Scatter correction in scintigraphy: the state of the art

99mTc/123I Dual-Radionuclide Correction for Self-Scatter, Down-Scatter, and Tailing Effect for a CZT SPECT with Varying Tracer Distributions

SPECT systems distinguish radionuclides by using multiple energy windows. For CZT detectors, the energy spectrum has a low energy tail leading to additional crosstalk between the radionuclides. Previous work developed models to correct the scatter and crosstalk for CZT-based dedicated cardiac systems with similar 99mTc/123I tracer distributions. These models estimate the primary and scatter components by solving a set of equations employing the MLEM approach. A penalty term is applied to ensure convergence. The present work estimates the penalty term for any 99mTc/123I activity level. An iterative approach incorporating Monte Carlo into the iterative image reconstruction loops was developed to estimate the penalty terms. We used SIMIND and XCAT phantoms in this study. Distribution of tracers in the myocardial tissue and blood pool were varied to simulate a dynamic acquisition. Evaluations of the estimated and the real penalty terms were performed using simulations and large animal data. The myocardium to blood pool ratio was calculated using ROIs in the myocardial tissue and the blood pool for quantitative analysis. All corrected images yielded a good agreement with the gold standard images. In conclusion, we developed a CZT crosstalk correction method for quantitative imaging of 99mTc/123I activity levels by dynamically estimating the penalty terms.

Investigating the lesion detectability of Tc-99m planar scintigraphy acquired with LEHRS collimator for patients with different body sizes: A phantom study

Purpose

The aim of this work was to investigate the lesion detectability of Tc‐99m planar scintigraphy acquired with a low‐energy high‐resolution and sensitivity (LEHRS) collimator and processed by Clarity 2D for patients with different body sizes through phantom study.

Methods

A NEMA IEC body phantom set was covered by two layers of 25‐mm‐thick bolus to construct phantom in three different sizes. All image data were performed on a Discovery NM/CT 870 DR with an LEHRS collimator and processed by Clarity 2D with blend ratio a of 0%, 20%, 40%, 60%, 80%, and 100%. The lesion detectability in gamma scintigraphy was evaluated by calculating the contrast‐to‐noise ratio (CNR). Multiple linear regression methods were used to analyze the impact of body size, target size, and Clarity 2D blending weight on the lesion detectability of Tc‐99m planar scintigraphy.

Results

It was found that changing the blend ratio could improve CNR, and this phenomenon was more significant in anterior view than in posterior view. Our results also suggested that the blend ratio should be selected according to patient body size in order to maintain consistent CNR. Hence, when a blend ratio of 60% was used for a patient before cancer treatment, a lower blend ratio should be used for the same patient experiencing treatment‐related weight loss to achieve consistent lesion detectability in Tc‐99m planar scintigraphy acquired with LEHRS and processed by Clarity 2D.

Conclusion

The magnitude of photon attenuation and scattering is higher in patients with larger body size, so Tc‐99m planar scintigraphy usually has lower lesion detectability in obese patients. Although photon attenuation and scattering are inevitable during image formation, their impacts on image quality can be eased by employing appropriate image protocol parameters.

Quantitative SPECT/CT for dosimetry of peptide receptor radionuclide therapy

Neuroendocrine tumors (NETs) are uncommon malignancies of increasing incidence and prevalence. As these slow growing tumors usually overexpress somatostatin receptors (SSTRs), the use of ⁶⁸Ga-DOTA-peptides (gallium-68 chelated with dodecane tetra-acetic acid to somatostatin), which bind to the SSTRs, allows for PET based imaging and selection of patients for peptide receptor radionuclide therapy (PRRT). PRRT with radiolabeled somatostatin analogues such as ¹⁷⁷Lu-DOTATATE (lutetium-177-[DOTA,Tyr³]-octreotate), is mainly used for the treatment of metastatic or inoperable NETs. However, PRRT is generally administered at a fixed injected activity in order not to exceed dose limits in critical organs, which is suboptimal given the variability in radiopharmaceutical uptake among patients. Advances in SPECT (single photon emission computed tomography) imaging enable the absolute quantitative measure of the true radiopharmaceutical distribution providing for PRRT dosimetry in each patient. Personalized PRRT based on patient-specific dosimetry could improve therapeutic efficacy by optimizing effective tumor absorbed dose while limiting treatment related radiotoxicity.

Small-angle Compton Scatter Artifact in Tc-99m-IDA Hepatobiliary Scintigraphy Resulting in the Breast Overlying the Liver in Planar Dynamic Imaging

Compton scatter photons are generally considered problematic in nuclear medicine imaging. Therefore, efforts are being made to minimize the involvement of these photons by employing some special strategies in daily practice. Basically, photons scattering at a small angle and traveling in the proper direction stand a chance of getting recorded and thereby participate in the image formation. These photons may create artifactual hot spots in the vicinity of a region with high concentration of radioactivity. The present study focuses on the negative impact of such photons during routine imaging in clinical setting, through an artifact detected in technetium-99m-IDA hepatobiliary scintigraphy, with the purpose of highlighting this issue to the nuclear medicine practitioners.

