[A Nationwide Survey on Additional Scan in Nuclear Medicine Imaging].

The aim of the present study was to clarify the routine protocols and the frequency of added or omitted imaging on nuclear medicine imaging in Japan. A nationwide survey on routine protocols and current state of added or omitted imaging in major nuclear medicine imaging were performed for Japanese nuclear medicine technologist. The survey showed that the routine protocols were almost 100% fixed, some of the routine protocols were found to be useful and percentage of imaging techniques such as single photon emission computed tomography/computed tomography that increased patient burden and reduced through put were low. Furthermore, the survey showed that additional or omission imaging were frequently performed on bone scintigraphy and positron emission tomography and added or omitted judgements were often depend upon the rule of thumb by nuclear medicine technologist. In this study, we have concluded that the quality of examination and the diagnosis might depend on the knowledge of nuclear medicine technologist, performed added or omitted imaging.

[Development of a Novel Body Phantom with Bone Equivalent Density for Evaluation of Bone SPECT].

We developed a custom-designed phantom for bone single photon emission computed tomography (SPECT)-specific radioactivity distribution and linear attenuation coefficient. The aim of this study was to evaluate the accuracy of the phantom. The lumbar phantom consisted of the trunk of a body phantom (background) containing a cylinder (vertebral body), a sphere (tumor), and a T-shaped container (processus). The vertebral body, tumor, and processus phantoms contained a K(2)HPO(4) solution of bone equivalent density and 50, 300 and 50 kBq/mL of (99m)Tc, respectively. The body phantom contained 8 kBq/mL of (99m)Tc solution. SPECT images were acquired using low-energy high-resolution collimation, a 128 × 128 matrix and 120 projections over 360° with a dwell time of 15 sec/view × 4 times. Thereafter, CT images were acquired at 130 kV and 70 ref mAs using adaptive dose modulation. The SPECT data were reconstructed with ordered subset expectation maximization with three-dimensional, scatter, and CT-based attenuation correction. Count ratio, linear attenuation coefficient (LAC), and full-width at half-maximum (FWHM) were measured. Count ratios between the background, the vertebral body, and the tumor in SPECT images were 463.8: 2888.0: 15150.3 (1: 6.23: 32.7). The LAC of the background and vertebral body in the CT-derived attenuation map were 0.155 cm⁻¹ and 0.284 cm⁻¹, respectively, and the FWHM measured from the processus was 15.27 mm. The precise counts and LAC indicated that the phantom was accurate and could serve as a tool for evaluating acquisition, reconstruction parameters, and quantitation in bone SPECT images.

[Usefulness of spatially adaptive noise reduction processing in computer-assisted diagnosis system for bone scintigraphy].

OBJECTIVES: The goal of this study was to assess the diagnostic accuracy of Pixon-processed images in comparison with raw images for computer-assisted interpretation of bone scintigraphy (BONENAVI). METHODS: Whole-body scans of 57 patients with prostate cancer who had undergone bone scintigraphy for suspected bone metastases were obtained approximately 3 h after intravenous injection of 740 MBq (99m)Tc-methylene diphosphonate. We obtained two image sets: raw images and images processed using the Pixon method. Artificial neural network (ANN) values, bone scan index (BSI), number of hotspots and regional ANN value of two images set were automatically calculated by the BONENAVI software. Areas under the receiver operator characteristic curves (AUC) were calculated in patient-based and lesion-based analyses. RESULTS: In ten cases with bone metastases, ANN, BSI and number of hotspots for processed images were equivalent to those in the raw images. However, in 47 cases without bone metastases, ANN, BSI and number of hotspots for processed images showed significantly lower values than those for the raw images (p<0.05). Sensitivity, specificity and accuracy of the raw images were 90.2, 44.7 and 65.9%, and those of the processed images were 90.2, 57.4 and 72.7%, respectively. The AUC for processed images was equivalent to that for raw images. CONCLUSIONS: Specificity and accuracy in the detection of bone metastases showed the Pixon-processed images to have high diagnostic performance. We conclude that the precision of computer-assisted interpretation of bone scintigraphy can be enhanced by using Pixon processing.

