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Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, Vinjamuri S, Mohamad M. Revising and exploring the variations in methodologies for establishing the diagnostic reference levels for paediatric PET/CT imaging. Nucl Med Commun 2023; 44:937-943. [PMID: 37615527 DOI: 10.1097/mnm.0000000000001748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
PET-computed tomography (PET/CT) is a hybrid imaging technique that combines anatomical and functional information; to investigate primary cancers, stage tumours, and track treatment response in paediatric oncology patients. However, there is debate in the literature about whether PET/CT could increase the risk of cancer in children, as the machine is utilizing two types of radiation, and paediatric patients have faster cell division and longer life expectancy. Therefore, it is essential to minimize radiation exposure by justifying and optimizing PET/CT examinations and ensure an acceptable image quality. Establishing diagnostic reference levels (DRLs) is a crucial quantitative indicator and effective tool to optimize paediatric imaging procedures. This review aimed to distinguish and acknowledge variations among published DRLs for paediatric patients in PET/CT procedures. A search of relevant articles was conducted using databases, that is, Embase, Scopus, Web of Science, and Medline, using the keywords: PET-computed tomography, computed tomography, PET, radiopharmaceutical, DRL, and their synonyms. Only English and full-text articles were included, with no limitations on the publication year. After the screening, four articles were selected, and the review reveals different DRL approaches for paediatric patients undergoing PET/CT, with primary variations observed in patient selection criteria, reporting of radiation dose values, and PET/CT equipment. The study suggests that future DRL methods for paediatric patients should prioritize data collection in accordance with international guidelines to better understand PET/CT dose discrepancies while also striving to optimize radiation doses without compromising the quality of PET/CT images.
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Affiliation(s)
- Qays Alhorani
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Saudi Arabia
| | - Mohammad Rawashdeh
- Radiologic Technology Program, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid
| | - Akmal Sabarudin
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rukiah A Latiff
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Centre, Amman, Jordan
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Mazlyfarina Mohamad
- Center for Diagnostics, Therapeutics and Investigative, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Chin J, Vali R, Charron M, Shammas A. Update on Pediatric Nuclear Medicine in Acute Care. Semin Nucl Med 2023; 53:820-839. [PMID: 37211467 DOI: 10.1053/j.semnuclmed.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/24/2023] [Accepted: 04/29/2023] [Indexed: 05/23/2023]
Abstract
Various radiopharmaceuticals are available for imaging pediatric patients in the acute care setting. This article focuses on the common applications used on a pediatric patient in acute care. To confirm the clinical diagnosis of brain death, brain scintigraphy is considered accurate and has been favorably compared with other methods of detecting the presence or absence of cerebral blood flow. Ventilation-perfusion lung scans are easy and safe to perform with less radiation exposure than computed tomography pulmonary angiography and remain an appropriate procedure to perform on children with suspected pulmonary embolism as a first imaging test in a hemodynamically stable patient with no history of lung disease and normal chest radiograph. 99mTc-pertechnetate scintigraphy (Meckel's scan) is the best noninvasive procedure to establish the diagnosis of ectopic gastric mucosa in Meckel's diverticulum. 99mTcred blood cell scintigraphy generally is useful for assessing lower GI bleeding in patients from any cause. Hepatobiliary scintigraphy is the most accurate diagnostic imaging modality for acute cholecystitis. 99mTc-dimercaptosuccinic acid scintigraphy is the simplest, and the most reliable and sensitive method for the early diagnosis of focal or diffuse functional cortical damage. 99mTcmercaptoacetyltriglycine scintigraphy is used to evaluate for early and late complications of renal transplantation. Bone scintigraphy is a sensitive and noninvasive technique for diagnosis of bone disorders such as osteomyelitis and fracture. 18F-fluorodeoxyglucose-positron emission tomography could be valuable in the evaluation of fever of unknown origin in pediatric patients, with better sensitivity and significantly less radiation exposure than a gallium scan. Moving forward, further refinement of pediatric radiopharmaceutical administered activities, including dose reduction, greater radiopharmaceutical applications, and updated consensus guidelines is warranted, with the use of radionuclide imaging likely to increase.
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Affiliation(s)
- Joshua Chin
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Reza Vali
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
| | - Martin Charron
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Amer Shammas
- Diagnostic Imaging, Nuclear Medicine Division, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Bazewicz M, Heissigerova J, Pavesio C, Willermain F, Skrzypecki J. Ocular sarcoidosis in adults and children: update on clinical manifestation and diagnosis. J Ophthalmic Inflamm Infect 2023; 13:41. [PMID: 37721575 PMCID: PMC10507006 DOI: 10.1186/s12348-023-00364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 09/01/2023] [Indexed: 09/19/2023] Open
Abstract
Sarcoidosis-associated uveitis, is the predominant ocular sarcoidosis presentation, which affects both adults and children. For adults, international ocular sarcoidosis criteria (IWOS) and sarcoidosis-associated uveitis criteria (SUN) are defined. However, for children they are not yet established internationally. Due to the specificity of pediatric manifestations of sarcoidosis, this task is even more challenging. In children, sarcoidosis is subdivided into Blau syndrome and early-onset sarcoidosis (BS/EOS) affecting younger children (< 5 years) and the one affecting older children with clinical presentation resembling adults. Differential diagnosis, clinical work-up as well as diagnostic criteria should be adapted to each age group. In this article, we review the clinical manifestation of sarcoidosis-associated uveitis in adults and children and the sensitivity and specificity of various ocular sarcoidosis diagnostic modalities, including chest X-ray and CT, FDG PET-CT, gallium-67 scintigraphy, bronchoalveolar lavage fluid, genetic testing for NOD2 mutations and serum biomarkers, such as ACE, lysozyme and IL2R.
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Affiliation(s)
- Magdalena Bazewicz
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium.
- Department of Ophthalmology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.
| | - Jarmila Heissigerova
- Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Carlos Pavesio
- Uveitis Service, Moorfields Eye Hospital, National Health Service Foundation Trust London, London, UK
- University College London, London, UK
| | - François Willermain
- Department of Ophthalmology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
- Department of Ophthalmology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
- Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Janusz Skrzypecki
- Department of Ophthalmology, Independent Public University Eye Hospital, Warsaw, Poland
- Department of Experimental Physiology and Pathophysiology, Medical University of Warsaw, Warsaw, Poland
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Hu H, Huang Y, Sun H, Zhou K, Jiang L, Zhong J, Chen L, Wang L, Han Y, Wu H. A proper protocol for routine 18F-FDG uEXPLORER total-body PET/CT scans. EJNMMI Phys 2023; 10:51. [PMID: 37695324 PMCID: PMC10495295 DOI: 10.1186/s40658-023-00573-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Conventional clinical PET scanners typically have an axial field of view (AFOV) of 15-30 cm, resulting in limited coverage and relatively low photon detection efficiency. Taking advantage of the development of long-axial PET/CT, the uEXPLORER PET/CT scanner with an axial coverage of 194 cm increases the effective count rate by approximately 40 times compared to that of conventional PET scanners. Ordered subset expectation maximization (OSEM) is the most widely used iterative algorithm in PET. The major drawback of OSEM is that the iteration process must be stopped before convergence to avoid image degradation due to excessive noise. A new Bayesian penalized-likelihood iterative PET reconstruction, named HYPER iterative, was developed and is now available on the uEXPLORER total-body PET/CT, which incorporates a noise control component by using a penalty function in each iteration and finds the maximum likelihood solution through repeated iterations. To date, its impact on lesion visibility in patients with a full injected dose or half injected dose is unclear. The goal of this study was to determine a proper protocol for routine 18F-FDG uEXPLORER total-body PET/CT scans. RESULTS The uEXPLORER total-body PET/CT images reconstructed using both OSEM and HYPER iterative algorithms of 20 tumour patients were retrospectively reviewed. The quality of the 5 min PET image was excellent (score 5) for all of the dose and reconstruction methods. Using the HYPER iterative method, the PET images reached excellent quality at 1 min with full-dose PET and at 2 min with half-dose PET. The PET image reached a similar excellent quality at 2 min with a full dose and at 3 min with a half dose using OSEM. The noise in the OSEM reconstruction was higher than that in the HYPER iterative. Compared to OSEM, the HYPER iterative had a slightly higher SUVmax and TBR of the lesions for large positive lesions (≥ 2 cm) (SUVmax: up to 9.03% higher in full dose and up to 12.52% higher in half dose; TBR: up to 8.69% higher in full dose and up to 23.39% higher in half dose). For small positive lesions (≤ 10 mm), the HYPER iterative had an obviously higher SUVmax and TBR of the lesions (SUVmax: up to 45.21% higher in full dose and up to 74.96% higher in half dose; TBR: up to 44.91% higher in full dose and up to 93.73% higher in half dose). CONCLUSIONS A 1 min scan with a full dose and a 2 min scan with a half dose are optimal for clinical diagnosis using the HYPER iterative and 2 min and 3 min for OSEM. For quantification of the small lesions, HYPER iterative reconstruction is preferred.
