Slow-rotation dynamic SPECT with a temporal second derivative constraint.

PURPOSE: Dynamic tracer behavior in the human body arises as a result of continuous physiological processes. Hence, the change in tracer concentration within a region of interest (ROI) should follow a smooth curve. The authors propose a modification to an existing slow-rotation dynamic SPECT reconstruction algorithm (dSPECT) with the goal of improving the smoothness of time activity curves (TACs) and other properties of the reconstructed image. METHODS: The new method, denoted d2EM, imposes a constraint on the second derivative (concavity) of the TAC in every voxel of the reconstructed image, allowing it to change sign at most once. Further constraints are enforced to prevent other nonphysical behaviors from arising. The new method is compared with dSPECT using digital phantom simulations and experimental dynamic 99mTc -DTPA renal SPECT data, to assess any improvement in image quality. RESULTS: In both phantom simulations and healthy volunteer experiments, the d2EM method provides smoother TACs than dSPECT, with more consistent shapes in regions with dynamic behavior. Magnitudes of TACs within an ROI still vary noticeably in both dSPECT and d2EM images, but also in images produced using an OSEM approach that reconstructs each time frame individually, based on much more complete projection data. TACs produced by averaging over a region are similar using either method, even for small ROIs. Results for experimental renal data show expected behavior in images produced by both methods, with d2EM providing somewhat smoother mean TACs and more consistent TAC shapes. CONCLUSIONS: The d2EM method is successful in improving the smoothness of time activity curves obtained from the reconstruction, as well as improving consistency of TAC shapes within ROIs.

Analysis of radioactive waste generated during the cyclotron production of 99mTc.

Past and prospective shortages of medical radioisotopes have driven recent developments in the direct production of 99mTc via the 100Mo(p,2n)99mTc reaction. The cyclotron-based production method has been shown to successfully produce 99mTc, however trace impurities present in the enriched molybdenum target can also lead to the unintended creation of other radioisotopes which constitute waste. The isotopic composition of the waste has to be investigated in order to determine how it can be handled, transported and safely stored. In this article, we report which waste radioisotopes are created alongside 99mTc during target irradiation. Results are based on the gamma spectroscopy of waste produced. Significant complexities in the emission spectra made automated identification of radioisotopes inaccurate; complexities were resolved using a manual radioisotope identification procedure. The impact of target composition, integrated beam current and duration of target irradiation on the waste produced was studied. Results indicate that an average of 0.059 ± 0.003 GBq of waste is generated per 1 GBq of 99mTc produced. Two-thirds of the total waste activity produced was attributed to 99Mo (T 1/2 = 66 h) alone, while a total of fifty radioisotopes were found in the waste. Long-lived isotopes (T 1/2 > 2 months) constituted only 1% of the total waste activity at end of beam (EOB). In conclusion, it was determined that the waste generated during cyclotron-based 99mTc production was acceptably low for routine clinical production.

Accuracy of quantitative reconstructions in SPECT/CT imaging.

The goal of this study was to determine the quantitative accuracy of our OSEM-APDI reconstruction method based on SPECT/CT imaging for Tc-99m, In-111, I-123, and I-131 isotopes. Phantom studies were performed on a SPECT/low-dose multislice CT system (Infinia-Hawkeye-4 slice, GE Healthcare) using clinical acquisition protocols. Two radioactive sources were centrally and peripherally placed inside an anthropometric Thorax phantom filled with non-radioactive water. Corrections for attenuation, scatter, collimator blurring and collimator septal penetration were applied and their contribution to the overall accuracy of the reconstruction was evaluated. Reconstruction with the most comprehensive set of corrections resulted in activity estimation with error levels of 3-5% for all the isotopes.

Resolution recovery for Compton camera using origin ensemble algorithm.

