U.S. PET/CT and Gamma Camera Diagnostic Reference Levels and Achievable Administered Activities for Noncardiac Nuclear Medicine Studies.

Existing surveys of radiopharmaceutical doses for U.S. nuclear medicine laboratories are of limited scope and size. Dose data are important because they can be used to benchmark individual laboratories, understand geographic variations in practice, and provide source data for societal guidelines and appropriateness criteria. Diagnostic reference levels (DRLs) and achievable administered activities (AAAs) for 13 noncardiac adult gamma camera and PET/CT examinations were derived retrospectively from American College of Radiology accreditation data (January 1, 2015, to December 31, 2017). The calculated DRL and AAA are consistent with previously published surveys. The distributions of radiopharmaceutical doses across facilities are in general consistent but show variation within a particular examination. Analysis of dose distribution suggests this variation results from differences in clinical protocols, educational gaps, and/or equipment factors. The AAA for the surveyed facilities exceeds dose ranges proposed in societal practice guidelines for several common nuclear medicine studies. Compared with similar surveys from Europe and Japan, geographic variation is observed, with some doses greater and others lower than used in the United States. Overall, radiopharmaceutical dose variation within the United States and internationally, and deviation from societal guidelines, imply that these dose-related benchmarks may be used to further standardize and improve clinical practice.

Comparison of the prognostic value of myocardial perfusion imaging using a CZT-SPECT camera with a conventional anger camera.

BACKGROUND: Recent studies have shown that myocardial perfusion imaging (MPI) in cadmium-zinc-telluride (CZT) cameras allow faster exams with less radiation dose but there are little data comparing its prognosis information with that of dedicated cardiac Na-I SPECT cameras OBJECTIVE: The objective of this study is to compare the prognostic value of MPI using an ultrafast protocol with low radiation dose in a CZT-SPECT and a traditional one. METHODS: Group 1 was submitted to a two-day MIBI protocol in a conventional camera, and group 2 was submitted to a 1-day MIBI protocol in CZT camera. MPI were classified as normal or abnormal, and perfusion scores were calculated. Propensity score matching methods were performed RESULTS: 3554 patients were followed during 33±8 months. Groups 1 and 2 had similar distribution of age, gender, body mass index, risk factors, previous revascularization, and use of pharmacological stress. Group 1 had more abnormal scans, higher scores than group 2. Annualized hard events rate was higher in group 1 with normal scans but frequency of revascularization was similar to normal group 2. Patients with abnormal scans had similar event rates in both groups CONCLUSION: New protocol of MPI in CZT-SPECT showed similar prognostic results to those obtained in dedicated cardiac Na-I SPECT camera, with lower prevalence of hard events in patients with normal scan.

Prognostic value of the cadmium-zinc-telluride camera: A comparison with a conventional (Anger) camera.

BACKGROUND: New multipinhole cadmium-zinc-telluride (CZT) cameras allow for faster imaging and lower radiation doses for single photon emission computed tomography (SPECT) studies, but assessment of prognostic ability is necessary. METHODS AND RESULTS: We collected data from all myocardial SPECT perfusion studies performed over 15 months at our institution, using either a CZT or conventional Anger camera. A Cox proportional hazards model was used to assess the relationship between camera type, imaging results, and either death or myocardial infarction (MI). Clinical variables including age, sex, body mass index (BMI), and historical risk factors were used for population description and model adjustments. We had 2,088 patients with a total of 69 deaths and 65 MIs (122 events altogether). A 3% increase in DDB (difference defect burden) represented a 12% increase in the risk of death or MI, whereas a 3% increase in rest defect burden or stress defect burden represented an 8% increase; these risks were the same for both cameras (P > .24, interaction tests). CONCLUSIONS: The CZT camera has similar prognostic values for death and MI to conventional Anger cameras. This suggests that it may successfully be used to decrease patient dose.

A toolkit for the characterization of CCD cameras for transmission electron microscopy.