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Affiliation(s)
- Huiran Hu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Yanchao Huang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Hongyan Sun
- United Imaging Healthcare, Shanghai, People's Republic of China
| | - Kemin Zhou
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Li Jiang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Jinmei Zhong
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Li Chen
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Lijuan Wang
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China
| | - Yanjiang Han
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China.
| | - Hubing Wu
- Nanfang PET Center, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Avenue North, Guangzhou, 510515, Guangdong Province, People's Republic of China.
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Chen WJ, Rae WID, Kench PL, Meikle SR. The potential advantages and workflow challenges of long axial field of view PET/CT. J Med Radiat Sci 2023; 70:310-318. [PMID: 37156564 PMCID: PMC10500105 DOI: 10.1002/jmrs.686] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 04/20/2023] [Indexed: 05/10/2023] Open
Abstract
Recently developed Long (≥100 cm) axial field of view (AFOV) PET/CT scanners are capable of producing images with higher signal-to-noise ratio, or performing faster whole-body acquisitions, or scanning with lower radiation dose to the patient, compared with conventional PET/CT scanners. These benefits, which arise due to their substantially higher, by more than an order of magnitude, geometric efficiency, have been well described in the recent literature. The introduction of Long AFOV PET/CT technology into the clinic also has important implications for the design and workflow of PET/CT facilities and their effects on radiation exposure to staff and patients. Maximising the considerable benefits of this technology requires a thorough understanding of the relationships between these factors to optimise workflows while appropriately managing radiation exposure. This article reviews current knowledge on PET/CT facility design, workflows and their effects on radiation exposure, identifies gaps in the literature and discusses the challenges that need to be considered with the introduction of Long AFOV PET/CT into the clinic.
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Affiliation(s)
- Wei‐Ting J. Chen
- Discipline of Medical Imaging Science, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - William I. D. Rae
- Discipline of Medical Imaging Science, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Medical Imaging DepartmentPrince of Wales HospitalRandwickNew South WalesAustralia
| | - Peter L. Kench
- Discipline of Medical Imaging Science, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Medical Image Optimisation and Perception Group (MIOPeG), Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
| | - Steven R. Meikle
- Discipline of Medical Imaging Science, Faculty of Medicine and HealthUniversity of SydneyCamperdownNew South WalesAustralia
- Brain and Mind CentreUniversity of SydneyCamperdownNew South WalesAustralia
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Mhlanga J, Alazraki A, Cho SY, Lai H, Nadel H, Pandit-Taskar N, Qi J, Rajderkar D, Voss S, Watal P, McCarten K. Imaging recommendations in pediatric lymphoma: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29968. [PMID: 36114654 PMCID: PMC10641880 DOI: 10.1002/pbc.29968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/08/2022]
Abstract
Hodgkin lymphoma (HL) and non-Hodgkin lymphoma (NHL) are both malignancies originating in the lymphatic system and both affect children, but many features differ considerably, impacting workup and management. This paper provides consensus-based imaging recommendations for evaluation of patients with HL and NHL at diagnosis and response assessment for both interim and end of therapy (follow-up).
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Affiliation(s)
- Joyce Mhlanga
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, Saint Louis, Missouri, USA
| | - Adina Alazraki
- Departments of Pediatrics and Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Steve Y Cho
- Department of Radiology, Nuclear Medicine and Molecular Imaging Section, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Hollie Lai
- Department of Radiology, Children's Health of Orange County, Orange, California, USA
| | - Helen Nadel
- Department of Pediatric Radiology, Lucile Packard Children's Hospital at Stanford, Stanford University School of Medicine, Stanford, California, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Molecular imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
- Department of Radiology, Weill Cornell Medical College, New York City, New York, USA
| | - Jing Qi
- Department of Radiology, Medical College of Wisconsin and Children's Wisconsin, Milwaukee, Wisconsin, USA
| | - Dhanashree Rajderkar
- Department of Radiology, Division of Pediatric Radiology, College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Stephan Voss
- Harvard Medical School, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Pankaj Watal
- University of Central Florida College of Medicine, Nemours Children's Hospital, Orlando, Florida, USA
| | - Kathleen McCarten
- Diagnostic Imaging and Pediatrics, Imaging and Radiation Oncology Core, Lincoln, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Modarai B, Haulon S, Ainsbury E, Böckler D, Vano-Carruana E, Dawson J, Farber M, Van Herzeele I, Hertault A, van Herwaarden J, Patel A, Wanhainen A, Weiss S, Esvs Guidelines Committee, Bastos Gonçalves F, Björck M, Chakfé N, de Borst GJ, Coscas R, Dias NV, Dick F, Hinchliffe RJ, Kakkos SK, Koncar IB, Kolh P, Lindholt JS, Trimarchi S, Tulamo R, Twine CP, Vermassen F, Document Reviewers, Bacher K, Brountzos E, Fanelli F, Fidalgo Domingos LA, Gargiulo M, Mani K, Mastracci TM, Maurel B, Morgan RA, Schneider P. Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on Radiation Safety. Eur J Vasc Endovasc Surg 2023; 65:171-222. [PMID: 36130680 DOI: 10.1016/j.ejvs.2022.09.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 09/15/2022] [Indexed: 01/24/2023]
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Guja KE, Nadel H, Iagaru A. Overview and Recent Advances in 18F-FDG PET/CT for Evaluation of Pediatric Lymphoma. Semin Nucl Med 2022. [DOI: 10.1053/j.semnuclmed.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Tan H, Mao W, Cao Y, Cai D, Sui X, Qi C, Yu H, Zhang Y, Shi H. Half-dose versus full-dose 18 F-FDG total-body PET/CT in patients with colorectal cancer. Nucl Med Commun 2022; 43:928-936. [PMID: 35634804 DOI: 10.1097/mnm.0000000000001589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate image quality and lesion detectability of half-dose (1.85 MBq/kg) 18 F-fluorodeoxyglucose (FDG) total-body positron emission tomography/computed tomography (PET/CT) for colorectal cancer, full-dose (3.7 MBq/kg) 18 F-FDG serving as a reference. METHODS Fifty patients confirmed to have colorectal cancer who underwent total-body PET/CT with half-dose 18 F-FDG were included. Another 50 colorectal cancer patients with 3.70 MBq/kg 18 F-FDG activity were selected for the full-dose group. PET images in the half-dose group were scanned for 15 min and split into 1-, 2-, 3-, 4- and 10-min duration groups, denoted G1, G2, G3, G4 and G10, respectively. In the full-dose group, PET scanning was performed for 5 min, reconstructed with the first 0.5, 1, 2 and 5 min intervals, defined as G0.5', G1', G2' and G5', respectively. Subjective image quality was assessed with 5-point Likert scales. Objective image quality parameters included maximum standardized uptake values (SUV max) , mean standardized uptake values (SUV mean )and signal-to-noise ratio (SNR) of the liver, blood pool and muscle and SUV max and tumor-to-background ratio (TBR) of lesions. RESULTS In the two groups, the G3 and G2' images met clinical diagnosis requirements in terms of subjective image quality, with scores ≥3. There were no differences in terms of subjective and objective image quality between the groups (G1 and G0.5', G2 and G1', G4 and G2' and G10 and G5'). In the half-dose group, 56 colorectal lesions in 50 patients confirmed by surgical pathology were clearly visible in all groups. The number of FDG-avid lymph nodes was 37 in G1, 38 in G2 and 39 in the remaining half-dose groups. The number of missed metastatic liver lesions was 1 both in G1 and G2. CONCLUSIONS Total-body PET/CT with half-dose was feasible for diagnosing and staging colorectal cancer compared with full-dose 18 F-FDG PET/CT. Moreover, for half-dose total-body PET/CT, a 3-min scan duration could maintain image quality and lesion detectability.
