Medical Radiology and Radiation Safety. 2023. Vol. 68. № 1

DOI: 10.33266/1024-6177-2023-68-1-78-85

A.V. Petryakova1,2, L.A. Chipiga1,3,4, M.S. Tlostanova3, A.A. Ivanova3,
D.A. Vazhenina3, A.A. Stanzhevsky3, D.V. Ryzhkova4, V.Yu. Sukhov5, I.V. Boikov6,
Yu.N. Priporova6, A.A. Balabanova7, D.V. Zakhs7, G.M. Mitusova2, E.M. Zykov8,
А.I. Pronin9, O.D. Ryzhova9

Method of Experts’ Quality Evaluation of the PET Images of the Patients

1P.V. Ramzaev Saint Petersburg Research Institute of Radiation Hygiene, Saint Petersburg, Russia

2Saint Petersburg Hospital No 40 of the Resort District, Saint Petersburg, Russia

3A.M. Granov Russian Research Center of Radiology and Surgical Technologies, Saint Petersburg, Russia

4V.A. Almazov National Medical Research Center, Saint Petersburg, Russia

5A.M. Nikiforov Russian Center of Emergency and Radiation Medicine, Saint Petersburg, Russia

6S.M. Kirov Military Medical Academy, Saint Petersburg, Russia

7N.P. Bechtereva Institute of Human Brain, Saint Petersburg, Russia

8Saint Petersburg Clinical Research Center of Specialized Type of Care (Oncology), Saint Petersburg, Russia

9N.N. Blokhin National Medical Research Center of Oncology, Moscow, Russia

Contact person: A.V. Petryakova



Purpose: To develop the method of experts’ quality evaluation of the PET images as an additional quality control method for accurate, comparable, and reproducible PET diagnostics results, and to conduct image quality evaluation in different PET departments used this method.

Material and methods: 60 PET images (without CT) of the patients who underwent whole body PET/CT with 18F-FDG were collected from 12 PET/CT scanners in 9 PET departments. Experts’ quality evaluation was conducted with questioning of the experts. Each expert evaluated the image quality by five-point scale and filled out the special form which include three image quality criteria: image clarity, artefacts, and general image quality. There were 28 experts from 8 different PET departments who have work experience in radiology from 1 to 32 years. The results of experts’ quality evaluation of the PET images were examined for correlations with parameters of acquisition and reconstruction protocols, examination methods. The results were also examined for dependance of subjective factors such as work experience and work conditions of experts. The minimum required number of experts were defined. The results were analyzed used statistical methods.

Results: The PET images obtained by 8 PET/CT scanners had mean quality value more than 4 points (good quality). PET/CT scanners, which had the lowest quality value, have the obsolete or unusual settings and reconstruction parameters. The correlations between experts’ quality evaluation of the PET images and acquisition parameters (acquisition time per bed, multiplication of injected activity and acquisition time per bed), and examination methods (injected activity and uptake time) were established. The results of experts’ quality evaluation of the PET images were dependent on work experience and work conditions of experts.

Conclusion: The method of experts’ quality evaluation of the PET images of the patients based on the questioning of the experts working in PET was developed and demonstrated in the current study. The results showed this method has the potential to compare the PET images obtained by different acquisition and reconstruction protocols, and it can be applied during the optimization of examination method and for the determination of obsolete and unusual settings of PET/CT. Experts’ evaluation of the PET images should include the opinion of at least six experts with different work experience in PET from several PET departments.

Key words: positron emission tomography, experts’ evaluation, diagnostics quality, image quality control

For citation: Petryakova AV, Chipiga LA, Tlostanova MS, Ivanova AA, Vazhenina DA, Stanzhevsky AA, Ryzhkova DV, Sukhov VYu, Boikov IV, Priporova YuN, Balabanova AA, Zakhs DV, Mitusova GM, Zykov EM, Pronin АI, Ryzhova OD. Method of Experts’ Quality Evaluation of the PET Images of the Patients. Medical Radiology and Radiation Safety. 2023;68(1):78–85. (In Russian). DOI: 10.33266/1024-6177-2023-68-1-78-85



1. Onishchenko G.G., Popova A.Yu., Romanovich I.K., Vodovatov A.V., Bashketova N.S., Istorik O.A., et al. Modern Principles of the Radiation Protection from Sources of Ionizing Radiation in Medicine. Part 1. Trends, Structure of x-Ray Diagnostics and Doses from Medical Exposure. Radiatsionnaya Gigiyena = Radiation Hygiene. 2019;12;1:6-24. DOI: 10.21514/1998-426X-2019-12-1-6-24 (In Russ.).

2. Boellaard R., Delgado-Bolton R., Oyen W.J., Giammarile F., Tatsch K., Eschner W., et al. FDG PET/CT: EANM Procedure Guidelines for Tumour Imaging: Version 2.0. Eur. J. Nucl. Med. Mol. Imaging. 2015;42;2:328-354. DOI: 10.1007/s00259-014-2961-x. 

3. Mansor S., Pfaehler E., Heijtel D., Lodge M.A., Boellaard R., Yaqub M. Impact of PET/CT System, Reconstruction Protocol, Data Analysis Method, and Repositioning on PET/CT Precision: An Experimental Evaluation Using an Oncology and Brain Phantom. Med. Phys. 2017;44;12:6413-6424. DOI: 10.1002/mp.12623. 

4. Chipiga L.A., Zvonova I.A., Ryzhkova D.V., Menkov M.A., Dolgushin M.B. Levels of Patients Exposure and a Potential for Optimization of The PET Diagnostics in the Russian Federation. Radiatsionnaya Gigiyena = Radiation Hygiene. 2017;10;4:31-43. DOI: 10.21514/1998-426X-2017-10-4-31-43 (In Russ.).

