title: Quality assessment of fluorodeoxyglucose positron emission tomography imaging in clinical setting: definition of standard quality control parameters for patients treated for lymphoma.
abstract: OBJECTIVE
  We designed standard parameters for quality controls (QCs) of F-fluorodeoxyglucose positron emission tomography (FDG PET) images in the clinical setting, and validated them in both cross-sectional and longitudinal cohorts of patients with lymphoma under treatment.
  
  
  METHODS
  The procedure is based on the measurement of mean standardized uptake value (SUV mean) in three specific regions of interest drawn within pulmonary, liver, and bone tissues [reference (Ref)]. Intraobserver and interobserver reproducibility [percentage of coefficient of variation (CV%)] were calculated using PET scans of healthy participants. Cross-sectional interpatient QCs were defined as the 95% ranges of normal values of Ref-SUV mean. Transversal QCs were applied on PET scans of patients treated for lymphoma (n=378) looking at Ref-SUV mean out of range. Longitudinal intrapatient QCs were defined as the 95% limits of the SUV mean variation between two consecutive scans (ΔSUV limits). Longitudinal QCs were applied in a group of 94 pairs of consecutive PET scans under treatment for lymphoma looking at patients having Ref-ΔSUV limits out of range.
  
  
  RESULTS
  Intraobserver CV% remained below 3%, whereas interobserver CV% was a maximum of 5.3%. Both in transversal and longitudinal cohorts of patients treated for lymphoma, none of the PET scans simultaneously showed the three Ref-SUV mean out of range. Similar results were obtained with ΔSUV limits. Situations in which these limits were exeeded were associated with a recent history of acute infectious pulmonary disease (lung tissues) and granulocytes colony-stimulating factors concomitant treatment and stimulation of bone marrow (bone tissues).
  
  
  CONCLUSIONS
  A standardized and reproducible FDG PET QC protocol using SUV mean measurements using three tissues of Ref was validated, and may be applied in the clinical setting or in a clinical trial.
authors.affiliation: Ecole des Mines de Nantes, La Chantrerie, 4 rue Alfred Kastler, Nantes, France. Suisse, Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Retif
authors.forename: Claude
authors.initials: C
authors.lastname: Jegouic
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Slosman
mesh_terms: D002138:Calibration; D003430:Cross-Sectional Studies; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008137:Longitudinal Studies; D008223:Lymphoma / Q000000981:diagnostic imaging* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000295:instrumentation / Q000592:standards*; D011786:Quality Control; D015203:Reproducibility of Results; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D019788:Fluorodeoxyglucose F18