Feasibility study for positron emission mammography

Advances in Breast PET Instrumentation

Dedicated breast PET scanners currently have a spatial resolution in the 1.5 to 2 mm range, and the ability to provide tomographic images and quantitative data. They are also commercially available from a few vendors. A review of past and recent advances in the development and performance of dedicated breast PET scanners is summarized.

Clinical Applications of Dedicated Breast Positron Emission Tomography

Breast-specific positron imaging systems provide higher sensitivity than whole-body PET for breast cancer detection. The clinical applications for breast-specific positron imaging are similar to breast MRI including preoperative local staging and neoadjuvant therapy response assessment. Breast-specific positron imaging may be an alternative for patients who cannot undergo breast MRI. Further research is needed in expanding the field-of-view for posterior breast lesions, increasing biopsy capability, and reducing radiation dose. Efforts are also necessary for developing appropriate use criteria, increasing availability, and advancing insurance coverage.

Molecular Breast Imaging and Positron Emission Mammography

There is growing interest in application of functional imaging modalities for adjunct breast imaging due to their unique ability to evaluate molecular/pathophysiologic changes, not visible by standard anatomic breast imaging. This has led to increased use of nuclear medicine dedicated breast-specific single photon and coincidence imaging systems for multiple indications, such as supplemental screening, staging of newly diagnosed breast cancer, evaluation of response to neoadjuvant treatment, diagnosis of local disease recurrence in the breast, and problem solving. Studies show that these systems maybe especially useful for specific subsets of patients, not well served by available anatomic breast imaging modalities.

Evaluating attenuation correction strategies in a dedicated, single-gantry breast PET-tomosynthesis scanner

We are developing a dedicated, combined breast positron emission tomography (PET)-tomosynthesis scanner. Both the PET and digital breast tomosynthesis (DBT) scanners are integrated in a single gantry to provide spatially co-registered 3D PET-tomosynthesis images. The DBT image will be used to identify the breast boundary and breast density to improve the quantitative accuracy of the PET image. This paper explores PET attenuation correction (AC) strategies that can be performed with the combined breast PET-DBT scanner to obtain more accurate, quantitative high-resolution 3D PET images. The PET detector is comprised of a 32 × 32 array of 1.5 × 1.5 × 15 mm3 LYSO crystals. The PET scanner utilizes two detector heads separated by either 9 or 11 cm, with each detector head having a 4 × 2 arrangement of PET detectors. GEANT4 Application for Tomographic Emission simulations were performed using an anthropomorphic breast phantom with heterogeneous attenuation under clinical DBT-compression. FDG-avid lesions, each 5 mm in diameter with 8:1 uptake, were simulated at four locations within the breast. Simulations were performed with a scan time of 2 min. PET AC was performed using the actual breast simulation model as well as DBT reconstructed volumetric images to derive the breast outline. In addition to using the known breast density as defined by the breast model, we also modeled it as uniform patient-independent soft-tissue, and as a uniform patient-specific material derived from breast tissue composition. Measured absolute lesion uptake was used to evaluate the quantitative accuracy of performing AC using the various strategies. This study demonstrates that AC is necessary to obtain a closer estimate of the true lesion uptake and background activity in the breast. The DBT image dataset assists in measuring lesion uptake with low bias by facilitating accurate breast delineation as well as providing accurate information related to the breast tissue composition. While both the uniform soft-tissue and patient-specific material approaches provides a close estimate to the ground truth, <5% bias can be achieved by using a uniform patient-specific material to define the attenuation map.

Evaluation of primary breast cancers using dedicated breast PET and whole-body PET

Metabolic imaging of the primary breast tumor with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) PET may assist in predicting treatment response in the neoadjuvant chemotherapy (NAC) setting. Dedicated breast PET (dbPET) is a high-resolution imaging modality with demonstrated ability in highlighting intratumoral heterogeneity and identifying small lesions in the breast volume. In this study, we characterized similarities and differences in the uptake of [¹⁸F]FDG in dbPET compared to whole-body PET (wbPET) in a cohort of ten patients with biopsy-confirmed, locally advanced breast cancer at the pre-treatment timepoint. Patients received bilateral dbPET and wbPET following administration of 186 MBq and 307 MBq [¹⁸F]FDG on separate days, respectively. [¹⁸F]FDG uptake measurements and 20 radiomic features based on morphology, tumor intensity, and texture were calculated and compared. There was a fivefold increase in SUL_peak for dbPET (median difference (95% CI): 4.0 mL⁻¹ (1.8–6.4 mL⁻¹), p = 0.006). Additionally, spatial heterogeneity features showed statistically significant differences between dbPET and wbPET. The higher [¹⁸F]FDG uptake in dbPET highlighted the dynamic range of this breast-specific imaging modality. Combining with the higher spatial resolution, dbPET may be able to detect treatment response in the primary tumor during NAC, and future studies with larger cohorts are warranted.

