Nuclear medicine

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Questions and Answers

Which Nobel Prize was awarded for the development of X-ray computerized tomography (CT)?

  • George de Hevesy
  • Lauterbur & Mansfield
  • Wilhelm Roentgen
  • Hounsfield & Cormack (correct)

What characteristic is associated with X-ray as a probe in imaging modalities?

  • Proton density
  • Electron density (correct)
  • Magnetic field strength
  • Radionuclide distribution

Which Nobel Prize was awarded in 2003 for contributions to the development of Magnetic Resonance Imaging (MRI)?

  • Lauterbur & Mansfield (correct)
  • George de Hevesy
  • Wilhelm Roentgen
  • Hounsfield & Cormack

In the context of nuclear medicine, what modality uses gamma rays as a probe?

<p>SPECT (B)</p> Signup and view all the answers

What is the primary focus of nuclear medicine compared to radiology?

<p>Physiology (D)</p> Signup and view all the answers

Which method uses RF as a probe to assess a specific characteristic?

<p>MRI (D)</p> Signup and view all the answers

Who received the Nobel Prize for recognizing isotopes as tracers in chemical process studies?

<p>George de Hevesy (D)</p> Signup and view all the answers

Which of these modalities does not primarily focus on electron density?

<p>MRI (D)</p> Signup and view all the answers

What is the primary advantage of using SPECT/CT imaging compared to traditional imaging techniques?

<p>No overlap of structures in images (B)</p> Signup and view all the answers

What determines the ultimate spatial resolution in PET imaging?

<p>Uncertainties in annihilation location and particle momentum (D)</p> Signup and view all the answers

Why do PET scanners not use collimators?

<p>Photon direction is determined by lines of response (LOR) (A)</p> Signup and view all the answers

Which of the following radionuclides is primarily used in PET imaging?

<p>18F (D)</p> Signup and view all the answers

What factor contributes to image noise in PET images?

<p>Random coincidences from delayed coincidence detection (B)</p> Signup and view all the answers

How is scattered radiation addressed in PET imaging?

<p>Modeling from transmission &amp; emission data (C)</p> Signup and view all the answers

Which of the following best describes the relationship between the types of coincidences during PET imaging?

<p>Only true coincidences accurately represent the distribution of radioactivity (A)</p> Signup and view all the answers

What factor affects the matrix size in relation to pixel size?

<p>Spatial resolution (C)</p> Signup and view all the answers

Which configuration is used in SPECT data acquisition for capturing images?

<p>Two detectors at either 90º or 180º (B)</p> Signup and view all the answers

Which of the following is a known issue for planar NM imaging?

<p>Detecting overlapping activities (D)</p> Signup and view all the answers

What is the significance of the bar phantom in nuclear medicine imaging?

<p>To assess both extrinsic and intrinsic spatial resolution (A)</p> Signup and view all the answers

Regarding count rate in data acquisition, which statement is true?

<p>Count rate should be maintained under 20000/sec (C)</p> Signup and view all the answers

What is one advantage of SPECT over planar imaging?

<p>Enhanced depth resolution (C)</p> Signup and view all the answers

Which of the following matrices represents a common configuration in nuclear medicine imaging?

<p>128×128 (D)</p> Signup and view all the answers

What is the main purpose of using a collimator in imaging?

<p>To define and limit the angle of incoming radiation (C)</p> Signup and view all the answers

In SPECT, what is the effect of using a circular versus elliptical rotation orbit?

<p>Elliptical orbit allows for smoother imaging transitions (A)</p> Signup and view all the answers

What measurement does the pixel depth refer to in matrix imaging?

<p>Bit-depth of each pixel (D)</p> Signup and view all the answers

What is the correct formula to calculate the effective half-life (Te) of a radiopharmaceutical in the body?

<p>Te = 1 / (1/Tp + 1/Tb) (D)</p> Signup and view all the answers

What is the effect of decreasing the number of angular stops during SPECT image acquisition?

<p>It causes streaking in the images. (B)</p> Signup and view all the answers

What is the unit of decay constant (𝜆) in radioactivity?

<p>1/sec or 1/hr (A)</p> Signup and view all the answers

How does the number of views relate to the matrix size in 360º SPECT?

<p>The number of views is equal to the matrix size. (D)</p> Signup and view all the answers

Which decay process does NOT change the mass number (A) or atomic number (Z)?

