Production of radioactive quality assurance phantoms using a standard inkjet printer.

This note proposes the use of a standard inkjet printer to produce radioactive (99m)Tc phantoms that can be used for routine quality control of gamma cameras. The amount of activity that will be deposited on paper per unit area was predicted and compared to the measured activity. The uniformity of the printouts was compared to the uniformity obtained with a standard (57)Co flood source. A scintillation detector connected to a multi-channel analyzer was used to evaluate the uniformity of the printout independently from the gamma camera. Joining two A4 size printed phantoms to create larger sources was evaluated. The spatial resolution obtained with printed sources was compared to that obtained using standard line source techniques. The results indicated that the uniformity of the printed phantoms compared well with those obtained with the (57)Co flood source (integral uniformity 2.29% (printed source) and 2.10% ((57)Co flood source)). There was no difference in the resolution measurements obtained with the printed sources and those obtained with the standard methods. This study demonstrates that affordable phantoms can easily be created to evaluate system uniformity and resolution in any department where a standard PC and inkjet printer are available.

The channel ratio method of scatter correction for radionuclide image quantitation.

The accuracy of quantitation of radionuclide distributions in human tissue with the scintillation camera is decreased by attenuation and scatter of photons. If scatter correction is applied satisfactorily, narrow beam attenuation can be applied. In this article, a scatter correction technique, the channel ratio (CR) method, is introduced. The CR scatter correction method is proposed for quantitation of the radionuclide distribution in organs. The improvement in the geometrical resolution was measured and examples of clinical images are presented. In this method, the change in the ratio of counts from two symmetrical adjacent energy windows straddling the energy photopeak was used to eliminate the contribution of scattered photons during imaging with 99mTc. The theory and methods for the empirical affirmation are described. To apply the CR scatter correction method, two constants, the ratio of primary photons G and the ratio of scattered photons H in the same windows, were determined. Different sized sources in varying depths of water were imaged. When the source activities were quantified after scatter correction with the CR method, the measurements ranged from 96%-108% in comparison to the reference value in 100 mm water. The scatter fraction increased from 0.20 in 10 mm water to 1.44 in 200 mm water. The geometrical resolution expressed as full width at tenth maximum in 150 mm water improved by 30.4% and was restored to the value of the geometrical resolution in air. The CR scatter correction method is a simple method to correct for scatter in order to facilitate accurate quantitation of the radionuclide distribution during imaging with a scintillation camera.

Biodistribution and absorbed radiation dose estimates of 99mTc-labeled dimercaptopropionyl human serum albumin.

UNLABELLED: The use of 99mTc-labeled red blood cells (RBC) for the evaluation of left ventricular function using equilibrium-gated blood-pool imaging suffers from several problems and potential risks. In this study, we estimated the absorbed radiation dose of 99mTc-labeled dimercaptopropionyl human serum albumin (DMP-HSA) as a potential alternative to 99mTc-RBC. METHODS: After the administration of 99mTc-DMP-HSA, whole-body imaging was performed up to 48 h after injection in five volunteers. The heart contents, liver and remainder of the body were used as source organs. Multicompartment modeling of the biodistribution was performed and absorbed radiation dose estimates for 99mTc-DMP-HSA were obtained using the Medical Internal Radiation Dose (MIRD) calculation. RESULTS: Residence times of 0.62 and 0.43 h were obtained for the heart contents and liver, respectively. Radiation dose estimates yielded an effective dose of 0.0055 mSv/MBq. CONCLUSION: 99MTC-DMP-HSA yielded absorbed radiation doses comparable with those of 99mTc-RBC. Therefore, the radiation properties of 99mTc-DMP-HSA are such that it can be used for clinical diagnostic studies.

Verification of a varying threshold edge detection SPECT technique for spleen volume: a comparison with computed tomography volumes.

