University of Baghdad

College of Medicine

Positron Emission Tomography Scan

Presented by
Group D1
‫ مسره معتز شاهين عباس‬-
‫ مالك هيثم اسماعيل ابراهيم‬-
‫ محمد نمير عبد االمير علي‬-
‫ محمد مصطفى خاشع محسن‬-
‫ محمد عمار مولى حمود‬-
‫ محمد علي عقيل منذور حمزة‬-
‫ محمد علي عباده جياد‬-

Supervised by
Dr. Ramaq Al-Qadhi
Lec. Dalya Al-Eqabi

Objectives:

• What is PET?
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• PET history
• Main system components
• Principle of PET
• Image Acquisition
• Image reconstruction
• PET facility configuration
• Clinical applications of PET
• Pros and cons
• PET/CT principles and applications of PET/CT
• PET radiopharmaceuticals
• FDG

What is PET?
Positron Emission Tomography (PET) is at present one of the most
technologically advanced diagnostic methods for non-invasive imaging in
medicine.

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It plays a unique role both in medical diagnostics and in monitoring effects
of therapy, in particular in oncology, cardiology, neurology and psychiatry.
In PET measurement the patient is injected with radiotracer, containing a
large number of metastable atoms of positron emitting radionuclide.

Since the rate of assimilation of radiopharmaceuticals depends on the type

of the tissues, sections of the diseased cells can be identified with high
accuracy, even if they are not yet detectable via morphological changes.
Therefore, PET is extremely effective in locating and diagnosing cancer
metastases.

As the result of positron annihilation, two photons travelling off with nearly
opposite directions are produced. The detection system is usually arranged
in layers forming a ring around the diagnosed patient.

History of PET:
The first demonstration of PET technique for medical imaging use was
given in early 1950s by Brownell and Burnham. This was an inspiration for
the concept of emission tomography used to visualize functional processes
in the body in the late 1950s. The first 3-dimensional PET detector, called

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PC-1, was developed at the Massachusetts General Hospital and completed
in 1969.

This PET device comprised two planar opposed arrays of crystal

scintillators. In 1973 Robertson and his co-workers built the first ring PET
scanner, which consisted of 32 detectors. The cylindrical array of detectors
has soon become the prototype of the current shape of PET.

the first ring PET scanner

First clinical positron imaging device.

Drs. Brownell (left) and Aronow are shown with scanner (1953).

Main system components:

A positron emission tomography (PET) system consists of several components that
work together to capture images of the body's metabolic processes.
The main components of a PET system include:
1. Scanner ring: The scanner ring is essentially a large circular detector
that

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surrounds the patient. It consists of multiple detector that are designed to
detect the gamma rays.
2. Patient bed: The patient bed is where the patient lies during the
scanning process

3.Radiotracer injection system: A drugs that emit positrons, which are

positively charged particles. The radiotracer injection system is used to
administer the radiotracer into the patient's body.

4. Coincidence detection system: used to localize the source of the emitted

gamma rays. it detects two gamma rays emitted in opposite directions.
This information is used to reconstruct an image.

5. Data acquisition system: It converts the detected gamma ray signals

into data that can be further processed and analyzed.

6. Computer system and software: it acts as the central processing unit for
the PET system. It converts the acquired data and generates detailed
images of the patient's body.

7. Display: PET images are typically displayed on monitor, allowing

radiologists and physicians to analyze the metabolic activity in different
areas of the body.

Principle of PET:
-PET uses radiotracer or pharmaceutical fluoro deoxy-glocuse (FDG).
-Firstly, FDG is injected intravenously into the patient.
-FDG emits positron by going into the patient abnormalities or malignance
tissue.
-The half-life of positron is very short.

