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Instrumentation

for Nuclear Cardiology


James R. Galt, Ph.D.
Associate Professor of Radiology and Imaging Science
Director of Nuclear Medicine Physics
Emory University School of Medicine

Acknowledgement: Jonathon Nye, PhD David Cooke, MSEE


Fabio Esteves, MD John Votaw, PhD

James R. Galt, Ph.D.


Declaration:
• Royalties from the sale of
Emory ExSPECT II software for SPECT
attenuation correction.
• Research support from GE Healthcare.
Instrumentation for
Radiation Detection and Measurement
• Gas filled detectors
• Scintillation detectors
• Solid state detectors

Gas Filled + -
Anode +
Radiation Detectors -
• Voltage applied across -
gas-filled chamber +

• Incident radiation causes +


ionization within the gas Cathode -
• Voltage determines detector
performance
Continuous Discharge Zone
Geiger-Mueller Plateau
Counts

Recombination Zone G-M


Counter
Ionization Plateau
Proportional
Ion Counters
Chamber

Voltage
Gas Filled Ionization Chamber + -
Anode + 50-300 v
Radiation Detectors -
• Voltage applied across -
gas-filled chamber +

• Incident radiation causes +


ionization within the gas Cathode -
• Ionization Chamber
• Ions flow to the electrodes
• Current is measured Geiger-Muller Counter + -
• Example: 850-1000 v
Dose Calibrators Anode +
--
• Geiger-Muller Counter - -- -- -- +
• Higher applied voltage causes a + +
+
cascade of secondary ionization --
+ -- --
• A pulse is created + + +
• Example: GM survey meters Cathode -

Dose Calibrator Chamber


• Ionization Chamber
Anode
• Calibrated for each isotope
• No energy discrimination Cathode
• Isotope chosen by operator Sample
• Quality Control
• Daily QC
• Constancy of response
• Measurement of a known long-
lived source
• Quarterly
• Accuracy (2 different isotopes)
• Linearity (Different Count Rates)
• On Install
• Geometry
Dose Calibrator
• EUH Nuclear Medicine

Dose Calibrator
• EUH PET
• Note the extra shielding
Geiger Probe Anode

• Geiger-Muller Chamber
• Very sensitive
• No energy discrimination
Mica window
• Quality Control Mesh Screen Cathode
• Daily QC
• Battery with acceptable operating limits
• Background exposure
• to check for contamination of the
instrument itself
• Constancy of response
• Counting rate with a known long-lived
source
• Calibration
• On install, annually and after repair

Geiger Probe
Geiger-Muller Probe at EUH
• Very sensitive
• Seldom used for count rates
greater than a few hundred
counts per second
• Paralyzable
• Long dead-time
• May become paralyzed in a
very high radiation field –
should always use ionization
chamber instruments for
measuring such fields
Scintillation Detector –
NaI(Tl) Crystal Scintillation
• Inorganic crystal – NaI(Tl) photons
Sodium Iodide doped with Thallium
– Optically transparent
Preamplifier
– No cracks or boundaries
– Hydroscopic
• Radiation (x or gamma ray) Incident photon Photocathode Amplifier
penetrates crystal Scintillator
– Compton Scatter or Photoelectric effect
– Secondary Ionizations and Excitations Energy Spectrum Pulse-height
analyzer
– Return to ground state emits scintillation

Number of detected photons


photons in the high end of the visible light
spectrum to the ultraviolet Scaler/ti Rate
• Light output from scintillation is mer meter
proportional to energy of original
radiation
• Scintillation photons strike the Measured energy

photocathode of a PMT
(photomultiplier tube)
Photon Energy

True energy

Scintillation Detector –
Photomultiplier Tube Scintillation
• Scintillation photons strike the photons
photocathode producing electrons
• Electrons are attracted to the first
Preamplifier
dynode Incident photon
• accelerated to kinetic energies equal
to the potential difference between Photocathode Amplifier
the photocathode and the first Scintillator
dynode
Energy Spectrum Pulse-height
• About 5 electrons are ejected analyzer
from the dynode for each electron
Number of detected photons

hitting it Scaler/ti Rate


mer meter
• These electrons are attracted to
the second dynode, and so on,
finally reaching the anode
Measured energy
• The resulting current is measured
to produce a count rate and
energy spectrum Photon Energy

