Kiosk Content

FDG PET/CT

Draft 3

FDG-PET/CT Technical CommitteeAims and Objectives

Five specific objectives were identified as having value and feasibility;

1)      Enable tracking of software versions.

2)      Identify clinically significant covariates in the quantitation of FDG signal and recommend recording and normalization.

3)      Compare the various vendors’ computations for quantitation and make recommendations to ensure any patient’s images would yield the same numbers irrespective of vendor.

4)      Define the parameters for automated setting of regions of interest.

5)      Develop a Digital Reference Object (image db) for quality control

The aim of the QIBA FDG-PET/CT Technical Committee is to foster adoption of pragmatic and

cost-effective standards for accurate and reproducible quantitation of tumor metabolism via longitudinal measurements by FDG-PET/CT, with

clinical relevance and known sigma.

FDG-PET/CT Technical CommitteeAchievements and Next Steps

As an example, sub-team #5 (Digital Reference Standard) has

a) acquired images of a single reference phantom from multiple vendors’ scanners,

b) compared the DICOM header information,

c) harmonized the standard with the AAPM/SNM Task Group 146.

Next steps are to

1) agree with major vendors the procedure for distributing and beta-testing a digital image set,

2) test them on 3rd party review stations, and

3) initiate the IHE process for roll-out.

After delivery of this objective, the team will consider repeating these efforts using a db farther up the data stream, eg raw data.

FDG-PETCT Technical Committee Subcommittee Topics [chair]

Quantitation Computation [David Clunie]

Software version tracking [Daniel Gagnon]

Digital Reference Objects – Images [Paul Kinahan]

Covariates rationale (Normalization) [Yuying Hwang]

RoI Definition (and then Adoption) [Tim Turkington]

Editorial in follow-up to Maguire “needs”[Richard Frank]

* in some cases just enabling data capture & reporting

Milestones Horizon/PET-CTBeyond RSNA’08

Quantitation Computation

Documentation of terms

RSNA ‘08

RSNA ‘09

RSNA ’10 and onF

easi

bilit

yH

, M, L

Val

ueH

, M, L

Prio

rity

H, M

, L

High

Interoperability of

Results Encoding

Image Quality Metrics

Calibration Phantoms

Characterization Lo, Hi rads

RoI Definition*

Dynamic Range lesion size**

High

Medium

High

High

High

High

Quick Hits

High

High

High

High

High

High

*Adoption 2010-11, Defined in 2008

**Ideal Phantom 2010-11 Current phantom by 2008

Monitoring Rx Benefit = Individualized MedicineConvergence of Biomarkers and DiagnosticsH/o Commercial Dx

Individuals - thresholds

Categorical, staging

Workflow/# studies

Binary – choice of Rx

Biomarkers become Dx

Populations – means

Continuous, quantitative

Automation/bias

Longitudinal – Rx effectQuantifying the effects of drugs in development

may beg access to biomarkers as diagnostics

Version 10

Kiosk proposed content

• 1-Statement of Purpose

• 2-Main Subgroups

• 3-activities to date

• 4-Bulleted next steps (3-6)

Statement of PurposeFoster adoption of…•pragmatic and cost effective standards for

•accurate,

•reproducible, and

•longitudinal

•quantitation via FDG-PETCT of

•tumor metabolism

•with clinical relevance

•and known sigma

FDG-PETCT Technical Committee Subcommittees Progress to Date

Quantitation Computation [David Clunie]

* References

FDG-PETCT Technical Committee Subcommittees Progress to Date

Software version tracking [Daniel Gagnon]

* References

FDG-PETCT Technical Committee Subcommittees Progress to Date

Digital Reference Objects – Images [Paul Kinahan]

1. Collected PET/CT images of the same reference phantom from scanners from GE, Philips, Siemens

2. Image data is being collated and compared w.r.t. DICOM header information

3. Initiated [will do!] manufacturer-driven discussion on methods for distributing and testing a purely digital version of the reference phantom

4. Harmonized PET/CT reference standard with efforts of AAPM/SNM Task Group 145

• Next Steps:

