SUVreproducibilityondifferentreportingplatforms

DJTowey,ImperialCollege/NorthamptonGeneralJTaylor,SheffieldteachingHospitalNHSTrust

JCullis,UniversityHospitalsCoventryandWarwickshireNHSTrustMBarnfield,LeedsTeachingHospitalsNHsTrust

SCade,RoyalunitedHospitalsBathKCarson,StLuke’sHospitalDublin

DHall,BristolRoyalInfirmaryBKenny,LinkMedicalLtd

EO’Shaughnessy,PooleHospitalNHSFoundationTrustDWhite,BarnsleyHospital

AWMurray,SheffieldteachingHospitalNHSTrustIPEMNMSoftwareQualityGroup

𝑆𝑈𝑉 = %&/()*%&/*+

• SUVmax =maximuminROI/image- sensitivetonoise• SUVmean=averageinROI/VOI- sensitivetoROI/VOIsize• SUVpeak=averageinstandardsizedVOI• OtherscalingfactorsSUV: ScaledtoLeanBodyMass,BSA,

glucose

WhatisSUV?Imagedata

Patientweight

Injectedactivity

• ToauditNM/PETreportingsoftwareinthefollowingareas:– Testoforientation/alignment– SUVconsistency(usingSUV-maxnooperatorvariability)

– Transverse=Sagittal=Coronal– DoesincludingaCTmakeanydifference?– EffectofCTslicethickness

Aims

• ThreephantomsscannedonthreeclinicalPET-CTscannerstotalof12datasets

Method

Method

Auditpasscriteria• Orientation– knownfromacquisition• SUVconsistency:– Use‘mode’ofresultsasgoldstandard– ManuallycalculatedSUVmax usingDICOMtagsonly

• Differentlevelsofquotedprecision(1-5decimalplaces)androundingerrors/differences– Quotedprecisionor1%,Whichevergreaterasallowederror

Vendor Softwarepackage Notes

GE Volumetrix forXeleris 2 Useoriginalor UseDisplayedoptions

GE Volumetrix forXeleris 3 Useoriginalor UseDisplayedoptions

GE AW(AdvantageWorkstation) V4.6

Hermes Volumefusion Unixbased

Hermes HybridViewer MS-Windowsbased

MIM MIM

MIRADA XDAdvanced

Osirix Osirix Only ‘research’versionstestedFDAapprovedversionalso

available

Reporting/analysisplatforms

Vendor Softwarepackage Notes

Philips EBW Multiple versionstested

Siemens TrueD Onreportingworkstations

Siemens 3dViewer Onacquisitionstations

Siemens MSviewer

Siemens Syngo-Via (resultsfromManufacturer)

FusionViewer Onlyquotes pixelvalues

ImageJ Onlyquotes pixelvalues

MiPAV Onlyquotespixelvalues

Reporting/analysisplatforms

Results• Allsoftwareinterpretedtheorientationtagscorrectly– OSIRIXdidn’tautomaticallygointo‘radiographicorientation’butdidlabelcorrectly

Results– SUVconsistency

DisplayedImage OriginalDataRawdata~50x50pixels

GEHealthcare• GE- AdvantageWindows(GE-AWworkstation)

– Dataimportedcorrectlyandresultsmatched

• GE- Volumetrix forXeleris 2/Xeleris 3– UseoriginaldatavsUsedisplayeddata

• ‘Originaldata’givescorrectresultonTransversesliceonly• ‘Displayeddata’hasbeeninterpolatedandthereforedoesnotmatchtheothervendors

– Userpromptedforinputfornon-GEdata• Injectiondate&time,residueactivitydate&time,forSiemensandPhilipsdata

• Notabletoreplicatetheproblemloadingnon-GEdata• TheVolumetrixmanualstatesthatquantitativedatashould

betakenfromtransverseslicesonly• TheyrecommendusingthededicatedAWworkstationsfor

quantitativeanalysis

HermesMedicalSolutions• HermesHybridDisplay

– Dataimportedcorrectlyandresultsmatched

• Volumefusiondisplay– Lastupdated2008,availableonmostHermesinstallations– WhenjustPETdataloaded- valuesfromTransverseslicesarecorrect– Sagittalandcoronalvaluesarealwaysdifferent– WhenPETandCTloadedtogetherSUVresultsdecrease

