Performance Characteristics of a New-Generation Digital Bismuth Germanium Oxide PET/CT System, Omni Legend 32, According to NEMA NU 2-2018 Standards

The Omni Legend 32 PET/CT system features silicon photomultiplier (SiPM)-based detectors with bismuth germanium oxide crystals and a 32-cm axial field of view (FOV). The present study aimed to determine the performance characteristics of the Omni Legend 32 PET/CT system according to National Electrical Manufacturers Association (NEMA) NU 2-2018 standards. Methods: The PET component of this system comprises 22 detector modules; each module contains 24 detector blocks with 72 bismuth germanium oxide crystals with a volume of 4.1 × 4.1 × 30 mm coupled to 18 SiPM devices with a 6 × 6 mm area, resulting in an axial FOV of 32 cm. The spatial resolution, sensitivity, count rate performance, and image quality delivered by PET were evaluated using the NEMA NU 2-2018 standard. PET images of 2 patients were evaluated to get a visual first impression of the Omni Legend 32 PET/CT system together with Precision DL. Results: The average spatial resolution at 1, 10, and 20 cm from the central axis was 4.3, 5.3, and 6.2 mm, respectively, for filtered backprojection and 3.7, 4.3, and 5.1 mm, respectively, for ordered-subset expectation maximization. The NEMA sensitivity was 47.30 and 47.05 cps/kBq at the axial center of the FOV and at a 10-cm radial offset, respectively. The scatter fraction, count rate accuracy, and peak noise-equivalent count rates were 35.4%, 1.7%, and 501.7 kcps, respectively, at 15.7 kBq/mL. Contrast recovery for the NEMA body phantom from the smallest to the largest sphere ranged from 61.3% to 93.0%, with a background variability of 5.4%-11.7% and a lung error of 5.1% for Q.Clear (β-value, 50). Good patient image quality was obtained with the Omni Legend 32. Conclusion: The Omni Legend 32 has class-leading sensitivity and count rates within the category of whole-body PET systems while maintaining spatial resolution broadly comparable to that of other current SiPM-based PET/CT systems. This combination of properties results in a very good image quality.

Modified signal-to-noise ratio in the liver using the background-to-lung activity ratio to assess image quality of whole-body 18F-fluorodeoxyglucose positron emission tomography

The signal-to-noise ratio in the liver (SNR liver) is commonly used to assess the quality of positron emission tomography (PET) images; however, it is weakly correlated with visual assessments. Conversely, the noise equivalent count (NEC) density showed a strong correlation with visual assessment but did not consider the effects of image reconstruction conditions. Therefore, we propose a new indicator, the modified SNR liver, and plan to verify its usefulness by comparing it with conventional indicators. We retrospectively analyzed 103 patients who underwent whole-body PET/computed tomography (CT). Approximately 60 min after the intravenous injection of ¹⁸F-fluorodeoxyglucose (FDG), the participants were scanned for 2 min/bed. The SNR liver and NEC density were calculated according to the Japanese guidelines for oncology FDG-PET/CT. The modified SNR live was calculated by multiplying the background-to-lung activity ratio by the SNR liver. Patients were classified into groups based on body mass index (BMI) and visual scores. Subsequently, the relationships between these physical indicators, BMI, and visual scores were evaluated. Although the relationship between the modified SNR liver and BMI was inferior to that of NEC density and BMI, the modified SNR liver distinguished the BMI groups more clearly than the conventional SNR liver. Additionally, the modified SNR liver distinguished low visual scores from high scores more accurately than the conventional SNR liver and NEC density. Whether the modified SNR liver is more suitable than the NEC density remains equivocal; however, the modified SNR liver may be superior to the conventional SNR liver for image-quality assessment.

New standards for phantom image quality and SUV harmonization range for multicenter oncology PET studies