PURPOSE: Compton cameras (CCs) use electronic collimation to reconstruct the images of activity distribution. Although this approach can greatly improve imaging efficiency, due to complex geometry of the CC principle, image reconstruction with the standard iterative algorithms, such as ordered subset expectation maximization (OSEM), can be very time-consuming, even more so if resolution recovery (RR) is implemented. We have previously shown that the origin ensemble (OE) algorithm can be used for the reconstruction of the CC data. Here we propose a method of extending our OE algorithm to include RR. METHODS: To validate the proposed algorithm we used Monte Carlo simulations of a CC composed of multiple layers of pixelated CZT detectors and designed for imaging small animals. A series of CC acquisitions of small hot spheres and the Derenzo phantom placed in air were simulated. Images obtained from (a) the exact data, (b) blurred data but reconstructed without resolution recovery, and (c) blurred and reconstructed with resolution recovery were compared. Furthermore, the reconstructed contrast-to-background ratios were investigated using the phantom with nine spheres placed in a hot background. RESULTS: Our simulations demonstrate that the proposed method allows for the recovery of the resolution loss that is due to imperfect accuracy of event detection. Additionally, tests of camera sensitivity corresponding to different detector configurations demonstrate that the proposed CC design has sensitivity comparable to PET. When the same number of events were considered, the computation time per iteration increased only by a factor of 2 when OE reconstruction with the resolution recovery correction was performed relative to the original OE algorithm. We estimate that the addition of resolution recovery to the OSEM would increase reconstruction times by 2-3 orders of magnitude per iteration. CONCLUSIONS: The results of our tests demonstrate the improvement of image resolution provided by the OE reconstructions with resolution recovery. The quality of images and their contrast are similar to those obtained from the OE reconstructions from scans simulated with perfect energy and spatial resolutions.

Molybdenum target specifications for cyclotron production of 99mTc based on patient dose estimates.

In response to the recognized fragility of reactor-produced (99)Mo supply, direct production of (99m)Tc via (100)Mo(p,2n)(99m)Tc reaction using medical cyclotrons has been investigated. However, due to the existence of other Molybdenum (Mo) isotopes in the target, in parallel with (99m)Tc, other technetium (Tc) radioactive isotopes (impurities) will be produced. They will be incorporated into the labeled radiopharmaceuticals and result in increased patient dose. The isotopic composition of the target and beam energy are main factors that determine production of impurities, thus also dose increases. Therefore, they both must be considered when selecting targets for clinical (99m)Tc production. Although for any given Mo target, the patient dose can be predicted based on complicated calculations of production yields for each Tc radioisotope, it would be very difficult to reverse these calculations to specify target composition based on dosimetry considerations. In this article, a relationship between patient dosimetry and Mo target composition is studied. A simple and easy algorithm for dose estimation, based solely on the knowledge of target composition and beam energy, is described. Using this algorithm, the patient dose increase due to every Mo isotope that could be present in the target is estimated. Most importantly, a technique to determine Mo target composition thresholds that would meet any given dosimetry requirement is proposed.

Imaging study of using radiopharmaceuticals labeled with cyclotron-produced 99mTc.

Cyclotron-produced 99mTc (CPTc) has been recognized as an attractive and practical substitution of reactor/generator based 99mTc. However, the small amount of 92-98Mo in the irradiation of enriched 100Mo could lead to the production of other radioactive technetium isotopes (Tc-impurities) which cannot be chemically separated. Thus, these impurities could contribute to patient dose and affect image quality. The potential radiation dose caused by these Tc-impurities produced using different targets, irradiation conditions, and corresponding to different injection times have been investigated, leading us to create dose-based limits of these parameters for producing clinically acceptable CPTc. However, image quality has been not considered. The aim of the present work is to provide a comprehensive and quantitative analysis of image quality for CPTc. The impact of Tc-impurities in CPTc on image resolution, background noise, and contrast is investigated by performing both Monte-Carlo simulations and phantom experiments. Various targets, irradiation, and acquisition conditions are employed for investigating the image-based limits of CPTc production parameters. Additionally, the relationship between patient dose and image quality of CPTc samples is studied. Only those samples which meet both dose- and image-based limits should be accepted in future clinical studies.

Quantitative analysis of relationships between irradiation parameters and the reproducibility of cyclotron-produced (99m)Tc yields.