Impact of Using Uniform Attenuation Coefficients for Heterogeneously Dense Breasts in a Dedicated Breast PET/X-ray Scanner

We investigated PET image quantification when using a uniform attenuation coefficient (μ) for attenuation correction (AC) of anthropomorphic density phantoms derived from high-resolution breast CT scans. A breast PET system was modeled with perfect data corrections except for AC. Using uniform μ for AC resulted in quantitative errors roughly proportional to the difference between μ used in AC (μ _AC) and local μ, yielding approximately ± 5% bias, corresponding to the variation of μ for 511 keV photons in breast tissue. Global bias was lowest when uniform μ _AC was equal to the phantom mean μ (μ _mean). Local bias in 10-mm spheres increased as the sphere μ deviated from μ _mean, but remained only 2-3% when the μ _sphere was 6.5% higher than μ _mean. Bias varied linearly with and was roughly proportional to local μ mismatch. Minimizing local bias, e.g., in a small sphere, required the use of a uniform μ value between the local μ and the μ _mean. Thus, biases from using uniform-μ AC are low when local μ _sphere is close to μ _mean. As the μ _sphere increasingly differs from the phantom μ _mean, bias increases, and the optimal uniform μ is less predictable, having a value between μ _sphere and the phantom μ _mean.

Performance evaluation of developed dedicated breast PET scanner and improvement of the spatial resolution by wobbling: a Monte Carlo study

PURPOSE

Molecular imaging, particularly PET scanning, has become an important cancer diagnostic tool. Whole-body PET is not effective for local staging of cancer because of their declining efficiency in detecting small lesions. The preliminary results of the performance evaluation of designed dedicated breast PET scanner presented.

METHODS AND MATERIALS

A new scanner is based on LYSO crystals coupled with SiPM, and it consists of 14 compact modules with a transaxial FOV of 180 mm in diameter. In this study, initial GATE simulation studies were performed to predict the spatial resolution, absolute sensitivity, noise equivalent count rate (NECR) and scatter fraction (SF) of the new design. Spatial wobbling acquisitions were also implemented. Finally, the obtained projections were reconstructed using analytical and iterative algorithms.

RESULTS

The simulation results indicate that absolute sensitivity is 1.42% which is appropriate than other commercial breast PET systems. The calculated SF and NECR in our design are 20.6% and 21.8 kcps. The initial simulation results demonstrate the potential of this design for breast cancer detection. A small wobble motion to improve spatial resolution and contrast.

CONCLUSION

The performance of the dedicated breast PET scanner is considered to be reasonable enough to support its use in breast cancer imaging.

A dedicated breast-PET/CT scanner: Evaluation of basic performance characteristics

PURPOSE

Application of advanced imaging techniques, such as PET and x ray CT, can potentially improve detection of breast cancer. Unfortunately, both modalities have challenges in the detection of some lesions. The combination of the two techniques, however, could potentially lead to an overall improvement in diagnostic breast imaging. The purpose of this investigation is to test the basic performance of a new dedicated breast-PET/CT.

METHODS

The PET component consists of a rotating pair of detectors. Its performance was evaluated using the NEMA NU4-2008 protocols. The CT component utilizes a pulsed x ray source and flat panel detector mounted on the same gantry as the PET scanner. Its performance was assessed using specialized phantoms. The radiation dose to a breast during CT imaging was explored by the measurement of free-in-air kerma and air kerma measured at the center of a 16 cm-diameter PMMA cylinder. Finally, the combined capabilities of the system were demonstrated by imaging of a micro-hot-rod phantom.

RESULTS

Overall, performance of the PET component is comparable to many pre-clinical and other dedicated breast-PET scanners. Its spatial resolution is 2.2 mm, 5 mm from the center of the scanner using images created with the single-sliced-filtered-backprojection algorithm. Peak NECR is 24.6 kcps; peak sensitivity is 1.36%; the scatter fraction is 27%. Spatial resolution of the CT scanner is 1.1 lp/mm at 10% MTF. The free-in-air kerma is 2.33 mGy, while the PMMA-air kerma is 1.24 mGy. Finally, combined imaging of a micro-hot-rod phantom illustrated the potential utility of the dual-modality images produced by the system.

