Effects of Detector Thickness on Geometric Sensitivity and Event Positioning Errors in the Rectangular PET/X Scanner.

We used simulations to investigate the relationship between sensitivity and spatial resolution as a function of crystal thickness in a rectangular PET scanner intended for quantitative assessment of breast cancers. The system had two 20 × 15-cm2 and two 10 × 15-cm2 flat detectors forming a box, with the larger detectors separated by 4 or 8 cm. Depth-of-interaction (DOI) resolution was modeled as a function of crystal thickness based on prior measurements. Spatial resolution was evaluated independent of image reconstruction by deriving and validating a surrogate metric from list-mode data (dFWHM). When increasing crystal thickness from 5 to 40 mm, and without using DOI information, the dFWHM for a centered point source increased from 0.72 to 1.6 mm. Including DOI information improved dFWHM by 12% and 27% for 5- and 40-mm-thick crystals, respectively. For a point source in the corner of the FOV, use of DOI information improved dFWHM by 20% (5-mm crystal) and 44% (40-mm crystal). Sensitivity was 7.7% for 10-mm-thick crystals (8-cm object). Increasing crystal thickness on the smaller side detectors from 10 to 20 mm (keeping 10-mm crystals on the larger detectors) boosted sensitivity by 24% (relative) and degraded dFWHM by only ~3%/8% with/without DOI information. The benefits of measuring DOI must be evaluated in terms of the intended clinical task of assessing tracer uptake in small lesions. Increasing crystal thickness on the smaller side detectors provides substantial sensitivity increase with minimal accompanying loss in resolution.

Positron emission mammography (PEM): effect of activity concentration, object size, and object contrast on phantom lesion detection.

PURPOSE: To characterize the relationship between lesion detection sensitivity and injected activity as a function of lesion size and contrast on the PEM (positron emission mammography) Flex Solo II scanner using phantom experiments. METHODS: Phantom lesions (spheres 4, 8, 12, 16, and 20 mm diameter) were randomly located in uniform background. Sphere activity concentrations were 3 to 21 times the background activity concentration (BGc). BGc was a surrogate for injected activity; BGc ranged from 0.44-4.1 kBq∕mL, corresponding to 46-400 MBq injections. Seven radiologists read 108 images containing zero, one, or two spheres. Readers used a 5-point confidence scale to score the presence of spheres. RESULTS: Sensitivity was 100% for lesions ≥12 mm under all conditions except for one 12 mm sphere with the lowest contrast and lowest BGc (60% sensitivity). Sensitivity was 100% for 8 mm spheres when either contrast or BGc was high, and 100% for 4 mm spheres only when both contrast and BGc were highest. Sphere contrast recovery coefficients (CRC) were 49%, 34%, 26%, 14%, and 2.8% for the largest to smallest spheres. Cumulative specificity was 98%. CONCLUSIONS: Phantom lesion detection sensitivity depends more on sphere size and contrast than on BGc. Detection sensitivity remained ≥90% for injected activities as low as 100 MBq, for lesions ≥8 mm. Low CRC in 4 mm objects results in moderate detection sensitivity even for 400 MBq injected activity, making it impractical to optimize injected activity for such lesions. Low CRC indicates that when lesions <8 mm are observed on PEM images they are highly tracer avid with greater potential of clinical significance. High specificity (98%) suggests that image statistical noise does not lead to false positive findings. These results apply to the 85 mm thick object used to obtain them; lesion detectability should be better (worse) for thinner (thicker) objects based on the reduced (increased) influence of photon attenuation.

DOI-based reconstruction algorithms for a compact breast PET scanner.

PURPOSE: The authors discuss the design and evaluate the performance of combined event estimation and image reconstruction algorithms designed for a proposed high-resolution rectangular breast PET scanner (PETX). The PETX scanner will be capable of measuring the depth of interaction by utilizing detector modules composed of depth-of-interaction microcrystal element (dMiCE) crystal pairs. This design allows a unique combination of event estimation and fast projection methods. METHODS: The authors implemented a Monte Carlo simulator to model the PETX system using only true coincident events. The performance of the dMiCE crystal pairs was determined experimentally over a range of depths of interaction. This distribution was used to simulate the noisy dMiCE detector signals and to estimate the line of response for each decay. Three different statistical methods were implemented to determine photon event positioning. Images were reconstructed from these line of response estimators with the exact planogram frequency distance rebinning algorithm, which is an exact analytical reconstruction algorithm for planar systems. Reconstructed images were analyzed with contrast, noise, and spatial resolution metrics. RESULTS: The authors' simulations demonstrate the ability for the PETX system to produce quantitatively accurate images from true coincident events with a contrast recovery coefficient of greater than 0.8 for 5 mm spheres at the axial center of the scanner and a spatial resolution (FWHM) of 3 mm throughout most of the imaging field of view. CONCLUSIONS: The authors' proposed positioning and reconstruction algorithms for the PETX system show the potential for creating high-quality, high-resolution, and quantitatively accurate images within a clinically feasible reconstruction time.

