title: Variation of system performance, quality control standards and adherence to international FDG-PET/CT imaging guidelines. A national survey of PET/CT operations in Austria.
abstract: OBJECTIVE
  To gather information on clinical operations, quality control (QC) standards and adoption of guidelines for FDG-PET/CT imaging in Austrian PET/CT centres.
  
  
  METHODS
  A written survey composed of 68 questions related to A) PET/CT centre and installation, B) standard protocol parameters for FDG-PET/CT imaging of oncology patients, and C) standard QC procedures was conducted between November and December 2013 among all Austrian PET/CT centres. In addition, a NEMA-NU2 2012 image quality phantom test was performed using standard whole-body imaging settings on all PET/CT systems with a lesion-to-background ratio of 4. Recovery coefficients (RC) were calculated for each lesion and PET/CT system.
  
  
  RESULTS
  A) 13 PET/CT systems were installed in 12 nuclear medicine departments at public hospitals. B) Average fasting prior to FDG-PET/CT was 7.6 (4-12) h. All sites measured blood glucose levels while using different cut-off levels (64%: 150 mg/dl). Weight-based activity injection was performed at 83% sites with a mean FDG activity of 4.1 MBq/kg. Average FDG uptake time was 55 (45-75) min. All sites employed CT contrast agents (variation from 1%-95% of the patients). All sites reported SUV-max. C) Frequency of QC tests varied significantly and QC phantom measurements revealed significant differences in RCs.
  
  
  CONCLUSIONS
  Significant variations in FDG-PET/CT protocol parameters among all Austrian PET/CT users were observed. Subsequently, efforts need to be put in place to further standardize imaging protocols. At a minimum clinical PET/CT operations should ensure compliance with existing guidelines. Further, standardized QC procedures must be followed to improve quantitative accuracy across PET/CT centres.
authors.affiliation: Ivo Rausch, Centre for medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, Austria, Tel. +43/1/404 005 54 50, Fax +43/1/4040 03 98 89, E-mail: ivo.rausch@meduniwien.ac.at).
authors.forename: I
authors.initials: I
authors.lastname: Rausch
authors.forename: H
authors.initials: H
authors.lastname: Bergmann
authors.forename: B
authors.initials: B
authors.lastname: Geist
authors.forename: M
authors.initials: M
authors.lastname: Schaffarich
authors.forename: A
authors.initials: A
authors.lastname: Hirtl
authors.forename: M
authors.initials: M
authors.lastname: Hacker
authors.forename: T
authors.initials: T
authors.lastname: Beyer
mesh_terms: D001317:Austria; D019788:Fluorodeoxyglucose F18; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D038622:Internationality; D064847:Multimodal Imaging / Q000592:standards* / Q000706:statistics & numerical data; D009683:Nuclear Medicine / Q000592:standards*; D049268:Positron-Emission Tomography / Q000592:standards* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000592:standards* / Q000706:statistics & numerical data
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
keywords: Austria; FDG; PET/CT; multicentre; protocols; quality control