Three-dimensional PET emission scan registration and transmission scan synthesis

The duration of a positron emission tomography (PET) imaging scan can be reduced if the transmission scan of one patient which is used for emission correction can be synthesized by using the reference transmission scan of another patient. In this paper, we propose a new intersubjects PET emission scan registration method and PET transmission synthesis method by using the boundary information of the body or brain scan of the PET emission scans. The PET emission scans have poor image quality and different intensity statistics so that we preprocess the emission scans to have similar histogram and then apply the point distribution model (PDM) [15] to extract the contours of the emission scan. The extracted boundary contour of every slice is used to reconstruct the three-dimensional (3-D) surface of the reference set and the target set. Our registration is 3-D surface-based which uses the normal flow method [17] to find the correspondence vector field between two 3-D reconstructed surfaces. Since it is difficult to analyze internal organ using the PET emission scan imaging without correction, we assume that the deformation of internal organ is homogeneous. With the corresponding vector field between the two emission scans and the transmission scan of the reference set, we can synthesize the transmission scan of the target set.     

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.     

Helical CT reconstruction with longitudinal filtration

Each of the currently used helical reconstruction algorithms represents one tradeoff selection of the image noise or mA requirement and resultant artifacts versus the width of the section profile. For many applications, the performance tradeoffs different from those existed are desired. In this paper, we present a general framework of incorporating the longitudinal (z) filtration in helical CT reconstruction, which leads to a new class of helical reconstruction algorithms with tunable performance characteristics to suit various applications. The z-filtering algorithm enables us to derive the performance curve of image noise or mA requirement versus the width of the section profile, whereas the existing helical reconstruction algorithms only represent limited discrete samples of the curve. We demonstrate that using a new helical reconstruction algorithm derived from this general framework, a substantial reduction in image noise or mA requirement can be achieved with a slight increase of FWHM of the section profile. Thus for many applications requiring both compact section profile and low image noise or mA requirement, the new algorithm represents a better tradeoff than both the 180 degrees and 360 degrees interpolation algorithms. The new algorithm also offers the following potential clinical benefits: (1) longer x-ray tube life; (2) longer scan duration with less x-ray tube cooling delays--longer volume coverage and/or longer thin-slice scan; (3) less radiation to patient; (4) less image noise; and (5) less helical artifacts. Initial clinical results are also presented.     

Significance of nonuniform attenuation correction in quantitative brain SPECT imaging

The purposes of this study were to develop a method for nonuniform attenuation correction of 123I emission brain images based on transmission imaging with a longer-lived isotope (i.e., 57Co) and to evaluate the relative improvement in quantitative SPECT images achieved with nonuniform attenuation correction. METHODS: Emission and transmission SPECT scans were acquired on three different sets of studies: a heterogeneous brain phantom filled with 1231 to simulate the distribution of dopamine transporters labeled with 2beta-carbomethoxy-3beta-(4-123I-iodophenyl)tropane (123I-beta-CIT); nine healthy human control subjects who underwent transmission scanning using two separate line sources (57Co and 123I); and a set of eight patients with Parkinson's disease and five healthy control subjects who received both emission and transmission scans after injection of 123I-beta-CIT. Attenuation maps were reconstructed using a Bayesian transmission reconstruction algorithm, and attenuation correction was performed using Chang's postprocessing method. The spatial distribution of errors within the brain was obtained from attenuation correction factors computed from uniform and nonuniform attenuation maps and was visualized on a pixel-by-pixel basis as an error image. RESULTS: For the heterogeneous brain phantom, the uniform attenuation correction had errors of 2%-6.5% for regions corresponding to striatum and background, whereas nonuniform attenuation correction was within 1%. Analysis of 123I transmission images of the nine healthy human control subjects showed differences between uniform and nonuniform attenuation correction to be in the range of 6.4%-16.0% for brain regions of interest (ROIs). The human control subjects who received transmission scans only were used to generate a curvilinear function to convert 57Co attenuation values into those for 123I, based on a pixel-by-pixel comparison of two coregistered transmission images for each subject. These values were applied to the group of patients and healthy control subjects who received transmission 57Co scans and emission 123I scans after injection of 123I-beta-CIT. In comparison to nonuniform attenuation correction as the gold standard, uniform attenuation with the ellipse drawn around the transmission image caused an approximately 5% error, whereas placement of the ellipse around the emission image caused a 15% error. CONCLUSION: Nonuniform attenuation correction allowed a moderate improvement in the measurement of absolute activity in individual brain ROIs. When images were analyzed as target-to-background activity ratios, as is commonly performed with 123I-beta-CIT, these outcome measures showed only small differences when Parkinson's disease patients and healthy control subjects were compared using nonuniform, uniform or even no attenuation correction.     

