Operation System of PET and

Cyclotron in SNUH

Hong Jae LEE

Nuclear Medicine in Korea(KSNMT)

Hospital : 133
 Nuclear Medicine Manpower
2500

393

2000

397

259
1500

400
264

207 201
209
1000 401 267
195
210 204

272 210
208 201
89
92 404 8
15 205 27 98
500 208 99 198 8 78 40
291 21 18 99 46
12 25 85
113 16 11 42
12 217 9 87 100
203 199
149 17 90 97
377 14 20 24 39
309 15 12 9 99 91 40
193 223 195 10
161
89 98
0 15 17 31 9 40
Specialist Resident In-Vivo PET/CT Cyclotron In-Vitro Cyclotron
Medical Doctor Radiologiclal Technologist Medical Laboratory Etc. Nurse Pharmacist Officer Researcher Nuclear
Technologist Scientists

2013 2014 2015 2016 2017 2018

 Nuclear Medicine Equipment

250

200

150

100

50

Radio-
0
r r r r T RI RI l . r r Protec-
to ile to to to CT an em T/C
T D
PE /C
T M CT CT CT ita on Et
c
en
t
en
t
en
t
en
t to t e CA
ec ob ec ec ec PE Sc st BM T /M PE E T/ T/ /M p ti ra un tion M &
et M Gamma t t t S o y E C PE T SP EC PE T o s Animal ra m m m m
lib o
D D
e e
DCamera D
e
ac m e
S
SP
PET PE SP PE H p e Study tru t ru t ru t ru a C Analysis
ed le al le r di a m
t ak oo in
s
in
s
in
s
in
s
e
C dy
Fi
x ng D
u i p
Ca M p lc g g g g os bo
Si Tr U na i n i n i n i n D le
d io ur ur ur ur
o i
at as as as as ho
yr uc e e e e W
Th ed
m m m m
l- m
a
e ta
n ity en
i a B u m
tr am m ci
d us G I m S pe
in o-
a di
R

2013 2014 2015 2016 2017 2018

 Radiopharmaceutical
160,000,000

146,223,852

140,000,000
128,647,887

120,000,000

100,000,000 90,578,192

88,024,102
75,060,940
80,000,000
70,303,959

60,000,000 2,665,443 58,645

12,210 401,709280,271 5,180 123,765 98,235

2,465,865 2,590 95,793
288,082 376,915 28,490
40,000,000 117,105
4 7,434 93,092 8,325
2,126,760 107,670223,73918,315 4,107 52,355 185 127,798
429,311
38,036888
2,698,558
2 7,232 86,432 7,955 1,347,048 471,709413,697 33,485 254,560 619,269
20,000,000 14,652 1,628
12,580 33,448
1,375,475 44,030 43,956 163,022272,320 21,275 7,400 71,410 57,350 225,330

989,232 7,2151,110 54,908

20,905 8,880 55,833
555 1,4801,283,315
3,848 214,341 64,935 68,265 00536,426
2,077 7,252 2,2200207,57044,400
0

2013 2014 2015 2016 2017 2018

 Therapy Patient Room
175

172
170 171

165

164
163
162
160

158

155

150
2013 2014 2015 2016 2017 2018

Patient Single room

 Number of Nuclear Medicine Study

Therapy
35,000
PET
30,887 450,000
30,000
407,739 410,006
400,000

25,000
24,442 350,000

300,000
20,000

250,000
222,903 228,153
15,545 216,454 216,951
15,000
200,000

12,491
11,013 11,026 150,000
10,000

100,000

5,000
50,000

0
0 2013 2014 2015 2016 2017 2018
2013 2014 2015 2016 2017 2018
 Number of Nuclear Medicine Study

In-Vivo
600,000
In-Vitro
7,000,000
500,000

6,000,000

400,000

5,000,000

300,000
4,000,000

200,000
3,000,000

100,000 2,000,000

1,000,000
0
2013 2014 2015 2016 2017 2018

0
Digestive System Thyroid 2013 2014 2015 2016 2017 2018
Brain-Nervous System Musculoskeletal
Urinary System Circulatory System Hormone Cancer Marker Hepatitis
Tumor Thyroid etc. In-Vivo, Vitro
 Number of Nuclear Medicine Study(Details)