Charge-coupled devices (CCD) are nowadays commonly utilized in transmission electron microscopy (TEM) for applications in life sciences. Direct access to digitized images has revolutionized the use of electron microscopy, sparking developments such as automated collection of tomographic data, focal series, random conical tilt pairs and ultralarge single-particle data sets. Nevertheless, for ultrahigh-resolution work photographic plates are often still preferred. In the ideal case, the quality of the recorded image of a vitrified biological sample would solely be determined by the counting statistics of the limited electron dose the sample can withstand before beam-induced alterations dominate. Unfortunately, the image is degraded by the non-ideal point-spread function of the detector, as a result of a scintillator coupled by fibre optics to a CCD, and the addition of several inherent noise components. Different detector manufacturers provide different types of figures of merit when advertising the quality of their detector. It is hard for most laboratories to verify whether all of the anticipated specifications are met. In this report, a set of algorithms is presented to characterize on-axis slow-scan large-area CCD-based TEM detectors. These tools have been added to a publicly available image-processing toolbox for MATLAB. Three in-house CCD cameras were carefully characterized, yielding, among others, statistics for hot and bad pixels, the modulation transfer function, the conversion factor, the effective gain and the detective quantum efficiency. These statistics will aid data-collection strategy programs and provide prior information for quantitative imaging. The relative performance of the characterized detectors is discussed and a comparison is made with similar detectors that are used in the field of X-ray crystallography.

[Diagnostic use of positron emission tomography in France: from the coincidence gamma-camera to mobile hybrid PET/CT devices]. / Application diagnostique de la tomographie par émission de positons en France. De la gamma-caméra modifée à la machine hybride TEP/TDM.

Positron emission tomography (PET) is a well-established medical imaging method. PET is increasingly used for diagnostic purposes, especially in oncology. The most widely used radiopharmaceutical is FDG, a glucose analogue. Other radiopharmaceuticals have recently been registered or are in development. We outline technical improvements of PET machines during more than a decade of clinical use in France. Even though image quality has improved considerably and PET-CT hybrid machines have emerged, spending per examination has remained remarkably constant. Replacement and maintenance costs have remained in the range of 170-190 Euros per examination since 1997, whether early CDET gamma cameras or the latest time-of-flight PET/CT devices are used. This is mainly due to shorter acquisition times and more efficient use of FDG New reimbursement rates for PET/CT are needed in France in order to favor regular acquisition of state-of-the-art devices. One major development is the coupling of PET and MR imaging.

Tailored supplemental screening for breast cancer: what now and what next?

OBJECTIVE: This article reviews breast cancer risk assessment and the rationale for current screening guidelines, including when to consider using supplemental screening with MRI or sonography in addition to mammography, and discusses other emerging technologies. Radiologists can help identify women who may benefit from supplemental screening and can help to recommend when and which techniques to perform for this additional screening. CONCLUSION: Mammography remains the mainstay of breast cancer screening. Mammography should be performed as digital imaging when possible in women with dense breasts. In women at high risk, particularly if they also have dense breasts, annual MRI is recommended, although further validation of outcomes is needed. In intermediate-risk women with dense breasts, especially those with other risk factors, and in high-risk women with dense breasts who are unable to tolerate MRI, supplemental sonography screening is an option at facilities with availability of qualified personnel. Developing technologies are not appropriate for screening at this time, although further study is encouraged.

Single-acquisition method for simultaneous determination of extrinsic gamma-camera sensitivity and spatial resolution.

A new method for measuring simultaneously both the extrinsic sensitivity and spatial resolution of a gamma-camera in a single planar acquisition was implemented. A dual-purpose phantom (SR phantom; sensitivity/resolution) was developed, tested and the results compared with other conventional methods used for separate determination of these two important image quality parameters. The SR phantom yielded reproducible and accurate results, allowing an immediate visual inspection of the spatial resolution as well as the quantitative determination of the contrast for six different spatial frequencies. It also proved to be useful in the estimation of the modulation transfer function (MTF) of the image formation collimator/detector system at six different frequencies and can be used to estimate the spatial resolution as function of the direction relative to the digital matrix of the detector.