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Affiliation(s)
- Hui Tan
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Wujian Mao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yanyan Cao
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Danjie Cai
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Xiuli Sui
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Chi Qi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Haojun Yu
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Yiqiu Zhang
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
| | - Hongcheng Shi
- Department of Nuclear Medicine, Zhongshan Hospital, Fudan University
- Nuclear Medicine Institute of Fudan University
- Shanghai Institute of Medical Imaging, Shanghai, China
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10
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Wu E, Lee JY, Gelarden I, Engen RM. Nondestructive versus advanced post-transplant lymphoproliferative disorder in a single-center pediatric kidney transplant population. Pediatr Transplant 2022; 26:e14238. [PMID: 35098630 DOI: 10.1111/petr.14238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 01/11/2022] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pediatric kidney transplant recipients are at risk for the development of post-transplant lymphoproliferative disorders (PTLD), a group of potentially devastating diseases that present on a spectrum of severity ranging from nondestructive PTLD to more histologically destructive lesions. Currently, there is inadequate evidence to guide evaluation and management of nondestructive PTLD. METHODS This is a single-center case series of pediatric kidney transplant recipients between January 1, 2008 and December 31, 2019, who were diagnosed with PTLD. The aim was to describe clinical characteristics, presentation, and management of nondestructive versus advanced PTLD. RESULTS Eighteen patients were diagnosed with nondestructive PTLD and seven with more advanced PTLD histopathology. The majority (66.7%) of nondestructive PTLD patients (n = 16) presented with tonsillar hypertrophy and/or snoring and were managed conservatively, with minimal reduction in tacrolimus dose and no further evaluation. No patient progressed to more advanced PTLD. Advanced PTLD patients (n = 7) were more likely to present with fever, elevated creatinine, a new mass of gastrointestinal symptoms. They received workup with imaging and oncology consultation, and were managed with chemotherapy. CONCLUSIONS Patients with nondestructive PTLD often present with symptoms of sleep-disordered breathing and can be managed conservatively with excellent clinical outcomes. More study is needed to guide care of this under-researched population.
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Affiliation(s)
- Ellen Wu
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joo-Young Lee
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ian Gelarden
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rachel M Engen
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Piccardo A, Albert NL, Borgwardt L, Fahey FH, Hargrave D, Galldiks N, Jehanno N, Kurch L, Law I, Lim R, Lopci E, Marner L, Morana G, Young Poussaint T, Seghers VJ, Shulkin BL, Warren KE, Traub-Weidinger T, Zucchetta P. Joint EANM/SIOPE/RAPNO practice guidelines/SNMMI procedure standards for imaging of paediatric gliomas using PET with radiolabelled amino acids and [ 18F]FDG: version 1.0. Eur J Nucl Med Mol Imaging 2022; 49:3852-3869. [PMID: 35536420 PMCID: PMC9399211 DOI: 10.1007/s00259-022-05817-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/23/2022] [Indexed: 01/18/2023]
Abstract
Positron emission tomography (PET) has been widely used in paediatric oncology. 2-Deoxy-2-[18F]fluoro-D-glucose ([18F]FDG) is the most commonly used radiopharmaceutical for PET imaging. For oncological brain imaging, different amino acid PET radiopharmaceuticals have been introduced in the last years. The purpose of this document is to provide imaging specialists and clinicians guidelines for indication, acquisition, and interpretation of [18F]FDG and radiolabelled amino acid PET in paediatric patients affected by brain gliomas. There is no high level of evidence for all recommendations suggested in this paper. These recommendations represent instead the consensus opinion of experienced leaders in the field. Further studies are needed to reach evidence-based recommendations for the applications of [18F]FDG and radiolabelled amino acid PET in paediatric neuro-oncology. These recommendations are not intended to be a substitute for national and international legal or regulatory provisions and should be considered in the context of good practice in nuclear medicine. The present guidelines/standards were developed collaboratively by the EANM and SNMMI with the European Society for Paediatric Oncology (SIOPE) Brain Tumour Group and the Response Assessment in Paediatric Neuro-Oncology (RAPNO) working group. They summarize also the views of the Neuroimaging and Oncology and Theranostics Committees of the EANM and reflect recommendations for which the EANM and other societies cannot be held responsible.
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Affiliation(s)
- Arnoldo Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera", Genoa, Italy
| | - Nathalie L Albert
- Department of Nuclear Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Lise Borgwardt
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Darren Hargrave
- Department of Paediatric Oncology, Great Ormond Street Hospital NHS Trust, London, UK
| | - Norbert Galldiks
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie Paris, Paris, France
| | - Lars Kurch
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany.
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Egesta Lopci
- Nuclear Medicine Unit, IRCCS-Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milano, Italy
| | - Lisbeth Marner
- Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Giovanni Morana
- Department of Neurosciences, University of Turin, Turin, Italy
| | - Tina Young Poussaint
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Victor J Seghers
- Singleton Department of Pediatric Radiology, Texas Children's Hospital, Houston, TX, USA
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA
| | - Barry L Shulkin
- Nuclear Medicine Department of Diagnostic Imaging St. Jude Children's Research Hospital, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Katherine E Warren
- Department of Pediatric Oncology, Dana Farber Cancer Institute, Boston, MA, USA
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Pietro Zucchetta
- Nuclear Medicine Unit, Department of Medicine - DIMED, University Hospital of Padova, Padua, Italy
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12
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Mohammadi N, Akhlaghi P. Evaluation of radiation dose to pediatric models from whole body PET/CT imaging. J Appl Clin Med Phys 2022; 23:e13545. [PMID: 35112453 PMCID: PMC8992961 DOI: 10.1002/acm2.13545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/06/2022] Open
Abstract
Positron emission tomography (PET)/computed tomography (CT) is a well-known modality for the diagnosis of various diseases in children and adult patients. On the other hand, younger patients are more radiosensitive than adults, so there are concerns about the level of ionizing radiation exposure in pediatric whole body PET/CT imaging. In this regard, comprehensive specific radiation dosimetry for whole body PET/CT imaging is highly desired for different ages, sizes, and shapes. Therefore, in this study, organ absorbed doses were evaluated for pediatric voxel models from 4 to 14 years old and compared with those of ICRP phantoms. Monte Carlo calculation was performed to evaluate S-value, absorbed dose, and effective dose from 18 F-FDG radiotracers and whole body CT scan for different computational models, including 4- to 14-year-old phantoms. The results showed that the S-value and, therefore, absorbed dose of 18 F-FDG strongly depended on the phantom anatomy. These variations were justified by the distance between source and target organs. Moreover, on average, the absorbed doses from whole body CT scans were 13.5 times lower than those from 18 F-FDG for all organs. According to the results, various anatomies and ages should be considered for accurate dose evaluation. These data can be used for specific risk assessment of the pediatric population in clinical nuclear imaging.
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Affiliation(s)
- Najmeh Mohammadi
- Faculty of Sciences, Physics Department, Sahand University of Technology, Tabriz, Iran
| | - Parisa Akhlaghi
- Faculty of Medicine, Department of Medical Physics, Tabriz University of Medical Sciences, Tabriz, Iran
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13
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Patient preparation for PET studies. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00043-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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14
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Khalatbari H, Shulkin BL, Aldape L, Parisi MT. Pediatric Nuclear Medicine: Technical Aspects. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00074-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Abstract
Nuclear medicine provides methods and techniques in that has benefited pediatric patients and their referring physicians for over 40 years. Nuclear medicine provides qualitative and quantitative information about overall and regional function of organs, systems, and lesions in the body. This involves applications in many organ systems including the skeleton, the brain, the kidneys and the heart as well as in the diagnosis and treatment of cancer. The practice of nuclear medicine requires the administration of radiopharmaceuticals which expose the patient to very low levels of ionizing radiation. Advanced approaches in the estimation of radiation dose from the internal distribution of radiopharmaceuticals in patients of various sizes and shapes have been developed in the past 20 years. Although there is considerable uncertainty in the estimation of the risk of adverse health effects from radiation at the very low exposure levels typically associated with nuclear medicine, some considers it prudent to be more cautious when applied to children as they are generally considered to be at higher risk than adults. Standard guidelines for administered activities for nuclear medicine procedures in children have been established including the North American consensus guidelines and the Paediatric Dosage Card developed by the European Association of Nuclear Medicine. As we move into the future, these guidelines would likely be reviewed in response to changes in clinical practice, a better understanding of radiation dosimetry as applied to children as well as new clinical applications, new advancements in the field with respect to both instrumentation and image reconstruction and processing.
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Affiliation(s)
- S Ted Treves
- Harvard Medical School; Brigham and Women's Hospital.
