Diagnostic Reference Levels for nuclear medicine imaging in Austria: A nationwide survey of used dose levels for adult patients

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Abstract

Purpose

To assess dose levels in routine nuclear medicine (NUC) procedures in Austria as a prior to a legislative update of the National Diagnostic Reference Levels (NDRL).

Method

As part of a nationwide survey of common NUC-examinations between June 2019 and November 2019, data sets were collected from 33 Austrian hospitals with NUC equipment. All hospitals were asked to report the NUC imaging devices in use (model, type, year of manufacture, detector material, collimators), the standard protocol parameters for selected examinations (standard activity, collimator, average acquisition time, reconstruction type, use of time-of-flight) and to report data from 10 representative examinations (e.g. injected activity, weight), incl. the most common NUC-examinations for planar imaging/SPECT and PET. Median/mean values for injected activity were calculated and compared to current Austrian and international NDRL. A Pearson correlation coefficient was computed comparing different variables.

Results

In total, all 33 hospitals (100% response rate) reported data for this study for 60 SPECT devices, 21 PET/CT devices and 23 scintigraphy devices. Fixed activity values for scintigraphy/SPECT and PET were employed by about 90% and 56% of the hospitals, respectively. The most widely performed examinations for scintigraphy/SPECT are bone imaging, thyroid imaging, renal imaging (with MAG3/EC) and lung perfusion imaging (in 88% of the hospitals) and F-18 FDG-PET studies for oncology indications (in 100% of the hospitals). Significant correlations were found for patient weight and injected activity (scintigraphy/SPECT), use of iterative reconstruction and injected activity (PET) as well as size of field-of-view and injected activity (PET).

Conclusions

The reported injected activity levels were comparable to those in other countries. However, for procedures for which NDRL exist, deviations in injected activities of >20% compared to the NDRL were found. These deviations are assumed to result mainly from advances in technology but also from deviations between NDRL and prescribed activities as given in the information leaflets of the radiopharmaceuticals.

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Most cited references 40

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

Ronald Boellaard, Roberto Delgado-Bolton, Wim Oyen … (2014)

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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68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0

Wolfgang P. Fendler, Matthias Eiber, Mohsen Beheshti … (2017)

The aim of this guideline is to provide standards for the recommendation, performance, interpretation and reporting of (68)Ga-PSMA PET/CT for prostate cancer imaging. These recommendations will help to improve accuracy, precision, and repeatability of (68)Ga-PSMA PET/CT for prostate cancer essentially needed for implementation of this modality in science and routine clinical practice.

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Is Open Access

State of the art in total body PET

Stefaan Vandenberghe, Pawel Moskal, Joel S Karp (2020)

The idea of a very sensitive positron emission tomography (PET) system covering a large portion of the body of a patient already dates back to the early 1990s. In the period 2000–2010, only some prototypes with long axial field of view (FOV) have been built, which never resulted in systems used for clinical research. One of the reasons was the limitations in the available detector technology, which did not yet have sufficient energy resolution, timing resolution or countrate capabilities for fully exploiting the benefits of a long axial FOV design. PET was also not yet as widespread as it is today: the growth in oncology, which has become the major application of PET, appeared only after the introduction of PET-CT (early 2000).The detector technology used in most clinical PET systems today has a combination of good energy and timing resolution with higher countrate capabilities and has now been used since more than a decade to build time-of-flight (TOF) PET systems with fully 3D acquisitions. Based on this technology, one can construct total body PET systems and the remaining challenges (data handling, fast image reconstruction, detector cooling) are mostly related to engineering. The direct benefits of long axial FOV systems are mostly related to the higher sensitivity. For single organ imaging, the gain is close to the point source sensitivity which increases linearly with the axial length until it is limited by solid angle and attenuation of the body. The gains for single organ (compared to a fully 3D PET 20-cm axial FOV) are limited to a factor 3–4. But for long objects (like body scans), it increases quadratically with scanner length and factors of 10–40 × higher sensitivity are predicted for the long axial FOV scanner. This application of PET has seen a major increase (mostly in oncology) during the last 2 decades and is now the main type of study in a PET centre. As the technology is available and the full body concept also seems to match with existing applications, the old concept of a total body PET scanner is seeing a clear revival. Several research groups are working on this concept and after showing the potential via extensive simulations; construction of these systems has started about 2 years ago. In the first phase, two PET systems with long axial FOV suitable for large animal imaging were constructed to explore the potential in more experimental settings. Recently, the first completed total body PET systems for human use, a 70-cm-long system, called PennPET Explorer, and a 2-m-long system, called uExplorer, have become reality and first clinical studies have been shown. These results illustrate the large potential of this concept with regard to low-dose imaging, faster scanning, whole-body dynamic imaging and follow-up of tracers over longer periods. This large range of possible technical improvements seems to have the potential to change the current clinical routine and to expand the number of clinical applications of molecular imaging. The J-PET prototype is a prototype system with a long axial FOV built from axially arranged plastic scintillator strips.This paper gives an overview of the recent technical developments with regard to PET scanners with a long axial FOV covering at least the majority of the body (so called total body PET systems). After explaining the benefits and challenges of total body PET systems, the different total body PET system designs proposed for large animal and clinical imaging are described in detail. The axial length is one of the major factors determining the total cost of the system, but there are also other options in detector technology, design and processing for reducing the cost these systems. The limitations and advantages of different designs for research and clinical use are discussed taking into account potential applications and the increased cost of these systems.

