Experimental study on the location of energy windows for scatter correction by the TEW method in 201Tl imaging]

To investigate validity of scatter correction by the TEW method in 201Tl imaging, we performed an experimental study using the gamma camera with the capability to perform the TEW method and a plate source with a defect. Images were acquired with the triple energy window which is recommended by the gamma camera manufacturer. The result of the energy spectrum showed that backscattered photons were included within the lower sub-energy window and main energy window, and the spectral shapes in the upper half region of the photopeak (70 keV) were not changed greatly by the source shape and the thickness of scattering materials. The scatter fraction calculated using energy spectra and, visual observation and the contrast values measured at the defect using planar images also showed that substantial primary photons were included in the upper sub-energy window. In TEW method (for scatter correction), two sub-energy windows are expected to be defined on the part of energy region in which total counts mainly consist of scattered photons. Therefore, it is necessary to investigate the use of the upper sub-energy window on scatter correction by the TEW method in 201Tl imaging.     

The dual photopeak-area method applied to scintillation camera measurements of effective depth and activity of in vivo 123I-distributions

Attenuation curves and photopeak ratios of 159 keV and 28 keV photons emitted in the decay of 123I have been studied using a scintillation camera equipped with an extra ADC for recording the pulse height distribution of the energy signal. Cavities of various sizes containing 123I-solution were placed at different depths in a water phantom in order to vary the effective depth i.e., the thickness of attenuating material above the cavity plus the distance to the centre of activity in the cavity. The centre of activity varies with the distribution of activity in the cavity, size of cavity, and the effective attenuation coefficient derived from the attenuation curves. From the photopeak ratio an average effective depth is determined which can be used for calculating the attenuation correction factor. The dual photopeak ratio has been used in clinical evaluation of thyoid 123I uptake measurements where effective depths ranging from 21 to 43 mm were obtained for the activity in the thyroid. Applications of the photopeak ratio method for renography with 123I-hippuran and blood flow studies using 133Xe or 127Xe and studies with many other radionuclides are also discussed.     

Simultaneous acquisition of iodine-123 emission and technetium-99m transmission data for quantitative brain single-photon emission tomographic imaging

The aim of this study was to obtain quantitative iodine-123 brain single-photon emission tomographic (SPET) images with scatter and attenuation correction. We used a triple-headed SPET gamma camera system equipped with fan-beam collimators with a technetium-99m line transmission source placed at one of the focal lines of the fan-beam collimators. Four energy windows were employed for data acquisition: (a) 126-132 keV, (b) 132-143 keV, (c) 143-175 keV and (d) 175-186 keV. A simultaneous transmission-emission computed tomography scan (TCT-ECT) was carried out for a brain phantom containing 123I solution. The triple energy window scatter correction was applied to the 123I ECT data measured by means of the windows (b), (c) and (d) acquired by two detectors. Attenuation maps were reconstructed from 99mTc TCT data measured by means of the windows (a), (b) and (c) acquired by one detector. Chang's iterative attenuation correction method using the attenuation maps was applied to the 123I ECT images. In the phantom study cross-calibrated SPET values obtained with the simultaneous mode were almost equal to those obtained with the sequential mode, and they were close to the true value, within an error range of 5.5%. In the human study corrected images showed a higher grey-to-white matter count ratio and relatively higher uptake in the cerebellum, basal ganglia and thalamus than uncorrected images. We conclude that this correction method provides improved quantification and quality of SPET images and that the method is clinically practical because it requires only a single scan with a 99mTc external source.     

Application of models of working at the interface between primary care and mental health services in Israel

A practical method for scatter and attenuation compensation was employed in thallium-201 myocardial single-photon emission tomography (SPET or ECT) with the triple-energy-window (TEW) technique and an iterative attenuation correction method by using a measured attenuation map. The map was reconstructed from technetium-99m transmission CT (TCT) data. A dual-headed SPET gamma camera system equipped with parallel-hole collimators was used for ECT/TCT data acquisition and a new type of external source named "sheet line source" was designed for TCT data acquisition. This sheet line source was composed of a narrow long fluoroplastic tube embedded in a rectangular acrylic board. After injection of 99mTc solution into the tube by an automatic injector, the board was attached in front of the collimator surface of one of the two detectors. After acquiring emission and transmission data separately or simultaneously, we eliminated scattered photons in the transmission and emission data with the TEW method, and reconstructed both images. Then, the effect of attenuation in the scatter-corrected ECT images was compensated with Chang's iterative method by using measured attenuation maps. Our method was validated by several phantom studies and clinical cardiac studies. The method offered improved homogeneity in distribution of myocardial activity and accurate measurements of myocardial tracer uptake. We conclude that the above correction method is feasible because a new type of 99mTc external source may not produce truncation in TCT images and is cost-effective and easy to prepare in clinical situations.     