Effects of MR surface coils on PET quantification.

PURPOSE: The goal of this work was to investigate the effects of MRI surface coils on attenuation-corrected PET emission data. The authors studied the cases where either an MRI or a CT scan would be used to provide PET attenuation correction (AC). Combined MR/PET scanners that use the MRI for PET AC (MR-AC) face the challenge of absent surface coils in MR images and thus cannot directly account for attenuation in the coils. Combining MR and PET images could be achieved by transporting the subject on a stereotactically registered table between independent MRI and PET scanners. In this case, conventional PET CT-AC methods could be used. A challenge here is that high atomic number materials within MR coils cause artifacts in CT images and CT based AC is typically not validated for coil materials. METHODS: The authors evaluated PET artifacts when MR coils were absent from AC data (MR-AC), or when coil attenuation was measured by CT scanning (CT-AC). They scanned PET phantoms with MR surface coils on a clinical PET/CT system and used CT-AC to reconstruct PET data. The authors then omitted the coil from the CT-AC image to mimic the MR-AC scenario. Images were acquired using cylinder and anthropomorphic phantoms. They evaluated and compared the following five scenarios: (1) A uniform cylinder phantom and head coil scanned and reconstructed using CT-AC; (2) similar emission data (with head coil present) were reconstructed without the head coil in the AC data; (3) the same cylinder scanned without the head coil present (reference scan); (4) a PET torso phantom with a full MR torso coil present in both PET and CT; (5) only half of the separable torso coil present in the PET/CT acquisition. The authors also performed analytic simulations of the first three scenarios. RESULTS: Streak artifacts were present in CT images containing MR surface coils due to metal components. These artifacts persisted after the CT images were converted for PET AC. The artifacts were significantly reduced when half of the separable coil was removed during the scan. CT scans tended to over-estimate the linear attenuation coefficient (micro) of the metal components when using conventional methods for converting from CT number to micro(511 keV). Artifacts were visible outside the phantom in some of the PET emission images, corresponding to the MRI coil geometry. However, only subtle artifacts were apparent in the emission images inside the phantoms. On the other hand, the PET emission image quantitative accuracy was significantly affected: the activity was underestimated by 19% when AC did not include the head coil, and overestimated by 28% when the CT-AC included the head coil. CONCLUSIONS: The presence of MR coils during PET or PET/CT scanning can cause subtle artifacts and potentially important quantification errors. Alternative CT techniques that mitigate artifacts should be used to improve AC accuracy. When possible, removing segments of an MR coil prior to the PET/CT exam is recommended. Further, MR coils could be redesigned to reduce artifacts by rearranging placement of the most attenuating materials.

Positron emission mammography: correlation of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status and 18F-FDG.

OBJECTIVE: The study objective was to assess the correlation between (18)F-FDG uptake values on positron emission mammography (PEM), expressed as maximum uptake value and lesion-to-background ratio, and receptor status (i.e., estrogen receptor [ER], progesterone receptor [PR], and human epidermal growth factor receptor 2 [HER2]), tumor histology, and tumor grade. We also evaluated for the correlation between maximum uptake value on PEM and maximum uptake value on a whole-body PET/CT. MATERIALS AND METHODS: We retrospectively reviewed our database for patients with newly diagnosed breast cancer who were referred for PEM between June 2007 and September 2009. A subset of patients also underwent a whole-body PET/CT scan. The original pathology reports were reviewed to establish the histologic type, grade, and receptor status. RESULTS: The study involved 98 patients with 100 lesions. ER-negative tumors and PR-negative tumors had significantly higher mean lesion-to-background ratio than did their respective receptor-positive tumors (p = 0.02). Triple-negative tumors (i.e., ER-negative, PR-negative, and HER2-negative tumors) had statistically higher mean lesion-to-background ratio than did ER-positive PR-positive HER2-negative tumors (p = 0.04). Infiltrating ductal carcinomas had significantly higher PEM FDG uptake values than did infiltrating lobular carcinomas (p = 0.02-0.04). Breast tumors with higher histologic grade also had significantly higher PEM FDG uptake values than did those with lower grade (p = 0.03 and p < 0.001). A moderately high correlation (0.76-0.79) was seen between whole-body PET/CT and PEM uptake values. CONCLUSION: This study shows a correlation between PEM FDG uptake values and the prognostic factors that have been shown to predict breast cancer survival.

