Accurate and efficient rapid acquisition early post-injection stress-first CZT SPECT myocardial perfusion imaging with tetrofosmin and attenuation correction.

INTRODUCTION: Myocardial perfusion imaging (MPI) protocols have not changed significantly despite advances in instrumentation and software. We compared an early post-injection, stress-first SPECT protocol to standard delayed imaging. METHODS: 95 patients referred for SPECT MPI were imaged upright and supine on a Spectrum Dynamics D-SPECT CZT system with CT attenuation correction. Patients received injection of 99mTc tetrofosmin at peak of regadenoson stress and were imaged. Early post-stress (mean 17 ± 2 minutes) and Standard 1-h delay (mean 61 ± 13 min). Three blinded readers evaluated images for overall interpretation, perceived need for rest imaging, image quality, and reader confidence. Laboratory efficiency was also evaluated. RESULTS: Blinded readers had the same response for the need for rest in 77.9% of studies. Studies also had the same interpretation in 89.5% of studies. Reader confidence was high (86.0% (Early) and 90.3% (Standard p = 0.52. Image quality was good or excellent in 87.4% Early vs 96.8% Standard (p = 0.09). Time between patient check-in and end of stress imaging was 104 ± (Standard) to 60 ± 18 minutes (Early) (p < 0.001). CONCLUSION: Early post-injection stress-only imaging using CZT SPECT/CT appears promising with Tc-99m tetrofosmin with similar image quality, reader confidence, diagnosis, and need for a rest scan.

Technetium pyrophosphate nuclear scintigraphy for cardiac amyloidosis: Imaging at 1 vs 3 hours and planar vs SPECT/CT.

BACKGROUND: Multi-societal consensus recommendations endorse both planar and single photon emission tomographic (SPECT) image acquisitions for the evaluation of cardiac amyloidosis. However, the correlation between planar and SPECT findings and the optimal timing of image acquisitions remain uncertain. METHODS: This is an analysis of 109 consecutive patients who underwent technetium pyrophosphate nuclear scintigraphy for the evaluation of cardiac amyloidosis. Patients were imaged at 1 and 3 hours after radiotracer injection using both planar and SPECT/CT, and the correlations between imaging protocols were compared. RESULTS: In the overall cohort (median age 77 years, 75% male), 33 patients had radiotracer localized to the myocardium on SPECT/CT images. There was strong correlation between 1- and 3-hour planar heart-to-contralateral lung ratios (mean difference 0.07, r = 0.94). However, there was discordance between planar image interpretation (based upon semiquantitative score and H/CL ratio) and myocardial localization of radiotracer on SPECT/CT in 17 patients (16%). The pattern of SPECT/CT uptake was identical at 1 and 3 hours in all cases (32 diffuse, 1 focal). CONCLUSION: These data support the recommendation that SPECT/CT should be obtained in addition to planar images when performing nuclear scintigraphy for the detection of cardiac amyloidosis. A 1-hour planar and SPECT/CT protocol appears optimal.

Drivers of radiation dose reduction with myocardial perfusion imaging: A large health system experience.

BACKGROUND: Despite increasing emphasis on reducing radiation exposure from myocardial perfusion imaging (MPI), the use of radiation-sparing practices (RSP) at nuclear laboratories remains limited. Defining real-world impact of RSPs on effective radiation dose (E) can potentially further motivate their adoption. METHODS: MPI studies performed between 1/2010 and 12/2016 within a single health system were included. Mean E was compared between sites with 'basic' RSP (defined as elimination of thallium-based protocols and use of stress-only (SO) imaging on conventional single photon emission computed tomography (SPECT) cameras) and those with 'advanced' capabilities (sites that additionally used solid-state detector (SSD) SPECT cameras, advanced post-processing software (APPS) or positron emission tomography (PET) imaging), after matching patients by age, gender, and weight. Contributions of individual RSP to E reduction were determined using multiple linear regression after adjusting for factors affecting tracer dose. RESULTS: Among 55,930 MPI studies performed, the use of advanced RSP was associated with significantly lower mean E compared to basic RSP (7 ± 5.6 mSv and 16 ± 5.4 mSv, respectively; P < 0.001), with a greater likelihood of achieving E < 9 mSv (65.7% vs. 10.8%, respectively; OR 15.8 [95% CI 14 to 17.8]; P < 0.0001). Main driver of E reduction was SO-SSD SPECT (mean reduction = 11.5 mSv), followed by use of SO-SPECT + APPS (mean reduction = 10.1 mSv), ;ET (mean reduction = 9.7 mSv); and elimination of thallium protocols (mean reduction = 9.1 mSv); P < 0.0001 for all comparisons. CONCLUSION: In a natural experiment with implementation of radiation-saving practices at a large health system, stress-only protocols used in conjunction with modern SPECT technologies, the use of PET and elimination of thallium-based protocols were associated with greatest reductions in radiation dose. Availability of several approaches to dose reduction within a health system can facilitate achievement of targeted radiation benchmarks in a greater number of performed studies.