Validation of the three-dimensional acquisition mode in positron emission tomography for the quantitation of [18F]fluoro-DOPA uptake in the human striata

Three-dimensional (3D) positron emission tomography (PET) is attractive for [18F]fluoro-DOPA studies, since the sensitivity improvement is maximal for radioactive sources located in central planes, which is usually the case for the human striata. However, the image quantitation in that mode must be assessed because of the nearly threefold increase in scattered coincidences. We report the results of [18F]fluoro-DOPA studies performed on six normal volunteers. Each one was scanned in the 3D and two-dimensional (2D) modes on the same tomograph. The quantitation in the 3D and 2D modes was compared for a Patlak graphical analysis with the occipital counts as the input function (Ki) and a striatooccipital ratio analysis. We find that, in 3D PET, a scatter correction is required to preserve the same quantitation as in 2D PET. When the 3D data sets are corrected for scatter, the quantitation of the [18F]fluoro-DOPA uptake, using the Patlak analysis, is similar in the 2D and 3D acquisition modes. Conversely, analysis of the striatooccipital ratio leads to higher values in 3D PET because of a better in-plane resolution. Finally, using the 3D mode, the dose injected to the subjects can be reduced by a factor greater than 1.5 without any loss in accuracy compared to the 2D mode.     

The Mark IV system for radionuclide computed tomography of the brain

The Mark IV scanning system is a simple four-sided arrangement of 32 independent detectors which rotate continously as a unit, detecting, processing, and displaying the reconstructed data while the study progresses. Detection is by single photon counting and is compatible with commercially available radionuclides. An empirical correction is applied for attenuation, difference in detector response, and scatter. It is a high-sensitivity device with approximately uniform resolution throughout the section plane. There is good reproducibility and accuracy for absolute quantification of radionuclide concentration in the brain. Clinical applications include scans of 99mTcO4, 99mTc-RBC, 123I-iodoantipyrine, 99mTc-diphosphonate, and 111In-DTPA.     

Three-window transformation cross-talk correction for simultaneous dual-isotope imaging

A newly developed cross-talk correction method for simultaneous dual-isotope SPECT imaging was tested in a canine model. The method is based on the assumption that the transformations, which modify the primary energy window images into the scatter images as viewed in the other energy windows, are known. These transformations were found by measuring the point spread functions (PSFs) in two different energy windows for both isotopes in water. The dual-isotope correction method is described by two convolution equations which were applied in frequency space. The equations take into account the different spatial distributions of the primary and scatter cross-talk photons. The new enhancement of the method was in applying restoration filters to the resulting corrected images. Three separate studies were acquired in our dog study: two single-isotope and one dual-isotope study. The single isotope images were used as references. The contrast between the left ventricle cavity (LVC) and the myocardium was used in transaxial and short-axis slices as a parameter to evaluate results of dual-isotope correction method with restoration. The change in contrast in the dual-isotope corrected images in both energy windows, i.e., Tc-99m primary window (140 keV) and Tl-201 primary window (70 keV), was significant. The only exception was for the short-axis Tc-99m window images. The corrected 140 keV dual-isotope short-axis slice had the contrast of 0.60 vs 0.58, which was the value in the noncorrected dual-isotope short-axis slice. For dual-isotope 140 keV transaxial slice, the contrast changed from 0.72 to 0.82 after correction. In comparison, for single-isotope Tc-99m 140 keV transaxial slice, contrast changed from 0.62 to 0.84 after restoration correction. There was less change in contrast in the short-axis Tc-99m 140 keV slice, i.e., from 0.56 to 0.61. In the Tl-201 primary window for the transaxial slices the improvement of contrast was from 0.38 to 0.64, and for short-axis slices from 0.22 to 0.32 after correction. In the same 70 keV energy window for single-isotope Tl-201 images, contrast improved from 0.61 to 0.69 and from 0.35 to 0.38 for transaxial and short-axis slice, respectively, after applying restoration correction. In conclusion, the presented dual-isotope correction method with restoration improves the quality of the simultaneous rest Tl-201/stress Tc-99m sestamibi SPECT imaging.     