<p>𝛾- decay (B)</p> Signup and view all the answers

In terms of image quality in nuclear medicine, what is a major consequence of scatter?

<p>Decreases lesion visibility (A)</p> Signup and view all the answers

Which of the following filters is primarily used to suppress blurring in filtered back projection?

<p>Ramp Filter (A)</p> Signup and view all the answers

What is a limitation of filtered back projection in SPECT imaging?

<p>It cannot correct for attenuation. (C)</p> Signup and view all the answers

What is the typical effective range of administered activity in nuclear medicine imaging?

<p>1 to 30 mCi (D)</p> Signup and view all the answers

What happens to spatial resolution as the distance between the patient and collimator increases?

<p>Spatial resolution degrades (D)</p> Signup and view all the answers

In iterative reconstruction algorithms like OSEM, how does increasing the number of iterations affect image quality?

<p>It increases noise while sharpening images. (D)</p> Signup and view all the answers

Which factor does not influence noise in SPECT imaging?

<p>Patient age (D)</p> Signup and view all the answers

What does the term 'counted' refer to in the context of image degradation due to scatter?

<p>Detected signals surpassing the noise level (B)</p> Signup and view all the answers

What can be said about the selection of filters in SPECT imaging?

<p>Filters trade off noise for resolution and vary patient to patient. (A)</p> Signup and view all the answers

Which equation accurately describes the relationship between the initial amount of radioactive atoms (N0) and the amount at time t (Nt)?

<p>Nt = N0 * e^(-𝜆t) (B)</p> Signup and view all the answers

What is the traditional unit of radioactivity represented by 3.7 × 10^10 disintegrations per second?

<p>Curie (Ci) (A)</p> Signup and view all the answers

What is the primary purpose of attenuation correction in radionuclide imaging?

<p>To compensate for signal loss due to tissues absorbing radiation. (D)</p> Signup and view all the answers

How does the typical effectiveness of a LEHR collimator compare to its theoretical capabilities?

<p>Low effectiveness at approximately 2% (C)</p> Signup and view all the answers

How long does a typical projection take during SPECT image acquisition?

<p>30 seconds per projection. (A)</p> Signup and view all the answers

What can be concluded about the step and shoot acquisition method in SPECT?

<p>It results in less blur but incurs some time loss. (C)</p> Signup and view all the answers

Flashcards

X-Ray

A type of medical imaging that uses X-rays to create detailed images of the inside of the body.

CT Scan

A highly specialized technique that uses X-rays to produce detailed cross-sectional images of the body, revealing structures like bones, organs, and soft tissues.

MRI

A non-invasive imaging technique that utilizes strong magnetic fields and radio waves to produce detailed images of the body. It excels in imaging soft tissues.

PET Scan

A type of nuclear medicine imaging that uses radioactive tracers to produce images of metabolic processes, like how organs are functioning.

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SPECT Scan

A type of nuclear medicine imaging that uses radioactive tracers to create images of the distribution of the tracer within the body, highlighting the functional processes happening in the organs.

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Radiopharmaceutical

A visual representation of a specific biological process within the body using a radioactive tracer. It can be a chemical compound or molecule.

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Radiology

This is the medical science focused on anatomy and the use of imaging techniques like X-rays, CT scans, and other structural examinations to identify and assess the physical structure of organs and tissues.

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Nuclear Medicine

This field of medicine investigates the physiological function of organs and tissues. It utilizes imaging techniques including PET, SPECT, and related procedures to understand how organs work.

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Physical Half-life (Tp)

The time it takes for the number of radioactive atoms to decrease by half.

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Disintegration Rate (A(t))

The decay rate at a specific time, measured in disintegrations per second. It's how quickly a radioactive substance decays.

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Becquerel (Bq)

A measure of the radioactivity of a substance. One Bq is equal to one disintegration per second.

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Effective Half-life (Te)

The time it takes for a radiopharmaceutical to reduce in the body by half due to both radioactive decay and biological clearance.

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Detector Efficiency

The ratio of counts detected by the detector to the actual number of photons emitted from the source.

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Scatter

A major source of degradation in nuclear medicine images. It increases image noise and decreases the contrast between lesions and healthy tissues.