Improving quantitative dosimetry in (177)Lu-DOTATATE SPECT by energy window-based scatter corrections

PURPOSE

Patient-specific dosimetry of lutetium-177 ((177)Lu)-DOTATATE treatment in neuroendocrine tumours is important, because uptake differs across patients. Single photon emission computer tomography (SPECT)-based dosimetry requires a conversion factor between the obtained counts and the activity, which depends on the collimator type, the utilized energy windows and the applied scatter correction techniques. In this study, energy window subtraction-based scatter correction methods are compared experimentally and quantitatively.

MATERIALS AND METHODS

(177)Lu SPECT images of a phantom with known activity concentration ratio between the uniform background and filled hollow spheres were acquired for three different collimators: low-energy high resolution (LEHR), low-energy general purpose (LEGP) and medium-energy general purpose (MEGP). Counts were collected in several energy windows, and scatter correction was performed by applying different methods such as effective scatter source estimation (ESSE), triple-energy and dual-energy window, double-photopeak window and downscatter correction. The intensity ratio between the spheres and the background was measured and corrected for the partial volume effect and used to compare the performance of the methods.

RESULTS

Low-energy collimators combined with 208 keV energy windows give rise to artefacts. For the 113 keV energy window, large differences were observed in the ratios for the spheres. For MEGP collimators with the ESSE correction technique, the measured ratio was close to the real ratio, and the differences between spheres were small.

CONCLUSION

For quantitative (177)Lu imaging MEGP collimators are advised. Both energy peaks can be utilized when the ESSE correction technique is applied. The difference between the calculated and the real ratio is less than 10% for both energy windows.

A comparison of different energy window subtraction methods to correct for scatter and downscatter in I-123 SPECT imaging

OBJECTIVE

One of the main problems in quantification of single photon emission computer tomography imaging is scatter. In iodine-123 (I-123) imaging, both the primary 159 keV photons and photons of higher energies are scattered. In this experimental study, different scatter correction methods, based on energy window subtraction, have been compared with each other.

METHODS AND MATERIALS

Iodine-123 single photon emission computed tomography images of a phantom with a known intensity ratio between background and hollow spheres were acquired for three different collimators (low energy high resolution, low energy general purpose, and medium energy general purpose). The hollow spheres were filled with a higher activity concentration than the uniform background activity concentration, resulting in hot spots. Counts were collected in different energy windows, and scatter correction was performed by applying different methods such as effective scatter source estimation, triple and dual energy window (TEW and DEW), double peak window (DPW) and downscatter correction. The intensity ratio between the spheres and the background was used to compare the performance of the different methods.

RESULTS

The results revealed that the efficiency of the scatter correction techniques vary depending on the collimator used. For the low energy high resolution collimator, all correction methods except the effective scatter source estimation and the DPW perform well. For the medium energy general purpose collimator, even without scatter correction, the calculated ratio is close to the real ratio. The DEW and DPW methods tend to overestimate the ratio. For the low energy general purpose collimator, only the DEW and the combined DEW and downscatter correction methods perform well.

CONCLUSION

The only correction method that provides a ratio that differs by less than 5% from the real ratio for all the collimators is the combined DEW and downscatter correction method.

Quantitative capabilities of four state-of-the-art SPECT-CT cameras

BACKGROUND

Four state-of-the-art single-photon emission computed tomography-computed tomography (SPECT-CT) systems, namely Philips Brightview, General Electric Discovery NM/CT 670 and Infinia Hawkeye 4, and Siemens Symbia T6, were investigated in terms of accuracy of attenuation and scatter correction, contrast recovery for small hot and cold structures, and quantitative capabilities when using their dedicated three-dimensional iterative reconstruction with attenuation and scatter corrections and resolution recovery.

METHODS

The National Electrical Manufacturers Association (NEMA) NU-2 1994 phantom with cold air, water, and Teflon inserts, and a homemade contrast phantom with hot and cold rods were filled with 99mTc and scanned. The acquisition parameters were chosen to provide adequate linear and angular sampling and high count statistics. The data were reconstructed using Philips Astonish, General Electric Evolution for Bone, or Siemens Flash3D, eight subsets, and a varying number of iterations. A procedure similar to the one used in positron emission tomography (PET) allowed us to obtain the factor to convert counts per pixel into activity per unit volume.

RESULTS

Edge and oscillation artifacts were observed with all phantoms and all systems. At 30 iterations, the residual fraction in the inserts of the NEMA phantom fell below 3.5%. Contrast recovery increased with the number of iterations but became almost saturated at 24 iterations onwards. In the uniform part of the NEMA and contrast phantoms, a quantification error below 10% was achieved.

CONCLUSIONS

In objects whose dimensions exceeded the SPECT spatial resolution by several times, quantification seemed to be feasible within 10% error limits. A partial volume effect correction strategy remains necessary for the smallest structures. The reconstruction artifacts nevertheless remain a handicap on the road towards accurate quantification in SPECT and should be the focus of further works in reconstruction tomography.

