Application of the 4-D XCAT Phantoms in Biomedical Imaging and Beyond.

The four-dimensional (4-D) eXtended CArdiac-Torso (XCAT) series of phantoms was developed to provide accurate computerized models of the human anatomy and physiology. The XCAT series encompasses a vast population of phantoms of varying ages from newborn to adult, each including parameterized models for the cardiac and respiratory motions. With great flexibility in the XCAT's design, any number of body sizes, different anatomies, cardiac or respiratory motions or patterns, patient positions and orientations, and spatial resolutions can be simulated. As such, the XCAT phantoms are gaining a wide use in biomedical imaging research. There they can provide a virtual patient base from which to quantitatively evaluate and improve imaging instrumentation, data acquisition, techniques, and image reconstruction and processing methods which can lead to improved image quality and more accurate clinical diagnoses. The phantoms have also found great use in radiation dosimetry, radiation therapy, medical device design, and even the security and defense industry. This review paper highlights some specific areas in which the XCAT phantoms have found use within biomedical imaging and other fields. From these examples, we illustrate the increasingly important role that computerized phantoms and computer simulation are playing in the research community.

A SPECT Camera for Combined MRI and SPECT for Small Animals.

We describe an MR-compatible SPECT camera for small animals. The SPECT camera system can be inserted into the bore of a state-of-the-art MRI system and allows researchers to acquire tomographic images from a mouse in-vivo with the MRI and the SPECT acquiring simultaneously. The SPECT system provides functional information, while MRI provides anatomical information. Until today it was impossible to operate conventional SPECT inside the MRI because of mutual interference. The new SPECT technology is based on semiconductor radiation sensors (CZT, ASICs), and it fits into conventional high field MRI systems with a minimum 12-cm bore size. The SPECT camera has an MR-compatible multi-pinhole collimator for mice with a ø25-mm field-of-view. For the work reported here we assembled a prototype SPECT camera system and acquired SPECT and MRI data from radioactive sources and resolution phantoms using the camera outside and inside the MRI.

MicroCT with energy-resolved photon-counting detectors.

The goal of this paper was to investigate the benefits that could be realistically achieved on a microCT imaging system with an energy-resolved photon-counting x-ray detector. To this end, we built and evaluated a prototype microCT system based on such a detector. The detector is based on cadmium telluride (CdTe) radiation sensors and application-specific integrated circuit (ASIC) readouts. Each detector pixel can simultaneously count x-ray photons above six energy thresholds, providing the capability for energy-selective x-ray imaging. We tested the spectroscopic performance of the system using polychromatic x-ray radiation and various filtering materials with K-absorption edges. Tomographic images were then acquired of a cylindrical PMMA phantom containing holes filled with various materials. Results were also compared with those acquired using an intensity-integrating x-ray detector and single-energy (i.e. non-energy-selective) CT. This paper describes the functionality and performance of the system, and presents preliminary spectroscopic and tomographic results. The spectroscopic experiments showed that the energy-resolved photon-counting detector was capable of measuring energy spectra from polychromatic sources like a standard x-ray tube, and resolving absorption edges present in the energy range used for imaging. However, the spectral quality was degraded by spectral distortions resulting from degrading factors, including finite energy resolution and charge sharing. We developed a simple charge-sharing model to reproduce these distortions. The tomographic experiments showed that the availability of multiple energy thresholds in the photon-counting detector allowed us to simultaneously measure target-to-background contrasts in different energy ranges. Compared with single-energy CT with an integrating detector, this feature was especially useful to improve differentiation of materials with different attenuation coefficient energy dependences.

4D XCAT phantom for multimodality imaging research.

