Recent developments and future trends in nuclear medicine instrumentation

Technological Advances in SPECT and SPECT/CT Imaging

Single photon emission tomography/computed tomography (SPECT/CT) is a mature imaging technology with a dynamic role in the diagnosis and monitoring of a wide array of diseases. This paper reviews the technological advances, clinical impact, and future directions of SPECT and SPECT/CT imaging. The focus of this review is on signal amplifier devices, detector materials, camera head and collimator designs, image reconstruction techniques, and quantitative methods. Bulky photomultiplier tubes (PMTs) are being replaced by position-sensitive PMTs (PSPMTs), avalanche photodiodes (APDs), and silicon PMs to achieve higher detection efficiency and improved energy resolution and spatial resolution. Most recently, new SPECT cameras have been designed for cardiac imaging. The new design involves using specialised collimators in conjunction with conventional sodium iodide detectors (NaI(Tl)) or an L-shaped camera head, which utilises semiconductor detector materials such as CdZnTe (CZT: cadmium-zinc-telluride). The clinical benefits of the new design include shorter scanning times, improved image quality, enhanced patient comfort, reduced claustrophobic effects, and decreased overall size, particularly in specialised clinical centres. These noticeable improvements are also attributed to the implementation of resolution-recovery iterative reconstructions. Immense efforts have been made to establish SPECT and SPECT/CT imaging as quantitative tools by incorporating camera-specific modelling. Moreover, this review includes clinical examples in oncology, neurology, cardiology, musculoskeletal, and infection, demonstrating the impact of these advancements on clinical practice in radiology and molecular imaging departments.

S-values estimation of positron-emitting radionuclides in the ICRP voxel-based adult male organs using a new Geant4-based code DoseCalcs: validation study

Identifying the organs and tissues at risk from internal radiation exposure caused by radiopharmaceuticals requires determining the absorbed dose. The absorbed dose for radiopharmaceuticals is calculated by multiplying cumulated activity in source organs by the S-value, a crucial quantity that connects the energy deposited in the target organ and the emitting source one. It is defined as the ratio of absorbed energy in the target organ per unit of mass and unit of nuclear transition in the source organ. In this study, we used a new Geant4-based code called DoseCalcs to estimate the S-values for four positron-emitting radionuclides ([Formula: see text]C, [Formula: see text]N, [Formula: see text]O, and [Formula: see text]F) using decay and energy data from International Commission on Radiological Protection (ICRP) Publication 107. Twenty-three regions were simulated as radiation sources in the ICRP voxelized adult model developed in ICRP Publication 110. The Livermore physics packages were tailored to radionuclide photon mono-energy and [Formula: see text]-mean energy. The estimated S-values based on [Formula: see text]-mean energy show good agreement with those in the OpenDose data whose values were calculated using the full [Formula: see text] spectrum. The results provide new S-values data for selected source regions; hence, they could be used for comparison and adult-patient dose estimation.

Photon-specific absorbed fraction estimates in stylized ORNL and voxelized ICRP adult male phantoms using a new developed Geant4-based code "DoseCalcs": a validation study

When a radiotracer is injected into a patient's body as part of a nuclear medicine investigation, the entire body is exposed to the ionizing radiation emitted, which can cause biological damage. Therefore, it is important to predict the internal radiation dose to properly balance the advantages of radiological examinations. Currently, various Monte Carlo tools, such as MCNP, Geant4, and GATE, are available to estimate internal radiation dosimetry-related quantities, such as S values (S) and specific absorbed fractions (SAF). Such codes make physics easier for physicists who are experienced with computer programming; however, programming and/or simulation inputs remain a time-consuming and intensive task. In this study, we present a newly developed Geant4-based code for internal dosimetry calculations, namely "DoseCalcs". To assess the performance of the geometrical methods and computational capabilities of our developed tool, we used the GDML, TEXT, STL, and C++ methods to model the ORNL adult phantom, and a voxel-based structure to construct the ICRP adult male. SAFs in the ORNL and ICRP adult male phantoms for eight discrete mono-energetic photons with energies ranging from 0.01 to 2 MeV are calculated with DoseCalcs and compared to ORNL and OpenDose reference data. The two phantoms showed good agreement with both references, which indicates the accuracy of DoseCalcs for subsequent use in estimating internal dosimetry quantities using a variety of geometrical methods.