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16
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Fang T, Meng N, Feng P, Huang Z, Li Z, Fu F, Yuan J, Yang Y, Liu H, Roberts N, Wang M. A Comparative Study of Amide Proton Transfer Weighted Imaging and Intravoxel Incoherent Motion MRI Techniques Versus (18) F-FDG PET to Distinguish Solitary Pulmonary Lesions and Their Subtypes. J Magn Reson Imaging 2021; 55:1376-1390. [PMID: 34723413 DOI: 10.1002/jmri.27977] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/15/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Amide proton transfer weighted imaging (APTw), intravoxel incoherent motion (IVIM), and positron emission tomography (PET) imaging all have the potential to characterize solitary pulmonary lesions (SPLs). PURPOSE To compare APTw and IVIM with PET imaging for distinguishing between benign and malignant SPLs and their subtypes. STUDY TYPE Prospective. POPULATION Ninety-five patients, 78 with malignant SPLs (including 48 with adenocarcinoma [AC] and 17 with squamous cell carcinoma [SCC]), and 17 with benign SPLs. FIELD STRENGTH/SEQUENCE Fast spin-echo (FSE) T2WI, FSE APTw and echo-planar imaging IVIM, MR-base attenuation correction (MRAC), and PET imaging on a 3-T whole-body PET/MR system. ASSESSMENT The magnetization transfer ratio asymmetry (MTRasym) at 3.5 ppm, diffusion coefficient (D), pseudo diffusion coefficient (D*), perfusion fraction (f), and the maximum standardized uptake value (SUVmax) were analyzed. STATISTICAL TESTS Individual sample t-test, Delong test, Pearson's correlation analysis, and area under the receiver operating characteristic curve (AUC). P < 0.05 indicated statistical significance. RESULTS The MTRasym and SUVmax were significantly higher, and D was significantly lower in the malignant group (3.3 ± 2.6 [%], 7.8 ± 5, and 1.2 ± 0.3 [×10-3 mm2 /second]) compared to the benign group (-0.3 ± 1.6 [%], 3.1 ± 3.8, and 1.6 ± 0.3 [×10-3 mm2 /second]). The MTRasym and D were significantly lower, and SUVmax was significantly higher in the SCC group (0.8 ± 1.0 [%], 1.0 ± 0.2 [×10-3 mm2 /second] than in the AC group (4.1 ± 2.6 [%], 1.3 ± 0.3 [×10-3 mm2 /second], 6.7 ± 4.6). Besides, the combination (AUC = 0.964) of these three methods showed higher diagnostic efficacy than any individual method (AUC = 0.917, 0.851, 0.82, respectively) in identifying malignant and benign SPLs. However, APTw showed better diagnostic efficacy than the combination of three methods or PET imaging alone in distinguishing SCC and AC groups (AUC = 0.934, 0.781, 0.725, respectively). DATA CONCLUSION APTw, IVIM, and PET imaging are all effective methods to distinguish benign and malignant SPLs and their subtypes. APTw is potentially more capable than PET imaging of distinguishing lung SCC from AC. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ting Fang
- Department of Medical Imaging, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Nan Meng
- Department of Medical Imaging, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Pengyang Feng
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Medical Imaging, Henan University People's Hospital, Zhengzhou, China
| | - Zhun Huang
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Medical Imaging, Henan University People's Hospital, Zhengzhou, China
| | - Ziqiang Li
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Medical Imaging, Xinxiang Medical University, Xinxiang, China
| | - Fangfang Fu
- Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Jianmin Yuan
- Central Research Institute, UIH Group, Shanghai, China
| | - Yang Yang
- Beijing United Imaging Research Institute of Intelligent Imaging, UIH Group, Beijing, China
| | - Hui Liu
- UIH America, Inc, Houston, Texas, USA
| | - Neil Roberts
- Clinical Research Imaging Centre, School of Clinical Sciences and Community Health, College of Medicine and Veterinary Medicine, The University of Edinburgh, Edinburgh, UK
| | - Meiyun Wang
- Department of Medical Imaging, Zhengzhou University People's Hospital, Zhengzhou, China.,Department of Medical Imaging, Henan University People's Hospital, Zhengzhou, China.,Department of Medical Imaging, Xinxiang Medical University, Xinxiang, China
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17
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Gould SM, Mackewn J, Chicklore S, Cook GJR, Mallia A, Pike L. Optimisation of CT protocols in PET-CT across different scanner models using different automatic exposure control methods and iterative reconstruction algorithms. EJNMMI Phys 2021; 8:58. [PMID: 34331602 PMCID: PMC8325723 DOI: 10.1186/s40658-021-00404-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/13/2021] [Indexed: 11/20/2022] Open
Abstract
Background A significant proportion of the radiation dose from a PET-CT examination is dependent on the CT protocol, which should be optimised for clinical purposes. Matching protocols on different scanners within an imaging centre is important for the consistency of image quality and dose. This paper describes our experience translating low-dose CT protocols between scanner models utilising different automatic exposure control (AEC) methods and reconstruction algorithms. Methods The scanners investigated were a newly installed Siemens Biograph mCT PET with 64-slice SOMATOM Definition AS CT using sinogram affirmed iterative reconstruction (SAFIRE) and two GE Discovery 710 PET scanners with 128-slice Optima 660 CT using adaptive statistical reconstruction (ASiR). Following exploratory phantom work, 33 adult patients of various sizes were scanned using the Siemens scanner and matched to patients scanned using our established GE protocol to give 33 patient pairs. A comparison of volumetric CT dose index (CTDIvol) and image noise within these patient pairs informed optimisation, specifically for obese patients. Another matched patient study containing 27 patient pairs was used to confirm protocol matching. Size-specific dose estimates (SSDEs) were calculated for patients in the second cohort. With the acquisition protocol for the Siemens scanner determined, clinicians visually graded the images to identify optimal reconstruction parameters. Results In the first matched patient study, the mean percentage difference in CTDIvol for Siemens compared to GE was − 10.7% (range − 41.7 to 50.1%), and the mean percentage difference in noise measured in the patients’ liver was 7.6% (range − 31.0 to 76.8%). In the second matched patient study, the mean percentage difference in CTDIvol for Siemens compared to GE was − 20.5% (range − 43.1 to 1.9%), and the mean percentage difference in noise was 19.8% (range − 27.0 to 146.8%). For these patients, the mean SSDEs for patients scanned on the Siemens and GE scanners were 3.27 (range 2.83 to 4.22) mGy and 4.09 (range 2.81 to 4.82) mGy, respectively. The analysis of the visual grading study indicated no preference for any of the SAFIRE strengths. Conclusions Given the different implementations of acquisition parameters and reconstruction algorithms between vendors, careful consideration is required to ensure optimisation and standardisation of protocols.
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Affiliation(s)
- Sarah-May Gould
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK.
| | - Jane Mackewn
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Sugama Chicklore
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Gary J R Cook
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Andrew Mallia
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
| | - Lucy Pike
- King's College London & Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7EH, UK
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18
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Hu X, Li D, Hu G, Huang Q, Wang P, Cai J. Diagnostic performance of 18F-FDG PET/CT in pediatric lymphoma infiltrating bone marrow: a meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00452-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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19
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Vali R, Alessio A, Balza R, Borgwardt L, Bar-Sever Z, Czachowski M, Jehanno N, Kurch L, Pandit-Taskar N, Parisi M, Piccardo A, Seghers V, Shulkin BL, Zucchetta P, Lim R. SNMMI Procedure Standard/EANM Practice Guideline on Pediatric 18F-FDG PET/CT for Oncology 1.0. J Nucl Med 2021; 62:99-110. [PMID: 33334912 PMCID: PMC8679588 DOI: 10.2967/jnumed.120.254110] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 02/06/2023] Open
Abstract
The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional nonprofit medical association founded in 1985 to facilitate communication worldwide among individuals pursuing clinical and academic excellence in nuclear medicine. SNMMI and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine. The SNMMI and EANM will periodically put forth new standards/guidelines for nuclear medicine practice to help advance the science of nuclear medicine and improve service to patients. Existing standards/guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each standard/guideline, representing a policy statement by the SNMMI/EANM, has undergone a thorough consensus process, entailing extensive review. The SNMMI and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging requires particular training and skills, as described in each document. These standards/guidelines are educational tools designed to assist practitioners in providing appropriate and effective nuclear medicine care for patients. These guidelines are consensus documents, and are not inflexible rules or requirements of practice. They are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the SNMMI and the EANM cautions against the use of these standards/guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by medical professionals taking into account the unique circumstances of each case. Thus, there is no implication that action differing from what is laid out in the standards/guidelines, standing alone, is below standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the standards/guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the standards/guidelines. The practice of medicine involves not only the science, but also the art of dealing with the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible for general guidelines to consistently allow for an accurate diagnosis to be reached or a particular treatment response to be predicted. Therefore, it should be recognized that adherence to these standards/guidelines will not ensure a successful outcome. All that should be expected is that the practitioner follows a reasonable course of action, based on their level of training, the current knowledge, the available resources, and the needs/context of the particular patient being treated. PET and computerized tomography (CT) have been widely used in oncology. 18F-FDG is the most common radiotracer used for PET imaging. The purpose of this document is to provide imaging specialists and clinicians guidelines for recommending, performing, and interpreting 18F-FDG PET/CT in pediatric patients in oncology. There is not a high level of evidence for all recommendations suggested in this paper. These recommendations represent the expert opinions of experienced leaders in this field. Further studies are needed to have evidence-based recommendations for the application of 18F-FDG PET/CT in pediatric oncology. These recommendations should be viewed in the context of good practice of nuclear medicine and are not intended to be a substitute for national and international legal or regulatory provisions.