A new method to correct the attenuation map in simultaneous transmission/emission tomography using Gd/Ga radioisotopes

Reconstruction of the tomographic images without attenuation correction can cause erroneously high count densities and reduced image contrast in low attenuation regions. In order to solve the problem of photon attenuation, one needs to know the attenuation coefficient for the individual patient being studied. Therefore, we made an attempt to correct the attenuation map in simultaneous transmission/emission tomography with ¹⁵³Gd/⁶⁷Ga using maximum likelihood method using the expectation maximization (ML-EM) algorithm to correct the transmission window for both the spillover and downscatter. Spillover fraction, scatter fraction and parameters for the scatter function (A, b and c) were determined experimentally and optimized using the optimization program written in IDL based on simplex theory. All measurements were performed on a Vertex gamma camera using the anthropomorphic thorax phantom for validation of data obtained by the proposed method. It was observed that without spillover and downscatter correction, the mean counts were 19.29 in liver and 26.90 in lung, whereas after after applying the corrections, the mean counts were reduced to 3.80 and 15.10 in liver and lung, respectively, which were close to true mean counts (liver 2.15 and lung 14.89). In this proposed method, we introduced the set of F_t(spillover) and K_t(downscatter) to account for the variations in projection pixels (f_t and k_t) with the density and thickness. The F_t and K_t were determined using the transmission data by an iterative process. The quantitative error was reduced by 98.0% for lung and 90.0% for liver when the corrected transmission images were obtained after the subtraction of spillover and downscatter fraction.

Attenuation correction for lung SPECT: evidence of need and validation of an attenuation map derived from the emission data

PURPOSE

The aim of our study was to investigate the importance of attenuation correction (AC) in reconstructed and reprojected images on lung SPECT studies.

METHODS

Simulation studies were undertaken to evaluate the influence of AC on defect-to-normal ratios (D/N), to demonstrate the influence of errors in the correction map values and to detect lung boundaries used for AC. The use of a synthetic map (SM) for AC of the clinical data was also evaluated and the results compared with those obtained with data derived from CT (CTM). Additionally, the role of AC in reprojected SPECT data was assessed and level of noise on the 'planar-like' images was measured.

RESULTS

Phantom studies showed that AC markedly affects the D/N ratio. However, variations in micro values typical of those found in clinical studies resulted in relatively small changes in results. Eroded and dilated conditions did not cause any significant effect on D/N. The level of noise in the reprojected images is reduced in comparison with real planar data. Clinical SPECT/CT data reconstructed with AC using CTM and SM showed an excellent correlation between the two methods.

CONCLUSION

AC improves D/N in lung SPECT studies, thus potentially enhancing the diagnostic capability of the method. The use of a synthetic map for AC is feasible, avoiding the need for an additional procedure and the increased radiation dose involved. Planar-like images generated from reprojected SPECT data are well matched to normal planar images provided AC is performed and attenuation included in the reprojection.

PET & SPECT instrumentation

The nuclear medical imaging methods, positron emission tomography (PET) and single photon emission computed tomography (SPECT), utilize the detection of gamma rays leaving the body after a radioactive tracer has been administered. The sensitivity of PET allows the detection of picomolar tracer amounts in vivo and current technology offers millimeter (PET) or submillimeter (SPECT) spatial resolution. These techniques are used in clinical and preclinical applications. The basic principles of gamma ray detection and image generation in PET and SPECT are summarized in this chapter. Furthermore, effects causing degradation of image quality are discussed.

Model-based compensation for quantitative 123I brain SPECT imaging

Previously we have developed a model-based method that can accurately estimate downscatter contamination from high-energy photons in 123I imaging. In this work we combined the model-based method with iterative reconstruction-based compensations for other image-degrading factors such as attenuation, scatter, the collimator-detector response function (CDRF) and partial volume effects to form a comprehensive method for performing quantitative 123I SPECT image reconstruction. In the model-based downscatter estimation method, photon scatter inside the object was modelled using the effective source scatter estimation (ESSE) technique, including contributions from all the photon emissions. The CDRFs, including the penetration and scatter components due to the high-energy 123I photons, were estimated using Monte Carlo (MC) simulations of point sources in air at various distances from the face of the collimator. The downscatter contamination was then compensated for during the iterative reconstruction by adding the estimated results to the projection steps. The model-based downscatter compensation (MBDC) was evaluated using MC simulated and experimentally acquired projection data. From the MC simulation, we found about 39% of the total counts in the energy window of 123I were attributed to the downscatter contamination, which reduced image contrast and caused a 1.5% to 10% overestimation of activities in various brain structures. Model-based estimates of the downscatter contamination were in good agreement with the simulated data. Compensation using MBDC removed the contamination and improved the image contrast and quantitative accuracy to that of the images obtained from 159 keV photons. The errors in absolute quantitation were reduced to within +/-3.5%. The striatal specific binding potential calculated based on the activity ratio to the background was also improved after MBDC. The errors were reduced from -4.5% to -10.93% without compensation to -0.55% to 4.87% after compensation. The model-based method provided accurate downscatter estimation and, when combined with iterative reconstruction-based compensations, accurate quantitation was obtained with minimal loss of precision.