Gated Radiotherapy Development and its Expansion

One of the most important challenges in treatment of patients with cancerous tumors of chest and abdominal areas is organ movement. The delivery of treatment radiation doses to tumor tissue is a challenging matter while protecting healthy and radio sensitive tissues. Since the movement of organs due to respiration causes a discrepancy in the middle of planned and delivered dose distributions. The moderation in the fatalistic effect of intra-fractional target travel on the radiation therapy correctness is necessary for cutting-edge methods of motion remote monitoring and cancerous growth irradiancy. Tracking respiratory milling and implementation of breath-hold techniques by respiratory gating systems have been used for compensation of respiratory motion negative effects. Therefore, these systems help us to deliver precise treatments and also protect healthy and critical organs. It seems aspiration should be kept under observation all over treatment period employing tracking seed markers (e.g. fiducials), skin surface scanners (e.g. camera and laser monitoring systems) and aspiration detectors (e.g. spirometers). However, these systems are not readily available for most radiotherapy centers around the word. It is believed that providing and expanding the required equipment, gated radiotherapy will be a routine technique for treatment of chest and abdominal tumors in all clinical radiotherapy centers in the world by considering benefits of respiratory gating techniques in increasing efficiency of patient treatment in the near future. This review explains the different technologies and systems as well as some strategies available for motion management in radiotherapy centers.

Spinning slithole collimation for high-sensitivity small animal SPECT: Design and assessment using GATE simulation

PURPOSE

While traditional collimations are widely used in preclinical SPECT imaging, they usually suffer from possessing a low system sensitivity leading to noisy images. In this study, we are aiming at introducing a novel collimator, the slithole, offering a superior resolution-sensitivity tradeoff for small animal SPECT.

METHODS

The collimator was designed for a molecular SPECT scanner, the HiReSPECT. The slithole is a knife-edge narrow long aperture extended across long-axis of the camera's head. To meet the data completeness requirement, the collimator-detector assembly spins at each regular SPECT angle. The collimator was modeled within GATE Monte Carlo simulator and the data acquisition was performed for NEMA Image Quality (IQ) phantom. In addition, a dedicated 3D iterative reconstruction algorithm based upon plane-integral projections was also developed.

RESULTS

The mean sensitivity of the slithole is 285cps/MBq while the current parallel-hole collimator holds a sensitivity of 36cps/MBq at a 30mm distance. The slithole collimation gives rise to a tomographic resolution of 1.8mm compared to a spatial resolution of∼1.7mm for the parallel-hole one (even after resolution modeling). A 1.75 reduction factor in the noise level was observed when the current parallel-hole collimator is replaced by the slithole. Furthermore, quantitative analysis proves that 3 full-iterations of our dedicated image reconstruction lead to optimal image quality. For the largest rod in the NEMA IQ phantom, a recovery coefficient of∼0.83 was obtained.

CONCLUSION

The slithole collimator outperforms the current parallel-hole collimation by exhibiting a better resolution-sensitivity compromise for preclinical SPECT studies.

Automated radiosynthesis of no-carrier-added 4-[18F]fluoroiodobenzene: a versatile building block in 18F radiochemistry

4-[18F]Fluoroiodobenzene ([18F]FIB) is a versatile building block in 18F radiochemistry used in various transition metal-mediated C-C and C-N cross-coupling reactions and [18F]fluoroarylation reactions. Various synthesis routes have been described for the preparation of [18F]FIB. However, to date, no automated synthesis of [18F]FIB has been reported to allow access to larger amounts of [18F]FIB in high radiochemical and chemical purity. Herein, we describe an automated synthesis of no-carrier-added [18F]FIB on a GE TRACERlab™ FX automated synthesis unit starting from commercially available(4-iodophenyl)diphenylsulfonium triflate as the labelling precursor. [18F]FIB was prepared in high radiochemical yields of 89 ± 10% (decay-corrected, n = 7) within 60 min, including HPLC purification. The radiochemical purity exceeded 95%, and specific activity was greater than 40 GBq/μmol. Typically, from an experiment, 6.4 GBq of [18F]FIB could be obtained starting from 10.4 GBq of [18F]fluoride.