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Spatial Resolution

The ability of the detector to distinguish between two closely spaced points. It is a measure of how sharp the image is.

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Collimator Resolution

The ability of a collimator to block radiation from outside the field of view. It limits the amount of scatter reaching the detector.

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Sensitivity

The minimum amount of activity required to produce a diagnostically useful image. This depends on the type of radiopharmaceutical, the imaging technique, and the patient's anatomy.

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Contrast Resolution

The ability of the imaging system to differentiate between tissues with different activities. This is crucial for identifying lesions and abnormalities.

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Collimator

A component of a gamma camera that helps to focus the radiation emitted by a radioisotope and adjust the image resolution. It's like a lens for the camera.

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Energy Window

A range of energy levels detected by the gamma camera. It helps to eliminate unwanted signals and improve image quality. It's like a filter for a specific bandwidth of light.

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Pixel Size

The size of individual picture elements in a gamma camera image. A smaller pixel size provides better detail and spatial resolution but requires more data.

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Matrix Size

Shows the number of pixels in a row and column of a gamma camera's digital image.

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Uniformity

The quality of uniformity in the image measured across the entire detector surface. It's like ensuring the camera is not showing any uneven brightness.

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Bar Phantom

A quality control tool used to assess the linearity and spatial resolution of the gamma camera. It's like a ruler for the camera's ability to capture the image in the right shape and size.

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Tomographic NM Imaging (SPECT)

A technique used to acquire images from multiple angles around the patient. It's similar to a CT scan, but uses radioactive tracers instead of X-rays.

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SPECT Data Acquisition

The process of obtaining images at various positions around the patient, allowing for the reconstruction of a 3D image. It's like taking multiple photographs to create a 3D model.

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SPECT Orbit

The path of the detector during the acquisition of data in a SPECT scan, it can be circular or elliptical. It's like the way a camera moves to capture a 3D object.

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SPECT Radiopharmaceutical

A special type of radiopharmaceutical that is used to detect specific biological processes, like blood flow or metabolism, in a SPECT scan.

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Positron

A particle with the same mass as an electron but with a positive charge. It is the antimatter counterpart of the electron.

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Annihilation

The process where a positron and an electron collide, resulting in their annihilation and the release of two gamma photons traveling in opposite directions.

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Coincidence Detection

The detection of two gamma photons simultaneously, indicating their origin from the same annihilation event. This allows for precise localization of the positron emission.

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Spatial Resolution in PET

The ability of a PET scanner to differentiate between two closely spaced points in the image. A higher spatial resolution results in sharper and more detailed images.

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Attenuation Correction

A correction applied to PET images to account for the attenuation of photons as they pass through the body. This helps to ensure accurate measurement of the distribution of radioactivity.

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Normalization Correction

A correction applied to PET images to compensate for variations in the performance of individual detectors in the scanner. This ensures uniform sensitivity across the image.

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Lesion Activity

The process of differentiating between the activity of a lesion and the surrounding normal tissue. It is important for judging the activity of lesions.

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View number

The number of projections acquired during a SPECT scan. It's determined by the matrix size of the image. For example, a 128 x 128 image will involve 128 projections.

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Back Projection

The process of transforming projection data into a 3D image. It involves mathematically reconstructing the image from the projections acquired at different angles.

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Filtered Back Projection

A technique used to reduce blurring during image reconstruction in SPECT. It uses filtering to enhance the sharpness of the image.

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Ordered Subsets Expectation Maximization (OSEM)

A type of iterative reconstruction algorithm commonly used in SPECT. It estimates the distribution of the tracer by iteratively refining the image based on the projections.

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Camera Head Separation

The distance between two adjacent detector heads during data acquisition. It affects spatial resolution.

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Resolution

The ability of SPECT to distinguish between two closely located points or objects.

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Data Collection

The process of acquiring a set of projection images at different angles around the patient to create a complete 3D image.

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Study Notes

Medical Physics - Introduction to Nuclear Medicine

  • The presentation covers medical imaging techniques, including X-rays, radiopharmaceuticals, CT, and MRI.
  • Wilhelm Roentgen received the Nobel Prize in 1901 for discovering X-rays.
  • George de Hevesy received the Nobel Prize in 1943 for employing isotopes as tracers in chemical processes.
  • Godfrey Hounsfield and Allan Cormack were awarded the Nobel Prize in 1979 for developing X-ray computed tomography (CT).
  • Peter Mansfield and Paul Lauterbur received the Nobel Prize in 2003 for their contributions to the development of magnetic resonance imaging (MRI).
  • Nuclear Medicine studies physiology, while Radiology studies anatomy.