Diagnostic accuracy of high-resolution attenuation-corrected Anger-camera SPECT in the detection of coronary artery disease.

BACKGROUND: There is limited data on diagnostic accuracy of recently introduced high-resolution Anger (HRA) SPECT incorporating attenuation correction (AC), noise reduction, and resolution recovery algorithms. We therefore studied 54 consecutive patients (excluding those with prior MI or cardiomyopathy) who had HRA-AC SPECT and coronary angiography (CA) ≤ 30 days and no change in symptoms. METHODS: The HRA-AC studies were acquired in 128 × 128 matrix (3.2 mm pixel) format with simultaneous Gd-153 line-source AC. Measured variables were image quality, interpretive certainty, sensitivity and specificity for any CAD, sensitivity for single- and multivessel CAD, and the influence of gender, body mass index (BMI), and stress modality. RESULTS: The mean age of the patients was 66 ± 11 years with a BMI of 32 ± 7 kg·m(-2). Mean interpretive certainty score was 2.7 on a 3-point scale and mean image quality score was 3.3 on a 4-point scale. Stress perfusion defects were detected in 34 of 38 patients with obstructive CAD [sensitivity 89%, 95% confidence interval (CI) 76%-95%]. The specificity was 75% (CI 51%-90%) and overall diagnostic accuracy was 85% (CI 73%-92%). Accuracy did not differ for females vs males, for BMI ≤30 vs >30, or for pharmacologic vs exercise SPECT. Sensitivity for single-vessel disease was 88% (CI 69%-96%) and for multivessel disease was 93% (CI 69%-99%). CONCLUSION: New Anger technology incorporating innovative improvements results in high image quality with excellent interpretive certainty and high diagnostic accuracy.

Secondary neutron spectra from modern Varian, Siemens, and Elekta linacs with multileaf collimators.

Neutrons are a by-product of high-energy x-ray radiation therapy (threshold for [gamma,n] reactions in high-Z material -7 MeV). Neutron production varies depending on photon beam energy as well as on the manufacturer of the accelerator. Neutron production from modern linear accelerators (linacs) has not been extensively compared, particularly in terms of the differences in the strategies that various manufacturers have used to implement multileaf collimators (MLCs) into their linac designs. However, such information is necessary to determine neutron dose equivalents for different linacs and to calculate vault shielding requirements. The purpose of the current study, therefore, was to measure the neutron spectra from the most up-to-date linacs from three manufacturers: Varian 21EX operating at 15, 18, and 20 MV, Siemens ONCOR operating at 15 and 18 MV, and Elekta Precise operating at 15 and 18 MV. Neutron production was measured by means of gold foil activation in Bonner spheres. Based on the measurements, the authors determined neutron spectra and calculated the average energy, total neutron fluence, ambient dose equivalent, and neutron source strength. The shapes of the neutron spectra did not change significantly between accelerators or even as a function of treatment energy. However, the neutron fluence, and therefore the ambient dose equivalent, did vary, increasing with increasing treatment energy. For a given nominal treatment energy, these values were always highest for the Varian linac. The current study thus offers medical physicists extensive information about the neutron production of MLC-equipped linacs currently in operation and provides them information vital for accurate comparison and prediction of neutron dose equivalents and calculation of vault shielding requirements.

Effects of tertiary MLC configuration on secondary neutron spectra from 18 MV x-ray beams for the Varian 21EX linear accelerator.