Efficacy of a Novel Respiratory Motion Reduction Block in Reducing Motion Artifact on Myocardial Perfusion Single-Photon Emission Computed Tomography.

PURPOSE: Motion artifacts caused by heart motion during myocardial perfusion single-photon emission computed tomography (SPECT) can compromise image quality and diagnostic accuracy. This study aimed to evaluate the efficacy of the novel respiratory motion reduction block (RRB) device in reducing motion artifacts by compressing the hypochondrium and improving SPECT image quality. METHODS: In total, 91 patients who underwent myocardial perfusion SPECT with 99mTc-sestamibi were retrospectively analyzed. Patients (n = 28) who underwent SPECT without the RRB were included in the control group, and those (n = 63) who underwent SPECT with the RRB were in the RRB group. The distance of heart motion during dynamic acquisition was measured, and projection data were assessed for patient motion and motion artifacts. Patient motion was classified into various levels, and motion artifacts on SPECT images were visually examined. RESULTS: The distances of heart motion without and with the RRB were 15.4 ± 5.3 and 7.5 ± 2.3, respectively. Compared with the control group, the RRB group had a lower frequency of heart motion based on the projection data, particularly in terms of creep and shift motion. The RRB group had a significantly lower incidence of motion artifacts on SPECT images than the control group. CONCLUSIONS: The RRB substantially reduced specific types of motion, such as shift and creep, and had a low influence on bounce motion. However, it could effectively suppress respiratory-induced heart motion and reduce motion artifacts on myocardial perfusion SPECT, thereby emphasizing its potential for improving image quality.

[Accuracy of Effective Diameter and Water Equivalent Diameter Using Phantoms in Various CT Systems].

PURPOSE: The effects of scanning parameters such as CT system performance, CT bed geometry, and upper limb position on effective diameter (ED) and water equivalent diameter (WED) have not been assessed. The purpose of this study was to compare both ED and WED obtained with various CT systems with theoretical values and to assess their accuracy. METHODS: Jaszczak cylindrical phantom (Data Spectrum, Durham, NC, USA), NEMA IEC body phantom (AcroBio, Tokyo), and thoracic bone phantom were used in this study with and without upper limb phantom. The ED, WED, and size-specific dose estimate (SSDE) obtained using 8 types of CT systems were computed using radiation dose control software. RESULTS: The EDs had <5% error for all systems, but the error increased as the aspect ratio of the phantom increased. The accuracy of WED varied depending on the CT systems, with a maximum difference of 3.57 cm between systems. The influence of the upper limb depended on the shape of the bed of the CT systems, which affected the correlation between ED as well as WED and SSDE. CONCLUSION: Although the ED did not show any dependence on the CT system, the accuracy of WED for fusion CT was low. We found that there are issues in the management of scanning data, including the upper limb.

[Investigation of Imaging Conditions Using Human Body Equivalent Phantom and Neonatal Phantom in Portable Chest Radiography of Newborns].

PURPOSE: Investigation of imaging conditions using human body equivalent phantom and neonatal phantom in portable chest radiography of newborns. Although attempts have been made to reduce dose by image processing in portable X-ray radiography of neonates, no evaluation has been made at the raw data level of the images. In this study, we investigated dose reduction from the current imaging conditions using a simulated phantom and a neonatal phantom in terms of raw data level image quality and incident surface dose. METHODS: The pixel values of each region were calculated from chest photographs of newborn infants taken at 60 kV and 2.0 mAs, and the thickness and combination of acrylic, aluminum, and copper were adjusted to create a simulated phantom with equivalent pixel values. The SdNR and incident surface dose at each site obtained from the simulated phantom were compared to obtain imaging conditions equivalent to or better than 60 kV, 2.0 mAs. The neonatal phantom was imaged, and the CNR of the processed images was compared to that of 60 kV, 2.0 mAs. RESULTS: SdNR and incident surface dose results showed that 62 kV, 1.8 mAs was superior. Comparison with neonatal phantoms showed no significant difference. CONCLUSION: The simulated phantom was used to reproduce the clinical situation and to obtain excellent imaging conditions.