Energy-based scatter corrections for scintillation camera images of iodine-131

The use of high-dose 131I antibody therapy requires accurate measurement of normal tissue uptake to optimize the therapeutic dose. One of the factors limiting the accuracy of such measurements is scatter and collimator septal penetration. This study evaluated two classes of energy-based scatter corrections for quantitative 131I imaging: window-based and spectrum-fitting. METHODS: The window-based approaches estimate scatter from data in two or three energy windows placed on either side of the 364-keV photopeak using empirical weighting factors. A set of images from spheres in an elliptical phantom were used to evaluate each of the window-based corrections. The spectrum-fitting technique estimates detected scatter at each pixel by fitting the observed energy spectrum with a function that models the photopeak and scatter, and which incorporates the response function of the camera. This technique was evaluated using a set of Rollo phantom images. RESULTS: All of the window-based methods performed significantly better than a single photopeak window (338-389 keV), but the weighting factors were found to depend on the object being imaged. For images contaminated with scatter, the spectrum-fitting method significantly improved quantitation over photopeak windowing. Little difference, however, between any of the methods was observed for images containing small amounts of scatter. CONCLUSION: Most clinical 131I imaging protocols will benefit from qualitative and quantitative improvements provided by the spectrum-fitting scatter correction. The technique offers the practical advantage that it does not require phantom-based calibrations. Finally, our results suggest that septal penetration and scatter in the collimator and other detector-head components are important sources of error in quantitative 131I images.     

Transmission-based scatter correction of 180 degrees myocardial single-photon emission tomographic studies

Meaningful comparison of single-photon emission tomographic (SPET) reconstructions for data acquired over 180 degrees or 360 degrees can only be performed if both attenuation and scatter correction are applied. Convolution subtraction has appeal as a practical method for scatter correction; however, it is limited to data acquired over 360 degrees. A new algorithm is proposed which can be applied equally well to data acquired over 180 degrees or 360 degrees. The method involves estimating scatter based on knowledge of reconstructed transmission data in combination with a reconstructed estimate of the activity distribution, obtained using attenuation correction with broad beam attenuation coefficients. Processing is implemented for planes of activity parallel to the projection images for which a simplified model for the scatter distribution may be applied, based on the measured attenuation. The appropriate broad beam (effective) attenuation coefficients were determined by considering the scatter buildup equation. It was demonstrated that narrow beam attenuation coefficients should be scaled by 0.75 and 0.65 to provide broad beam attenuation coefficients for technetium-99m and thallium-201 respectively. Using a thorax phantom, quantitative accuracy of the new algorithm was compared with conventional transmission-based convolution subtraction (TDCS) for 360 degrees data. Similar heart to lung contrasts were achieved and correction of 180 degrees data yielded a 10.4% error for cardiac activity compared to 5.2% for TDCS. Contrast for myocardium to ventricular cavity was similarly good for scatter-corrected 180 degrees and 360 degrees data, in contrast to attenuation-corrected data, where contrast was significantly reduced. The new algorithm provides a practical method for correction of scatter applicable to 180 degrees myocardial SPET.     

Performance evaluation of a whole-body PET scanner using the NEMA protocol. National Electrical Manufacturers Association

