Artificial intelligence for reduced dose 18F-FDG PET examinations: a real-world deployment through a standardized framework and business case assessment

Background To determine whether artificial intelligence (AI) processed PET/CT images of reduced by one-third of 18-F-FDG activity compared to the standard injected dose, were non-inferior to native scans and if so to assess the potential impact of commercialization. Materials and methods SubtlePET (TM) AI was introduced in a PET/CT center in Italy. Eligible patients referred for 18F-FDG PET/CT were prospectively enrolled. Administered 18F-FDG was reduced to two-thirds of standard dose. Patients underwent one low-dose CT and two sequential PET scans; PET-processed with reduced dose and standard acquisition time, and PET-native with an elapsed time to simulate standard acquisition time and dose. PET-processed images were reconstructed using SubtlePET (TM). PET-native images were defined as the standard of reference. The datasets were anonymized and independently evaluated in random order by four blinded readers. The evaluation included subjective image quality (IQ) assessment, lesion detectability, and assessment of business benefits. Results From February to April 2020, 61 patients were prospectively enrolled. Subjective IQ was not significantly different between datasets (4.62 +/- 0.23, p=0.237) for all scanner models, with almost perfect inter-reader agreement. There was no significant difference between datasets in lesions' detectability, target lesion mean SUVmax value, and liver mean SUVmean value (182.75/181.75 [SD:0.71], 9.8/11.4 [SD:1.13], 2.1/1.9 [SD:0.14] respectively). No false-positive lesions were reported in PET-processed examinations. Agreed SubtlePET (TM) price per examination was 15-20% of FDG savings. Conclusion This is the first real-world study to demonstrate the non-inferiority of AI processed 18F-FDG PET/CT examinations obtained with 66% standard dose and a methodology to define the AI solution price.

Automated summary

This study demonstrated the non-inferiority of AI processed low-dose PET/CT images compared to standard dose native scans in terms of image quality and lesion detectability, with potential business benefits in cost savings.