Quantitation in SPECT using an effective model of the scattering

Quantitative SPECT/CT for dosimetry of peptide receptor radionuclide therapy

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

Digital Solid-State SPECT/CT Quantitation of Absolute 177Lu Radiotracer Concentration: In Vivo and In Vitro Validation

The accuracy of ¹⁷⁷Lu radiotracer concentration measurements using quantitative clinical software was determined by comparing in vivo results for a digital solid-state cadmium-zinc-telluride SPECT/CT system with in vitro sampling. Methods: First, image acquisition parameters were assessed for an International Electrotechnical Commission body phantom emulating clinical count rates loaded with a lung insert and 6 hot spheres with a 12:1 target-to-background ratio of ¹⁷⁷Lu solution. Then, the data of 28 whole-body SPECT/CT scans of 7 patients who underwent ¹⁷⁷Lu prostate-specific membrane antigen radioligand therapy were retrospectively analyzed. Three users analyzed SPECT/CT images for in vivo urinary bladder radiotracer uptake using quantitative software. In vitro radiopharmaceutical concentrations were calculated using urine sampling obtained immediately after each scan, scaled to SUVs. Any in vivo or in vitro identity relations were determined by linear regression (ideally, slope = 1 and intercept = 0), within a 95% confidence interval. Results: Phantom results demonstrated lower quantitative error for acquisitions using the 113-keV ¹⁷⁷Lu energy peak rather than including the 208-keV peak, given that only low-energy collimation was available in this camera configuration. In the clinical study, 24 in vivo-in vitro pairs were eligible for further analysis, with 4 having been rejected as outliers (via Cook distance calculations). All linear regressions (R ² ≥ 0.82, P < 0.0001) provided identity in vivo-in vitro relations (95% confidence interval), with SUV averages from all users giving a slope of 0.96 ± 0.13, an intercept of -0.07 ± 0.46 g/mL, and an average residual difference of 19.5%. In acquisitions with the lower-energy ¹⁷⁷Lu energy peak, solid-state SPECT/CT imaging provided an accuracy to within approximately 20% of in vivo urinary bladder radiotracer concentrations. Conclusion: This noninvasive in vivo quantitation method can potentially improve diagnosis, patient management, and treatment response assessment and provide data essential to ¹⁷⁷Lu dosimetry.

Absolute radiotracer concentration measurement using whole-body solid-state SPECT/CT technology: in vivo/in vitro validation

The accuracy of recently approved quantitative clinical software was determined by comparing in vivo/in vitro measurements for a solid-state cadmium-zinc-telluride SPECT/CT (single photon emission computed tomography/x-ray computed tomography) camera. Bone SPECT/CT, including the pelvic region in the field of view, was performed on 16 patients using technetium-99m methylene diphosphonic acid as a radiotracer. After imaging, urine samples from each patient provided for the measurement of in vitro radiopharmaceutical concentrations. From the SPECT/CT images, three users measured in vivo radiotracer concentration and standardized uptake value (SUV) for the bladder using quantitative software (Q.Metrix, GE Healthcare). Linear regression was used to validate any in vivo/in vitro identity relations (ideally slope = 1, intercept = 0), within a 95% confidence interval (CI). Thirteen in vivo/in vitro pairs were available for further analysis, after rejecting two as clinically irrelevant (SUVs > 100 g/mL) and one as an outlier (via Cook's distance calculations). All linear regressions (R² ≥ 0.85, P < 0.0001) provided identity in vivo/in vitro relations (95% CI), with SUV averages from all users giving a slope of 0.99 ± 0.25 and intercept of 0.14 ± 5.15 g/mL. The average in vivo/in vitro residual difference was < 20%. Solid-state SPECT/CT imaging can reliably provide in vivo urinary bladder radiotracer concentrations within approximately 20% accuracy. This practical, non-invasive, in vivo quantitation method can potentially improve diagnosis and assessment of response to treatment. Graphical abstract.

Yttrium-90-labeled microsphere tracking during liver selective internal radiotherapy by bremsstrahlung pinhole SPECT: feasibility study and evaluation in an abdominal phantom

BACKGROUND

The purpose of the study is to evaluate whether a pinhole collimator is better adapted to bremsstrahlung single photon emission computed tomography [SPECT] than parallel-hole collimators and in the affirmative, to evaluate whether pinhole bremsstrahlung SPECT, including a simple model of the scatter inside the patient, could provide a fast dosimetry assessment in liver selective internal radiotherapy [SIRT].

