[Intl_DxMedPhys] QC on Dedicated Cardiac PET/CT (IAC, TJC)

[Scott Fuller]

Thank you, all, for the great feedback.  I’m not internal for this organization and was provided the plans last week so I had some concerns/questions.  The site shared that the vendor rep was fine with their proposed setup, but it certainly seems like there are a few items that should be considered more thoroughly before proceeding.  There are likely some short-sited visions (at the facility) of what the suite will provide that don’t account for changes/adaptation down the road.

This is my first experience with a facility that is 100% dedicated to cardiac imaging with their PET/CT so there were a few items that are new to me. I appreciate the community responses and experiences shared.

Scott

> On Jan 23, 2026, at 9:06 AM, Nicole Ranger <nicoletranger at yahoo.com> wrote:
> 
> I concur with Erin.  Even though my most recent affiliation used unit doses, we committed to assaying doses prior to admin as a best practice.  We had at some point discovered a discrepancy in regional radiopharmacy dose assays which was addressed so it is important to have a secondary verification.  All of the above is relevant to SPECT and some PET applications where the half-life is long enough that a dose assay in the dose calibrator is feasible.  There are however, many applications where the half-life is short enough that you lose viable activity with any delays and there automatic injection and dose assaying within the automatic administration system becomes important.  Over and above whatever the manufacturer’s requirements are, I would write up a policy and procedure on how you will ensure the system is operating correctly and run this by your licensing agency.  We oftentimes have to spell out these details when renewing a license and the magnitude of the chan. ge you are describing is sufficient that you would want to either notify your regulators to get feedback on your plan and/or seek a license amendment that describes the operational change with the installation of this new system and any changes to you “Authorized Use” areas should you in fact decommission your hot lab (which I would not recommend).  There are stringent survey requirements
> for doing so and as Erin pointed out, having a Hot Lab “just in case” is helpful and not overly burdensome because it is just one more location for surveying and conducting wipe tests.  Also, keep in mind that the Hot Lab is also oftentimes the location where sealed sources and radiopharnaceuticals are stored in inventory either temporarily or long-term.  It is also a convenient drop-off location for commercial radiopharmacy drivers or FEDEX.
> 
> Sent from my iPhone
> 
>> On Jan 23, 2026, at 8:30 AM, Erin Niven via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu <mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
>> 
>> 
>> I would think you would need at least a mini hot lab, with at least a shielded well counter, contamination monitor, spills kit, and waste container?  
>> 
>> As for QC, I would expect the need to receive and use F-18 for acceptance testing if undergoing accreditation.  And has the PET/CT vendor said you never need F-18?
>> 
>> 
>> 
>> Sent from Yahoo Mail. Get the app <https://urldefense.com/v3/__https://yho.com/148vdq__;!!KGKeukY!y0iJtUxCkYlpxTNhFVJjnEtQDPjxZJzoyoPyY8iu7vnRNzrNOVwIZe6lDsNuMjD5tpXS8bWUho1-EeUaEyzpC4gtlkod-Mlkgcf9zkQ3$>
>> 
>> 
>> On Friday, January 23, 2026 at 12:20:28 a.m. NST, Scott Fuller via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu> wrote:
>> 
>> 
>> Yes, this is a Bracco system and it operates exactly as Michael has explained…the clinical dose assay occurs as the rubidium is injected into the patient.  Sounds like I need to ask a few more questions about the daily QC process to advise if the facility will want to keep its current dose calibrator (they are transitioning from SPECT to the PET/CT system).  To make room for the scanner, however, the hope is to be able to get rid of the hot lab.  I’ll ask a few more questions of everyone involved.
>> 
