We evaluated a commercial positron emission mammography (PEM) camera, the PEM Flex Solo II. This system comprises two 6 × 16.4 cm detectors that scan together covering up to a 24 × 16.4 cm field of view (FOV). There are no specific standards for testing this detector configuration. We performed several tests important to breast imaging, and we propose tests that should be included in standardized testing of PEM systems. Methods: We measured spatial resolution, uniformity, counting- rate linearity, recovery coefficients, and quantification accuracy using the system's software. Image linearity and coefficient of variation at the edge of the FOV were also characterized. Anecdotal examples of clinical patient data are presented. Results: The spatial resolution was 2.4 mm in full width at half maximum for image planes parallel to the detector faces. The background variability was approximately 5%, and quantification accuracy and recovery coefficients varied within the FOV. Positioning linearity began at approximately 13 mm from the edge of the detector housing. The coefficient of variation was significantly higher close to the edge of the FOV because of limited sensitivity in these image planes. Conclusion: A reconstructed spatial resolution of 2.4 mm represented a significant improvement over conventional whole-body PET scanners and should reduce the lower threshold on lesion size and tracer uptake for detection in the breast. Limited-angle tomography and a lack of data corrections result in spatially variable quantitative results. PEM acquisition geometry limits sampling statistics at the chest-wall edge of the camera, resulting in high variance in that portion of the image. Example patient images demonstrate that lesions can be detected at the chest-wall edge despite variance artifacts, and fine structure is visualized routinely throughout the FOV in the focal plane. The PEM Flex camera should enable the functional imaging of breast cancer earlier in the disease process than whole-body PET.

The EORTC-Lung Cancer Group initiated a Delphi consensus process to establish a consensual definition of resectable stage III non-small cell lung cancer (NSCLC) for the use in clinical trials, including a systematic review, survey, and review of clinical cases. Here, the survey results are presented, aimed to identify areas of controversy. A survey was distributed among the members of six international organizations related to lung cancer. Respondents were interrogated on the resectability (not limited to the technical resectability) of all stage III NSCLC TNM-subsets (8th edition). Additionally, four N2-subdivisions were used. The threshold for agreement was 75%. Answers with "yes" were considered upfront resectable. "Yes" and "maybe" were grouped together and considered potentially resectable. Answers with "no" were considered unresectable. 558 responses were collected from thoracic surgeons (38%), radiation oncologists (27%), medical oncologists (17%), pulmonologists (14%), and others (4%). Most worked in a specialized center (80%), had >5 years of experience (80%), were European (76%), male (73%), and treated >20 patients with stage III NSCLC annually (77%). Agreement was found in 26 (70%) out of 37 TNM-subsets: 9 (24%) were considered (potentially) resectable, and 17 (46%) unresectable. There was no agreement for 11 (30%) TNM-subsets: smaller tumors with N2-multistation, larger tumors with N2-single station, and invasive T4-tumors with maximum N2-single station involvement. This international and multidisciplinary survey showed agreement on the resectability for the majority of stage III NSCLC TNM-subsets, but also identified several TNM-subsets for which no agreement was found.