Table 1. .

Summary of recommendations

Summary of recommendations
1. Radiopharmaceutical selection may be dictated by availability and cost and researchers should explore this at an early stage in the study work-up.
2. PET-CT positioning needs to be optimized for radiotherapy planning in applications where accurate localization of PET uptake on the planning images is essential. This will require use of an indexed flat couch overlay and immobilization devices.
3. A dedicated radiotherapy planning PET-CT should be acquired with the patient in the radiotherapy position for direct planning in advanced delivery techniques, image-guided and adaptive radiotherapy and applications where the PET signal is used to define subvolumes or voxels within the tumour for dose escalation or "dose painting".
4. PET-CT scanners should be accredited to ensure quantitative results are consistent across centres.
5. For applications requiring the most accurate and reproducible positioning, the PET-CT should be commissioned for radiotherapy planning purposes and be included within the radiotherapy QA system.
6. A nuclear medicine physician/radiologist and MPE with experience in PET should be involved in the protocol development.
7. A standardized imaging protocol should be provided to centres identifying critical requirements to achieve the trial outcomes.
8. The CT parameters for the PET-CT will need to be optimized for delineation if replacing the radiotherapy planning CT for direct planning.
9. Experienced radiotherapy radiographers should position patients on the PET-CT scanner for applications requiring high accuracy and reproducibility.
10. Integrity of PET data should be tested throughout the anonymization and data transfer process to ensure quantitative values and volumes are preserved.
11. Registration techniques (rigid or non-rigid) should be validated for the intended application to assess the registration accuracy and registered images verified on a per patient basis.
12 . Volume delineation guidelines should be developed for the intended application to improve reproducibility across centres. For complex planning applications, a series of benchmark cases should be provided to individual centres for training.
13. Automated segmentation techniques should be validated for the intended application.
14. Volumes derived using automated segmentation algorithms must be visually inspected by the clinical oncologist on a per patient basis and manually edited where appropriate.

MPE, medical physics expert; PET, positron emission tomography; QA, quality assurance.