization. Numerous studies have shown that the 18 F‐FDG whole‐body PET/CT delivers higher effective doses (12 mSv to 14 mSv) to patients than either of the PET (3.8 mSv to 7 mSv) or CT (6.25 mSv to 8.6 mSv) exams, when considered in isolation . Thus, highlighting the importance of monitoring and optimizing PET/CT radiation doses …”

“…have shown that the 18 F-FDG whole-body PET/CT delivers higher effective doses (12 mSv to 14 mSv) to patients than either of the PET (3.8 mSv to 7 mSv) or CT (6.25 mSv to 8.6 mSv) exams, when considered in isolation. 6,7 Thus, highlighting the importance of monitoring and optimizing PET/CT radiation doses. 7,8 The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) Code of Practice, Section 3.1.8 (Radiation Protection Series No.…”

“…6,7 Thus, highlighting the importance of monitoring and optimizing PET/CT radiation doses. 7,8 The Australian Radiation Protection and Nuclear Safety Agency (ARPANSA) Code of Practice, Section 3.1.8 (Radiation Protection Series No. 14), recommended that 'the responsible person must establish a program to ensure that radiation doses administered to a patient for diagnostic purposes are: periodically compared with diagnostic reference levels (DRLs) for diagnostic procedures for which DRLs have been established in Australia'.…”