Not only visual interpretation for lesion detection, staging, and characterization, but also quantitative treatment response assessment are key roles for ¹⁸F-FDG PET in oncology. In multicenter oncology PET studies, image quality standardization and SUV harmonization are essential to obtain reliable study outcomes. Standards for image quality and SUV harmonization range should be regularly updated according to progress in scanner performance. Accordingly, the first aim of this study was to propose new image quality reference levels to ensure small lesion detectability. The second aim was to propose a new SUV harmonization range and an image noise criterion to minimize the inter-scanner and intra-scanner SUV variabilities. We collected a total of 37 patterns of images from 23 recent PET/CT scanner models using the NEMA NU2 image quality phantom. PET images with various acquisition durations of 30-300 s and 1800 s were analyzed visually and quantitatively to derive visual detectability scores of the 10-mm-diameter hot sphere, noise-equivalent count (NEC_phantom), 10-mm sphere contrast (Q_H,10 mm), background variability (N_10 mm), contrast-to-noise ratio (Q_H,10 mm/N_10 mm), image noise level (CV_BG), and SUVmax and SUVpeak for hot spheres (10-37 mm diameters). We calculated a reference level for each image quality metric, so that the 10-mm sphere can be visually detected. The SUV harmonization range and the image noise criterion were proposed with consideration of overshoot due to point-spread function (PSF) reconstruction. We proposed image quality reference levels as follows: Q_H,10 mm/N_10 mm ≥ 2.5 and CV_BG ≤ 14.1%. The 10th-90th percentiles in the SUV distributions were defined as the new SUV harmonization range. CV_BG ≤ 10% was proposed as the image noise criterion, because the intra-scanner SUV variability significantly depended on CV_BG. We proposed new image quality reference levels to ensure small lesion detectability. A new SUV harmonization range (in which PSF reconstruction is applicable) and the image noise criterion were also proposed for minimizing the SUV variabilities. Our proposed new standards will facilitate image quality standardization and SUV harmonization of multicenter oncology PET studies. The reliability of multicenter oncology PET studies will be improved by satisfying the new standards.

Motion tracking of low-activity fiducial markers using adaptive region of interest with list-mode positron emission tomography

PURPOSE

Motion compensated positron emission tomography (PET) imaging requires detecting and monitoring of patient body motion. We developed a semiautomatic list-mode method to track the three-dimensional (3D) motion of fiducial positron-emitting markers during PET imaging.

METHODS

A previously developed motion tracking method using positron-emitting markers (PeTrack) was enhanced to work with PET imaging. A novel combination of filtering methods was developed to reject physiological tracer background, which would drown out the events from the marker if unfiltered. The most critical filter rejects events whose line-of-response (LOR) is outside an adaptive region of interest (ADROI). The size of ROI was optimized by exploiting the distinct differences between the distributions of events from background and marker. The ADROI PeTrack method was evaluated with Monte Carlo and phantom studies. A 92.5-kBq 22 Na marker moving sinusoidally in 3D was simulated with Monte Carlo methods. The simulated events were combined with list-mode data from cardiac PET imaging patients to evaluate the performance of the tracking. In phantom studies, three 22 Na markers were placed on a dynamic torso phantom with an initial activity of 680 MBq of 82 Rb in its cardiac insert. The motion of the markers was tracked while the phantom simulated various types of patient motion. Motion correction on an event-by-event basis of the list-mode data was then applied and images were reconstructed.

RESULTS

Simulation results show that the background rejection methods can significantly suppress the tracer background and increase the fraction of marker events by a factor of up to 2500. A 92.5-kBq marker can be tracked in 3D at a frequency of 2.0 Hz with an accuracy of 0.8 mm and a precision of 0.3 mm. The phantom study experimentally confirms that the algorithm can track various types of motion. The relative accuracy of the experimental tracking is 0.26 ± 0.14 mm. Motion-corrected images from the phantom study show reduced blurring.

CONCLUSIONS

An algorithm and background rejection methods were developed that can track the 3D motion of low-activity positron-emitting markers during PET imaging. The motion information may be used for motion-compensated PET imaging.

Initial experience with a PET/computed tomography system using silicon photomultiplier detectors

PURPOSE

A PET/computed tomography (CT) that uses silicon photomultiplier (SiPM) technology was installed at our institution. Here, we report the initial use of the new scanner and evaluate the image quality in comparison to standard PET/CT scanners.

PROCEDURES

Seventy-two patients were scanned first using standard PET/CT followed immediately by the new PET/CT system. Images from the new PET/CT system were reconstructed using a conventional [non time-of-flight (TOF)] algorithm, TOF alone and TOF in combination with BSREM. Images from standard PET/CT were reconstructed using clinical standard-of-care settings. Three blinded readers randomly reviewed four datasets (standard, non-TOF, TOF alone, TOF+BSREM) per patient for image quality using a five-point Likert scale. SUV measurements for the single most avid lesion on each dataset were also recorded.