CONCLUSION

The basic performance characteristics of a new dedicated breast-PET/CT scanner are good, demonstrating that its performance is similar to current dedicated PET and CT scanners. The potential value of this system is the capability to produce combined duality-modality images that could improve detection of breast disease. The next stage in development of this system is testing with more advanced phantoms and human subjects.

Simulation study of quantitative precision of the PET/X dedicated breast PET scanner

The goal for positron emission tomography (PET)/X is measuring changes in radiotracer uptake for early assessment of response to breast cancer therapy. Upper bounds for detecting such changes were investigated using simulation and two image reconstruction algorithms customized to the PET/X rectangular geometry. Analytical reconstruction was used to study spatial resolution, comparing results with the distance of the closest approach (DCA) resolution surrogate that is independent of the reconstruction method. An iterative reconstruction algorithm was used to characterize contrast recovery in small targets. Resolution averaged [Formula: see text] full width at half maximum when using depth-of-interaction (DOI) information. Without DOI, resolution ranged from [Formula: see text] to [Formula: see text] for scanner crystal thickness between 5 and 15 mm. The DCA resolution surrogate was highly correlated to image-based FWHM. Receiver-operating characteristic analysis showed specificity and sensitivity over 95% for detecting contrast change from 5:1 to 4:1 (area under curve [Formula: see text]). For PET/X parameters modeled here, the ability to measure contrast changes benefited from higher photon absorption efficiency of thicker crystals while being largely unaffected by degraded resolution obtained with thicker crystals; DOI provided marginal improvements. These results assumed perfect data corrections and other idealizations, and thus represent an upper bound for detecting changes in small lesion radiotracer uptake of clinical interest using the PET/X system.

Open-field mouse brain PET: design optimisation and detector characterisation

'Open-field' PET, in which an animal is free to move within an enclosed space during imaging, is a very promising advance for neuroscientific research. It provides a key advantage over conventional imaging under anesthesia by enabling functional changes in the brain to be correlated with an animal's behavioural response to environmental or pharmacologic stimuli. Previously we have demonstrated the feasibility of open-field imaging of rats using motion compensation techniques applied to a commercially available PET scanner. However, this approach of 'retro-fitting' motion compensation techniques to an existing system is limited by the inherent geometric and performance constraints of the system. The goal of this project is to develop a purpose-built PET scanner with geometry, motion tracking and imaging performance tailored and optimised for open-field imaging of the mouse brain. The design concept is a rail-based sliding tomograph which moves according to the animal's motion. Our specific aim in this work was to evaluate candidate scanner designs and characterise the performance of a depth-of-interaction detector module for the open-field system. We performed Monte Carlo simulations to estimate and compare the sensitivity and spatial resolution performance of four scanner geometries: a ring, parallel plate, and two box variants. Each system was based on a detector block consisting of a 23  ×  23 array of 0.785  ×  0.785  ×  20 mm³ LSO crystals (overall dim. 19.6  ×  19.6  ×  20 mm). We found that a DoI resolution capability of 3 mm was necessary to achieve approximately uniform sub-millimetre spatial resolution throughout the FoV for all scanners except the parallel-plate geometry. With this DoI performance, the sensitivity advantage afforded by the box geometry with overlapping panels (16% peak absolute sensitivity, a 36% improvement over the ring design) suggests this unconventional design is best suited for imaging the mouse brain. We also built and characterised the block detector modelled in the simulations, including a dual-ended readout based on 6  ×  6 arrays of through-silicon-via silicon photomultipliers (active area 84%) for DoI estimation. Identification of individual crystals in the flood map was excellent, energy resolution varied from 12.4%  ±  0.6% near the centre to 24.4%  ±  3.4% at the ends of the crystal, and the average DoI resolution was 2.8 mm  ±  0.35 mm near the central depth (10 mm) and 3.5 mm  ±  1.0 mm near the ends. Timing resolution was 1.4  ±  0.14 ns. Therefore, the DoI detector module meets the target specifications for the application and will be used as the basis for a prototype open-field mouse PET scanner.

Comparison of Diagnostic Performance of Three-Dimensional Positron Emission Mammography versus Whole Body Positron Emission Tomography in Breast Cancer

Objective

To compare the diagnostic performance of three-dimensional (3D) positron emission mammography (PEM) versus whole body positron emission tomography (WBPET) for breast cancer.

