Data-driven head motion correction for PET using time-of-flight and positron emission particle tracking techniques.

OBJECTIVES: Positron emission tomography (PET) is susceptible to patient movement during a scan. Head motion is a continuing problem for brain PET imaging and diagnostic assessments. Physical head restraints and external motion tracking systems are most commonly used to address to this issue. Data-driven methods offer substantial advantages, such as retroactive processing but typically require manual interaction for robustness. In this work, we introduce a time-of-flight (TOF) weighted positron emission particle tracking (PEPT) algorithm that facilitates fully automated, data-driven head motion detection and subsequent automated correction of the raw listmode data. MATERIALS METHODS: We used our previously published TOF-PEPT algorithm Dustin Osborne et al. (2017), Tasmia Rahman Tumpa et al., Tasmia Rahman Tumpa et al. (2021) to automatically identify frames where the patient was near-motionless. The first such static frame was used as a reference to which subsequent static frames were registered. The underlying rigid transformations were estimated using weak radioactive point sources placed on radiolucent glasses worn by the patient. Correction of raw event data were achieved by tracking the point sources in the listmode data which was then repositioned to allow reconstruction of a single image. To create a "gold standard" for comparison purposes, frame-by-frame image registration based correction was implemented. The original listmode data was used to reconstruct an image for each static frame detected by our algorithm and then applying manual landmark registration and external software to merge these into a single image. RESULTS: We report on five patient studies. The TOF-PEPT algorithm was configured to detect motion using a 500 ms window. Our event-based correction produced images that were visually free of motion artifacts. Comparison of our algorithm to a frame-based image registration approach produced results that were nearly indistinguishable. Quantitatively, Jaccard similarity indices were found to be in the range of 85-98% for the former and 84-98% for the latter when comparing the static frame images with the reference frame counterparts. DISCUSSION: We have presented a fully automated data-driven method for motion detection and correction of raw listmode data. Easy to implement, the approach achieved high temporal resolution and reliable performance for head motion correction. Our methodology provides a mechanism by which patient motion incurred during imaging can be assessed and corrected post hoc.

Practical Tools for Patient-specific Characterization and Dosimetry of Radiopharmaceutical Extravasation.

ABSTRACT: Extravasation during radiopharmaceutical injection may occur with a frequency of more than 10%. In these cases, radioactivity remains within tissue and deposits unintended radiation dose. Characterization of extravasations is a necessary step in accurate dosimetry, but a lack of free and publicly available tools hampers routine standardized analysis. Our objective was to improve existing extravasation characterization and dosimetry methods and to create and validate tools to facilitate standardized practical dosimetric analysis in clinical settings. Using Monte Carlo simulations, we calculated dosimetric values for sixteen nuclear medicine isotopes: 11 C, 64 Cu, 18 F, 67 Ga, 68 Ga, 123 I, 131 I, 111 In, 177 Lu, 13 N, 15 O, 82 Rb, 153 Sm, 89 Sr, 99m Tc, and 90 Y. We validated our simulation results against five logical alternative dose assessment methods. We then created three new characterization tools: a worksheet, a spreadsheet, and a web application. We assessed each tool by recalculating extravasation dosimetry results found in the literature and used each of the tools for patient cases to show clinical practicality. Average variation between our simulation results and alternative methods was 3.1%. Recalculation of published dosimetry results indicated an average error of 7.9%. Time required to use each characterization tool ranged from 1 to 5 min, and agreement between the three tools was favorable. We improved upon existing methods by creating new tools for characterization and dosimetry of radiopharmaceutical extravasation. These free and publicly available tools will enable standardized routine clinical analysis and benefit patient care, clinical follow-up, documentation, and event reporting.

The Scientific and Clinical Case for Reviewing Diagnostic Radiopharmaceutical Extravasation Long-Standing Assumptions.

