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Selected and proven procedures, quality control tests and tools used to harmonize PET scanners could be used for QSPECT harmonization. The results of the integrated works of international teams of experts are the guidelines for performing, interpreting and reporting the results of PET/CT studies. The standardization of quantitative PET results is also done by committees and the working group established by the Society of Nuclear Medicine and Molecular Imaging and the Radiological Society of North America. To obtain and maintain the EARL accredited status, PET centers are required to complete and submit two phantoms scans for calibration quality control (using a uniform cylindrical phantom), and image quality control (using a NEMA NU2-2007 Body Phantom). The harmonizing standards are based on the precise calibration of PET scanners. Standardization includes the unification procedures of patient preparation, scan acquisition, image reconstruction and data analysis settings. The EANM/EARL accreditation program has been developed to facilitate comparisons of quantitative PET parameters in multicenter studies or at medical centers equipped with several PET systems. Program), i.e., the multicenter program of standardization and harmonization and accreditation of PET/CT scanners. In 2006, the EANM (European Association of Nuclear Medicine) started the EARL (EANM Research Ltd. However, variability in methodology across centers prohibited the exchange of SUV data. From the beginning of its existence, this diagnostic method was considered a quantitative one and, therefore, absolute quantification was the overriding goal of the development of PET technology. Harmonization and standardization of quantitative test results have been successfully implemented for PET/CT (positron emission tomography/computed tomography) imaging technique. SUVmax, which is preferred by physicians, depends, among other things, on the chosen SPECT/CT image reconstruction technique. A measured SUV cannot be used as an absolute number. Physical and clinical conditions for its measurement still need to be standardized. Standard uptake value (SUV) is a widely available and easy-to-use quantifier of radioactivity concentration in SPECT images. Repeatability in SPECT relates to the uncertainty in obtaining the same result in the same patient examined more than once on the same system. Reproducibility relates to the variation that results when different conditions are used to make the measurements, for example, different gamma camera systems.

Repeatability and reproducibility are essential requirements for any quantitative measurement.

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Software from different vendors may also produce different quantitative results from the same SPECT system. There are differences in the calibration of these systems, in the reconstruction methods and in the correction techniques being applied.

Many studies showed the need for harmonization of quantitative SPECT/CT scanners across centers. However, so far, no guidelines for quantitative SPECT/CT systems harmonization have been published. The standard methodology for evaluating the performance of quantitative SPECT/CT systems has been established. SPECT is a quantitative imaging technique and therefore requires a common quality control procedure to maintain the accuracy and precision of quantitation. The integrated diagnostic SPECT/CT (single-photon emission computed tomography/computed tomography) systems with iterative algorithms for image reconstruction allow for the clinical use of quantitative SPECT.

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