RESULTS

Datasets from the new scanner had higher image quality (P < 0.001) and SUV measurements (P < 0.001) compared with the standard scanners, and scores further improved when TOF and BSREM algorithms were added (mean scores for standard, non-TOF, TOF alone and TOF+BSREM were 3.1, 3.9, 4.3 and 5.0, respectively; mean SUVmax for hottest lesion were 8.8, 10.3, 10.7 and 13.3, respectively).

CONCLUSION

The SiPM-based PET/CT system outperforms two standard Bismuth germanium oxide- and Lutetium-yttrium oxyorthosilicate-based scanners in terms of image quality, with further benefits added using TOF and BSREM. This may be beneficial for detecting small lesions and more accurate disease staging.

Performance characteristics of silicon photomultiplier based 15-cm AFOV TOF PET/CT

Background

This paper describes the National Electrical Manufacturers Association (NEMA) system performance of the Discovery MI 3-ring PET/CT (GE Healthcare) installed in Bruges, Belgium. This time-of-flight (TOF) PET camera is based on silicon photomultipliers instead of photomultiplier tubes.

Methods

The NEMA NU2-2012 standard was used to evaluate spatial resolution, sensitivity, image quality (IQ) and count rate curves of the system. Timing and energy resolution were determined.

Results

Full width at half maximum (FWHM) of spatial resolution in radial, tangential and axial direction was 4.69, 4.08 and 4.68 mm at 1 cm; 5.58, 4.64 and 5.83 mm at 10 cm; and 7.53, 5.08 and 5.47 mm at 20 cm from the centre of the field of view (FOV) for the filtered backprojection reconstruction. For non-TOF ordered subset expectation maximization (OSEM) reconstruction without point spread function (PSF) correction, FWHM was 3.87, 3.69 and 4.15 mm at 1 cm; 4.80, 3.81 and 4.87 mm at 10 cm; and 7.38, 4.16 and 3.98 mm at 20 cm. Sensitivity was 7.258 cps/kBq at the centre of the FOV and 7.117 cps/kBq at 10-cm radial offset. Contrast recovery (CR) using the IQ phantom for the TOF OSEM reconstruction without PSF correction was 47.4, 59.3, 67.0 and 77.0% for the 10-, 13-, 17- and 22-mm radioactive spheres and 82.5 and 85.1% for the 28- and 37-mm non-radioactive spheres. Background variability (BV) was 16.4, 12.1, 9.1, 6.6, 5.1 and 3.8% for the 10-, 13-, 17-, 22-, 28- and 37-mm spheres. Lung error was 8.5%. Peak noise equivalent count rate (NECR) was 102.3 kcps at 23.0 kBq/ml with a scatter fraction of 41.2%. Maximum accuracy error was 3.88%. Coincidence timing resolution was 375.6 ps FWHM. Energy resolution was 9.3% FWHM. Q.Clear reconstruction significantly improved CR and reduced BV compared with OSEM.

Conclusion

System sensitivity and NECR are lower and IQ phantom’s BV is higher compared with larger axial FOV (AFOV) scanners like the 4-ring discovery MI, as expected from the smaller solid angle of the 3-ring system. The other NEMA performance parameters are all comparable with those of the larger AFOV scanners.

Comparison between new-generation SiPM-based and conventional PMT-based TOF-PET/CT

PURPOSE

This study aimed to determine whether the SiPM-PET/CT, Discovery MI (DMI) performs better than the PMT-PET/CT system, Discovery 710 (D710).

METHODS

The physical performance of both systems was evaluated using NEMA NU 2 standards. Contrast (%), uniformity and image noise (%) are criteria proposed by the Japanese Society of Nuclear Medicine (JSNM) for phantom tests and were determined in images acquired from Hoffman and uniform phantoms using the DMI and D710. Brain and whole-body [¹⁸F]FDG images were also acquired from a healthy male using the DMI and D710.

RESULTS

The spatial resolution at 1.0cm off-center in the DMI and D710 was 3.91 and 4.52mm, respectively. The sensitivity of the DMI and D710 was 12.62 and 7.50cps/kBq, respectively. The observed peak noise-equivalent count rates were 185.6kcps at 22.5kBq/mL and 137.0kcps at 29.0kBq/mL, and the scatter fractions were 42.1% and 37.9% in the DMI and D710, respectively. The D710 had better contrast recovery and lower background variability. Contrast, uniformity and image noise in the DMI were 61.0%, 0.0225, and 7.85%, respectively. These outcomes were better than those derived from the D710 and satisfied the JSNM criteria. Brain images acquired by the DMI had better grey-to-white matter contrast and lower image noise at the edge of axial field of view.

