Essentials and guidelines for clinical medical physics residency training programs: executive summary of AAPM Report Number 249.

There is a clear need for established standards for medical physics residency training. The complexity of techniques in imaging, nuclear medicine, and radiation oncology continues to increase with each passing year. It is therefore imperative that training requirements and competencies are routinely reviewed and updated to reflect the changing environment in hospitals and clinics across the country. In 2010, the AAPM Work Group on Periodic Review of Medical Physics Residency Training was formed and charged with updating AAPM Report Number 90. This work group includes AAPM members with extensive experience in clinical, professional, and educational aspects of medical physics. The resulting report, AAPM Report Number 249, concentrates on the clinical and professional knowledge needed to function independently as a practicing medical physicist in the areas of radiation oncology, imaging, and nuclear medicine, and constitutes a revision to AAPM Report Number 90. This manuscript presents an executive summary of AAPM Report Number 249.

Hybrid imaging technology: from dreams and vision to clinical devices.

Early in the history of nuclear medicine imaging it was realized that the nature of physiological mechanisms associated with the use of radiotracers prevented the identification of anatomic structures with a high degree of accuracy. This limitation often created difficulties in accurate interpretations of acquired images and caused investigators to seek methods of obtaining accurate anatomic correlations. Initial work centered on the use of software tools to combine anatomic and physiological data. Limitations in the use of these techniques, coupled with the development and refinements of anatomic imaging technologies (computed tomography [CT] and magnetic resonance imaging [MRI]), resulted in the development of hybrid imaging systems that combined CT with single-photon emission computed tomography (SPECT) and positron emission tomography (PET). With these hybrid systems, the images can be viewed separately or combined in a fused presentation for direct image correlation of anatomy and physiology. Presently, SPECT systems are available either with nondiagnostic CT capability for attenuation correction and image correlation, or with fully diagnostic CT capability, providing complementary diagnostic information. Equivalently, PET systems with diagnostic CT capability that provide high-resolution physiological and anatomic images are also now commercially available. These systems continue to evolve with the development of new detector materials and data acquisition and image processing technology. The widespread use of SPECT in cardiac imaging has resulted in the development of several new approaches to data acquisition and these new systems currently have either CT capability or the addition of this technology is planned in the future. The development and commercial availability of hybrid imaging systems has provided physicians with important new tools that significantly improve the diagnostic, staging, and treatment planning processes that are now available for their use.

SPECT/CT physical principles and attenuation correction.

Using nuclear medicine techniques, physiologic activity and processes can be identified in a way that is unique from other modalities. Oftentimes it is helpful to know the exact location of the physiologic uptake that is visualized on a scan. Knowing the exact location can sometimes help to distinguish normal from abnormal physiologic uptake. When an abnormality has been identified, knowing the exact location can then be helpful in treatment planning. The ability to provide precise localization of physiologic data from nuclear medicine studies is now possible with hybrid SPECT/CT systems. Additionally, these systems provide an accurate attenuation correction of the nuclear medicine image data. After reading this article, the technologist will be able to list and describe the inherent problems associated with SPECT image acquisition and reconstruction, briefly explain how data acquired from the CT scanner are used to provide attenuation correction data for SPECT and anatomic information for diagnostic purposes, list and briefly describe the different types of clinical SPECT/CT systems, and discuss the importance of accurate CT and SPECT image registration.