Impact of Using Uniform Attenuation Coefficients for Heterogeneously Dense Breasts in a Dedicated Breast PET/X-ray Scanner.

We investigated PET image quantification when using a uniform attenuation coefficient (µ) for attenuation correction (AC) of anthropomorphic density phantoms derived from high-resolution breast CT scans. A breast PET system was modeled with perfect data corrections except for AC. Using uniform µ for AC resulted in quantitative errors roughly proportional to the difference between µ used in AC (µ AC) and local µ, yielding approximately ± 5% bias, corresponding to the variation of µ for 511 keV photons in breast tissue. Global bias was lowest when uniform µ AC was equal to the phantom mean µ (µ mean). Local bias in 10-mm spheres increased as the sphere µ deviated from µ mean, but remained only 2-3% when the µ sphere was 6.5% higher than µ mean. Bias varied linearly with and was roughly proportional to local µ mismatch. Minimizing local bias, e.g., in a small sphere, required the use of a uniform µ value between the local µ and the µ mean. Thus, biases from using uniform-µ AC are low when local µ sphere is close to µ mean. As the µ sphere increasingly differs from the phantom µ mean, bias increases, and the optimal uniform µ is less predictable, having a value between µ sphere and the phantom µ mean.

Image Reconstruction for a Partially Collimated Whole Body PET Scanner.

Partially collimated PET systems have less collimation than conventional 2-D systems and have been shown to offer count rate improvements over 2-D and 3-D systems. Despite this potential, previous efforts have not established image-based improvements with partial collimation and have not customized the reconstruction method for partially collimated data. This work presents an image reconstruction method tailored for partially collimated data. Simulated and measured sensitivity patterns are presented and provide a basis for modification of a fully 3-D reconstruction technique. The proposed method uses a measured normalization correction term to account for the unique sensitivity to true events. This work also proposes a modified scatter correction based on simulated data. Measured image quality data supports the use of the normalization correction term for true events, and suggests that the modified scatter correction is unnecessary.

Longitudinal monitoring of reconstructed activity concentration on a clinical time-of-flight PET/CT scanner.

Positron emission tomography (PET) images are potential quantitative biomarkers. Understanding long-term (months/years) biomarker variability is important for establishing confidence intervals on studies using such biomarkers over these time frames. PET biomarkers are derived from activity concentration ([Formula: see text]) extracted from PET images. Over 30 months, we measured the stability of decay-normalized counts ([Formula: see text]) and [Formula: see text] by scanning the same 4.5-cm-diameter Ge-68 cylinder weekly, the same Na-22 point source daily, and a refilled 20-cm F-18 cylinder phantom monthly on a clinical TOF-PET/CT scanner. Longitudinal and adjacent-measurement variability was characterized. We found no drift in [Formula: see text] or [Formula: see text] for properly calibrated images over 24 months. During this time, [Formula: see text] ranged [Formula: see text] to 6% for count-matched Ge-68 and F-18 images, with coefficient of variation (COV) across time of 2.3% (Ge-68, 81 scans) and 3.2% (F-18, 24 scans). At typical patient image count levels the Ge-68 [Formula: see text] ([Formula: see text]) COV across time was 6.9% (9.6%). Changes in [Formula: see text] between adjacent F-18 scans ([Formula: see text]) ranged between [Formula: see text], with corresponding date-matched changes in Ge-68 [Formula: see text] ranging [Formula: see text]. We recommend (1) tracking trends in [Formula: see text] with image [Formula: see text] as a check of quantitative data corrections/calibrations and (2) tracking both mean and COV of [Formula: see text] (single time point measures) to hundredths precision using standardized uptake values.