CONCLUSIONS

The DMI offers better sensitivity, performance under conditions of high count rates and image quality than the conventional PMT-PET/CT system, D710.

Calculation Accuracy of Gross Tumor Volume at the Diaphragm Boundary Evaluated Using Respiratory-gated PET/CT

OBJECTIVE

The present study aimed to clarify gross tumor volume (GTV) contouring accuracy at the diaphragm boundary using respiratory-gated PET/CT.

METHODS

The lung/diaphragm boundary was simulated using a phantom containing ¹⁸F solution (10.6 kBq/mL). Tumors were simulated using spheres (diameter, 11-38 mm) containing ¹⁸F and located at the positions of the lungs and liver. The tumor background ratios (TBR) were 2, 4, and 8. The phantom was moved from the superior to inferior direction with a 20-mm motion displacement at 3.6 s intervals. The recovery coefficient (RC), volume RC (VRC), and standardized uptake value (SUV) threshold were calculated using stationary, non-gated (3D), and gated (4D) PET/CT.

RESULTS

In lung cancer simulation, RC and VRC in 3D PET images were, respectively, underestimated and overestimated in smaller tumors, whereas both improved in 4D PET images regardless of tumor size and TBR. The optimal SUV threshold was about 30% in 4D PET images. In liver cancer simulation, RC and VRC were, respectively, underestimated and overestimated in smaller tumors, and when the TBR was lower, but both improved in 4D PET images when tumors were >17 mm and the TBR was >4. The optimal SUV threshold tended to depend on the TBR.

CONCLUSIONS

The contouring accuracy of GTV was improved by considering TBR and using an optimal SUV threshold acquired from 4D PET images.

18F-FDG silicon photomultiplier PET/CT: A pilot study comparing semi-quantitative measurements with standard PET/CT

Purpose

To evaluate if the new Discovery Molecular Insights (DMI) PET/CT scanner provides equivalent results compared to the standard of care PET/CT scanners (GE Discovery 600 or GE Discovery 690) used in our clinic and to explore any possible differences in semi-quantitative measurements.

Methods

The local Institutional Review Board approved the protocol and written informed consent was obtained from each patient. Between September and November 2016, 50 patients underwent a single ¹⁸F-FDG injection and two scans: the clinical standard PET/CT followed immediately by the DMI PET/CT scan. We measured SUV_max and SUV_mean of different background organs and up to four lesions per patient from data acquired using both scanners.

Results

DMI PET/CT identified all the 107 lesions detected by standard PET/CT scanners, as well as additional 37 areas of focal increased ¹⁸F-FDG uptake. The SUV_max values for all 107 lesions ranged 1.2 to 14.6 (mean ± SD: 2.8 ± 2.8), higher on DMI PET/CT compared with standard of care PET/CT. The mean lesion:aortic arch SUV_max ratio and mean lesion:liver SUV_max ratio were 0.2–15.2 (mean ± SD: 3.2 ± 2.6) and 0.2–8.5 (mean ± SD: 1.9 ± 1.4) respectively, higher on DMI PET/CT than standard PET/CT. These differences were statistically significant (P value < 0.0001) and not correlated to the delay in acquisition of DMI PET data (P < 0.0001).

Conclusions

Our study shows high performance of the new DMI PET/CT scanner. This may have a significant role in diagnosing and staging disease, as well as for assessing and monitoring responses to therapies.

Studies of a Next-Generation Silicon-Photomultiplier-Based Time-of-Flight PET/CT System