• Test digital reference object (DRO) on 3rd party review stations

• Initiate IHE process for manufacturer-driven roll-out

• Explore potential for moving further up the data generation stream, i.e., closer to raw data

* References

FDG-PETCT Technical Committee Subcommittees Progress to Date

Covariates rationale (Normalization) [Yuying Hwang]

Subcommittee in development stage

* References

FDG-PETCT Technical Committee Subcommittees Progress to Date

RoI Definition (and then Adoption) [Tim Turkington]

* References

FDG-PETCT Technical Committee Subcommittees Progress to Date

Editorial in follow-up to Maguire1 [Richard Frank]

DONE2

1 Hallett WA, Maguire RP, McCarthy TJ, Schmidt ME, Young H. Considerations for generic oncology FDG-PET/CT protocol preparation in drug development. IDrugs, 2007 Nov; 10(11):791-6.

2 Quantitative Imaging Biomarkers Alliance FDG-PET/CT Working Group Report; Editorial [ http://www.springerlink.com/content/m4572700677q4732/ ]

FDG-PETCT Technical Committee Subcommittees Progress to Date

Quantitation Computation [David Clunie]

Software version tracking [Daniel Gagnon]

Digital Reference Objects – Images [Paul Kinahan]

Covariates rationale (Normalization) [Yuying Hwang]

RoI Definition (and then Adoption) [Tim Turkington]

Editorial in follow-up to Maguire “needs” [Richard Frank]

* References

Next Steps

Chairs convene working groups

Letter to editor in follow-up to Maguire “needs” article

Develop matrices

Identify commonalities within QIBA (eg RoI)

Identify adjacent players, stakeholders

Deliver goods

Report out during RSNA’08

Reprioritize remaining deliverables, eg “3D and iterative reconstruction has created a quagmire!”

QIBA

IRATS

AACR

ASCO

UPICT

NEMAMITA AAPM

ACRIN

AMISMI

FDANCI

PhRMA

EORTC

SNM

NIST

CDISCNCIA*

Appendices

Topic F V H Chair

Calibration Phantoms – Build and use

Step 1 Use Existing Phantoms

Image Quality Metrics

H M 2009

Step 2 Characterization appropos of

low, high radiation

Scanner

H H 2010-11

QC Patient/Image/Visit

?Repeat Scan

M H 2010-11

(Near term, Current practice)

Enhanced PET Object Adoption L M >2011

Minimum Measurable Lesion

Dynamic Range

Current Phantom, Ideal Phantom

H H 2009

Longitudinal Quantitation M 2010-11

Qualitative – New Lesion Threshold

ROI Definition

Draw boundary

H H 2008 (define)

2010-11 (adopt)

Turkington + vCT

Topic F V H Chair

Data Extraction

Analysis (in ROI)

1) Factors in Decision

2) Recommended Choice

H M 1) 2008

2) 2009

Digital Ref Object

Software Phantom

Reference Data Set

Version Tracking H H 2008 Gagnon-vendors

Image? Quantification H H 2008 Kinahan-SNM

Raw Data To Reconstruction

(Black Box)

M M 2010-11

Topic F V H Chair

Software Phantom Reference Data Set

Image ? Data ?

Covariates/Normalizations

Serum Glucose

LBM

1) Factors in rationale

2) Build normalization into products

1) H

2) H

H 1) 2008

2) 2010-11

MacGuire-send requests and will compile list

Quantitation Computation

Document Terms

H H 2008 Clunie

Inputs QC M M >2011

Interoperability

Results Encoding

H H 2009

Topic F V H Chair

Artifact

Contrast L L 2010-11

Prostheses L L 2010-11

Define Factors in Low vs. High Dose (RADS)

Define factors and rationale

Recommendations

Combination Scanning

RECIST & PET

H

L

H 2008

2010-11

Quantitative Imaging Biomarker Alliance FDG-PET/CT Working Group Report

RSNA News September 2008, Vol 18, No 9

Molecular Imaging and Biology1536-1632 (Print) 1860-2002 (Online)