Radiolabeled lipid nanoparticles for diagnostic imaging

BACKGROUND

Nanoparticles are increasingly being incorporated into the design of diagnostic imaging agents. Significant research efforts have been conducted with one class of lipid nanoparticle (liposomes) radiolabeled with gamma-emitting radionuclides as radiopharmaceuticals for scintigraphic imaging of cancer, inflammation/infection and sentinel lymph node detection.

OBJECTIVE

This article reviews the current literature with special emphasis on the clinical studies performed with liposome radiopharmaceuticals for detection of tumors, infectious/inflammatory sites or metastatic lymph nodes. Future uses of liposome radiopharmaceuticals are also described.

METHODS

Characteristics required of the radionuclide, liposome formulation and radiolabeling method for an effective radiopharmaceutical are discussed. A description of the procedures and instrumentation for conducting an imaging study with liposome radiopharmaceutical is included. Clinical studies using liposome radiopharmaceuticals are summarized. Future imaging applications of first- and second-generation radiolabeled liposomes for chemodosimetry and the specific targeting of a disease process are also described.

RESULTS/CONCLUSION

The choice of radionuclide, liposome formulation and radiolabeling method must be carefully considered during the design of a liposome radiopharmaceutical for a given application. After-loading and surface chelation methods are the most efficient and practical. Clinical studies with liposome radiopharmaceuticals demonstrated that a wide variety of tumors could be detected with good sensitivity and specificity. Liposome radiopharmaceuticals could also clearly detect various soft tissue and bone inflammatory/infectious lesions, and performed equal to or better than infection imaging agents that are approved at present. Yet, despite these favorable results, no liposome radiopharmaceutical has been approved for any indication. Some of the reasons for this can be attributed to reports of an unexpected infusion-related adverse reaction in two studies, the requirement of more complex liposome manufacturing procedures, and the adoption of other competing imaging procedures. Continued research of liposome radiopharmaceutical design based on a better understanding of liposome biology, improved radiolabeling methodologies and advances in gamma camera technology is warranted.

Treatment planning in molecular radiotherapy

In molecular radiotherapy a radionuclide or a radioactively labelled pharmaceutical is administered to the patient. Treatment planning therefore comprises the determination of activity to administer. This administered activity should maximize tumour cell sterilization while minimizing normal tissue damage. In this work we present different approaches that are frequently used for determining the suitable activity. These approaches may be cohort- based as in chemotherapy, or patient-specific using dosimetry based on individual biokinetics. The approaches are different with respect to the input complexity, the corresponding costs and - in consequence - the quality of the therapy. In addition, a general scheme for data collection and analysis is proposed. To develop an effective and safe treatment, elaborate data need to be obtained. The main challenges, however, are collecting these complex data and analyse them properly.

Future of medicine: models in predictive diagnostics and personalized medicine

Molecular medicine is undergoing fundamental changes driving the whole area towards a revolution in modern medicine. The breakthrough was generated the fast-developing technologies in molecular biology since the first draft sequence of the human genome was published. The technological advances enabled the analysis of biological samples from cells and organs to whole organisms in a depth that was not possible before. These technologies are increasingly implemented in the medical and health care system to study diseases and refine diagnostics. As a consequence, the understanding of diseases and the health status of an individual patient is now based on an enormous amount of data that can only be interpreted in the context of the body as a whole. Systems biology as a new field in the life sciences develops new approaches for data integration and interpretation. Systems medicine as a specialized aspect of systems biology combines in an interdisciplinary approach all expertise necessary to decipher the human body in all its complexity. This created new challenges in the area of information and communication technologies to provide the infrastructure and technology needed to cope with the data flood that will accompany the next generation of medicine. The new initiative 'IT Future of Medicine' aims at driving this development even further and integrates not only molecular data (especially genomic information), but also anatomical, physiological, environmental, and lifestyle data in a predictive model approach-the 'virtual patient'-that will allow the clinician or the general practitioner to predict and anticipate the optimal treatment for the individual patient. The application of the virtual patient model will allow truly personalized medicine.