Dual-slice spiral versus single-slice spiral scanning: comparison of the physical performance of two computed tomography scanners

In this paper we deal with two types of spiral scanners; one is a single-slice spiral scanner, while the other employs dual-slice technology into spiral scanning. Physical performance parameters, including image noise, contrast resolution, spatial resolution (transversal and longitudinal), and radiation exposure are measured. Computer simulations based on two interpolation methods (180 degrees and 360 degrees linear interpolation) are also used in evaluating the slice-sensitivity profile (SSP) and noise. The results show that the noise behaves in the same way for both types of scanners. The noise change, relative to that of the standard scan with the same scanning parameters, depends solely on the interpolation algorithm. Table speed and scanner geometry (either single slice or dual slice) have no effect on the noise value. For the given table speed, as well as individual detector collimation (slice width) the dual-slice scan results in better longitudinal resolution (SSP) compared to a single-slice scan if the scan is obtained with nonoverlapping slices (pitch greater than 2). This is because the dual-slice scan obtains twice the number of nonoverlapped projections for the same length, which reduces the degradation of the slice profile by using more densely arranged projections (in the longitudinal direction) for the interpolation. In the dual-slice scanner the workable scan rate is extended up to pitch 4 compared to a pitch of 2 for the single-slice scanner. Therefore, the dual-slice spiral scanner is preferred in applications requiring an increased scan rate with comparative image quality.     

Dosimetry of transmission measurements in nuclear medicine: a study using anthropomorphic phantoms and thermoluminescent dosimeters

Quantification in positron emission tomography (PET) and single photon emission tomographic (SPET) relies on attenuation correction which is generally obtained with an additional transmission measurement. Therefore, the evaluation of the radiation doses received by patients needs to include the contribution of transmission procedures in SPET (SPET-TM) and PET (PET-TM). In this work we have measured these doses for both PET-TM and SPET-TM. PET-TM was performed on an ECAT EXACT HR+ (CTI/Siemens) equipped with three rod sources of germanium-68 (380 MBq total) and extended septa. SPET-TM was performed on a DST (SMV) equipped with two collimated line sources of gadolinium-153 (4 GBq total). Two anthropomorphic phantoms representing a human head and a human torso, were used to estimate the doses absorbed in typical cardiac and brain transmission studies. Measurements were made with thermoluminescent dosimeters (TLDs, consisting of lithium fluoride) having characteristics suitable for dosimetry investigations in nuclear medicine. Sets of TLDs were placed inside small plastic bags and then attached to different organs of the phantoms (at least two TLDs were assigned to a given organ). Before and after irradiation the TLDs were placed in a 2.5-cm-thick lead container to prevent exposure from occasional sources. Ambient radiation was monitored and taken into account in calculations. Transmission scans were performed for more than 12 h in each case to decrease statistical noise fluctuations. The doses absorbed by each organ were calculated by averaging the values obtained for each corresponding TLD. These values were used to evaluate the effective dose (ED) following guidelines described in ICRP report number 60. The estimated ED values for cardiac acquisitions were 7.7 x 10(-4) +/- 0.4 x 10(-4) mSv/MBq.h and 1.9 x 10(-6) +/- 0.4 x 10(-6) mSv/MBq.h for PET-TM and SPET-TM, respectively. For brain scans, the values of ED were calculated as 2.7 x 10(-4) +/- 0.2 x 10(-4) mSv/MBq.h for PET-TM and 5.2 x 10(-7) +/- 2.3 x 10(-7) mSv/MBq.h for SPET-TM. In our institution, PET-TM is usually performed for 15 min prior to emission. SPET-TM is performed simultaneously with emission and usually lasts 30 and 15 min for brain and cardiac acquisitions respectively. Under these conditions ED values, estimated for typical source activities at delivery time (22,000 MBq in SPET and 555 MBq for PET), were 1.1 x 10(-1) +/- 0.1 x 10(-1) mSv and 1.1 x 10(-2) +/- 0.2 x 10(-2) mSv for cardiac PET-TM and SPET-TM respectively. For brain acquisitions, the ED values obtained under the same conditions were 3.7 x 10(-2) +/- 0.3 x 10(-2) mSv and 5.8 x 10(-3) +/- 2.6 x 10(-3) mSv for PET-TM and SPET-TM respectively. These measurements show that the dose received by a patient during a transmission scan adds little to the typical dose received in a routine nuclear medicine procedure. Radiation dose, therefore, does not represent a limit to the generalised use of transmission measurements in clinical SPET or PET.     

