not meet the standard (cost, ALARA). ⢠Good news: way ahead of ... large impact on quantification. Reconstruction settings will be based on MC-QC results.
Otto S Hoekstra VU University Medical Centre, Amsterdam EORTC Imaging Group
Why is this important for us ? • Imaging field moves towards quantification • PET is the best quantitative procedure • PET still needs to qualify as prognostic and predictive biomarker, e.g. •
response evaluation
•
stratification for adjuvant therapy
• Concern: repeat baseline scans because initial scan did not meet the standard (cost, ALARA) • Good news: way ahead of competing technologies
FDG PET(-CT) EANM Procedure Guidelines for Tumour PET Imaging (1.0)
PET imaging / SUV uncertainties Technical factors – Relative calibration between PET scanner and dose calibrator (10%) – Residual activity in syringe (5%) – Incorrect synchronization of clocks (10%) – Injection vs calibration time (10%) – Quality of administration (50%)
Physics related factors – Scan acquisition parameters (15%) – Image reconstruction parameters (30%) – Use of contrast agents (15%) – ROI (50%)
Biological factors – Uptake period (15%) – Patient motion and breathing (30%) – Blood glucose levels (15%)
R. Boellaard 2009, J Nucl Med Supplement Issue 50: 11S
SUV 51-61 min normalised to weight scan 1
Why do we need a guideline for quantitative FDG PET ?
16.00000
12.00000
8.00000
4.00000
0
1
2
3
Hospital
Recent (2009) observation on site differences in SUV -Site 1 & 2 closely followed NL standardized protocol -Site 3 did not – almost factor 2 lower SUV on average
The EANM guideline for FDG PET(-CT) provides recommendations for:
Minimizing physiological or biological effects by patient preparation guidelines Procedures to ensure accurate FDG administration Matching of PET study statistics (‘image quality’) by prescribing FDG dosage as function of patient weight, type of scanner, acquisition mode and scan duration Matching of image resolution by specifying image reconstruction settings and providing activity concentration recovery coefficients specifications (QC experiment) Standardization of data analysis by prescribing region of interest strategies and SUV measures Multi-center QC/QA procedures for PET and PET/CT scanners
Factors affecting SUV biological factors – uptake period
Lowe VJ et al. Optimum scanning protocol?for FDG-PET evaluation of pulmonary malignancy. J Nucl Med. 1995
FDG dosage and acquisition ‘image quality and quantification’
Dosage and acquisition definitions aim at matching NEC (statistics, ‘image quality’) across scanners/institutes (to avoid upward bias in SUV). Dosage is given as function of patient weight, scan mode, bed overlap and scan duration.
Image reconstruction Defined reconstruction settings aim at matching final image resolution (~7 mm FWHM=PET/CT) / convergence / contrast recovery across scanners, as this aspect has a large impact on quantification. Reconstruction settings will be based on MC-QC results Effects of different number of OSEM iterations, as seen in the Netherlands, on SUV
SUVmax = 4.0 SUV 50%= 3.0
5.9 4.1
6.4 4.6
8.6 5.9
Good imaging practice visually optimal
together with
quantitatively optimal
Multi-center QC and calibration
1. Daily QC conform standard procedure of system / manufacturer 2. Calibration QC using (cylindrical) phantom (15-30cm diameter) 3. “Adjusted” NEMA NU 2-2001 Image Quality procedure/measurement to measure recovery coefficients as function of sphere size (= ‘effective image resolution’) 4. CT-QC cf recommendations of ESR/national law 5. Misc. QC (e.g. for scales, alignment etc)
Absolute activity concentration recoveries – NEMA NU 2 2001 IQ Phantom
w/o
with standardisation
Activity concentration recovery
1.000
Recovery coefficient
1.00
0.800
0.75
0.600
0.50 0.400
0.25
0.200 avg
0.00
0.000
0
2
4
6
8
Sphere volume (ml)
10
12
0.1
1
10
100
‘ phantom war ’ upcoming ? • NEMA: handling -, range of spheres ++ • ACR • SNM: handling ++, few spheres calibrations underway you do not need a physicist, any tech can do this after instruction
Effects of central QA and data analysis (SUVmax) QA, central read
100
100
75
75
50
50
25
25
0 -25
0
5
10
15
20
% TRT
% TRT
All, local read
0 -25
-50
-50
-75
-75
-100
-100 Average SUV
Centralized QA mainly removes outliers
0
5
10
Average SUV
15
20
EORTC imaging group activities (as a sequel to NL HOVON initiative – Zijlstra et al.)