Fully 3D Monte Carlo reconstruction in SPECT: a feasibility study

In single photon emission computed tomography (SPECT) with parallel hole collimation, image reconstruction is usually performed as a set of bidimensional (2D) analytical or iterative reconstructions. This approach ignores the tridimensional (3D) nature of scatter and detector response function that affects the detected signal. To deal with the 3D nature of the image formation process, iterative reconstruction can be used by considering a 3D projector modelling the 3D spread of photons. In this paper, we investigate the value of using accurate Monte Carlo simulations to determine the 3D projector used in a fully 3D Monte Carlo (F3DMC) reconstruction approach. Given the 3D projector modelling all physical effects affecting the imaging process, the reconstruction problem is solved using the maximum likelihood expectation maximization (MLEM) algorithm. To validate the concept, three data sets were simulated and F3DMC was compared with two other 3D reconstruction strategies using analytical corrections for attenuation, scatter and camera point spread function. Results suggest that F3DMC improves spatial resolution, relative and absolute quantitation and signal-to-noise ratio. The practical feasibility of the approach on real data sets is discussed.

Influence of collimator choice and simulated clinical conditions on 123I-MIBG heart/mediastinum ratios: a phantom study

PURPOSE

(123)I presents imaging problems owing to high-energy photon emission. We investigated the influence of collimators on (123)I-MIBG heart/mediastinum ratios (H/M ratios). Secondly, we assessed the influence on H/M ratios of different activity concentrations, simulating clinical conditions. Thirdly, the value of scatter correction was assessed.

METHODS

The AGATE cardiac phantom was filled with (123)I in three sequential conditions: A, heart and mediastinal activity; B, adding lung activity; and C, adding liver activity (protocol I). In protocol II, myocardium and liver were filled with different activities ranging from low to high. For each condition, static anterior planar and single-photon emission computed tomography studies were acquired on a Siemens e.cam (SI) and a General Electric Millennium VG (GE) system, using low-energy high-resolution and medium-energy (ME) collimators for protocol I and only ME collimators for protocol II . For the SI camera, a triple energy window (TEW) scatter correction was applied.

RESULTS

Planar H/M ratios were influenced by scatter and septal penetration from increasing amounts of liver activity. These effects were less pronounced for ME collimators. Although the TEW scatter correction increased ratios overall, TEW correction did not improve the relative differences between the ratios. TEW correction therefore does not add any benefit to obtain an accurate reflection of myocardial activity concentrations.

CONCLUSION

For straightforward implementation of semi-quantitative (123)I-MIBG myocardial studies, we recommend the use of ME collimators without scatter correction.

The effect of imaging time, radiopharmaceutical, full fat milk and water on interfering extra-cardiac activity in myocardial perfusion single photon emission computed tomography

BACKGROUND AND AIM

Extra-cardiac activity can interfere with observer interpretation of myocardial perfusion single photon emission computed tomography (SPECT) images. Fatty meals and drinks to reduce interference have been tested; however, a simple study of delayed imaging with (99m)Tc-tetrofosmin and (99m)Tc-sestamibi has not been specifically addressed. The aim was to quantify the effects of imaging time, radiopharmaceutical and oral administration of full fat milk and water on interfering activity.

METHODS

Myocardial perfusion SPECT images were acquired using either tetrofosmin or sestamibi. Patients were imaged at 0.5, 1 or 2 h post-injection (tetrofosmin, 59; sestamibi, 72). Additional groups of patients were imaged either with or without milk (tetrofosmin, 54; sestamibi, 45) and with milk and water (sestamibi, 30). A myocardial region was drawn on the anterior projection and a thin adjacent extra-cardiac region was generated automatically. The count density ratio was calculated and validated with a trial of five observers. A decreasing ratio correlated significantly with observer rank of increasing interference with SPECT image interpretation (r=0.95, P=0.001).

RESULTS

The ratio improved significantly as the imaging time increased for both tetrofosmin and sestamibi groups (P<0.05). The groups given milk or milk plus water showed no significant improvement against control groups (P > or = 0.2). There was no significant difference between tetrofosmin and sestamibi at any time point (P > or = 0.4).

CONCLUSIONS

Image interpretation may be improved by delayed imaging for tetrofosmin and sestamibi. However, in contrast with common practice, the administration of milk or water appears to be of no clinical value compared with delayed imaging, and there is no significant difference between interfering activity from tetrofosmin and sestamibi.

Collimator choice in cardiac SPECT with I-123-labeled tracers

BACKGROUND

Septal penetration of high-energy photons may degrade the quality of single photon emission computed tomography (SPECT) of the heart with iodine 123-labeled tracers. We investigated the impact of collimator choice on cardiac SPECT with I-123.

METHODS AND RESULTS

SPECT of a thoracic phantom containing I-123 solution was performed with a low-energy high-resolution (LEHR) collimator, special LEHR (SLEHR) collimator, and medium-energy (ME) collimator, and the cavity-to-myocardium contrast, wall thickness, and defect contrast were compared among the collimators. For all indices, use of the SLEHR collimator yielded the best results. Comparison between the LEHR and ME collimators revealed that the cavity-to-myocardium contrast and contrast for large defects were better with the ME collimator, whereas wall thickness and contrast for small defects were similar. Scatter correction by the triple-energy window method improved the indices examined; however, the superiority of the SLEHR collimator was still observed after correction.

CONCLUSIONS

Collimator choice substantially influences the quality of cardiac SPECT with I-123-labeled agents, and an appropriate collimator needs to be selected in consideration of septal penetration and spatial resolution.