Background: The patient benefit from a diagnostic nuclear medicine procedure far outweighs the associated radiation risk. This benefit/risk ratio assumes a properly administered radiopharmaceutical. However, a significant diagnostic radiopharmaceutical extravasation can confound the procedure in many ways. We identified three current extravasation hypotheses espoused by medical societies, advisory committees, and hundreds of individual members of the nuclear medicine community: diagnostic extravasations do not cause harm, do not result in high absorbed dose to tissue, and require complex dosimetry methods that are not readily available in nuclear medicine centers. We tested these hypotheses against a framework of current knowledge, recent developments, and original research. We conducted a literature review, searched regulatory databases, examined five clinical cases of extravasated patients, and performed dosimetry on those extravasations to test these globally accepted hypotheses. Results: A literature review found 58 peer-reviewed documents suggesting patient harm. Adverse event/vigilance report database reviews for extravasations were conducted and revealed 38 adverse events which listed diagnostic radiopharmaceutical extravasation as a factor, despite a regulatory exemption for required reporting. In our own case material, assessment of care was evaluated for five extravasated patients who underwent repeat imaging. Findings reflected results of literature review and included mis- or non-identification of lesions, underestimation of Standardized Uptake Values (SUVs) by 19-73%, classification of scans as non-diagnostic, and the need to repeat imaging with the associated additional radiation exposure, inconvenience, or delays in care. Dosimetry was performed for the same five cases of diagnostic radiopharmaceutical extravasation. Absorbed doses to 5 cm3 of tissue were between 1.1 and 8.7 Gy, and shallow dose equivalent for 10 cm2 of skin was as high as 4.2 Sv. Conclusions: Our findings suggest that significant extravasations can or have caused patient harm and can irradiate patients' tissue with doses that exceed medical event reporting limits and deterministic effect thresholds. Therefore, diagnostic radiopharmaceutical injections should be monitored, and dosimetry of extravasated tissue should be performed in certain cases where thresholds are thought to have been exceeded. Process improvement efforts should be implemented to reduce the frequency of extravasation in nuclear medicine.

Patient-specific Extravasation Dosimetry Using Uptake Probe Measurements.

ABSTRACT: Extravasation is a common problem in radiopharmaceutical administration and can result in significant radiation dose to underlying tissue and skin. The resulting radiation effects are rarely studied and should be more fully evaluated to guide patient care and meet regulatory obligations. The purpose of this work was to show that a dedicated radiopharmaceutical injection monitoring system can help clinicians characterize extravasations for calculating tissue and skin doses. We employed a commercially available radiopharmaceutical injection monitoring system to identify suspected extravasation of 18F-fluorodeoxyglucose and 99mTc-methylene diphosphonate in 26 patients and to characterize their rates of biological clearance. We calculated the self-dose to infiltrated tissue using Monte Carlo simulation and standard MIRD dosimetry methods, and we used VARSKIN software to calculate the shallow dose equivalent to the epithelial basal-cell layer of overlying skin. For 26 patients, injection-site count rate data were used to characterize extravasation clearance. For each, the absorbed dose was calculated using representative tissue geometries. Resulting tissue-absorbed doses ranged from 0.6 to 11.2 Gy, and the shallow dose equivalent to a 10 cm2 area of adjacent skin in these patients ranged from about 0.1 to 5.4 Sv. Extravasated injections of radiopharmaceuticals can result in unintentional doses that exceed well-established radiation protection and regulatory limits; they should be identified and characterized. An external injection monitoring system may help to promptly identify and characterize extravasations and improve dosimetry calculations. Patient-specific characterization can help clinicians determine extravasation severity and whether the patient should be followed for adverse tissue reactions that may present later in time.

Guidelines on Setting Up Stations for Remote Viewing of Nuclear Medicine and Molecular Imaging Studies During COVID-19.

The current pandemic has created a situation where nuclear medicine practitioners and medical physicists read or process nuclear medicine images remotely from their home office. This article presents recommendations on the components and specifications when setting up a remote viewing station for nuclear medicine imaging.

A data-driven respiratory motion estimation approach for PET based on time-of-flight weighted positron emission particle tracking.