Medical Imaging Techniques

  • X-rays: Discovered in 1901 by Wilhelm Roentgen. These are high-energy electromagnetic radiation able to pass through soft tissues but get absorbed by denser structures, creating images of the internal structure.
  • Radiopharmaceuticals: Radioactive materials are chemical compounds that concentrate in specific organs or tissues to allow visualization of the organ's or tissue's function.
  • CT (Computed Tomography): Developed in 1979, CT scans use X-rays to create detailed cross-sectional images of the body.
  • MRI (Magnetic Resonance Imaging): Discovered in 2003, MRI uses strong magnetic fields and radio waves to create detailed images of the body's soft tissues.

Radioisotopes and Radiopharmaceuticals

  • Radioisotope: A radioactive form of an element that emits radiation.
  • Radiopharmaceutical: A drug containing a radioisotope that targets specific organs or tissues, allowing assessment of their function in relation to the radioisotope's activity.
  • A radiopharmaceutical is made by combining a radioisotope with a pharmaceutical.
  • Example: Fluorine-18 + Glucose = 18F-FDG, a commonly used radiopharmaceutical in PET scans.

Radiation Detectors in Nuclear Medicine

  • Survey meters (ionization chambers, Geiger-Müller): Used for detecting radiation levels.
  • Dose calibrator (ionization chambers): Measures the activity of radioactive sources.
  • Well counter (scintillation detector): Measures the activity in liquid samples.
  • Thyroid probe (scintillation detector): Used to measure thyroid function.

Nuclear Decay Rules

  • Beta-minus (β−) decay: A neutron converts to a proton, emitting an electron and an antineutrino.
  • Beta-plus (β+) decay: A proton converts to a neutron, releasing a positron and a neutrino.
  • Electron capture: A proton absorbs an electron, turning into a neutron and emitting a neutrino.
  • Gamma decay (γ-decay): Changes in nuclear energy levels without alteration in A or Z (atomic number).

Radioactivity

  • Becquerel (Bq): The SI unit of radioactivity, representing one disintegration per second.
  • Curie (Ci): A traditional unit of radioactivity, equaling 3.7 × 10¹⁰ Bq.
  • 1 mCi = 37 MBq
  • Nuclear medicine imaging generally uses 1 to 30 mCi (30 - 1100 MBq).

Physical Half-life (Tp)

  • The time required for the number of radioactive atoms to reduce by half, following exponential decay.
  • Basic equations, incorporating decay constant λ: N₁ = Noe-λt or A₁ = Aoe-λt and T₁/₂ = 0.693/ λ.

Effective Half-life (Te)

  • The time needed for the concentration of a radiopharmaceutical to decrease by half in a biological system due to radioactive decay and physiological clearance.
  • Te = [Tp × Tb] / [Tp + Tb] and if Tp >> Tb, then Te ≈ Tb and if Tp << Tb, then Te ≈ Tp. where Tp = physical half life. Tb is biological half life.

Radionuclides used in Nuclear Medicine

  • The presentation lists various radionuclides and their uses in nuclear medicine (imaging and therapy).

Structural & Functional Imaging

  • Images are used to show either structure or function of body parts and organs.
  • CT & MRI are anatomical imaging techniques.
  • Radioactive tracer methods (e.g., PET, SPECT) are functional imaging techniques.

NM and PET Process

  • The presentation explains the steps in nuclear medicine and positron emission tomography (PET) processes, including how radiopharmaceuticals are used and how images are created.

Why is Nuclear Medicine Different?

  • Nuclear medicine uses the patient's own body as the source of radiation.
  • It is used for functional imaging and not anatomical imaging.

NM Activity Poles

  • Three main roles/groups:
    • Radiopharmacy
    • Physicians (for procedure applications and interpretative analysis)
    • Instrumentation / manufacture (equipment).

Methods for Obtaining a NM Image

  • Administer the radiopharmaceutical (tracer).
  • The radiopharmaceutical concentrates in the desired location(s).
  • The nucleus of the radiopharmaceutical decays and emits gamma rays.
  • Detect the gamma photons using a gamma camera.