Biophysical evidence that frostbite is triggered on nanocrystals of biogenic magnetite in garlic cloves (Allium sativum).

Trace levels of biologically precipitated magnetite (Fe3O4) nanocrystals are present in the tissues of many living organisms, including those of plants. Recent work has also shown that magnetite nanoparticles are powerful ice nucleation particles (INPs) that can initiate heterogeneous freezing in supercooled water just below the normal melting temperature. Hence there is a strong possibility that magnetite in plant tissues might be an agent responsible for triggering frost damage, even though the biological role of magnetite in plants is not understood. To test this hypothesis, we investigated supercooling and freezing mortality in cloves of garlic (Allium sativum), a species which is known to have moderate frost resistance. Using superconducting magnetometry, we detected large numbers of magnetite INPs within individual cloves. Oscillating magnetic fields designed to torque magnetite crystals in situ and disturb the ice nucleating process produced significant effects on the temperature distribution of supercooling, thereby confirming magnetite's role as an INP in vivo. However, weak oscillating fields increased the probability of freezing, whereas stronger fields decreased it, a result that predicts the presence of magnetite binding agents that are loosely attached to the ice nucleating sites on the magnetite crystals.

[Effect of Whole-body Continuous Scanning Speed of Bone Scintigraphy on the Detectability of Vertebral Lesions].

PURPOSE: This study aimed to evaluate the influence of the scanning speed of whole-body scans on the detectability of positive vertebral bone images in bone scintigraphy. METHODS: We used SIM2 bone phantom to obtain planar images equivalent to scanning speeds of 15, 17, and 20 cm/min. Receiver operating characteristic (ROC) analysis to evaluate lesion detectability and average count (Ct)/pixel, contrast ratio, and contrast-to-noise ratio (CNR) of the normal vertebral body and the simulated tumor site were measured. RESULTS: The average area under the ROC curves (AUC) was 0.936, 0.929, and 0.915 at speeds of 15, 17, and 20 cm/min, respectively. The average AUC at 20 cm/min was significantly lower than that at 15 cm/min (p<0.05) . However, no other significant differences were found (p=0.448, 0.139). The average Ct/pixel and CNR decreased at 15, 17, and 20 cm/min. The contrast ratio did not change. CONCLUSIONS: The results showed that increasing the scan speed from 15 cm/min to 17 cm/min had no effect on the detection of vertebral lesions. Thus, it is possible to reduce the scan time, albeit slightly.

[Feasibility of Adapting Various Tumor-to-normal Bone Ratio Images on an Automatic Quantification Package for Phantom-based Image Quality Assessment in Bone SPECT].

We investigated the impact of the tumor-to-normal bone ratio (TNR) on the concordance rate between a detectability score classified by software (DSsoft) using an automatic quantification package for bone SPECT (Hone Graph) and a detectability score classified by visual assessment (DSvisual), and considered the feasibility of applying this software to various TNR images. 99mTc solution was filled into a SIM2 bone phantom to achieve TNRs of 4, 6, and 8, performed by dynamic SPECT acquisitions performed for 12 minutes; reconstructions were performed using ordered subset expectation maximization at timepoints ranging from 4 to 12 minutes. This yielded a total of 384 lesions (96 SPECT images). We investigated the weighted kappa (κw) coefficient between DSsoft and DSvisual at various TNRs and evaluated the change in analysis accuracy before and after applying newly created analysis parameters. DSs were defined on a 4-point scale (4: excellent, 3: adequate, 2: average, 1: poor), and visual evaluations were conducted by three board-certified nuclear medicine technologists. The κw coefficients between DSsoft and DSvisual were 0.75, 0.97, and 0.93 for TNRs 4, 6, and 8, respectively, with each κw coefficient being significant (p<0.01). In the TNR 4 image group, κw coefficients significantly increased with the implementation of new parameters proposed in this study. We concluded that the software's automatic analysis would be closer to a visual assessment within the TNR range of 4-8 and that applying new parameters derived from this study to images with TNR 4 further improves the software's automatic analysis accuracy of DSsoft. We suggest that software will be a useful tool for optimizing bone SPECT imaging techniques.