True energy
Thyroid Uptake Probe

PMT

Scintillator

Well Counter
Shielding

Well

Scintillator

PMT
Photon
Solid-State Detectors (gamma or x-ray)

• Work on the principle of Cathode (-) +- Hole


+- - Electron
electron-hole pairs in
-
semiconductor material +- +-
-
– Ge(Li) and Si(Li) -
+- -
– Cadmium Zinc Telluride (CZT) +- +-
• Only ~3 ev required for - -
Anode (+)
ionization (~34 eV, air)
• Benefits
– Good energy resolution
Cathode (-) +- +- +-
– High sensitivity +- +
- +- +
- Hole (positive)
– Allow compact detectors
• Drawbacks
– Expensive ($$$)
Free Electrons
– Require high purity materials - - -
-
– Typically require cooling to Anode (+) - - -
reduce noise

Dead time
• The time required before a detector can count a second event
• Largely determined by the component in the series with the
longest dead time
– GM counter systems: detector (gas filled chamber)
– Multichannel analyzer systems: often the analog-to-digital converter
– Scintillation systems: can be the duration of the scintillation event
• Non-paralyzable system
– an interaction that occurs during the dead time after a previous event is
not counted (as if it did not occur)
• Paralyzable systems
– an interaction that occurs during the dead time after a previous event
not counted and extends the dead time
– At very high interaction rates, a paralyzable system will be unable to
detect any interactions after the first, causing the detector to indicate a
count rate of zero
Dead Time
• Dead time – time required before counting a second event
– With a short dead time all events are counted Total: 11

COUNT 1 2 3 4 5 6 7 8 9 10 11

• Non-paralyzable
– Events that occur during an earlier events dead time are ignored Total = 7

COUNT 1 2 3 4 5 6 7

• Paralyzable
– Dead time starts over with each new event Total = 5

COUNT 1 2 3 4 5

Imaging Instrumentation
for Nuclear Cardiology
• SPECT
• PET
• Tomographic Image Reconstruction
• PET/CT and SPECT/CT
Mechanical Collimation (SPECT)
Versus
Electrical Collimation (PET)
Mechanical Collimation
• Radionuclide decays and emits a single photon
• Off angle photons eliminated by the collimator
• Photons traveling in line with the collimator
holes are counted
• Relatively simple and
inexpensive

Electrical Collimation
• Dual Photons emitted after a
positron/electron annihilation
• Two photons detected at the ~ same time (within
coincidence window) are counted.
• Two photons detected outside of the coincidence
window are rejected
• Better – sensitivity, resolution,
• Simpler attenuation correction

Scintillation Camera
Collimator
• Collimator
• Screens gamma rays
Crystal
• Gamma ray interaction in crystal
• Scintillation (visible light) PMT
Photo-
• Proportional to gamma energy
cathode
• PMT (photomultiplier tube)
• Photoelectron produced in Dynodes
cathode
Anode
• Amplified by dynodes
• Signal from each PMT
• Analyzed to determine
location and brightness of the
scintillation
Analog and Digital Scintillation Cameras
Advantages of
Analog Digital Scintillation Cameras
• Higher Count Rate
– PMT output is processed by
separate channels
• Better Spatial Resolution
• Better Energy Resolution
– Sophisticated software
energy determination and
Digital
correction algorithms

Energy resolution
• Width of the peak is Energy Spectrum

measured at half the


Number of detected photons

maximum
maximal height of the
peak ½ maximum

• Full Width at Measured energy

Half-Maximum (FWHM)
Photon Energy

• Scintillation camera True energy

– Typically 10-14% for 99mTc


FWHM
Energy resolution = ´ 100%
Pulse height at center of peak
Energy Window 99mTc

• Definition: range of photon energies


accepted into an image
• Specified as a % centered on
the on the photopeak
– 20%: Peak ± 10%

