FDG PET/CT

FDG-PET/CT Technical CommitteeBreakout 081204

Regular meetings of working groups with RSNA administrative support and milestones for delivery during 2009

Regular “SNM cross-over” each TC tcon

Communication of recommendations to vendors with reasonable expectation of implementation timeframe

Expanded list of co-variates

New Profiles

•QC

•Export standards (RIC, cross-check, Bresolin)

•De-identification irrespective of medium (DICOM cross-check)

•Trials and service apps (public & private label & access)

•Performance elements and standards (Yap)

Monitoring Rx Benefit = Individualized MedicineConvergence of Biomarkers and Diagnostics

H/o Commercial Dx

Individuals - thresholds

Categorical, staging

Workflow/# studies

Binary – choice of Rx

Biomarkers become Dx

Population means, s

Continuous, quantitative

Automation/bias

Longitudinal – monitor Rx

Quantifying the effects of drugs in developmentmay beg access to biomarkers as diagnostics

Quantitative Imaging

Are we there yet?

Tumor Tracking ApplicationSimplifying cancer patient management

Compare, analyze, and track tumor progression with up to six sequential PET/CT studies

SUV-based semi -automatic tumor segmentation

Measurement of changes in tumor volume and metabolic activity

Export tables and graphs or 3D contours

Reality Today with Siemens syngo TrueD

Visualization3 Time Points DisplayMIP TriangulationGating Support

Quantification2D/3D Iso-Contouring1-Click SUVmaxRT Structure Export

TrendingTrending ChartsVOI PropagationDeformable Registration

Innovation is in our genes.

6 Siemens Medical Solutions Molecular Imaging

Longitudinal Quantificationin Hybrid Imaging

1. Automatic co-registration of multiple studies

2. Automatic segmentation of VOI based on % or SUV

3. CT or PET-guided lesion definition

Timepoint 3 Timepoint 2 Timepoint 1

Compare tumors across any number of time points for multiple modalities

Gradient-based PET segmentation for more accurate tumor volumes and statistics

Export statistics for sharing with referring physicians

Accurate registration allows the same region to be compared

Difference images highlight variable tumor response

Therapy Response

Assessment

www.mimvista.com

Automatically register serial studies for longitudinal accuracy

Automatically segment and propagate ROIs for efficiency and robustness

Quantify serial changes with a comprehensive set of metrics (SUV, Total Lesion Glycolysis, Functional Volume) and present in tabulated and graphical form

Export tabulated data for easy utilization in 3rd party analysis routines

GE PET VCAR…Powerful Longitudinal Analysis

FDG-PET/CT Technical CommitteeAim

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 measures by FDG-PET/CT, with

•clinical relevance and known sigma.

System and protocol

character-ization

SUV quantitation

and ROIcomputation

Covariates,data/version

tracking,verification

Digital referenceo

bject

Serial and multi-center SUV measurements

SUV change analysis

Profile claims

Profile detail specification

Precursor specifications

Pattern for PET SUV Measurements as a Biomarker

PET SUVs as a target- and mechanism-specific biomarker of responseA. Drug development; Business decisionsB. Drug development; Regulatory decisionsC. Patient monitoring; Individualization of therapy

Patient variability and effect

size

Uses:

FDG-PETCT Technical Committee Subcommittee Topics [chair]

Quantitation Computation [David Clunie]

Digital Reference Objects – Images [Paul Kinahan]

Covariates rationale (Normalization) [Yuying Hwang]

RoI Definition (and then Adoption) [Tim Turkington]

Subcomm

ittee sl

ides delete

d for s

ake of

file size

need updating to

curre

nt sta

tus

Milestones Horizon/PET-CTBeyond RSNA’08

Quantitation Computation

Documentation of terms

RSNA ‘08

RSNA ‘09

RSNA ’10 and onFeasi

bili

tyH

, M

, L

Valu

eH

, M

, L

Pri

ori

tyH

, 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

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)

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.

FDG PET/CT