Variations in Clinical PET/CT Operations: Results of an International Survey of Active PET/CT Users

This study gathered information about clinical PET/CT operations worldwide to help guide discussions on the use and standardization of clinical PET/CT. Methods: A Web-based survey of PET/CT users was initiated in November 2009 through e-mail advertising using Academy of Molecular Imaging databases. Recipients were asked 58 questions related to demographics (e. g., location, number of PET/CT systems, and staffing), PET/CT operations and use, and variations in F-18-FDG oncology imaging protocols. Results: The responders were from centers in the Americas (71%), Europe (22%), Asia-Pacific (6%), and Middle East (1%), with most responding sites representing public health care institutions (60%). PET/CT systems were most frequently installed in nuclear medicine departments (59%). Of the sites operating a PET/CT system, 16% had 10 y or more of stand-alone PET experience. About 40% of all sites operated at least 2 PET/CT systems. PET/CT was most frequently used for applications in torso or whole-body oncology (87%), radiation therapy planning (4%), cardiology (4%), and neurology (5%). The average interval of fasting before an F-18-FDG PET/CT examination was 7 +/- 3 h (range, 4-12 h). Blood glucose levels were measured at 99% of sites, but acceptable maximal glucose levels varied substantially (an upper limit of 200 mg/dL was applied at >50% of the institutions). A weight-based radioactivity dose injection was performed at 44% of sites. The mean F-18-FDG activity injected was 390 MBq (range, 110-585 MBq) for 3-dimensional PET of a 75-kg patient. The mean uptake time was 64 +/- 14 min (range, 20-90 min). Split protocols involving patient repositioning and adapted imaging parameters were used at 51% of sites. Only 41% used patient positioning aids. Intravenous or oral CT contrast material was used at 52% of sites in up to 25% of patients. Most sites (90%) measured maximum standardized uptake value as an index of tissue glucose use. Only 62% of sites provided a fully integrated PET/CT report. Conclusion: An international survey among clinical PET/CT users revealed significant variations in standard F-18-FDG PET/CT protocols. This finding illustrates the need for continuous training and ongoing standardization in an effort to optimize PET/CT in oncology.