A novel objective method for discriminating pathological and physiological colorectal uptake in the lower abdominal region using whole-body dynamic 18F-FDG-PET.

OBJECTIVES: To investigate whether the center-of-mass shift distance (CMSD) analysis on whole-body dynamic positron emission tomography (WBD-PET) with continuous bed motion is an objective index for discriminating pathological and physiological uptake in the lower abdominal colon. METHODS: We retrospectively analyzed the CMSD in 39 patients who underwent delayed imaging to detect incidental focal uptake that was difficult to determine as pathological and physiological on a conventional early-PET (early) image reconstructed by 5-phase WBD-PET images. The CMSD between each phase of WBD-PET images and between conventional early and delayed (two-phase) PET images were classified into pathological and physiological uptake groups based on endoscopic histology or other imaging diagnostics. The diagnostic performance of CMSD analysis on WBD-PET images was evaluated by receiver operator characteristic (ROC) analysis and compared to that of two-phase PET images. RESULTS: A total of 66 incidental focal uptake detected early image were classified into 19 and 47 pathological and physiological uptake groups, respectively. The CMSD on WBD-PET and two-phase PET images in the pathological uptake group was significantly lower than that in the physiological uptake group (p < 0.01), respectively. The sensitivity, specificity, and accuracy in CMSD analysis on WBD-PET images at the optimal cutoff of 5.2 mm estimated by the Youden index were 94.7%, 89.4%, and 89.4%, respectively, which were not significantly different (p = 0.74) from those of two-phase PET images. CONCLUSIONS: The CMSD analysis on WBD-PET was useful in discriminating pathological and physiological colorectal uptake in the lower abdominal region, and its diagnostic performance was comparable to that of two-phase PET images. We suggested that CMSD analysis on WBD-PET images would be a novel objective method to omit unnecessary additional delayed imaging.

Feasibility of using counts-per-volume approach with a new SPECT phantom to optimize the relationship between administered dose and acquisition time.

We developed a phantom for single-photon emission computed tomography (SPECT), with the objective of assessing image quality to optimize administered dose and acquisition time. We investigated whether the concept of counts-per-volume (CPV), which is used as a predictor of visual image quality in positron emission tomography, can be used to estimate the acquisition time required for each SPECT image. QIRE phantoms for the head (QIRE-h) and torso (QIRE-t) were developed to measure four physical indicators of image quality in a single scan: uniformity, contrast of both hot and defective lesions with respect to the background, and linearity between radioactivity concentration and count density. The target organ's CPV (TCPV), sharpness index (SI), and contrast-to-noise ratio (CNR) were measured for QIRE-h and QIRE-t phantoms, and for anthropomorphic brain and torso phantoms. The SPECT image quality of the four phantoms was visually assessed on a 5-point scale. The acquisition time and TCPV were correlated for all four phantoms. The SI and CNR values were nearly identical for the QIRE and anthropomorphic phantoms with comparable TCPV. The agreement between the visual scores of QIRE-h and brain phantoms, as well as QIRE-t and torso phantoms, was moderate and substantial, respectively. Comparison of SPECT image quality between QIRE and anthropomorphic phantoms revealed close agreement in terms of physical indicators and visual assessments. Therefore, the TCPV concept can also be applied to SPECT images of QIRE phantoms, and optimization of imaging parameters for nuclear medicine examinations may be possible using QIRE phantoms alone.