SPECT enables quantitation of organ volume with radionuclide techniques using threshold edge detection methods. Previous phantom studies showed that a negative correlation exists between volume and threshold value. In those studies, the use of calibration curves were believed to correct for volume dependence on threshold values. The aim of this study was to evaluate the accuracy of spleen volume determination in 20 patients with SPECT by employing a varying threshold edge detection technique with volumes derived from CT. All patients had both radionuclide and CT examinations that were reconstructed with a filtered backprojection algorithm. During SPECT reconstruction, transverse slices were obtained with attenuation correction (Method A) and without attenuation correction (Method B). CT volumes were calculated from manually drawn regions of interest, whereas SPECT volumes were calculated with an automated algorithm using previously determined calibration curves. A confidence interval for calculated SPECT volumes also was calculated because of possible errors in the threshold value. The spleen volumes studied ranged from 91.2 ml to 1660.1 ml. Regression analysis yielded equations of CT = 0.97 SPECT + 7.07 (r = 0.996) and CT = 1.05 SPECT - 19.25 (r = 0.990) between CT and SPECT spleen volumes with a standard error of the y estimates of 31.10 ml and 54.47 ml, respectively. A mean percentage difference of 10.5% +/- 7.6% and 11.4% +/- 6.6% in spleen volume was obtained for Methods A and B in comparison with CT spleen volumes. The threshold value varied between 40.9% and 32.4% for Method A and between 41.2% and 28.5% for Method B because the spleen volume is increased. The varying threshold edge detection technique described in this paper can be implemented successfully in the clinical setting.

The effects of different correction techniques on absolute volume determination with SPECT using a threshold edge detection method.

Quantitation of planar radionuclide images is hampered by structures containing radioactivity which overlie or underlie the organ of interest. The introduction of single photon emission computerized tomography (SPECT) overcame this problem to a large extent and enhanced the contrast of the images. Attenuation of photons, however, degrades the resultant SPECT images and correction methods for photon absorption and scatter were subsequently proposed. The different correction methods have variable effects on the reconstructed images. If threshold techniques are used to quantitate organ volume, i.e., combining pixels with the same percentage of the maximum pixel count in the volume, the selected threshold values which give the most accurate volume determination, will be affected by the specific correction method used. In this study, the effect of various SPECT image correction methods on threshold was investigated. A thorax phantom containing volumes ranging from 30 to 1200 ml was used. Threshold values varying from 45.6% (210 ml without any correction) to 23.7% (1200 ml with a combination of scatter subtraction and attenuation correction) were used to produce correct quantitation when different methods were investigated. A negative correlation was found between threshold and volume. This reduction in threshold was most prominent when scatter and attenuation correction were combined. This study shows that correction methods for attenuation of photons influence the threshold value for volume quantitation and the use of a constant threshold value could lead to underestimation of larger volumes.

Quantitation of SPECT performance: Report of Task Group 4, Nuclear Medicine Committee.

A comprehensive performance testing program is an essential ingredient of high-quality single-photon emission computed tomography (SPECT). Many of the procedures previously published are complicated, time consuming, or require a special testing environment. This Task Group developed a protocol for evaluating SPECT imaging systems that was simple, practical, required minimal test equipment, and could be performed in a few hours using processing software available on all nuclear medicine computers. It was designed to test rotational stability of uniformity and sensitivity, tomographic spatial resolution, uniformity and contrast, and the accuracy of attenuation correction. It can be performed in less than three hours and requires only a Co-57 flood source, a line source, and a tomographic cylindrical phantom. The protocol was used 51 times on 42 different cameras (seven vendors) by four different individuals. The results were used to establish acceptable ranges for the measured parameters. The variation between vendors was relatively small and appeared to reflect slight differences in basic camera performance, collimation, and reconstruction software. Individuals can use the tabulated values to evaluate the performance of individual systems.

Implementation of a Tc-99m and Ce-139 scanning line source for attenuation correction in SPECT using a dual opposing detector scintillation camera.

