08/03/2018
“An image is worth a thousand
Nuclear Medicine Imaging
By
Nawab Singh Baghel
Radiation Medicine Centre
Bhabha Atomic Research Centre
Email: nawab@barc.gov.in
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Medical Imaging
Formation of images of human body to see
inside for disease diagnosis either non-
invasively or less invasively
The images are generated with various
instruments (imaging systems) depending
on the kind of information required
3 4
words”
- An early Chinese Emperor
All the more reason to describe an object by an
image
Medical Image
Digital image is an arrays of elements having real or
complex numbers represented by a finite number of
bits
An element may be denoted by f(x,y)
x and y denote spatial coordinates and value of f(x,y)
represents the brightness (gray level) at (x,y)
Digital Image is a matrix (square) of rows and columns
and each element of this matrix is generally called
“pixel” or “pel”
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Physics of Medical Imaging

Medical Imaging Modalities: Medical information depends on the signals obtained by an

imaging modality used
• US Medical information can be categorized as:
• X-ray Anatomical:
• CT X-rays: transmitted x-ray (linear attenuation coefficient)
• MRI CT: transmitted x-ray (linear attenuation coefficient)
• Rectilinear Scanner US: reflected echo (reflectivity, elasticity of tissues)
• Gamma Camera MRI: radio-frequency waves (hydrogen proton density)
• SPECT Functional:
• SPECT-CT Nuclear Medicine: emitted gamma ray (concentration of
• PET radiotracer) (Planar camera, SPECT, PET etc)
• PET-CT
• PET-MRI
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Radiography Imaging
US images

Film
Patient

X-Ray
Beam

X-Ray
Tube

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Digital Radiography

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Computed Tomography
X-ray detectors X-ray source

MRI Scanner

CT shows patient’s
anatomical
information

9 Scan 10

Dual Head Gamma Camera SPECT System Medical Imaging Modalities

Risk-free:
• Magnetic resonance imaging (MRI)
• Ultrasound imaging

With the radiation exposure:

• X-ray projection imaging (radiograph)
• X-ray computed tomography (CT)
• Nuclear medicine imaging (PET, SPECT)

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OVERVIEW OF NUCLEAR MEDICINE Imaging Systems

(THE USE OF RADIOACTIVE MATERIALS TO DIAGNOSE AND TREAT DISEASES)
Consists two elements of hardware:
Physiology

Diagnosis Therapy Sensor: A device which produces

electrical signals proportional to level of
In-Vivo In-Vitro energy sensed

Non-imaging Imaging Digitizer: A device which converts

electrical signals into digital form
Planer SPECT PET13 14

Sampling and Quantization Sampling and Quantization

• Conversion of object from real space to digital
Image
• Square matrix is commonly used for digital image as 2n
i.e. 64x64, 128x128, 256x256, 512x512, 1024x1024
• Spatial coordinates digitization is called image
sampling (pixel)
• Quantization is carried out in byte (1 byte) or word (2
bytes) mode i.e. 256 grey levels in byte mode and 65,536
• Intensity digitization is called Quantization (gray
levels in word mode.
level)

Sampling and Quantization is carried out during Resolution of an image strongly depends on
image acquisition and Matrix size and number of these two parameters (sampling rate)
grey levels are decided as per application requirement 15 16

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Principle of Nuclear Medicine

Sampling
Diagnosis:
Radioactive dye (organic compound), similar to
body fluids, so as not to disturb functional status,
injected into body. Radioisotope emits gamma
rays, comes out of body that are detected by
imaging devices. Produce information of its
distribution which indicates functional status of
organ

Therapy:
Radioactive dye deposits at malignant place emit
out radiation which kills malignant cells. Rate of
damage to malignant cells is much faster than that
17 of normal cells 18

Imaging systems

Input Output

Object Imaging System Image

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Gamma Camera

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Image Storage

• Image is collected in memory stack during Acquisition Methods: Gamma Camera

acquisition
 Frame Mode and List Mode Acquisitions
• Transferred to Hard disk for further processing
 Static
and interpretation
 Dynamic
• Space occupied depends on its resolution e.g.  Gated Acquisitions
256x256 matrix image in word mode needs  Whole Body Acquisitions
256x256x2 bytes.