PURPOSE: The authors develop the 4D extended cardiac-torso (XCAT) phantom for multimodality imaging research. METHODS: Highly detailed whole-body anatomies for the adult male and female were defined in the XCAT using nonuniform rational B-spline (NURBS) and subdivision surfaces based on segmentation of the Visible Male and Female anatomical datasets from the National Library of Medicine as well as patient datasets. Using the flexibility of these surfaces, the Visible Human anatomies were transformed to match body measurements and organ volumes for a 50th percentile (height and weight) male and female. The desired body measurements for the models were obtained using the PEOPLESIZE program that contains anthropometric dimensions categorized from 1st to the 99th percentile for US adults. The desired organ volumes were determined from ICRP Publication 89 [ICRP, "Basic anatomical and physiological data for use in radiological protection: reference values," ICRP Publication 89 (International Commission on Radiological Protection, New York, NY, 2002)]. The male and female anatomies serve as standard templates upon which anatomical variations may be modeled in the XCAT through user-defined parameters. Parametrized models for the cardiac and respiratory motions were also incorporated into the XCAT based on high-resolution cardiac- and respiratory-gated multislice CT data. To demonstrate the usefulness of the phantom, the authors show example simulation studies in PET, SPECT, and CT using publicly available simulation packages. RESULTS: As demonstrated in the pilot studies, the 4D XCAT (which includes thousands of anatomical structures) can produce realistic imaging data when combined with accurate models of the imaging process. With the flexibility of the NURBS surface primitives, any number of different anatomies, cardiac or respiratory motions or patterns, and spatial resolutions can be simulated to perform imaging research. CONCLUSIONS: With the ability to produce realistic, predictive 3D and 4D imaging data from populations of normal and abnormal patients under various imaging parameters, the authors conclude that the XCAT provides an important tool in imaging research to evaluate and improve imaging devices and techniques. In the field of x-ray CT, the phantom may also provide the necessary foundation with which to optimize clinical CT applications in terms of image quality versus radiation dose, an area of research that is becoming more significant with the growing use of CT.

Implementation of angular response function modeling in SPECT simulations with GATE.

Among Monte Carlo simulation codes in medical imaging, the GATE simulation platform is widely used today given its flexibility and accuracy, despite long run times, which in SPECT simulations are mostly spent in tracking photons through the collimators. In this work, a tabulated model of the collimator/detector response was implemented within the GATE framework to significantly reduce the simulation times in SPECT. This implementation uses the angular response function (ARF) model. The performance of the implemented ARF approach has been compared to standard SPECT GATE simulations in terms of the ARF tables' accuracy, overall SPECT system performance and run times. Considering the simulation of the Siemens Symbia T SPECT system using high-energy collimators, differences of less than 1% were measured between the ARF-based and the standard GATE-based simulations, while considering the same noise level in the projections, acceleration factors of up to 180 were obtained when simulating a planar 364 keV source seen with the same SPECT system. The ARF-based and the standard GATE simulation results also agreed very well when considering a four-head SPECT simulation of a realistic Jaszczak phantom filled with iodine-131, with a resulting acceleration factor of 100. In conclusion, the implementation of an ARF-based model of collimator/detector response for SPECT simulations within GATE significantly reduces the simulation run times without compromising accuracy.

Analytic system matrix resolution modeling in PET: an application to Rb-82 cardiac imaging.

This work explores application of a novel resolution modeling technique based on analytic physical models which individually models the various resolution degrading effects in PET (positron range, photon non-collinearity, inter-crystal scattering and inter-crystal penetration) followed by their combination and incorporation within the image reconstruction task. In addition to phantom studies, the proposed technique was particularly applied to and studied in the task of clinical Rb-82 myocardial perfusion imaging, which presently suffers from poor statistics and resolution properties in the reconstructed images. Overall, the approach is able to produce considerable enhancements in image quality. The reconstructed FWHM for a Discovery RX PET/CT scanner was seen to improve from 5.1 mm to 7.7 mm across the field-of-view (FoV) to approximately 3.5 mm nearly uniformly across the FoV. Furthermore, extended-source phantom studies indicated clearly improved images in terms of contrast versus noise performance. Using Monte Carlo simulations of clinical Rb-82 imaging, the resolution modeling technique was seen to significantly outperform standard reconstructions qualitatively, and also quantitatively in terms of contrast versus noise (contrast between the myocardium and other organs, as well as between myocardial defects and the left ventricle).

Realistic CT simulation using the 4D XCAT phantom.