ASNC Recommendations
201Tl
• 99mTc
– 20%: 140 ± 14 keV è126 to 154 keV
or
– 15%: 140 ± 10.5 keV è129 to 150 keV
• 201Tl

– 30%: 70 ± 10.5 keV è59 to 80 keV


and
– 20%: 167 ± 10 keV è154 to 179 keV

Energy Window
• 123I 123I

– 159 keV photopeak


– Plateau of scattered
photons from several low
occurrence, high energy,
photons that
penetrated the collimator
• Energy Window
– 20%: 159 ± 16 keV è143 to 175 keV
or
– 15%: 159 ± 12 keV è147 to 171 keV
Time 00:00:01 00:00:04 00:00:07
Scintillation 0 0 0 0 0 1 0 0 0 1 0 0 0 2 0 0

Camera 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0

Image Acquisition0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

• Frame Mode The image evolves as time passes.


– Pixel counts are
incremented as scintillation Time X Y Energy
events are detected. 00:00:01 2 4 136
• List Mode 00:00:02 3 3 100
– A list is kept with selected 00:00:04 3 2 145
information about each 00:00:07 2 4 142
pixel event.
– The list can contain other Assume energy window of 126-154 keV.
information, such as Max
R-wave trigger events
– Images are created by
sorting the list mode file.

Common Collimators
Parallel Hole

Activity Pinhole
Crystal Area Exposed to Activity

Converging

Activity
Crystal Area Exposed to Activity
Parallel Hole LEAP Collimator Septa

Collimation
• Lengthen Holes
• Resolution - j

• Sensitivity ¯
• Smaller Holes Hi-Resolution (LEHR)
• Resolution - Area Subtended by
Single Hole of Collimator

• Sensitivity ¯
• Thicker Septa
• Resolution =
• Sensitivity ¯ j
• Energy -

Parallel Hole
Collimation
• Increased distance
è poorer resolution
è constant sensitivity
(greater area exposed
compensates for
count loss due to
distance) Collimator Septa
LEHR
• 1st Row (5 cm)
– 100 kCnts
18.4 seconds
– 326 kCnts
60 seconds
– 1,648 kCnts
300 seconds
• 2nd Row (10 cm)
– 100 kCnts
18.4 seconds
– 324 kCnts
60 seconds
– 1,612 kCnts
300 seconds
Images were made with the camera
raised 5 cm and 10 cm over phantom.
Acquisitions were set for 100 k counts,
one minute, and 5 minutes.

Planar Versus SPECT Imaging


Pixel Counts

Planar
0 16 32 48 64
Pixel Location
Voxel Counts

SPECT 0 16 32 48 64
Voxel Location
Projection Based Tomography
SPECT
• Acquisition
– Projections – images that contain
a “projection” of the activity
through the patient.
– Acquired in at least a 180° arc
around the patient.
– Radon Transform – These
projections contain sufficient
information to reconstruct the
activity distribution in the patient. Emission Projection
• Reconstruction
– SPECT and PET naturally yield
transaxial slices (perpendicular to
the axis of the camera) Emission Transaxail
– Once reconstructed, tomographic
images can be extracted at any
angle (for example: short, vertical SA - Filtered Backprojection
long, and horizontal long axis
images of the heart).
VLA - Filtered Backprojection

SPECT Camera Orbits


45° RAO – 45° LPO Orbit

Circular Orbit Elliptical Orbit

• 180° versus 360° • Circular versus Elliptical


– 180° Orbits Improve Contrast in – Elliptical Orbits Improve Resolution
Myocardial Defects (generally preferred – But collimator resolution effects
for cardiac SPECT) may create apical defect if detector
– But, collimator resolution effects comes too close to apex.
degrade uniformity. – Use elliptical orbits with caution.
– But, less attenuation in RAO - LPO
180o orbit:
360o orbit 45o RAO – 45o LPO

45o LAO projection

180o reconstructions

45o RPO projection

360o reconstructions

Physical Factors that Degrade SPECT

Photon Attenuation Compton Scatter Collimator Resolution


• Attenuation
– Photons are absorbed in tissue and are not detected
– More photons are absorbed in some directions than others, projections are
inconsistent.
• Compton Scatter
– Photons interact with electrons, lose energy and change direction
– If the photon loses enough energy it is lost.
– If not, it appears to come from the point of scatter, not its origin.
• Collimator Resolution
– Resolution degrades with distance from the collimator.
– At any point in the patient, resolution is better in some projections than others.
Physical Factors that Degrade SPECT
Breast Attenuation?