This article presents system performance studies for the Discovery MI PET/CT system, a new time-of-flight system based on silicon photomultipliers. System performance and clinical imaging were compared between this next-generation system and other commercially available PET/CT and PET/MR systems, as well as between different reconstruction algorithms. Methods: Spatial resolution, sensitivity, noise-equivalent counting rate, scatter fraction, counting rate accuracy, and image quality were characterized with the National Electrical Manufacturers Association NU-2 2012 standards. Energy resolution and coincidence time resolution were measured. Tests were conducted independently on two Discovery MI scanners installed at Stanford University and Uppsala University, and the results were averaged. Back-to-back patient scans were also performed between the Discovery MI, Discovery 690 PET/CT, and SIGNA PET/MR systems. Clinical images were reconstructed using both ordered-subset expectation maximization and Q.Clear (block-sequential regularized expectation maximization with point-spread function modeling) and were examined qualitatively. Results: The averaged full widths at half maximum (FWHMs) of the radial/tangential/axial spatial resolution reconstructed with filtered backprojection at 1, 10, and 20 cm from the system center were, respectively, 4.10/4.19/4.48 mm, 5.47/4.49/6.01 mm, and 7.53/4.90/6.10 mm. The averaged sensitivity was 13.7 cps/kBq at the center of the field of view. The averaged peak noise-equivalent counting rate was 193.4 kcps at 21.9 kBq/mL, with a scatter fraction of 40.6%. The averaged contrast recovery coefficients for the image-quality phantom were 53.7, 64.0, 73.1, 82.7, 86.8, and 90.7 for the 10-, 13-, 17-, 22-, 28-, and 37-mm-diameter spheres, respectively. The average photopeak energy resolution was 9.40% FWHM, and the average coincidence time resolution was 375.4 ps FWHM. Clinical image comparisons between the PET/CT systems demonstrated the high quality of the Discovery MI. Comparisons between the Discovery MI and SIGNA showed a similar spatial resolution and overall imaging performance. Lastly, the results indicated significantly enhanced image quality and contrast-to-noise performance for Q.Clear, compared with ordered-subset expectation maximization. Conclusion: Excellent performance was achieved with the Discovery MI, including 375 ps FWHM coincidence time resolution and sensitivity of 14 cps/kBq. Comparisons between reconstruction algorithms and other multimodal silicon photomultiplier and non-silicon photomultiplier PET detector system designs indicated that performance can be substantially enhanced with this next-generation system.

Effect of Scatter Limitation Correction with Misregistration between Computed Tomography and Positron Emission Tomography on Scatter Correction: A Physical Phantom Study

PURPOSE

This study aimed to evaluate the advantage of scatter limitation correction with misregistration between μ-map in the computed tomography attenuation correction and positron emission tomography in PET/CT study.

METHODS

We used torso phantom including simulated tumor and arms phantom. The CT scan was performed by changing the position of arms phantom after PET scan. Arms phantom movement was out-side direction, in-side direction, and top-side direction by 1-12 cm, respectively. The standardized uptake value (SUV) of simulated tumor and background (B.G.) were evaluated for three specific parameters. Two scatter corrections were performed with scatter correction (SC), and scatter limitation correction (SLC).

RESULTS

The SUV_max of simulated tumor was increased by 2.80% (SC), and 2.78% (SLC) on out-side arms movement. In the SUV_max, SC and SLC were decreased by 28.6%, 9.04% on in-side arms, respectively. SUV_max of the SC, and SLC were increased on top-side arms. The scatter fraction factor (SFF) of SC and SLC were 0.25, 0.25 on out-side 5 cm and were 0.732, 0.391 on in-side 5 cm and were 0.785, 0.434 on top-side 12 cm, respectively.

CONCLUSION

SLC improved the overestimation of the SUV_max by SC. However, it is necessary to pay attention, in order not to be improved completely. The finding results indicated that SFF was setting 0.40-0.45 in our institute PET/CT system.

