PDF(Pubmed)
Abstract：
The goal of this guideline/procedure standard is to assist nuclear medicine physicians, other nuclear medicine professionals, oncologists or other medical specialists for recommended use of [18F]FDG PET/CT in oncological patients undergoing immunotherapy, with special focus on response assessment in solid tumors.
In a cooperative effort between the EANM, the SNMMI and the ANZSNM, clinical indications, recommended imaging procedures and reporting standards have been agreed upon and summarized in this joint guideline/procedure standard.
The field of immuno-oncology is rapidly evolving, and this guideline/procedure standard should not be seen as definitive, but rather as a guidance document standardizing the use and interpretation of [18F]FDG PET/CT during immunotherapy. Local variations to this guideline should be taken into consideration.
The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association founded in 1985 to facilitate worldwide communication among individuals pursuing clinical and academic excellence in nuclear medicine. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote science, technology and practical application of nuclear medicine. The Australian and New Zealand Society of Nuclear Medicine (ANZSNM), founded in 1969, represents the major professional society fostering the technical and professional development of nuclear medicine practice across Australia and New Zealand. It promotes excellence in the nuclear medicine profession through education, research and a commitment to the highest professional standards. EANM, SNMMI and ANZSNM members are physicians, technologists, physicists and scientists specialized in the research and clinical practice of nuclear medicine. All three societies will periodically put forth new standards/guidelines for nuclear medicine practice to help advance the science of nuclear medicine and improve service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each standard/guideline, representing a policy statement by the EANM/SNMMI/ANZSNM, has undergone a thorough consensus process, entailing extensive review. These societies recognize that the safe and effective use of diagnostic nuclear medicine imaging requires particular training and skills, as described in each document. These standards/guidelines are educational tools designed to assist practitioners in providing appropriate and effective nuclear medicine care for patients. These guidelines are consensus documents based on current knowledge. They are not intended to be inflexible rules or requirements of practice, nor should they be used to establish a legal standard of care. For these reasons and those set forth below, the EANM, SNMMI and ANZSNM caution against the use of these standards/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 medical professionals considering the unique circumstances of each case. Thus, there is no implication that an action differing from what is laid out in the guidelines/procedure standards, standing alone, is below standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/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/procedure standards. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible for general guidelines to consistently allow for an accurate diagnosis to be reached or a particular treatment response to be predicted. Therefore, it should be recognized that adherence to these standards/ guidelines will not ensure a successful outcome. All that should be expected is that practitioners follow a reasonable course of action, based on their level of training, current knowledge, clinical practice guidelines, available resources and the needs/context of the patient being treated. The sole purpose of these guidelines is to assist practitioners in achieving this objective. The present guideline/procedure standard was developed collaboratively by the EANM, the SNMMI and the ANZSNM, with the support of international experts in the field. They summarize also the views of the Oncology and Theranostics and the Inflammation and Infection Committees of the EANM, as well as the procedure standards committee of the SNMMI, and reflect recommendations for which the EANM and SNMMI cannot be held responsible. The recommendations should be taken into the context of good practice of nuclear medicine and do not substitute for national and international legal or regulatory provisions.
In a cooperative effort between the EANM, the SNMMI and the ANZSNM, clinical indications, recommended imaging procedures and reporting standards have been agreed upon and summarized in this joint guideline/procedure standard.
The field of immuno-oncology is rapidly evolving, and this guideline/procedure standard should not be seen as definitive, but rather as a guidance document standardizing the use and interpretation of [18F]FDG PET/CT during immunotherapy. Local variations to this guideline should be taken into consideration.