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-Glucose molecule by metabolism become Gloucose-6 phosphate.
-FDG is similar to our glucose molecule and travels in the body same way
as glucose and undergoes metabolism.
-FDG is metabolized into FDG-6 phosphate by Hexokinase.
-if the tissue is normal, this process continues during the metabolism.
-if there is any malignance, presence of pathology, infection or other
abnormalities, the FDG gets trapped.
-FDG emits positron from abnormal tissue.
-The emitted positron joins (interact) With an electron and undergoes
annihilation.
-The positron annihilation produces 2 photons of energy each emitted in
opposite direction (180 degree) in the body site.
-These photons are detected by a set of ring detectors surrounding the
patient.
-The detector sends these signals to the computer and the computer
creates the final image from these signals.

Image acquisition and Image reconstruction

Image acquisition :
Is the creation of a digital representation of the visual characteristics of an
object, such as a physical scene or the interior structure of an object. The
term is often assumed to imply or include the processing, compression,
storage, printing and display of such images.

Image acquisition is
an action of retrieving
image from an external
source for further
processing because it's
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completely unprocessed, It's the foundation step in the workflow since no
process is available before obtaining an image. The three steps of image
acquisition are Energy reflected from the thing of interest, an optical
system that focuses the energy and lastly a sensor that measures the
quantity of energy. The most common and basic sensor for image
acquisition is a photodiode which is constructed of silicon materials so its
output voltage is proportional to incoming light.

In most PET scanners today, images acquired through scintillation

detectors which are used as detection elements, they couple inorganic
scintillation crystals that emit visible or near ultraviolet light after
interaction with an incident high energy (511 Kev) photon, to photo
detectors and measure the scintillation photons. Knowing that the typical
acquisition time for a PET scan is 3 min per bed position.
Image reconstruction:
It is a mathematical process that generates tomographic images from
signal projection data acquired at many different angles around the
patient. Image reconstruction has fundamental impacts on image quality
and therefore on radiation dose.

-The aim is to provide cross-sectional images of the radio tracer distribution

in an object, using the coincidence events detected by a scanner. The
resolution of images of PET scan is substantially less than that of CT or
MRI, this lower resolution is largely due to the smaller amount of
information and lower signal to noise that is available during acquisition.

-Since in a PET system the object is placed in the scanner, the scintillator
ring can detect extremely low signal, the signal consists of a single
positron, so each detector element is quite large.

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-Recent advances in technology have enabled smaller and smaller elements
in this array which in turn leads to better resolution. The use of cascade
photo diodes to replace the scintillator ring also increases the speed of
acquisition that will in turn increase resolution.

-In PET imaging a radio tracer is injected and once this binds with the
target tissue a collision event occurs, resulting in two positrons being
emitted in opposite directions to each other at the speed of light and hit
the detector ring simultaneously, so the scanner records a CO-INCIDENCE
event frequently. Time scale over this happens is depended on the tracers
binding potential and the abundance of what is being bound but typically is
between 6 and 12 nanoseconds.

-Then the output data from the scanner is a series of points that represents
the coincidence events, each event is represented as two points through
which a line can be drawn called LINE OF RESPONSE or LOR. As we add
more of the events, the result is a final probabilistic map of the source of
the events. The most typically used techniques of this involves first sorting
the LORs into similar directions, grouping them into sonograms and then
reconstructing them as per CT back projection.

PET facility configuration:

PET facility configuration typically refers to the setup of a Positron Emission
Tomography (PET) imaging facility. It involves the arrangement of
equipment, including PET scanners, radiochemistry labs, and patient
preparation areas. The configuration aims to optimize workflow, safety, and
efficiency for conducting PET scans, which are used in medical imaging to
visualize metabolic processes in the body.

The configuration of a PET facility involves several key components:

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1. PET Scanner Room: This is where the PET scanner is located. The room
is designed to shield external interference and provide a controlled
environment for imaging.

2. Radiochemistry Laboratory: This is where radiotracers are prepared.

Radiotracers are compounds labeled with a radioactive isotope used in PET
imaging. The lab should be equipped for safe handling of radioisotopes.