Image degradation during single photon emission computed tomography (SPECT) due to attenuation and Compton scatter of photons can cause clinical image artifacts and will also result in inaccurate quantitative data. Therefore attenuation correction methods recently received wide interest. Transmission imaging can be performed to obtain the attenuation coefficients of a nonhomogeneous attenuating medium accurately. The aim of this study was firstly to evaluate the imaging characteristics of the scanning line source assembly. The results obtained with Tc-99m and Ce-139 were compared. Secondly the calculated attenuation coefficients were compared with known values from literature, using Tc-99m and Ce-139 as transmission sources. Lastly the method of acquiring simultaneous transmission and emission data was investigated. This study shows that an attenuation coefficient map can be obtained using a scanning line source for transmission imaging with a dual opposing detector camera. The imaging characteristics of Tc-99m and Ce-139 as transmission sources are similar. The resolution obtained with the Ce-139 line source was poorer than that obtained with the Tc-99m line source. A linear relationship was found between CT numbers and attenuation coefficients for transmission images using both Tc-99m and Ce-139 line sources. The attenuation coefficient value for water was underestimated by 1% using the Tc-99m transmission source and underestimated by 10% using Ce-139 as transmission source. This underestimation of attenuation coefficient values was also obtained in the human study. A myocardial perfusion study processed without and with attenuation correction clearly demonstrated the effect of the attenuation correction in the inferior myocardial region. The potential of using a scanning line source as transmission source with a dual opposing detector camera has been demonstrated in this study. The transmission source, Ce-139 was successfully introduced in this investigation for simultaneous acquisition of transmission and emission data.

Radiation doses obtained from 99mTc-labelled human milk fat globule monoclonal antibodies.

Human milk fat globule (HMFG) monoclonal antibodies labelled with 123I and 111In are used for the diagnosis of ovarian and breast cancer. Methods have been developed to label HMFG with 99mTc and this study reports on the subsequent radiation dose delivered. The 99mTc HMFG1 distribution was obtained in 5 normal female baboons up to 71 h after administration. The liver, kidneys, bladder and whole body were identified as source organs and total absorbed doses for the target organs were 0.054 (kidneys), 0.013 (liver), 0.140 (bladder), 0.010 (ovaria), 0.004 (bone marrow), 0.002 (thyroid), 0.003 (heart wall), 0.017 (uterus) and 0.005 mGy/MBq (whole body). The effective dose was 0.014 mSv/MBq.

Evaluation of samarium-153 and holmium-166-EDTMP in the normal baboon model.

Bone-seeking radiopharmaceuticals such as ethylenediaminetetramethylene phosphonate (EDTMP) complexes of samarium-153 and holmium-166 are receiving considerable attention for therapeutic treatment of bone metastases. In this study, using the baboon experimental model, multicompartmental analysis revealed that with regard to pharmacokinetics, biodistribution, and skeletal localisation, 166Ho-EDTMP was significantly inferior to 153Sm-EDTMP and 99mTc-MDP. A more suitable 166Ho-bone-seeking agent should thus be sought for closer similarity to 153Sm-EDTMP to exploit fully the therapeutic potential of its shorter half-life and more energetic beta radiation.

A Monte Carlo evaluation of the channel ratio scatter correction method.

Several methods exist to eliminate the contribution of scattered photons during imaging. One of these, the channel ratio (CR) scatter correction technique, uses the change in the ratio of counts from two symmetrical adjacent energy windows straddling the energy photopeak. The accuracy of the results depends upon the assumption that the ratio of the scatter components in the two windows (H value) is constant and is independent of the relative size of the scatter contribution. In this study a Monte Carlo simulation was used to investigate the behaviour of the scatter component for different source sizes at different depths. Four disc sources containing a 99Tcm solution were simulated at different depths as imaged with a scintillation camera. Two 10% energy windows with 5% offsets to either side of the 140 keV photopeak of 99Tcm were used. The ratio of the scattered counts in the lower energy window to the scattered counts in the upper window (true H value) was determined from the simulation for each source at every depth. Since it is impossible to measure the true H value at different organ depths during a clinical study, the use of an average H value was considered. Scatter correction was applied to the images simulated at the various depths in water. The geometric mean was calculated and attenuation correction performed assuming mono-exponential attenuation. For quantitation purposes the corrected counts were expressed in terms of a references source. The choice of the reference source yielding the best quantitative results was also investigated. Results of this Monte Carlo simulation study show that although the true H value depends on both source size and depth of the source in the scattering medium, the CR scatter correction technique can be applied successfully when an average H value is used.

Staff radiation doses during eight years in a nuclear medicine radiopharmacy.