“CalculationofSUVmaxInordertoimprovethequantitativeaccuracy,thecalculationofSUVmax inHermesisderivedfromtheoriginalvoxelsofthePETdata.Thecalculationisindependentofanymanipulationusedfordisplaypurposes:nomatterwhatmanipulationisusedfordisplay,theoriginalvoxeldataisalwaysusedfortheSUVmax calculation.ThisimprovedmethodisimplementedinHermesHybridViewer™,whichreplacedtheHermesClassicapplicationVolumeDisplay.VolumeDisplayisnolongercurrentproductandisbeingphasedout.ThecalculationthereforediffersbetweenHybridViewerandVolumeDisplay,andthisdifferenceisexplicitlydescribedintherespectiveusermanualsfortheseapplications.“

JoakimArwidson,QualityManager

MIMDataimportedcorrectlyandresultsmatched

Mirada- XDDataimportedcorrectlyandresultsmatched

OSIRIXDataimportedcorrectlyandresultsmatchedNotautomaticallyinradiographicmode

Philips- EBW• ResultstestedonthreeinstallationsofEBWsoftware• Allthreegavedifferentresults• 2Dand3Dviewingoptions• 2Dand3Dtools

• “Itlooksliketheusershaveusedthe2DROImeasurementtoolsontheEBW-NMtochecktheSUVvalues.

• Whendoingabsolutecomparisonswerecommendusingthe2Dlayoutwhichdisplaystheoriginaltransaxial data(thisisdocumented).

• AlternativelyIwouldalwaysrecommendusingoneofour3DROImeasurementtoolsforlookingatSUVvaluestheseobtaintheirvaluesfromtheoriginalslicedataratherthantheresampledslicestheyareplacedin”

JoeGlenon,Philips

SiemensHealthcare• TrueD

– Dataimportedcorrectlyandresultsmatched

• MSViewer– Dataimportedcorrectlyandresultsmatched

• (Syngo-Via- Manufacturersresults)– Dataimportedcorrectlyandresultsmatched

• 3DViewer– Basicsoftwareavailableonmany(?all)PETacquisitionworkstations– DisplaysimagesasPET,Fusedandinregistrationpanels/windows-

Differentresultsineachpanel

Siemens– 3dviewer

• SUVmax =1.9004or1.8740or1.7443?• SUVmax moderesult=1.96

• “the3DViewerisnotdesignedforsuchquantification,itisonlyaquickviewingtool.ApplicationslikeTrueD orsyngo.via (MMOncology)aretheonestouseforquantificationofPETimagedata.

• Onthe3DViewer,thequantificationisderivedfromthescreenpixelinterpolatedimageratherthanthestoredimage.Thatwouldexplainalsowhythevaluesdifferwhencalculatedfromthenativeimageandfromthefusedviewsasthepixelinterpolationprocessisdifferent.Thisapplicationwasdesignedforquickreview.”

JeromeDeclerck,Siemens

Summaryofresults• Allmanufactureshavealeastonepieceofsoftwarethatcangivetherightanswer

• ThethreescannermanufacturesandHermesallhaveatleastonepieceofsoftwarethatcangivethewronganswer(butmostmention‘differences’inthemanuals)

• Variationsof~24%seen(evenfromsamepieceofsoftware)

• Problemsarisingwhenquantitationisbeingdoneonresampled/interpolateddata

Beverycarefulhowyouuse:• GEvolumetrix• Hermesvolumedisplay• PhilipsEBW

Quantitativeresultsagreeonthefollowingsoftware:• GEAW• Hermes– hybriddisplay• MIM• MiradaXD• OsiriX• SiemensTrueD• SiemensMSviewer

Consideralternativesbeforeusing…• Siemens3Dviewer

Nextstages• PhantomimageswillsoonavailableonNMSQGwebsiteforlocaltesting

• SUV-peak,SUV-mean– Digitalphantomhasbeendevelopedandwillbeavailableshortly

Thanksto…..• Myco-authorsfromtheIPEMsoftwareSIG• LauraPerry– ImperialCollegeHealthcare• AllisonCraig- RoyalMarsden