Imaging Instrumentation
Group 1 Report
19-21 November 2007
Dr Hideo Muruyama, Japan
Prof. Shengzu Chen, China
Dr Noriah Jamal, Malaysia
Assoc. Prof. Dr Rujaporn Chanachai, Thailand
Mr. Nguyen Manh Hung, Viet Nam

• On behalf of Prof. Dr Ahmad Zakaria and Group 1
members, Dr Muruyama will present on thesummary of the discussion for Guideline Notes
For Performance Evaluation Of PET/CT.
• Country reports were presented by 5 countries:
China, Japan, Malaysia, Thailand and Viet Nam.
• China: number of PET and PET/CT is increasing.
The current number is 100 and 65 cyclotron. The
QA and QC program of PET and PET/CT has
been carried out routinely and successfully.

• Japan: An example of practice on QC of PET andthe performance of the next generation prototype
PET, jPET-D4 were presented. Role of crosscalibration was emphasized to confirm theaccuracy of the performance.
• Thailand: The number of PET/CT is 4 and 2
cyclotron. Acceptance test of PET/CT was
performed according to NEMA NU-2 2001 and
AAPM 39, the results of the test were comparedwith the manufacture specifications. Such periodic
maintenance is important for QC of PET.

• Malaysia: Draft of Notes For Performance
Evaluation of PET/CT was presented for group
discussion. PET/CT draft has 2 parts PET and CT
with the total of 55 pages. The performance of PET
is based on NEMA NU- 2 2001 and CT is on
AAPM 39.
• Viet Nam: CT and SPECT are currently used, andthere is a plan to set up cyclotron and PET/CT
centre in Tran Hung Dao Hospital. The documents
of QC for SPECT and CT were issued by theGovernment. Activity of FNCA project is very
important.

Summary of Group 1 Report• A draft of PET/CT Performance Evaluation is proposed
based on the standard of NEMA NU-2 2001 for PET
and the Guideline of AAPM 39 for CT.
• Performance evaluation of PET has been put into
practice in FNCA countries according to the proposalof previous FNCA workshop.
• Periodic performance evaluation of PET was
confirmed to be of importance for QC.
• Cross calibration is an important practice with a pool
phantom and a dose calibrator.
• FNCA activity is useful for all the countries whichhave a plan to establish centre of PET/CT in the future.

Recommendations• Activity of FNCA should be increased to support
expert mission for workshop and site training
course for QA/QC of PET/CT.
• Copyrights of NEMA and AAPM should be takencare for the publication of the documents for
QC/QA.

FNCA 2007:
Workshop on Cyclotron andPositron Emission
Tomography (PET)in Medicine
20 Nov 2007
Kuala Lumpur. Malaysia.

GROUP 2

Group Members
Dato’ Dr. Rehir Dahalan (Malaysia)
 Dr. Zulkifli Mohd. Hashim (Malaysia)
 Mr. Syed Asraf Wafa
(Malaysia)
 Mr. Azahari Kasbollah (Malaysia) Ms. Siti Najila(Malaysia) Ms. Rasyieda Abdullah (Malaysia)
 Dr. Kazutoshi Suzuki(Japan) Mr. Takehiko Kato
(Japan) Mr. Yoshihito Kameda(Japan) Prof. Fan Wo(China) Mr. Jiranadai Saramkanan(Thailand)Planning &Implementation
 Radiation Safety(Design of Premises)- Malaysia
 Radionuclide Production(18F & 18F-FDG)- China & Thailand QA/QC of PETRadiopharmaceuticals(18F-FDG)- JapanActivity Planning First draft to be submitted to

Malaysia before 30th April2008.
 1 month to complete of review
and comments (to be submittedend of May 2008).

NO.
1

SUBJECTCONTENTS

Radiation Safety
1. Radiation Protection(Malaysia – leader)a. Documentations/records
Refer to ICRP/NRCP
b. Radiation exposure limit
or other
2. Radiation Safety Education
documentations
a. Syllabus
3. Design of premisesa. Layout – Concept layout(refer to Hospital Putrajaya(16 MeV), Wijaya
International Medical
Centre (11 MeV) & other
30 MeV cyclotron models.
b. Equipment and systemc. Shielding
d. Ventilatione. Radioactive waste
management

NO.

SUBJECT

1

Radiation Safety(Malaysia – leader)
Refer to ICRP/NRCP orother documentations

CONTENTS
4.

Control of radiation
exposurea. Control Exposure
i. Administration
ii. Technology
b. Monitoring of
exposurec. Control of radiation
exposure to publicd. Emergency response
5.
Health Physics
a. Requirement ofsafety officer [before and after
Flourine-18
production]b. During transferring
fluorine-18 tosynthesize FDG
modulec. Surface
contaminationNO.

SUBJECTCONTENTS

2

Flourine-18
production andsynthesize of FDG

1. General operatingprocedure
2. Operation of cyclotron
a. Checklist or inspection
before bombardment
b. Distribution of FDG
c. Maintenance of
Cyclotron

3

Quality Assurance
and Quality Control
of PET Radiopharmaceutical

1. Qualification of personnel
2. Documentation
3. Quality Control Criteria
a. Radionuclidic identity /purityb. Radiochemical identity/ purityc. Chemical purity
d. Specific activity
e. pH
f. Osmolarity
g. Stability
h. Filter Integrity
i. Residual solventQUALITY CONTROLCRITERIA FOR 18FFDG
 Remark: ONLY STERILITYTEST carry out after releasedof the drug. Other tests must
be done before drug released.