MATERIALS AND METHODS

Bremsstrahlung SPECT of an abdominal-shaped phantom including one cold and five hot spheres was performed using two long-bore parallel-hole collimators: a medium-energy general-purpose [MEGP] and a high-energy general-purpose [HEGP], and also using a medium-energy pinhole [MEPH] collimator. In addition, ten helical MEPH SPECTs (acquisition time 3.6 min) of a realistic liver-SIRT phantom were also acquired.

RESULTS

Without scatter correction for SPECT, MEPH SPECT provided a significantly better contrast recovery coefficient [CRC] than MEGP and HEGP SPECTs. The CRCs obtained with MEPH SPECT were still improved with the scatter correction and became comparable to those obtained with positron-emission tomography [PET] for the 36-, 30- (cold), 28-, and 24-mm-diameter spheres: CRC = 1.09, 0.59, 0.91, and 0.69, respectively, for SPECT and CRC = 1.07, 0.56, 0.84, and 0.63, respectively, for PET. However, MEPH SPECT gave the best CRC for the 19-mm-diameter sphere: CRC = 0.56 for SPECT and CRC = 0.01 for PET. The 3.6-min helical MEPH SPECT provided accurate and reproducible activity estimation for the liver-SIRT phantom: relative deviation = 10 ± 1%.

CONCLUSION

Bremsstrahlung SPECT using a pinhole collimator provided a better CRC than those obtained with parallel-hole collimators. The different designs and the better attenuating material used for the collimation (tungsten instead of lead) explain this result. Further, the addition of an analytical modeling of the scattering inside the phantom resulted in an almost fully recovered contrast. This fills the gap between the performance of90Y-PET and bremsstrahlung pinhole SPECT which is a more affordable technique and could even be used during the catheterization procedure in order to optimize the90Y activity to inject.

The effect of volume-of-interest misregistration on quantitative planar activity and dose estimation

In targeted radionuclide therapy (TRT), dose estimation is essential for treatment planning and tumor dose response studies. Dose estimates are typically based on a time series of whole-body conjugate view planar or SPECT scans of the patient acquired after administration of a planning dose. Quantifying the activity in the organs from these studies is an essential part of dose estimation. The quantitative planar (QPlanar) processing method involves accurate compensation for image degrading factors and correction for organ and background overlap via the combination of computational models of the image formation process and 3D volumes of interest defining the organs to be quantified. When the organ VOIs are accurately defined, the method intrinsically compensates for attenuation, scatter and partial volume effects, as well as overlap with other organs and the background. However, alignment between the 3D organ volume of interest (VOIs) used in QPlanar processing and the true organ projections in the planar images is required. The aim of this research was to study the effects of VOI misregistration on the accuracy and precision of organ activity estimates obtained using the QPlanar method. In this work, we modeled the degree of residual misregistration that would be expected after an automated registration procedure by randomly misaligning 3D SPECT/CT images, from which the VOI information was derived, and planar images. Mutual information-based image registration was used to align the realistic simulated 3D SPECT images with the 2D planar images. The residual image misregistration was used to simulate realistic levels of misregistration and allow investigation of the effects of misregistration on the accuracy and precision of the QPlanar method. We observed that accurate registration is especially important for small organs or ones with low activity concentrations compared to neighboring organs. In addition, residual misregistration gave rise to a loss of precision in the activity estimates that was on the order of the loss of precision due to Poisson noise in the projection data. These results serve as a lower bound on the effects of misregistration on the accuracy and precision of QPlanar activity estimate and demonstrate that misregistration errors must be taken into account when assessing the overall precision of organ dose estimates.

Fast hybrid SPECT simulation including efficient septal penetration modelling (SP-PSF)

Single photon emission computed tomography (SPECT) images are degraded by the detection of scattered photons and photons that penetrate the collimator septa. In this paper, a previously proposed Monte Carlo software that employs fast object scatter simulation using convolution-based forced detection (CFD) is extended towards a wide range of medium and high energy isotopes measured using various collimators. To this end, a fast method was developed for incorporating effects of septal penetrating (SP) photons. The SP contributions are obtained by calculating the object attenuation along the path from primary emission to detection followed by sampling a pre-simulated and scalable septal penetration point spread function (SP-PSF). We found that with only a very slight reduction in accuracy, we could accelerate the SP simulation by four orders of magnitude. To achieve this, we combined: (i) coarse sampling of the activity and attenuation distribution; (ii) simulation of the penetration only for a coarse grid of detector pixels followed by interpolation and (iii) neglection of SP-PSF elements below a certain threshold. By inclusion of this SP-PSF-based simulation it became possible to model both primary and septal penetrated photons while only 10% extra computation time was added to the CFD-based Monte Carlo simulator. As a result, a SPECT simulation of a patient-like distribution including SP now takes less than 5 s per projection angle on a dual processor PC. Therefore, the simulator is well-suited as an efficient projector for fully 3D model-based reconstruction or as a fast data-set generator for applications such as image processing optimization or observer studies.

