FDGPETCT Technical Committee

1
FDG-PET/CT Technical Committee

• May 19-20, 2009

2
Overall Claim

• Quantitation, both single point and
  longitudinal, of tumor metabolism via FDG-PET/CT
  that can be used practically and efficiently as a
  biomarker. This biomarker shall be of known
  precision and accuracy when used in single- and
  multi-center, multi-vendor clinical trials and
  meta-analyses, enhancing its potential for use in
  patient care and qualification for use in
  clinical studies of pathophysiology and
  therapeutic interventions.
•  
• measuring change over time (e.g., pre- and
  post-treatment in a clinical trial of an
  investigational agent or for refinement of
  patient care during a course of therapy.

3
Digital Reference Object

• Can find in the DICOM header reliable data
  required for SUV calculation
• Short-term single standard stack, multiple
  vendors
• Mid-term validate receiving workstations with
  vendor-specific stack with header and
  standardized SUV truth values (sample data)
• Long-term raw data--validate image generation
  beyond acquisition point AND receiving workstation

4
FDG-PET Covariates

• Completed description of rationale, limitations,
  and proposed solutions for patient weight,
  height, injected activity, blood glucose, time,
  fasting time, hydration, physical activity, FDG
  uptake time (based in part on NCI guidelines)
• General proposal is to
• Improve and standardize measurements affecting
  SUV quantification (e.g. time, weight)
• Embed results in public DICOM tags of patient
  study
• Display results on viewing and analysis
  workstations (glucose, FDG uptake period)

5
Software Version Tracking

• Can create, store, retrieve FDG-PET/CT images
• Stage 1 Manually record the SW version number
  and flag the impact on quantitation
• Stage 2 Record all SW Version numbers in DICOM
  header

6
Quality Control

• Completed description of rationale, limitations,
  and proposed solutions for CT and PET calibration
  and quality control
• Propose that vendors make QC results (only
  pass/fail/warning) and calibration results (mean,
  variance) readily accessible as external files or
  ideally incorporated in the public DICOM tags of
  each patient study

7
ROI

• Claim Can create, store and retrieve markups of
  SUV measurements in accordance with a standard
  definition for RoI that provides a known balance
  between precision and accuracyPrecursor
  Survey of vendor to assess ROI tools and
  algorithms currently available to determine
  whether current methodologies can be defined on
  current systems and make recommendations to
  vendors for ROI in the future.

8
ROI

• Improve the max-pixel method by additionally
  reporting the mean of a pre-defined cluster of
  neighboring pixels
• For a given pixel cluster, use for calculated a
  mean value (equivalent to smoothing the image
  with a kernel based on this luster shape and size
  and reporting the maximum pixel value within a
  broad user-defined region)

9
ROI - future

• Anatomically based ROIs to provide objective
  means of measuring FDG uptake within larger
  volumes