Extra-Cardiac Activity
(Compton Scatter / Collimator Resolution)

Russel Folks, CNMT


Emory University, 9/00

SPECT Attenuation Correction


Requires a Transmission Scan (CT)
– Sealed radioactive source Emission Projection
– Imaging by Scintillation Camera
Or
– X-ray source and detector
Transmission Projection

Emission Transaxail

X-ray Transmission (CT) Scanning Line Source


Transmission Transaxail

SA - Filtered Backprojection

SA - Corrected

VLA - Filtered Backprojection

Scanning High Energy Points Line Source Array


VLA - Corrected
Emission/Transmission Acquisition

Example 4 - Normal Male James R. Galt, Ph.D.


Emory University, 10/00

Stress 99mTc Sestamibi


Filtered Backprojection

MLEM with Attenuation Correction

Normal Male
Suggested QC Procedures for SPECT
Procedure Frequency

Energy peaking Daily

Uniformity Daily

Resolution and linearity Manufacturer’s Recommendation

Sensitivity Manufacturer’s Recommendation


Center of rotation
Manufacturer’s Recommendation
Multi-detector registration
Uniformity calibration Manufacturer’s Recommendation

Total performance (SPECT phantom) Quarterly

*Updated SPECT ASNC guidelines, J Nucl Cardiol, Online, June 2010

How do you make a


compact gamma camera?
Scintillation cameras Solid state cameras

Collimator Crystal and PMTs


Compact, Replaced by
Crystal Position Sensitive, Solid State Detectors
PMTs PMTs Replaced by (i.e.. CZT)
PMTs
Solid State Detectors
Circuitry (i.e.. Photodiodes)
How do you make a
solid state gamma camera?
PMTs Replaced by Crystal and PMTs
Solid State Detectors Replaced by
(i.e.. Photodiodes) Solid State
Detectors
(i.e.. CZT)

Collimator
Crystal
PMTs
Circuitry

CsI/Photodiode - Triple Head SPECT


Discrete
- Scintillation Crystal /
Photodiode
Gamma Camera

CsI(Na)
crystal

diode
Solid-state electronics
Unique CZT Cardiac SPECT Scanners
• Solid State Detectors
– Cadmium Zinc Telluride
– Improved energy resolution
– Small, thin pixelated
detectors
• Innovative
Multiple Scanning Detectors
– Camera design
– Collimation
• James Galt’s Pet Peeve
– Improved sensitivity is Multiple
result of camera design and Fixed Pin-hole
collimation. Not the use of
CZT as a detector.

Unique CZT Cardiac SPECT Scanners


Multiple
scanning detectors

Multiple
fixed
pinhole
CZT Energy Resolution – 57Co

Upper peak

Standard Scintillation Camera CZT Camera


Energy resolution ~ 11% Energy resolution ~ 6%

CZT SPECT - Normal Example


Standard SPECT Multiple Pinhole CZT
12 min Stress, 14 min rest 2 min Stress, 4 min rest
Imaging Instrumentation
for Nuclear Cardiology
• SPECT
• PET
• Tomographic Image Reconstruction
• PET/CT and SPECT/CT

g (511 keV)
Coincidence Detection e-
• Positron-electron annihilation yields two 511 keV photons at b+
~ 180° g (511 keV)
• If both are detected, the difference in time will be very
Positron-electron annihilation
small. They are said to be in coincidence and will be
counted.
Coincidence window (6-12 nS)

A B A B

Time
• Photons from different annihilation events are unlikely to be
counted within the coincidence window.