Simulation study of quantitative precision of the PET/X dedicated breast PET scanner.

The goal for positron emission tomography (PET)/X is measuring changes in radiotracer uptake for early assessment of response to breast cancer therapy. Upper bounds for detecting such changes were investigated using simulation and two image reconstruction algorithms customized to the PET/X rectangular geometry. Analytical reconstruction was used to study spatial resolution, comparing results with the distance of the closest approach (DCA) resolution surrogate that is independent of the reconstruction method. An iterative reconstruction algorithm was used to characterize contrast recovery in small targets. Resolution averaged [Formula: see text] full width at half maximum when using depth-of-interaction (DOI) information. Without DOI, resolution ranged from [Formula: see text] to [Formula: see text] for scanner crystal thickness between 5 and 15 mm. The DCA resolution surrogate was highly correlated to image-based FWHM. Receiver-operating characteristic analysis showed specificity and sensitivity over 95% for detecting contrast change from 5:1 to 4:1 (area under curve [Formula: see text]). For PET/X parameters modeled here, the ability to measure contrast changes benefited from higher photon absorption efficiency of thicker crystals while being largely unaffected by degraded resolution obtained with thicker crystals; DOI provided marginal improvements. These results assumed perfect data corrections and other idealizations, and thus represent an upper bound for detecting changes in small lesion radiotracer uptake of clinical interest using the PET/X system.

Evaluation of Cross-Calibrated 68Ge/68Ga Phantoms for Assessing PET/CT Measurement Bias in Oncology Imaging for Single- and Multicenter Trials.

Quantitative PET imaging is an important tool for clinical trials evaluating the response of cancers to investigational therapies. The standardized uptake value, used as a quantitative imaging biomarker, is dependent on multiple parameters that may contribute bias and variability. The use of long-lived, sealed PET calibration phantoms offers the advantages of known radioactivity activity concentration and simpler use than aqueous phantoms. We evaluated scanner and dose calibrator sources from two batches of commercially available kits, together at a single site and distributed across a local multicenter PET imaging network. We found that radioactivity concentration was uniform within the phantoms. Within the regions of interest drawn in the phantom images, coefficients of variation of voxel values were less than 2%. Across phantoms, coefficients of variation for mean signal were close to 1%. Biases of the standardized uptake value estimated with the kits varied by site and were seen to change in time by approximately ±5%. We conclude that these biases cannot be assumed constant over time. The kits provide a robust method to monitor PET scanner and dose calibrator biases, and resulting biases in standardized uptake values.

Positron Emission Mammography Image Interpretation for Reduced Image Count Levels.

UNLABELLED: We studied the effects of reduced (18)F-FDG injection activity on interpretation of positron emission mammography (PEM) images and compared image interpretation between 2 postinjection imaging times. METHODS: We performed a receiver-operating-characteristic (ROC) study using PEM images reconstructed with different count levels expected from injected activities between 23 and 185 MBq. Thirty patients received 2 PEM scans at postinjection times of 60 and 120 min. Half of the patients were scanned with a standard protocol; the others received one-half of the standard activity. Images were reconstructed using 100%, 50%, and 25% of the total counts acquired. Eight radiologists used a 5-point confidence scale to score 232 PEM images for the presence of up to 3 malignant lesions. Paired images were analyzed with conditional logistic regression and ROC analysis to investigate changes in interpretation. RESULTS: There was a trend for increasing lesion detection sensitivity with increased image counts: odds ratios were 2.2 (P = 0.01) and 1.9 (P = 0.04) per doubling of image counts for 60- and 120-min uptake images, respectively, without significant difference between time points (P = 0.7). The area under the ROC curve (AUC) was highest for the 100%-count, 60-min images (0.83 vs. 0.75 for 50%-counts, P = 0.02). The 120-min images had a similar trend but did not reach statistical significance (AUC = 0.79 vs. 0.73, P = 0.1). Our data did not yield significant trends between specificity and image counts. Lesion-to-background ratios increased between 60- and 120-min scans (P < 0.001). CONCLUSION: Reducing the image counts relative to the standard protocol decreased diagnostic accuracy. The increase in lesion-to-background ratio between 60- and 120-min uptake times was not enough to improve detection sensitivity in this study, perhaps in part due to fewer counts in the later scan.