Optimized Scratch Assay for In Vitro Testing of Cell Migration with an Automated Optical Camera.

Cell migration is an important process that influences many aspects of health, such as wound healing and cancer, and it is, therefore, crucial for developing methods to study the migration. The scratch assay has long been the most common in vitro method to test compounds with anti- and pro-migration properties because of its low cost and simple procedure. However, an often-reported problem of the assay is the accumulation of cells across the edge of the scratch. Furthermore, to obtain data from the assay, images of different exposures must be taken over a period of time at the exact same spot to compare the movements of the migration. Different analysis programs can be used to describe the scratch closure, but they are labor intensive, inaccurate, and forces cycles of temperature changes. In this study, we demonstrate an optimized method for testing the migration effect, e.g. with the naturally occurring proteins Human- and Bovine-Lactoferrin and their N-terminal peptide Lactoferricin on the epithelial cell line HaCaT. A crucial optimization is to wash and scratch in PBS, which eliminates the aforementioned accumulation of cells along the edge. This could be explained by the removal of cations, which have been shown to have an effect on keratinocyte cell-cell connection. To ensure true detection of migration, pre-treating with mitomycin C, a DNA synthesis inhibitor, was added to the protocol. Finally, we demonstrate the automated optical camera, which eliminates excessive temperature cycles, manual labor with scratch closure analysis, while improving on reproducibility and ensuring analysis of identical sections of the scratch over time.

Quality control in dual head gamma-cameras: Comparison between methods and software used for image analysis.

Patient radiation dose and image quality are primary issues in the conduct of nuclear medicine (NM) procedures. A range of protocols are currently used in image acquisition and analysis of quality control (QC) tests, with National Electrical Manufacturers Association (NEMA) methods and protocols widely accepted in providing an accurate description, measurement and report of γ-camera performance parameters. However, no standard software is available for image analysis. Present study compares vendor QC software analysis and three types of software freely downloadable from the internet: NMQC, NM Toolkit and ImageJ-NM Toolkit software. These were used for image analysis of QC tests of γ-cameras based on NEMA protocols including non-uniformity evaluation. Ten non-uniformity QC images were obtained using a dual head γ-camera installed in Trieste General Hospital and then analyzed. Excel analysis was used as the baseline calculation for the non-uniformity test according to NEMA procedures. The results of non-uniformity analysis showed good agreement between the independent types of software and Excel calculations (the average differences were 0.3%, 2.9%, 1.3% and 1.6% for the Useful Field of View (UFOV) integral, UFOV differential, Central Field of View (CFOV) integral and CFOV differential, respectively), while significant differences were detected following analysis using the company QC software when compared with Excel analysis (the average differences were 14.6%, 20.7%, 25.7% and 31.9% for the UFOV integral, UFOV differential, CFOV integral and CFOV differential, respectively). Compared to use of Excel calculations use of NMQC software was found to be in close accord. Variation in results obtained using the three types of software and γ-camera QC software was due to the use of different pixel sizes. It is important to conduct independent analyses tests in addition to using the vendor QC software in order to determine the differences between values.

Optimization of the Compton camera for measuring prompt gamma rays in boron neutron capture therapy.

Optimization of the Compton camera for measuring prompt gamma rays (0.478MeV) emitted during boron neutron capture therapy (BNCT) was performed with Geant4. The parameters of the Compton camera were determined as follows: 3cm thick - 10cm wide scatter detector (Silicon), 10cm thick - 10cm wide absorber detector (Germanium), and 1cm distance between the scatter and absorber detectors. For a typical brain tumor treatment, the overall detection efficiency of the optimized Compton camera was approximately 0.1425% using the Snyder's head phantom with a sphere tumor (4cm diameter and ~1cm depth).

Gamma camera calibration and validation for quantitative SPECT imaging with (177)Lu.