Cyclotron production of (99m)Tc through the (100)Mo(p,2n) (99m)Tc reaction channel is actively being investigated as an alternative to reactor-based (99)Mo generation by nuclear fission of (235)U. An exciting aspect of this approach is that it can be implemented using currently-existing cyclotron infrastructure to supplement, or potentially replace, conventional (99m)Tc production methods that are based on aging and increasingly unreliable nuclear reactors. Successful implementation will require consistent production of large quantities of high-radionuclidic-purity (99m)Tc. However, variations in proton beam currents and the thickness and isotopic composition of enriched (100)Mo targets, in addition to other irradiation parameters, may degrade reproducibility of both radionuclidic purity and absolute (99m)Tc yields. The purpose of this article is to present a method for quantifying relationships between random variations in production parameters, including (100)Mo target thicknesses and proton beam currents, and reproducibility of absolute (99m)Tc yields (defined as the end of bombardment (EOB) (99m)Tc activity). Using the concepts of linear error propagation and the theory of stochastic point processes, we derive a mathematical expression that quantifies the influence of variations in various irradiation parameters on yield reproducibility, quantified in terms of the coefficient of variation of the EOB (99m)Tc activity. The utility of the developed formalism is demonstrated with an example. We show that achieving less than 20% variability in (99m)Tc yields will require highly-reproducible target thicknesses and proton currents. These results are related to the service rate which is defined as the percentage of (99m)Tc production runs that meet the minimum daily requirement of one (or many) nuclear medicine departments. For example, we show that achieving service rates of 84.0%, 97.5% and 99.9% with 20% variations in target thicknesses requires producing on average 1.2, 1.5 and 1.9 times the minimum daily activity requirement. The irradiation parameters that would be required to achieve these service rates are described. We believe the developed formalism will aid in the development of quality-control criteria required to ensure consistent supply of large quantities of high-radionuclidic-purity cyclotron-produced (99m)Tc.

A fast and simple dose-calibrator-based quality control test for the radionuclidic purity of cyclotron-produced (99m)Tc.

Cyclotron production of 99mTc through the (100)Mo(p,2n)99mTc reaction channel is actively being investigated as an alternative to reactor-based (99)Mo generation by nuclear fission of (235)U. Like most radioisotope production methods, cyclotron production of 99mTc will result in creation of unwanted impurities, including Tc and non-Tc isotopes. It is important to measure the amounts of these impurities for release of cyclotron-produced 99mTc (CPTc) for clinical use. Detection of radioactive impurities will rely on measurements of their gamma (γ) emissions. Gamma spectroscopy is not suitable for this purpose because the overwhelming presence of 99mTc and the count-rate limitations of γ spectroscopy systems preclude fast and accurate measurement of small amounts of impurities. In this article we describe a simple and fast method for measuring γ emission rates from radioactive impurities in CPTc. The proposed method is similar to that used to identify (99)Mo breakthrough in generator-produced 99mTc: one dose calibrator (DC) reading of a CPTc source placed in a lead shield is followed by a second reading of the same source in air. Our experimental and theoretical analysis show that the ratio of DC readings in lead to those in air are linearly related to γ emission rates from impurities per MBq of 99mTc over a large range of clinically-relevant production conditions. We show that estimates of the γ emission rates from Tc impurities per MBq of 99mTc can be used to estimate increases in radiation dose (relative to pure 99mTc) to patients injected with CPTc-based radiopharmaceuticals. This enables establishing dosimetry-based clinical-release criteria that can be tested using commercially-available dose calibrators. We show that our approach is highly sensitive to the presence of 93gTc, 93mTc, 94gTc, 94mTc, 95mTc, 95gTc, and 96gTc, in addition to a number of non-Tc impurities.

Reconstruction of dynamic renal tomographic data acquired by slow rotation.

UNLABELLED: Nuclear medicine renal studies can be performed using slow-rotation SPECT, but reconstruction of such data is largely underdetermined. METHODS: A new method of reconstruction of data acquired using slow camera rotations was developed. In this method we used a factor model of the data in which the factors and factor coefficients were determined by modeling their relationship directly with the projection measurements. This was done by solving a least-squares problem that fits the projections of factors and factor coefficients to the projection data with nonnegativity constraints imposed on the solution. The method was tested on computer simulations and applied to experimental renal (99m)Tc-mercaptoacetyltriglycine canine and patient studies. RESULTS: Computer simulations showed that the extracted time-activity curves of kidneys agreed well with the simulated curves for data with noise levels similar to those in the experimental studies. In the canine study, the method showed that >2 factors were necessary to adequately reproduce the kinetics of the kidney. In the patient study, the method was able to extract separate factors that correspond to the kidney cortex and the kidney pelvis. CONCLUSION: The computer simulation, the canine study, and the patient study all show that reconstructions of the data obtained with 1 detector displayed artifacts, whereas reconstructions of the data obtained with 2 and 3 detectors were free of artifacts. Computer simulations showed that the method gives accurate results that allow quantitation.

Multiple line source array for SPECT transmission scans: simulation, phantom and patient studies.