The authors develop a unique CT simulation tool based on the 4D extended cardiac-torso (XCAT) phantom, a whole-body computer model of the human anatomy and physiology based on NURBS surfaces. Unlike current phantoms in CT based on simple mathematical primitives, the 4D XCAT provides an accurate representation of the complex human anatomy and has the advantage, due to its design, that its organ shapes can be changed to realistically model anatomical variations and patient motion. A disadvantage to the NURBS basis of the XCAT, however, is that the mathematical complexity of the surfaces makes the calculation of line integrals through the phantom difficult. They have to be calculated using iterative procedures; therefore, the calculation of CT projections is much slower than for simpler mathematical phantoms. To overcome this limitation, the authors used efficient ray tracing techniques from computer graphics, to develop a fast analytic projection algorithm to accurately calculate CT projections directly from the surface definition of the XCAT phantom given parameters defining the CT scanner and geometry. Using this tool, realistic high-resolution 3D and 4D projection images can be simulated and reconstructed from the XCAT within a reasonable amount of time. In comparison with other simulators with geometrically defined organs, the XCAT-based algorithm was found to be only three times slower in generating a projection data set of the same anatomical structures using a single 3.2 GHz processor. To overcome this decrease in speed would, therefore, only require running the projection algorithm in parallel over three processors. With the ever decreasing cost of computers and the rise of faster processors and multi-processor systems and clusters, this slowdown is basically inconsequential, especially given the vast improvement the XCAT offers in terms of realism and the ability to generate 3D and 4D data from anatomically diverse patients. As such, the authors conclude that the efficient XCAT-based CT simulator developed in this work will have applications in a broad range of CT imaging research.

Impact of respiratory motion on the detection of small pulmonary nodules in SPECT imaging.

The objective of this investigation is to determine the impact of respiratory motion on the detection of small solitary pulmonary nodules (SPN) in single photon emission computed tomographic (SPECT) imaging. We have previously modeled the respiratory motion of SPN based on the change of location of anatomic structures within the lungs identified on breath-held CT images of volunteers acquired at two different stages of respiration. This information on respiratory motion within the lungs was combined with the end-expiration and time-averaged NCAT phantoms to allow the creation of source and attenuation maps for the normal background distribution of Tc-99m NeoTect. With the source and attenuation distribution thus defined, the SIMIND Monte Carlo program was used to produce SPECT projection data for the normal background and separately for each of 150 end-expiration and time-averaged simulated 1.0 cm tumors. Normal and tumor SPECT projection sets each containing one lesion were combined with a clinically realistic noise level and counts. These were reconstructed with RBI-EM using 1) no correction (NC), 2) attenuation correction (AC), 3) detector response correction (RC), and 4) attenuation correction, detector response correction, and scatter correction (AC_RC_SC). The post-reconstruction parameters of number of iterations and 3-D Gaussian filtering were optimized by human-observer studies. Comparison of lesion detection by human-observer LROC studies reveals that respiratory motion degrades tumor detection for all four reconstruction strategies, and that the magnitude of this effect is greatest for NC and RC, and least for AC_RC_SC. Additionally, the AC_RC_SC strategy results in the best detection of lesions.

Fast modelling of the collimator-detector response in Monte Carlo simulation of SPECT imaging using the angular response function.

Interactions of incident photons with the collimator and detector, including septal penetration, scatter and x-ray fluorescence, are significant sources of image degradation in applications of SPECT including dual isotope imaging and imaging using radioisotopes that emit high- or medium-energy photons. Modelling these interactions using full Monte Carlo (MC) simulations is computationally very demanding. We present a new method based on the use of angular response functions (ARFs). The ARF is a function of the incident photon's direction and energy and represents the probability that a photon will either interact with or pass through the collimator, and be detected at the intersection of the photon's direction vector and the detection plane in an energy window of interest. The ARFs were pre-computed using full MC simulations of point sources that include propagation through the collimator-detector system. We have implemented the ARF method for use in conjunction with the SimSET/PHG MC code to provide fast modelling of both interactions in the patient and in the collimator-detector system. Validation results in the three cases studied show that there was good agreement between the projections generated using the ARF method and those from previously validated full MC simulations, but with hundred to thousand fold reductions in simulation time.

Fast maximum entropy approximation in SPECT using the RBI-MAP algorithm.