Over the last years (177)Lu has received considerable attention from the clinical nuclear medicine community thanks to its wide range of applications in molecular radiotherapy, especially in peptide-receptor radionuclide therapy (PRRT). In addition to short-range beta particles, (177)Lu emits low energy gamma radiation of 113keV and 208keV that allows gamma camera quantitative imaging. Despite quantitative cancer imaging in molecular radiotherapy having been proven to be a key instrument for the assessment of therapeutic response, at present no general clinically accepted quantitative imaging protocol exists and absolute quantification studies are usually based on individual initiatives. The aim of this work was to develop and evaluate an approach to gamma camera calibration for absolute quantification in tomographic imaging with (177)Lu. We assessed the gamma camera calibration factors for a Philips IRIX and Philips AXIS gamma camera system using various reference geometries, both in air and in water. Images were corrected for the major effects that contribute to image degradation, i.e. attenuation, scatter and dead- time. We validated our method in non-reference geometry using an anthropomorphic torso phantom provided with the liver cavity uniformly filled with (177)LuCl3. Our results showed that calibration factors depend on the particular reference condition. In general, acquisitions performed with the IRIX gamma camera provided good results at 208keV, with agreement within 5% for all geometries. The use of a Jaszczak 16mL hollow sphere in water provided calibration factors capable of recovering the activity in anthropomorphic geometry within 1% for the 208keV peak, for both gamma cameras. The point source provided the poorest results, most likely because scatter and attenuation correction are not incorporated in the calibration factor. However, for both gamma cameras all geometries provided calibration factors capable of recovering the activity in anthropomorphic geometry within about 10% (range -11.6% to +7.3%) for acquisitions at the 208keV photopeak. As a general rule, scatter and attenuation play a much larger role at 113keV compared to 208keV and are likely to hinder an accurate absolute quantification. Acquisitions of only the (177)Lu main photopeak (208keV) are therefore recommended in clinical practice. Preliminary results suggest that the gamma camera calibration factor can be assessed with a standard uncertainty below (or of the order of) 3% if activity is determined with equipment traceable to primary standards, accurate volume measurements are made, and an appropriate chemical carrier is used to allow a homogeneous and stable solution to be used during the measurements.

Activity concentration measurements using a conjugate gradient (Siemens xSPECT) reconstruction algorithm in SPECT/CT.

The interest in quantitative single photon emission computer tomography (SPECT) shows potential in a number of clinical applications and now several vendors are providing software and hardware solutions to allow 'SUV-SPECT' to mirror metrics used in PET imaging. This brief technical report assesses the accuracy of activity concentration measurements using a new algorithm 'xSPECT' from Siemens Healthcare. SPECT/CT data were acquired from a uniform cylinder with 5, 10, 15 and 20 s/projection and NEMA image quality phantom with 25 s/projection. The NEMA phantom had hot spheres filled with an 8 : 1 activity concentration relative to the background compartment. Reconstructions were performed using parameters defined by manufacturer presets available with the algorithm. The accuracy of activity concentration measurements was assessed. A dose calibrator-camera cross-calibration factor (CCF) was derived from the uniform phantom data. In uniform phantom images, a positive bias was observed, ranging from ∼6% in the lower count images to ∼4% in the higher-count images. On the basis of the higher-count data, a CCF of 0.96 was derived. As expected, considerable negative bias was measured in the NEMA spheres using region mean values whereas positive bias was measured in the four largest NEMA spheres. Nonmonotonically increasing recovery curves for the hot spheres suggested the presence of Gibbs edge enhancement from resolution modelling. Sufficiently accurate activity concentration measurements can easily be measured on images reconstructed with the xSPECT algorithm without a CCF. However, the use of a CCF is likely to improve accuracy further. A manual conversion of voxel values into SUV should be possible, provided that the patient weight, injected activity and time between injection and imaging are all known accurately.

Assessment of a Monte-Carlo simulation of SPECT recordings from a new-generation heart-centric semiconductor camera: from point sources to human images.

