Variations in Clinical PET/CT Operations: Results of an International Survey of Active PET/CT Users

Abstract

This study gathered information about clinical PET/CT operations worldwide to help guide discussions on the use and standardization of clinical PET/CT. Methods: A Web-based survey of PET/CT users was initiated in November 2009 through e-mail advertising using Academy of Molecular Imaging databases. Recipients were asked 58 questions related to demographics (e.g., location, number of PET/CT systems, and staffing), PET/CT operations and use, and variations in 18 F-FDG oncology imaging protocols. Results: The responders were from centers in the Americas (71%), Europe (22%), AsiaPacific (6%), and Middle East (1%), with most responding sites representing public health care institutions (60%). PET/CT systems were most frequently installed in nuclear medicine departments (59%). Of the sites operating a PET/CT system, 16% had 10 y or more of stand-alone PET experience. About 40% of all sites operated at least 2 PET/CT systems. PET/CT was most frequently used for applications in torso or whole-body oncology (87%), radiation therapy planning (4%), cardiology (4%), and neurology (5%). The average interval of fasting before an 18 F-FDG PET/CT examination was 7 6 3 h (range, 4-12 h). Blood glucose levels were measured at 99% of sites, but acceptable maximal glucose levels varied substantially (an upper limit of 200 mg/dL was applied at .50% of the institutions). A weight-based radioactivity dose injection was performed at 44% of sites. The mean 18 F-FDG activity injected was 390 MBq (range, 110-585 MBq) for 3-dimensional PET of a 75-kg patient. The mean uptake time was 64 6 14 min (range, 20-90 min). Split protocols involving patient repositioning and adapted imaging parameters were used at 51% of sites. Only 41% used patient positioning aids. Intravenous or oral CT contrast material was used at 52% of sites in up to 25% of patients. Most sites (90%) measured maximum standardized uptake value as an index of tissue glucose use. Only 62% of sites provided a fully integrated PET/CT report. Conclusion: An international survey among clinical PET/CT users revealed significant variations in standard 18 F-FDG PET/CT protocols. This finding illustrates the need for continuous training and ongoing standardization in an effort to optimize PET/CT in oncology.

Life is not black and white, nor just Shades of Gray

“…Nevertheless, an international survey performed in 2011 demonstrated that the majority of PET/CT users still employed CT contrast agents in only a small proportion of patients [22]. Likewise, in a survey performed in 2014 among international SPECT/CT users, an overwhelming majority of respondents wanted to employ their SPECT/CT system as a SPECT system with attenuation correction and coarse anatomical localization rather than to implement closer integration of radiology-driven imaging perspectives [23].…”

“…Although only a minority of groups have adapted PET/CT acquisition protocols to optimize information obtained from both the nuclear medicine and the radiology perspective they have documented convincing positive results [20,21]. And while the Bnuclear medicine approach^dominates in Europe and the Bradiology approach^is more common in the US, the paucity of truly combined reporting of hybrid imaging is independent of geographical location [22,23].…”

Nuclear medicine 2013: from status quo to status go

“…A recent survey among SPECT/CT users [11] found that the majority of examinations are performed with little attention to the CT element. Likewise, few users of PET/CT utilize the full potential of the CT element through the use of radiology-equivalent protocols [12]. This is in addition to a general variability in adhering to imaging standards [13].…”

Optimisation and harmonisation: two sides of the same coin?

“…Often, use of these new technologies is preferred by the nuclear medicine physicians for visual assessment of the images [16,17]. At the same time use of these new technologies may result in a wider variability (and change) of SUV across different centres [16,19,21]. Moreover, use of the maximum SUV (SUV max ), being the de facto standard in many studies, in combination with these new technologies may even worsen accuracy and precision [19,22].…”