Comparison of prone versus supine 18F-FDG-PET of locally advanced breast cancer: Phantom and preliminary clinical studies.

PURPOSE: Previous studies have demonstrated how imaging of the breast with patients lying prone using a supportive positioning device markedly facilitates longitudinal and/or multimodal image registration. In this contribution, the authors' primary objective was to determine if there are differences in the standardized uptake value (SUV) derived from [(18)F]fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in breast tumors imaged in the standard supine position and in the prone position using a specialized positioning device. METHODS: A custom positioning device was constructed to allow for breast scanning in the prone position. Rigid and nonrigid phantom studies evaluated differences in prone and supine PET. Clinical studies comprised 18F-FDG-PET of 34 patients with locally advanced breast cancer imaged in the prone position (with the custom support) followed by imaging in the supine position (without the support). Mean and maximum values (SUVpeak and SUVmax, respectively) were obtained from tumor regions-of-interest for both positions. Prone and supine SUV were linearly corrected to account for the differences in 18F-FDG uptake time. Correlation, Bland-Altman, and nonparametric analyses were performed on uptake time-corrected and uncorrected data. RESULTS: SUV from the rigid PET breast phantom imaged in the prone position with the support device was 1.9% lower than without the support device. In the nonrigid PET breast phantom, prone SUV with the support device was 5.0% lower than supine SUV without the support device. In patients, the median (range) difference in uptake time between prone and supine scans was 16.4 min (13.4-30.9 min), which was significantly-but not completely-reduced by the linear correction method. SUVpeak and SUVmax from prone versus supine scans were highly correlated, with concordance correlation coefficients of 0.91 and 0.90, respectively. Prone SUVpeak and SUVmax were significantly lower than supine in both original and uptake time-adjusted data across a range of index times (P < < 0.0001, Wilcoxon signed rank test). Before correcting for uptake time differences, Bland-Altman analyses revealed proportional bias between prone and supine measurements (SUVpeak and SUVmax) that increased with higher levels of FDG uptake. After uptake time correction, this bias was significantly reduced (P < 0.01). Significant prone-supine differences, with regard to the spatial distribution of lesions relative to isocenter, were observed between the two scan positions, but this was poorly correlated with the residual (uptake time-corrected) prone-supine SUVpeak difference (P = 0.78). CONCLUSIONS: Quantitative 18F-FDG-PET/CT of the breast in the prone position is not deleteriously affected by the support device but yields SUV that is consistently lower than those obtained in the standard supine position. SUV differences between scans arising from FDG uptake time differences can be substantially reduced, but not removed entirely, with the current correction method. SUV from the two scan orientations is quantitatively different and should not be assumed equivalent or interchangeable within the same subject. These findings have clinical relevance in that they underscore the importance of patient positioning while scanning as a clinical variable that must be accounted for with longitudinal PET measurement, for example, in the assessment of treatment response.

Imaging of metastatic pulmonary tumors following NIS gene transfer using single photon emission computed tomography.

The Na+/I- symporter (NIS) is a membrane glycoprotein that facilitates the uptake of iodine into thyroid follicular cells. Recently, we and others have demonstrated the feasibility of imaging subcutaneous xenografts expressing exogenous NIS, suggesting that NIS may serve as an imaging reporter gene to monitor vector delivery and therapeutic gene expression. In this study, we established NIS-expressing pulmonary tumors in nude mice to investigate the minimal tumor size required for in vivo detection of pulmonary tumors by single photon emission computed tomography (SPECT) with pinhole collimation. In order to define the anatomic location of NIS-expressing tumor nodules detectable by SPECT, we performed simultaneous, dual-isotope imaging. We injected 1 mCi 99mTc-MAA via tail vein to image pulmonary perfusion and injected 1 mCi Na125I intraperitoneally to image NIS-expressing tumors. Fused images showed that 99mTc-MAA perfusion defects correlated with NIS-mediated 125I uptake. Post-mortem analysis revealed that tumors 3 mm in diameter could be detected by SPECT with pinhole collimation. These studies demonstrate the feasibility of SPECT to detect pulmonary tumors expressing exogenous NIS in mice.

A novel silicon array designed for intraoperative charged particle imaging.

