Standardization and quality control in PET imaging: Advances, challenges, and clinical implications

Positron emission tomography (PET) has transformed diagnostic imaging and therapeutic monitoring by enabling quantitative assessment of molecular processes in vivo. However, reliable use of standardized uptake values (SUVs) and other PET-derived biomarkers requires strict quality assurance (QA), harmonization, and continuous performance monitoring. This review summarizes recent advances in PET harmonization strategies, international quality control (QC) guidelines, and performance evaluation of next-generation digital PET/CT systems, with special focus on the uMI 550 and uMI 780 platforms.

SUV variability remains a major challenge in PET quantification, affecting the consistency and reliability of results across different scans and systems. One promising innovation to address quality control issues is sourceless QC using intrinsic ¹⁷⁶Lu activity, which offers a more convenient and potentially robust alternative to traditional methods. Additionally, harmonization strategies play a crucial role in improving reproducibility, helping to standardize measurements and reduce variability across different imaging centers and protocols.

This review highlights technological innovations such as silicon photomultiplier (SiPM) detectors, non-radioactive QC methods, and phantom-based harmonization tools, emphasizing their clinical relevance for multicenter studies, precision oncology, and routine practice.

Adoption of advanced systems enables dose reduction, shorter scan times, and improved image quality, benefiting both patients and workflow. Implementing intrinsic detector-based QC methods can reduce staff workload, radiation exposure, and reliance on external calibration sources.