It is important that staff radiation doses be kept 'as low as reasonably achievable' (ALARA). Staff working in the radiopharmacy and nursing staff responsible for injecting radionuclides are being monitored constantly in our department. We report here on the effective doses and doses to the hands received by staff at two hospitals during 8 years from January 1985 to December 1992. In addition to the doses determined monthly by the South African Bureau of Standards' Radiation Protection Service (SABS), radiation doses received to the hands and whole body were measured every week using lithium fluoride thermoluminescent dosimetry (TLD). The workload (number of patient studies each year) and the estimated amount of 99Tcm received per month were also established, and results have been expressed in relation to these where possible. The combined radiation doses and the absorbed dose per unit activity a single radiographer would have received, since 1988 when radiopharmacy duties were centralized, were calculated. The highest total radiation dose received in any one year by any one person at hospital A was 223.53 mSv to the hands, and 10.20 mSv and 8.37 mSv to the whole body depending on the dosimeter used. The corresponding values for hospital B were 54.05 mSv to the hands and 6.94 mSv and 4.43 mSv to the whole body. If only one radiographer should do all the work the calculated highest dose received would be 447.06 mSv to the hands and 9.68 mSv SABS effective dose.(ABSTRACT TRUNCATED AT 250 WORDS)

Radiation dose estimates of 186Re-hydroxyethylidene diphosphonate for palliation of metastatic osseous lesions: an animal model study.

A common complication in patients with breast or prostate cancer is bone metastases causing pain. New radionuclide therapy methods have recently been proposed for palliation, including 186Re-hydroxyethylidene diphosphonate (186Re-HEDP). This paper reports on the local development of 186Re-HEDP and the biodistribution studied in animals for eventual use in patients. Adult dose was computed assuming a 70 kg standard man. The 186Re was labelled to HEDP using standard techniques. The biodistribution in five Chacma baboons (Papio ursinus) was studied. Doses ranging from 39.4 to 44.9 MBq kg(-1) (mean 43.6 +/- 2.8 MBq kg[-1]) were administered, corresponding to an adult human dose of 2960 MBq (80 mCi). Whole-body images of the animals were obtained with a dual-headed scintillation camera on an hourly basis for 6 h post-injection and then daily for 3 days. The bone, soft tissue, kidneys and urinary bladder were considered source organs and data from these organs were used in a compartmental model to obtain the mean residence times of the radionuclide in the different source organs. Radiation dose estimates for 186Re-HEDP were subsequently obtained with the MIRDOSE 3 program. The estimated absorbed radiation doses to some of the organs (expressed in mGy MBq[-l]) were as follows: bone surface 1.69; kidneys 0.09; liver 0.04; ovaries 0.04; red marrow 0.75; total body 0.12; urinary bladder wall 0.43. 186Re-HEDP yielded an effective dose of 0.17 mSv MBq(-1). The radiation dose delivered to the bone marrow in this study did not cause any detrimental effect to the baboons, indicating that locally produced 186Re-HEDP is suitable for clinical use.

Measurement of plasma volume using 99Tc(m)-labelled DMP-HSA.

Red cell volume (RCV) and plasma volume (PV) measurements are performed routinely in nuclear medicine departments to diagnose a number of haematological disorders. Currently, 125I-HSA is used as a plasma tracer and 99Tcm-labelled red cells to determine red cell volume. 125I-HSA is not always readily available, leading to inconvenience for patients and medical practitioners. Due to the availability of 99Tcm in nuclear medicine departments, the use of albumin labelled with 99Tcm was investigated. A new 99Tcm-human serum albumin labelling kit (99Tcm-DMP-HSA) was developed by Verbeke and supplied for use in this study. The main aim of the study was to investigate the use of 99Tcm-DMP-HSA for PV determination. Secondly, the feasibility to determine red cell and plasma volume simultaneously using 99Tcm as radionuclide in both instances was investigated. Fourteen healthy volunteers were enrolled in the dual-phase study. During the first study, 99Tcm-DMP-HSA was used as tracer to calculate PV (PV1a) after intravenous administration. Subsequently, 99Tcm-labelled red cells were administered and the PV (PV1b) and RCV (RCV1) were calculated. The second study was repeated within 2 weeks using the conventional method. 125I-HSA and 99Tcm-labelled red cells were administered simultaneously. The PV (PV2) and RCV (RCV2) were calculated. We found that the redistribution of 99Tcm-DMP-HSA is faster than that of 125I-HSA; therefore, the plasma counts obtained at different times were back-extrapolated to time zero for plasma volume calculations. The mean values for the different calculated PVs were 2964+/-470 ml for PV1a, 3006+/-623 ml for PV1b and 3001+/-530 ml for PV2, the reference PV. The confidence intervals indicate no significant differences between plasma volumes PV1a and PV2 and plasma volumes PV1a and PV1b. The mean calculated RCV1 was 2130+/-322 ml; that of RCV2 was 2128+/-353 ml. The difference between RCV1 and RCV2 was not significant. Our results indicate that 99Tcm-DMP-HSA could be used for plasma volume calculation. Red cell and plasma volumes can be calculated simultaneously using 99Tcm as radionuclide in both cases.