PURPOSE: Respiratory motion of patients during positron emission tomography (PET)/computed tomography (CT) imaging affects both image quality and quantitative accuracy. Hardware-based motion estimation, which is the current clinical standard, requires initial setup, maintenance, and calibration of the equipment, and can be associated with patient discomfort. Data-driven techniques are an active area of research with limited exploration into lesion-specific motion estimation. This paper introduces a time-of-flight (TOF)-weighted positron emission particle tracking (PEPT) algorithm that facilitates lesion-specific respiratory motion estimation from raw listmode PET data. METHODS: The TOF-PEPT algorithm was implemented and investigated under different scenarios: (a) a phantom study with a point source and an Anzai band for respiratory motion tracking; (b) a phantom study with a point source only, no Anzai band; (c) two clinical studies with point sources and the Anzai band; (d) two clinical studies with point sources only, no Anzai band; and (e) two clinical studies using lesions/internal regions instead of point sources and no Anzai band. For studies with radioactive point sources, they were placed on patients during PET/CT imaging. The motion tracking was performed using a preselected region of interest (ROI), manually drawn around point sources or lesions on reconstructed images. The extracted motion signals were compared with the Anzai band when applicable. For the purposes of additional comparison, a center-of-mass (COM) algorithm was implemented both with and without the use of TOF information. Using the motion estimate from each method, amplitude-based gating was applied, and gated images were reconstructed. RESULTS: The TOF-PEPT algorithm is shown to successfully determine the respiratory motion for both phantom and clinical studies. The derived motion signals correlated well with the Anzai band; correlation coefficients of 0.99 and 0.94-0.97 were obtained for the phantom study and the clinical studies, respectively. TOF-PEPT was found to be 13-38% better correlated with the Anzai results than the COM methods. Maximum Standardized Uptake Values (SUVs) were used to quantitatively compare the reconstructed-gated images. In comparison with the ungated image, a 14-39% increase in the max SUV across several lesion areas and an 8.7% increase in the max SUV on the tracked lesion area were observed in the gated images based on TOF-PEPT. The distinct presence of lesions with reduced blurring effect and generally sharper images were readily apparent in all clinical studies. In addition, max SUVs were found to be 4-10% higher in the TOF-PEPT-based gated images than in those based on Anzai and COM methods. CONCLUSION: A PEPT- based algorithm has been presented for determining movement due to respiratory motion during PET/CT imaging. Gating based on the motion estimate is shown to quantifiably improve the image quality in both a controlled point source phantom study and in clinical data patient studies. The algorithm has the potential to facilitate true motion correction where the reconstruction algorithm can use all data available.

Assessing and reducing PET radiotracer infiltration rates: a single center experience in injection quality monitoring methods and quality improvement.

BACKGROUND: Successful injection of radiolabeled compounds is critical for positron emission tomography (PET) imaging. A poor quality injection limits the tracer availability in the body and can impact diagnostic results. In this study, we attempt to quantify our infiltration rates, develop an actionable quality improvement plan to reduce potentially compromised injections, and compare injection scoring to PET/CT imaging results. METHODS: A commercially available system that uses external radiation detectors was used to monitor and score injection quality. This system compares the time activity curves of the bolus relative to a control reading in order to provide a score related to the quality of the injection. These injection scores were used to assess infiltration rates at our facility in order to develop and implement a quality improvement plan for our PET imaging center. Injection scores and PET imaging results were reviewed to determine correlations between image-based assessments of infiltration, such as liver SUVs, and injection scoring, as well as to gather infiltration reporting statistics by physicians. RESULTS: A total of 1033 injections were monitored at our center. The phase 1 infiltration rate was 2.1%. In decision tree analysis, patients < 132.5lbs were associated with infiltrations. Additional analyses suggested patients > 127.5 lbs. with non-antecubital injections were associated with lower quality injections. Our phase 2 infiltration rate was 1.9%. Comparison of injection score to SUV showed no significant correlation and indicated that only 63% of suspected infiltrations were visible on PET/CT imaging. CONCLUSIONS: Developing a quality improvement plan and monitoring PET injections can lead to reduced infiltration rates. No significant correlation between reference SUVs and injection score provides evidence that determination of infiltration based on PET images alone may be limited. Results also indicate that the number of infiltrated PET injections is under-reported.

Clinical and Technical Considerations for Brain PET Imaging for Dementia.

The number of cases of dementia has dramatically increased over the last decade. Imaging of the brain with PET has been used for many years, but in the past decade the radiopharmaceuticals and technology available for imaging dementia have vastly improved. In recent years, the U.S. Food and Drug Administration has approved 3 PET radiopharmaceuticals for detecting amyloid in brain, and tau PET radiopharmaceuticals are being investigated in clinical trials for use in dementia imaging. This paper will discuss different forms of dementia that can be imaged with PET, review common radiopharmaceuticals used for imaging dementia, and provide technical recommendations for performing the studies.

Novel methods for the quantification of toxic, residual phase transfer catalyst in fluorine-18 labeled radiotracers.

