title: A Digital Reference Object to Analyze Calculation Accuracy of PET Standardized Uptake Value.
abstract: OBJECTIVE
  To determine the extent of variations in computing standardized uptake value (SUV) by body weight (SUV(BW)) among different software packages and to propose a Digital Imaging and Communications in Medicine (DICOM) reference test object to ensure the standardization of SUV computation between medical image viewing workstations.
  
  
  METHODS
  Research ethics board approval was not necessary because this study only evaluated images of a phantom. A synthetic set of positron emission tomographic (PET)/computed tomographic (CT) image data, called a digital reference object (DRO), with known SUV was created. The DRO was sent to 16 sites and evaluated on 21 different PET/CT display software packages. Users were asked to draw various regions of interest (ROIs) on specific features and report the maximum, minimum, mean, and standard deviation of the SUVs for each ROI. Numerical tolerances were defined for each metric, and the fraction of reported values within the tolerance was recorded, as was the mean, standard deviation, and range of the metrics.
  
  
  RESULTS
  The errors in reported maximum SUV ranged from -37.8% to 0% for an isolated voxel with 4.11:1 target-to-background activity level, and errors in the reported mean SUV ranged from -1.6% to 100% for a region with controlled noise. There was also a range of errors in the less commonly used metrics of minimum SUV and standard deviation SUV.
  
  
  CONCLUSIONS
  The variability of computed SUV(BW) between different software packages is substantial enough to warrant the introduction of a reference standard for medical image viewing workstations.
authors.affiliation: From the Department of Radiology, University of Washington, 1715 Columbia Road N, Portage Bay Building, Suite 222, Seattle, WA 98195-7987 (L.A.P., B.F.E., P.E.K.); PixelMed Publishing, Bangor, Pa (D.A.C.); and MiM Software, Cleveland, Ohio (D.N.).
authors.forename: Larry A
authors.initials: LA
authors.lastname: Pierce
authors.affiliation: From the Department of Radiology, University of Washington, 1715 Columbia Road N, Portage Bay Building, Suite 222, Seattle, WA 98195-7987 (L.A.P., B.F.E., P.E.K.); PixelMed Publishing, Bangor, Pa (D.A.C.); and MiM Software, Cleveland, Ohio (D.N.).
authors.forename: Brian F
authors.initials: BF
authors.lastname: Elston
authors.affiliation: From the Department of Radiology, University of Washington, 1715 Columbia Road N, Portage Bay Building, Suite 222, Seattle, WA 98195-7987 (L.A.P., B.F.E., P.E.K.); PixelMed Publishing, Bangor, Pa (D.A.C.); and MiM Software, Cleveland, Ohio (D.N.).
authors.forename: David A
authors.initials: DA
authors.lastname: Clunie
authors.affiliation: From the Department of Radiology, University of Washington, 1715 Columbia Road N, Portage Bay Building, Suite 222, Seattle, WA 98195-7987 (L.A.P., B.F.E., P.E.K.); PixelMed Publishing, Bangor, Pa (D.A.C.); and MiM Software, Cleveland, Ohio (D.N.).
authors.forename: Dennis
authors.initials: D
authors.lastname: Nelson
authors.affiliation: From the Department of Radiology, University of Washington, 1715 Columbia Road N, Portage Bay Building, Suite 222, Seattle, WA 98195-7987 (L.A.P., B.F.E., P.E.K.); PixelMed Publishing, Bangor, Pa (D.A.C.); and MiM Software, Cleveland, Ohio (D.N.).
authors.forename: Paul E
authors.initials: PE
authors.lastname: Kinahan
mesh_terms: D003198:Computer Simulation; D006801:Humans; D007089:Image Enhancement / Q000379:methods* / Q000592:standards; D007090:Image Interpretation, Computer-Assisted / Q000379:methods* / Q000592:standards; D019047:Phantoms, Imaging; D049268:Positron-Emission Tomography / Q000592:standards*; D011868:Radioisotopes / Q000493:pharmacokinetics*; D012016:Reference Values; D012984:Software
chemical_list: D011868:Radioisotopes