Advances in multimodality molecular imaging

Multimodality molecular imaging using high resolution positron emission tomography (PET) combined with other modalities is now playing a pivotal role in basic and clinical research. The introduction of combined PET/CT systems in clinical setting has revolutionized the practice of diagnostic imaging. The complementarity between the intrinsically aligned anatomic (CT) and functional or metabolic (PET) information provided in a “one-stop shop” and the possibility to use CT images for attenuation correction of the PET data has been the driving force behind the success of this technology. On the other hand, combining PET with Magnetic Resonance Imaging (MRI) in a single gantry is technically more challenging owing to the strong magnetic fields. Nevertheless, significant progress has been made resulting in the design of few preclinical PET systems and one human prototype dedicated for simultaneous PET/MR brain imaging. This paper discusses recent advances in PET instrumentation and the advantages and challenges of multimodality imaging systems. Future opportunities and the challenges facing the adoption of multimodality imaging instrumentation will also be addressed.

New principles in nuclear medicine imaging: a full aperture stereoscopic imaging technique

In nuclear medicine, images of planar scintigraphy and single photon emission computerized tomography (SPECT) obtained through gamma camera (GC) appear to be blurred. Alternatively, coded aperture imaging (CAI) can surpass the quality of GC images, but still it is not extensively used due to the decoding complexity of some images and the difficulty in controlling the noise. Summing up, the images obtained through GC are low quality and it is still difficult to implement CAI technique. Here we present a full aperture imaging (FAI) technique which overcomes the problems of CAI ordinary systems. The gamma radiation transmitted through a large single aperture is edge-encoded, taking advantage of the fact that nuclear radiation is spatially incoherent. The novel technique is tested by means of Monte Carlo method with simple and complex sources. Spatial resolution tests and parallax tests of GC versus FAI were made, and three-dimensional capacities of GC versus FAI were analyzed. Simulations have allowed comparison of both techniques under ideal, identical conditions. The results show that FAI technique has greater sensitivity (approximately 100 times) and greater spatial resolution (>2.6 times at 40 cm source-detector distance) than that of GC. FAI technique allows to obtain images with typical resolution of GC short source-detector distance but at longer source-detector distance. The FAI decoding algorithm simultaneously reconstructs four different projections, while GC produces only one projection per acquisition. Our results show it is possible to apply an extremely simple encoded imaging technique, and get three-dimensional radioactivity information. Thus GC-based systems could be substituted, given that FAI technique is simple and it produces four images which may feed stereoscopic systems, substituting in some cases, tomographic reconstructions.

Current status and future perspectives of in vivo small animal imaging using radiolabeled nanoparticles

Small animal molecular imaging is a rapidly expanding efficient tool to study biological processes non-invasively. The use of radiolabeled tracers provides non-destructive, imaging information, allowing time related phenomena to be repeatedly studied in a single animal. In the last decade there has been an enormous progress in related technologies and a number of dedicated imaging systems overcome the limitations that the size of small animal possesses. On the other hand, nanoparticles (NPs) gain increased interest, due to their unique properties, which make them perfect candidates for biological applications. Over the past 5 years the two fields seem to cross more and more often; radiolabeled NPs have been assessed in numerous pre-clinical studies that range from oncology, till HIV treatment. In this article the current status in the tools, applications and trends of radiolabeled NPs reviewed.

Molecular PET/CT imaging-guided radiation therapy treatment planning

The role of positron emission tomography (PET) during the past decade has evolved rapidly from that of a pure research tool to a methodology of enormous clinical potential. (18)F-fluorodeoxyglucose (FDG)-PET is currently the most widely used probe in the diagnosis, staging, assessment of tumor response to treatment, and radiation therapy planning because metabolic changes generally precede the more conventionally measured parameter of change in tumor size. Data accumulated rapidly during the last decade, thus validating the efficacy of FDG imaging and many other tracers in a wide variety of malignant tumors with sensitivities and specificities often in the high 90 percentile range. As a result, PET/computed tomography (CT) had a significant impact on the management of patients because it obviated the need for further evaluation, guided further diagnostic procedures, and assisted in planning therapy for a considerable number of patients. On the other hand, the progress in radiation therapy technology has been enormous during the last two decades, now offering the possibility to plan highly conformal radiation dose distributions through the use of sophisticated beam targeting techniques such as intensity-modulated radiation therapy (IMRT) using tomotherapy, volumetric modulated arc therapy, and many other promising technologies for sculpted three-dimensional (3D) dose distribution. The foundation of molecular imaging-guided radiation therapy lies in the use of advanced imaging technology for improved definition of tumor target volumes, thus relating the absorbed dose information to image-based patient representations. This review documents technological advancements in the field concentrating on the conceptual role of molecular PET/CT imaging in radiation therapy treatment planning and related image processing issues with special emphasis on segmentation of medical images for the purpose of defining target volumes. There is still much more work to be done and many of the techniques reviewed are themselves not yet widely implemented in clinical settings.