Geant4 application for tomographic emission (GATE), a Monte-Carlo simulation platform, has previously been used for optimizing tomoscintigraphic images recorded with scintillation Anger cameras but not with the new-generation heart-centric cadmium-zinc-telluride (CZT) cameras. Using the GATE platform, this study aimed at simulating the SPECT recordings from one of these new CZT cameras and to assess this simulation by direct comparison between simulated and actual recorded data, ranging from point sources to human images. Geometry and movement of detectors, as well as their respective energy responses, were modeled for the CZT 'D.SPECT' camera in the GATE platform. Both simulated and actual recorded data were obtained from: (1) point and linear sources of (99m)Tc for compared assessments of detection sensitivity and spatial resolution, (2) a cardiac insert filled with a (99m)Tc solution for compared assessments of contrast-to-noise ratio and sharpness of myocardial borders and (3) in a patient with myocardial infarction using segmented cardiac magnetic resonance imaging images. Most of the data from the simulated images exhibited high concordance with the results of actual images with relative differences of only: (1) 0.5% for detection sensitivity, (2) 6.7% for spatial resolution, (3) 2.6% for contrast-to-noise ratio and 5.0% for sharpness index on the cardiac insert placed in a diffusing environment. There was also good concordance between actual and simulated gated-SPECT patient images for the delineation of the myocardial infarction area, although the quality of the simulated images was clearly superior with increases around 50% for both contrast-to-noise ratio and sharpness index. SPECT recordings from a new heart-centric CZT camera can be simulated with the GATE software with high concordance relative to the actual physical properties of this camera. These simulations may be conducted up to the stage of human SPECT-images even if further refinement is needed in this setting.

Dual-head gamma camera system for intraoperative localization of radioactive seeds.

Breast-conserving surgery is a standard option for the treatment of patients with early-stage breast cancer. This form of surgery may result in incomplete excision of the tumor. Iodine-125 labeled titanium seeds are currently used in clinical practice to reduce the number of incomplete excisions. It seems likely that the number of incomplete excisions can be reduced even further if intraoperative information about the location of the radioactive seed is combined with preoperative information about the extent of the tumor. This can be combined if the location of the radioactive seed is established in a world coordinate system that can be linked to the (preoperative) image coordinate system. With this in mind, we propose a radioactive seed localization system which is composed of two static ceiling-suspended gamma camera heads and two parallel-hole collimators. Physical experiments and computer simulations which mimic realistic clinical situations were performed to estimate the localization accuracy (defined as trueness and precision) of the proposed system with respect to collimator-source distance (ranging between 50 cm and 100 cm) and imaging time (ranging between 1 s and 10 s). The goal of the study was to determine whether or not a trueness of 5 mm can be achieved if a collimator-source distance of 50 cm and imaging time of 5 s are used (these specifications were defined by a group of dedicated breast cancer surgeons). The results from the experiments indicate that the location of the radioactive seed can be established with an accuracy of 1.6 mm ± 0.6 mm if a collimator-source distance of 50 cm and imaging time of 5 s are used (these experiments were performed with a 4.5 cm thick block phantom). Furthermore, the results from the simulations indicate that a trueness of 3.2 mm or less can be achieved if a collimator-source distance of 50 cm and imaging time of 5 s are used (this trueness was achieved for all 14 breast phantoms which were used in this study). Based on these results we conclude that the proposed system can be a valuable tool for (real-time) intraoperative breast cancer localization.

Color Doppler ultrasonography for the assessment of renal blood flow in heart failure.

To validate color Doppler ultrasonography of renal arteries for the assessment of renal blood flow (RBF), we compared left and right RBF estimates and their sum (total RBF) by echo-Doppler with data obtained by iodine 123-123I-p-aminohippuric acid (PAH) scintigraphy in 19 patients with heart failure and 7 normal control subjects. Single-side and total RBF estimates by echo-Doppler ranged, respectively, between 179 and 428 mL/min/m2 and from 378 to 835 mL/min/m2 in patients with heart failure and between 265 and 601 mL/min/m2 and from 564 to 1,182 mL/min/m2 in normal control subjects. Single-side and total RBF estimates by echo-Doppler correlated well with measurements obtained by scintigraphy (r = 0.74 and 0.76, respectively, in patients with heart failure; both: p < 0.001). At Bland and Altman's analysis of correspondence between the 2 techniques, there were 17 disagreements (33.7%) for single-side RBF and 8 disagreements (31.8%) for total RBF. However, the two techniques disagreed markedly in only two single-side and one total RBF estimates. Thus, in patients with heart failure, RBF assessed noninvasively by color Doppler ultrasonography has a good correlation with 123I-PAH renal scintigraphy data over a wide range of blood flow.