Performance Characteristics of the Whole-Body Discovery IQ PET/CT System

The aim of this study was to assess the physical performance of a new PET/CT system, the Discovery IQ with 5-ring detector blocks. Methods: Performance was measured using the National Electrical Manufacturers Association NU2-2012 methodology. Image quality was extended by accounting for different acquisition parameters (lesion-to-background ratios [8:1, 4:1, and 2:1] and acquisition times) and reconstruction algorithms (VUE-point HD [VPHD], VPHD with point-spread-function modeling [VPHD-S], and Q.Clear). Tomographic reconstruction was also assessed using a Jaszczak phantom. Additionally, 30 patient lesions were analyzed to account for differences in lesion volume and SUV quantification between reconstruction algorithms. Results: Spatial resolution ranged from 4.2 mm at 1 cm to 8.5 mm at 20 cm. Sensitivity measured at the center and at 10 cm was 22.8 and 20.4 kps/kBq, respectively. The noise-equivalent counting rate peak was 124 kcps at 9.1 kBq/cm³ The scatter fraction was 36.2%. The accuracy of correction for count losses and randoms was 3.9%. In the image quality test, contrast recovery for VPHD, VPHD-S, and Q.Clear ranged from 18%, 18%, and 13%, respectively (hot contrast; 10-mm sphere diameter; ratio, 2:1), to 68%, 67%, and 81%, respectively (cold contrast; 37-mm sphere diameter; ratio, 8:1). Background variability ranged from 3.4%, 3.0%, and 2.1%, respectively (ratio, 2:1), to 5.5%, 4.8%, and 3.7%, respectively (ratio, 8:1). On Q.Clear reconstruction, the decrease in the penalty term (β) increased the contrast recovery coefficients and background variability. With the Jaszczak phantom, image quality increased overall when a reconstruction algorithm modeling the point-spread function was used, and use of Q.Clear increased the signal-to-noise ratio. Lesions analyzed using VPHD-S and Q.Clear had an SUV_mean of 6.5 ± 3 and 7 ± 3, respectively (P < 0.01), and an SUV_max of 11 ± 4.8 and 12 ± 4, respectively (P < 0.01). No significant difference in mean lesion volume was found between algorithms. Conclusion: Among the various Discovery bismuth germanium oxide-based PET/CT scanners, the IQ with 5-ring detector blocks has the highest overall performance, with improved sensitivity and counting rate performance. Q.Clear reconstruction improves the PET image quality, with higher recovery coefficients and lower background variability.

NEMA NU 2-2012 performance studies for the SiPM-based ToF-PET component of the GE SIGNA PET/MR system

PURPOSE

The GE SIGNA PET/MR is a new whole body integrated time-of-flight (ToF)-PET/MR scanner from GE Healthcare. The system is capable of simultaneous PET and MR image acquisition with sub-400 ps coincidence time resolution. Simultaneous PET/MR holds great potential as a method of interrogating molecular, functional, and anatomical parameters in clinical disease in one study. Despite the complementary imaging capabilities of PET and MRI, their respective hardware tends to be incompatible due to mutual interference. In this work, the GE SIGNA PET/MR is evaluated in terms of PET performance and the potential effects of interference from MRI operation.

METHODS

The NEMA NU 2-2012 protocol was followed to measure PET performance parameters including spatial resolution, noise equivalent count rate, sensitivity, accuracy, and image quality. Each of these tests was performed both with the MR subsystem idle and with continuous MR pulsing for the duration of the PET data acquisition. Most measurements were repeated at three separate test sites where the system is installed.

RESULTS

The scanner has achieved an average of 4.4, 4.1, and 5.3 mm full width at half maximum radial, tangential, and axial spatial resolutions, respectively, at 1 cm from the transaxial FOV center. The peak noise equivalent count rate (NECR) of 218 kcps and a scatter fraction of 43.6% are reached at an activity concentration of 17.8 kBq/ml. Sensitivity at the center position is 23.3 cps/kBq. The maximum relative slice count rate error below peak NECR was 3.3%, and the residual error from attenuation and scatter corrections was 3.6%. Continuous MR pulsing had either no effect or a minor effect on each measurement.

CONCLUSIONS

Performance measurements of the ToF-PET whole body GE SIGNA PET/MR system indicate that it is a promising new simultaneous imaging platform.

Evaluation of spatial dependence of point spread function-based PET reconstruction using a traceable point-like 22Na source

Background

The point spread function (PSF) of positron emission tomography (PET) depends on the position across the field of view (FOV). Reconstruction based on PSF improves spatial resolution and quantitative accuracy. The present study aimed to quantify the effects of PSF correction as a function of the position of a traceable point-like ²²Na source over the FOV on two PET scanners with a different detector design.

Methods

We used Discovery 600 and Discovery 710 (GE Healthcare) PET scanners and traceable point-like ²²Na sources (<1 MBq) with a spherical absorber design that assures uniform angular distribution of the emitted annihilation photons. The source was moved in three directions at intervals of 1 cm from the center towards the peripheral FOV using a three-dimensional (3D)-positioning robot, and data were acquired over a period of 2 min per point. The PET data were reconstructed by filtered back projection (FBP), the ordered subset expectation maximization (OSEM), OSEM + PSF, and OSEM + PSF + time-of-flight (TOF). Full width at half maximum (FWHM) was determined according to the NEMA method, and total counts in regions of interest (ROI) for each reconstruction were quantified.

