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Frequency of Quality Control Procedures

The first group of procedures need to be performed on a Daily basis. These procedures are designed to quickly test the camera’s basic
performance. The purpose of these procedures is to assure that the camera system is operating correctly and can be used to image
patients. These procedures usually include Peaking and Uniformity procedures. The Peaking procedure assures the operator that the
camera system is properly focused on the photopeak caused by the detection of the incident photons. The Uniformity procedure
assures the operator that the camera system is providing an even response, with no ‘hot’ or ‘cold’ spots, upon exposure to a uniform
radiation field.

The second group of procedures need to be performed on a Weekly to Quarterly basis. These procedures are more time consuming,
more detailed and are designed to test the performance of components and features that are very important to producing quality images
but are more stable relative to the first group. These procedures usually include Linearity/Resolution (LR), Center-or-Rotation (COR)
and Multi-Detector-Alignment (MDA) procedures. The LR procedure uses a series of equally spaced lead bars of different thickness
to produce an image of ‘hot’ and ‘cold’ lines. The image is subjectively evaluated to determine the smallest bar that can be resolved
and also if any nonlinearity is observed in the lines. Another less frequent procedure, the COR procedure, is performed to verify and
correct the alignment of the mechanical and electronic point around which the camera rotates. Errors in this calibration can lead to
image artifacts. Similar to the COR procedure, the MDA procedure is used to verify and correct the alignment in a multi-detector
imaging system. Again, errors in this calibration can lead to image artifacts.

The third group of procedures need to be performed on an ‘As Needed’ basis. These procedures can be both corrective as well as
diagnostic in nature. These procedures are performed for many reasons. The reasons may include: (1) in response to a detected
problem, (2) for Regulatory Compliance, (3) per Manufacturer Recommendation and (4) at Significant Events.

Performing quality control
must be knowledgeable of the pieces of equipment that are to be covered in the program.
must document the QC plan, once the detailed requirements of the equipment are understood.
must monitor the results once the solid QC plan is created and documented and assure the tests are performed based on the plan.
must quickly respond to any detected issues, once the QC plan is operating successfully.

22 Why performance and problems? Because identifying and addressing the problems / limitations is often a measurement of the
system performance. (although problems may also be thought of as performance factors)
23 Because the collimator is such a crucial (but removable) part of the gamma camera, there’re two types of performance measures
defined. System measures are of course more matching to clinical use, but intrinsic allows for isolated comparison between different
cameras
So the list of performance measures are divided between system and intrinsic measurements, e.g., spatial resolution can be viewed as
system resolution, which is a function of collimator spatial resolution and intrinsic resolution
24 If you expose the camera to a uniform source, you expect a uniform image
Test performed by either placing a point source > (5x diameter of crystal) from the camera or using a planar source that can cover the
entire camera head. Usually these would be filled with Co-57 (5-10 mCi) or a Tc-99m solution.
As mentioned before, you can test for system uniformity (with grid) and intrinsic uniformity (without grid)
Performance is measured as (max – min) / (max + min), typical values is for intrinsic performance
25 It really just boils down to variations (differences) between the different PMTs, different locations in the crystal and different parts
of the grid.
Corrections are calculated by exposing to a very uniform source, looking at the deviations and storing them in a lookup table
26 Spatial resolution = sharpness / detail. In other words, how small is the smallest object you can differentiate from its surroundings?
Point source = a single “point” of radionuclide source, e.g., a radioactive pellet
Line source = a single line of radionuclide source, e.g., a capillary tube of Tc-99m solution
This really only makes sense with the grid (system spatial resolution), but intrinsic spatial resolution is also measurable by shielding
the camera with a lead sheet + hole or slit

27 A line profile is generated by drawing a line across the center of the point or perpendicular to the line and plotting the pixel values
Full width at half maximum (FWHM) is a standard, commonly used method to calculate the width of a peak (in real world
measurements, signals are almost never straight edged, which leads to ambiguity on where to define the edges)
Rs = system resolution, Rc = collimator resolution, Ri = intrinsic resolution
Collimator resolution can be calculated from the size of the collimator holes