C D
C D
Time
• If two unrelated photons are counted within the
coincidence window, they are called randoms. The number
of randoms is dependent on the conincidence window and
the count rate.
PET:
Projection Based Tomography
• Projections: PET acquires
projections simultaneously
in all directions but
acquisition data is rarely
displayed as a projection.
instead
• Sinograms: images that
show the projection data
required to reconstruct one
slice…

2D versus 3D PET
2-D 3-D
– Coincidence events are restricted to a – Improves Sensitivity
single ring of detectors – Increases Scatter and Randoms
– Lead septa between the rings helps – More Complicated Reconstruction
screen out undesirable photons
PET Acquisition 0º A
B
Anterior

• Sinogram:
– Image of coincidence events required 90º C Rt Lateral

to reconstruct one transaxial slice D


E
– Angle versus radial distance 180º Posterior

A B C D

PET Scan Resolution


• Positron Range
– Coincidence detection provides
location of β+ annihilation –
not site of β+ decay
• Co-linearity of g
annihilation photons 1
– Annihilation photons are
emitted at 180° ± 0.5°
• Diameter of ring
– Larger ring, larger error due g2
to non co-linearity
• Detector Size
– Individual crystals 4-7
PET: Time of Flight
t1
Detector 1 Dt Detector 1

g1 g1
b+ b+
b- b-

Localization

x ≈ c(t1-t2)

Localization
g2 g2
Detector 2 x ≈ PET ring diameter Detector 2

Dt t2

Non-TOF TOF

PET: Time of Flight


Localization Localization

Non-TOF TOF
Scintillation Response of Detectors

NaI(Tl) GSO BGO LSO/LYSO


Stopping
0.34/cm 0.67/cm 0.92/cm 0.87/cm
Power
Decay Time 204 ns 60 ns 300 ns 40 ns
Relative Light
100% 35% 15% 75%
Output

Physical Factors that Degrade PET

Photon Attenuation Compton Scatter Randoms


• Attenuation
– Photons are absorbed in tissue, if one of a pair is not detected, the pair is lost…
– More photons are absorbed in some directions than others, sinograms are inconsistent.
• Compton Scatter
– Photons interact with electrons, lose energy and change direction
– If the photon loses enough energy it is lost.
– If not, the event is counted between the point where the two photons were detected.
• Randoms
– Two unrelated photons are detected within the coincidence window.
– An event is counted between the two points of detection.
Photon Attenuation in PET
and SPECT
SPECT

γ1
γ1

γ2

PET AC path length

FDG Imaging with High Energy Collimators


or Gamma Camera PET
• FDG Collimation SPECT 99mTc-MIBI
– Heavy Collimation
– Simultaneous 99mTc SPECT
– Compromised 99mTc SPECT

• Coincidence
(Gamma Camera PET)
– Re-imbursement? 18FDG
– Requires Attenuation
Correction
– Collimators must be
changed between
18FDG
Coincidence and SPECT CoDeTM

Martin Sandler, Vanderbuilt University


PET Attenuation Correction
Requires a Transmission Scan (CT)
– Sealed radioactive source (rotating rod)
– PET Emitter
– Singles Source
Or
– CT Scanner
Required for Cardiac PET
– PET has more attenuation than SPECT because
both photons must escape the patient.
– PET attenuation is easier to correct for because
it can be directly measured.
Un-Corrected Corrected
Sealed Source Transmission Scanning PET/CT

Rotating Rod
PET CT

Camera QC Procedures for PET


• User Quality Control
– Daily Blank Scan
(Attenuation Scan with
No Attenuator)
– Visually inspected and
compared to a
Reference Scan
– PET equivalent of the
daily flood for a
scintillation camera.

Detector Block Failure


Image Courtesy of Jon Nye, PhD, Emory University
Suggested QC Procedures for PET
Procedure Frequency

Daily QC, as recommended by the


manufacturer (attenuation blank scan, Daily
phantom scan, etc.)