In this work, we present a method for approximating constrained maximum entropy (ME) reconstructions of SPECT data with modifications to a block-iterative maximum a posteriori (MAP) algorithm. Maximum likelihood (ML)-based reconstruction algorithms require some form of noise smoothing. Constrained ME provides a more formal method of noise smoothing without requiring the user to select parameters. In the context of SPECT, constrained ME seeks the minimum-information image estimate among those whose projections are a given distance from the noisy measured data, with that distance determined by the magnitude of the Poisson noise. Images that meet the distance criterion are referred to as feasible images. We find that modeling of all principal degrading factors (attenuation, detector response, and scatter) in the reconstruction is critical because feasibility is not meaningful unless the projection model is as accurate as possible. Because the constrained ME solution is the same as a MAP solution for a particular value of the MAP weighting parameter, beta, the constrained ME solution can be found with a MAP algorithm if the correct value of beta is found. We show that the RBI-MAP algorithm, if used with a dynamic scheme for estimating beta, can approximate constrained ME solutions in 20 or fewer iterations. We compare results for various methods of achieving feasible images on a simulation of Tl-201 cardiac SPECT data. Results show that the RBI-MAP ME approximation provides images and quantitative estimates close to those from a slower algorithm that gives the true ME solution. Also, we find that the ME results have higher spatial resolution and greater high-frequency noise content than a feasibility-based stopping rule, feasibility-based low-pass filtering, and a quadratic Gibbs prior with beta selected according to the feasibility criterion. We conclude that fast ME approximation is possible using either RBI-MAP with the dynamic procedure or a feasibility-based stopping rule, and that such reconstructions may be particularly useful in applications where resolution is critical.

Performance of ordered-subset reconstruction algorithms under conditions of extreme attenuation and truncation in myocardial SPECT.

UNLABELLED: We studied the bias and variance characteristics of the ordered-subset expectation maximization (OSEM) and rescaled block-iterative EM (RBIEM) iterative reconstruction algorithms in myocardial SPECT under extreme, but realistic, conditions. METHOD: We used the 2-dimensional mathematic cardiac torso phantom to simulate 2 patient anatomies: a large male with a raised diaphragm and a female with large breast size, approximating extreme cases of attenuation conditions found in the clinic. For each anatomy, realistic 201Tl projection data were simulated for a 180 degrees acquisition arc. Three cases of truncation for a 90 degrees-configured dual detector system were simulated: no truncation, moderate truncation, and extreme truncation. For each case, an ensemble of 250 noise simulations was generated, and each noisy dataset was reconstructed with the OSEM and RBIEM algorithms. The reconstructions modeled only the effects of nonuniform attenuation and used a range of subset configurations. Over the ensemble, we computed means and variances of activity in 8 regions of interest (ROIs) in the heart as a function of iteration. RESULTS: Under conditions of no truncation and moderate truncation, the results from OSEM and RBIEM were very close to those from maximum-likelihood EM (MLEM); in all cases, the difference in ROI means was <2.5%. For extreme truncation, the errors increased to as much as 11% with OSEM, but these were no greater than the errors for MLEM under the same conditions. The OSEM algorithm with 2 views per subset was found to result in much higher variance of ROI estimates for the same bias as compared with RBIEM or OSEM with 4 or more views per subset. CONCLUSION: The OSEM and RBIEM algorithms are at least as robust to highly attenuating patients and truncation as MLEM algorithm and can be adequate substitutes for MLEM, even in extreme cases. Clinical users should apply the smallest number of subsets that can be accommodated by allowable processing time to reduce image noise and variance in quantitative estimates.

Receiver operating characteristic evaluation of iterative reconstruction with attenuation correction in 99mTc-sestamibi myocardial SPECT images.

UNLABELLED: The purpose of this study was to evaluate differences in myocardial defect detection between 99mTc-sestamibi myocardial SPECT images reconstructed using conventional filtered backprojection (FBP) without attenuation correction (AC) and those reconstructed using maximum-likelihood expectation maximization with nonuniform attenuation correction (MLAC). METHODS: An observer study and receiver operating characteristic (ROC) curve analysis were performed using simulated 99mTc-sestamibi SPECT data from a population of 24 mathematic anthropomorphic torso phantoms, which realistically modeled a wide range of anatomic variations. The phantoms modeled male patients with a flat diaphragm, male patients with a diaphragm raised to the level of the heart, and female patients with large breasts. Transmural, cold defects with a contrast of 0.25 were simulated in the left ventricular wall for 6 locations. Noisy projection data were generated from the phantoms and included the effects of nonuniform attenuation, collimator-detector response, and scatter. The data were then reconstructed using FBP and MLAC. Images were displayed in the short- and long-axis formats, as in clinical practice. Eight observers viewed blocks of FBP and MLAC images and, for each image, indicated on a continuous rating scale the probability that a defect was present. From the rating data, FBP and MLAC ROC curves were generated, and their areas (Az) were estimated and compared. RESULTS: In general, the FBP and MLAC ROC curves did not cross and the MLAC curve showed a higher Az than did the corresponding FBP curve. For male phantoms with a flat diaphragm, the average difference in Az was 0.04 and was not statistically significant (at the P = 0.05 level) for 6 of 8 observers. For male phantoms with a raised diaphragm, the average difference in Az was 0.22 and was statistically significant for 6 of 8 observers. For female phantoms with large breasts, the average difference in Az was 0.19 and was statistically significant for all 8 observers. CONCLUSION: This study showed an improvement in defect detection in myocardial SPECT images using MLAC in comparison with images using FBP without AC, particularly for patients with large breasts or with a diaphragm raised to the level of the heart.

