Variation of system performance, quality control standards and adherence to international FDG-PET/CT imaging guidelines

Summary

Aim: To gather information on clinical operations, quality control (QC) standards and adoption of guidelines for FDG-PET/CT imaging in Austrian PET/CT centres. Methods: A written survey composed of 68 questions related to A) PET/CT centre and installation, B) standard protocol parameters for FDG-PET/CT imaging of oncology patients, and C) standard QC procedures was conducted between November and December 2013 among all Austrian PET/CT centres. In addition, a NEMA-NU2 2012 image quality phantom test was performed using standard whole-body imaging settings on all PET/CT systems with a lesion-to- background ratio of 4. Recovery coefficients (RC) were calculated for each lesion and PET/ CT system. Resu lts: A) 13 PET/CT systems were installed in 12 nuclear medicine departments at public hospitals. B) Average fasting prior to FDG-PET/CT was 7.6 (4-12) h. All sites measured blood glucose levels while using different cut-off levels (64%: 150 mg/dl). Weight- based activity injection was performed at 83% sites with a mean FDG activity of 4.1 MBq/kg. Average FDG uptake time was 55 (45-75) min. All sites employed CT contrast agents (variation from 1 %-95% of the patients). All sites reported SUV-max. C) Frequency of QC tests varied significantly and QC phantom measurements revealed significant differences in RCs. Conclusion: Significant variations in FDG-PET/CT protocol parameters among all Austrian PET/CT users were observed. subsequently, efforts need to be put in place to further standardize imaging protocols. At a minimum clinical PET/CT operations should ensure compliance with existing guidelines. Further, standardized QC procedures must be followed to improve quantitative accuracy across PET/CT centres.

Zusammenfassung

Ziel: Informationen zu erhalten über die klinische Anwendung von FDG-PET/CT als auch über Qualitätssicherungs-(QS)-Maßnahmen und die Einhaltung von Bildgebungsrichtlinien in Österreich. Methode: Eine Umfrage bestehend aus 68 Fragen bezüglich A) PET/CT-Zentrum im Allgemeinen B) Standard-Protokolle für onkologische FDG-PET/CT-Untersuchungen und C) QS- Maßnahmen wurde zwischen November und Dezember 2013 in allen österreichischen PET/ CT-Zentren durchgeführt. Zusätzlich erfolgte an allen PET/CT-Systemen eine Phantommessung (NEMA-NU2 2012 Image Quality Phantom) mit den jeweiligen Ganzkörper FDG-PET/ CT-Protokollen. Daraus wurden Recovery-Koef- fizienten (RC) für jedes System berechnet. Ergebnisse: A) 13 PET/CTs sind in 12 öffentlichen nuklearmedizinischen Abteilungen installiert. B) Die durchschnittliche Nahrungsmittelkarenz vor einer FDG-PET/CT-Untersuchung betrug 7,6 (4-12) h. Alle Zentren bestimmten den Blutzuckerspiegel, jedoch gab es Unterschiede bei den oberen Grenzwerten (64%: 150 mg/dl). Die Aktivität war in 83% der Zentren abhängig vom Patientengewicht (mittleren Aktivität: 4,1 MBq/kg). Die durchschnittliche FDG-Anreiche- rungszeit betrug 55 (45-75) min. Alle Zentren verwendeten CT-Kontrastmittel, allerdings mit verschiedener Häufigkeit. Alle Zentren bestimmten den SUVmax. C) Die QS-Maßnahmen variierten stark in ihrer Frequenz. Die Phantommessungen zeigten signifikante Unterschiede in den RC. Schlussfolgerung: Es bestehen große Unterschiede in den FDG-PET/CT-Protokollen zwischen den Zentren in Österreich. Es bedarf weiterer Bemühungen, um eine Standardisierung der FDG-PET/CT-Protokolle umzusetzen. Als minimalen Konsens sollten PET/CT-Unter- suchungen im Einklang mit den Richtlinien erfolgen. Standardisierten QS-Maßnahmen sollte gefolgt werden, um die quantitative Genauigkeit zwischen PET/CT-Zentren zu verbessern.

Keywords

PET/CT - FDG - Austria - protocols - quality control - multicentre

Schlüsselwörter

PET/CT - FDG - Österreich - Protokolle - Qualitätssicherung - multizentrisch

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