Sensitivity and overall system performance Weekly (or at least monthly)


Accuracy (corrections for count losses and
At least annually
randoms)
Scatter Fraction At least annually
Accuracy of attenuation correction At least annually
Image Quality At least annually

Measurements specified by the manufacturer As per the manufacturer

*Updated PET ASNC guidelines, J Nucl Cardiol, Online, July 2009

Imaging Instrumentation
for Nuclear Cardiology
• SPECT
• PET
• Tomographic Image Reconstruction
• PET/CT and SPECT/CT
SPECT and PET Image Reconstruction
• The Problem
– Estimate unknown 3-D distribution Projection
of radiopharmaceutical in the
patient from 2-D projection data.
• The Solutions
– Filtered Backprojection Transaxial

• Computationally acceptable
• No compensation for physical factors
Sinogram
– Iterative Methods
• Computationally challenging
• Theoretically more accurate
• Better noise characteristics
• Allows compensation for physical factors
(Attenuation, Compton Scatter, Collimator Resolution)

Projections and Sinograms


1
64
Phantom 32
96

Projections 1
(Either
SPECT or 32
PET)
64

96

1
Sinograms 32
(Pixels x, 64
96
Projection y) 128

• Each row of pixels in a projection forms one sinogram


• Each sinogram is used to reconstruct a transaxial slice.
Simple Backprojection
1. Acquisition of Projection Data
2. Backprojection
3. Result: Blurred Tomographic Images

Acquisition Back-projection 8 Projections 64 Projections

Filtered Backprojection: Ramp Filter


1.00
Filter Function

Ram p

Projection 0.50

0.00
0.00 0.20 0.40 0.60 0.80

Frequency (1/cm)

Filtered Projection

Convolution
Filter kernel

Convolution: Combining two functions, the result has


elements of both.
Filtered Backprojection
1. Acquisition of Projection Data
2. Filtering of Projection Data
3. Backprojection
4. Result: Un-Blurred Tomographic Images

Acquisition Back-projection 8 Projections 64 Projections

Common Iterative
Reconstruction Methods
• MLEM
– Maximization Likelihood Expectation Maximization
– Based on statistical methods
– What is the most likely distribution of activity that
produced these projections?
• OSEM
– Ordered Subsets Expectation Maximization
– Based on MLEM
– Speeds up EM by processing “Subsets” or groups of
projections, instead of the whole acquisition.
Project
through MLEM stop? Output
AC map
with no yes reconstruction

Initial guess Attenuation


transaxial Correction Current
guess
transaxial

Computed
projection
update guess image

compare backproject

Measured projection Projection error Reconstruction error

iteration: 1 5 10 20 30 50 100
Blurry Noise artifacts

MLEM
Reconstruction
• Image becomes sharper and 1 2 3
more detailed with each
iteration.
• Too many iterations leads to
a noisy image.
4 6 8
• Preferences
– Start with blank transaxial
(1st guess)
– 3D post-filtering
– Cardiac SPECT 10 20 30
• 64 x 64 matrix
• Need 20-30 iterations

Butterworth Filter 60 100 FBP


End
OSEM
Stop?
Start Begin new iteration no yes
Output reconstruction

Project Repeat for each subset


All Subsets?
Subset
no yes

Initial guess Computed Current


transaxial projection guess
transaxial

Update guess image

Backproject
Compare Subset

Measured
projection Projection error Reconstruction error

Example: 64 projections, 8 subsets. Repeat shaded area 8 times for 8 projections each.

MLEM OSEM
OSEM
vs MLEM
•OSEM converges 1 2 3 1
much faster
•OSEM Preferences
–Same as MLEM
–Start with blank
transaxial
(1st guess) 4 6 8 2
–3D post-filtering
–Cardiac SPECT
• 64x64 matrix
• Need 3-4 iterations
(20-30 for MLEM)

10 20 30 3

Butterworth Filter. 60 100 FBP 4


Imaging Instrumentation
for Nuclear Cardiology
• SPECT
• PET
• Tomographic Image Reconstruction
• PET/CT and SPECT/CT

PET/CT

PET CT
PET/CT Scanner
Position PET CT Scout
PET bed 1 Position CT Remove Patient
PET bed 2
Spiral CT
PET bed 3