Effect of collimator choice on quantitative assessment of cardiac iodine 123 MIBG uptake

BACKGROUND

Quantitative accuracy in iodine 123 studies may be impaired by septal penetration. We evaluated the effect of collimator choice on estimation of the heart-to-mediastinum (H/M) ratio in cardiac I-123 metaiodobenzylguanidine (MIBG) imaging.

METHODS AND RESULTS

A low-energy high-resolution (LEHR) collimator, special LEHR (SLEHR) collimator, and medium-energy (ME) collimator were used. In experiments in which a phantom of simple geometry was used, the use of the LEHR collimator provided the lowest contrast accuracy, suggesting the effect of septal penetration. Thoracic phantom studies demonstrated contamination of heart and mediastinum counts by lung and liver activities, which was greatest with the LEHR collimator and least with the ME collimator. In 8 patients anterior chest views were acquired successively with the three collimators after I-123 MIBG injection. H/M ratios were significantly higher with the SLEHR collimator than with the LEHR collimator and were still higher with the ME collimator. The difference in H/M ratios between the LEHR and ME collimators showed a high positive correlation with the lung-to-mediastinum ratio.

CONCLUSIONS

Collimator choice substantially influences estimation of the H/M ratios in cardiac I-123 MIBG imaging. The use of an ME collimator provides high quantitative accuracy and may enhance reliability in the evaluation of cardiac sympathetic nerve function.

Impact of photon energy recovery on the assessment of left ventricular volume using myocardial perfusion SPECT

BACKGROUND

Photon energy recovery (PER) is a spectral deconvolution technique validated for scatter removal in patients and phantom studies. The purpose of this study was to examine the impact of PER on left ventricular volume measurement based on myocardial perfusion single photon emission computed tomography (SPECT).

METHODS AND RESULTS

SPECT acquisitions were performed by use of a static cardiac phantom and in 25 patients after a rest injection of technetium 99m sestamibi by use of multiple energy windows (126-136, 137-144, and 145-154 keV). Data were successively reconstructed with and without PER, by use of iterative reconstruction and post-processing filtering (Butterworth filter; order, 5; cutoff, 0.30 cycles/pixel). Image contrast was evaluated in reconstructed data, and volumes were calculated by use of QGS. PER increased reconstructed image contrast from 62% +/- 2.7% to 84.3% +/- 5.7% in the phantom studies (P <.0001) and from 49% +/- 2% to 73% +/- 2% in patients (P <.0001). Although it remained underestimated (P <.0001), phantom volume was higher after PER correction compared with uncorrected data (50.9 +/- 0.8 mL vs 44.6 +/- 1 mL, P <.0001). The error in volume measurement was decreased by PER correction (16.6% +/- 1.3% vs 27% +/- 1.7% [uncorrected data], P <.0001). In patients, left ventricular volume increased from 83 +/- 10 mL to 91 +/- 10 mL (P <.0001), and the PER-induced volume increase was correlated with the image contrast increase (r = 0.61, P =.001). Finally, the percentage of volume increase was higher in patients with small left ventricular volumes.

CONCLUSIONS

PER has a significant impact on image contrast and left ventricular volume measurement by use of perfusion SPECT. PER improves the accuracy of phantom volume assessment. In patients, volume increase is correlated to image contrast increase and is higher in those with small ventricles.

Scatter modelling and compensation in emission tomography

In nuclear medicine, clinical assessment and diagnosis are generally based on qualitative assessment of the distribution pattern of radiotracers used. In addition, emission tomography (SPECT and PET) imaging methods offer the possibility of quantitative assessment of tracer concentration in vivo to quantify relevant parameters in clinical and research settings, provided accurate correction for the physical degrading factors (e.g. attenuation, scatter, partial volume effects) hampering their quantitative accuracy are applied. This review addresses the problem of Compton scattering as the dominant photon interaction phenomenon in emission tomography and discusses its impact on both the quality of reconstructed clinical images and the accuracy of quantitative analysis. After a general introduction, there is a section in which scatter modelling in uniform and non-uniform media is described in detail. This is followed by an overview of scatter compensation techniques and evaluation strategies used for the assessment of these correction methods. In the process, emphasis is placed on the clinical impact of image degradation due to Compton scattering. This, in turn, stresses the need for implementation of more accurate algorithms in software supplied by scanner manufacturers, although the choice of a general-purpose algorithm or algorithms may be difficult.

Voxeldoes: a computer program for 3-D dose calculation in therapeutic nuclear medicine

A computer program, VoxelDose, was developed to calculate patient specific 3-D-dose maps at the voxel level. The 3-D dose map is derived in three steps: (i) The SPECT acquisitions are reconstructed using a filtered back projection method, with correction for attenuation and scatter; (ii) the 3-D cumulated activity map is generated by integrating the SPECT data; and (iii) a 3-D dose map is computed by convolution (using the Fourier Transform) of the cumulated activity map and corresponding MIRD voxel S values. To validate the VoxelDose software, a Liqui-Phil abdominal phantom with four simulated organ inserts and one spherical tumor (radius 4.2 cm) was filled with known activity concentrations of 111In. Four cylindrical calibration tubes (from 3.7 to 102 kBq/mL) were placed on the phantom. Thermoluminescent mini-dosimeters (mini-TLDs) were positioned on the surface of the organ inserts. Percent differences between the known and measured activity concentrations were determined to be 12.1 (tumor), 1.8 (spleen), 1.4, 8.1 (right and left kidneys), and 38.2% (liver), leading to percent differences between the calculated and TLD measured doses of 41, 16, 3, 5, and 62%. Large differences between the measured and calculated dose in the tumor and the liver may be attributed to several reasons, such as the difficulty in precisely associating the position of the TLD to a voxel and limits of the quantification method (mainly the scatter correction and partial volume effect). Further investigations should be performed to better understand the impact of each effect on the results and to improve absolute quantification. For all other organs, activity concentration measurements and dose calculations agree well with the known activity concentrations.