UNLABELLED: Accurate attenuation and scatter corrections in quantitative SPECT studies require attenuation maps of the density distribution in the scanned object. These can be obtained from simultaneous emission/transmission scans. METHODS: A new method has been developed using a multiple line source array (MLA) for transmission scans, and its performance has been investigated using computer simulations and experimental data. The activity in the central lines of the MLA was higher than at the edges of the system, so that more transmission photons would be directed toward the thicker parts of the human body. A series of transmission-only and simultaneous emission/transmission studies were performed for different phantom configurations and human subjects. Attenuation maps were generated and used in reconstruction of attenuation-corrected emission images. RESULTS: The mu coefficients for attenuation maps obtained using the MLA system and simulated and experimental data display no artifacts and are qualitatively and quantitatively correct. For phantoms, the agreement between the measured and the true value of mu for water was found to be better than 4%. The attenuation-corrected emission images for the phantom studies demonstrate that the activity in the heart can be accurately reconstructed. A significant qualitative improvement was also obtained when the attenuation correction was used on patient data. CONCLUSION: Our results indicate that the MLA transmission source can be used in simultaneous transmission/emission imaging to generate accurate attenuation maps. These maps allow for performing an object-specific, attenuation correction of the emission images.

An EM algorithm for dynamic SPECT.

In this paper we present two variants of the EM algorithm for dynamic SPECT imaging. A version based on compartmental modeling which fits a sum of exponentials and a more general approach allowing for arbitrary decaying activities. The underlying probabilistic models are discussed and the incomplete and complete data spaces are shown to be physically meaningful. We indicate that the second method, leading to a convex program in the M step, is easier to treat numerically and we present a possible numerical approach. Some preliminary numerical tests indicating the feasibility of the method are included.

Performance of the dynamic single photon emission computed tomography (dSPECT) method for decreasing or increasing activity changes.

Radionuclide imaging is now widely used whenever functional information is required. We present a new approach to dynamic SPECT imaging (dSPECT method) that uses a single slow rotation of a conventional camera and allows us to reconstruct a series of 3D images corresponding to the radiotracer distribution in the body at various times. Using simulations of various camera configurations and acquisition protocols, we have shown that this method is able to reconstruct washout half-lives with an accuracy greater than 90% when used with triple-head SPECT cameras. Accuracy decreases when using fewer camera heads, but dual-head geometries still give an accuracy greater than 80% for short and 90% for long half-lives and about 50-75% for single-head systems. Dynamic phantom experiments have yielded similar results. Presence of attenuation and background activity does not affect the accuracy of the dSPECT reconstructions. In all situations investigated satisfactory dynamic images were produced. A preliminary normal volunteer study measuring renal function was performed. The reconstructed dynamic images may be presented as a three-dimensional movie showing movement of the tracer through the kidneys and the measurement of the regional renal function can be performed. The time-activity curves determined from this dSPECT data are very similar to those obtained from dynamic planar scans.

Three-dimensional personalized dosimetry for 188Re liver selective internal radiation therapy based on quantitative post-treatment SPECT studies.

We demonstrate that accurate patient-specific distributions of microspheres labeled with 188Re and resulting absorbed doses can be obtained from single-photon emission computed tomography (SPECT) studies performed after 188Re selective internal radiation therapy when accurate correction methods are employed in image reconstruction. Our quantitative image reconstruction algorithm includes corrections for attenuation, resolution degradations and scatter as well as a window-based compensation for contamination. The procedure has been validated using four phantom experiments containing an 18 ml cylindrical source (82-93 MBq of 188Re activity) simulating a liver tumor. In addition, we applied our approach to post-therapy SPECT studies of ten patients with progressive primary or metastatic liver carcinomas. Our quantitative algorithm accurately (within 9%) recovered 188Re activity from four phantom experiments. In addition, for two patients that received three scans, deviations remained consistent between the measured and the reconstructed activities that were determined from studies with differing severity of the dead-time effect. The analysis of absorbed doses for patient studies allowed us to hypothesize that D90 (the minimum dose received by 90% of the tumor volume) may be a reliable metric relating therapy outcomes to the calculated doses. Among several considered metrics, only D90 showed statistically significant correlation with the overall survival.

Graphical user interface for yield and dose estimations for cyclotron-produced technetium.