Results

The radial FWHM of FBP and OSEM increased towards the peripheral FOV, whereas PSF-based reconstruction recovered the FWHM at all points in the FOV of both scanners. The radial FWHM for PSF was 30–50 % lower than that of OSEM at the center of the FOV. The accuracy of PSF correction was independent of detector design. Quantitative values were stable across the FOV in all reconstruction methods. The effect of TOF on spatial resolution and quantitation accuracy was less noticeable.

Conclusions

The traceable ²²Na point-like source allowed the evaluation of spatial resolution and quantitative accuracy across the FOV using different reconstruction methods and scanners. PSF-based reconstruction reduces dependence of the spatial resolution on the position. The quantitative accuracy over the entire FOV of the PET system is good, regardless of the reconstruction methods, although it depends slightly on the position.

Image quality and variability for routine diagnostic FDG-PET scans in a Japanese community hospital: current status and possibility of improvement

PURPOSE

In Japan, commercially delivered FDG is manufactured in three batches per day at fixed constant activity and distributed in vials. Consequently, the amount of activity administered to the patient varies depending on the timing of injection. We evaluated a method for adjusting the scan time according to the body mass index (BMI) to obtain equivalent image quality for every patient.

METHODS

We examined a total of 301 routine clinical oncology PET scans using commercially delivered FDG. The relation between the injected activity and the noise equivalent count per scan length (NECpatient) was evaluated as a marker of image quality; its association with BMI was also examined.

RESULTS

The injected activity and NECpatient exhibited large variations (230.4 ± 55.8 MBq and 19.9 ± 2.9 Mcounts/m). There was a weak correlation between the injected activity and NECpatient (r ~ 0.3) for thin patients (BMI < 21 kg/m(2)), but no correlation for patients with higher BMIs. However, a significant correlation was found between BMI and NECpatient (p < 0.0001).

CONCLUSION

In a community hospital using commercially delivered FDG, it is possible to reduce the variability of the NECpatient and obtain uniform image quality by changing the scan time as a function of patient BMI, even with uncontrollable injected activity.

[Usefulness of Determining Acquisition Time by True Count Rate Measurement Method for Delivery 18F-FDG PET/CT]

A stable quality of delivery 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) requires suitable acquisition time, which can be obtained from an accurate true count of 18F-FDG. However, the true count is influenced by body mass index (BMI) and attenuation of 18F-FDG. In order to remove these influences, we have developed a new method (actual measurement method) to measure the actual true count rate based on sub-pubic thigh, which allows us to calculate a suitable acquisition time. In this study, we aimed to verify the acquisition count through our new method in terms of two categories: (1) the accuracy of acquisition count and (2) evaluation of clinical images using physical index. Our actual measurement method was designed to obtain suitable acquisition time through the following procedure. A true count rate of sub-pubic thigh was measured through detector of PET, and used as a standard true count rate. Finally, the obtained standard count rate was processed to acquisition time. This method was retrospectively applied to 150 patients, receiving 18F-FDG administration from 109.7 to 336.8 MBq, and whose body weight ranged from 37 to 95.4 kg. The accuracy of true count was evaluated by comparing relationships of true count, relative to BMI or to administered dose of 18F-FDG. The PET/CT images obtained by our actual measurement method were assessed using physical index. Our new method resulted in accurate true count, which was not influenced by either BMI or administered dose of 18F-FDG, as well as satisfied PET/CT images with recommended criteria of physical index in all patients.

Evaluation of scatter limitation correction: a new method of correcting photopenic artifacts caused by patient motion during whole-body PET/CT imaging

OBJECTIVE

Overcorrection of scatter caused by patient motion during whole-body PET/computed tomography (CT) imaging can induce the appearance of photopenic artifacts in the PET images. The present study aimed to quantify the accuracy of scatter limitation correction (SLC) for eliminating photopenic artifacts.

METHODS

This study analyzed photopenic artifacts in (18)F-fluorodeoxyglucose ((18)F-FDG) PET/CT images acquired from 12 patients and from a National Electrical Manufacturers Association phantom with two peripheral plastic bottles that simulated the human body and arms, respectively. The phantom comprised a sphere (diameter, 10 or 37 mm) containing fluorine-18 solutions with target-to-background ratios of 2, 4, and 8. The plastic bottles were moved 10 cm posteriorly between CT and PET acquisitions. All PET data were reconstructed using model-based scatter correction (SC), no scatter correction (NSC), and SLC, and the presence or absence of artifacts on the PET images was visually evaluated. The SC and SLC images were also semiquantitatively evaluated using standardized uptake values (SUVs).