This study evaluates the performance of the newly developed high-resolution whole-body PET scanner ECAT EXACT HR+. METHODS: The scanner consists of four rings of 72 bismuth germanate block detectors each, covering an axial field of view of 15.5 cm with a patient port of 56.2 cm. A single block detector is divided into an 8 x 8 matrix, giving a total of 32 rings with 576 detectors each. The dimensions of a single detector element are 4.39 x 4.05 x 30 mm3. The scanner is equipped with extendable tungsten septa for two-dimensional two-dimensional measurements, as well as with three 68Ge line sources for transmission scans and daily quality control. The spatial resolution, scatter fraction, count rate, sensitivity, uniformity and accuracy of the implemented correction algorithms were evaluated after the National Electrical Manufacturers Association protocol using the standard acquisition parameters. RESULTS: The transaxial resolution in the two-dimensional mode is 4.3 mm (4.4 mm) in the center and increases to 4.7 mm (4.8 mm) tangential and to 8.3 mm (8.0 mm) radial at a distance of r = 20 cm from the center. The axial slice width measured in the two-dimensional mode varies between 4.2 and 6.6 mm FWHM over the transaxial field of view. In the three-dimensional mode the average axial resolution varies between 4.1 mm FWHM in the center and 7.8 mm at r = 20 cm. The scatter fraction is 17.1% (32.5%) for a lower energy discriminator level of 350 keV. The maximum true event count rate of 263 (345) kcps was measured at an activity concentration of 142 (26.9) kBq/ml. The total system sensitivity for true events is 5.7 (27.7) cps/Bq/ml. From the uniformity measurements, we obtained a volume variance of 3.9% (5.0%) and a system variance of 1.6% (1.7%). The implemented three-dimensional scatter correction algorithm reveals very favorable properties, whereas the three-dimensional attenuation correction yields slightly inaccurate results in low- and high-density regions. CONCLUSION: The ECAT EXACT HR+ has an excellent, nearly isotropic spatial resolution, which is advantageous for brain and small animal studies. While the relatively low slice sensitivity may hamper the capability for performing fast dynamic two-dimensional studies, the scanner offers a sufficient sensitivity and count rate capacity for fully three-dimensional whole-body imaging.     

Calcium mobilization evoked by amyloid beta-protein involves inositol 1,4,5-triphosphate production in human platelets

In the radionuclide imaging by 201Tl several K-X rays are acquired, so it is difficult to eliminate scattered photons in the acquired photons. This paper describes the limitation and efficiency of the triple energy window (TEW) method in the application of 201Tl myocardial studies. We evaluated the TEW method by simulations and the setting of the parameters in the TEW method were 20, 30 and 40% for the width of the main window, 3, 5 and 7% for the width of the two sub-windows. Moreover, the location of the main window was shifted by each 1 keV from 60 to 80 keV. Simulation results were evaluated with the mean square error between true scattered photons and estimated scattered photons. The results show that the mean square error was minimized when the widths of the main window were 20, 30 and 40%, and the centers of the main window were 66-68, 69-70 and 72-73 keV, respectively.     

Multiple line source array for SPECT transmission scans: simulation, phantom and patient studies

Accurate attenuation and scatter corrections in quantitative SPECT studies require attenuation maps of the density distribution in the scanned object. These can be obtained from simultaneous emission/transmission scans. METHODS: A new method has been developed using a multiple line source array (MLA) for transmission scans, and its performance has been investigated using computer simulations and experimental data. The activity in the central lines of the MLA was higher than at the edges of the system, so that more transmission photons would be directed toward the thicker parts of the human body. A series of transmission-only and simultaneous emission/transmission studies were performed for different phantom configurations and human subjects. Attenuation maps were generated and used in reconstruction of attenuation-corrected emission images. RESULTS: The mu coefficients for attenuation maps obtained using the MLA system and simulated and experimental data display no artifacts and are qualitatively and quantitatively correct. For phantoms, the agreement between the measured and the true value of mu for water was found to be better than 4%. The attenuation-corrected emission images for the phantom studies demonstrate that the activity in the heart can be accurately reconstructed. A significant qualitative improvement was also obtained when the attenuation correction was used on patient data. CONCLUSION: Our results indicate that the MLA transmission source can be used in simultaneous transmission/emission imaging to generate accurate attenuation maps. These maps allow for performing an object-specific, attenuation correction of the emission images.     

Combined scatter and attenuation correction for 201Tl myocardial perfusion SPECT using OS-EM algorithm