A mathematical model of motion of the heart for use in generating source and attenuation maps for simulating emission imaging.

This manuscript documents the alteration of the heart model of the three-dimensional (3D) mathematical cardiac torso (MCAT) phantom to represent cardiac motion. The objective of the inclusion of motion was to develop a digital simulation of the heart such that the impact of cardiac motion on single-photon emission computed tomography (SPECT) imaging could be assessed and methods of quantitating cardiac function could be investigated. The motion of the gated 3D MCAT's (gMCAT) heart is modeled using 128 separate and evenly spaced time samples from a blood volume curve approximating an average heart cycle. Sets of adjacent time samples can be grouped together to represent a single time interval within the heart cycle. Maximum and minimum chamber volumes were selected to be similar to those of a normal healthy person while the total heart volume stayed constant during the cardiac cycle. Myocardial mass was conserved during the cardiac cycle and the bases of the ventricles were modeled as moving towards the static apex. The orientation of the 3D MCAT heart was changed during contraction to rotate back and forth around the long axis through the center of the left ventricle (LV) using the end systolic time interval as the time point at which to reverse direction. Simple respiratory motion was also introduced by changing the orientation of the long axis of the heart to represent its variation with respiration. Heart models for 24 such orientations spanning the range of motion during the respiratory cycle were averaged together for each time sample to represent the blurring of the heart during the acquisition of multiple cardiac cycles. Finally, an option to model apical thinning of the myocardium was included. As an illustration of the application of the gMCAT phantom, the gated heart model was evaluated by measuring myocardial wall thickening. A linear relationship was obtained between maximum myocardial counts and myocardial thickness, similar to published results. Similar results were obtained for full width at half maximum (FWHM) measurements. With the presence of apical thinning, an apparent increase in counts in the apical region compared to the other heart walls in the absence of attenuation compensation turns into an apparent decrease in counts with attenuation compensation. The apical decrease was more prominent in end systole (ES) than end diastole (ED) due to the change in the partial volume effect. These observations agree with clinical trends. It is concluded that the gMCAT phantom can be used to study the influence of various physical parameters on radionuclide perfusion imaging.

Effects of scatter substraction on detection and quantitation in hepatic SPECT.

UNLABELLED: The purpose of this investigation was to examine the effects of subtractive scatter compensation methods on lesion detection and quantitation. METHODS: Receiver operating characteristic (ROC) methodology was used to measure human observer detection accuracy for tumors in the liver using synthetic images. Furthermore, ROC results were compared with mathematical models for detection and activity quantitation to examine (a) the potential for predicting human performance and (b) the relationship between the detection and quantitation tasks. Images with both low and high amounts of scatter were compared with the ideal case of images of primary photons only (i.e., perfect scatter rejection) and with images corrected by subtracting a scatter image estimated by the dual photopeak window method. RESULTS: With low contrast tumors in a low count background, the results showed that scatter subtraction improved quantitation but did not produce statistically significant increases in detection accuracy. However, primary images did produce some statistically significant improvements in detection accuracy when compared with uncorrected images, particularly for high levels of scatter. CONCLUSION: Although scatter subtraction methods may provide improved activity quantitation, they may not significantly improve detection for liver SPECT. The results imply that significant improvement in detection accuracy for the conditions tested may depend on the development of gamma cameras with better scatter rejection.

Simultaneous technetium-99m/thallium-201 SPECT imaging with model-based compensation for cross-contaminating effects.