3. Hot Lab: This specialized room is dedicated to handling and processing

radioactive materials. It ensures the safety of personnel and minimizes
radiation exposure.

4. Patient Preparation Area: A space for patients to be prepared for the

scan, including injection of radiotracers. It may include changing rooms
and waiting areas.

5. Control Room: Operators control and monitor the PET scanner from this
room, ensuring the imaging process runs smoothly.

6. Storage and Waste Disposal: Safe storage for radiotracers and proper
disposal systems for radioactive waste are essential.

7. Shielding: Adequate radiation shielding is crucial to protect staff and the

public from exposure to ionizing radiation generated during the imaging
process.

Clinical applications of PET :

Positron Emission Tomography (PET) has various clinical applications,
including:

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1. Oncology: PET is widely used in cancer diagnosis, staging, and
treatment planning. It helps visualize and quantify metabolic activity, aiding
in the detection of tumors and assessment of their response to treatment.

2. Neurology: PET is valuable in neuroimaging, especially for conditions like

Alzheimer's disease and other neurodegenerative disorders. It allows for
the visualization of glucose metabolism and specific biomarkers associated
with these conditions.

3. Cardiology: PET can assess myocardial perfusion and viability, providing

information on blood flow and identifying areas of damaged or scarred
tissue in the heart. It is used in the evaluation of coronary artery disease
and planning cardiac interventions.

4. Infectious Diseases: PET imaging with specific radiotracers can help

detect and localize infections in the body. It's used in cases like diagnosing
certain types of pneumonia and evaluating the extent of infection.

5. Rheumatology: PET can be employed to assess inflammation and

disease activity in conditions like rheumatoid arthritis. It helps in planning
treatment strategies.

6. Endocrinology: PET scans can be used in endocrine disorders, such as

locating abnormal hormone-secreting tumors (e.g., insulinomas) or
assessing thyroid nodules.

7. Psychiatry: PET is utilized in psychiatric research to study brain function

and neurotransmitter activity. It helps understand conditions like
depression, schizophrenia, and bipolar disorder.

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8. Pediatrics: In pediatric oncology, PET assists in tumor detection, staging,
and treatment monitoring. It is also used in certain neurological and
inflammatory conditions in children.

These applications highlight the versatility of PET in providing functional

and molecular information, aiding in the diagnosis and management of
various medical conditions.

Pros and Cons of PET :

Pros:
1-Uniquely shows the chemical functioning of organs and tissues.

2-Detect functional changes Study metabolic functions-may be an alternative

to biopsy.

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3-Distinguish between benign and malignant tumors-reducing unnecessary
surgeries due to misdiagnosis.

4-Determine the spread of disease (cancer)and function of the heart.

5-Diagnose early stages of neurological illness, e.g. Epilepsy, Alzheimer's

disease.

Cons:
1-lonizing radiation

2-Radioactive compound is short lived.

3-Radioisotope must be produced in a laboratory near the PET scanner.

PET/CT principle and applications of

PET/CT
PET/CT principle:
- FDG PET is a strictly functional modality with anatomical
landmarks.

- Unless anatomical correlation is available to delineate normal

structures, pathological sites of FDG accumulation can easily be
confused with normal physiological uptake, leading to false-positive or false-
negative findings.

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- Coregistration of PET scans with CT using a combined PET-CT
scanner improves the overall sensitivity and specificity of information
provided by PET or CT alone.

- PET-CT provides more precise anatomical definition for both

the physiological and pathological uptake seen at FDG PET.
Applications of PET/CT:
1-Brain Tumor
2-Head and Neck Cancer
3-Thyroid Cancer
4-Lung Cancer
5-Lymphoma
6-Infection and Inflammation, And many other applications…

PET radiopharmaceuticals:
radiopharmaceuticals, which are drugs labeled with a small amount of
radioisotope to detect and measure the distribution and metabolism
of these compounds in the body.