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Affiliation(s)
- Reza Vali
- Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Adam Alessio
- Michigan State University, East Lansing, Michigan
| | - Rene Balza
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lise Borgwardt
- Department for Clinical Physiology, Nuclear Medicine & PET, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Zvi Bar-Sever
- Schneider Children's Medical Center, Petach Tikva, Israel
| | | | - Nina Jehanno
- Department of Nuclear Medicine, Institut Curie, Paris, France
| | - Lars Kurch
- University Hospital Leipzig, Department of Nuclear Medicine, Leipzig, Germany
| | | | - Marguerite Parisi
- University of Washington School of Medicine and Seattle Children's Hospital, Seattle, Washington
| | | | - Victor Seghers
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Barry L Shulkin
- St. Jude Children's Research Hospital, Memphis, Tennessee; and
| | | | - Ruth Lim
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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20
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Kertész H, Beyer T, London K, Saleh H, Chung D, Rausch I, Cal-Gonzalez J, Kitsos T, Kench PL. Reducing Radiation Exposure to Paediatric Patients Undergoing [18F]FDG-PET/CT Imaging. Mol Imaging Biol 2021; 23:775-786. [PMID: 33846898 PMCID: PMC8410733 DOI: 10.1007/s11307-021-01601-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the possibility of reducing the injected activity for whole-body [18F]FDG-PET/CT studies of paediatric oncology patients and to assess the usefulness of time-of-flight (TOF) acquisition on PET image quality at reduced count levels. PROCEDURES Twenty-nine paediatric oncology patients (12F/17M, 3-18 years old (median age 13y), weight 45±20 kg, BMI 19±4 kg/m2), who underwent routine whole-body PET/CT examinations on a Siemens Biograph mCT TrueV system with TOF capability (555ps) were included in this study. The mean injected activity was 156 ± 45 MBq (3.8 ± 0.8 kg/MBq) and scaled to patient weight. The raw data was collected in listmode (LM) format and pre-processed to simulate reduced levels of [18F]FDG activity (75, 50, 35, 20 and 10% of the original counts) by randomly removing events from the original LM data. All data were reconstructed using the vendor-specific e7-tools with standard OSEM only, with OSEM plus resolution recovery (PSF). The reconstructions were repeated with added TOF (TOF) and PSF+TOF. The benefit of TOF together with the reduced count levels was evaluated by calculating the gains in signal-to-noise ratio (SNR) in the liver and contrast-to-noise ratio (CNR) in all PET-positive lesions before and after TOF employed at every simulated reduced count level. Finally, the PSF+TOF images at 50, 75 and 100% of counts were evaluated clinically on a 5-point scale by three nuclear medicine physicians. RESULTS The visual inspection of the reconstructed images did not reveal significant differences in image quality between 75 and 100% count levels for PSF+TOF. The improvements in SNR and CNR were the greatest for TOF reconstruction and PSF combined. Both SNR and CNR gains did increase linearly with the patients BMI for both OSEM only and PSF reconstruction. These benefits were observed until reducing the counts to 50 and 35% for SNR and CNR, respectively. CONCLUSIONS The benefit of using TOF was noticeable when using 50% or greater of the counts when evaluating the CNR and SNR. For [18F]FDG-PET/CT, whole-body paediatric imaging the injected activity can be reduced to 75% of the original dose without compromising PET image quality.
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Affiliation(s)
- Hunor Kertész
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Hamda Saleh
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David Chung
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jacobo Cal-Gonzalez
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Ion Beam Applications, Protontherapy Center Quironsalud, Madrid, Spain
| | - Theo Kitsos
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Peter L Kench
- Discipline of Medical Imaging Science and Brain and Mind Centre, Faculty Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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21
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Ultra-low dose whole-body CT for attenuation correction in a dual tracer PET/CT protocol for multiple myeloma. Phys Med 2021; 84:1-9. [PMID: 33799056 DOI: 10.1016/j.ejmp.2021.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 02/22/2021] [Accepted: 03/13/2021] [Indexed: 01/17/2023] Open
Abstract
PURPOSE To investigate within phantoms the minimum CT dose allowed for accurate attenuation correction of PET data and to quantify the effective dose reduction when a CT for this purpose is incorporated in the clinical setting. METHODS The NEMA image quality phantom was scanned within a large parallelepiped container. Twenty-one different CT images were acquired to correct attenuation of PET raw data. Radiation dose and image quality were evaluated. Thirty-one patients with proven multiple myeloma who underwent a dual tracer PET/CT scan were retrospectively reviewed. 18F-fluorodeoxyglucose PET/CT included a diagnostic whole-body low dose CT (WBLDCT: 120 kV-80mAs) and 11C-Methionine PET/CT included a whole-body ultra-low dose CT (WBULDCT) for attenuation correction (100 kV-40mAs). Effective dose and image quality were analysed. RESULTS Only the two lowest radiation dose conditions (80 kV-20mAs and 80 kV-10mAs) produced artifacts in CT images that degraded corrected PET images. For all the other conditions (CTDIvol ≥ 0.43 mGy), PET contrast recovery coefficients varied less than ± 1.2%. Patients received a median dose of 6.4 mSv from diagnostic CT and 2.1 mSv from the attenuation correction CT. Despite the worse image quality of this CT, 94.8% of bone lesions were identifiable. CONCLUSION Phantom experiments showed that an ultra-low dose CT can be implemented in PET/CT procedures without any noticeable degradation in the attenuation corrected PET scan. The replacement of the standard CT for this ultra-low dose CT in clinical PET/CT scans involves a significant radiation dose reduction.
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22
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Zhao YM, Li YH, Chen T, Zhang WG, Wang LH, Feng J, Li C, Zhang X, Fan W, Hu YY. Image quality and lesion detectability in low-dose pediatric 18F-FDG scans using total-body PET/CT. Eur J Nucl Med Mol Imaging 2021; 48:3378-3385. [PMID: 33738519 DOI: 10.1007/s00259-021-05304-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/07/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To investigate the effects of dose reduction on image quality and lesion detectability of oncological 18F-FDG total-body PET/CT in pediatric oncological patients and explore the minimum threshold of administered tracer activity. METHODS A total of 33 pediatric patients (weight 8.5-58.5 kg; age 0.8-17.6 years) underwent total-body PET/CT using uEXPLORER scanner with an 18F-FDG administered dose of 3.7 MBq/kg and an acquisition time of 600 s were retrospectively enrolled. Low-dose images (0.12-1.85 MBq/kg) were simulated by truncating the list-mode PET data to reducing count density. Subjective image quality was rated on a 5-point scale. Semi-quantitative uptake metrics for low-dose images were assessed using region-of-interest (ROI) analysis of healthy liver and suspected lesions and were compared with full-dose images. The micro-lesion detectability was compared among the dose-dependent PET images. RESULTS Our analysis shows that sufficient subjective image quality and lesion conspicuity could be maintained down to 1/30th (0.12 MBq/kg) of the administered dose of 18F-FDG, where good image quality scores were given to 1/2- and 1/10- dose groups. The image noise was significantly more deranged than the overall quality and lesion conspicuity in 1/30- to 1/10-dose groups (all p < 0.05). With reduced doses, quantitative analysis of ROIs showed that SUVmax and SD in the liver increased gradually (p < 0.05), but SUVmax in the lesions and lesion-to-background ratio (LBR) showed no significant deviation down to 1/30-dose. One hundred percent of the 18F-FDG-avid micro-lesions identified in full-dose images were localized down to 1/15-dose images, while 97% of the lesion were localized in 1/30-dose images. CONCLUSION The total-body PET/CT might significantly decrease the administered dose upon maintaining the image quality and diagnostic performance of micro-lesions in pediatric patients. Data suggests that using total-body PET/CT, optimal image quality could be achieved with an administered dose-reduction down to 1/10-dose (0.37 MBq/kg).
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Affiliation(s)
- Yu-Mo Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Ying-He Li
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Tao Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Wei-Guang Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Lin-Hao Wang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China
| | - Jiatai Feng
- Central research institute, United Imaging Healthcare, Shanghai, China
| | - Chenwei Li
- Central research institute, United Imaging Healthcare, Shanghai, China
| | - Xu Zhang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
| | - Wei Fan
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
| | - Ying-Ying Hu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China. .,Department of Nuclear Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfengdong Road, Guangzhou, 510060, Guangdong, China.