Simultaneous acquisition of dual-isotope SPECT data offers a number of advantages over separately acquired data; however, simultaneous acquisition can result in cross-contamination between isotopes. In this work we propose and evaluate two frameworks for iterative model-based compensation of cross-contamination in dual-isotope SPECT. The methods were applied to cardiac imaging with technetium-99m-sestamibi and thallium-201, and they were compared with a subtraction-based compensation method using a cross-talk estimate obtained from an auxiliary energy window. Monte Carlo simulations were performed to carefully study aspects of bias and noise for the methods, and a torso phantom with cardiac insert was used to evaluate the performance of the methods for experimentally acquired data. The cross-talk compensation methods substantially improved lesion contrast and significantly reduced quantitative errors for simultaneously acquired data. Thallium image normalized mean square error (NMSE) was reduced from 0.522 without cross-talk compensation to as low as 0.052 with model-based cross-talk compensation. This is compared with a NMSE of 0.091 for the subtraction-based compensation method. The application of a preliminary model for cross-talk arising from lead fluorescence x-rays and collimator scatter gave promising results, and the future development of a more accurate model for collimator interactions would probably benefit simultaneous Tc/Tl imaging. Model-based compensation methods provide feasible cross-talk compensation in clinically acceptable times, and they may ultimately make simultaneous dual-isotope protocols an effective alternative for many imaging procedures.

Velocity sensitivity of slice-selective excitation.

The purpose of this study was to investigate how flow affects slice-selective excitation, particularly for radiofrequency (rf) pulses optimized for slice-selective excitation of stationary material. Simulation methods were used to calculate the slice profiles for material flowing at different velocities, using optimal flow compensation when appropriate. Four rf pulses of very different shapes were used in the simulation study: a 90 degrees linear-phase Shinnar-LeRoux pulse; a 90 degrees self-refocusing pulse; a minimum-phase Shinnar-LeRoux inversion pulse; and a SPINCALC inversion pulse. Slice profiles from simulations with a laminar flow model were compared with experimental studies for two different rf pulses using a clinical magnetic resonance imaging (MRI) system. We found that, for a given rf pulse, the effect of flow on slice-selective excitation depends on the product of the selection gradient amplitude, the component of velocity in the slice selection direction, and the square of the rf pulse duration. The shapes of the slice profiles from the Shinnar-LeRoux pulses were relatively insensitive to velocity. However, the slice profiles from the self-refocusing pulse and the SPINCALC pulse were significantly degraded by velocity. Experimental slice profiles showed excellent agreement with simulation. In conclusion, our study demonstrates that slice-selective excitation can be significantly degraded by flow depending on the velocity, the gradient amplitude, and characteristics of the rf excitation pulse used. The results can aid in the design of rf pulses for slice-selective excitation of flowing material.

Quantitative myocardial perfusion SPECT.

In recent years, there has been much interest in the clinical application of attenuation compensation to myocardial perfusion single photon emission computed tomography (SPECT) with the promise that accurate quantitative images can be obtained to improve clinical diagnoses. The different attenuation compensation methods that are available create confusion and some misconceptions. Also, attenuation-compensated images reveal other image-degrading effects including collimator-detector blurring and scatter that are not apparent in uncompensated images. This article presents basic concepts of the major factors that degrade the quality and quantitative accuracy of myocardial perfusion SPECT images, and includes a discussion of the various image reconstruction and compensation methods and misconceptions and pitfalls in implementation. The differences between the various compensation methods and their performance are demonstrated. Particular emphasis is directed to an approach that promises to provide quantitative myocardial perfusion SPECT images by accurately compensating for the 3-dimensional (3-D) attenuation, collimator-detector response, and scatter effects. With advances in the computer hardware and optimized implementation techniques, quantitatively accurate and high-quality myocardial perfusion SPECT images can be obtained in clinically acceptable processing time. Examples from simulation, phantom, and patient studies are used to demonstrate the various aspects of the investigation. We conclude that quantitative myocardial perfusion SPECT, which holds great promise to improve clinical diagnosis, is an achievable goal in the near future.

Application of reconstruction-based scatter compensation to thallium-201 SPECT: implementations for reduced reconstructed image noise.