Resolution of image should be decided as per

requirement of its application to optimise
resources 23 24

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Gamma Camera Components

 Collimator
 NaI(Tl) crystal
 Light Guide (optical coupling)
 PM-Tube array
 Pre-amplifier
 Position logic circuits (differential & addition etc.)
 Amplifier (gain control etc)
 Pulse height analyser
 ADCs
 Computer and accessaries

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Bone Scan

Liver scan
Gated Blood Pool

Ant Post

Ant Post

Normal Thyroid Scan Dynamic-Kidney

Abnormal

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Gated Study Analysis

Gated Acquisition
MUGA

SPECT System

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Basic Principle: SPECT

Advantages

• Increased contrast at plane of interest

• Rotating Gamma Camera • Additional dimension depth

• Better sensitivity
• Forward Projection (data acq.) • Physiological quantitative measurements
• Early detection of physiological disturbances

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Contrast Enhancement SPECT

SPECT system is a scintillation

gamma camera which has
additional hardware to rotate
detector/s around patient and
software to extract 3D information
from set of 2D projections

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Acquisition of Projections
SPECT procedure

Acquisition: Collection of Raw data (Forward

Projection)
Set of angular projections (static images)

Reconstruction: Extract 3D information from 2D

Processing: Presentation/quantification Display of 3D

information
37 Soni 38

SPECT Nomenclature
Acquisition of projections
• Mechanical axes – Xm, Ym, Zm
• Electrical axes – Xe, Ye, Ze
• Computer Axes – Xc, Yc, Zc
• Axis of Rotation (AOR) – horizontal line passing
through centre of gantry
• Radius of Rotation (ROR) – perpendicular distance
from detector to axis of rotation
• Projection – static image acquired at certain angle
• Angle of projection – angle at which projection is
acquired
• Angular step (angle between two projections)
• Centre of Rotation (COR)

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SPECT Acquisition : Preset parameters

Acquisition  Parameters that affect the SPECT acquisition: pixel size, arc
selection, number of angular samples, acquisition time at each
angle, rotation mode.

• An Acquisition is the collection of raw data  Pixel size - system’s spatial resolution
• Raw data is projections of an object at various angles
Arc selection - 360, 180 for heart, no less than 180.
• Projection is static image by gamma camera at given angle 

• Static image is 2D tracer distribution inside object  Angular samples: n=2πR/d (d: pixel size, R: radial distance)

 Acquisition time: Total acquisition time /n (~10-30 min).

 Rotation mode: step-and-shoot (good resolution); Continues

Raw data is a set of sequential static images (more efficient)
acquired around an object (organ) by rotating
 Gated SPECT: A gated study instead of each simple projection.
gamma camera
 Whole body SPECT: Several SPECT acquisition re-assembled
41 42

Reconstruction Methods
Analytical:
• Filtered back Projection (FBP) algorithm:
Most popular technique in earlier days as it
requires less memory and processor speed

Iterative:
• Provides better quality of images but time
consuming and takes more memory and fast
processor
• OSEM is more popular amongst other iterative Back projections
methods recently Back projections

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Filtered Back Projection Method

Fourier series and Fourier Transform
are used in filtered back projection
reconstruction
Raw data consists actual data and
inevitable background and noise
FBP Reconstruction
 Filtering is done in Fourier domain
 It is easy to remove noise in Fourier Domain
 No information is lost during filtering like space
domain

1- Filtering (to minimise background

and noise) First we have to convert data from spatial domain to
Fourier domain using Fourier transform
2- Backprojection
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Complex function may be decomposed

Decomposition into some simpler functions

 Complex entity may be decomposed into some

simpler components
– A sentence is decomposed into words
– A Word is decomposed into letters
 The idea of decomposition has a great number
application in different area of the sciences
including mathematics
 A complex function can be decomposed into a
combination of some simpler function

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This curve may be decomposed into two

exponentials f(t) The function to be decomposed

Basic sinusoidal functions Integration in 100 periods

Sin(0)

Sin(ωt)

Sin(2ωt)

Sin(3ωt)

Sin(4ωt)

Sin(5ωt)

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Graphical representation A simple convention:

Each sinusoid is shown using a bar
 The amplitude of the
bar is equal to the
amplitude of
sinusoid

 Its place on x-axis is

equal to the
frequency of
sinusoid.
Showing too many sinusoids in a single graph make
them congested and difficult to distinguish
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Graphical representation Fourier Transform

 A mathematical procedure to decompose a

function into some Sine and Cosine
functions.
 A mathematical procedure to transform a
function into frequency domain.
 A mathematical procedure to visualize the
frequency components of a function

53 54

Line Integrals and Projections

RADON Transform
P (t )1

The 2-D Radon transform is the y

The function is known as the
mathematical relationship which maps Radon transform of the f ( x, y)
function f(x,y). P (t )1
the spatial domain (x,y) to the Radon
domain. The Radon transform consists 
P (t )   f ( x, y)ds x
of taking a line integral along a line (ray) ( ,t ) line

which passes through the object space.  