Correction of background noise in direct digital dental radiography

OBJECTIVES: To clarify the source of noise in direct digital intra-oral radiography with RVG-S (Trophy Radiologie, Vincennes, France) and to use these to develop a method for correction of background noise. METHODS: Sensor temperature, image acquisition time and X-ray dose were independently analysed with the IPLab Spectrum (Signal Analytics, Vienna, VA) software. RESULTS: The decrease in pixel value due to the dark current was linearly related to the image acquisition time. Although a variation in sensitivity was observed when the sensor was exposed to X-rays, the mean pixel value of the entire image was linearly related to the exposure time. The image showing only the signal due to X-ray dose was derived from the original RVG-S image by correcting for the dark current and the pixel-by-pixel sensitivity variation of the CCD sensor. CONCLUSION: The image formed only by X-ray dose distribution can be derived by correcting for the background noise.     

"Anatometabolic" tumor imaging: fusion of FDG PET with CT or MRI to localize foci of increased activity

Positron emission tomographic (PET) images of visceral cancers are commonly visualized as "hot spots" of increased activity with relatively little normal anatomy discernable, when 2-[18F]-fluoro-2-deoxy-D-glucose (FDG) is used as the tracer. We describe a method by which computed tomography or magnetic resonance anatomic images can be digitally fused in three dimensions, using a rigid rotate-translate scale model with PET "metabolic" images, to simultaneously display registered anatomic and metabolic information. Such "anatometabolic" fusion images were produced in 10 patients with a variety of visceral cancers. External fiducial markers placed during both the anatomic and the metabolic study, as well as internal anatomic fiducials defined from landmarks observed on reconstructed transmission images, were used to achieve image fusion. The mean error magnitude +/- s.e.m. of fiducial registration in the nine patients with successful realignments was 5.0 +/- 0.8 mm. The mean accuracy in realignment between known anatomic structures seen on both the anatomic study and on the emission PET scan (but not used in realignment) was 6.3 +/- 0.8 mm. Localization of foci of increased FDG uptake to specific anatomic structures was achieved by this method, which represented an enhancement over the rudimentary anatomy available from the emission images alone. Anatometabolic fusion images made using this reasonably simple method should prove useful in the management of patients with cancer and other diseases.     

Relativistic coupled-cluster calculations for open-shell atoms

A procedure for patient repositioning and compensation for misalignment between transmission and emission data in positron emission tomography (PET) heart studies has been developed. Following the transmission scan (TR1), patients are moved from the scanner bed for the administration of the tracer, and repositioned when ready for the emission scan (EM1). A short postinjection transmission scan (TR2) is performed at the end of the EM1 study. TR1 and TR2 images are compared to recognize misalignment between transmission and emission studies. TR1 sinograms are compensated for misalignment to allow for a proper attenuation correction. The procedure has been tested on phantom and [18F]FDG PET heart studies. Misalignments down to 2.5 mm translation and 1 degree rotation in the transaxial plane and 4 mm in the axial direction can be recognized and compensated for. The procedure is suitable for clinical purposes, allowing reduction of patient time on the scanner bed, increased patient comfort and significant increase of patient throughput.     

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.     