The effect of the jaw configuration and the presence and configuration of the tertiary multileaf collimator (MLC) on the secondary neutron spectra for an 18 MV Varian 21EX linear accelerator (linac) is investigated in detail. The authors report the measured spectra for four collimator (jaw-and-MLC) configurations. These configurations represent the extreme settings of the jaws and MLC and should therefore describe the range of possible fluence and spectra that may be encountered during use of this linac. In addition to measurements, a Monte Carlo model was used to simulate the four collimator configurations and calculate the energy spectra and fluence at the same location as it was measured. The Monte Carlo model was also used to calculate the sources of neutron production in the linac head for each collimator configuration. They found that photoneutron production in the linac treatment head is dominated by the order in which the primary photon beam intercepts the high-Z material. The primary collimator, which has the highest position in the linac head (in a fixed location), is the largest source of secondary neutrons. Thereafter, the collimator configuration plays a role in where the neutrons originate. For instance, if the jaws are closed, they intercept the beam and contribute substantially to the secondary neutron production. Conversely, if the jaws are open, the MLC plays a larger role in neutron production (assuming, of course, that it intercepts the beam). They found that different collimator configurations make up to a factor of 2 difference in the ambient dose equivalent.

Neutron detection performance of gallium nitride based semiconductors.

Neutron detection is crucial for particle physics experiments, nuclear power, space and international security. Solid state neutron detectors are of great interest due to their superior mechanical robustness, smaller size and lower voltage operation compared to gas detectors. Gallium nitride (GaN), a mature wide bandgap optoelectronic and electronic semiconductor, is attracting research interest for neutron detection due to its radiation hardness and thermal stability. This work investigated thermal neutron scintillation detectors composed of GaN thin films with and without conversion layers or rare-earth doping. Intrinsic GaN-based neutron scintillators are demonstrated via the intrinsic 14N(n, p) reaction, which has a small thermal neutron cross-section at low neutron energies, but is comparable to other reactions at high neutron energies (>1 MeV). Gamma discrimination is shown to be possible with pulse-height in intrinsic GaN-based scintillation detectors. Additionally, GaN-based scintillation detector with a 6LiF neutron conversion layer and Gd-doped GaN detector are compared with intrinsic GaN detectors. These results indicate GaN scintillator is a suitable candidate neutron detector in high-flux applications.

Experimental validation of the new nanodosimetry-based cell survival model for mixed neutron and gamma-ray irradiation.

The new nanodosimetry-based linear-quadratic (LQ) formula has been reviewed for mixed-LET irradiation. V-79 Chinese hamster cells have been irradiated with a mixed-LET field of fission neutrons and gamma rays at the University of Maryland Training Reactor (MUTR). The results show that the experimental survival curve agrees well with that predicted by the new nanodosimetry-based LQ model. The experimental study described in this note, therefore, serves as a validation for the new model to be used for mixed-LET radiotherapies, e.g. 252Cf brachytherapy.

Measured Neutron Spectra and Dose Equivalents From a Mevion Single-Room, Passively Scattered Proton System Used for Craniospinal Irradiation.

PURPOSE: To measure, in the setting of typical passively scattered proton craniospinal irradiation (CSI) treatment, the secondary neutron spectra, and use these spectra to calculate dose equivalents for both internal and external neutrons delivered via a Mevion single-room compact proton system. METHODS AND MATERIALS: Secondary neutron spectra were measured using extended-range Bonner spheres for whole brain, upper spine, and lower spine proton fields. The detector used can discriminate neutrons over the entire range of the energy spectrum encountered in proton therapy. To separately assess internally and externally generated neutrons, each of the fields was delivered with and without a phantom. Average neutron energy, total neutron fluence, and ambient dose equivalent [H* (10)] were calculated for each spectrum. Neutron dose equivalents as a function of depth were estimated by applying published neutron depth-dose data to in-air H* (10) values. RESULTS: For CSI fields, neutron spectra were similar, with a high-energy direct neutron peak, an evaporation peak, a thermal peak, and an intermediate continuum between the evaporation and thermal peaks. Neutrons in the evaporation peak made the largest contribution to dose equivalent. Internal neutrons had a very low to negligible contribution to dose equivalent compared with external neutrons, largely attributed to the measurement location being far outside the primary proton beam. Average energies ranged from 8.6 to 14.5 MeV, whereas fluences ranged from 6.91 × 10(6) to 1.04 × 10(7) n/cm(2)/Gy, and H* (10) ranged from 2.27 to 3.92 mSv/Gy. CONCLUSIONS: For CSI treatments delivered with a Mevion single-gantry proton therapy system, we found measured neutron dose was consistent with dose equivalents reported for CSI with other proton beamlines.

Liposome-based delivery of a boron-containing cholesteryl ester for high-LET particle-induced damage of prostate cancer cells: a boron neutron capture therapy study.