Count-rate statistics of the gamma camera.

The temporal distribution of decay events recorded by a gamma camera in 'list mode' differs from the Poisson distribution because of dead-time effects. We propose a new model for the dead-time behaviour of a gamma camera. The most important feature of our model is that the loss of events occurs in pairs or higher multiples due to the so-called 'pile-up' effect. We analyse the consequences of pile-up for the temporal distribution of events recorded by a gamma camera. The probability distribution for the time intervals between events recorded by the camera is calculated from first principles. We construct estimators for the parameter of the new distribution. We distinguish between the estimation of the total count rate and the estimation of a certain subset of the total count rate. Computer simulation confirms that our estimators are less influenced by dead-time effects than the standard estimator.

[Characterization of the response of hexagonal parallel-hole collimators of scintillation cameras]. / Caractérisation de la réponse des collimateurs à trous parallèles hexagonaux des caméras à scintillation.

This paper presents a formulation of the frequency response of hexagonal parallel-hole collimator scintillation cameras. To describe this response, we propose an equation determined semi-empirically from a great number of simulations. The utility of the equation is that it enables the simple calculation of the response from collimator characteristics by taking into account the collimator's hexagonal structure. Because the equation does not assume translation invariance, the results can be directly compared with experimental measurements obtained with a point source. It is particularly interesting for collimators with large holes, like the medium-resolution ones used for high-energy radiation. Quality control and physical performance measurements are thus facilitated for this kind of collimator. Also, we present a new parameter that gives a quantitative assessment of the importance of partition penetration. This parameter is measured directly from the collimator frequency response. It has been studied by simulation, taking into account gamma photon attenuation in collimator partitions. The experimental measurements that have been made are in accord with the proposed equations.

[Simulation study of the influence of collimator defects on the uniformity of scintigraphic images]. / Etude en simulation de l'influence des défauts des collimateurs sur l'uniformité des images scintigraphiques.

The mechanical tolerances in building collimators for scintillation cameras are studied. A simulation method has been used to quantify the effects of defects in hole inclination and hole diameter on the uniformity of planar and tomographic images. The calculation takes into account the geometry of the hexagonal hole collimator, the camera intrinsic resolution, the object size, the pixel size, the effect of low-pass filtering, as well as the type, size and position of the defect. For instance, a 0.03 mm diameter defect on several holes located in the central region of a very high resolution collimator can result in a 12% uniformity artefact in tomographic imaging of an 18 cm diameter cylinder, using a 3.45 mm resolution camera, 4.5 mm pixel size, and Hamming filtering with a Nyquist frequency cut-off. A 0.17 degree inclination defect of a few holes can result in the same uniformity artefact. These results show that the building of a collimator has to be very precise.

A new correction method for gamma camera non-uniformity due to energy response variability.

We present a new uniformity correction (Fourier energy correction) which is designed to correct for gamma camera non-uniformity caused by variations of the energy response function within a wide spectral range. A convolution model is used to describe the spatial distortions of the energy response function. The model is solved in Fourier space. A preliminary flood acquisition is required to obtain energy-dependent Fourier weights which are used to correct subsequent acquisitions. The influence of the parameters involved in the correction procedure is studied and the Fourier energy correction is compared to a conventional multiplicative energy correction for different acquisition geometries. The Fourier energy correction appears especially useful when the energy information associated with each detected photon is analysed using a fine sampling, or when windows different from the photopeak window are used.