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SNM issues first procedure guideline for imaging cancer in adults and children with PET/CT

May Journal of Nuclear Medicine to publish landmark document for physicians, technologists in recommending, performing, interpreting, reporting results of 18F-FDG PET/CT

Society of Nuclear Medicine

Reston, Va.--The first procedure guideline for using positron emission tomography (PET) combined with computed tomography (CT) to image tumors in adults and children has been developed by SNM and will be published in the May issue of the Journal of Nuclear Medicine.

This landmark document, "Procedure Guideline for Tumor Imaging With 18F-FDG PET/CT 1.0," will assist molecular and nuclear imaging physicians and technologists "in recommending, performing, integrating and reporting the results of PET/CT imaging with the radiopharmaceutical 18F-fluorodeoxyglucose or FDG--all to the benefit of current and future patients," said SNM President Peter S. Conti, professor of radiology, clinical pharmacy and biomedical engineering at the University of Southern California, Los Angeles. "PET/CT will lead to improvements in the diagnosis and treatment of cancer and other diseases by providing more useful physiological and biochemical information than is available today and advancing research into molecular imaging," added Conti, who as SNM president represents more than 16,000 physician, technologist and scientist members. "It is critical for health care professionals to follow standardized PET/CT guidelines; it is key in providing consistent and quality patient care," said the director of the PET Imaging Science Center at USC's Keck School of Medicine.

"This 11-page document is an educational tool, identifying those elements that are most important in obtaining high-quality PET/CT images and interpretation," explained Dominique Delbeke, lead author of the article and the director of nuclear medicine and the PET Center at Vanderbilt University Medical Center in Nashville, Tenn. This guideline, approved by the society's board of directors Feb. 11 at its Mid-Winter Educational Symposium in Tempe, Ariz., covers patient preparation, image acquisition, interpretation criteria and quality control. "The article stresses the importance of establishing qualifications for physicians, technologists and medical physicists," added Delbeke.

PET and CT are standard imaging tools that can be used to pinpoint the location of cancer within the body. The highly sensitive PET detects the metabolic signal of actively growing cancer cells. When PET is used to image cancer, a radiopharmaceutical (such as FDG, which includes both a sugar and a radionuclide) is injected into a patient. Cancer cells metabolize sugar at higher rates than normal cells, and the radiopharmaceutical is thus drawn in higher concentrations to cancerous areas. A PET scan shows where the radiopharmaceutical is by tracking signals given off by the drug. CT is an X-ray procedure that generates a detailed view of internal anatomy. When these two results are fused together, they can reveal the size, shape and location of cancer cells with a high level of accuracy.

As discussed in the guideline, "Only appropriately trained, qualified physicians should interpret PET/CT images." The guideline includes a summary of PET/CT on-the-job training requirements for interpreting images that was developed by a collaborative working group and published in the July 2005 issue of JNM. Traditional training guidelines recommend a set number of continuing education credit and a set number of cases interpreted under supervision. However, alternative approaches such as determining the accuracy of each physician's interpretation compared to his or her peers using a workstation simulator and a report generation and scoring system may have equal or greater validity.

In addition, to be eligible for the recertification examination of the American Board of Nuclear Medicine, diplomates will need to participate in a maintenance of certification program and continue training in PET, CT and PET/CT image interpretation.

To help molecular and nuclear imaging professionals meet these guidelines and maintenance of certification for ABNM, SNM debuted its online maintenance of certification program, the Lifelong Learning and Self-Assessment Program, last year. SNM's LLSAP program offers Web-based self-assessment modules covering the recent developments in nuclear medicine and correlative imaging in a number of specialty fields and addresses such topics as the technical aspects and evaluation and treatment of patients using PET, CT, PET/CT, single photon emission tomography (SPECT), SPECT/CT and therapy with unsealed radioactive sources.


Besides Dominique Delbeke, co-authors of "Procedure Guidelines for Tumor Imaging With 18F-FDG PET/CT 1.0" include R. Edward Coleman, Milton J. Guiberteau, Manuel L. Brown, Henry D. Royal, Barry A. Siegel, David W. Townsend, Lincoln L. Berland, J. Anthony Parker, Karl Hubner, Michael G. Stabin, George Zubal, Marc Kachelriess, Valerie Cronin and Scott Holbrook.

The Journal of Nuclear Medicine article, "Procedure Guideline for Tumor Imaging With 18F-FDG PET/CT 1.0," is currently posted on SNM's Web site at (click on Practice Management, then Procedure Guidelines). To register or learn more about SNM's LLSAP program, please go online to To read "Concurrent PET/CT With an Integrated Imaging System: Intersociety Dialogue From the Joint Working Group of the American College of Radiology, the Society of Nuclear Medicine and the Society of Computed Body Tomography and Magnetic Resonance," published in the July 2005 issue of JNM, go online to

About SNM
SNM is an international scientific and professional organization of more than 16,000 members dedicated to promoting the science, technology and practical applications of molecular and nuclear imaging to diagnose, manage and treat diseases in women, men and children. Founded more than 50 years ago, SNM continues to train physicians, technologists, scientists, physicists, chemists and radiopharmacists in state-of-the-art imaging procedures and advances; provide essential resources for health care practitioners and patients; publish the most prominent peer-reviewed resource in the field; sponsor research grants, fellowships and awards; and host the premier annual meeting for medical imaging. SNM members have introduced--and continue to explore--biological and technological innovations in medicine that noninvasively investigate the molecular basis of diseases, benefiting countless generations of patients. SNM is based in Reston, Va.; additional information can be found online at

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