Comparison of four scatter correction methods for patient whole-body imaging during therapeutic trials with iodine-131

BACKGROUND

Activity in regions of interest can be measured using serial whole-body scintigraphic images to estimate the dose received by a patient after therapeutic injections. As scatter and attenuation introduce biases in quantitative measurements, these phenomena need to be corrected to allow accurate determination of tracer concentration.

METHODS

The feasibility of iodine-131 whole-body imaging in list mode was studied over an extended spectrum (0-750 keV) in order to compare four scatter correction methods by the geometric mean approach (20%, Dual Energy Window, Triple Energy Window, and Spectral Factor Analysis methods). All data were corrected for attenuation using a Transmission Attenuation Correction prototype from Sopha Médical Vision international. The half-life of an iodine-131 standard source was calculated from scatter-corrected anterior views. Whole-body activities, using the Day 0, Hour 1, image as a reference (calibration from an administered dose) and an external calibration source (calibration from an imaged known-activity source), were calculated for three patients undergoing a radioimmunotherapy trial in order to assess the reliability of quantification by the geometric mean approach.

RESULTS

Patient studies confirmed the clinical feasibility of this type of acquisition. As expected, all methods allowed determination of an accurate half-life for the calibration source. A slight impact of scatter correction was observed in quantification with calibration from an administered dose. For quantification with calibration from an imaged known-activity source, whole-body activity was overestimated by +100% to +200% with the 20% window, depending on the size of the patient, whereas errors were about +50% with scatter correction. However, the influence of patient morphology was less marked when a scatter correction method was used.

CONCLUSIONS

When the geometric mean approach is used together with a sophisticated transmission acquisition device for quantification with calibration from an administered dose, the 20% energy window appears to be adequate. However, for quantification with calibration from an imaged known-activity source, accurate activity estimates cannot be obtained even when scatter correction is used to compensate for the influence of patient morphology.

The effect of scatter and attenuation on aerosol deposition as determined by gamma scintigraphy

Gamma scintigraphy is often used to quantify deposition patterns from aerosol inhalers. The errors caused by scatter and tissue attenuation in planar Tc-99m gamma scintigraphy were investigated based on the data collected from four subjects in this study. Several error correction methods were tested. The results from two scatter correction methods, Jaszczak's method and factor analysis of dynamic sequences (FADS), were similar. Scatter accounted for 20% of raw data in the whole lung, 20% in the oropharynx, and 43% in the central airways and esophagus. Three attenuation correction methods were investigated and compared. These were: uniform attenuation correction (UAC), a known method used for inhalation drug imaging work; the broad-beam attenuation correction used for organ imaging in nuclear medicine; and a narrow-beam inhomogeneous tissue attenuation correction proposed in this study. The three methods differed significantly (p < 0.05), but all indicated that attenuation is a severe quantification problem. The narrow beam attenuation correction with scatter correction, showed that raw data underestimated tracer deposition by 44% in the lung, 137% in the oropharynx, and 153% in the trachea/esophageal region. To quantify aerosol lung deposition using planar scintigraphy even in relative terms, corrections are necessary. Much of the literature concerning quantified aerosol dose distributions measured by gamma scintigraphy needs to be interpreted carefully.

Image-correction techniques in SPECT

This overview takes a look at different correction techniques for Single Photon Emission Computed Tomography (SPECT). We discuss the influence of the detection system followed by the scatter and attenuation caused by the object of investigation. When possible we describe how the correction methods for the different physical effects can be incorporated in the reconstruction method, being either filtered backprojection or iterative reconstruction.

Improvement of image resolution and quantitative accuracy in clinical Single Photon Emission Computed Tomography

Clinical Single Photon Emission Computed Tomography (SPECT) is a scanning technique which acquires gamma-camera images ('projections') over a range of angles around a patient. These projections allow the reconstruction of cross sectional ('tomographic') images of the gamma-radiating pharmaceutical distribution in the patient, thus providing interesting information about the functioning of organs and tissues.SPECT images are seriously affected by a variety of image degrading processes. Restrictions on the amount of radio-pharmaceutical that can be administered to a patient cause noise in the projections and the limited spatial resolution of the gamma-camera results in blurring of the projections. In addition to these image degradations, the reconstruction of cross-sections is complicated by Compton scattering of gamma-photons in tissue, which causes attenuation of the photon flux received by the gamma-camera and causes improper detection of photons which have been scattered in tissue. This results in some additional blurring and loss of accuracy of the SPECT images in predicting activity concentrations. Tremendous efforts have been made to improve the quantitative accuracy and the spatial resolution of SPECT, and to reduce the noise in the reconstructed images. These efforts have resulted in corrective reconstruction algorithms, which are generally based on incorporation of accurate models of the main image degrading factors. Improvements of the data acquisition hardware can further increase image quality. In this paper, the image formation process of SPECT, including image-degrading factors, is explained. In addition, reconstruction algorithms and hardware modifications are reviewed, and their effects on image quality are illustrated with physical phantom and simulation experiments.