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Alkhorayef M. Effective radiation doses in pediatric PET/CT examinations: Pilot study. Appl Radiat Isot 2021; 168:109412. [DOI: 10.1016/j.apradiso.2020.109412] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 08/08/2020] [Accepted: 09/04/2020] [Indexed: 01/04/2023]
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Chong A, Park JM, Pak K, Kim YI, Kwon HW, Lee ES, Nam KP, Lee HY, Lee HJ, Yoo ID, Eo JS, Kim JY, Yoon JK, Kim KM, Kim SM, Kim TS. Recent Survey of Effective Doses of F-18 FDG Torso PET/CT in Korea and the Current Recommendations for CT Protocols of PET/CT. Nucl Med Mol Imaging 2020; 54:224-232. [PMID: 33088351 DOI: 10.1007/s13139-020-00654-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/04/2020] [Accepted: 07/10/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose This study aimed to construct a database of the effective doses (ED) from F-18 fluorodeoxyglucose (FDG) torso positron emission tomography/computed tomography (PET/CT) in Korea to provide data that supports the reduction of the CT dose of PET/CT and optimization of PET/CT protocols in Korea. Methods We investigated data of ED and CT parameters of FDG PET/CT. The data were analyzed by body weight groups. Results A total of 31 hospitals participated in the survey (99 adults). The mean total EDs (± SD) were 8.77 ± 2.76, 10.93 ± 3.14, and 12.57 ± 3.79 mSv for the 55-, 70-, and 85-kg groups, respectively. The FDG EDs were 4.80 ± 0.98, 6.05 ± 1.15, and 6.89 ± 1.52 mSv, and the CT EDs were 4.00 ± 2.12, 4.88 ± 2.51, and 5.68 ± 2.89 mSv, respectively. Of the enrolled hospitals, 54.5% used ultra-low-dose CT protocols, and their CT ED was significantly lower than low-dose CT group in all groups (2.9 ± 1.0, 3.2 ± 1.1, and 3.3 ± 1.0 mSv vs. 6.6 ± 1.6, 7.2 ± 2.1, and 7.9 ± 2.2 mSv, all p < 0.001, respectively). In the ultra-low-dose CT group, the CT ED with the iterative reconstruction was significantly lower than that of CT without iterative reconstruction in the 55-kg group (2.4 ± 0.9 vs. 3.3 ± 0.9, p = 0.04). Conclusions These results and current recommendations can be helpful for optimizing PET/CT diagnostic reference level (DRL) and reducing unnecessary PET/CT radiation exposure.
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Affiliation(s)
- Ari Chong
- Department of Nuclear Medicine, Chosun University Hospital, Gwangju, South Korea
| | - Jung Mi Park
- Department of Nuclear Medicine, Soonchunhyang University Bucheon Hospital, Bucheon-si, Gyeonggi-do Republic of Korea
| | - Kyoungjune Pak
- Department of Nuclear Medicine, Pusan National University Hospital, Busan, South Korea
| | - Yong-Il Kim
- Department of Nuclear Medicine, Asan Medical Center, Seoul, South Korea
| | - Hyun Woo Kwon
- Department of Nuclear Medicine, Korea University Anam Hospital, Seoul, South Korea
| | - Eun Seong Lee
- Department of Nuclear Medicine, Korea University Medical Center, Korea University College of Medicine, Seoul, South Korea
| | - Ki Pyo Nam
- Department of Nuclear Medicine, Asan Medical Center, Seoul, South Korea
| | - Ho-Young Lee
- Department of Nuclear Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hong Jae Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ik Dong Yoo
- Department of Nuclear Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, South Korea
| | - Jae Seon Eo
- Department of Nuclear Medicine, Korea University Guro Hospital, Seoul, South Korea
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Guri Hospital, Guri-si, South Korea
| | - Joon-Kee Yoon
- Department of Nuclear Medicine, Ajou University Medical Center, Suwon, South Korea
| | - Kyeong Min Kim
- Division of Applied RI, Korea Institute of Radiological and Medical Sciences, Seoul, South Korea
| | - Seong Min Kim
- Department of Nuclear Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, National Cancer Center, Goyang-si, South Korea
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Schmall JP, Surti S, Otero HJ, Servaes S, Karp JS, States LJ. Investigating Low-Dose Image Quality in Whole-Body Pediatric 18F-FDG Scans Using Time-of-Flight PET/MRI. J Nucl Med 2020; 62:123-130. [DOI: 10.2967/jnumed.119.240127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/07/2020] [Indexed: 12/20/2022] Open
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Saade-Lemus S, Nevo E, Soliman I, Otero HJ, Magee RW, Drum ET, States LJ. Clinical pediatric positron emission tomography/magnetic resonance program: a guide to successful implementation. Pediatr Radiol 2020; 50:607-617. [PMID: 32076750 DOI: 10.1007/s00247-019-04578-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/16/2019] [Accepted: 11/13/2019] [Indexed: 11/29/2022]
Abstract
Children with malignancies undergo recurrent imaging as part of tumor diagnosis, staging and therapy response assessment. Simultaneous positron emission tomography (PET) and magnetic resonance (MR) allows for decreased radiation exposure and acts as a one-stop shop for disease in which MR imaging is required. Nevertheless, PET/MR is still less readily available than PET/CT across institutions. This article serves as a guide to successful implementation of a clinical pediatric PET/MR program based on our extensive clinical experience. Challenges include making scanners more affordable and increasing patient throughput by decreasing total scan time. With improvements in workflow and robust acquisition protocols, PET/MR imaging is expected to play an increasingly important role in pediatric oncology.
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Affiliation(s)
- Sandra Saade-Lemus
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elad Nevo
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Iman Soliman
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Ralph W Magee
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Elizabeth T Drum
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
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L-Glucose: Another Path to Cancer Cells. Cancers (Basel) 2020; 12:cancers12040850. [PMID: 32244695 PMCID: PMC7225996 DOI: 10.3390/cancers12040850] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 01/31/2023] Open
Abstract
Cancerous tumors comprise cells showing metabolic heterogeneity. Among numerous efforts to understand this property, little attention has been paid to the possibility that cancer cells take up and utilize otherwise unusable substrates as fuel. Here we discuss this issue by focusing on l-glucose, the mirror image isomer of naturally occurring d-glucose; l-glucose is an unmetabolizable sugar except in some bacteria. By combining relatively small fluorophores with l-glucose, we generated fluorescence-emitting l-glucose tracers (fLGs). To our surprise, 2-NBDLG, one of these fLGs, which we thought to be merely a control substrate for the fluorescent d-glucose tracer 2-NBDG, was specifically taken up into tumor cell aggregates (spheroids) that exhibited nuclear heterogeneity, a major cytological feature of malignancy in cancer diagnosis. Changes in mitochondrial activity were also associated with the spheroids taking up fLG. To better understand these phenomena, we review here the Warburg effect as well as key studies regarding glucose uptake. We also discuss tumor heterogeneity involving aberrant uptake of glucose and mitochondrial changes based on the data obtained by fLG. We then consider the use of fLGs as novel markers for visualization and characterization of malignant tumor cells.
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28
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Quinn BM, Gao Y, Mahmood U, Pandit-Taskar N, Behr G, Zanzonico P, Dauer LT. Patient-adapted organ absorbed dose and effective dose estimates in pediatric 18F-FDG positron emission tomography/computed tomography studies. BMC Med Imaging 2020; 20:9. [PMID: 31996149 PMCID: PMC6988339 DOI: 10.1186/s12880-020-0415-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/21/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Organ absorbed doses and effective doses can be used to compare radiation exposure among medical imaging procedures, compare alternative imaging options, and guide dose optimization efforts. Individual dose estimates are important for relatively radiosensitive patient populations such as children and for radiosensitive organs such as the eye lens. Software-based dose calculation methods conveniently calculate organ dose using patient-adjusted and examination-specific inputs. METHODS Organ absorbed doses and effective doses were calculated for 429 pediatric 18F-FDG PET-CT patients. Patient-adjusted and scan-specific information was extracted from the electronic medical record and scanner dose-monitoring software. The VirtualDose and OLINDA/EXM (version 2.0) programs, respectively, were used to calculate the CT and the radiopharmaceutical organ absorbed doses and effective doses. Patients were grouped according to age at the time of the scan as follows: less than 1 year old, 1 to 5 years old, 6 to 10 years old, 11 to 15 years old, and 16 to 17 years old. RESULTS The mean (+/- standard deviation, range) total PET plus CT effective dose was 14.5 (1.9, 11.2-22.3) mSv. The mean (+/- standard deviation, range) PET effective dose was 8.1 (1.2, 5.7-16.5) mSv. The mean (+/- standard deviation, range) CT effective dose was 6.4 (1.8, 2.9-14.7) mSv. The five organs with highest PET dose were: Urinary bladder, heart, liver, lungs, and brain. The five organs with highest CT dose were: Thymus, thyroid, kidneys, eye lens, and gonads. CONCLUSIONS Organ and effective dose for both the CT and PET components can be estimated with actual patient and scan data using commercial software. Doses calculated using software generally agree with those calculated using dose conversion factors, although some organ doses were found to be appreciably different. Software-based dose calculation methods allow patient-adjusted dose factors. The effort to gather the needed patient data is justified by the resulting value of the characterization of patient-adjusted dosimetry.
