EARL introduced ¹⁸F standards 2 accreditation, while maintaining ¹⁸F standards 1. With the introduction of ultra-high-sensitivity PET/CT and PET/MR systems, including those with a large axial field of view, EARL now introduces ¹⁸F standards 3 to accommodate the advanced technologies. These systems enable higher spatial resolution while maintaining image quality and noise levels within acceptable limits. ¹⁸F stadards 3 allow sites to fully leverage their ultra-high-sensitivity systems’ potential for patient care and clinical research while ensuring harmonised performance and quantitative comparability (e.g. across multicentre studies and future generations of systems).

The limits of acceptability for the recovery coefficients for each of the two standards can be reviewed in the section Accreditation Specifications.

Imperative points to consider include but are not limited to:

• Images conforming to one EARL ¹⁸F standard (standards 1, 2, or 3) cannot be pooled with images conforming to either of the other two standards.
• The visual interpretation of the PET images may differ between these two standards as stated in Updating PET/CT performance standards and PET/CT interpretation criteria should go hand in hand by Boellaard et al. EJNMMI Research 2019
• ¹⁸F standards 2 & 3 allow sites to benefit from state-of-the-art PET/CT technology while still ensuring harmonised system performance and SUV comparability in a multicenter studies.
• Uniformity phantom data is submitted every quarter, while a NEMA IEC body phantom is requested to be submitted once pear year. Both of those data sets are required to be submitted every time there is a scanner recalibration, hardware and/or software update.