RESULTS

Photopenic artifacts were not recognizable in any NSC and SLC image from all 12 patients in the clinical study. The SUVmax of mismatched SLC PET/CT images were almost equal to those of matched SC and SLC PET/CT images. Applying NSC and SLC substantially eliminated the photopenic artifacts on SC PET images in the phantom study. SLC improved the activity concentration of the sphere for all target-to-background ratios. The highest %errors of the 10 and 37-mm spheres were 93.3 and 58.3%, respectively, for mismatched SC, and 73.2 and 22.0%, respectively, for mismatched SLC.

CONCLUSION

Photopenic artifacts caused by SC error induced by CT and PET image misalignment were corrected using SLC, indicating that this method is useful and practical for clinical qualitative and quantitative PET/CT assessment.

An Adaptive Thresholding Method for BTV Estimation Incorporating PET Reconstruction Parameters: A Multicenter Study of the Robustness and the Reliability

OBJECTIVE

The aim of this work was to assess robustness and reliability of an adaptive thresholding algorithm for the biological target volume estimation incorporating reconstruction parameters.

METHOD

In a multicenter study, a phantom with spheres of different diameters (6.5-57.4 mm) was filled with (18)F-FDG at different target-to-background ratios (TBR: 2.5-70) and scanned for different acquisition periods (2-5 min). Image reconstruction algorithms were used varying number of iterations and postreconstruction transaxial smoothing. Optimal thresholds (TS) for volume estimation were determined as percentage of the maximum intensity in the cross section area of the spheres. Multiple regression techniques were used to identify relevant predictors of TS.

RESULTS

The goodness of the model fit was high (R(2): 0.74-0.92). TBR was the most significant predictor of TS. For all scanners, except the Gemini scanners, FWHM was an independent predictor of TS. Significant differences were observed between scanners of different models, but not between different scanners of the same model. The shrinkage on cross validation was small and indicative of excellent reliability of model estimation.

CONCLUSIONS

Incorporation of postreconstruction filtering FWHM in an adaptive thresholding algorithm for the BTV estimation allows obtaining a robust and reliable method to be applied to a variety of different scanners, without scanner-specific individual calibration.

Effects of injected dose, BMI and scanner type on NECR and image noise in PET imaging

Noise equivalent count rate (NECR) and image noise are two different but related metrics that have been used to predict and assess image quality, respectively. The aim of this study is to investigate, using patient studies, the relationships between injected dose (ID), body mass index (BMI) and scanner type on NECR and image noise measurements in PET imaging. Two groups of 90 patients each were imaged on a GE DSTE and a DRX PET/CT scanner, respectively. The patients in each group were divided into nine subgroups according to three BMI (20-24.9, 25-29.9, 30-45 kg m(-2)) and three ID (296-444, 444-555, 555-740 MBq) ranges, resulting in ten patients/subgroup. All PET data were acquired in 3D mode and reconstructed using the VuePoint HD® fully 3D OSEM algorithm (2 iterations, 21(DRX) or 20 (DSTE) subsets). NECR and image noise measurements for bed positions covering the liver were calculated for each patient. NECR was calculated from the trues, randoms and scatter events recorded in the DICOM header of each patient study, while image noise was determined as the standard deviation of 50 non-neighboring voxels in the liver of each patient. A t-test compared the NECR and image noise for different scanners but with the same BMI and ID. An ANOVA test on the other hand was used to compare the results of patients with different BMI but the same ID and scanner type as well as different ID but the same BMI and scanner type. As expected the t-test showed a significant difference in NECR between the two scanners for all BMI and ID subgroups. However, contrary to what is expected no such findings were observed for image noise measurement. The ANOVA results showed a statistically significant difference in both NECR and image noise among the different BMI for each ID and scanner subgroup. However, there was no statistically significant difference in NECR and image noise across different ID for each BMI and scanner subgroup. Although the GE DRX PET/CT scanner has better count rate performance than the GE DSTE PET/CT scanner, this improvement does not translate to a lower image noise when using OSEM reconstruction. Our results show that patients with larger BMI consistently generate poorer image quality. Dose reduction from >555 to 296-444 MBq has minimal impact on image quality independent of the scanner used. A reduction in ID decreases patient and technologist exposure and can potentially reduce the overall cost of the study.