Major Components of a Gamma Camera

  • A scintillation crystal (e.g., NaI(Tl)) converts gamma radiation to light.
  • Photomultiplier tubes detect light photons and convert them into electronic signals.
  • Collimators direct detected photons into useful areas of detection.
  • Electronics process the signals from PMTs to form an image.

Major Components of a PET Scanner

  • Multiple rings of detectors to detect photons from positron-electron annihilation.
  • Electronics process the signals from the detector array for reconstructing images.
  • A computer with software to process data and display the image.
  • A system to hold the patient and perform necessary movements for the scan.

Gamma Camera, Scintillation Camera

  • These are two names for the same system.
  • They detect and convert gamma rays into light and then to electronic signals to create an image.

Basic Principle of Scintillation Detectors

  • Gamma rays hit the scintillator and produce light flashes.
  • Photomultiplier tubes detect the light flashes and convert them into electric pulses.

Basic Principle of Gamma Camera

  • Gamma rays hit a crystal causing light flashes.
  • The light flashes are converted to electrical pulses.
  • The pulses determine the energy & position of the incident photons.
  • The system forms an image of the radionuclide distribution in the body.

Nuclear medicine is emission imaging

  • Gamma photons are emitted from inside the patient's body.
  • Relatively poor image quality due to limited photon numbers, image noise, and poor spatial resolution.
  • CT uses transmission imaging.

Nuclear Medicine is Molecular Imaging

  • Interaction of radiopharmaceutical with cells or molecules.
  • Radiopharmaceutical molecules bind to a target molecule.
  • Accumulation by molecular or cellular activities (e.g., 18F-FDG, 99mTc-sestamibi, 131|¯).
  • Molecular or cellular studies (perfusion of heart, brain; metabolism of cancers) lead to earlier diagnosis.

Different Parallel-Hole Collimators

  • Low-energy (LEAP), medium-energy (MEAP), and high-energy (HEAP)
  • Used for different radionuclides and photon energies.
  • Collimators are used in different orientations (e.g., parallel-hole, pin-hole, converging).

Collimators

  • Determine geometric relationships between source and image.
  • Affect count rate and spatial resolution of the result.

Scintillation Process in Detector

  • Detector material converts photons to photons of a different color.
  • The photon numbers are proportional to the energy deposited by the original incident photon.
  • A PMT counts the number of electrons from photons to characterize the energy of the source radiation.
  • The electrical pulse height is proportional to the energy deposited by the original photon in the crystal.

Desirable Scintillator Properties

  • High density (p), atomic number (Z) → high absorption efficiency.
  • High light output → high conversion efficiency and improved energy discrimination.
  • Transparent to emitted light → improved light output linearity, sensitive detector.

Photomultiplier Tube (PMT)

  • Photocathode converts light into electrons.
  • Dynodes amplify the electron signal.
  • Anode collects the amplified electron signal.
  • High efficiency in converting and amplifying incoming light flashes.

Time-of-Flight PET Scan

  • Measures delay between photon detection
  • Improves signal to noise ratio & quality
  • Necessary for wider scan areas/longer scans.

Patient Studies and their Advantages/Disadvantages

  • No overlap of structural images.
  • 3-dimensional lesion locations are measurable.
  • Fusion with high resolution images (CT or MRI) is possible.
  • Time consuming.
  • Images are noisy.

PET Image Formation

  • A positron is emitted from the radioisotope inside the patient.
  • The positron and an electron annihilate, producing 2 gamma photons.
  • The detector determines the direction of the photons, which is directly related to the location of the radioisotope-emitting area in the body.
  • The detectors analyze the time interval between the emissions and assign a location of origin to each image point.

Positron Emission

  • The process in which a proton transforms into a neutron, releasing a positron and neutrino.
  • Fluorine-18 isotope is typically used.
  • Positrons are the antimatter equivalent of electrons.

Detector Materials

  • Various materials are used in different PET imaging systems.
  • Materials considered include BGO, LSO, LYSO, and GSO.

Advantages of PET Imaging

  • Higher spatial resolution.
  • Higher detection efficiency.

Attenuation Correction in PET/CT

  • Used to account for the fact that some gamma photons are lost due to absorption by tissues located between the source of emission and the detector.
  • Attenuation maps and related calculations/models correct the issue and enhance clarity of the image.