PURPOSE: The efficacy of a boron-containing cholesteryl ester compound (BCH) as a boron neutron capture therapy (BNCT) agent for the targeted irradiation of PC-3 human prostate cancer cells was examined. MATERIALS AND METHODS: Liposome-based delivery of BCH was quantified with inductively coupled plasma-mass spectrometry (ICP-MS) and high-performance liquid chromatography (HPLC). Cytotoxicity of the BCH-containing liposomes was evaluated with neutral red, 3-(4,5-dimethylthiazol-2-yl)-5-(3-carboxymethoxyphenyl)-2-(4-sulfophenyl)-2H-tetrazolium (MTS), and lactate dehydrogenase assays. Colony formation assays were utilized to evaluate the decrease in cell survival due to high-linear energy transfer (LET) particles resulting from (10)B thermal neutron capture. RESULTS: BCH delivery by means of encapsulation in a lipid bilayer resulted in a boron uptake of 35.2 ± 4.3 µg/10(9) cells, with minimal cytotoxic effects. PC-3 cells treated with BCH and exposed to a 9.4 × 10(11) n/cm(2) thermal neutron fluence yielded a 20-25% decrease in clonogenic capacity. The decreased survival is attributed to the generation of high-LET α particles and (7)Li nuclei that deposit energy in densely ionizing radiation tracks. CONCLUSION: Liposome-based delivery of BCH is capable of introducing sufficient boron to PC-3 cells for BNCT. High-LET α particles and (7)Li nuclei generated from (10)B thermal neutron capture significantly decrease colony formation ability in the targeted PC-3 cells.

Guidance on the use of handheld survey meters for radiological triage: time-dependent detector count rates corresponding to 50, 250, and 500 mSV effective dose for adult males and adult females.

In June 2006, the Radiation Studies Branch of the Centers for Disease Control and Prevention held a workshop to explore rapid methods of facilitating radiological triage of large numbers of potentially contaminated individuals following detonation of a radiological dispersal device. Two options were discussed. The first was the use of traditional gamma cameras in nuclear medicine departments operated as makeshift wholebody counters. Guidance on this approach is currently available from the CDC. This approach would be feasible if a manageable number of individuals were involved, transportation to the relevant hospitals was quickly provided, and the medical staff at each facility had been previously trained in this non-traditional use of their radiopharmaceutical imaging devices. If, however,substantially larger numbers of individuals (100's to 1,000's) needed radiological screening, other options must be given to first responders, first receivers, and health physicists providing medical management. In this study, the second option of the workshop was investigated--the use of commercially available portable survey meters (either NaI or GM based) for assessing potential ranges of effective dose (< 50, 50-250, 250-500,and >500 mSv). Two hybrid computational phantoms were used to model an adult male and an adult female subject internally contaminated with 241Am, 60Cs, 137Cs, 131I, or 192Ir following an acute inhalation or ingestion intake. As a function of time following the exposure, the net count rates corresponding to committed effective doses of 50, 250, and 500 mSv were estimated via Monte Carlo radiation transport simulation for each of four different detector types, positions, and screening distances.Measured net count rates can be compared to these values, and an assignment of one of four possible effective dose ranges could be made. The method implicitly assumes that all external contamination has been removed prior to screening and that the measurements be conducted in a low background, and possibly mobile, facility positioned at the triage location. Net count rate data are provided in both tabular and graphical format within a series of eight handbooks available at the CDC website (http://www.bt.cdc.gov/radiation/clinicians/evaluation).

Calibration of indium response functions in an Au-In-BSE system up to 800 MeV.

Calibration of the response functions of a gold (Au)-indium (In) dual foil Bonner sphere extended (BSE) system was described. The response of the In and Au foil of the system was calculated using MCNPX code with different activation cross-sectional libraries: (ACTL and ENDF VI for gold and ACTL and 532DOS2 for In). To verify and correct the calculated response functions the Bonner sphere set (BSS) was irradiated using (252)Cf and (241)AmBe sources of known neutron strengths for neutrons ranging from thermal to 20 MeV, and was irradiated at the 800-MeV neutron beam of the Los Alamos Neutron Science Center. The neutron spectrum of the 800 MeV beam was determined using time-of-flight (TOF) technique. We observed that the uncertainty of activation cross section in the resonance region can result in great uncertainty in the MCNPX-calculated response functions of activation foil-based BSS. The MCNPX-calculated response functions must be corrected using neutron sources of known spectrum and strength.