From the June 2017 issue of HealthCare Business News magazine

There has been a major focus on standardizing PET imaging, especially for FDG. In addition, the Clinical Trials Working Group within the QIN has focused on methods to report quantitative results from PET and other modalities to develop standardized reporting criteria and evaluate variability across performance sites. These results have shown good comparability in SUVmax measurements, but leave room for improvement in the SUVpeak and other metrics. Currently, QIN members and others are piloting a software solution called Auto PERCIST to improve the repeatability of quantitative PET metrics. Overall, these efforts by the QIN and other organizations are promoting the standardization of PET imaging.

Other nuclear medicine modalities such as SPECT have also been used in a variety of clinical trials. Originally, SPECT imaging was not quantitative, due to the lack of compensation for image degrading factors. The development of compensation methods for hybrid SPECT/CT has opened the door to clinical quantitative SPECT. Studies performed as part of the QIN have helped establish the accuracy and repeatability of quantitative SPECT. However, standardization of acquisition protocols and reconstruction, compensation, calibration and analysis methods to reduce variability is still needed. The RSNA’s Quantitative Imaging Biomarker Alliance is in a process of drafting a profile for quantitative imaging of I-123 ioflupane, and the SNMMI CTN is developing a standard for assessing quantitative capabilities of imaging sites.


The question is not about how to standardize quantitative imaging methods, but rather how to bring these standards into clinical practice. This is a challenge every bit as large as the creation of the standards in the first place. Equipment manufacturers need to be brought on board to implement a full set of quantitative imaging settings, and national protocols must be established in order to bring quantitative imaging into multi-site clinical trials. Imaging technologists must be trained to use the quantitative settings and protocols as needed, and radiologists must be made aware that ringing quantitative procedures to clinical trials will help reduce costs and improve accuracy of trial outcome.

About the authors: Robert J. Nordstrom, Ph.D., is the chief of the Imaging Guided Intervention Branch, Division of Cancer Treatment and Diagnosis, National Cancer Institute. Hyunsuk Shim, Ph.D., is a professor in the Department of Radiology and Imaging Sciences at Emory University. Contributions to this article were also made by Richard Wahl, M.D., Washington University, St. Louis; John Buatti, M.D.; John Sunderland, Ph.D., University of Iowa; and Eric Frey, Ph.D., Johns Hopkins.

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