Best Practice NaF PET/CT Protocol for Multicenter Bone Imaging Trials

Objectives: The learning objectives of this exhibit are:

1. To introduce current NaF PET/CT protocol guidelines in multi-institutional bone imaging trials supported by IROC for the NCTN (National Clinical Trial Network).

2. To evaluate data compliance, quality assurance, protocol deviations, overall challenges and clinical review experience compared to trial protocol guidelines as well as compared to sites local standard of care NaF PET/CT imaging protocols.

3. To summarize the variability observed in NaF PET/CT imaging data sets received from trial participating sites in North-America.

4. To discuss and propose best practice NaF PET/CT protocol and its potential benefits and advantages serving for future multi-center NaF bone imaging clinical trials.

Methods: IROC serves as the imaging core lab for several clinical trials which use NaF PET imaging. In most trials, NaF PET/CT can be chosen as an alternate for Tc99m bone imaging and is performed as clinically reimbursable, standard of care imaging to monitor disease progression. We will review all aspects of standard of care NaF PET/CT imaging acquired from different sites. Using a standardized quality control (QC) process, we are able to pull key information from the DICOM tags of the submitted cases that are the used for the overall semi-automated QC process. Based on the variability observed within several multicenter oncological clinical trials, we have developed a recommended NaF protocol approach.

Results: The educational exhibit will draw on a multiyear experience that we have gained collected from multiple multi-center clinical trials that use NaF for assessment of bone metastasis and changes during therapy. We present an overview of variation in post injection time, dosage, consistency within uptake time, consistency with scanner, and arm position. We will highlight these variations and address how the NaF protocol should be structured based on our findings. Overall, we also want to encourage the use of lower NaF doses in clinical trials as well as the consistent imaging in regard to uptake time as current dosing recommendations and post injection imaging times are based on decade-old data and based on older PET equipment.

Conclusion: This exhibit will demonstrate and establish a refined approach for implementing appropriate NaF PET/CT acquisition protocols for multi-center clinical trials and the related quality assurance approaches. Research Support: NCI 5U24CA180803 (IROC), NCI U10CA180821 (Alliance)