Comparison of the detectability of hot lesions on bone SPECT using six state-of-the-art SPECT/CT systems: a multicenter phantom study to optimize reconstruction parameters.

Single-photon emission computed tomography with X-ray computed tomography (SPECT/CT) systems have diversified due to the remarkable developments made by each manufacturer. This study aimed to optimize the reconstruction parameters of six state-of-the-art SPECT/CT systems and compare their image quality of bone SPECT. SPECT images were acquired on SPECT/CT systems, including Symbia Intevo, Discovery NM/CT 670, Discovery NM/CT 870 CZT, Brightview XCT, and VERITON-CT. SIM2 bone phantom with tough lung phantoms on both sides of the spinal inserts that simulate the thorax was used for image quality assessment. SPECT images were obtained at individual workstations using an ordered subset expectation maximization method with three-dimensional resolution recovery, as well as CT attenuation and scatter correction, subset 2, iteration 12-84, and a full width at half maximum 10-mm Gaussian smooth filter. An automatic image analysis software dedicated to SIM2 bone phantom was used to assess the contrast-to-noise ratio (CNR), relative recovery coefficient, percentage of coefficient of variance, contrast, and detectability. The optimal parameters for each system were defined with superior detectability of spherical lesions and noise characteristics, as well as the highest CNR. All systems exhibited better image quality indexes using the optimal parameters than using the manufacturer's recommended parameters. The detectability of all systems was in agreement while using the optimal parameters. Detectability agreement can be achieved by optimizing the reconstruction parameters for different reconstruction algorithms, which can further improve the image quality. Therefore, future research should focus on optimal reconstruction parameters for SPECT alone.

Feasibility of ultra-high-speed acquisition in xSPECT bone algorithm: a phantom study with advanced bone SPECT-specific phantom.

OBJECTIVE: Although xSPECT Bone (xB) provides quantitative single-photon emission computed tomography (SPECT) high-resolution images, patients' burden remains high due to long acquisition time; therefore, this study aimed to investigate the feasibility of shortening the xB acquisition time using a custom-designed phantom. METHODS: A custom-designed xSPECT bone-specific (xSB) phantom with simulated cortical and spongious bones was developed based on the thoracic bone phantom. Both standard- and ultra-high-speed (UHS) xB acquisitions were performed in a male patient with lung cancer. In this phantom study, SPECT was acquired for 3, 6, 9, 12, and 30 min. The clinical SPECT acquisition time per rotation was 9 and 3 min for standard and UHS, respectively. SPECT images were reconstructed using ordered subset expectation maximization with three-dimensional resolution recovery (Flash3D; F3D) and xB algorithms. Quantitative SPECT value (QSV) and coefficient of variation (CV) were measured using the volume of interests (VOIs) placed at the center of the vertebral body and hot sphere. A linear profile was plotted on the spinous process at the center of the xSB phantom; then, the full width at half maximum (FWHM) was measured. The standardized uptake value (SUV) and standard deviation from the first thoracic to the fifth lumbar vertebrae in clinical standard- and UHS-xB images were measured using a 1-cm3 VOI. RESULTS: The QSV of F3D images was underestimated even in large regions, whereas those of xB images were close to actual radioactivity concentration. The CV was similar or lower for xB images than that for F3D images but was not decreased with increasing acquisition time for both reconstruction images. The FWHM of xB images was lower than those of F3D images at all acquisition times. The mean SUV values from the first thoracic to fifth lumbar vertebrae for standard- and UHS-xB images were 6.73 ± 0.64 and 6.19 ± 0.87, respectively, showing a strong positive correlation. CONCLUSIONS: Results of this phantom study suggest that xB imaging can be obtained in only one-third of the acquisition time without compromising the image quality. The SUV of UHS-xB images can be similar to that of standard-xB images in terms of clinical interpretation.

Beads phantom for evaluating heterogeneity of SUV on 18F-FDG PET images.