INTRODUCTION: Fluorine-18 labeled radiopharmaceuticals undergo quality control testing for residual phase-transfer-catalyst content. The almost universally used quality-control test is a silica plate spot-test comparison of the radiopharmaceutical beside a 50-ppm standard. Once developed by staining, the radiopharmaceutical spot must be of equal or less intensity to pass the test. There is currently a need for a quantitative, inexpensive, and less subjective quality control method that allows the automatic incorporation of the acquired measurement directly into electronic batch reports. RESULTS: In the developed method, a resazurin test solution is mixed with an aliquot of the radiopharmaceutical analyte along with dichloromethane (DCM). The mixture is vortexed. The potassium resazurin-phase transfer catalyst complex solubilizes into the DCM imparting a blue color. The organic layer is then removed for analysis. Three measurement methods were utilized: visual colorimetry against pre-prepared standards, spectrophotometric measurement of transmittance, and electrical conductance. A simple prototype spectrophotometer and an electrical test cell were constructed to acquire data. Sodium Resazurin dye was found to be a suitable test chromophore for residual phase transfer catalyst analysis of aqueous solutions. Quantitative spectrophotometric measurements are possible in the 0-100-ppm range (18-crown-6) and 0-150-ppm range (Kryptofix® or tetrabutylammonium). Electrical resistance measurements of the phase transfer-catalyst resazurin complex in DCM are also a viable method, allowing quantitative phase transfer catalyst measurements in the 0-100-ppm range. CONCLUSION: The methodologies developed are more quantitative alternatives to the current spot-test method. The spectrophotometric method was determined to be the most accurate method.

Quality Improvement Initiatives to Assess and Improve PET/CT Injection Infiltration Rates at Multiple Centers.

PET/CT radiotracer infiltration is not uncommon and is often outside the imaging field of view. Infiltration can negatively affect image quality, image quantification, and patient management. Until recently, there has not been a simple way to routinely practice PET radiopharmaceutical administration quality control and quality assurance. Our objectives were to quantify infiltration rates, determine associative factors for infiltration, and assess whether rates could be reduced at multiple centers and then sustained. Methods: A "design, measure, analyze, improve, and control" quality improvement methodology requiring novel technology was used to try to improve PET/CT injection quality. Teams were educated on the importance of quality injections. Baseline infiltration rates were measured, center-specific associative factors were analyzed, team meetings were held, improvement plans were established and executed, and rates remeasured. To ensure that injection-quality gains were retained, real-time feedback and ongoing monitoring were used. Sustainability was assessed. Results: Seven centers and 56 technologists provided data on 5,541 injections. The centers' aggregated baseline infiltration rate was 6.2% (range, 2%-16%). On the basis of their specific associative factors, 4 centers developed improvement plans and reduced their aggregated infiltration rate from 8.9% to 4.6% (P < 0.0001). Ongoing injection monitoring showed sustainability. Significant variation was found in center- and technologist-level infiltration rates (P < 0.0001 and P = 0.0020, respectively). Conclusion: A quality improvement approach with new technology can help centers measure infiltration rates, determine associative factors, implement interventions, and improve and sustain injection quality. Because PET/CT images help guide patient management, the monitoring and improvement of radiotracer injection quality are important.

Collection of Real-Time Data with a Modular Detector System to Assess Injection Quality.

A modular radiation detector device that was developed by Lucerno Dynamics, LLC, collects data during the entire uptake period of a molecular imaging study and then retrospectively assesses these data for signs of dose infiltration. The objective of this study was to test the feasibility of using this device for real-time, rather than retrospective, assessment of the injected dose. Methods: For 20 patients undergoing a clinical PET scan, we manually collected real-time counts from the device for 60 s and then compared the resultant time-activity curves with those generated from automated 60-min counts collected by the device. Results: The R 2 value calculated for the averages across the 2 curves was 0.93 (93%), meaning the 2 curves matched statistically. Conclusion: The external detector device may be used to ascertain, within only 60 s, whether an injection is sufficient.

Relative skeletal distribution of proliferating marrow in the adult dog determined using 3'-deoxy-3'-[18 F]fluorothymidine.