Quality
Control
Tests

Acceptance Frequency
Criteria
Of TestFrequency
Of TestGMP

Non-GMP

Every Batch

Every Batch

pH

Clear, colorlessor slightly
yellow
5.0-8.0

Every Batch

Every Batch

Radionuclidic
Identify

Half-life: 105 115 min

Every Batch

Every Batch

Radiochemical
Identify /Radiochemical
PurityKryptofix 222>95% (RadioTLC)

Every Batch

Every Batch<50 μg/mL

Every Batch

Every Batch

Residual
Solvents<0.04%
acetonitrile,<0.5% alcohol,<0.5% ether

Every Batch

Twice per year

AppearanceBacterial
Endotoxins

175 EU/V

Every Batch

Every Batch

Sterility

Meets the Test

Every Batch

Every Batch

Membrane>50 psiFilter Integrity

Every Batch

Not necessary

Radionuclidic
Purity>99.5% (511,1022 keV)

Not necessary Twice per year

Specific
Radioactivity

No carrier added Not necessary Not necessary

ClDG

-

(USP: <1.0
mg/V)

Not necessary Once a year

Aluminium Ion -(Japanese
Std: <10μg/mL)

Not necessary Not necessary

Osmolality

Not necessary Not necessary

TERIMA KASIHTHANK YOUFNCA 2007
Workshop on Applicationof Cyclotron
and PET in Medicine
19 – 21 November 2007

PET CLINICAL DIAGNOSISGROUP 3
PET CLINICAL DIAGNOSISWork plan members 2007
Dato' Dr Mohamed Ali Abdul Khader

MALAYSIA

Dr Fadzilah Hamzah

MALAYSIA

Ms Dang Yaping

CHINA

Dr Tomio INOUEJAPANDr Nobukazu TAKAHASHI

JAPAN

A.P Dr Pawana Pusuwan

THAILANDDr Jonas Francisco Santiago

PHILIPPINEDr Le Ngoc Ha

VIETNAMCOMPONENTS OF PROJECT

Theme: Publication of case review of clinical PET
Activity: Establishment of the FNCA Case Review
Database System for Clinical PET to Generate the
Educational Materials.
Target Outcome: Publication of Case Review of PET-CT
Clinical Cases in CD form.

Group Discussion
 Cases Presented:
 Japan: Thailand : Malaysia:
 Philipines:

2
5
9
1

 Others: Philippines

 China Japan Viet Nam: State of PET in Philippines: Study on “Application of PET/CT in Diagnosis
and Management of Lung Cancer ”: “Plan of Clinical Group in Japan”: “ Current status of PET and cyclotron
establishment in Viet Nam”

Data in Case Card of Case 1
Female 73 y.o.
 Chief complaint： no complaint Present and past history:
She had medical therapy for Rheumatoid arthritis (RA) at
small hospital near her house.
The doctor detected small coin lesion in her right upper lungby chest X-ray examination in May 2001. Confirmed diagnosis
can not be obtained by bronchoscopic examination.
She was admitted to the department of 1st surgery of
Yokohama City University hospital in October 2001.
Data in Case Card of Case 1
 Clinical examination:

Small coin lesion was detected in right S3 without LN
metastases by CT.
 Image findings and interpretation:
FDG did not accumulated in the small coin lesion in S3
detected in CT.
 Final diagnosis (confirmed diagnosis):
Lung Cancer (Well differentiated adenocarcinoma)(T1N0M0, Stage IA).

Pearls and Pitfalls:
FDG accumulation is low in well differentiated adenocarcinomaof the lung.
Teaching point:
Correlation was seen between FDG uptake and degree of celldifferentiation in adenocarcinoma of the lung.
References:






1.
2.

3.

4.

Higashi K J Nucl Med. 1998 Jun;39(6):1016-20
Nomori H. et al. Evaluation of F-18 fluorodeoxyglucose (FDG) PET
scanning for pulmonary nodules less than 3 cm in diameter, with specialreference to the CT images. Lung Cancer. 2004 Jul;45(1):19-27
Kim BT et al. Localized form of bronchioloalveolar carcinoma: FDG
PET findings. AJR Am J Roentgenol. 1998 Apr;170(4):935-9.
Nomori H. et al. Visual and semi quantitative analyses for F-18
fluorodeoxyglucose PET scanning in pulmonary nodules 1 cm to 3 cm
in size.Ann Thorac Surg. 2005 Mar;79(3):984-8

Contents of the Database
Case presentation
 Identification (Keyword for search engine)
Category (oncology/neurology, cardiology, infection,others)
System: Respiratory etc
Organ: lung etc
Diagnosis(ex. Lung cancer)
Date of examination
day/month( eg January)/ year
Tracer used:(ex. 18F FDG-PET)
Sex
Age Chief complaint Indication (diagnosis/staging/assessment oftherapy/restaging/others) Present and past history
 Clinical Examination
 Investigations

Contents of the Database Image findings and interpretation
 Final diagnosis (confirmed diagnosis)

 Additional comments or opinions
 Images:

PET or PET/CT images &Reference Images (CT, MRI,US) Teaching Point (including pearls and pitfalls)
 Cross references: eg artifact/normal variant
 References (max of 5)
 Contributor ( Hospital/Institutions, Country)

Work plan Input






Methodology:Two cases from each contributing country per month.
Sent to Malaysia in Jpeg format for images and Word Documentfor other information
Editing by Malaysia
Further input /comments from member countries.
First 2 cases from each member countries to be submitted on thelast week of December 2007, subsequently last week of every
month.

Target 100 cases by end of project.
No short form is used in the case note.
Informed consent : depends on the individual country.
Email address with security authorized code for security andconfidentiality purposes.

Topic

Cases

Artifacts

Physiological Variants, Artifacts and Pitfalls

Dental Caries

BreastHeart

Brain
Brown fat

Muscles
ThymusBowel hypermotility

Liver cyst

Achievements

Contributors