Daily serial evaluation of left ventricular function with equilibrium radionuclide ventriculography following thrombolysis during acute myocardial infarction.

The changes in ventricular function after reperfusion by coronary thrombolysis are important when deciding about further definitive treatment necessary to ensure long-term vessel patency. The purpose of this study was to evaluate the early changes in left ventricular function after reperfusion. Left ventricular function was serially evaluated for 10 days in a group of 18 patients receiving intracoronary thrombolytic therapy for an acute myocardial infarction. Comparison of the global ventricular function in the successfully and unsuccessfully reperfused groups of patients showed significantly better function in the successful group than the unsuccessful group after the first day, which was maintained for the entire study period. Global and regional ventricular function in the successfully reperfused patients showed significant early improvement during the initial 72 h with maintenance of this improvement for the study period of 10 days. In the patients in whom reperfusion was unsuccessful, regional ventricular function showed no change, while the global function declined from day 5 to day 8 of the study period. This study then confirms the significant improvement in ventricular function after successful reperfusion. The time course pattern of the change in ventricular function indicates that the most significant improvement occurs within the first 72 h after reperfusion. These changes are similar to those previously reported in experimental animals.

The effect of exercise on normal splenic volume measured with SPECT.

In a study group of 20 healthy young men, splenic volume was determined with SPECT before and after exercise. A randomly chosen control group of 10 comparable men was studied similarly, but without exercise intervention. The mean splenic volume did not change significantly in the control group (i.e., from 292.9 ml to 282.1 ml [P = 0.75]). The mean splenic volume decreased 60.1 ml from 279.4 to 219.3 ml (21.5%) in the study group and this was highly significant (P = 0.01). Although exercise induced splenic autotransfusion is generally considered to be unimportant in humans, significant splenic contractility was observed with this technique. In the normal individual with a large spleen or with functional splenomegaly, the contractility response may become more important and can now be measured in a quick and easy manner.

Persistent left superior vena cava detected with radionuclide angiocardiography.

A 28-year-old man presented with paresthesias, fatigue, central cyanosis, and erythrocytosis. A first pass flow study with Tc-99m as free pertechnetate was done, among other tests, to exclude a central shunt when a persistent left superior vena cava was incidentally detected. The value of radionuclide angiocardiography to examine the central circulation noninvasively was again illustrated in this case.

Airflow distribution with manual hyperinflation as assessed through gamma camera imaging: a crossover randomised trial.