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Affiliation(s)
- Brian M Quinn
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Yiming Gao
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Usman Mahmood
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Neeta Pandit-Taskar
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Gerald Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Pat Zanzonico
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Lawrence T Dauer
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.,Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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29
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Ruhlmann M, Ruhlmann V. PET in Head and Neck Cancer. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Imaging for diagnosis, staging and response assessment of Hodgkin lymphoma and non-Hodgkin lymphoma. Pediatr Radiol 2019; 49:1545-1564. [PMID: 31620854 DOI: 10.1007/s00247-019-04529-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 08/14/2019] [Accepted: 09/06/2019] [Indexed: 02/07/2023]
Abstract
Hodgkin lymphoma and non-Hodgkin lymphoma are common malignancies in children and are now highly treatable. Imaging plays a major role in diagnosis, staging and response using conventional CT and MRI and metabolic imaging with positron emission tomography (PET)/CT and PET/MRI. Cross-sectional imaging has replaced staging laparotomy and splenectomy by demonstrating abdominal nodal groups and organ involvement. [F-18]2-fluoro-2-deoxyglucose (FDG) PET provides information on bone marrow involvement, and MRI elucidates details of cortical bone and confirmation of bone marrow involvement. The staging system for Hodgkin lymphoma is the Ann Arbor system with Cotswald modifications and is based on imaging, whereas the non-Hodgkin staging system is the St. Jude Classification by Murphy or the more recent revised International Pediatric Non-Hodgkin Lymphoma Staging System (IPNHLSS). Because all pediatric lymphomas are metabolically FDG-avid and identify all nodal, solid organ, cortical bone and bone marrow disease, staging evaluations require FDG PET as PET/CT or PET/MRI in both Hodgkin and non-Hodgkin lymphoma. Both diseases have in common issues of airway compromise at presentation demonstrated by imaging. Differences exist in that Hodgkin lymphoma has several independent poor prognostic factors seen by imaging such as large mediastinal adenopathy, Stage IV disease, systemic symptoms, pleural effusion and pericardial effusion. Non-Hodgkin lymphoma includes more organ involvement such as renal, ovary, central nervous system and skin. Early or interim PET-negative scans are a reliable indicator of improved clinical outcome and optimize risk-adapted therapy and patient management; imaging may not, however, predict who will relapse. A recent multicenter trial has concluded that it is usually sufficient for pediatric lymphoma at staging and interim assessment to evaluate children with PET imaging from skull base to mid-thigh. Various systems of assessment of presence of disease or response are used, including the Deauville visual scale, where avidity is compared to liver; Lugano, which includes size change as part of response; or quantitative PET, which uses standardized uptake values to define more accurate response. Newer methods of immunotherapy can produce challenges in FDG PET evaluation because of inflammatory changes that may not represent disease.
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31
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Chambers G, Frood R, Patel C, Scarsbrook A. 18F-FDG PET-CT in paediatric oncology: established and emerging applications. Br J Radiol 2019; 92:20180584. [PMID: 30383441 PMCID: PMC6404840 DOI: 10.1259/bjr.20180584] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/01/2018] [Accepted: 10/27/2018] [Indexed: 12/11/2022] Open
Abstract
Accurate staging and response assessment is vital in the management of childhood malignancies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (FDG PET-CT) provides complimentary anatomical and functional information. Oncological applications of FDG PET-CT are not as well-established within the paediatric population compared to adults. This article will comprehensively review established oncological PET-CT applications in paediatric oncology and provide an overview of emerging and future developments in this domain.
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Affiliation(s)
- Greg Chambers
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Russell Frood
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Chirag Patel
- Department of Nuclear Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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32
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Zucchetta P, Branchini M, Zorz A, Bodanza V, Cecchin D, Paiusco M, Bui F. Quantitative analysis of image metrics for reduced and standard dose pediatric 18F-FDG PET/MRI examinations. Br J Radiol 2019; 92:20180438. [PMID: 30673306 DOI: 10.1259/bjr.20180438] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE: The study performs a comprehensive analysis of image metrics to objectively support the reduction of injected activity in pediatric oncology 18F-FDG PET/MR (18F-fludeoxyglucose PET/MR) examinations. Contrast-to-Noise Ratio (CNR), Normalized Noise (NN), tumor burden, and standardized uptake value (SUV) parameters stability were investigated to robustly define the acceptable reduced activity level that preserves the clinical utility of images, considering different PET applications. METHODS: 21 PET/MRI examinations performed on a 3-Tesla Biograph mMR scanner were analyzed. Tracer activity reduction was stimulated by decreasing the count statistics of the original list-mode data (3 MBq kg-1). In addition to the already studied SUV metrics and subjective scoring on lesion detectability, a thorough analysis of CNR, NN, Metabolic Tumor Volume (MTV), and Total Lesion Glycolysis (TLG) was performed. RESULTS: SUVmax and SUVmean increased more than 5% only in 0.6 MBq kg-1 reconstructed images (+10% and +9%, respectively), while SUVpeak was almost unaffected (average variations < 2%). The quantified CNR, NN, MTV, and TLG behavior with the decrease of the injected activity clearly defines 1.5 MBq kg-1 as a threshold of activity after which the quality of the image degrades. Subjective and objective analyses yielded consistent results. All 56 lesions were detected until activity of 1.2 MBq kg-1, whereas five lesions were missed on the 0.6 MBq kg-1 image. Perceived image quality (IQ) decreased in Lower Tracer Activity (LTA) images but remained acceptable until 1.5 MBq kg-1. CONCLUSION: Results about the stability of image metrics beyond the semi-quantitative SUV parameters and subjective analysis, rigorously proves the feasibility of the reduction of injected activity to 1.5 MBqkg-1 for pediatric patients aged between 7 and 17 years. ADVANCES IN KNOWLEDGE: This is the first report on the quantitative evaluation of the effect of activity reduction on image quality in pediatric PET/MR. The findings offer objective corroboration to the feasibility of a significant dose reduction without consequences on clinical image reading and tumor burden metrics.
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Affiliation(s)
- Pietro Zucchetta
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
| | - Marco Branchini
- 2 Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - Alessandra Zorz
- 2 Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - Valentina Bodanza
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
| | - Diego Cecchin
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
| | - Marta Paiusco
- 2 Medical Physics Department, Veneto Institute of Oncology IOV-IRCCS , Padova , Italy
| | - Franco Bui
- 1 Nuclear Medicine Unit, Department of Medicine DIMED, University-Hospital of Padova , Padova , Italy
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Baranska D, Matera K, Podgorski M, Gorska-Chrzastek M, Krajewska K, Trelinska J, Grzelak P. Feasibility of diffusion-weighted imaging with DWIBS in staging Hodgkin lymphoma in pediatric patients: comparison with PET/CT. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2018; 32:381-390. [PMID: 30498885 PMCID: PMC6525117 DOI: 10.1007/s10334-018-0726-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 12/17/2022]
Abstract
Objective The aim of the study was to evaluate feasibility of diffusion-weighted whole-body imaging with background body signal suppression (DWIBS) method in diagnosing Hodgkin lymphoma in pediatric patients and to compare it with 18F-FDG PET/CT as a gold standard. Materials and methods Eleven patients (median age 14) with newly diagnosed Hodgkin lymphoma were examined with 18F-FDG PET/CT and MRI including whole-body DWIBS sequence (b = 0, 800 s/mm2), before the oncologic treatment. About 26 locations of lymphatic tissues were evaluated visually and quantitatively using ADCmean (DWIBS) and SUVmax (18F-FDG PET/CT), respectively. Results All affected lymph node regions (n = 134) diagnosed in 18F-FDG PET/CT were found with DWIBS, presenting decreased diffusion. Significant correlation was found between ADC and SUV values (R2 = − 0.37; p = 0.0001). Nevertheless, additional 33 regions were recognized only by DWIBS. They were significantly smaller than regions diagnosed by both methods. Discussion Agreement between DWIBS and 18F-FDG PET/CT for detection and staging of malignant lymphoma is high. DWIBS can be used for the evaluation of pediatric Hodgkin lymphoma.
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Affiliation(s)
- Dobromila Baranska
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland
| | - Katarzyna Matera
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland.
| | - Michal Podgorski
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland
| | | | - Karolina Krajewska
- Department of Pediatrics, Oncology, Hematology and Diabetology Medical, University of Lodz, Pankiewicza 16, 91-738, Lodz, Poland
| | - Joanna Trelinska
- Department of Pediatrics, Oncology, Hematology and Diabetology Medical, University of Lodz, Pankiewicza 16, 91-738, Lodz, Poland
| | - Piotr Grzelak
- Department of Diagnostic Imaging, Polish Mother's Memorial Hospital-Research Institute in Lodz, Rzgowska 281/289, 93-338, Lodz, Poland
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34
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Do Deauville Scores Improve the Clinical Utility of End-of-Therapy FDG PET Scans for Pediatric Hodgkin Lymphoma? AJR Am J Roentgenol 2018; 212:456-460. [PMID: 30476458 DOI: 10.2214/ajr.18.19755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical utility of Deauville scores in interpretation of end-of-chemotherapy FDG PET scans. CONCLUSION Deauville scores improve the clinical utility of end-of-chemotherapy PET, as evidenced by an increase in positive predictive value to 72.7% from 44.4% on the basis of report alone. The negative predictive value remains greater than 95%.
