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      Quantification, improvement, and harmonization of small lesion detection with state-of-the-art PET

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          In recent years, there have been multiple advances in positron emission tomography/computed tomography (PET/CT) that improve cancer imaging. The present generation of PET/CT scanners introduces new hardware, software, and acquisition methods. This review describes these new developments, which include time-of-flight (TOF), point-spread-function (PSF), maximum-a-posteriori (MAP) based reconstruction, smaller voxels, respiratory gating, metal artefact reduction, and administration of quadratic weight-dependent 18F–fluorodeoxyglucose (FDG) activity. Also, hardware developments such as continuous bed motion (CBM), (digital) solid-state photodetectors and combined PET and magnetic resonance (MR) systems are explained. These novel techniques have a significant impact on cancer imaging, as they result in better image quality, improved small lesion detectability, and more accurate quantification of radiopharmaceutical uptake. This influences cancer diagnosis and staging, as well as therapy response monitoring and radiotherapy planning. Finally, the possible impact of these developments on the European Association of Nuclear Medicine (EANM) guidelines and EANM Research Ltd. (EARL) accreditation for FDG-PET/CT tumor imaging is discussed.

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          FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0

          The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.
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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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              Partial-volume effect in PET tumor imaging.

              PET has the invaluable advantage of being intrinsically quantitative, enabling accurate measurements of tracer concentrations in vivo. In PET tumor imaging, indices characterizing tumor uptake, such as standardized uptake values, are becoming increasingly important, especially in the context of monitoring the response to therapy. However, when tracer uptake in small tumors is measured, large biases can be introduced by the partial-volume effect (PVE). The purposes of this article are to explain what PVE is and to describe its consequences in PET tumor imaging. The parameters on which PVE depends are reviewed. Actions that can be taken to reduce the errors attributable to PVE are described. Various PVE correction schemes are presented, and their applicability to PET tumor imaging is discussed.

                Author and article information

                +31 6 115 130 27 ,
                Eur J Nucl Med Mol Imaging
                Eur. J. Nucl. Med. Mol. Imaging
                European Journal of Nuclear Medicine and Molecular Imaging
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                8 July 2017
                8 July 2017
                : 44
                : Suppl 1
                : 4-16
                [1 ]ISNI 0000 0004 0444 9382, GRID grid.10417.33, Department of Radiology and Nuclear Medicine, , Radboud University Medical Centre, ; Nijmegen, The Netherlands
                [2 ]ISNI 0000 0004 0399 8953, GRID grid.6214.1, MIRA Institute for Biomedical Technology and Technical Medicine, , University of Twente, ; Enschede, The Netherlands
                [3 ]ISNI 0000 0001 0547 5927, GRID grid.452600.5, Department of Nuclear Medicine, , Isala Hospital, ; Zwolle, The Netherlands
                [4 ]ISNI 0000 0004 0398 8384, GRID grid.413532.2, Department of Medical Physics, , Catharina Hospital, ; Eindhoven, The Netherlands
                [5 ]Department of Nuclear Medicine & Molecular Imaging, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
                [6 ]ISNI 0000 0004 0435 165X, GRID grid.16872.3a, Department of Radiology and Nuclear Medicine, , VU University Medical Center, ; Amsterdam, The Netherlands
                [7 ]ISNI 0000 0001 0547 5927, GRID grid.452600.5, Department of Medical Physics, , Isala, ; Zwolle, The Netherlands
                [8 ]ISNI 0000 0004 1936 9457, GRID grid.8993.b, Department of Surgical Sciences, , Uppsala University, ; Uppsala, Sweden
                [9 ]ISNI 0000 0001 2351 3333, GRID grid.412354.5, Department of Medical Physics, , Uppsala University Hospital, ; Uppsala, Sweden
                © The Author(s) 2017

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                Funded by: Radboud University Medical Center
                Review Article
                Custom metadata
                © Springer-Verlag GmbH Germany 2017

                Radiology & Imaging

                earl, lesion detectability, pet/mr, digital pet, point-spread-function, time-of-flight


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