Roadmap toward the 10 ps time-of-flight PET challenge.

Since the seventies, positron emission tomography (PET) has become an invaluable medical molecular imaging modality with an unprecedented sensitivity at the picomolar level, especially for cancer diagnosis and the monitoring of its response to therapy. More recently, its combination with x-ray computed tomography (CT) or magnetic resonance (MR) has added high precision anatomic information in fused PET/CT and PET/MR images, thus compensating for the modest intrinsic spatial resolution of PET. Nevertheless, a number of medical challenges call for further improvements in PET sensitivity. These concern in particular new treatment opportunities in the context personalized (also called precision) medicine, such as the need to dynamically track a small number of cells in cancer immunotherapy or stem cells for tissue repair procedures. A better signal-to-noise ratio (SNR) in the image would allow detecting smaller size tumours together with a better staging of the patients, thus increasing the chances of putting cancer in complete remission. Moreover, there is an increasing demand for reducing the radioactive doses injected to the patients without impairing image quality. There are three ways to improve PET scanner sensitivity: improving detector efficiency, increasing geometrical acceptance of the imaging device and pushing the timing performance of the detectors. Currently, some pre-localization of the electron-positron annihilation along a line-of-response (LOR) given by the detection of a pair of annihilation photons is provided by the detection of the time difference between the two photons, also known as the time-of-flight (TOF) difference of the photons, whose accuracy is given by the coincidence time resolution (CTR). A CTR of about 10 picoseconds FWHM will ultimately allow to obtain a direct 3D volume representation of the activity distribution of a positron emitting radiopharmaceutical, at the millimetre level, thus introducing a quantum leap in PET imaging and quantification and fostering more frequent use of 11C radiopharmaceuticals. The present roadmap article toward the advent of 10 ps TOF-PET addresses the status and current/future challenges along the development of TOF-PET with the objective to reach this mythic 10 ps frontier that will open the door to real-time volume imaging virtually without tomographic inversion. The medical impact and prospects to achieve this technological revolution from the detection and image reconstruction point-of-views, together with a few perspectives beyond the TOF-PET application are discussed.

TOF-PET Image Reconstruction With Multiple Timing Kernels Applied on Cherenkov Radiation in BGO.

Today Time-of-Flight (TOF), in PET scanners, assumes a single, well-defined timing resolution for all events. However, recent BGO-Cherenkov detectors, combining prompt Cherenkov emission and the typical BGO scintillation, can sort events into multiple timing kernels, best described by the Gaussian mixture models. The number of Cherenkov photons detected per event impacts directly the detector time resolution and signal rise time, which can later be used to improve the coincidence timing resolution. This work presents a simulation toolkit which applies multiple timing spreads on the coincident events and an image reconstruction that incorporates this information. A full cylindrical BGO-Cherenkov PET model was compared, in terms of contrast recovery and contrast-to-noise ratio, against an LYSO model with a time resolution of 213 ps. Two reconstruction approaches for the mixture kernels were tested: 1) mixture Gaussian and 2) decomposed simple Gaussian kernels. The decomposed model used the exact mixture component applied during the simulation. Images reconstructed using mixture kernels provided similar mean value and less noise than the decomposed. However, typically, more iterations were needed. Similarly, the LYSO model, with a single TOF kernel, converged faster than the BGO-Cherenkov with multiple kernels. The results indicate that the model complexity slows down convergence. However, due to the higher sensitivity, the contrast-to-noise ratio was 26.4% better for the BGO model.