Addressing unmet needs in nuclear medicine: Italian experience with PET/CT features and structured reporting in oncology

Background Positron emission tomography/computed tomography (PET/CT) is nowadays widely incorporated into international guidelines for tumor management. However, variability in reporting practices and uncertainty regarding the optimal use of structured elements in PET/CT reports may affect communication with referring clinicians and the clinical impact of the examination. This study aimed to characterize current oncological PET/CT reporting practices among nuclear medicine physicians in Italy, with particular focus on the use of structured reporting elements.Materials and methods This observational study included nuclear medicine physicians practicing in Italy. Data were collected using a standardized 31-item web-based questionnaire developed by the Young Working Group of the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN) and reviewed by the AIMN Oncology Working Group. Heterogeneity across reporting domains was quantified using the normalized Shannon-Wiener Index. Differences in reporting practices according to PET interpretation experience (≤ 10 vs. > 10 years) were assessed using the chi-square test.Results A total of 152 nuclear medicine physicians were included, with broad geographic representation across Italy. Considerable variability was observed in self-reported PET/CT reporting practices, including the incorporation of patients' clinical history, the reporting approach adopted (TNM-based, lesion-based, or anatomical region-based), and the use of semiquantitative parameters and standardized interpretation score. CT findings corresponding to PET abnormalities were generally included in the report, whereas approaches to incidental findings and PET-negative findings varied among participants. Attitudes toward standardized reporting were heterogeneous, with approximately half of participants considering it useful only in selected clinical settings.Conclusions Oncological PET/CT reporting practices among nuclear medicine physicians in Italy show substantial heterogeneity despite extensive professional experience. Greater harmonization of reporting practices may improve the clarity and clinical utility of PET/CT reports. These findings may provide a basis for scientific societies to develop practical reporting recommendations that balance standardization with flexibility in routine clinical practice.