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Author and article information

Contributors

David Wachabauer

Ivo Rausch

Journal

Journal ID (nlm-ta): Z Med Phys

Journal ID (iso-abbrev): Z Med Phys

Title: Zeitschrift für medizinische Physik

Publisher: Elsevier

ISSN (Print): 0939-3889

ISSN (Electronic): 1876-4436

Publication date PMC-release: 20 January 2022

Publication date Collection: August 2022

Publication date (Electronic): 20 January 2022

Volume: 32

Issue: 3

Pages: 283-295

Affiliations

[a ]Austrian National Public Health Institute (Gesundheit Österreich GmbH (GÖG)), Vienna, Austria

[b ]QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Austria

[c ]Austrian Society of Nuclear Medicine and Molecular Biology (OGNMB), Vienna, Austria

[d ]Federal Ministry of Social Affairs, Health, Care and Consumer Protection, Vienna, Austria

[e ]Department of Nuclear Medicine and Endocrinology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria

[f ]rtaustria - Austrian Society of Radiological Technologists, Wiener Neustadt, Austria

[g ]Clinic Hietzing, Institute for Hospital Physics, Vienna, Austria

[h ]Austrian Society for Medical Physics (ÖGMP), Vienna, Austria

[i ]Institute of Diagnostic and Interventional Radiology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria

[j ]Austrian Roentgen Society, Vienna, Austria

[k ]Karl Landsteiner University of Health Sciences; Department of Nuclear Medicine, University Hospital St. Poelten, Austria

[l ]Austrian Society for Radiation Protection in Medicine (VMSÖ), Vienna, Austria

[m ]Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria

[n ]Vienna Thyroid Center Schilddruesenpraxis Josefstadt, Vienna, Austria

[o ]Federal Working Group Nuclear Medicine of the Austrian Medical Association, Austria

Author notes

[* ]Corresponding author: David Wachabauer, Austrian National Public Health Institute (Gesundheit Österreich GmbH (GÖG)), Vienna, Austria. Tel.: +43 1 515 61 354. David.wachabauer@ 123456goeg.at

[** ]Corresponding author: Ivo Rausch, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20/4L, 1090 Vienna, Austria. Tel.: +43 1 40400 19880. ivo.rausch@ 123456meduniwien.ac.at

Article

Publisher Item ID: S0939-3889(21)00113-6

DOI: 10.1016/j.zemedi.2021.11.007

PMC ID: 9948827

PubMed ID: 35067426

SO-VID: c410cd02-ad9c-4242-8f03-b02fda935dc3

License:

This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Diagnostic Reference Levels for nuclear medicine imaging in Austria: A nationwide survey of used dose levels for adult patients

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Abstract

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Conclusions

Related collections

Pakistan Journal of Nuclear Medicine (PJNM)

Most cited references 40

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

68Ga-PSMA PET/CT: Joint EANM and SNMMI procedure guideline for prostate cancer imaging: version 1.0

State of the art in total body PET

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