POSITRON

EMISSION
TOMOGRAPHY
(PET)
 INTRODUCTION
• Positron emission tomography (PET) generates transverse images that
describe the distribution of positron-emitting nuclides in patients. It is
equivalent to a CT scanner in diagnostic radiology, which detects radiation,
transmitted from the patient. However, PET scanner gives, cross-sectional
view of the activity, in a plane through the origin of interest in the patient.
 PRINCIPLE
• Positron-emitting isotope (10 mCi) is injected to the patient intravenously.
The radiotracer decays by emission of positron, with short half-life, e.g.
fluorodeoxyglucose, the FDG.
• The positron annihilation produces two photons of energy 511 keV each
emitted in opposite directions (180 degrees) in the body site. These photons
are detected by the set of ring detectors surrounded the patient.
• If two or more detectors detect the photons at the same time, it is called
annihilation coincidence detection (ACD).
• Scintillation detectors are used to detect the ACD. The above information is
stored in the computer. The computer then performs the filtered back
projection of this data, to create the transverse images. Finally, visual display
of the slice of interest is obtained.
POSITRON EMITTERS
 PET EQUIPMENT
• PET equipment consists of a ring of detectors surrounding the patient.
Scintillation crystals (10,000–20,000) are used as detectors.
• The various scintillation detectors are: Bismuth germanate (BGO), lutetium
oxyorthosilicate (LSO), and gadolinium oxyorthosilicate (GSO).Generally,
detectors must have high detection efficiency, less after glow, and good
energy resolution.
Detectors:
• Detectors are made in block format coupled with photomultiplier tubes
(PMT). A single larger crystal, is coupled to more than one PMT. The signals
from the PMT are sent to the pulse height analyzer (PHA) circuits, which
reject the pulses other than 511 keV energy.
• PET scanners detect the emission photons and convert them to light signals.
This scintillation event is converted into an electric signal by PMT, that can
be displayed on a monitor.
Coincidence Detection:
• Annihilation coincidence detection circuit, detects coincidence interaction
within each pair of detectors and obtain line of response (LOR). The
effective attenuation suffered by the two photons is determined. The time of
flight (TOF) of the photons are also detected.
• The coincidence may be true coincidence, random coincidence, scatter
coincidence and multiple coincidence. A true coincidence arises from a single
event, in the same plane. The scattered coincidence is due to single event, but
in different plane, due to scatter.
• The random coincidence is due
to two independent events, not
in the same plane. Multiple
coincidences is the detection of
two independent events that are
detected at the same time.
Data Acquisition:
• The computer performs a filtered back projection of the data, to produce
transverse images of the radionuclide distribution in the patient.
• It starts with a sonogram. These sinograms are computer analyzed to give
series of 2D projection views.
• 3D acquisition & reconstruction algorithm is used for 3D projection views.
• The features of PET scanner are: (i) PET images gives functional and
physiological information, (ii) it is a noninvasive, and investigative procedure,
and (iii) it provides absolute quantitative information on perfusion and
metabolism with low noise. Usually, images are fused with CT (PET-CT) and
MRI (PET-MRI).
• There are dedicated PET-CT and PET-MRI equipments available with PET
and CT or MRI in the same gantry.
PET-CT SCANNER
 INTRODUCTION
• PET-CT is a medical imaging device which combines in a single gantry
system, both Positron emission tomography (PET) and X-ray computed
tomography (CT).
• PET-CT is a hybrid imaging device which has a CT scanner for producing
high quality images of anatomy and PET scanner to produce high quality
images of function.
• Images acquired from both devices can be taken sequentially, in the same
session from the patient and combined into a single superposed (Co-
registered) image
• In addition, CT provides attenuation correction that is required for PET
images. There is a computer and software to fuse and display images.
Functional imaging obtained by PET, which depicts the spatial distribution
of metabolic or biochemical activity in the body can be more precisely
aligned or correlated with anatomic imaging obtained by CT scanning.
• No patient motion between the imaging studies. It displays anatomy, function
and the parameters fused in a series of images.