The cyclotron-based (100)Mo(p,2n)(99m)Tc reaction has been proposed as an alternative method for solving the shortage of (99m)Tc. With this production method, however, even if highly enriched molybdenum is used, various radioactive and stable isotopes will be produced simultaneously with (99m)Tc. In order to optimize reaction parameters and estimate potential patient doses from radiotracers labeled with cyclotron produced (99m)Tc, the yields for all reaction products must be estimated. Such calculations, however, are extremely complex and time consuming. Therefore, the objective of this study was to design a graphical user interface (GUI) that would automate these calculations, facilitate analysis of the experimental data, and predict dosimetry. The resulting GUI, named Cyclotron production Yields and Dosimetry (CYD), is based on Matlab®. It has three parts providing (a) reaction yield calculations, (b) predictions of gamma emissions and (c) dosimetry estimations. The paper presents the outline of the GUI, lists the parameters that must be provided by the user, discusses the details of calculations and provides examples of the results. Our initial experience shows that the proposed GUI allows the user to very efficiently calculate the yields of reaction products and analyze gamma spectroscopy data. However, it is expected that the main advantage of this GUI will be at the later clinical stage when entering reaction parameters will allow the user to predict production yields and estimate radiation doses to patients for each particular cyclotron run.

Two methods to generate templates for template-based partial volume effect correction: SPECT phantom experiments.

In this paper, we explore the applicability of template-based compensation for the partial volume effect (PVE) for situations where (i) the image has multiple uptake sites (tumors and organs) but only one of them is treated as a region of interest (ROI) with the boundaries available from a high-resolution modality and (ii) no information regarding activities inside or outside this ROI is a priori available. We modeled this situation by performing SPECT acquisitions of phantoms containing 21 containers, which had different shapes and sizes and were filled with different levels of activity. In our analysis, each of these containers was treated as an individual ROI. We compared the performance of two methods of template construction. In method 1, the ROI template value was obtained from a conventionally reconstructed (without PVEC) image. In method 2, the ROI template value was directly (bypassing the PVE-affected conventional image) calculated from projections using region-based reconstruction. Our processing shows that method 1 resulted in consistent (activities for all 21 ROIs were improved) but relatively weak PVE compensation (errors of recovered total activities were equal to or lower than 10% for 5 ROIs only). Application of method 2 resulted in a selective (activities for 19 ROIs were improved) but considerably better compensation when compared to method 1 (errors of recovered total activities were equal to or lower than 10% for 10 ROIs).

Simulation-based reconstruction of absolute activities from the (99m)Tc/(111)In dual-isotope SPECT/CT: phantom experiments and imaging of neuroendocrine tumors.

We investigate the quantitative accuracy of the reconstruction of absolute (99m)Tc and (111)In activities from (99m)Tc/(111)In dual-isotope SPECT studies. The separate reconstruction of two images is achieved by applying Monte Carlo simulation-based corrections for self-scatter and cross-talk between energy windows. For method evaluation, a series of (99m)Tc/(111)In physical phantom experiments was performed using a clinical SPECT/CT camera. The containers were filled with different ratios of (99m)Tc and (111)In activities to create cross-talk with varying severity levels. In addition, we illustrate the performance of our method by reconstructing images from four simultaneous (99m)Tc/(111)In SPECT/CT studies of neuroendocrine patients. Similarly to the phantom experiments, clinical cases provide examples with different severity of cross-talk. Phantom experiments showed that Monte Carlo simulation-based corrections improved both quantitative accuracy and visual properties of (99m)Tc and (111)In images. While the errors of absolute activities for both tracers in six containers ranged from 16% to 75% if no corrections for self-scatter and cross-talk were applied, these errors decreased to below 10% when images were reconstructed with the aforementioned corrections. These activities were measured using regions of interest larger than the true sizes of the containers in order to account for the spill-out effect. Analysis of patient studies confirmed that accurate simulation-based compensations improved resolution and contrast for both (99m)Tc and (111)In images.

Effects of attenuation in single slow rotation dynamic SPECT.

Dynamic imaging using SPECT has been a topic of research interest for many years. Several proposed approaches have considered the reconstruction of dynamic images from SPECT data acquired with a conventional single slow rotation of the camera, which results in an extremely underdetermined reconstruction problem. Accurate attenuation correction (AC) is particularly important in this context, in order to distinguish the actual dynamic behavior of the tracer within a region from the effects of attenuation on the projection data as the camera rotates around the patient. In this paper, we demonstrate that the standard approach to AC used in conventional SPECT imaging is not sufficient to account for the effects of attenuation in dynamic imaging of this type. As a result, artifacts may be created in the reconstructed images. Using realistic dynamic 3D phantom simulations, as well as real-life dynamic renal SPECT data, we assess the severity of these artifacts and investigate a method to eliminate them. The proposed method is shown to substantially improve the accuracy of the reconstructed image.