P (t )    f ( x, y)( x cos  y sin   t )dxdy

x cos   y sin   t
x cos   y sin   t1

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Line Integrals and Projections

Fourier Slice Theorem
A projection is formed by combining a set of line integrals. Here the
simplest projection, a collection of parallel ray integrals i.e constant θ,
is shown.

1D Fourier Transform of a projection of 2D image at

P 1 (t ) certain angle is same as 2D Fourier transform of the
original Image at corresponding radial frequency
y

P 2 (t ) f ( x, y)


x It means that the object can be estimated by simply
performing the 2D inverse Fourier transform of
given the projection data of the same object
This is called Reconstruction
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The Fourier Slice Theorem FBP Reconstruction

The Fourier Slice theorem relates the Fourier transform of the
object along a radial line.
Collection of projections of an
object at a number of angles
P 1 (t ) t v

y
Fourier transform
f ( x, y)

v
 u
x

u
For the reconstruction to be made it
is common to determine the values
onto a square grid by linear
interpolation from the radial points.
Space Domain Frequency Domain But for high frequencies the points
are further apart resulting in image
degradation.
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Image Transform Spatial Domain :

2-D image is represented in Space/Object Domain as f(x,y)
in terms of spatial coordinates and its intensity and in Information of tracer distribution in organ
Frequency domain as F(u,v) in terms of spatial frequency visually
and amplitude

Images can be converted from one domain to other easily

by Fourier Transform and Inverse Fourier Transform

A mathematical expression which converts information

from space domain to Fourier (frequency) domain
 f ( x)  u 0 F (u )e i 2Nux
N 1 N 1
F (u )  1
N x 0
f ( x)e  i 2Nux
FT IFT
Fast Fourier Transform (FFT) is used to reduce complex
Intensity is a function of pixel counts at position (x,y)
multiplications from N2 to Nlog2N 62

Frequency representation:
Frequency Domain :
Temporal frequency: cycles/sec (sec-1) --- Hertz –Hz
Information is represented in frequency and
amplitude Spatial frequency: cycles/cm ;cycles/pixel; Cycles/FOV

Nyquist Frequency: Highest frequency allowed by the

system

FN = 1/2a where a= pixel size

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System response
Filtering
Resultant filter = Ramp + Window filter

Behaves as low pass filter obstruct fine details Roll-off at high

frequencies to
For perfect recovery, we need to multiply by the compromise
recovery
function of amplitude equal to frequency

1/f X f=1
RAMP corrects blur but enhances high frequency noise
i.e. RAMP filter provides perfect correction for blur To reduce the noise, a high frequency cut-off filter is
compensation of blur introduced by acquisition device 65 also applied 66

Filter’s function: Types of filters:

• Smooth function has less high frequency • Every filter is expressed by a mathematical function
components • A mathematical function has one or more than one parameter
• A sharp function has high frequency components • Cut off frequency , order etc
• Nature of filter depends on these parameters
present at greater amplitude
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Freq Distribution of Data Basic principle to choose a filter

FBP always involves a Ramp filter.

• All images reconstructed with BP require filtering
However a second smoothing filter
(or combined smoothing/Ramp with a Ramp filter
filter) is necessary to control noise.

• A cut-off window is required to remove noise that

was enhanced by Ramp filter
• Cut-off frequency should never be higher than
Nyquist Frequency (0.5 Cycles/Pixel).
• Choice of cut-off frequency is a compromise
between smoothness of image & resolution
fm 69 70

Implementation
Steps in FBP Algorithm

1. Fourier Transform of the projection

X =
2. Filter the projection in frequency
domain
3. Inverse Fourier Transform to real
space (spatial domain)
4. Back project filtered projection
5. Repeat steps 1-4 for each projection

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Forward Projections - 2x2 Matrix Backward Projections - 2x2 Matrix

1 2

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3 4

BP to find out original

counts in each Pixel 1 2 (Back projection)
3 4
Original values

0 0 3 3 3 3
BP

0 0 7 7 7 7

1 2 1 2
5 5 5 5
4 4 6 3 4 4 6 3
Back Projections
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1 2 (Back projection) 1 2 (Back projection)

3 4 3 4
Original values
8 5 3 Original values
12 11 3
3 3 8 5
7 7 10 12
Modified
10 12 7 Modified
14 18 7
value value