A Monte Carlo and physical phantom evaluation of quantitative In-111 SPECT

Accurate estimation of the 3D in vivo activity distribution is important for dose estimation in targeted radionuclide therapy (TRT). Although SPECT can potentially provide such estimates, SPECT without compensation for image degrading factors is not quantitatively accurate. In this work, we evaluated quantitative SPECT (QSPECT) reconstruction methods that include compensation for various physical effects. Experimental projection data were obtained using a GE VH/Hawkeye system and an RSD torso phantom. Known activities of In-111 chloride were placed in the lungs, liver, heart, background and two spherical compartments with inner diameters of 22 mm and 34 mm. The 3D NCAT phantom with organ activities based on clinically derived In-111 ibritumomab tiuxetan data was used for the Monte Carlo (MC) simulation studies. Low-noise projection data were simulated using previously validated MC simulation methods. Fifty sets of noisy projections with realistic count levels were generated. Reconstructions were performed using the OS-EM algorithm with various combinations of attenuation (A), scatter (S), geometric response (G), collimator-detector response (D) and partial volume compensation (PVC). The QSPECT images from the various combinations of compensations were evaluated in terms of the accuracy and precision of the estimates of the total activity in each organ. For experimental data, the errors in organ activities for ADS and PVC compensation were less than 6.5% except the smaller sphere (-11.9%). For the noisy simulated data, the errors in organ activity for ADS compensation were less than 5.5% except the lungs (20.9%) and blood vessels (15.2%). Errors for other combinations of compensations were significantly (A, AS) or somewhat (AGS) larger. With added PVC, the error in the organ activities improved slightly except for the lungs (11.5%) and blood vessels (3.6%) where the improvement was more substantial. The standard deviation/mean ratios were all less than 1.5%. We conclude that QSPECT methods with appropriate compensations provided accurate In-111 organ activity estimates. For the collimator used, AGS was almost as good as ADS and may be preferable due to the reduced reconstruction time. PVC was important for small structures such as tumours or for organs in close proximity to regions with high activity. The improved quantitative accuracy from QSPECT methods has the potential for improving organ dose estimations in TRT.

Efficient fully 3-D iterative SPECT reconstruction with Monte Carlo-based scatter compensation

Quantitative accuracy of single photon emission computed tomography (SPECT) images is highly dependent on the photon scatter model used for image reconstruction. Monte Carlo simulation (MCS) is the most general method for detailed modeling of scatter, but to date, fully three-dimensional (3-D) MCS-based statistical SPECT reconstruction approaches have not been realized, due to prohibitively long computation times and excessive computer memory requirements. MCS-based reconstruction has previously been restricted to two-dimensional approaches that are vastly inferior to fully 3-D reconstruction. Instead of MCS, scatter calculations based on simplified but less accurate models are sometimes incorporated in fully 3-D SPECT reconstruction algorithms. We developed a computationally efficient fully 3-D MCS-based reconstruction architecture by combining the following methods: 1) a dual matrix ordered subset (DM-OS) reconstruction algorithm to accelerate the reconstruction and avoid massive transition matrix precalculation and storage; 2) a stochastic photon transport calculation in MCS is combined with an analytic detector modeling step to reduce noise in the Monte Carlo (MC)-based reprojection after only a small number of photon histories have been tracked; and 3) the number of photon histories simulated is reduced by an order of magnitude in early iterations, or photon histories calculated in an early iteration are reused. For a 64 x 64 x 64 image array, the reconstruction time required for ten DM-OS iterations is approximately 30 min on a dual processor (AMD 1.4 GHz) PC, in which case the stochastic nature of MCS modeling is found to have a negligible effect on noise in reconstructions. Since MCS can calculate photon transport for any clinically used photon energy and patient attenuation distribution, the proposed methodology is expected to be useful for obtaining highly accurate quantitative SPECT images within clinically acceptable computation times.