Quantitative image reconstruction for dual-isotope parathyroid SPECT/CT: phantom experiments and sample patient studies.

We investigated the quantitative accuracy of the model-based dual-isotope single-photon emission computed tomography (DI-SPECT) reconstructions that use Klein-Nishina expressions to estimate the scattered photon contributions to the projection data. Our objective was to examine the ability of the method to recover the absolute activities pertaining to both radiotracers: Tc-99m and I-123. We validated our method through a series of phantom experiments performed using a clinical hybrid SPECT/CT camera (Infinia Hawkeye, GE Healthcare). Different activity ratios and different attenuating media were used in these experiments to create cross-talk effects of varying severity, which can occur in clinical studies. Accurate model-based corrections for scatter and cross-talk with CT attenuation maps allowed for the recovery of the absolute activities from DI-SPECT/CT scans with errors that ranged 0-10% for both radiotracers. The unfavorable activity ratios increased the computational burden but practically did not affect the resulting accuracy. The visual analysis of parathyroid patient data demonstrated that our model-based processing improved adenoma/background contrast and enhanced localization of small or faint adenomas.

Theoretical dosimetry estimations for radioisotopes produced by proton-induced reactions on natural and enriched molybdenum targets.

This study presents a summary of the dosimetry calculations performed for three technetium agents most commonly used in nuclear medicine diagnostic studies, namely sestamibi™, phosphonates and pertechnetate, labeled with cyclotron-produced technetium. Calculated patient doses were compared to those that would be delivered by the same radiotracers labeled with technetium obtained from a generator produced in a reactor. The main difference is that technetium from a generator is pure, i.e. contains only (99m)Tc and its decay product (99g)Tc, while in a cyclotron a large number of other stable and radioactive isotopes are created. In our calculations only technetium radioisotopes (ground and isomeric states) were considered as they will be included in the radiotracer labeling process and will contribute to the patient dose. Other elements should be removed by chemical purification. These dose estimates are based on our theoretical calculations of the proton-induced reaction cross sections and radioisotope production yields. Thick targets of enriched (three different compositions) and natural molybdenum, and three initial beam energies (16, 19 and 24 MeV) were considered for irradiation times of 3, 6 and 12 h with a beam current of 200 µA. The doses were calculated for injection times corresponding to 0, 2, 8, 12 and 24 h after the end of beam.

Quantitative SPECT/CT reconstruction for ¹77Lu and ¹77Lu/9°Y targeted radionuclide therapies.

We investigated the quantitative accuracy of SPECT/CT imaging studies as would be performed before and after targeted radionuclide therapy (TRT) using phantom experiments with (i) (99m)Tc, (ii) ¹77Lu and (iii) 9°Y/¹77Lu. While the experiment with (99m)Tc imitated a diagnostic scan, the experiments with ¹77Lu and 9°Y/¹77Lu modeled post-therapy acquisitions. At the next stage, we reconstructed images from pre- and post-therapy patient studies. The data were first reconstructed using two methods with limited corrections for the physics effects. Then, to generate quantitatively accurate absolute activity distributions, we applied a hybrid (model-based and window-based) reconstruction strategy where some of the physics effects were accurately modeled while corrections for other effects were empirical and based on information obtained from the projection data. The accuracies of absolute activity recovered by the hybrid method from the six phantom experiments were very similar to each other and acceptable for potential use in TRT. When measured in identical regions of interest, the (99m)Tc 9°activity was reconstructed with errors ranging between -3.3% and 2.9%, while the ¹77Lu activity was reconstructed from experiments with ¹77Lu and Y/¹77Lu with errors ranging between -1.6% and 1.6%. The reconstruction algorithms with limited corrections led to larger and case-specific errors as might have been expected. From a clinical prospective, our results showed that physics-based reconstructions improved resolution of images corresponding to both diagnostic scans with (99m)Tc and post-therapy scans with ¹77Lu. Our analysis of patient study demonstrated that lack of corrections led to overestimation of activities in organs and tumor by 29-39% for the diagnostic scan with (99m)Tc and by 105-218% for post-therapy scan with ¹77Lu.