PURPOSE: This study aimed to develop a dedicated phantom using acrylic beads for texture analysis and to represent heterogeneous 18F-fluorodeoxyglucose (FDG) distributions in various acquisition periods. METHODS: Images of acrylic spherical beads with or without diameters of 5- and 10-mm representing heterogeneous and homogeneous 18F-FDG distribution in phantoms, respectively, were collected for 20 min in list mode. Phantom data were reconstructed using three-dimensional ordered subset expectation maximization with attenuation and scatter corrections, and the time-of-flight algorithm. The beads phantom images were acquired twice to evaluate the robustness of texture features. Thirty-one texture features were extracted, and the robustness of texture feature values was evaluated by calculating the percentage of coefficient of variation (%COV) and intraclass coefficient of correlation (ICC). Cross-correlation coefficients among texture feature values were clustered to classify the characteristics of these features. RESULTS: Heterogeneous 18F-FDG distribution was represented by the beads phantom images. The agreements of %COV between two measurements were acceptable (ICC ≥ 0.71). All texture features were classified into four groups. Among 31 texture features, 24 exhibited significant different values between phantoms with and without beads in 1-, 2-, 3-, 4-, 5-, 20-min image acquisitions. Whereas, the homogeneous and heterogeneous 18F-FDG distribution could not be discriminated by seven texture features: low gray-level run emphasis, high gray-level run emphasis, short-run low gray-level emphasis, low gray-level zone emphasis, high gray-level zone emphasis, short-zone low gray-level emphasis, and coarseness. CONCLUSIONS: We have developed the acrylic beads phantom for texture analysis that could represent heterogeneous 18F-FDG distributions in various acquisition periods. Most texture features could discriminate homogeneous and heterogeneous 18F-FDG distributions in the beads phantom images.

Effect of habitual exercise on renal carcinogenesis by ferric nitrilotriacetate.

OBJECTIVES: We investigated whether habitual exercise (HE) (treadmill running) suppresses development of renal cell carcinoma (RCC) induced by ferric nitrilotriacetate (Fe-NTA). METHODS: Male Fischer 344 rats were divided into six groups: group I, saline treatment (12 weeks = initiation period) and non-HE; group II, Fe-NTA treatment (12 weeks) and non-HE; group III, saline treatment and short-term (12 weeks) HE; group IV, Fe-NTA treatment and short-term HE; group V, saline treatment and long-term (40 weeks) HE; and group VI, Fe-NTA treatment and long-term HE. Saline treatment groups did not develop RCC, therefore we investigated the effects of HE among Fe-NTA treatment groups. RESULTS: Gross nodules (diagnosed as RCC), RCC represented by microcarcinomas (Mcs), karyomegalic cells (KCs), and degenerative tubules (DTs) were seen in rats treated with Fe-NTA. The number of Mcs, KCs, and DTs were increased in the short-term HE group when compared with those in the non-HE group, but were decreased in the long-term HE group when compared with those in the short-term HE group. CONCLUSIONS: Short-term (initiation period) HE promoted renal carcinogenesis induced by Fe-NTA; however, long-term HE after the initiation period suppressed the promoted carcinogenesis.

Optimization of cross-calibration factor for quantitative bone SPECT without attenuation and scatter correction in the lumbar spine: head-to-head comparison with attenuation and scatter correction.