The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association founded in 1985 to facilitate worldwide communication among individuals pursuing clinical and academic excellence in nuclear medicine. The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote science, technology and practical application of nuclear medicine. The Australian and New Zealand Society of Nuclear Medicine (ANZSNM), founded in 1969, represents the major professional society fostering the technical and professional development of nuclear medicine practice across Australia and New Zealand. It promotes excellence in the nuclear medicine profession through education, research and a commitment to the highest professional standards. EANM, SNMMI and ANZSNM members are physicians, technologists, physicists and scientists specialized in the research and clinical practice of nuclear medicine. All three societies will periodically put forth new standards/guidelines for nuclear medicine practice to help advance the science of nuclear medicine and improve service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each standard/guideline, representing a policy statement by the EANM/SNMMI/ANZSNM, has undergone a thorough consensus process, entailing extensive review. These societies recognize that the safe and effective use of diagnostic nuclear medicine imaging requires particular training and skills, as described in each document. These standards/guidelines are educational tools designed to assist practitioners in providing appropriate and effective nuclear medicine care for patients. These guidelines are consensus documents based on current knowledge. They are not intended to be inflexible rules or requirements of practice, nor should they be used to establish a legal standard of care. For these reasons and those set forth below, the EANM, SNMMI and ANZSNM caution against the use of these standards/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 medical professionals considering the unique circumstances of each case. Thus, there is no implication that an action differing from what is laid out in the guidelines/procedure standards, standing alone, is below standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/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/procedure standards. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation and treatment of disease. The variety and complexity of human conditions make it impossible for general guidelines to consistently allow for an accurate diagnosis to be reached or a particular treatment response to be predicted. Therefore, it should be recognized that adherence to these standards/ guidelines will not ensure a successful outcome. All that should be expected is that practitioners follow a reasonable course of action, based on their level of training, current knowledge, clinical practice guidelines, available resources and the needs/context of the patient being treated. The sole purpose of these guidelines is to assist practitioners in achieving this objective. The present guideline/procedure standard was developed collaboratively by the EANM, the SNMMI and the ANZSNM, with the support of international experts in the field. They summarize also the views of the Oncology and Theranostics and the Inflammation and Infection Committees of the EANM, as well as the procedure standards committee of the SNMMI, and reflect recommendations for which the EANM and SNMMI cannot be held responsible. The recommendations should be taken into the context of good practice of nuclear medicine and do not substitute for national and international legal or regulatory provisions.
摘要：
本指南/程序标准的目标是帮助核医学医师，其他核医学专业人员，肿瘤学家或其他医学专家建议在接受免疫治疗的肿瘤患者中使用[18F]FDGPET/CT，特别关注实体瘤的反应评估。
在EANM之间的合作努力中，SNMMI和ANZSNM，临床适应症,推荐的成像程序和报告标准已在本联合指南/程序标准中达成一致和总结.
免疫肿瘤学领域正在迅速发展，本指南/程序标准不应被视为明确的，而是作为指导文件规范[18F]FDGPET/CT在免疫治疗过程中的使用和解释。应考虑本指南的局部差异。
欧洲核医学协会（EANM）是一个专业的非营利性医学协会，成立于1985年，旨在促进追求核医学临床和学术卓越的个人之间的全球交流。核医学与分子影像学会（SNMMI）是一个国际科学和专业组织，成立于1954年，旨在促进科学，核医学技术和实际应用。澳大利亚和新西兰核医学学会（ANZSNM）成立于1969年，代表着促进澳大利亚和新西兰核医学实践技术和专业发展的主要专业协会。它通过教育促进核医学专业的卓越，研究和对最高专业标准的承诺。EANM,SNMMI和ANZSNM成员是医生，技术人员,专门从事核医学研究和临床实践的物理学家和科学家。所有三个协会都将定期提出新的核医学实践标准/指南，以帮助推进核医学科学并改善对患者的服务。将对现有标准/指南进行修订或更新，在适当的情况下,在他们五周年或更早的时候，如果指示。每个标准/准则，代表EANM/SNMMI/ANZSNM的政策声明，经历了彻底的共识过程，需要广泛的审查。这些社会认识到，安全有效地使用诊断核医学成像需要特殊的培训和技能，如每个文档中所述。这些标准/指南是旨在帮助从业人员为患者提供适当和有效的核医学护理的教育工具。这些准则是基于现有知识的共识文件。它们不是不灵活的规则或实践要求，它们也不应被用来建立法律的护理标准。出于这些原因和以下原因，EANM,SNMMI和ANZSNM告诫不要在诉讼中使用这些标准/指南，在诉讼中，从业者的临床决策受到质疑。关于任何特定程序或行动过程的适当性的最终判断必须由医疗专业人员考虑每个案例的独特情况。因此，这并不意味着一项行动不同于准则/程序标准中规定的行动，独自站立,低于护理标准。相反,在以下情况下，有良心的从业者可以负责任地采取与标准/准则中规定的不同的行动方针：在从业者的合理判断中，这种行动过程是由病人的情况表明的，准则/程序标准公布后，现有资源的限制或知识或技术的进步。医学的实践不仅涉及科学，也是处理预防的艺术，诊断,缓解和治疗疾病。人类状况的多样性和复杂性使得一般指南不可能一致地允许达到准确的诊断或预测特定的治疗反应。因此,应该认识到，遵守这些标准/准则并不能确保成功的结果。所有应该期待的是，从业者遵循合理的行动方针，根据他们的训练水平，当前知识,临床实践指南，可用资源和患者的需求/背景治疗。这些指南的唯一目的是帮助从业者实现这一目标。本指南/程序标准是由EANM合作开发的，SNMMI和ANZSNM，在该领域的国际专家的支持下。他们还总结了EANM肿瘤学和Theranostics以及炎症和感染委员会的观点，以及SNMMI的程序标准委员会，并反映EANM和SNMMI不能对此负责的建议。这些建议应纳入核医学的良好做法，不能取代国家和国际法律或监管规定。
在EANM之间的合作努力中，SNMMI和ANZSNM，临床适应症,推荐的成像程序和报告标准已在本联合指南/程序标准中达成一致和总结.