Human biodistribution and dosimetry of the PET perfusion agent copper-62-PTSM

Copper-62-pyruvaldehyde bis(N4-methyl)thiosemicarbazone (PTSM) has been proposed as a generator-produced radiopharmaceutical for perfusion imaging using PET. Several clinical studies have demonstrated the ability of 62Cu-PTSM to quantitate myocardial and cerebral perfusion in humans. Because 62Cu-PTSM is generator-produced, it can be provided to clinical centers without cyclotron availability and, therefore, represents a cost-effective, practical PET perfusion tracer for clinical applications. To assess the safety, time-dependent biodistribution, and whole-body and organ-specific absorbed radiation dose estimates of this tracer, a Phase I study of 62Cu-PTSM was performed using whole-body imaging with PET in 10 healthy volunteers and with the radiopharmaceutical delivered by a compact modular generator unit. METHODS: Five male and five female subjects underwent a series of clinical tests and head-to-midthigh, whole-body PET scans at three time points over 1 hr after intravenous injection of 62Cu-PTSM. Before injection of the tracer, PET transmission scans were performed and used to correct the emission data for attenuation. Final image data were expressed in units of mCi/cc. Using standard organ weights, the percent injected dose per organ was calculated. Biodistribution data were obtained at three different time points and from these data biological half-lives in different organs were determined for calculation of radiation absorbed dose estimates. RESULTS: The liver was seen as the critical organ receiving a dose of 0.0886 rad/mCi. This organ defined the maximum single injected dose at 56 mCi using the limit of 5 rads to a critical organ per study per year. The whole-body dose is 0.0111 rad/mCi, resulting in a 0.622 rad exposure with a maximum single injection dose. Only trace levels of activity were found in the urine, which suggests low levels of urinary excretion and bladder exposure. No significant clinical, electrocardiographic or laboratory abnormalities were seen after the injection of 62Cu-PTSM. CONCLUSION: Copper-62-PTSM is a clinically safe radiopharmaceutical with favorable dosimetry for human studies at injected doses significantly above those projected for use in clinical studies.     

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.     

Behavioral effects of atriopeptin in rats

High densities of atriopeptin-immunoreactive fibers and of highly specific and selective atriopeptin receptor sites are present in brain areas involved in animal behavior. The possible influence of these peptides on behavior was thus investigated in adult rats. The intracerebroventricular injection of atriopeptin II modified male sexual behavior (reduction in mount latency) at the dose of 5 micrograms/animal; lower and higher doses were ineffective. Open-field behavior was also modified by i.c.v. atriopeptin II at the doses of 5 and 10 micrograms/rat, which induced an increase in the number of external and internal crossings and of external rearings. Finally, in fasted rats, atriopeptin II, at the dose of 10 micrograms/rat, significantly increased the amount of food intake 30 and 60 min after injection. These findings indicate that atriopeptins may modify different animal behaviors.     

Transcranial magnetic stimulation during PET: reaching and verifying the target site

Transcranial magnetic stimulation (TMS) during positron emission tomography (PET) is a novel technique for in vivo measurements of connectivity and excitability of the human cerebral cortex. Here we describe tools that allow investigators to position the stimulating coil over a target region and to verify the actual position of the coil after the study. The former is achieved by coregistering the head of the subject with an MR image of his/her brain using frameless stereotaxy. The latter is accomplished by identifying the coil on a transmission scan and coregistering it, e.g., with a model of the electrical field induced in the brain.     

The evaluation of three dimensional image distortion of helical scanning CT

We developed a computer algorithm to simulate distortion in the three-dimensional (3D) displays obtained by helical scanning. The algorithm constitutes calculation of the image profile in the longitudinal direction, which is assumed to be a convolution of the object function with the slice sensitivity profile (SSP) of helical scanning. Experiments were performed to examine the algorithm for its validity with the use of a K2HPO4 phantom. Simulated results and measurements was in a good agreement. The distortion was investigated by the computer simulation. The model simulated was a high density object (Ol) surrounded by low density tissue (Os). The helical interpolation used was 360-degree linear interpolation. Two parameters were defined: delta Lz, which is the difference in length between the 3D image and the actual object Ol in the longitudinal direction, and the cut level index (CLI), which is defined as CLI = (Cut Level CT Number-CT Number of Os)/(CT Number of OI-CT Number of Os). We found that magnitude of delta Lz increased depending on the table feed distance per 360-degree scan (Dt). When Ol was twice as long as Dt, delta Lz directly depended on CLI, but was independent of Ol length. When Ol length was longer than Dt, delta Lz was shown to be 0 at CLI not equal to 0.5 at every Dt. When Ol was shorter than Dt, delta Lz decreased remarkably depending on the length of Ol in higher CLI. The simulations, with the use of a newly developed algorithm, were demonstrated to be useful for evaluating the amount of distortion and for better understanding the characteristics of 3D displays of helical scanning.     