OBJECTIVES: Manual hyperinflation (MHI) has been shown to improve lung compliance, reduce airway resistance, and enhance secretion removal and peak expiratory flow. The aims of this study were to investigate whether there is a difference in airflow distribution through patients' lungs when using the Laerdal and Mapleson-C circuits at a set level of positive end-expiratory pressure (PEEP), and to establish whether differences in lung compliance and haemodynamic status exist when patients are treated with both these MHI circuits. DESIGN: Crossover randomised controlled trial. SETTING: Adult multidisciplinary intensive care unit (ICU) at an academic hospital. PARTICIPANTS: Fifteen adult patients were recruited and served as their own controls. INTERVENTION: In the Nuclear Medicine Department, MHI with PEEP 7.5 cmH(2)O was performed in the supine position (Day 1) with either Laerdal or Mapleson-C circuits, in a random order, while technetium-99m (Tc-99m) aerosol was administered and images were taken with a gamma camera. Changes in heart rate (HR), mean arterial pressure (MAP) and dynamic lung compliance (C(D)) were documented at baseline, immediately after return to ICU, and 10, 20 and 30 minutes after return to ICU. The alternative circuit was used on Day 2. RESULTS: Tc-99m deposition was greater in the right lung field (62% and 63% for Laerdal and Mapleson-C circuits, respectively) than the left lung field (38% and 37%, respectively) for all patients, and least deposition occurred in the left lower segments (6% and 6%, respectively). No differences in Tc-99m deposition in the lungs, HR, MAP or C(D) were noted between the two MHI circuits. CONCLUSION: Airflow distribution through patients' lungs was similar when the Laerdal and Mapleson-C MHI circuits were compared using a set level of PEEP in the supine position.

Evaluation of an uncollimated printed paper transmission source used under scatter limiting conditions.

Transmission sources used for image attenuation correction, allowing image quantification, are collimated to reduce scatter. We propose the same effect can be achieved for an uncollimated source by increasing source to patient distance. The aim was to compare planar image performance characteristics and absorbed doses of uncollimated and collimated radioactive printed paper transmission sources. The scatter contribution to the uncollimated (99m)Tc source data was evaluated for different combinations of detector phantom distance, detector source distance and phantom source distance. Measurements were performed by increasing the Lucite phantom thickness in 1cm steps to 20 cm. Spatial resolution, detection efficiency and entrance absorbed dose rate were measured for the uncollimated and collimated transmission source images. Results derived from the energy spectra, obtained with the uncollimated transmission source indicate that scatter contribution increases with decreasing detector source distance. The scatter component in the uncollimated transmission images (detector source distances ≥ 60 cm; phantom source distances ≥ 40 cm) was comparable to that obtained with collimated transmission images. Attenuation coefficients obtained compared well (0.168 cm⁻¹ vs. 0.171 cm⁻¹). The full widths at half maxima differed by less than 0.9 mm. The detection efficiency of the uncollimated source was 2.5 times higher than obtained with the collimated source. The entrance absorbed dose obtained from an uncollimated source was 3.75 times larger than that obtained from the collimated source. An uncollimated transmission source (detector source distance ≥ 60 cm) results in acceptable image characteristics and presents a low cost, low dose, high efficiency option for transmission imaging.

The relationship between administered radiopharmaceutical activity in myocardial perfusion scintigraphy and imaging outcome.

INTRODUCTION: Lower radiopharmaceutical activities are used for myocardial perfusion scintigraphy (MPS) in the UK than in other countries. There is no evidence to suggest that higher activities improve imaging or clinical outcome. MATERIALS AND METHODS: We undertook a multicentre study of the relationship between radiopharmaceutical activity and imaging outcome. Fifty-one patients with clinical referrals for MPS followed a 2-day protocol with an injection of 1,000 MBq (99m)Tc-tetrofosmin for each of the stress and rest images. ECG-gated acquisition was performed in three rotations occupying 25, 35 and 40% of a standard acquisition, and rotations were summed to simulate administered activities of 250, 400, 750 and 1,000 MBq. Each set of images was reported by an experienced physician who was blinded to all clinical information and to the simulated activity. Scores were assigned for image quality, low count, attenuation and reconstruction artefact, segmental tracer uptake, segmental and global defect classification, and confidence in the global classification. The images were reported twice to assess intra-observer variability. RESULTS: Positive relationships were found between administered activity and overall image quality, observer confidence and intra-observer agreement of uptake score, and a negative relationship was found with low-count artefact. For the majority of comparisons, there was no additional improvement with increasing activity from 750 to 1,000 MBq. Intra-observer agreement was found to be better in female patients and in those below average body mass index. DISCUSSION: We conclude that higher administered radiopharmaceutical activities lead to better quality images and improved surrogate parameters for clinical outcome, but that activities above 750 MBq may be unnecessary in average patients.