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Khalatbari H, Parisi MT, Kwatra N, Harrison DJ, Shulkin BL. Pediatric Musculoskeletal Imaging: The Indications for and Applications of PET/Computed Tomography. PET Clin 2018; 14:145-174. [PMID: 30420216 DOI: 10.1016/j.cpet.2018.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The use of PET/computed tomography (CT) for the evaluation and management of children, adolescents, and young adults continues to expand. The principal tracer used is 18F-fluorodeoxyglucose and the principal indication is oncology, particularly musculoskeletal neoplasms. The purpose of this article is to review the common applications of PET/CT for imaging of musculoskeletal issues in pediatrics and to introduce the use of PET/CT for nononcologic issues, such as infectious/inflammatory disorders, and review the use of 18F-sodium fluoride in trauma and sports-related injuries.
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Affiliation(s)
- Hedieh Khalatbari
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA.
| | - Marguerite T Parisi
- Department of Radiology, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle Children's Hospital, 4800 Sandpoint Way NE, Seattle, WA 98105, USA
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Douglas J Harrison
- Department of Pediatrics, MD Anderson Cancer Center, 7600 Beechnut Street, Houston, TX 77074, USA
| | - Barry L Shulkin
- Department of Diagnostic Imaging, St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN 38105, USA
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36
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Tiddens HAWM, Kuo W, van Straten M, Ciet P. Paediatric lung imaging: the times they are a-changin'. Eur Respir Rev 2018; 27:27/147/170097. [PMID: 29491035 DOI: 10.1183/16000617.0097-2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 12/13/2017] [Indexed: 02/06/2023] Open
Abstract
Until recently, functional tests were the most important tools for the diagnosis and monitoring of lung diseases in the paediatric population. Chest imaging has gained considerable importance for paediatric pulmonology as a diagnostic and monitoring tool to evaluate lung structure over the past decade. Since January 2016, a large number of papers have been published on innovations in chest computed tomography (CT) and/or magnetic resonance imaging (MRI) technology, acquisition techniques, image analysis strategies and their application in different disease areas. Together, these papers underline the importance and potential of chest imaging and image analysis for today's paediatric pulmonology practice. The focus of this review is chest CT and MRI, as these are, and will be, the modalities that will be increasingly used by most practices. Special attention is given to standardisation of image acquisition, image analysis and novel applications in chest MRI. The publications discussed underline the need for the paediatric pulmonology community to implement and integrate state-of-the-art imaging and image analysis modalities into their structure-function laboratory for the benefit of their patients.
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Affiliation(s)
- Harm A W M Tiddens
- Pediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands .,Radiology and Nuclear Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Wieying Kuo
- Pediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.,Radiology and Nuclear Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marcel van Straten
- Radiology and Nuclear Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Pierluigi Ciet
- Pediatric Pulmonology and Allergology, Erasmus MC - Sophia Children's Hospital, University Medical Centre, Rotterdam, The Netherlands.,Radiology and Nuclear Medicine, Erasmus University Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands
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Colleran GC, Kwatra N, Oberg L, Grant FD, Drubach L, Callahan MJ, MacDougall RD, Fahey FH, Voss SD. How we read pediatric PET/CT: indications and strategies for image acquisition, interpretation and reporting. Cancer Imaging 2017; 17:28. [PMID: 29116015 PMCID: PMC5678769 DOI: 10.1186/s40644-017-0130-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 10/20/2017] [Indexed: 02/07/2023] Open
Abstract
PET/CT plays an important role in the diagnosis, staging and management of many pediatric malignancies. The techniques for performing PET/CT examinations in children have evolved, with increasing attention focused on reducing patient exposure to ionizing radiation dose whenever possible and minimizing scan duration and sedation times, with a goal toward optimizing the overall patient experience. This review outlines our approach to performing PET/CT, including a discussion of the indications for a PET/CT exam, approaches for optimizing the exam protocol, and a review of different approaches for acquiring the CT portion of the PET/CT exam. Strategies for PACS integration, image display, interpretation and reporting are also provided. Most practices will develop a strategy for performing PET/CT that best meets their respective needs. The purpose of this article is to provide a comprehensive overview for radiologists who are new to pediatric PET/CT, and also to provide experienced PET/CT practitioners with an update on state-of-the art CT techniques that we have incorporated into our protocols and that have enabled us to make considerable improvements to our PET/CT practice.
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Affiliation(s)
- Gabrielle C Colleran
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Neha Kwatra
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Leah Oberg
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Frederick D Grant
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Laura Drubach
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Michael J Callahan
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Robert D MacDougall
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Frederic H Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Stephan D Voss
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02115, USA.
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38
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Oziel M, Korenstein R, Rubinsky B. Radar based technology for non-contact monitoring of accumulation of blood in the head: A numerical study. PLoS One 2017; 12:e0186381. [PMID: 29023544 PMCID: PMC5638502 DOI: 10.1371/journal.pone.0186381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/30/2017] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND This theoretical study examines the use of radar to continuously monitor "accumulation of blood in the head" (ACBH) non-invasively and from a distance, after the location of a hematoma or hemorrhage in the brain was initially identified with conventional medical imaging. Current clinical practice is to monitor ABCH with multiple, subsequent, conventional medical imaging. The radar technology introduced in this study could provide a lower cost and safe alternative to multiple conventional medical imaging monitoring for ACBH. MATERIALS AND METHODS The goal of this study is to evaluate the feasibility of using radar to monitor changes in blood volume in the brain through a numerical simulation of ACBH monitoring from remote, with a directional spiral slot antennae, in 3-D models of the brain. The focus of this study is on evaluating the effect of frequencies on the antennae reading. To that end we performed the calculations for frequencies of 100 MHz, 500 MHz and 1 GHz. RESULTS AND DISCUSSION The analysis shows that the ACBH can be monitored with radar and the monitoring resolution improves with an increase in frequency, in the range studied. However, it also appears that when typical clinical dimensions of hematoma and hemorrhage are used, the variable ratio of blood volume radius and radar wavelength can bring the measurements into the Mie and Rayleigh regions of the radar cross section. In these regions there is an oscillatory change in signal with blood volume size. For some frequencies there is an increase in signal with an increase in volume while in others there is a decrease. CONCLUSIONS While radar can be used to monitor ACBH non-invasively and from a distance, the observed Mie region dependent oscillatory relation between blood volume size and wavelength requires further investigation. Classifiers, multifrequency algorithms or ultra-wide band radar are possible solutions that should be explored in the future.
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Affiliation(s)
- Moshe Oziel
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rafi Korenstein
- Department of Physiology and Pharmacology, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Boris Rubinsky
- Department of Mechanical Engineering, University of California at Berkeley, Berkeley, CA, United States of America
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Fahey FH, Goodkind A, MacDougall RD, Oberg L, Ziniel SI, Cappock R, Callahan MJ, Kwatra N, Treves ST, Voss SD. Operational and Dosimetric Aspects of Pediatric PET/CT. J Nucl Med 2017; 58:1360-1366. [PMID: 28687601 DOI: 10.2967/jnumed.116.182899] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 07/05/2017] [Indexed: 01/04/2023] Open
Abstract
No consistent guidelines exist for the acquisition of a CT scan as part of pediatric PET/CT. Given that children may be more vulnerable to the effects of ionizing radiation, it is necessary to develop methods that provide diagnostic-quality imaging when needed, in the shortest time and with the lowest patient radiation exposure. This article describes the basics of CT dosimetry and PET/CT acquisition in children. We describe the variability in pediatric PET/CT techniques, based on a survey of 19 PET/CT pediatric institutions in North America. The results of the survey demonstrated that, although most institutions used automatic tube current modulation, there remained a large variation of practice, on the order of a factor of 2-3, across sites, pointing to the need for guidelines. We introduce the approach developed at our institution for using a multiseries PET/CT acquisition technique that combines diagnostic-quality CT in the essential portion of the field of view and a low-dose technique to image the remainder of the body. This approach leads to a reduction in radiation dose to the patient while combining the PET and the diagnostic CT into a single acquisition. The standardization of pediatric PET/CT provides an opportunity for a reduction in the radiation dose to these patients while maintaining an appropriate level of diagnostic image quality.
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Affiliation(s)
- Frederic H Fahey
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts .,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Alison Goodkind
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Robert D MacDougall
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Leah Oberg
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Sonja I Ziniel
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado; and
| | - Richard Cappock
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Michael J Callahan
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - Neha Kwatra
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
| | - S Ted Treves
- Department of Radiology, Harvard Medical School, Boston, Massachusetts.,Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Stephan D Voss
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Boston Children's Hospital, Boston, Massachusetts.,Department of Radiology, Harvard Medical School, Boston, Massachusetts
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40
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Zucchetta P. Guest Editorial. Semin Nucl Med 2017; 47:188-189. [PMID: 28417850 DOI: 10.1053/j.semnuclmed.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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