Red marrow dosimetry for radiolabeled antibodies that bind to marrow, bone, or blood components

Hematologic toxicity limits the radioactivity that may be administered for radiolabeled antibody therapy. This work examines approaches for obtaining biodistribution data and performing dosimetry when the administered antibody is known to bind to a cellular component of blood, bone, or marrow. Marrow dosimetry in this case is more difficult because the kinetics of antibody clearance from the blood cannot be related to the marrow. Several approaches for obtaining antibody kinetics in the marrow are examined and evaluated. The absorbed fractions and S factors that should be used in performing marrow dosimetry are also examined and the effect of including greater anatomical detail is considered. The radiobiology of the red marrow is briefly reviewed. Recommendations for performing marrow dosimetry when the antibody binds to the marrow are provided.

Estimation of the depth-dependent component of the point spread function of SPECT

The point spread function (PSF) of a gamma camera describes the photon count density distribution at the detector surface when a point source is imaged. Knowledge of the PSF is important for computer simulation and accurate image reconstruction of single photon emission computed tomography (SPECT) images. To reduce the number of measurements required for PSF characterization and the amount of computer memory to store PSF tables, and to enable generalization of the PSF to different collimator-to-source distances, the PSF may be modeled as the two-dimensional (2D) convolution of the depth-dependent component which is free of detector blurring (PSF(ideal)) and the distance-dependent detector response. Owing to limitations imposed by the radioactive strength of point sources, extended sources have to be used for measurements. Therefore, if PSF(ideal) is estimated from measured responses, corrections have to be made for both the detector blurring and for the extent of the source. In this paper, an approach based on maximum likelihood expectation-maximization (ML-EM) is used to estimate PSF(ideal). In addition, a practical measurement procedure which avoids problems associated with commonly used line-source measurements is proposed. To decrease noise and to prevent nonphysical solutions, shape constraints are applied during the estimation of PSF(ideal). The estimates are generalized to depths other than those which have been measured and are incorporated in a SPECT simulator. The method is validated for Tc-99m and T1-201 by means of measurements on physical phantoms. The corrected responses have the desired shapes and simulated responses closely resemble measured responses. The proposed methodology may, consequently, serve as a basis for accurate three-dimensional (3D) SPECT reconstruction.

Efficient SPECT scatter calculation in non-uniform media using correlated Monte Carlo simulation

Accurate simulation of scatter in projection data of single photon emission computed tomography (SPECT) is computationally extremely demanding for activity distribution in non-uniform dense media. This paper suggests how the computation time and memory requirements can be significantly reduced. First the scatter projection of a uniform dense object (P(SDSE)) is calculated using a previously developed accurate and fast method which includes all orders of scatter (slab-derived scatter estimation), and then P(SDSE) is transformed towards the desired projection P which is based on the non-uniform object. The transform of P(SDSE) is based on two first-order Compton scatter Monte Carlo (MC) simulated projections. One is based on the uniform object (P(u)) and the other on the object with non-uniformities (P(nu)). P is estimated by P = P(SDSE) P(nu)/P(u). A tremendous decrease in noise in P is achieved by tracking photon paths for P(nu) identical to those which were tracked for the calculation of P(u) and by using analytical rather than stochastic modelling of the collimator. The method was validated by comparing the results with standard MC-simulated scatter projections (P) of 99mTc and 201Tl point sources in a digital thorax phantom. After correction, excellent agreement was obtained between P and P. The total computation time required to calculate an accurate scatter projection of an extended distribution in a thorax phantom on a PC is a only few tens of seconds per projection, which makes the method attractive for application in accurate scatter correction in clinical SPECT. Furthermore, the method removes the need of excessive computer memory involved with previously proposed 3D model-based scatter correction methods.

Scatter compensation methods in 3D iterative SPECT reconstruction: a simulation study

Effects of different scatter compensation methods incorporated in fully 3D iterative reconstruction are investigated. The methods are: (i) the inclusion of an 'ideal scatter estimate' (ISE); (ii) like (i) but with a noiseless scatter estimate (ISE-NF); (iii) incorporation of scatter in the point spread function during iterative reconstruction ('ideal scatter model', ISM); (iv) no scatter compensation (NSC); (v) ideal scatter rejection (ISR), as can be approximated by using a camera with a perfect energy resolution. The iterative method used was an ordered subset expectation maximization (OS-EM) algorithm. A cylinder containing small cold spheres was used to calculate contrast-to-noise curves. For a brain study, global errors between reconstruction and 'true' distributions were calculated. Results show that ISR is superior to all other methods. In all cases considered, ISM is superior to ISE and performs approximately as well as (brain study) or better than (cylinder data) ISE-NF. Both ISM and ISE improve contrast-to-noise curves and reduce global errors, compared with NSC. In the case of ISE, blurring of the scatter estimate with a Gaussian kernel results in slightly reduced errors in brain studies, especially at low count levels. The optimal Gaussian kernel size is strongly dependent on the noise level.