免疫肿瘤学领域正在迅速发展，本指南/程序标准不应被视为明确的，而是作为指导文件规范[18F]FDGPET/CT在免疫治疗过程中的使用和解释。应考虑本指南的局部差异。
欧洲核医学协会（EANM）是一个专业的非营利性医学协会，成立于1985年，旨在促进追求核医学临床和学术卓越的个人之间的全球交流。核医学与分子影像学会（SNMMI）是一个国际科学和专业组织，成立于1954年，旨在促进科学，核医学技术和实际应用。澳大利亚和新西兰核医学学会（ANZSNM）成立于1969年，代表着促进澳大利亚和新西兰核医学实践技术和专业发展的主要专业协会。它通过教育促进核医学专业的卓越，研究和对最高专业标准的承诺。EANM,SNMMI和ANZSNM成员是医生，技术人员,专门从事核医学研究和临床实践的物理学家和科学家。所有三个协会都将定期提出新的核医学实践标准/指南，以帮助推进核医学科学并改善对患者的服务。将对现有标准/指南进行修订或更新，在适当的情况下,在他们五周年或更早的时候，如果指示。每个标准/准则，代表EANM/SNMMI/ANZSNM的政策声明，经历了彻底的共识过程，需要广泛的审查。这些社会认识到，安全有效地使用诊断核医学成像需要特殊的培训和技能，如每个文档中所述。这些标准/指南是旨在帮助从业人员为患者提供适当和有效的核医学护理的教育工具。这些准则是基于现有知识的共识文件。它们不是不灵活的规则或实践要求，它们也不应被用来建立法律的护理标准。出于这些原因和以下原因，EANM,SNMMI和ANZSNM告诫不要在诉讼中使用这些标准/指南，在诉讼中，从业者的临床决策受到质疑。关于任何特定程序或行动过程的适当性的最终判断必须由医疗专业人员考虑每个案例的独特情况。因此，这并不意味着一项行动不同于准则/程序标准中规定的行动，独自站立,低于护理标准。相反,在以下情况下，有良心的从业者可以负责任地采取与标准/准则中规定的不同的行动方针：在从业者的合理判断中，这种行动过程是由病人的情况表明的，准则/程序标准公布后，现有资源的限制或知识或技术的进步。医学的实践不仅涉及科学，也是处理预防的艺术，诊断,缓解和治疗疾病。人类状况的多样性和复杂性使得一般指南不可能一致地允许达到准确的诊断或预测特定的治疗反应。因此,应该认识到，遵守这些标准/准则并不能确保成功的结果。所有应该期待的是，从业者遵循合理的行动方针，根据他们的训练水平，当前知识,临床实践指南，可用资源和患者的需求/背景治疗。这些指南的唯一目的是帮助从业者实现这一目标。本指南/程序标准是由EANM合作开发的，SNMMI和ANZSNM，在该领域的国际专家的支持下。他们还总结了EANM肿瘤学和Theranostics以及炎症和感染委员会的观点，以及SNMMI的程序标准委员会，并反映EANM和SNMMI不能对此负责的建议。这些建议应纳入核医学的良好做法，不能取代国家和国际法律或监管规定。