Radiopharmaceuticals used in PET imaging typically consist of a

biologically active molecule, called a tracer, and a positron-emitting
radionuclide. Positrons are emitted by the radionuclide, and when
they encounter electrons in the body, they hit each other. This
produces two photons that are emitted in opposite directions, which
can be detected by a PET scanner.

The most commonly used radiopharmaceutical in PET imaging is

fluorodeoxyglucose (FDG), which is a glucose analog labeled with the
positron-emitting radionuclide fluorine. FDG is taken up by cells that
have high glucose metabolism, such as cancer cells, and its
distribution in the body provides information about tumor activity.
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There are several other radiopharmaceuticals used in PET imaging for
different
purposes. Some examples include:

1. Carbon tracers: Used to study neurobiology and brain function

2. Oxygen tracers: tracers are used for quantifying blood flow,

tracking oxygen delivery, and metabolic studies of the heart and
brain.

These are just a few examples of the many radiopharmaceuticals

used in PET imaging. The choice of radiopharmaceutical depends on
the specific diagnostic or research, as well as the anatomical region
of interest…

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 FDG
As we know PET is special imaging technique used in nuclear medicine this
technique based on measurements of positron emission from Radio_labelled
tracer molecules.

it means PET Scan uses radiotracer injected into the patient before the scan to
visualize the blood flow, metabolic & biochemical activities in diseased &
healthy tissue.

FDG is a glucose analogue that tend to accumulate in the tissue with high
Glucose demand like tumors & inflammatory cells.
So the most common R-tracer used today is (18F - FDG).

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image with 18F- FDG → determine abnormal glucose metabolism sites
that characterize (describe) & localize (determine location)
the tumors.

FDG mechanism
→ The patient gets an injection or is injected with Radio-active Sugar
(FDG-18)
→ Cells absorb sugar.
→ Area using more energy pick more Sugar.
→ Cancer Cells Use or consume more energy than healthy Cells.
Because cancer cells have a highly glycolysis rate leading to increase transport
& accumulation of FDG into these cells compared to healthy cells.
→ PET Scan detect this accumulation due to the radioactive decay of fluorine-
18 which lead to radioactive emission.
→ The emission Source in FDG is fluorine 18 which has a life time about 10
min. when it decays the nucleus of 18F emits a positron. Collides with electron.
→ Collision result in annihilation.
→ annihilation leading to conversion of mass

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into energy.
→ This energy will be in form of two photons.
→ The scintillation crystals in the PET cameras absorb energy from photons
& emit light into electrical signals.

REFERENCES:

1-DIGITAL SIGNAL AND IMAGE PROCESSING IN JAGIELLONIAN, POSITRON

EMISSION TOMOGRAPHY by LECH RACZYŃSKI.
2-Positron Emission Tomography: Basic Sciences by D.L. Bailey, D.W. Townsend, P.E. Valk,
and M.N. Maisey (Springer, 2005)
3- https://radiopaedia.org/articles/positron-emission-tomography .
4-Phelps ME. PET: Molecular Imaging and Its Biological Applications. Springer; London, UK:
2004. [Google Scholar]
5-Weber WA, Figlin R. Monitoring cancer treatment with PET/CT: does it make a difference? J.
Nucl. Med. 2007;48(1):36S–44S. [PubMed] [Google Scholar]
6-Advances in Radiation Oncology www.advancesradonc.org
7-The journal of Medical investigation
8-University Medical Center Groningen http://doi.10.3390/cancers15215173
9- https://www.acr.org/Clinical-Resources/ACR-Appropriateness-Criteria
10-Li and Zhang BMC cancer http://doi.org/10.1186/s12885-023-11334-y
11- https://www.ncbi.nlm.nih.gov/books/NBK92546
12-Society of Nuclear Medicine and Molecular Imaging (SNMMI): Professional organization
with PET information https://www.snmmi.org/

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