Multicenter survey of PET/CT protocol parameters that affect standardized uptake values

Clinical trials that evaluate cancer treatments may benefit from positron emission tomography (PET) imaging, which for many cancers can discriminate between effective and ineffective treatments. However, the image metrics used to quantify disease and evaluate treatment may be biased by many factors related to clinical protocols and PET system settings, many of which are site- and/or manufacturer-specific. An observational study was conducted using two surveys that were designed to record key sources of bias and variability in PET imaging. These were distributed to hospitals across the United States. The first round of surveys was designed and distributed by the American College of Radiology's Centers of Quantitative Imaging Excellence program in 2011. The second survey expanded on the first and was completed by the National Cancer Institute's Quantitative Imaging Network. Sixty-three sites responded to the first survey and 36 to the second. Key imaging parameters varied across participating sites. The range of reported methods for image acquisition and reconstruction suggests that signal biases are not matched between sites. Patient preparation was also inconsistent, potentially contributing additional variability. For multicenter clinical trials, efforts to control biases through standardization of imaging procedures should precede patient measurements.