OBJECTIVES: Quantitative single-photon emission computed tomography (SPECT) with computed tomography (SPECT/CT) is known to improve diagnostic performance. Although SPECT-alone systems are used widely, accurate quantitative SPECT using these systems is challenging. This study aimed to improve the accuracy of quantitative bone SPECT of the lumbar spine with the SPECT-alone system. METHODS: The cross-calibration factor (CCF) was measured using three kinds of phantoms and the optimal values were determined. The recovery coefficient with and without attenuation and scatter correction (ACSC) were compared. Bone SPECT/CT was performed on 93 consecutive patients with prostate cancer, and the standardized uptake values (SUVs) were compared using the respective CCFs. The first 60 patients were classified according to body weight, and the correlation coefficient between SUVs with and without ACSC were calculated; the slopes were defined as body weight-based coefficients (BWCs). In the remaining 33 patients, the SUV was adjusted according to BWC, and the accuracy of the adjustment was verified. RESULTS: The quantitative SPECT values obtained from the CCF using SIM2 bone phantom showed nearly accurate radioactivity concentrations, even without ACSC. The recovery coefficients with and without ACSC were similar. Unadjusted SUVs with and without ACSC were strongly correlated; however, SUVs without ACSC were significantly higher than those with ACSC (P < 0.0001). The mean difference between the SUVs with and without ACSC disappeared when the SUVs without ACSC were adjusted by BWC (P = 0.9814). CONCLUSIONS: Our cross-calibration method for quantitative bone SPECT enables interpretation with a harmonized SUV even in SPECT-alone systems.

Current state of oncologic 18F-FDG PET/CT in Japan: A nationwide survey.

OBJECTIVES: Combined positron emission tomography/computed tomography (PET/CT) has gradually advanced with the introduction of newly developed techniques. However, the recent status of imaging techniques (e.g., scanning range, availability of correction methods, and decisions on performing delayed scan) in oncologic PET/CT with 18F-fluorodeoxyglucose (18F-FDG) in Japan is unclear. We conducted a nationwide cross-sectional survey to document 18F-FDG PET/CT protocols and clarify the recent status of imaging techniques for oncologic 18F-FDG PET/CT in Japan. METHODS: We conducted a web survey hosted by the Japanese Society of Radiological Technology between October and December 2017. The questionnaire included nine items on the demographics of the respondents, their scan protocols, and additional imaging to their routine protocols. RESULTS: We received responses from 119 Japanese technologists who performed 18F-FDG PET/CT in practice. Almost all the respondents stated that the scanning range was from the top of the head to the pelvis or mid-thigh region. Newly developed techniques were used by fewer than half of the respondents. Most respondents performed additional imaging in consultation with physicians, such as delayed imaging (83%) or an extended scanning range for early imaging (55%). CONCLUSIONS: Our survey helps in clarifying the recent state of oncologic 18F-FDG PET/CT imaging techniques in Japan. Given that 18F-FDG PET/CT practices most frequently performed additional imaging along with their routine scan protocol, the practice constitutes the most varied examination performed in Japanese nuclear medicine.

Automatic quantification package (Hone Graph) for phantom-based image quality assessment in bone SPECT: computerized automatic classification of detectability.

OBJECTIVE: We previously developed a custom-design thoracic bone scintigraphy-specific phantom ("SIM2 bone phantom") to assess image quality in bone single-photon emission computed tomography (SPECT). We aimed to develop an automatic assessment system for imaging technology in bone SPECT and demonstrate the validity of this system. METHODS: Four spherical lesions of 13-, 17-, 22-, and 28-mm diameters in the vertebrae of SIM2 bone phantom simulating the thorax were filled with radioactivity (target-to-background ratio: 4). Dynamic SPECT acquisitions were performed for 15 min; reconstructions were performed using ordered subset expectation maximization at 3-15-min timepoints. Consequently, 216 lesions (54 SPECT images) were obtained: 120 and 96 lesions were used for software development and validation, respectively. The developed software used statistical parametric mapping to rigidly register and automatically calculate quantitative indexes (contrast-to-noise ratio, % coefficient of variance, % detectability equivalence volume, recovery coefficient, target-to-normal bone ratio, and full width at half maximum). A detectability score (DS) was used to define the four observation types (4, excellent; 3, adequate; 2, average; 1, poor) to score hot spherical lesions. The gold standard for DSs was independently classified by three experienced board-certified nuclear medicine technologists using the four observation types; thereafter, a consensus regarding the gold standard for DSs was reached. Using 120 lesions for development, decision tree analysis was performed to determine DS based on the quantitative indexes. We verified the validation of the quantitative indexes and their threshold values for automatic classification using 96 lesions for validation. RESULTS: The trends in the automatically calculated quantitative indices were consistent. Decision tree analysis produced four terminal groups; two quantitative indexes (% detectability equivalence volume and contrast-to-noise ratio) were used to classify DS. The automatically classified DSs exhibited an almost perfect agreement with the gold standard. The percentage agreement and kappa coefficient were 91.7% and 0.93, respectively, in 96 lesions for validation. CONCLUSIONS: The developed software automatically classified the detectability of hot lesions in the SIM2 bone phantom using the automatically calculated quantitative indexes, suggesting that this software could provide a means to automatically perform detectability analysis after data input that is excellent in reproducibility and accuracy.