A novel Si-PIN imaging array is under investigation for a charged particle (beta, positron, or alpha) sensitive intraoperative camera to be used for (residual) tumor identification during surgery. This class of collimator-less nuclear imaging device has a higher signal response for direct interactions than its scintillator-optical detector-based counterparts. Monte Carlo simulations with 635 keV betas were performed, yielding maximum and projected ranges of 1.64 and 0.55 mm in Si. Up to 90% of these betas were completely absorbed in the first 0.30 mm. Based on these results, 300 microm thick prototype Si detector arrays were designed in a 16 x 16 crossed-grid arrangement with 0.8 mm wide orthogonal strips on 1.0 mm pitch. A NIM- and CAMAC-based high-density data acquisition and processing system was used to collect the list mode data. The system was calibrated by comparisons of measured spectra to energy deposition simulations or by direct measurement of various >100 keV conversion electron or beta emitters. Mean electronic noise per strip was <3.6 keV FWHM at room temperature. When detecting positrons, which have an accompanying 511 keV annihilation background, the flood irradiated beta/gamma ratio was approximately 40, indicating that beta images could be made without the use of background rejection techniques. The intrinsic spatial resolution corresponds to the 1 x 1 mm2 pixel size, and measurements of beta emitting point and line sources yielded FWHM resolutions of 1.5 (lateral) and 2.5 mm (diagonal), respectively, with the larger widths due to particle range blurting effects. Deconvolution of the finite source size yielded intrinsic resolutions that corresponded to the image pixel size. Transmission images of circle and line phantoms with various hole sizes and pitch were resolved with either pure beta or positron irradiation without a background correction. This novel semiconductor imaging device facilitates high charged particle and low gamma sensitivity, high signal/noise ratio, and allows for compact design to potentially aid surgical guidance by providing in situ images of clinical relevance.

Quantitative material characterization from multi-energy photon counting CT.

PURPOSE: To quantify the concentration of soft-tissue components of water, fat, and calcium through the decomposition of the x-ray spectral signatures in multi-energy CT images. METHODS: Decomposition of dual-energy and multi-energy x-ray data into basis materials can be performed in the projection domain, image domain, or during image reconstruction. In this work, the authors present methodology for the decomposition of multi-energy x-ray data in the image domain for the application of soft-tissue characterization. To demonstrate proof-of-principle, the authors apply several previously proposed methods and a novel content-aware method to multi-energy images acquired with a prototype photon counting CT system. Data from phantom and ex vivo specimens are evaluated. RESULTS: The number and type of materials in a region can be limited based on a priori knowledge or classification strategies. The proposed difference classifier successfully classified the image into air only, water+fat, water+fat+iodine, and water+calcium regions. Then, the content-aware material decomposition based on weighted least-square optimization generated quantitative maps of concentration. Bias in the estimation of the concentration of water and oil components in a phantom study was <0.10 ± 0.15 g/cc on average. Decomposition of ex vivo carotid endarterectomy specimens suggests the presence of water, lipid, and calcium deposits in the plaque walls. CONCLUSIONS: Initial application of the proposed methodology suggests that it can decompose multi-energy CT images into quantitative maps of water, adipose, iodine, and calcium concentrations.

SCOUT: a fast Monte-Carlo modeling tool of scintillation camera output.

We have developed a Monte-Carlo photon-tracking and readout simulator called SCOUT to study the stochastic behavior of signals output from a simplified rectangular scintillation-camera design. SCOUT models the salient processes affecting signal generation, transport, and readout of a scintillation camera. In this work, we compare output signal statistics from SCOUT to experimental results for both a discrete and a monolithic camera. We also benchmark the speed of this simulation tool and compare it to existing simulation tools. We find this modeling tool to be relatively fast and predictive of experimental results. Depending on the modeled camera geometry, we found SCOUT to be 4 to 140 times faster than other modeling tools.

Accuracy of CT-based attenuation correction in PET/CT bone imaging.

