Kevin J. Donohoe

FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0

The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.

Consensus recommendations for gastric emptying scintigraphy: A joint report of the American neurogastroenterology and motility society and the society of nuclear medicine

This consensus statement from the members of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine recommends a standardized method for measuring gastric emptying (GE) by scintigraphy. A low-fat, egg-white meal with imaging at 0, 1, 2, and 4 h after meal ingestion, as described by a published multicenter protocol, provides standardized information about normal and delayed GE. Adoption of this standardized protocol will resolve the lack of uniformity of testing, add reliability and credibility to the results, and improve the clinical utility of the GE test.

Appropriate use criteria for amyloid PET: A report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer's Association

Positron emission tomography (PET) of brain amyloid β is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. To provide guidance to dementia care practitioners, patients, and caregivers, the Alzheimers Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be used appropriately. Peer‐reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. Although empirical evidence of impact on clinical outcomes is not yet available, a set of specific appropriate use criteria (AUC) were agreed on that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient‐centered outcomes.

EANM/SNMMI Guideline for 18F-FDG Use in Inflammation and Infection

1Department of Nuclear Medicine, Universite Catholique de Louvain, Brussels, Belgium; 2Department of Nuclear Medicine, Cambridge Biomedical Campus, Cambridge, United Kingdom; 3Nuclear Medicine, Istituto Clinico Humanitas, Milan, Italy; 4Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah; 5Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; 6Department of Nuclear Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts; 7Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; 8Nuclear Medicine Department, Hospital Universitario de Bellvitge, Barcelona, Spain; and 9Nuclear Medicine Unit, Faculty of Medicine and Psychology, University “Sapienza,” Rome, Italy

Appropriate use criteria for amyloid PET: A report of the Amyloid Imaging Task Force, the Society of Nuclear Medicine and Molecular Imaging, and the Alzheimer’s Association

Positron emission tomography (PET) of brain amyloid β is a technology that is becoming more available, but its clinical utility in medical practice requires careful definition. To provide guidance to dementia care practitioners, patients, and caregivers, the Alzheimer’s Association and the Society of Nuclear Medicine and Molecular Imaging convened the Amyloid Imaging Taskforce (AIT). The AIT considered a broad range of specific clinical scenarios in which amyloid PET could potentially be used appropriately. Peer-reviewed, published literature was searched to ascertain available evidence relevant to these scenarios, and the AIT developed a consensus of expert opinion. Although empirical evidence of impact on clinical outcomes is not yet available, a set of specific appropriate use criteria (AUC) were agreed on that define the types of patients and clinical circumstances in which amyloid PET could be used. Both appropriate and inappropriate uses were considered and formulated, and are reported and discussed here. Because both dementia care and amyloid PET technology are in active development, these AUC will require periodic reassessment. Future research directions are also outlined, including diagnostic utility and patient-centered outcomes.

Consensus Recommendations for Gastric Emptying Scintigraphy: A Joint Report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine

This consensus statement from the members of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine recommends a standardized method for measuring gastric emptying (GE) by scintigraphy. A low-fat, egg-white meal with imaging at 0, 1, 2, and 4 h after meal ingestion, as described by a published multicenter protocol, provides standardized information about normal and delayed GE. Adoption of this standardized protocol will resolve the lack of uniformity of testing, add reliability and credibility to the results, and improve the clinical utility of the GE test.

Procedure Guideline for Diuretic Renography in Children 3.0

Hydronephrosis (distension of the pelvicalyceal system) is one of the most common indications for radionuclide evaluation of the kidneys in pediatrie patients. The etiology of the hydronephrosis can be an obstructed renal pelvis, an obstructed ureter, vesicoureteral reflux, the bladder itself or the bladder outlet, infection or congenital in nature. Contrast intravenous urography, ultrasonography and con ventional radionuclide renography cannot reliably differentiate obstructive from nonobstructive causes of hydronephrosis and hydroureteronephrosis (distension of the pelvicalyceal system and ureter). The pressure perfusion study (Whitaker test), which mea sures collecting system pressure under conditions of increased pelvic infusion is relatively invasive. The evaluation of function in the presence of obstruction does not give reliable indication of potential for recovery following surgical correction. High pressure in the collecting system results in reduction of renal blood flow and function. The most common cause of unilateral obstruction is the presence of a ureteropelvic obstruction. Obstructions can also occur more distally at the ureterovesical junction. Bilateral hydronephrosis can be produced by posterior urethral valves, bilateral ureteropelvic obstructions or even a full bladder. The purpose of diuretic renography is to differentiate a true obstruction from a dilated nonobstructed system (stasis) by serial imaging after intravenous administration of furosemide (Lasix).

Update on Appropriate Use Criteria for Amyloid PET Imaging: Dementia Experts, Mild Cognitive Impairment, and Education

Amyloid PET imaging is a novel diagnostic test that can detect in living humans one of the two defining pathologic lesions of Alzheimer disease, amyloid-β deposition in the brain. The Amyloid Imaging Task Force of the Alzheimer’s Association and Society for Nuclear Medicine and Molecular Imaging previously published appropriate use criteria for amyloid PET as an important tool for increasing the certainty of a diagnosis of Alzheimer disease in specific patient populations. Here, the task force further clarifies and expands 3 topics discussed in the original paper: first, defining dementia experts and their use of proper documentation to demonstrate the medical necessity of an amyloid PET scan; second, identifying a specific subset of individuals with mild cognitive impairment for whom an amyloid PET scan is appropriate; and finally, developing educational programs to increase awareness of the amyloid PET appropriate use criteria and providing instructions on how this test should be used in the clinical decision-making process.

Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 3.0

I. PURPOSE The purpose of this guideline is to assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of gastric-emptying and motility studies in adults. II. BACKGROUND INFORMATION AND DEFINITIONS Radionuclide studies of gastric emptying and motility are the most comprehensive and physiologic studies of gastric motor function available. The studies are noninvasive, use a physiologic meal (solids with or without liquids), and are quantitative. Serial testing can determine the effectiveness of therapy. The Society of Nuclear Medicine (SNM) and the American Neurogastroenterological and Motility Society have recently agreed on a standard meal and a standard imaging protocol for measurement of gastric emptying. The recommended meal is intended to simplify and standardize the methodology and reference values based on a large, multiinstitutional investigation of 123 healthy subjects. This standardization will alleviate the problem of comparing results between institutions that did not use the same meal or imaging protocol. The detailed recommendations for the recommended meal and the imaging protocol can be found in the paper by Abell et al. listed in the bibliography of this guideline.

Update on appropriate use criteria for amyloid PET imaging: dementia experts, mild cognitive impairment, and education. Amyloid Imaging Task Force of the Alzheimer’s Association and Society for Nuclear Medicine and Molecular Imaging.

Amyloid PET imaging is a novel diagnostic test that can detect in living humans one of the two defining pathologic lesions of Alzheimer disease, amyloid‐β deposition in the brain. The Amyloid Imaging Task Force of the Alzheimers Association and Society for Nuclear Medicine and Molecular Imaging previously published appropriate use criteria for amyloid PET as an important tool for increasing the certainty of a diagnosis of Alzheimer disease in specific patient populations. Here, the task force further clarifies and expands 3 topics discussed in the original paper: first, defining dementia experts and their use of proper documentation to demonstrate the medical necessity of an amyloid PET scan; second, identifying a specific subset of individuals with mild cognitive impairment for whom an amyloid PET scan is appropriate; and finally, developing educational programs to increase awareness of the amyloid PET appropriate use criteria and providing instructions on how this test should be used in the clinical decision‐making process.