There are two possible ways to obtain scatter-corrected images with the ML-EM (maximum likelihood expectation maximization) algorithm: one is the subtraction of scatter estimate si from projection data pi, and then (pi-si) is used for scatter-corrected projection data (denoted as SC(T)); the other method is the addition of scatter estimate si to the projections calculated from the reconstructed image without performing data subtraction (SC(E)). This paper investigated these two ML-EM algorithms of combined scatter and attenuation correction on 201Tl myocardial perfusion SPECT imaging. Scatter windows were placed one full width at half maximum (FWHM) below and above the photopeak centerline. The scatter fraction in the primary peak was estimated using trapezoidal approximation by the triple energy window method. Phantom and clinical images were reconstructed using 6 iterations of ordered subsets EM algorithm (OS-EM). A cylindrical phantom with a cold-rod insert and a heart/thorax phantom with liver insert were used to evaluate scatter and the attenuation compensation technique. A cylindrical phantom filled with uniform 201Tl solution was used to evaluate statistical noise. The percent root-mean-square uncertainty (%RMSU) was used as a quantitative measure of noise amplification. %RMSU showed that the SC(E) method amplified noise less in comparison with the SC(T) method, however, no significant difference in image quality was observed between the two methods. In conclusion, both the SC(T) and SC(E) methods provided significant and similar improvement in the removal of scatter in 201Tl myocardial perfusion SPECT imaging.     

A simplified approach to radionuclide venography: concise communication

A simplified method has been developed for performing radionuclide venography. The method makes use of the scintillation camera and a synchronized whole-body scanning bed. This technique permits a more integrated presentation of the data and is performed in conjunction with a standard ventilation-perfusion lung study. The total amount of 99mTc tracer injected is 2 mCi.     

Attenuation compensation for cardiac single-photon emission computed tomographic imaging: Part 1. Impact of attenuation and methods of estimating attenuation maps

Attenuation is believed to be one of the major causes of false-positive cardiac single-photon emission computed tomographic (SPECT) perfusion images. This article reviews the physics of attenuation, the artifacts produced by attenuation, and the need for scatter correction in combination with attenuation correction. The review continues with a comparison of the various configurations for transmission imaging that could be used to estimate patient specific attenuation maps, and an overview of how these are being developed for use on multiheaded SPECT systems, including discussions of truncation, noise, and spatial resolution of the estimated attenuation maps. Ways of estimating patient specific attenuation maps besides transmission imaging are also discussed.     

Simulation study of the influence of collimator defects on the uniformity of scintigraphic images

The mechanical tolerances in building collimators for scintillation cameras are studied. A simulation method has been used to quantify the effects of defects in hole inclination and hole diameter on the uniformity of planar and tomographic images. The calculation takes into account the geometry of the hexagonal hole collimator, the camera intrinsic resolution, the object size, the pixel size, the effect of low-pass filtering, as well as the type, size and position of the defect. For instance, a 0.03 mm diameter defect on several holes located in the central region of a very high resolution collimator can result in a 12% uniformity artefact in tomographic imaging of an 18 cm diameter cylinder, using a 3.45 mm resolution camera, 4.5 mm pixel size, and Hamming filtering with a Nyquist frequency cut-off. A 0.17 degree inclination defect of a few holes can result in the same uniformity artefact. These results show that the building of a collimator has to be very precise.     

An attenuation measurement technique for rotating planar detector positron tomographs

This paper presents a new attenuation measurement technique suitable for rotating planar detector positron tomographs. Transmission measurements are made using two unshielded positron-emitting line sources, one attached to the front face of each detector. Many of the scattered and accidental coincidences are rejected by including only those coincidences that form a vector passing within a predetermined distance of either line source. Some scattered and accidental coincidences are still included, which reduces the measured linear attenuation: in principle their contribution can be accurately estimated and subtracted, but in practice, when limited statistics are available (as is the case with the multi-wire Birmingham positron camera), this background subtraction unacceptably increases the noise. Instead an attenuation image having the correct features can be reconstructed from the measured projections. For objects containing only a few discrete linear attenuation coefficients, segmentation of this attenuation image reduces noise and allows the correct linear attenuation coefficients to be restored by renormalization. Reprojection through the segmented image may then provide quantitatively correct attenuation correction factors of sufficient statistical quality to correct for attenuation in PET emission images.     