We evaluate the accuracy of scaling CT images for attenuation correction of PET data measured for bone. While the standard tri-linear approach has been well tested for soft tissues, the impact of CT-based attenuation correction on the accuracy of tracer uptake in bone has not been reported in detail. We measured the accuracy of attenuation coefficients of bovine femur segments and patient data using a tri-linear method applied to CT images obtained at different kVp settings. Attenuation values at 511 keV obtained with a (68)Ga/(68)Ge transmission scan were used as a reference standard. The impact of inaccurate attenuation images on PET standardized uptake values (SUVs) was then evaluated using simulated emission images and emission images from five patients with elevated levels of FDG uptake in bone at disease sites. The CT-based linear attenuation images of the bovine femur segments underestimated the true values by 2.9 ± 0.3% for cancellous bone regardless of kVp. For compact bone the underestimation ranged from 1.3% at 140 kVp to 14.1% at 80 kVp. In the patient scans at 140 kVp the underestimation was approximately 2% averaged over all bony regions. The sensitivity analysis indicated that errors in PET SUVs in bone are approximately proportional to errors in the estimated attenuation coefficients for the same regions. The variability in SUV bias also increased approximately linearly with the error in linear attenuation coefficients. These results suggest that bias in bone uptake SUVs of PET tracers ranges from 2.4% to 5.9% when using CT scans at 140 and 120 kVp for attenuation correction. Lower kVp scans have the potential for considerably more error in dense bone. This bias is present in any PET tracer with bone uptake but may be clinically insignificant for many imaging tasks. However, errors from CT-based attenuation correction methods should be carefully evaluated if quantitation of tracer uptake in bone is important.

Quantifying and reducing the effect of calibration error on variability of PET/CT standardized uptake value measurements.

UNLABELLED: The purpose of this study was to measure the errors introduced by regular calibration of PET/CT scanners and to minimize the effect of calibration error on standardized uptake value measurements. METHODS: Global calibration factors from 2 PET/CT scanners were recorded for 3.5 and 1.8 y, comparing manufacturer-recommended protocols with modified protocols to evaluate error contributions due to operator-influenced procedures. Dose calibrator measurements were evaluated using National Institute of Standards and Technology-traceable sources. RESULTS: Dose calibrator variability was less than 1%, although there was a consistent bias. Global scaling variability was reduced from 6% to 4% for scanner 1 and from 11% to 4% for scanner 2 when quality assurance and quality control procedures were applied to the calibration protocol. When calibrations were done using a (68)Ge/(68)Ga phantom, the variability for both scanners was reduced to approximately 3%. CONCLUSION: Applying quality assurance and quality control procedures to scanner calibration reduces variability, but there is a still a residual longitudinal scanner variability of 3%-4%. The procedures proposed here reduce the impact of operator error on scanner calibration and thereby minimize longitudinal variability in standardized uptake value measurements.

SCOUT: A Fast Monte-Carlo Modeling Tool of Scintillation Camera Output.

We have developed a Monte-Carlo photon-tracking and readout simulator called SCOUT to study the stochastic behavior of signals output from a simplified rectangular scintillation-camera design. SCOUT models the salient processes affecting signal generation, transport, and readout. Presently, we compare output signal statistics from SCOUT to experimental results for both a discrete and a monolithic camera. We also benchmark the speed of this simulation tool and compare it to existing simulation tools. We find this modeling tool to be relatively fast and predictive of experimental results. Depending on the modeled camera geometry, we found SCOUT to be 4 to 140 times faster than other modeling tools.

Statistical LOR estimation for a high-resolution dMiCE PET detector.

We develop a statistical line of response (LOR) estimator of the three-dimensional interaction positions of a pair of annihilation photons in a PET detector module with depth of interaction capability. The three-dimensional points of interaction of a coincidence pair of photons within the detector module are estimated by calculation of an expectation of the points of interaction conditioned on the signals measured by the photosensors. This conditional expectation is computed from estimates of the probability density function of the light collection process and a model of the kinetics of photon interactions in the detector module. Our algorithm is capable of handling coincidences where each annihilation photon interacts any number of times within the detector module before being completely absorbed or escaping. In the case of multiple interactions, our algorithm estimates the position of the first interaction for each of the coincidence photons. This LOR estimation algorithm is developed for a high-resolution PET detector capable of providing depth-of-interaction information. Depth of interaction is measured by tailoring the light shared between two adjacent detector elements. These light-sharing crystal pairs are referred to as dMiCE and are being developed in our lab. Each detector element in the prototype system has a 2 x 2 mm(2) cross section and is directly coupled to a micro-pixel avalanche photodiode (MAPD). In this set-up, the distribution of the ratio of light shared between two adjacent detector elements can be expressed as a function of the depth of interaction. Monte Carlo experiments are performed using our LOR estimation algorithm and compared with Anger logic. We show that our LOR estimation algorithm provides a significant improvement over Anger logic under a variety of parameters.