18F, 68Ga, 89Zr Accreditation specifications
The EARL accreditation is based on quality control (QC) experiments that were described and published in the EANM guidelines in 2010. Meanwhile the field has moved forward and new developments, technologies and insights have become available. During the EANM Conference 2018 in Düsseldorf EARL announced the update of the EARL performance specifications. The current standard allows sites to benefit from state-of-the-art PET/CT technology and is based on a recent publication by EARL entitled “Feasibility of state-of-the-art PET/CT systems performance harmonisation”. The impact of the new 18F standard 2 on the quantification of clinical studies has been described in “Quantitative implications of the updated EARL 2019 PET–CT performance standards”. EARL is dedicated towards improving and supporting the quality of nuclear medicine procedures. You can review the presentation give by Prof. Dr. R. Boellaard in regards to this EARL update here.
Since 2026, EARL 18F standards 1 and 2 are transitioning from SUV recovery coefficients (RCs) to contrast recovery coefficients (CRCs) in PET scanner accreditation in order to create a more standardized, efficient, and consistent approach across clinical trials globally. The changes are based on unified work done and recently published: Standardization of PET/CT Performance Requirements for Whole-Body Quantitative Imaging: An International Proposal.
Calibration QC acceptability criteria for 18F, 68Ga and 89Zr are set to +/-10% for each isotope independently.
CRCs effective as of quarter 1 of 2026; SUV recovery coefficients effective as of quarter 3 of 2020:
NEMA IEC phantom spheres | 18F standards 1 CRCs** 18F standards 1 SUV RCs | 18F standards 2 CRCs** 18F standards 2 SUV RCs | ||||
Diameter (mm) | Volume (mL) | max | mean | max* | mean | peak** |
37 | 26.52 | 0.94 – 1.18 0.95 – 1.16 | 0.73 – 0.88 0.76 – 0.89 | 1.06 – 1.33 1.05 – 1.29 | 0.83 – 1.00 0.85 – 1.00 | 0.90 – 1.11 0.90 – 1.10 |
28 | 11.49 | 0.90 – 1.14 0.91 – 1.13 | 0.69 – 0.83 0.72 – 0.85 | 1.01 – 1.30 1.01 – 1.26 | 0.80 – 0.97 0.82 – 0.97 | 0.90 – 1.11 0.90 – 1.10 |
22 | 5.57 | 0.81 – 1.10 0.83 – 1.09 | 0.59 – 0.77 0.63 – 0.78 | 1.01 – 1.37 1.01 – 1.32 | 0.78 – 0.99 0.80 – 0.99 | 0.89 – 1.11 0.90 – 1.10 |
17 | 2.57 | 0.70 – 1.01 0.73 – 1.01 | 0.52 – 0.70 0.57 – 0.73 | 1.00 – 1.43 1.00 – 1.38 | 0.73 – 0.97 0.76 – 0.97 | 0.72 – 0.99 0.75 – 0.99 |
13 | 1.15 | 0.54 – 0.83 0.59 – 0.85 | 0.38 – 0.56 0.44 – 0.60 | 0.83 – 1.25 0.85 – 1.22 | 0.59 – 0.84 0.63 – 0.86 | 0.39 – 0.67 0.45 – 0.70 |
10 | 0.52 | 0.27 – 0.52 0.34 – 0.57 | 0.19 – 0.37 0.27 – 0.43 | 0.45 – 0.86 0.52 – 0.88 | 0.32 – 0.57 0.39 – 0.61 | 0.19 – 0.34 0.27 – 0.41 |
*SUVmax for total body PET/CT scanners is under investigation
**SUVpeak and CRCs limits are under a revision
Recovery coefficient values are calculated based on:
- RCSUVmean – 50% background corrected isocontour VOI
- RCSUVmax – the maximum voxel value included in VOI
- RCSUVpeak – spherical VOI with a diameter of 12 mm, positioned so to yield the highest uptake
VOIs used for the analysis are based on the PET data, not on the CT.
EARL FDG PET/CT optimization procedure: EARL procedure for assessing PET/CT system specific patient FDG activity preparations for quantitative FDG PET/CT studies. R.Boellaard, A.T. Willemsen, B.Arends, E.P. Visser