>> That still leaves me with the question of any sites who might be completing QC at a facility that does not routinely receive/handle F-18?  If anyone has that experience I would be appreciative of understanding what TJC/IAC expects.  Otherwise, my current advice to the facility is that they will need to set up an agreement to receive F-18 from a pharmacy (with whom they don’t currently have an agreement) to receive QC doses and perform ACR prescribed QC.
>> 
>> Thanks for the responses.
>> 
>> Scott
>> 
>>> On Jan 22, 2026, at 7:00 PM, Michael Masiar via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu> wrote:
>>> 
>> 
>> The Rubidium generator I've seen (Bracco), has a built in scintillation detector that measures the dose as it leaves the generator. The patient gets hooked up to the generator device and it automatically gives the prescribed dose. You don't assay the dose in a dose calibrator prior to injection to the patient.
>> 
>> The system has a daily QC and calibration procedure though... The daily QC involves putting a dose into a vial and measuring with your dose calibrator... 
>> 
>> So you don't assay the patient doses in a dose calibrator, but you do a QC procedure every morning that does go in the dose calibrator. I'm not sure how this could be done without one. 
>> 
>> Michael Masiar MS DABR
>> Certified Medical Physicist
>> Therapy Physics, Inc.
>> 2501 Cherry Ave., Suite 270
>> Signal Hill, CA 90755
>> email: mmasiar at gmail.com <mailto:mmasiar at gmail.com>
>> cell: 310-625-9906
>> office: 562-317-0650
>> 
>> 
>> 
>> On Thu, Jan 22, 2026 at 5:50 PM William Sensakovic via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu <mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>> wrote:
>> Thinking of 10cfr35.63
>> 
>> William F. Sensakovic, PhD, MRSC(MRSE), FAAPM
>> Chair and Assoc. Prof., Mayo Clinic (Arizona)
>> Founder, Telerad Physics Teaching, LLC
>> From: William Sensakovic <wfsensak at outlook.com <mailto:wfsensak at outlook.com>>
>> Sent: Thursday, January 22, 2026 5:20:21 PM
>> To: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu <mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
>> Subject: Re: [Intl_DxMedPhys] QC on Dedicated Cardiac PET/CT (IAC, TJC)
>>  
>> I did not think that would be allowed. If they are drawing from a generator themselves (instead of getting unit doses from the radiopharmacy) I thought they are required to assay dose before injection. I thought you can avoid dose assay only if you use a unit dose.
>> Am I mistaken?
>> 
>> William F. Sensakovic, PhD, MRSC(MRSE), FAAPM
>> Chair and Assoc. Prof., Mayo Clinic (Arizona)
>> Founder, Telerad Physics Teaching, LLC
>> From: Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list-bounces+wfsensak=outlook.com at lists.osu.edu <mailto:outlook.com at lists.osu.edu>> on behalf of Scott Fuller via Intl_dxmedphys_wd_osu_list <intl_dxmedphys_wd_osu_list at lists.osu.edu <mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
>> Sent: Wednesday, January 21, 2026 1:52:36 PM
>> To: DxMedPhys List <intl_dxmedphys_wd_osu_list at lists.osu.edu <mailto:intl_dxmedphys_wd_osu_list at lists.osu.edu>>
>> Subject: [Intl_DxMedPhys] QC on Dedicated Cardiac PET/CT (IAC, TJC)
>>  
>> I’m working with a facility that intends to install a Rubidium dedicated PET/CT system.  They would like to do so without installing any sort of a hot lab or dose measuring equipment as there is no intention of using anything other than Rb-82 (seems ok from a clinical perspective and all vendors involved have supported this).
>> 
>> My question is, does anyone have experience providing QC support for a setup such as this?  A dedication Rubidium unit that is not able to order, prepare, or store longer lived isotopes such as F-18?  I’m unsure how one would go about supporting an image quality assessment and program without, at minimum, scanning a filled phantom.
>> 
>> For accreditation purposes, the facility is under the umbrella of IAC and Joint Commission.  It looks like IAC provides some flexibility and will want the facility to follow manufacturer requirements.  Joint Commission provides me with a bit more confusion as to how the facility would meet the expectations.  
>> 
>> Thanks, in advance, for any prior experiences or insights shared.
>> 
>> Scott

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