Semiquantitative PET

  • Standard Uptake Value (SUV) is commonly used to assess the uptake of radiotracers, primarily in biological samples measured for cancer and other diagnostic purposes
  • Calculated as the ratio of activity in a region of interest (e.g., a tumor) divided by the activity per unit mass of the organ.
  • Used in clinical studies to evaluate diseases

Normalization

  • Correction for individual detector varying performance is called normalization.

Limitation of Functional Imaging

  • Limited spatial resolution.
  • Poor signal-to-noise ratio.
  • Poor uptake in diseased areas.
  • Registration with anatomical images is useful when combining functional and anatomical data.

Typical Oncology Protocol: FDG Scan

  • Administer 10-20 mCi/ml of FDG.
  • In a quiet space, wait 60 minutes to allow for uptake and clearance from blood.
  • Scan from eyes-to-thighs, taking 6-7 scans/positions 15cm.
  • Total scan time ~ 30 minutes.

Patient Dose for FDG Scan

  • Effective dose to patient = ~7 mSv for ~10 mCi of FDG.
  • CT dose for attenuation correction is ~ 5 -18 mSv.
  • Organ of max. dose is typically bladder.

SPECT vs. PET

  • SPECT uses single photons; PET uses coincident photons from the annihilation of positron-electron pairs in the body.
  • PET is better for resolution; SPECT is better for quick acquisition.
  • SPECT resolution is highly dependent on the collimator. Collimator resolution drops with scan distance.
  • SPECT images use one camera at a time, acquiring a single projection at a time.

Advantages of PET Over SPECT

  • Superior spatial resolution, usually less than 2mm.
  • Greater sensitivity for identifying areas of interest with high metabolic activity.
  • Easy attenuation correction.

Limitations of Functional Imaging

  • Limited spatial resolution
  • Poor signal to noise ratio
  • Poor radiotracer uptake in diseased conditions.
  • Combining with anatomical images for more comprehensive diagnosis.

Fusing Anatomy and Function

  • Hand-drawn, visual, software, and hardware fusion methods are used to combine anatomical (e.g., CT) and functional (e.g., PET) imaging data.

History of Dual-Modality Imaging (SPECT/CT and PET/CT)

  • Early prototypes (1990s and 1998) for combining SPECT/CT and PET/CT
  • Full commercial systems installed by approximately 1999 and 2000
  • Combining anatomical and functional imaging information.

Gamma Camera Components

  • Stationary gantry
  • Rotating gantry
  • Detectors
  • Patient table
  • Acquisition station
  • Processing station
  • Transmission acquisition system

PET Scanner Components

  • Gantry
  • Detector ring
  • Patient table
  • Acquisition and processing station

PET/CT Scanner

  • Gantry
  • PET detector module
  • CT detector module
  • Acquisition and processing station
  • Patient table

The PET/CT Power!

  • CT is used for determining if there are anatomical lesions
  • Combining anatomical and functional imaging data for a stronger diagnosis

Anatomic and Functional Imaging

  • Anatomic imaging (CT)
  • Functional imaging (NM)
  • Complementation of modalities (e.g., CT/NM & PET/CT)

Effective Dose of NM Procedures

  • Comprehensive list of effective dose values for different nuclear medicine procedures.
  • Ranges vary based on radionuclide, organ(s) undergoing the procedure, dosage, and other variables.
  • Effective doses are expressed in mSv.
  • Specific activity parameters and other factors must be taken into account when performing effective dose calculations.

Dose Limits

  • Occupational exposure limits, based on recommendations such as NCRP (1993)/ICRP (2007), vary based on type of exposure (e.g., occupational vs. public exposure)
  • Limits are specific for certain regions/parts of the body (e.g., lens of eye, skin, hands/feet) and cumulative exposures (annual/5-year).
  • Occupational exposure and cumulative limits and public exposure limits are expressed in mSv and are usually specific to specific bodies and/or parts of the body.

Other Topics

  • Further information/details on various topics are presented, such as attenuation correction, iterative reconstruction, different detectors (e.g., scintillators and PMTs), time-of-flight (ToF) imaging, and others. Additional details/images explaining the operation, results, and other processes are provided. The details and specific data relate to particular devices and are quite intricate.

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