Musculoskeletal
400,000

350,000

300,000

250,000

200,000

150,000

100,000

50,000

0
an le
) e) T T an O
)
O
)
O
)
an T T ry er
sc ho as EC /C sc PA PA PA sc EC /C et th
ne n P h S P
ECT w M M M 7 S P
ECT om O
Bo ( Pi ( 3 ne P ro ( H H (H -6 7 P sit
an an Bo
S ar an T( CT Ga -6 S n
sc sc ne m sc
C / Ga -6
7 de
Bo ne PE CT ne
ne ne BC
S E Ga
Bo Bo Bo W BC S P Bo
W BC
W

2014 2015 2016 2017 2018

 Number of Nuclear Medicine Study(Details)
PET
400000

350000

300000

250000

200000

150000

100000

50000

0
T T T t) t) t) t) T T RI RI RI RI RI RI T T l) T A T T l) T T T T T er h T T
PE PE PE en en en en PE PE /M /M /M /M /M /M PE PE ona PE OP PE PE ona PE PE PE PE PE at arc 연구 PE PE
& & & em em em em & & ET ET ET ET ET ET & & g i & FD & & g i & & & & & W s e
5 e 이외 T & T &
/ CT /CT /CT anc anc anc anc /CT /CT in P c P o P y P al P al P /CT /CT , Re /CT 18 /CT /CT , Re /CT /CT /CT /CT /CT -1 G r C C
T T T h h h h T T a ia rs d n n T T y T F- ET ET in ET ET ET ET ET O FD G ET/ ET/
PE PE PE -en (en -en (en l PE l PE Br ard To ebo gio itio PE PE od PE P P a P P P P P D P P
C n c l n T B S il te (Br in in in il 3 8 F n
in
T O rai dia non PET non PET ona ona FDG G C DG ho Re Add rai FL tal FE z en eta ET Bra Bra Bra zen NH F -1 i
ra Bra
A B ar ( ( gi i ti D F W G B 8 o 8 a c P a B
8 F T P m 13 q) yl)
T
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lu 11 nin 1 P prid MS Flu N-
D D / C / C G A ; - 1 ; F- FD 18 8 F P-C rs F - ace am
8 8 F & T & T D G I F I - F o o 1 o N r iz
-6 F-1 18 CT PE CT PE 8 F FD MR I ; R 1 8 F -1 8 (T 18 C thi C- acl 11 -11 eu
Ga - T/ o T / y 1 8 / R /M ; F- RI ; I ; F F-1 ET F- e R - C ( N l (V
F E s d F- -1 ET /M ET I M C o
P o r PE o R T/M MR
P 11 n
o G T dy le B F P ET P
P M E / one - 11 C- abe tam
rs T / P E T B C t e
To FD B
o ho
PE P aF be m
G 18 ole W N l or lute
F F
FD F- h G 8
1 8 -1 8
8 W FD F -1 -
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F- FD F-1
1 8
F-

2014 2015 2016 2017

Design of PET center
First PET Scanner

12
 Requirements
1. Atomic energy law
- Shielding, Ventilation, Drainage

2. Construction
- Space for installation, Schedule, Inspection and education

3. Facilities
- Thermo-hygrostat

4. Power
- Considering feature of scanner(including UPS)

5. Others
- Telephone, LAN, Computing system
13
 Reception

Injection
Room

Stabilization Room & Toilet

Scanner Room

Control Room
Shielding
Duct for Ventilation

16
 F-FDG Study Flow
18
 1. Main Reception

6. The end

5. Scanner room 2. Reception of injection room

18
F-FDG study flow

4. Stabilization Room 3. Injection Room

Main Reception
- Duty
1) Checking Preparation
2) Recording patient information
(Ex) Weight, Height, NPO duration and so on.