Accounting for the variation in collision kerma-to-terma ratio in polyenergetic photon beam convolution

In photon beam convolution, the distribution of energy deposition about a primary photon interaction site due to charged particles set in motion at that site is represented by the primary kernel. Energy deposited due to scattered photons, bremsstrahlung, and annihilation photons is represented by the scatter kernel. As the energy deposited in each kernel voxel is normalized to the energy imparted at the interaction site, it is known as a fractional energy distribution. In terma-based convolution, where kernels are normalized to total energy imparted at the interaction site and are convolved with the terma in the dose calculation process, the sum of fractional energies contained in the primary kernel is equal to the ratio of collision kerma (Kc) to terma (T) corresponding to the energy spectrum used to generate the kernel. Since the ratio of collision kerma to terma increases with depth as the beam hardens, the integral fractional energy in a primary kernel formed for the spectrum at the surface is less than the ratio Kc/T at depth. This causes primary dose to be increasingly underestimated with depth and scatter dose to be increasingly overestimated. Single polyenergetic convolution (using polyenergetic primary and scatter kernels formed using a polyenergetic primary photon spectrum) is thus not as rigorous as if a separate convolution is performed for each energy component. The ratio of true primary dose to single polyenergetic primary dose increases almost linearly with depth and is almost equal to the Kc/T ratio. Primary and scatter dose are calculated correctly if a single polyenergetic convolution is performed in terms of Kc (for primary) and T-Kc (for scatter), where the kernels are weighted sums of monoenergetic kernels normalized to Kc and T-Kc. With this method, it is ensured that total primary energy deposited due to primary photon interactions in a unit mass at a point is equal to Kc at that point.     

A CT assisted method for absolute quantitation of internal radioactivity

A method is described for the determination of radioactivity (microCi or MBq) at an organ site within an object or patient. Using both anatomic image data (CT or MRI scans) and planar gamma camera images, activity at depth is determined using a matrix inversion method based on least squares. The result of the inversion analysis was the unknown set of n linear (uniform) activity densities representative of each organ within the phantom or patient. The problem was overdetermined since the number of unknown activity densities (microCi/cm) was much less than the number of analysis points (N) within the nuclear image. This method, defined as the CT assisted matrix inversion (CAMI) technique, was accurate to within 15% for a three "organ" plastic phantom, wherein the organs were right circular cylinders having activities of 74 to 508 microCi (or 2.74 MBq to 18.8 MBq). This accuracy included image quantitation effects, particularly assumptions concerning attenuation correction. The average absolute percent error of the estimated activity in four distinct radioactive volumes in the phantom was 9.8%. It was found that the background activity within the phantom was estimated to be too high if sampling regions near strong sources were used in the analysis (scatter effect). This was minimized by going at least 2 cm away from such sources. By applying the method to a monoclonal antibody clinical study, activities within the patient's major organs such as liver, spleen, and kidney could be estimated, even in cases where the organ could not be visualized. Here, the CAMI algorithm gave internally consistent results for the patient's left and right lung linear activity concentrations. The CAMI technique resolves the problem of tissue superimposition using depth information from 3-D CT and is applicable in cases where a number of organs overlap in the gamma camera image. Thus, the method should be generally useful to nuclear image quantitation and the estimation of absorbed radiation doses in patients. One particular application is the estimation of radiation doses in radioimmunotherapy (RIT).     

Calculated energy response correction factors for LiF thermoluminescent dosemeters employed in the seventh EULEP dosimetry intercomparison

Several dosimetry intercomparisons for whole body irradiation of mice have been organized by the European Late Effects Project Group (EULEP). These studies were performed employing a mouse phantom loaded with LiF thermoluminescent dosemeters (TLDs). In-phantom, the energy response of the LiF TLDs differs from free-in-air, due to spectral differences caused by attenuation and scatter of x-rays. From previous studies, energy response correction factors in-phantom relative to free-in-air were available for full scatter conditions. In the more recent intercomparisons, however, full scatter conditions were not always employed by the participants. Therefore, Monte Carlo calculations of radiation transport were performed to verify the LiF TLD energy response correction factors in-phantom relative to free-in-air for full scatter conditions and to obtain energy response correction factors for geometries where full scatter conditions are not met. For incident x-rays with HVLs in the 1 to 3.5 mm Cu range, the energy response correction factor in-phantom deviates by 2 to 4 per cent from that measured free-in-air. This is in reasonable agreement with previously published results. The energy response correction factors obtained from the present study refer to a calibration in terms of muscle tissue dose in-phantom using 60Co gamma rays. For geometries where full scatter conditions are not fulfilled, the energy response correction factors are different by up to about 3 per cent at maximum from that at full scatter conditions. The dependence of the energy response correction factor as a function of the position in-phantom is small, i.e. about 1 per cent at maximum between central and top or bottom positions.