PET CT

PET/CT
Attenuation Correction
Stress

Rest

82Rb Normal male


Integrated, Slow Rotation
SPECT/CT

X-ray
X-ray tube
Acquisition

No
attenuation
correction With
attenuation
correction

Coupled SPECT/CT
No
attenuation
correction

With
attenuation
correction

Jaszczak Anthropomorphic Phantom


PROSPECTIVE VALIDATION OF ATTENUATION CORRECTED
REST/EXERCISE STRESS Tc-99m TETROFOSMIN MYOCARDIAL
PERFUSION NORMAL DATABASE FOR THE DNM530c CZT SPECT SYSTEM
JR Galt, RD Folks, L Verdes, EV Garcia, FP Esteves. Emory University School of Medicine, Atlanta, GA
No AC

AC

Pinhole projections for stress (20 mCi, 6 minute).


Rest (6 mCi, 8 minute) not shown.

Stress/Rest oblique slices and ECTb polar plots for


non-AC (top) and AC. Blackout regions are
determined by comparison to the normal database.

Manual software registration of Stress SPECT with a low


dose CT scan acquired on a stand-alone CT scanner.

PET/CT and SPECT/CT Considerations


• Most CT images are acquired SPECT Free Breathing CT

quickly and represent a


snapshot in time
• PET and SPECT images take
minutes to acquire
• Breathing Protocols
• Inspiration - CTÝÝ, ACßßß Breath-hold CT Free Breathing CT
• Expiration - CTÝ, ACßß
• Partial Inspiration
(“stop breathing”) - CTÝ, ACÛ
• Shallow
Free Breathing – CTßß, ACÝÝ
• ASNC recommendations (take your pick)
• End-expiration breath hold or shallow free breathing
• Shallow tidal breathing
Patient Motion Causes Misalignment of
Emission & Transmission Scans
Correct

Over-correction Under-correction

SPECT/CT Misregistration
SPECT/CT
Misalignment
• Pt moved between
SPECT and CT

Manual
Registration
• Used to correct for
mismatch
• Careful attenuation
to detail
PET/CT and SPECT/CT
Considerations
Metal Artifacts
• CT artifacts become SPECT
artifacts in the attenuation CT
corrected images.
• ECG leads
– Usually don’t cause problems
• ICD shock coils adjacent to
the ventricular wall
– Hot spot artifacts AC
• When artifacts cannot be
avoided, the attenuation
corrected images must be
carefully evaluated.

NC

PET/CT and SPECT/CT Considerations


CT Scan Truncation
• Truncation introduces
streak artifacts in
images
• Degrades the accuracy
of attenuation correction
• When truncation cannot
be avoided, the
attenuation corrected
images must be
carefully evaluated.
PET or SPECT Attenuation Correction
CT Based Transmission Quality Control
• CT Unit
– Quality Control Phantom
Imaged Regularly by
Manufacturer’s
Specifications

SPECT/CT Considerations
CT Scan QC Failure
• Rings in CT scans
can indicate failing
detectors
• Created through the
same process as ring
artifacts in SPECT
images
• May be more severe
with more
attenuation (larger
patients)
CT QC: SPECT or PET/CT
To check Frequency

Water phantom QA Daily

Tube warm-up Daily

Air calibration (“fast QA”) Daily

Water phantom checks: slice thickness,


Monthly
accuracy, positioning

Users should consult the manufacturer regarding the specific manner and frequency
with which tests should be performed for the CT component of their SPECT or PET/CT
device.

*Updated ASNC guidelines, J Nucl Cardiol, Online, June 2010

SPECT/CT Considerations
SPECT/CT Misalignment
• Routine QC
Should include
– SPECT QC
– CT QC
– An alignment
check of the two…
QC: Combined SPECT or PET/CT
To check Requirement

Registration Mandatory

Attenuation correction accuracy Mandatory

*Updated ASNC guidelines, J Nucl Cardiol, Online, June 2010

Imaging Instrumentation
for Nuclear Cardiology
• Radiation Detection and Measurement
– Gas filled detectors
– Scintillation detectors
– Solid state detectors
• Imaging Instrumentation
– SPECT
– PET
– Tomographic Image Reconstruction
– PET/CT and SPECT/CT
END