Anatomical data fusion for quantitative reconstruction in myocardial tomoscintigraphy using a spline model of the thorax organs

We present the fusion of anatomical data as a method for improving the reconstruction in single photon emission computed tomography (SPECT). Anatomical data is used to deduce a parameterized model of organs in a reconstructed slice using spline curves. This model allows us to define the imaging process, i.e., the direct problem, more adequately, and furthermore to restrict the reconstruction to the emitting zones. Instead of the usual square pixels, we use a new kind of discretization pixel, which fits to the contour in the region of interest. In the reconstruction phase, we estimate the activity in the emitting zones and also the optimum parameters of our model. Concentrating on the left ventricular (LV) wall activity, the simulation and phantom results show an accurate estimation of both the myocardial shape and the radioactive emission.

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.

Technical pitfalls in image acquisition, processing, and display

Optimal image quality is an ideal in nuclear medicine that is not always realized, being subject to a variety of conditions that can act, either singly or in combination, to undermine its accomplishment. These conditions include potential defects and limitations in both the hardware and software used for the acquisition and reconstruction of nuclear medicine images. Factors relating to individual patients can contribute to these obstacles, including limitations in mobility and compliance. Importantly, suboptimal or erroneous technique is a common source of poor imaging results, with loss of diagnostic efficacy. Appropriate test selection and careful attention to patient preparation and procedural details are essential elements in avoiding image flaws and artifacts in nuclear medicine.

Planar imaging quantification using 3D attenuation correction data and Monte Carlo simulated buildup factors

A new method to correct for attenuation and the buildup of scatter in planar imaging quantification is presented. The method is based on the combined use of 3D density information provided by computed tomography to correct for attenuation and the application of Monte Carlo simulated buildup factors to correct for buildup in the projection pixels. CT and nuclear medicine images were obtained for a purpose-built nonhomogeneous phantom that models the human anatomy in the thoracic and abdominal regions. The CT transverse slices of the phantom were converted to a set of consecutive density maps. An algorithm was developed that projects the 3D information contained in the set of density maps to create opposing pairs of accurate 2D correction maps that were subsequently applied to planar images acquired from a dual-head gamma camera. A comparison of results obtained by the new method and the geometric mean approach based on published techniques is presented for some of the source arrangements used. Excellent results were obtained for various source-phantom configurations used to evaluate the method. Activity quantification of a line source at most locations in the nonhomogeneous phantom produced errors of less than 2%. Additionally, knowledge of the actual source depth is not required for accurate activity quantification. Quantification of volume sources placed in foam, Perspex and aluminium produced errors of less than 7% for the abdominal and thoracic configurations of the phantom.

A Monte Carlo evaluation of the channel ratio scatter correction method

Several methods exist to eliminate the contribution of scattered photons during imaging. One of these, the channel ratio (CR) scatter correction technique, uses the change in the ratio of counts from two symmetrical adjacent energy windows straddling the energy photopeak. The accuracy of the results depends upon the assumption that the ratio of the scatter components in the two windows (H value) is constant and is independent of the relative size of the scatter contribution. In this study a Monte Carlo simulation was used to investigate the behaviour of the scatter component for different source sizes at different depths. Four disc sources containing a 99Tcm solution were simulated at different depths as imaged with a scintillation camera. Two 10% energy windows with 5% offsets to either side of the 140 keV photopeak of 99Tcm were used. The ratio of the scattered counts in the lower energy window to the scattered counts in the upper window (true H value) was determined from the simulation for each source at every depth. Since it is impossible to measure the true H value at different organ depths during a clinical study, the use of an average H value was considered. Scatter correction was applied to the images simulated at the various depths in water. The geometric mean was calculated and attenuation correction performed assuming mono-exponential attenuation. For quantitation purposes the corrected counts were expressed in terms of a references source. The choice of the reference source yielding the best quantitative results was also investigated. Results of this Monte Carlo simulation study show that although the true H value depends on both source size and depth of the source in the scattering medium, the CR scatter correction technique can be applied successfully when an average H value is used.

Fast SPECT simulation including object shape dependent scatter

A fast simulator of SPECT projection data taking into account attenuation, distance dependent detector response, and scatter has been developed, based on an analytical point spread function model. The parameters of the scatter response are obtained from a single line source measurement with a triangular phantom. The simulator is able to include effects of object curvature on the scatter response to a high accuracy. The simulator has been evaluated for homogeneous media by measurements of (99m)Tc point sources placed at different locations in a water-filled cylinder at energy windows of 15% and 20%. The asymmetrical shapes of measured projections of point sources are In excellent agreement with simulations for both energy windows. Scatter-to-primary ratio (SPR) calculations of point sources at different positions in a cylindrical phantom differ not more than a few percent from measurements. The simulator uses just a few megabytes of memory for storing the tables representing the forward model; furthermore, simulation of 60 SPECT projections from a three-dimensional digital brain phantom with 6-mm cubic voxels takes only ten minutes on a standard workstation. Therefore, the simulator could serve as a projector in iterative true 3-D SPECT reconstruction.