[14.02.2011] JNM: 18F-FDG PET standards daunting…but doable

Comparable quantitative imaging results and protocols are necessary to establish 18F-FDG PET/CT as a uniformly accepted biomarker, and while nuclear imaging has demonstrated the ligand’s clinical value, the establishment of standards remains a daunting obstacle, according to an editorial in the Journal of Nuclear Medicine.

“Standardization is a prerequisite to establishing 18F-FDG PET/CT as an accepted quantitative imaging biomarker and will pave the way for definition of metabolic response criteria, both for use in clinical trials and for patient care,” argued Andrew J. Buckler, MS, of Buckler Biomedical, and Ronald Boellaard, PhD, of the department of nuclear medicine and PET research at VU University Medical Center in Amsterdam.

Although Buckler and Boellaard consider the use of 18F-FDG PET/CT in nuclear imaging to be as ripe and refined as ever, the authors acknowledge the importance of the findings of two surveys in the Feb. 1 issue of JNM, which revealed large discrepancies in 18F-FDG PET/CT protocols, from patient preparation and dosage to reading practice. “It would seem that standardization is a long way off, if judged from the results of these critical reports,” Buckler and Boellaard lamented.

Looking forward, not down, is the authors’ remedy. With clinical data accruing and the European Association of Nuclear Medicine having already established standards for the European Union, Buckler and Boellaard called the field as “ready for this stage [of standardization] as it has never been before.” Indeed, support from the FDA, the Radiologic Society of North America (RSNA) and SNM have brought coordination and uniformity of standards closer in the U.S.

Still, despite this “quickening sense of progress,” there is no mistaking the persistence of the “still daunting challenge ahead of how to promulgate standardization across our varied centers.” Cooperation between institutions and organizations, practices and vendors, is essential, they argued. What stands in the way of uniform, standardized and widespread use of 18F-FDG PET/CT is a practical task of coordination, not a fundamental challenge.