1 2 1 2
5 5 5 5
4 4 6 3 4 4 6 3
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(Back projection)
- 10 (subtract total sum from each entry)
1 2 1 2
3 4 3 4
Original values
13 16 3 Original values
13 16 3
12 11
14 18
Modified
19 22 7 19 22 7
value

1 2 1 2
5 5 5 5
4 4 6 3 4 4 6 3
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/ 3 (divide each entry by 3)

Get back Original Numbers

1 2 1 2
3 4 3 6 3 3 4 1 2 3
Original values Original values

9 12 7 3 4 7

1 2 1 2
5 5 5 5
4 4 6 3 4 4 6 3
81 82

Reconstruction of a slice from projections (long axis) of

myocardial perfusion
Iterative Reconstruction
y Count rate y

An example of 2D
• Uses back-projection Forward-projection
z
together with forward- 19
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x-position projection 44
31
x z
1 1 1 1 1 1 1 1 2 1 1 1 1
1 1 2 2 1 2 2 1 2 7 2 1 2
• Repeated many times 1 1 3 1 7 3 7 5 5 7 2 1 1
1 7 3 7 8 6 7 8 9 8 5 2 1

over to improve quality 1 1 8 6 8 9 6 8 8 9 5 7 1

1 2 7 6 6 8 8 9 7 3 2 1 2

of back-projected image. 1 5 2 7 6 9 6 9 6 5 5 3 1
1 1 1 1 7 5 6 7 6 5 5 3 1
1 1 1 5 1 7 1 5 1 3 1 1 1
1 1 1 1 1 1 1 1 2 1 1 1 1

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Simultaneous Iterative Reconstruction

Iterative Least Square Technique Technique (SIRT)
(ILST)

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Algebraic Iterative Reconstruction

Maximum Likelihood Expectation Maximization
Technique (AIRT) (MLEM)
“True Image”
5 10 15
15 20 35 Data (noiseless)

25 20 30 25

First Image Forward-Projected Data Updated Image

Backprojected ratios
10 10 20 0.75 10.00
1.00 11.67
1.167 0.75
10 10 20 1.75 1.333 15.00
13.33 1.5 1.75

C 20 20 20 20 1.25 1.00 1.50 1.25

1.25 1.00 1.50 1.25
Ratio of Data to Estimate
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Ordered Subset of Expectation Maximization (OSEM)

“True Image”
MLEM Convergence 5 10 15
15 20 35 Data (noiseless)
“True Image”
5 10
25 20 30 25
15 20

First Image First Subset Second Subset

Iteration 0 Iteration 1 Iteration 5 Iteration 10 Iteration 20
10 10 10.00
1.00 15.00
1.50 25.00 0.60 0.60
6.00 0.60
9.00 0.60
10 10 10.00 11.67 6.43 9.96 5.46 9.82 5.07 9.96 10 10 10.00
1.00 15.00
1.50 25.00 1.40 1.40 21.00
14.00 1.40 1.40
10 10 13.33 15.00 14.38 19.23 14.84 19.89 14.98 19.99
20 20 1.00 1.50 23 27
1.00 1.50 1.09 0.93
Third Subset 5.56
0.93 9.78
1.09
End of Iteration 1
15.22
1.09 19.44
0.93

89 1.09 0.93 90

Effect of Iterations
OSEM Convergence
“True Image”
5 10 Image gets
15 20 sharper with
iterations & later
on star artifacts
Iteration 0 Iteration 1 Iteration 2 Iteration 4 Iteration 6
reappear & make
picture noisy
10 10 10.00
5.56 11.67
9.78 6.43
5.13 9.96
9.94 5.01
5.46 10.00
9.82 5.07 10.00
5.00 9.96
10 10 15.22
13.33 19.44
15.00 14.38
15.06 19.23
19.87 15.00
14.84 19.99
19.89 14.98 20.00
15.00 19.99

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Reconstructed Planes
Image Quality
FBP OSEM

93 94

SPECT artifacts (Errors)

Artifacts in SPECT arise from a combined effect of:
Spatial Resolution vs Distance
• The degradation in resolution with distance from the
collimator
• COR offset
• Photon Absorption (Attenuation)

• Photon Scatter
• Patient Motion

Various corrections need to be applied to improve image quality

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Centre of Rotation

COR

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Attenuation
COR defect

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Attenuation:
Attenuation:
 As gamma camera head rotates
around the body the attenuation of the
projected radiation varies with:

– Amount of tissue it travels through

The intensity of the transmitted beam is a function of the attenuation – Type of tissue it travels through
coefficient of the pixels traversed. Upper part, the intensity after crossing
one volume element; middle part, after traversing n volume elements; lower
part, the analog case. 101 102

Attenuation & Compton scatter

Attenuation correction
Attenuation correction is the
compensation for the effects of
radiation attenuation in computed
tomography, which may use
mathematical estimates or measured
transmission data.
Compton scattered photons lose energy as a result 1. Uniform attenuation corr.
of the deflection but, due to the limited energy 2. Non-uniform (measured) atten corr.
resolution of the gamma camera the scattered
photons may still be detected in the photo-peak.
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Methods used to achieve attenuation correction

(uniform attn corr.) Effect of attenuation correction

Conventional methods
 Pre-reconstruction method
 Post-reconstruction method

Both of these methods assume that the

attenuation is homogeneous within the
body.

105 106

Uniformity correction
Sealed source transmission scan-based
correction (Non-uniform (measured attn corr.)

 After acquisition, the transmission

projections are reconstructed using either
FBP (filter back-projection) or statistical
based reconstruction algorithms.

 Once a map of the attenuation values has

been reconstructed, a physical model of the
attenuation process can be incorporated into
an iterative reconstruction to correct the
degradation of attenuation
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Sealed source transmission scan-based

Sealed source transmission scan-based
correction methods
correction methods
 Most common sealed source is gadolinium-  Scanning line source systems use an
153 (t1/2=242 days;97 Kev & 103 Kev) electronic window that moves
simultaneously and opposite the external
 Used as a sealed line source with a collimator source to separate transmission and
on top and passed along the patient either emission data
after or at the same as the gamma camera is
reading  Simultaneous acquisition of emission and
transmission data. This provides efficient
 Important to realize that defects in acquisition and essential alignment of
transmission scan can have a detrimental transmission and emission scans.
effect to the attenuation corrected images 109 110

Compton Scatter Energy Spectrum

 When photons undergo Compton scattering

it changes direction and loses energy
 If these lower energy photons are detected
in the photo-peak energy window:

– They will be out of place in the image

– Reduce image contrast
– Reduce lesion detectability

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Scatter Correction Methods
Scatter correction methods for SPECT
require estimation of the number of scattered
photons in each pixel of the image.
 Dual window scatter subtraction
 Triple energy window technique
 Iterative Correction Techniques
Image Processing
 First reconstructed slices are transverse
(perpendicular to body axis)
 Orthogonal slices are transverse, sagittal and
coronal (Slice-the-Dice)
 Oblique Re-orientation (Reslicing)
 Display a set of slices (triangulation)
 To draw Region of Interest (simultaneously
multiple slice processing)
 Operation on tomographic ROIs (ROI statistics,
Background Subtraction, Time Activity Curve)

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Image Processing Techniques 3D Display

 Cardiac Perfusion Tomographic Processing  Surface Rendering (surface detection,
– 3D extension of planar processing observer and a light source for image
techniques generation)
– Bull’s eye or polar display
– Stress and Rest perfusion compared to  Volume Rendering (maximum pixel
normals intensity re-projection).
 Tomographic Cerebral Blood Flow and
Metabolism Processing
– ROI: Left and Right symmetry
– Ratio of Different Regions.
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Tomographic planes (Myocardium) Tomographic planes (Brain)

117 118

Brain Scan (Surface rendering) Cardiac Scan (Surface rendering)

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Myocardial Perfusion Imaging Gated Cardiac SPECT

121 122

SPECT/CT Systems

123 124
Volume rendering 3D Polar Map

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SPECT/CT Images
Advantages of SPECT/CT
 High quality of images in comparison to
sealed sources

 Correlation of the SPECTs functional

images and the CTs anatomical images
combined.

 Image co-registration (Fusion) provides

information more than both modalities
separately
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SPECT/CT Images
References

1.Physics in nuclear medicine by Simon R Cherry, James a

Sorenson, Micheal E Phelps
2. Effective use of Computers in Nuclear Medicine: Practical
Clinical Applications in the Imaging Laboratory by Michael
J. Gelfand, Stephen R. Thomas
3. Nuclear Medicine: The Requisites by Thrall (More clinical)
4.Nuclear medicine instrumentation by Jennifer Prekeges
5. Principles of Nuclear Medicine by Henry N. Wagner
6. Physics and Radiobiology of Nuclear Medicine by GopalSaha

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Any questions?

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