28 - The smaller and longer the collimator hole, the better the collimator resolution
- The thinner the crystal, the better the intrinsic resolution
- The lower the energy, the better the intrinsic resolution
- The smaller the PMT, the better the intrinsic resolution

→ more offsets → shift in position away from centre (depends on coordinate system used) Usually corrected by normalizing position signals by energy (total summed signal).The thicker the crystal. this is by far the most significant factor. so the gain in resolution with a loss in efficiency may actually result in overall lower resolution (due to low SNR) 29 The distance factor is due to geometric factors: distance from source will affect the photon angle as it passes the collimator This is most important because it is controllable during clinical practice: patient body must be as close as possible to camera head. This means that high energies will produce more light photons..Surprisingly. LEUHR = low energy. it could be argued that the rejected photons are “harmful” to the image) . the source to collimator distance has little effect on efficiency *except* for the pinhole collimator 36 This graph depicts the efficiency as a factor of photon energy and crystal thickness (in mm) Thickness of crystal chosen depends on radiopharmaceutical of interest. the better the intrinsic resolution Note that there is a tradeoff between intrinsic resolution and efficiency (sensitivity) for quite a few of the factors. However. 34 System efficiency (Es) is the product of collimator efficiency (Ec).The higher the energy. just like the earlier lectures on radiation measurement about radiation spectroscopy Since the factors effecting the measurement are quite random. this is seldom practical where patients are involved. Of course. many of the factors for spatial resolution and efficiency are related. all purpose. E. this can be corrected via lookup tables 33 This unique problem is due to the way spatial localization works in gamma cameras: light photons trigger multiple PMTs. spaces between the PMTs and the interfaces are non detecting surfaces. so is there any point to using crystal thickness > 6. Also. the signals are multiplied with the individual PMT coordinate offsets and summed to get the X and Y position. This causes a “wavy line” artifact Like uniformity. the higher the efficiency (since typical photon rejection rates > 99.g. LEHR = low energy. intrinsic efficiency (Ei) and the fraction of count events from the PMTs that are not rejected by the energy discrimination circuits (f) 35 Does this list sound familiar? As mentioned earlier.4 mm? 37 Energy resolution is important because this is how the gamma camera identifies and rejects scatter radiation or coincidence interactions Note the spectrum of the monoenergetic source: the long tail to the left is likely due to scattered photons (loss of energy) The photopeak is normalized by the energy 38 Since the final measurement (current) is really 2 degrees away from the actual measurement of interest (photons). whether it’s a straight line or a curve (but lines are easier to test) The “bad” image shows almost imperceptible deviations in the lines (most obvious at the two ends) 32 The PMT edges.The closer the distance. high resolution. don’t forget the organs of interest are usually deep in the body! 30 An illustration of the loss in system spatial resolution due to increasing object to collimator distance (note: LEAP = low energy. the system has to be calibrated. Tc-99m emits 140 keV gamma ray. This “gap” causes the position localization circuits to shift the X and Y coordinates towards the coordinate of the closest PMT centre. and there is often a tradeoff between the two parameters. . ultra high resolution. the higher the efficiency . we can’t make the energy window too narrow or we will discard too many “legitimate” events 39 “all in one” phantoms for testing spatial resolution and contrast (efficiency / sensitivity) 40 Phantoms for uniformity and spatial linearity 41 The tradeoff for high spatial resolution and high energy resolution is increased rejection.9%..The bigger and shorter the collimator hole. . these are all different types of collimators) 31 The camera should be able to image shapes accurately. the higher the efficiency (more light photons generated per gamma ray) . efficiency is not a factor either because scan time can just be extended (hours!) until the desired count is achieved. If scan time is not a factor.