Abstract
2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is indicated in head-and-neck cancer for the initial workup when clinically indicated (e. g., large tumors, clinically positive neck, cervical adenopathy from an unknown primary, etc.), for the assessment of treatment response 12 weeks after completion of (chemo)radiotherapy, and during follow-up when there is suspicion of relapse. The successful implementation of FDG-PET/CT in routine clinical practice requires an in-depth understanding of the recent advances in physics and engineering that have significantly improved the imaging capabilities of PET/CT scanners (e.g., digital silicon photomultipliers, point-spread function modeling, and time-of-flight, and Bayesian penalized likelihood reconstruction). Moreover, a coordinated harmonization effort from professional societies (e.g., EANM) and international bodies (e.g., IAEA) has resulted in the creation of quality assurance frameworks (e.g., QUANUM, EARL, GMP) and guidelines that collectively cover the entire spectrum from tracer production, hardware calibration, patient preparation, and scan acquisition, to image interpretation (e.g., PERCIST, Hopkins criteria). The ultimate goal is to standardize the PET/CT technique and to guarantee accurate and reproducible imaging results for every patient. This review summarizes the recent technical breakthroughs in PET/CT scan design and describes the existing quality assessment frameworks with a focus on applications in head-and-neck cancer. Strict adherence to these harmonization efforts will enable leveraging the full potential of PET/CT and translate the proven benefits of this technique into tangible improvements in outcome for patients with head-and-neck cancer in routine clinical care.
Highlights
INTRODUCTION2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is a hybrid functional imaging technique that visualizes tumor glucose metabolism
A best evidence review was performed by searching the PubMed database for English language publications indexed up to August 2019 using the keywords “positron emission tomography,” “PET,” “quality,” “harmonization,” and “FDG.” The abstracts of all 94 results were screened to identify publications addressing the technical basis supporting the need for harmonization, existing frameworks to perform standardized FDG-PET/CT imaging, and clinical data illustrating the impact of the use of these guidelines on reporting outcomes
Combined with a desire to move to more quantitative image analysis, it has become apparent that rigorous quality assurance is required spanning the entire workflow from tracer synthesis to patient preparation, image acquisition and reconstruction, and interpretation
Summary
2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is a hybrid functional imaging technique that visualizes tumor glucose metabolism. A thorough understanding of these potential pitfalls is increasingly important to avoid erroneous interpretation and conclusions This is apparent in the setting of multicenter imaging trials, where patients are scanned across many sites using various scanners [2,3,4]. A broader initiative to develop quality management in nuclear medicine has contributed to improving the standard of care. The aim of this narrative review is to highlight the various quality measures that exist today, focusing on the use of FDGPET/CT in head-and-neck cancer. This text is not intended to be exhaustive or a detailed recipe for highquality FDG-PET/CT imaging, but rather a gentle introduction to the underlying critical concepts and frameworks
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