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      A method to obtain correct standard uptake values in Pinnacle treatment planning system for target volume delineation

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          Abstract

          Standardized uptake value (SUV) is an advanced tool for quantitative tumor identification and metabolic target volume delineation (TVD) in diagnostic and therapeutic settings. It is thus important to establish a quality assured process to maintain the traceability of data correctly by positron emission tomography (PET) systems. Patient administration of 18fluoro-deoxy-glucose is increasingly delivered by automated infusion systems (AISs). Whenever AIS is used, its accuracy and traceability measurement need verification. In addition, it was observed that the unreproducible SUV displayed in PET and the treatment planning system (TPS) may cause grave concerns for radiation oncologists for TVD. This concern may complicate the correlation of TVD on PET and TPS and their clinical reporting. The SUV traceability was established from the PET system to AIS. Its accuracy was verified by cross-referencing to the reference dose calibrator traceable to a primary standard. The SUV values were converted in TPS using the in-house “clinical tool” to be identical as in PET, to allow radiation oncologists to use SUV confidently. The outcome of this study enables the clinical groups to rely on the correct SUV values displayed on the TPS and to improve the quality of care for patients in clinical procedures.

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          Most cited references14

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          FDG PET and PET/CT: EANM procedure guidelines for tumour PET imaging: version 1.0

          The aim of this guideline is to provide a minimum standard for the acquisition and interpretation of PET and PET/CT scans with [18F]-fluorodeoxyglucose (FDG). This guideline will therefore address general information about [18F]-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) and is provided to help the physician and physicist to assist to carrying out, interpret, and document quantitative FDG PET/CT examinations, but will concentrate on the optimisation of diagnostic quality and quantitative information.
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            The Netherlands protocol for standardisation and quantification of FDG whole body PET studies in multi-centre trials.

            Several studies have shown the usefulness of positron emission tomography (PET) quantification using standardised uptake values (SUV) for diagnosis and staging, prognosis and response monitoring. Many factors affect SUV, such as patient preparation procedures, scan acquisition, image reconstruction and data analysis settings, and the variability in methodology across centres prohibits exchange of SUV data. Therefore, standardisation of 2-[(18)F] fluoro-2-deoxy-D-glucose (FDG) PET whole body procedures is required in multi-centre trials. A protocol for standardisation of quantitative FDG whole body PET studies in the Netherlands (NL) was defined. This protocol is based on standardisation of: (1) patient preparation; (2) matching of scan statistics by prescribing dosage as function of patient weight, scan time per bed position, percentage of bed overlap and image acquisition mode (2D or 3D); (3) matching of image resolution by prescribing reconstruction settings for each type of scanner; (4) matching of data analysis procedure by defining volume of interest methods and SUV calculations and; (5) finally, a multi-centre QC procedure is defined using a 20-cm diameter phantom for verification of scanner calibration and the NEMA NU 2 2001 Image Quality phantom for verification of activity concentration recoveries (i.e., verification of image resolution and reconstruction convergence). This paper describes a protocol for standardization of quantitative FDG whole body multi-centre PET studies. The protocol was successfully implemented in the Netherlands and has been approved by the Netherlands Society of Nuclear Medicine.
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              18F-FDG PET and PET/CT in the evaluation of cancer treatment response.

              Multimodality imaging, as represented by its greatest exponent, PET/CT, has a firm place in the evaluation of a patient presenting with cancer. With 18F-FDG, PET/CT is rapidly becoming the key investigative tool for the staging and assessment of cancer recurrence. In the last 5 y, PET/CT has also gained widespread acceptance as a key tool used to demonstrate early response to intervention and therapy. In this setting, a major clinical need is being addressed with 18F-FDG PET/CT, because of its inherent ability to demonstrate (before other markers of response) if disease modification has occurred. This review presents available evidence to this effect.
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                Author and article information

                Journal
                J Med Phys
                J Med Phys
                JMP
                Journal of Medical Physics
                Medknow Publications & Media Pvt Ltd (India )
                0971-6203
                1998-3913
                Oct-Dec 2016
                : 41
                : 4
                : 240-245
                Affiliations
                [1]Department of Medical Physics and Radiation Engineering, Canberra Hospital, Canberra, Australia
                Author notes
                Address for correspondence: Mr. Farshid Salehzahi, Department of Medical Physics and Radiation Engineering, Canberra Hospital, Canberra, ACT 2605, Australia. E-mail: farshid.salehzahi@ 123456act.gov.au
                Article
                JMP-41-240
                10.4103/0971-6203.195188
                5228047
                a145ffc0-aaca-442a-898a-eb02fb1df9fc
                Copyright: © 2016 Journal of Medical Physics

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                : 27 July 2016
                : 24 October 2016
                : 26 October 2016
                Categories
                Original Article

                Medical physics
                functional imaging,metabolic target volume,positron emission tomography-computed tomography,standard uptake value,target volume delineation,treatment planning

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