Kinetic modelling in small animal imaging with PET

Small animal imaging with positron emission tomography has undergone a major evolution. This has been driven by technical improvements and the development of dedicated PET camera's for small animals. The focus has shifted from detection of tracer uptake and visualization of the tracer distribution towards the quantification of the physiological parameters necessary to use this technique for kinetic modelling of tracers. At the moment there are still several issues which need further research and evaluation before we can fully employ the possibilities of PET as an in-vivo measurement of underlying molecular biology. These issues relate to improved quantification of measurements, improved image reconstruction and processing, and the use of blood plasma data in combination with kinetic models. Besides the more technical issues, there are two more issues which need further clarification: the effect of the anaesthesia, and the effect of radiation on the experiment itself. In this review, we will give an overview of how the technique can be used but we will also discuss the issues mentioned above. The focus will be on the three major parts of the imaging procedure: acquisition, reconstruction of images, and kinetic modelling of the data.

The growing development of multimodality imaging in oncology

The first decade of the century has been the beginning of an era of new practice in daily medical imaging, that is the multimodality involving functional or metabolic imaging brought by nuclear medicine techniques directly associated with anatomical information brought by CT (Computed X-Ray Tomography) devices combined with nuclear medicine detectors. PET (Positron Emission Tomography)/CT and SPECT (Single Photon Emission Computed Tomography)/CT are now established to further increase the interest of PET and SPECT, thanks to improved localization of the pathologic processes, and in many instances thanks to a gain in specificity. An even better use of the combined information will necessitate redefining some protocols and indications, and the future will probably see the continued development of multimodality imaging in practice. Besides the combination with CT, another modality is expected in the future: PET/MRI (Magnetic Resonance Imaging).

Does a targeting ligand influence nanoparticle tumor localization or uptake?

Inclusion of a tumor-targeting molecule in nanosized delivery systems increases their in vivo efficacy. However, the biodistribution and pharmacokinetics of the uptake of such particles have not yet been well addressed. Several recent papers have suggested that tumor-targeting ligands function primarily to increase intracellular uptake of the nanocomplex and do not influence tumor localization. However, other reports indicate that they do play a role in the accumulation in the tumor. One difference might be the presence or absence of poly-[ethylene glycol] (PEG) in the complex and its impact on the enhanced permeability and retention (EPR) effect. Further studies are clearly needed to more fully elucidate the influence of composition on tumor-targeted, systemic delivery of nanoparticles.

Optimisation of whole-body PET/CT scanning protocols

Positron emission tomography (PET) has become one of the major tools for the in vivo localisation of positron-emitting tracers and now is performed routinely using (18)F-fluorodeoxyglucose (FDG) to answer important clinical questions including those in cardiology, neurology, psychiatry, and oncology. The latter application contributed largely to the wide acceptance of this imaging modality and its use in clinical diagnosis, staging, restaging, and assessment of tumour response to treatment. Dual-modality PET/CT systems have been operational for almost a decade since their inception. The complementarity between anatomic (CT) and functional or metabolic (PET) information provided in a "one-stop shop" has been the driving force of this technology. Although combined anato-metabolic imaging is an obvious choice, the way to perform imaging is still an open issue. The tracers or combinations of tracers to be used, how the imaging should be done, when contrast-enhanced CT should be performed, what are the optimal acquisition and processing protocols, are all unanswered questions. Moreover, each data acquisition-processing combination may need to be independently optimised and validated. This paper briefly reviews the basic principles of dual-modality imaging and addresses some of the practical issues involved in optimising PET/CT scanning protocols in a clinical environment.