A three-dimensional ray-driven attenuation, scatter and geometric response correction technique for SPECT in inhomogeneous media

The qualitative and quantitative accuracy of SPECT images is degraded by physical factors of attenuation, Compton scatter and spatially varying collimator geometric response. This paper presents a 3D ray-tracing technique for modelling attenuation, scatter and geometric response for SPECT imaging in an inhomogeneous attenuating medium. The model is incorporated into a three-dimensional projector-backprojector and used with the maximum-likelihood expectation-maximization algorithm for reconstruction of parallel-beam data. A transmission map is used to define the inhomogeneous attenuating and scattering object being imaged. The attenuation map defines the probability of photon attenuation between the source and the scattering site, the scattering angle at the scattering site and the probability of attenuation of the scattered photon between the scattering site and the detector. The probability of a photon being scattered through a given angle and being detected in the emission energy window is approximated using a Gaussian function. The parameters of this Gaussian function are determined using physical measurements of parallel-beam scatter line spread functions from a non-uniformly attenuating phantom. The 3D ray-tracing scatter projector-backprojector produces the scatter and primary components. Then, a 3D ray-tracing projector-backprojector is used to model the geometric response of the collimator. From Monte Carlo and physical phantom experiments, it is shown that the best results are obtained by simultaneously correcting attenuation, scatter and geometric response, compared with results obtained with only one or two of the three corrections. It is also shown that a 3D scatter model is more accurate than a 2D model. A transmission map is useful for obtaining measurements of attenuation and scatter in SPECT data, which can be used together with a model of the geometric response of the collimator to obtain corrected images with quantitative and diagnostically accurate information.

A slice-by-slice blurring model and kernel evaluation using the Klein-Nishina formula for 3D scatter compensation in parallel and converging beam SPECT

Converging collimation increases the geometric efficiency for imaging small organs, such as the heart, but also increases the difficulty of correcting for the physical effects of attenuation, geometric response and scatter in SPECT. In this paper, 3D first-order Compton scatter in non-uniform scattering media is modelled by using an efficient slice by-slice incremental blurring technique in both parallel and converging beam SPECT. The scatter projections are generated by first forming an effective scatter source image (ESSI), then forward-projecting the ESSI. The Compton scatter cross section described by the Klein-Nishina formula is used to obtain spatial scatter response functions (SSRFs) of scattering slices which are parallel to the detector surface. Two SSRFs of neighbouring scattering slices are used to compute two small orthogonal 1D blurring kernels used for the incremental blurring from the slice which is further from the detector surface to the slice which is closer to the detector surface. First-order Compton scatter point response functions (SPRFs) obtained using the proposed model agree well with those of Monte Carlo (MC) simulations for both parallel and fan beam SPECT. Image reconstruction in fan beam SPECT MC simulation studies shows increased left ventricle myocardium-to-chamber contrast (LV contrast) and slightly improved image resolution when performing scatter compensation using the proposed model. Physical torso phantom fan beam SPECT experiments show increased myocardial uniformity and image resolution as well as increased LV contrast. The proposed method efficiently models the 3D first-order Compton scatter effect in parallel and converging beam SPECT.

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

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

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

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

The influence of backscatter material on 99mTc and 201Tl line source responses

SPECT projections are contaminated by scatter, resulting in reduced image contrast and quantitative errors. When tissue is present behind the source, some of the detected photons backscatter via this tissue. Particularly in dual-isotope SPECT and in combined emission-transmission SPECT, backscatter constitutes a major part of the down-scatter contamination in lower-energy windows. In this paper, the effects of backscatter material were investigated. Planar images of 99mTc and 201Tl line sources between varying numbers of Perspex slabs were analysed using the photopeak windows and various scatter windows. In the 99mTc photopeak window no significant change in total counts due to backscatter material was measured. In the 201Tl photopeak window an increase of about 10% in total counts was observed. In the scatter windows an even more explicit influence of backscatter material was measured. For instance, at a forward depth of 10 cm, total counts of a 99mTc source detected in the 72 keV window eventually doubled with increasing backscatter material, compared with the situation without backscatter material. The backscatter contribution plateaued when more than 5-10 cm of scatter material was placed behind the source. In conclusion, backscatter should be taken into account, particularly in model-based down-scatter correction methods in dual-isotope SPECT and combined emission-transmission SPECT.

A non-negative fast multiplicative algorithm in 3D scatter-compensated SPET reconstruction

Single-photon emission tomographic (SPET) reconstruction can be improved, especially for noisy images, by using the iterative expectation-maximization of the maximum-likelihood (EM-ML) algorithm. Its application to clinical routine is, however, hampered by the high number of iterations necessary to achieve acceptable results. Therefore various methods have been developed to accelerate the EM-ML algorithm. In this paper a new accelerated EM-ML-like multiplicative algorithm is proposed for SPET reconstruction. Contrary to some other accelerating methods, it preserves two of the most important properties of the EM-ML, namely pixel positivity inside the patient body and null activity outside. The convergence speed is improved by a factor which can reach 100 in high spatial frequency or low count regions. Good estimates in the low count region are obtained without any smoothing, even at typical routine clinical count rates. The algorithm used in conjunction with the 3D effective one scatter path model provides high-quality SPET images and accurate quantitation.