* Printing patient label * Checking name and ID * Measure weight/height

Reception of Injection Room
- Duty
1) Controlling schedule
2) Checking BST
3) Providing water

* Checking BST * Drinking 3 cups of water

Injection Room
- Duty
1) 18F-FDG injection
2) Recording injection information
(Ex) Injection dose and time, IV site and special note

* Injection route using butterfly needle * Auto injector system * Printing Dose information
 Stabilization Room
- Duty
1) Resting 60min for Torso, 30min for Brain study
2) Dimly light for brain study

- CCTV and Microphone system

* Connected to each stabilization room * Explanation of PET/CT study

Scanner room
- Duty
1) Scanning
2) Image Processing
3) Sending images to PACS
4) Data Back-up

* Workstation for scan and PACS system * Workstation for processing

Thermo-hygrostat

25
4. Pneumatic tube system

오염
검사실 PET-MRI
물품 조정실
진찰실 창고
주사실
PET-MRI
영상 RI 폐기물
MINI PET 분석실 PET-MRI
기사실 RI 주사실
Scanner 기계실
CYCLO- QA
TRON 관
장비 리
수선실 실
안 안
안 정 정 안 감마
실 실 정 락커룸 계측실
정
실 실
방사선
냉
화학 약품
실험실 장
실험실 분석실
실

BONE PET CT PET CT PET CT PET CT

Scanner -1 -2 -3 -4
CYCLO-
TRON
운영실 크린룸

갱 CYCLO-
의 TRON
PET CT
실 기계실
조정실

End point
Start point( 크린룸 - 암센터 ) CYCLOTRON
Start point( 크린룸 - 의생명 ) 기계실
ECT

Phone

LAN

4
4 4 4 4
ECT 220V

110V

LAN Port

Wall Gas

Phone

4 2 4 2

4 1 4 4 4 1 4 4
44 2 4
4 2
5-3. ECT
Emergency Call 간호사 ( 접수 ) 연결 Phone
(12 개 안정실 )
LAN

Microphone

방송 케이블

방송 (CCTV 겸용 )
케이블
환자대기이름 표시
( 내과외래 참고 )

Emergency Call

4 4 4 4
Introduction of SNUH PET Scanner
PET/MRI

 Biograph mMR (PET/MRI)___SIEMENS

 PET
- Crystal : LSO
- APD(Avalanche Photo Diode) detector system
- FOV : 258mm
- Resolution : Up to 4.7 mm
- Bore size : 60 cm

 MRI
- 3 Tesla
- Coil : Body, Head/Neck, Spine,
Breast, Wrist, Flex

 Recon Algorithm
- FBP, OSEM 2D/3D, True X(OSEM3D+PSF)

 Scan Time
- 3 min/bed
- 15 min for Torso

 Feature
- Cardiac and Respiration gating available
- List mode available
- Attenuation correction by measurement using M
Cyclotron
3-2. Cyclotron
Clean Room (GMP System)
Synthesis modules

F-FDG
18
F-Reaserch
18 Ga-Compounds
68

C-Compounds
11

Metal Halogen Solid target system Synthesizer

Quality Control Equipment

PH meter MCA TLC

Residual K222 detection kit

HPLC
GC
PTS
Scan and Reconstruction
Injection Dose
Study Injection Dose
18
F-FDG Torso & WB 5.18MBq * kg
18
F-FDG Brain 3.7MBq * kg
C-Methionine Brain
11
7.4MBq * kg
11
F-FP-CIT Brain 185MBq(Fixed)
N-Ammonia Myocardial
13
370MBq(Fixed)

Uptake Time
Study Uptake Time
18
F-FDG Torso & WB 60 Minutes
18
F-FDG Brain 30 Minutes
C-Methionine Brain
11
20 Minutes
11
F-FP-CIT Brain 120 Minutes
13
N-Ammonia Heart Listmode scan
Scan Position

Torso Wholebody

Brain Heart
Scan Flow for 13
N-Ammonia Heart

1. Rest : 10 min list-mode dynamic

0’ 4’ 10’

List mode for CBF

For static image

N-NH3 10 mCi
13

2. Interval : > 30 min

3. Stress : 10 min list-mode dynamic

-3’ 0’ 3’ 4’ 10’

Adenosine
For quantification
0.14 mg/kg/min
For static image
N-NH3 10 mCi
13
Results in PACS

11
13
C-Methionine
N-Ammonia
F-FDG
F-FP-CIT
F-FDG
18 18
18
Wholebody
Torso
Brain
Heart
Brain
Structure of Data Back-up
Patient Data Research Data
petpet1@snu.ac.kr