Validation of an electronic image reader training programme for interpretation of [18F]flutemetamol β-amyloid PET brain images

Christopher J Buckley, Paul F Sherwin, Adrian P L Smith, Jan Wolber, Sharon M Weick, David J Brooks, Christopher J Buckley, Paul F Sherwin, Adrian P L Smith, Jan Wolber, Sharon M Weick, David J Brooks

Abstract

Objectives: An electronic training programme (ETP) was developed for interpretation of images during routine clinical use of the PET amyloid imaging agent [F]flutemetamol injection (VIZAMYL). This study was carried out to validate the ETP.

Materials and methods: Five nuclear medicine technologists (NMTs) and five readers previously inexperienced in amyloid image interpretation were required to self-train using the ETP and pass a test to participate. A total of 305 [F]flutemetamol PET images were then tested as the validation set, following preassessment and reorientation (where required) by one of five NMTs. Next, a new set of readers blinded to clinical information independently assessed all 305 images. Images had been acquired in previous studies from patients representing the full spectrum of cognitive capacity. When available, a standard of truth determined by histopathology or clinical history was used to derive sensitivity and specificity for image interpretation from this validation set. Randomly selected images (n=29) were read in duplicate to measure intrareader reproducibility. Images were read first without, and subsequently with anatomic images, if available.

Results: All NMTs and all readers scored 100% on the qualifying test. The interpretation of 135 cases without anatomic image support resulted in sensitivity ranging from 84% to 94% (majority 94%, median 92%) and specificity ranging from 77% to 96% (majority 92%, median 81%). Inter-reader agreement was very high, with most κ scores more than 0.8. Intrareader reproducibility ranged from 93 to 100%.

Conclusion: The self-guided ETP effectively trained new amyloid PET image readers to accurately and reproducibly interpret [F]flutemetamol PET images.

Figures

Fig. 1
Fig. 1
The electronic training programme (ETP) teaches the persons being trained to make a positive scan classification upon identification of several features in the following regions. Frontal pole and lobe: the lack of a marked sulcal pattern (dotted lines) and/or sharp intensity gradient from grey matter to cerebrospinal fluid. Posterior cingulate and precuneus: presence of cortical uptake in the circled region. Lateral temporal lobe: heightened uptake throughout and loss of the gyral/sulcal pattern (dotted circles). Parietal lobe: high uptake and decreased sulcal pattern within the dotted circles. Striatum: >50% uptake in the dotted region between the thalamus and the frontal lobe (axial or sagittal view).
Fig. 2
Fig. 2
Diagrammatic representation of the training and reading process for Study GE067–021 (internal GE reference number for the validation study). 1. Images from 276 individual patients and an additional 29 repeat images interspersed were read only in the first phase of the study. 2. Those images that had a tissue-based pathological standard of truth were rerandomized and read again with the support of anatomic images (mainly CT and some MRI). CRF, case report form; CSR, clinical study report; CT, computed tomography.

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