International EANM-SNMMI-ISMRM consensus recommendation for PET/MRI in oncology

Abstract

Preamble The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The merged International Society for Magnetic Resonance in Medicine (ISMRM) is an international, nonprofit, scientific association whose purpose is to promote communication, research, development, and applications in the field of magnetic resonance in medicine and biology and other related topics and to develop and provide channels and facilities for continuing education in the field.The ISMRM was founded in 1994 through the merger of the Society of Magnetic Resonance in Medicine and the Society of Magnetic Resonance Imaging. SNMMI, ISMRM, and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine and/or magnetic resonance imaging. The SNMMI, ISMRM, and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and/or magnetic resonance imaging and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the SNMMI/EANM/ISMRM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI, ISMRM, and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging and magnetic resonance imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the SNMMI, the ISMRM, and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.

Guardians of precision: advancing radiation protection, safety, and quality systems in nuclear medicine

“…This not provides the reliability of results across different centers which subsequently fortifies the trust in nuclear medicine’s diagnostic and therapeutic potential [ 8 ]. International guidelines and procedure standards produced by the main scientific associations are regularly updated and are key in the advancement in research and clinical applications in the field [ 7 , 9 – 14 ]. Collaboration between all the stakeholders is necessary for integrating patient care, an example being the recommendations for multidisciplinary care of cancer patients, in which nuclear medicine has a relevant role [ 15 – 21 ].…”

Leveraging Programmatic Collaboration for a Radiopharmaceutical Clinic

“…As clinically indicated for PET/MRI imaging, medications like furosemide for bladder lesions, gadolinium contrast like for neuroendocrine liver lesions, or changes in organ-specific protocols like a small field of view for pelvic tumors, augment these protocols. Our thoughts on these issues were developed from relevant guidelines [15][16][17][18][19][20].…”

PET/MRI and Novel Targets for Breast Cancer

“…The first fully integrated PET/MRI system was designed with an APD-based PET system [8]. However, the limited timing resolution of the APDs did not allow the time of flight (TOF) measurement, a capability available in PMT-based PET detector systems in modern PET/CT [9]. Subsequently, a TOF-capable fully integrated PET/MRI system was developed using SiPMs as light detectors [10].…”