5. Hristova I., Boellaard R., Galette P., Shankar L.K., Liu Y., Stroobants S., et al. Guidelines for Quality Control of PET/CT Scans in a Multicenter Clinical Study. EJNMMI Phys. 2017;4;1:23. DOI: 10.1186/s40658-017-0190-7. 

6. De Jong E.E.C., van Elmpt W., Hoekstra O.S., Groen H.J.M., Smit E.F., Boellaard R., et al. Quality Assessment of Positron Emission Tomography Scans: Recommendations for Future Multicentre Trials. Acta Oncol. 2017;56;11:1459-1464. DOI: 10.1080/0284186X.2017.1346824. 

7. Schaefferkoetter J.D., Osman M., Townsend D.W. The Importance of Quality Control for Clinical PET Imaging. J. Nucl. Med. Technol. 2017;45;4:265-266. DOI: 10.2967/jnmt.117.198465. 

8. Chipiga L.A., Vodovatov A.V., Katayeva G.V., Ryzhkova D.V., Dolgushin M.B., Menkov M.A., et al. Proposals of Quality Assurance in Positron Emission Tomography in Russia. Meditsinskaya Fizika = Medical Physics. 2019;82;2:78–92 (In Russ.).

9. Inozemtsev K.O., Narkevich B.Ya., Menkov M.A., Dolgushin M.B. The Development of Quality Assurance Program for Combined PET/CT-scanner. Meditsinskaya Fizika = Medical Physics. 2013;57;1:65-77 (In Russ.).

10. Klimanov V.A. Yadernaya Meditsina. Radionuklidnaya Diagnostika = Nuclear Medicine. Radionuclide Diagnostics. Textbook. Moscow, Yurayt Publ., 2018. 307 p. (In Russ.).

11. Vinogradova Yu.N., Tlostanova M.S., Ivanova A.A., Pakhomov A.Yu., Ilin N.V. Methodological Aspects of Measuring Metabolic Tumor Volume in Patients with Diffuse B-Cell Large Cell Lymphoma by PET/CT with 18F-FDG. Onkologicheskiy Zhurnal: Luchevaya Diagnostika, Luchevaya Terapiya = Journal of Oncology: Diagnostic Radiology and Radiotherapy. 2021;4;4:28-39. DOI: 10.37174/2587 7593 2021 4 4 28-39
(In Russ.).

12. NEMA Standards Publication NU 2-2018: Performance Measurements of Positron Emission Tomographs (PETS). National Electrical Manufacturers Association (NEMA). Washington, 2018.

13. Kaalep A., Sera T., Oyen W., Krause B.J., Chiti A., Liu Y., et al. EANM/EARL FDG-PET/CT Accreditation - Summary Results from the First 200 Accredited Imaging Systems. Eur. J. Nucl. Med. Mol. Imaging. 2018;45;3:412-422. DOI: 10.1007/s00259-017-3853-7. 

14. Vodovatov A.V., Kamyshanskaya I.G., Drozdov A.A. New Approach for The Determination of The Standard Patient to Be Used for The Optimization of The Medical Exposure Protection. Radiatsionnaya Gigiyena = Radiation Hygiene. 2014;7;4:104-116 (In Russ.).

15. International Atomic Energy Agency. PET/CT Atlas on Quality Control and Image Artefacts. IAEA Human Health Series No. 27. Vienna: IAEA, 2014.

16. International Atomic Energy Agency. Standard Operating Procedures for PET/CT: a Practical Approach for Use in Adult Oncology. IAEA Human Health Series No. 26, Vienna: IAEA, 2013.

17. Messerli M., Stolzmann P., Egger-Sigg M., Trinckauf J., D’Aguanno S., Burger I.A., et al. Impact of a Bayesian Penalized Likelihood Reconstruction Algorithm on Image Quality in Novel Digital PET/CT: Clinical Implications for the Assessment of Lung Tumors. EJNMMI Phys. 2018;5;1:27. DOI: 10.1186/s40658-018-0223-x.

18. Sah B.R., Stolzmann P., Delso G., Wollenweber S.D., Hüllner M., Hakami Y.A., Queiroz M.A., et al. Clinical Evaluation of a Block Sequential Regularized Expectation Maximization Reconstruction Algorithm in 18F-FDG PET/CT Studies. Nucl. Med. Commun. 2017;38;1:57-66. DOI: 10.1097/MNM.0000000000000604.

19. Akamatsu G., Ishikawa K., Mitsumoto K., Taniguchi T., Ohya N., Baba S., et al. Improvement in PET/CT Image Quality with a Combination of Point-Spread Function and Time-of-Flight in Relation to Reconstruction Parameters. J. Nucl. Med. 2012;53;11:1716-1722. DOI: 10.2967/jnumed.112.103861. 

20. Van Sluis J., Boellaard R., Dierckx R.A.J.O., Stormezand G.N., Glaudemans A.W.J.M., Noordzij W. Image Quality and Activity Optimization in Oncologic 18F-FDG PET Using the Digital Biograph Vision PET/CT System. J. Nucl. Med. 2020;61;5:764-771. DOI: 10.2967/


 PDF (RUS) Full-text article (in Russian)


Conflict of interest. The authors declare no conflict of interest.

Financing. The study had no sponsorship.

Contribution. Article was prepared with equal participation of the authors.

Article received: 20.09.2022. Accepted for publication: 25.11.2022.