Current state of bone scintigraphy protocols and practice in Japan.

OBJECTIVES: Nuclear medicine technologists in Japan often perform additional single-photon emission computed tomography (SPECT) with or without computed tomography (CT) after whole-body imaging for bone scintigraphy. In this study, we wanted to identify the bone scanning protocols used in Japan, together with the current clinical practices. METHODS: The study was conducted between October and December 2017. We created a web survey that was hosted by the Japanese Society of Radiological Technology. The questionnaire included 12 items regarding the demographics of the responders, their scan protocols, and the imaging added to, or omitted from, routine protocols. RESULTS: In total, 228 eligible responses were collected from participants with a mean of 11.6±8.4 years' experience in nuclear medicine examination. All responders reported using routine scan protocols that included whole-body imaging. However, only 2%, 4%, 20%, and 14% of the responders also acquired single-field SPECT, single-field SPECT/CT, multi-field SPECT, and multi-field SPECT/CT, respectively. CONCLUSION: Our survey results indicate that nuclear medicine practice in Japan is beginning to shift from planar whole-body imaging with additional spot planar images to additional SPECT or SPECT/CT. Further study is required to examine the optimal protocols for bone scintigraphy.

Imaging technology for myocardial perfusion single-photon emission computed tomography 2018 in Japan.

AIM: Recently, nuclear cardiology has dramatically advanced by a new technology development such as the device, short-term acquisition system, image reconstruction algorithm and image analysis. Although these innovations have been gradually employed in routine examinations, we did not investigate the current use of image acquisition, image reconstruction, and image analysis with myocardial perfusion single-photon emission computed tomography (MPS). We investigated the current status of MPS imaging technology in Japan. METHODS: We carried out a survey using a Web-based questionnaire system, the opening of which was announced via e-mail, and it was available on a website for 3 months. We collected data on the current use of MPS with 201Tl and/or 99mTc agents with respect to routine protocols, image acquisition, image reconstruction, and image analysis. RESULTS: We received responses to the Web-based questionnaire from 178 and 174 people for 99mTc and 201Tl MPS, respectively. The routine protocols of MPS of stress-rest and rest-stress MPS on 1-day protocols with 99mTc were 41.2% and 14.5%, respectively, and the rest-only scan response rate was 23.7%, whereas that of 201Tl MPS was 65.9% with stress-rest MPS, 19.0% with rest-only MPS, and 10.9% with stress-rest MPS adding a rest scan 24 h after injection. The filtered back projection (FBP) method is most commonly used image reconstruction method, yielding 70.5% for 99mTc MPS and 76.8% for 201Tl MPS, including combined FBP and ordered subset expectation maximization method. The results for no-correction (NC) images were 49.2% with 99mTc MPS and 55.2% with 201Tl MPS including the response of NC and combined attenuation correction (AC) and scatter correction (SC) (i.e., ACSC) images. The AC or ACSC images of 99mTc and 201Tl were provided by 30-40% of the institutions surveyed. CONCLUSIONS: We investigated the current status of MPS imaging technology in Japan, and found that although the use of various technical developments has been reported, some of these technologies have not been utilized effectively. Hence, we expect that nuclear medicine technology will be used more effectively to improve diagnosis.