Calculation of single detector efficiencies and extension of the normalization sinogram in PET

A fast iterative method is presented for calculating single detector efficiencies for positron emission tomographs. These efficiencies can be used to extend the normalization scan to areas outside that covered by the normalization source. The root mean square (rms) error of the calculated single detector efficiencies decreases exponentially with the number of iterations. Thirty iterations per normalization image are sufficient and take about 1 s on a SUN Classic. The geometry factors are composed of factors which only depend on the distance from the centre of the field-of-view (FOV) and of factors which show a more complex pattern over the normalization sinogram. The geometry factors are specific to each scanner. On the ECAT 931 scanner the complex part of the geometry factors showed a diamond shaped pattern (caused by the varying sensitivity of single detectors in a detector block with varying angle of incidence) and S-shaped curves (representing attenuation caused by supporting rods for the ring source). The coefficient of variation of the diamond-shaped pattern was 4% for detectors farthest from the centre of the FOV. Extensions of the normalization scan may, therefore, contain a relative rms error of about 4% if the applied geometry factors only take the distance from the centre of the FOV into account.     

PET imaging of prostate cancer using carbon-11-choline

Prostate cancer is difficult to visualize using current techniques. Recently, 31P magnetic resonance spectroscopy has revealed that the tumor, in general, is characterized by an increased uptake of choline into the cell to meet increased synthesis of phosphatidylcholine, an important cell membrane phospholipid. We succeeded in using 11C-choline to visualize prostate cancer and its local metastasis in PET. METHODS: PET was performed on 10 prostate cancer patients from the level of pelvis to the lower abdomen. After transmission scanning, 370 MBq 11C-choline were injected intravenously. The emission scan was performed 5-15 min postinjection. Finally, PET images were displayed so that each pixel was painted by a specified color representing the degree of the standardized uptake value (SUV). The 11C-choline image was compared with the 18F-fluorodeoxyglucose (FDG) image obtained from the same patient. RESULTS: Imaging of prostate cancer and its local metastasis was difficult when 18F-FDG was used because, within the pelvis, the areas of high uptake were concealed by the overwhelmingly abundant radioactivity in urine (in ureters and bladder). By contrast, it was easy when 11C-choline was used because the urinary activity was negligible and tumor uptake was marked. The radioactivity concentration of 11C-choline in prostate cancer and metastatic sites was at an SUV of more than three in most cases. The SUV of 18F-FDG was considerably lower than that of 11C-choline. CONCLUSION: Prostate cancer and its local metastasis were visualized clearly in PET using 11C-choline.     

Image quality in dynamic CT: a clinical discussion

Modern state-of-the-art computed tomographic (CT) scanners emphasize three capabilities: image quality, dynamic scan capability, and a high-resolution thin-section technique. Image quality is fundamental and dependent on optimum performance and the interrelationship of all system components. Variables that affect the performance of the scanner include x-ray tube output and rate of heat dissipation; quantum detection efficiency; electronic noise in the acquisition system; speed, accuracy, and integration of mechanical motion in the gantry and table; and the algorithm used for image reconstruction. System design must allow for dynamic scan operation, either in the single-scan or cluster mode, with short interscan or intergroup delays or, as more recently developed, with helical acquisition. Dynamic scanning is frequently used for nonneurologic applications, including diagnosis of vascular and perivascular diseases and multifocal organ disease, particularly hepatic disease. Efficient operation depends on rapid reconstruction and display capability. Modern systems have been engineered to provide flexible modes of operation, particularly in dynamic scanning, and rapid on-line review and analysis, all of which serve to improve the quality of images produced with dynamic CT scanning.