- implement guideline (SOP, QA/QC) with EANM - keosys platform - proposal to EANM: -regional / national coordinators -accreditation
UK multi-centre PET clinical trials network Multi-centre trials network operating since 2002 Informal network set up by St Thomas’ PET Centre FDG PET only 3 Studies completed / 2 in progress / 2 in preparation Accreditation and QC procedures Standardised data acquisition / analysis Anonymised data transfer Centralised or local reporting
Future developments Adoption of trials network by UK National Cancer Research Institute (NCRI) Develop audit processes Improved IT infrastructure Introduce new tracers
Courtesy of M. O’Doherty
Currently ~21 accredited sites
Status of multi-centre calibration in NL
QC studies performed in ~ 23 sites Disapproved 3 : deviation > 30% (1 corrected) 1 : deviation of ~ 15% Approved 8 : deviation of 5 to 7% 11: deviation < 5%
quantification = benefit, for patients & science Otto S Hoekstra VU University Medical Centre, Amsterdam EORTC Imaging Group
Cost-benefit analysis ofhealth programmes shows whether a particular ... in nature, rejuvenation refers to preventive maintenance of software aimed to reduce .
Hiya, if perhaps you have landed on this blog it is pretty most likely you were searching for where to buy COREFAIT Cost-Benefit Analysis. Model cheap, or ...
So if instead you're struggling to find COREFAIT Cost-Benefit Analysis Model coupons perhaps you might prefer to have a look at the links found all through this ...
Nov 22, 2006 - overcoming response costs and enabling high-effort behav- iors. A particularly ..... Page 4 ... onists at doses, which did not affect free food intake or food ..... Bautista LM, Tinbergen J, Kacelnik A (2001) To walk or to fly? How.
Nov 10, 2009 - the mesoaccumbens dopamine pathway, we need to deconstruct ..... Voltammetric data analysis was carried out using software written in ...
Service. Self service 100 % en ligne : vous gérez vous-même, facilement et à tout moment, ... Luminus est une marque et un nom commercial d'EDF Luminus SA, Rue du Marquis 1, 1000 .... recevez vos factures uniquement par email. Toutes ...
And You can Read Online feuilletages et quantification geometrique journees lyonnaises de la societe mathematique france 1417 juin. PDF file for free from our ...
A love that makes breath poor and speech unable (Goneril). What shall Cordelia speak? Love, and be silent. (1.1). But now our joy [â¦] what can you say to draw ...
3 Property Grammars. The Property Grammars (PG) approach [Blache05a] is purely constraint-based: all syntactic information is represented by means of ...
Compare ONLY to other labels with yellow numbers. Labels with yellow numbers are based on the same test procedures. $24. â½. ⢠Your cost will depend on ...
•Your cost will depend on your utility rates and use. •Cost range based only on ... electricity cost of 12 cents per kWh and natural gas cost of $1.09 per therm.
view). In 2006, I bit the bullet. I will now explore a way that maybe we can see the context ..... read all the books. Inverse-wide scope: every book might move to wide scope ... Skip some tricky issues about negative quantifiers (e.g. no), and their
This Quantification Non Invasive De La Microcirculation Imagerie Ultrasonore Fonctionnelle De Contraste Avec Les. Techniques Pdf file begin with Intro, Brief ...
sample sizes, blocking, etc. highly ... Uncertainty Analysis (degree of confidence in data and models) .... Computational strategies for the medium case:.
Models with. • Your cost will depend on your utility rates and use. Federal law prohibits removal of this label before consumer purchase. U.S. Government ...
The economic dilemma Baumol and Bowen referred to was the problem ... ductivity over time may occur for the following reasons: (1) increased capital per worker, (2) ... result, in the typical manufacturing industry the amount of labour time needed to
The answers in Section Two are supplemented by explanations where some amplification ... readers may work Parts I, II, and III of the workbook after reading each ...... move up or down, the rates of return for the subject security tend to .... pany X
Apr 8, 2009 - imaging studies of human delay-based decision making have been conducted .... black lines on the cues indicated the amount of effort (left, low effort; right, high ... previously gained in the block in white, and remained on the screen
The statistical analysis of latency distributions consti- tutes a major ..... scribed in Fig. 4, is capable of explaining the basic sta- ..... Active vision: The psychology.