 PATIENT PREPARATION
• Patient should have 6–12 hours overnight fasting. Twenty four hours prior to
study, they can have low calorie meal and avoid exercise.
• Blood sugar cutoff level should be about 150–200 mg/ml.
• During post injection, they should relax and do not talk and wait for about
45– 60 min.
• They should empty the bladder before the study begins. During the study,
they should lie down and breathe regularly.
 DATA ACQUISITION
• The data acquisition starts with a CT topogram, spiral CT scan followed by
PET scanning. CT acquisition parameters includes:
(i) rotation speed (0.33–1 sec),
(ii) tube current (20–400 mA),
(iii) tube voltage (80–140 kVp),
(iv) table motion (10–100 mm/rotation),
(v) collimation,
(vi) scan length.
 ATTENUATION CORRECTION
• There is a differential attenuation of photon beam from deeper and
superficial structures. As a result, image will show high activity near the
surface and low activity near the center.
• CT transmission scan can be used to generate an attenuation map, to correct
this attenuation effect.
 RADIATION DOSE
• The radiation dose rate is 5– 10 times higher in PET-CT scanner compared
to gamma camera, which is a matter of concern.
• The staff radiation dose is about 3-14 mSv per study, and 50% dose is due to
dose administration. The patient radiation dose is 2–5 times higher in
PET/CT.
• The PET contributes about 5–11 mSv, whereas CT contribution is about 1–3
mSv for head, 5–20 mSv for abdomen respectively.
 ADVANTAGES OF PET-CT
• PET-CT provides physicians with superior information for determining
tissue characterizations and classifications, staging of cancers, restaging of
cancers, patient prognosis and monitoring the effectiveness of cancer
therapies.
• Advantages include:
o Superior lesion localization from near-perfect anatomical/functional
registration with fewer motion artifacts.
o Better distinction between physiological uptake and pathological uptake.
o Merger of patient’s imaging studies.
o Shorter scan time (average of 30 minutes, vs 60 minutes with standard PET)
by using CT for attenuation correction. This aids in patient comfort and
minimizes claustrophobia problems.
 APPLICATIONS OF PET-CT
• Oncology (Cancer Imaging) - detection, staging, and monitoring of various
types of cancer.
• Neurology - study brain function and metabolism.
• Cardiology - assess myocardial perfusion and viability.
• Infection and Inflammation Imaging - identify sites of infection and
inflammation in the body.
• PET-CT Guided Biopsy.
 LIMITATIONS OF PET-CT
• PET-CT involves the use of radiopharmaceuticals which is not suitable for
everyone.
• Radiation exposure.
• Pregnancy.
• High cost.
• Very rarely an individual may have an allergic reaction to the tracer.
• PET-CT is not cancer specific and will accumulate in any areas of high rates
of metabolism.
PET-MRI
• PET-MRI is a hybrid imaging technique utilizing the functional uptake
information of positron emission tomography (PET) with the anatomical
and soft tissue detail of magnetic resonance imaging (MRI).
• Early systems were tested in the late 2000s with commercial availability from
2010 . The availability of PET-MRI remains limited, largely due to the costs
and expertise required. PET-MRI acquisition times are longer than those
experienced with PET-CT.
• PET-MRI offers a lower ionizing radiation dose alternative with higher
detection rates in a variety of studies when compared with the widely
established PET-CT hybrid imaging technique.
• PET-MRI is of particular benefit to pediatric patients with chronic
inflammatory conditions or malignancy, where serial follow up examinations
following therapy are required. Additional benefits of PET-MRI include
improved image alignment/co-registration due to simultaneous acquisition
of PET and MRI images, superior soft tissue contrast to PET-CT and ability
to use MRI contrast agents .
Applications: Current applications of PET-MRI include:
• Oncology
• Head and neck cancers
• Lung cancer particularly for evaluation of brain metastases and local invasion
in the thorax
• Hepatobiliary cancers
• Pelvic malignancies including prostate, rectal, ovarian, cervical and
endometrial cancers
• Hematology
• Infectious and inflammatory disorders
• Neurological conditions.