Scatter compensation in Tl-201 single photon emission computed tomography (SPECT) presents an interesting challenge because of the multiple emission energies and relatively large proportion of scattered photons. In this paper, we present a simulation study investigating reconstructed image noise levels arising from various implementations of iterative reconstruction-based scatter compensation (RBSC) in Tl-201 SPECT. A two-stage analysis was used to study single and multiple energy window implementations of reconstruction-based scatter compensation, and RBSC was compared to the upper limits on performance for other approaches to handling scatter. In the first stage, singular value decomposition of the system transfer matrix was used to analyze noise levels in a manner independent of the choice of reconstruction algorithm, providing results valid across a wide range of regularizations. In the second stage, the data were reconstructed using maximum-likelihood expectation-maximization, and the noise properties of the resultant images were analyzed. The best RBSC performance was obtained using multiple energy windows, one for each emission photopeak, and RBSC outperformed the upper limit on subtraction-based compensation methods. Implementing RBSC with the correct choice of energy window acquisition scheme is a promising method for performing scatter compensation for Tl-201 SPECT.

An investigation of the estimation of ejection fractions and cardiac volumes by a quantitative gated SPECT software package in simulated gated SPECT images.

BACKGROUND: The purpose of this investigation was to determine the accuracy of the estimation of ejection fractions (EFs) and left ventricular volumes from a commercially available software package (Quantitative Gated SPECT [QGS]) as a function of different true EFs, count level in the acquisitions, severity and location of perfusion defects, increasing hepatic activity, and modified wall motion. METHODS AND RESULTS: The dynamic mathematic cardiac-torso digital phantom was used to create three-dimensional source and attenuation maps representing the distribution of a technetium-99m-labeled cardiac perfusion agent in the chest. Three hearts with varying end-systolic volumes were used to investigate different EFs. Perfusion defects were created as localized uptake within selected portions of the cardiac walls, scaled to the desired fraction of the normal wall uptake, and subtracted from the normal distribution. The hepatic uptake was increased up to five times of the normal heart uptake to investigate the influence of a "hot" liver. Alteration of lateral wall motion was also investigated. A three-dimensional projector that included the influence of distance-dependent spatial resolution and nonuniform attenuation was then used to create projection images. The projections were scaled to the desired acquisition count level, and Poisson noise was added. Automatic determination of EF slightly overestimated the true EF for normal count levels by 3% to 7% of the true EF and underestimated the true EF by up to 9% for very low count levels for 180-degree reconstructions. The accuracy for determining the volumes was not as high as for the EFs (an average error of 12% was observed). The calculated EFs were relatively accurate for perfusion defects of 50% or less. When perfusion defects exceeded 50%, extracardiac counts were included in the heart contours, causing larger underestimations of EF. With removal of the extracardiac counts, the EFs increased. With a hepatic uptake of two or more times the heart uptake, no meaningful EF could be obtained. Either drawing a single region of interest for every slice or use of the manual mode with constrain option could remarkably improve the estimation. The accuracy of the calculation of EF and volumes for the heart with stationary wall was fairly high but decreased significantly when coupled with perfusion defects. CONCLUSION: It is concluded that the QGS program evaluates the functional parameter of EF accurately. The biggest limitations occurred in determining the appropriate cardiac contour if areas with very high extracardiac counts were present in the heart slices, and when a greater than 50% decrease occurred in uptake for perfusion defects.

Block-iterative techniques for fast 4D reconstruction using a priori motion models in gated cardiac SPECT.

We introduce a fast block-iterative maximum a posteriori (MAP) reconstruction algorithm and apply it to four-dimensional reconstruction of gated SPECT perfusion studies. The new algorithm, called RBI-MAP, is based on the rescaled block iterative EM (RBI-EM) algorithm. We develop RBI-MAP based on similarities between the RBI-EM, ML-EM and MAP-EM algorithms. RBI-MAP requires far fewer iterations than MAP-EM, and so should result in acceleration similar to that obtained from using RBI-EM or OS-EM as opposed to ML-EM. When complex four-dimensional clique structures are used in the prior, however, evaluation of the smoothing prior dominates the processing time. We show that a simple scheme for updating the prior term in the heart region only for RBI-MAP results in savings in processing time of a factor of six over MAP-EM. The RBI-MAP algorithm incorporating 3D collimator-detector response compensation is demonstrated on a simulated 99mTc gated perfusion study. Results of RBI-MAP are compared with RBI-EM followed by a 4D linear filter. For the simulated study, we find that RBI-MAP provides consistently higher defect contrast for a given degree of noise smoothing than does filtered RBI-EM. This is an indication that RBI-MAP smoothing does less to degrade resolution gained from 3D detector response compensation than does a linear filter. We conclude that RBI-MAP can provide smooth four-dimensional reconstructions with good visualization of heart structures in clinically realistic processing times.