3'-deoxy-3'-[18 F]fluorothymidine (18 FLT) is a radiopharmaceutical tracer used with positron emission tomography (PET), often in combination with computed tomography (CT), to image DNA synthesis, and thus, cellular proliferation. Characteristic accumulation of the tracer within haematopoietic bone marrow provides a noninvasive means to assess marrow activity and distribution throughout the living animal. The present study utilizes three-dimensional analysis of 18 FLT-PET/CT scans to quantify the relative skeletal distribution of active marrow by anatomic site in the dog. Scans were performed on six healthy, adult (3-6 years of age), mixed-breed dogs using a commercially available PET/CT scanner consisting of a 64-slice helical CT scanner combined with an integrated four ring, high-resolution LSO PET scanner. Regions of interest encompassing 11 separate skeletal regions (skull, cervical vertebral column, thoracic vertebral column, lumbar vertebral column, sacrum, ribs, sternum, scapulae, proximal humeri, ossa coxarum, and proximal femora) were manually drawn based on CT images and thresholded by standardized uptake value to delineate bone marrow activity. Activity within each skeletal region was then divided by the total skeletal activity to derive the per cent of overall marrow activity within an individual site. The majority of proliferative marrow was located within the vertebral column. Of the sites traditionally accessed clinically for marrow sampling, the proximal humerus contained the largest percentage, followed by the ossa coxarum, proximal femur, and sternum, respectively. This information may be used to guide selection of traditional marrow sampling sites as well as inform efforts to spare important sites of haematopoiesis in radiation therapy planning.

Respiratory Motion Correction Using A Novel Positron Emission Particle Tracking Technique: A Framework Towards Individual Lesion-Based Motion Correction.

Respiratory motion during PET/CT imaging is a matter of concern due to degraded image quality and reduced quantitative accuracy caused by motion artifacts. One class of motion correction methods relies on hardware-based respiratory motion tracking systems in order to use respiratory cycles for correcting motion artifacts. Another class of hardware-free methods extract motion information from the reconstructed images or sinograms. Hardware-based methods, however, are limited by calibration requirement, patient discomfort, lack of adaptability during scanning, presence of electronic drift during respiratory monitoring etc. Extracting motion information from reconstructed images is also limited by the fact that the original raw information requires significant processing before it can be used. Hence the motivation behind this work is to introduce a software-based approach that can be applied on raw 64-bit listmode data. The basic design of the proposed method is based on the fundamentals of Positron Emission Particle Tracking (PEPT) with additional incorporation of Time of Flight (TOF) information. Respiratory motion of patients has been extracted from the raw PET data by tracking a point source attached to the patient in areas on and near the chest. The key objective of this work is to describe a new process by which this particle tracking based motion correction system can eventually be lesion specific and correct the motion for a particular lesion within the patient. This work thus serves as a framework for lesion specific motion correction.

Practical Considerations for Integrating PET/CT into Radiation Therapy Planning.

Over the past 20 y, PET/CT has had many technologic and developmental advancements for patient care. PET/CT has evolved from being used as a diagnosis and staging tool to now having an impact on treating cancer through a collaboration with radiation oncology. There are multiple considerations when integrating PET/CT into radiation therapy planning, such as the needs of the PET/CT center, the types of scans to offer, workflow considerations between the PET/CT center and the radiation therapy planning center, PET/CT center growth and demand on schedules, and the impact PET/CT will have on radiation treatment planning. Careful planning and implementation are important in offering patients optimum care that integrates PET/CT in radiation therapy planning.

Feasibility assessment of yttrium-90 liver radioembolization imaging using amplitude-based gated PET/CT.

PURPOSE: The usage of PET/computed tomography (CT) to monitor hepatocellular carcinoma patients following yttrium-90 (Y) radioembolization has increased. Respiratory motion causes liver movement, which can be corrected using gating techniques at the expense of added noise. This work examines the use of amplitude-based gating on Y-PET/CT and its potential impact on diagnostic integrity. PATIENTS AND METHODS: Patients were imaged using PET/CT following Y radioembolization. A respiratory band was used to collect respiratory cycle data. Patient data were processed as both standard and motion-corrected images. Regions of interest were drawn and compared using three methods. Activity concentrations were calculated and converted into dose estimates using previously determined and published scaling factors. Diagnostic assessments were performed using a binary scale created from published Y-PET/CT image interpretation guidelines. RESULTS: Estimates of radiation dose were increased (P<0.05) when using amplitude-gating methods with Y PET/CT imaging. Motion-corrected images show increased noise, but the diagnostic determination of success, using the Kao criteria, did not change between static and motion-corrected data. CONCLUSION: Amplitude-gated PET/CT following Y radioembolization is feasible and may improve Y dose estimates while maintaining diagnostic assessment integrity.

90Y Liver Radioembolization Imaging Using Amplitude-Based Gated PET/CT.

The usage of PET/CT to monitor patients with hepatocellular carcinoma following Y radioembolization has increased; however, image quality is often poor because of low count efficiency and respiratory motion. Motion can be corrected using gating techniques but at the expense of additional image noise. Amplitude-based gating has been shown to improve quantification in FDG PET, but few have used this technique in Y liver imaging. The patients shown in this work indicate that amplitude-based gating can be used in Y PET/CT liver imaging to provide motion-corrected images with higher estimates of activity concentration that may improve posttherapy dosimetry.

Guidance for Efficient Small Animal Imaging Quality Control.

Routine quality control is a critical aspect of properly maintaining high-performance small animal imaging instrumentation. A robust quality control program helps produce more reliable data both for academic purposes and as proof of system performance for contract imaging work. For preclinical imaging laboratories, the combination of costs and available resources often limits their ability to produce efficient and effective quality control programs. This work presents a series of simplified quality control procedures that are accessible to a wide range of preclinical imaging laboratories. Our intent is to provide minimum guidelines for routine quality control that can assist preclinical imaging specialists in setting up an appropriate quality control program for their facility.

Clinical Workflow Considerations for Implementation of Continuous-Bed-Motion PET/CT.

Within the last 3 y, a new type of technology has emerged for PET imaging that uses a continuous-bed-motion (CBM) acquisition. For technologists, this type of acquisition requires some modifications of the standard approach to PET protocols and imaging workflows. There are several key aspects of CBM that technologists need to learn and understand when transitioning from traditional step-and-shoot PET imaging to this new technology, including differences in acquisition type, image quality, and protocol setup as well as the impact that CBM can have on workflow. This article explains how CBM differs from step and shoot and focuses on the issues critical for technologists to know when first using this technology.

Whole-body dynamic imaging with continuous bed motion PET/CT.

Most dynamic imaging protocols require long scan times that are beyond the range of what can be supported in a routine clinical environment and suffer from various difficulties related to step and shoot imaging techniques. In this short communication, we describe continuous bed motion (CBM) imaging techniques to create clinically relevant 15 min whole-body dynamic PET imaging protocols. We also present initial data that suggest that these CBM methods may be sufficient for quantitative analysis of uptake rates and rates of glucose metabolism. Multipass CBM PET was used in conjunction with a population-based input function to perform Patlak modeling of normal tissue. Net uptake rates were estimated and metabolic rates of glucose were calculated. Estimations of k3 (Ki/Vd) were calculated along with modeling of liver regions of interest to assess model stability. Calculated values of metabolic rates of glucose were well within normal ranges found in the previous literature. CBM techniques can potentially be used clinically to obtain reliable, quantitative multipass whole-body dynamic PET data. Values calculated for normal brain were shown to be within previously published values for normal brain glucose metabolism.

A Routine PET/CT Protocol with Streamlined Calculations for Assessing Cardiac Amyloidosis Using (18)F-Florbetapir.

INTRODUCTION: Cardiac amyloidosis is a rare condition characterized by the deposition of well-structured protein fibrils, proteoglycans, and serum proteins as amyloid. Recent work has shown that it may be possible to use (18)F-Florbetapir to image cardiac amyloidosis. Current methods for assessment include invasive biopsy techniques. This work enhances foundational work by Dorbala et al. by developing a routine imaging and analysis protocol using (18)F-Florbetapir for cardiac amyloid assessment. METHODS: Eleven patients, three healthy controls and eight myloid positive patients, were imaged using (18)F-Florbetapir to assess cardiac amyloid burden. Four of the patients were also imaged using (82)Rb-Chloride to evaluate possible (18)F-Florbetapir retention because of reduced myocardial blood flow. Quantitative methods using modeling, SUVs and SUV ratios were used to define a new streamlined clinical imaging protocol that could be used routinely and provide patient stratification. RESULTS: Quantitative analysis of (18)F-Florbetapir cardiac amyloid data were compiled from a 20-min listmode protocol with data histogrammed into two static images at 0-5, 10-15, or 15-20 min. Data analysis indicated the use of SUVs or ratios of SUVs calculated from regions draw in the septal wall were adequate in identification of all healthy controls from amyloid positive patients in this small cohort. Additionally, we found that it may be possible to use this method to differentiate patients suffering from AL vs. TTR amyloid. CONCLUSION: This work builds on the seminal work by Dorbala et al. by describing a short (18)F-Florbetapir imaging protocol that is suitable for routine clinical use and uses a simple method for quantitative analysis of cardiac amyloid disease.