Methods

A total of 410 women with normal breast or benign or highly suspicious malignant tumors were randomized at 1 : 1 ratio to undergo 3D-PEM followed by WBPET or WBPET followed by 3D-PEM. Lumpectomy or mastectomy was performed on eligible participants after the scanning.

Results

The sensitivity and specificity of 3D-PEM were 92.8% and 54.5%, respectively. WBPET showed a sensitivity of 95.7% and specificity of 56.8%. After exclusion of the patients with lesions beyond the detecting range of the 3D-PEM instrument, 3D-PEM showed higher sensitivity than WBPET (97.0% versus 95.5%, P = 0.913), particularly for small lesions (<1 cm) (72.0% versus 60.0%, P = 0.685).

Conclusions

The 3D-PEM appears more sensitive to small lesions than WBPET but may fail to detect lesions that are beyond the detecting range. This study was approved by the Ethics Committee (E2012052) at the Tianjin Medical University Cancer Institute and Hospital (Tianjin, China). The instrument positron emission mammography (PEMi) was approved by China State Food and Drug Administration under the registration number 20153331166.

Fourier rebinning and consistency equations for time-of-flight PET planograms

Due to the unique geometry, dual-panel PET scanners have many advantages in dedicated breast imaging and on-board imaging applications since the compact scanners can be combined with other imaging and treatment modalities. The major challenges of dual-panel PET imaging are the limited-angle problem and data truncation, which can cause artifacts due to incomplete data sampling. The time-of-flight (TOF) information can be a promising solution to reduce these artifacts. The TOF planogram is the native data format for dual-panel TOF PET scanners, and the non-TOF planogram is the 3D extension of linogram. The TOF planograms is five-dimensional while the objects are three-dimensional, and there are two degrees of redundancy. In this paper, we derive consistency equations and Fourier-based rebinning algorithms to provide a complete understanding of the rich structure of the fully 3D TOF planograms. We first derive two consistency equations and John's equation for 3D TOF planograms. By taking the Fourier transforms, we obtain two Fourier consistency equations and the Fourier-John equation, which are the duals of the consistency equations and John's equation, respectively. We then solve the Fourier consistency equations and Fourier-John equation using the method of characteristics. The two degrees of entangled redundancy of the 3D TOF data can be explicitly elicited and exploited by the solutions along the characteristic curves. As the special cases of the general solutions, we obtain Fourier rebinning and consistency equations (FORCEs), and thus we obtain a complete scheme to convert among different types of PET planograms: 3D TOF, 3D non-TOF, 2D TOF and 2D non-TOF planograms. The FORCEs can be used as Fourier-based rebinning algorithms for TOF-PET data reduction, inverse rebinnings for designing fast projectors, or consistency conditions for estimating missing data. As a byproduct, we show the two consistency equations are necessary and sufficient for 3D TOF planograms. Finally, we give numerical examples of implementation of a fast 2D TOF planogram projector and Fourier-based rebinning for a 2D TOF planograms using the FORCEs to show the efficacy of the Fourier-based solutions.

Evolution and Developments in Instrumentation for Positron Emission Mammography

Molecular imaging using high-resolution PET instrumentation is now playing a pivotal role in basic and clinical research. The development of optimized detection geometries combined with high-performance detector technologies and compact designs of PET tomographs have become the goal of active research groups in academic and corporate settings. Significant progress has been achieved in the design of commercial PET instrumentation in the last decade allowing a spatial resolution of about 4 to 6 mm to be reached for whole-body imaging, about 2.4 mm for PET cameras dedicated for brain imaging, and submillimeter resolution for female breast, prostate, and small-animal imaging. In particular, significant progress has been made in the design of dedicated positron emission mammography (PEM) units. The initial concept suggested in 1993 consisted of placing 2 planar detectors capable of detecting the 511-keV annihilation photons in a conventional mammography unit. Since that time, many different design paths have been pursued and it will be interesting to see which technologies become the most successful in the future. This paper discusses recent advances in PEM instrumentation and the advantages and challenges of dedicated standalone and dual-modality imaging systems. Future opportunities and the challenges facing the adoption of PEM imaging instrumentation and its role in clinical and research settings are also addressed.

Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

We studied the effects of reduced (18)F-FDG injection activity on interpretation of positron emission mammography (PEM) images and compared image interpretation between 2 postinjection imaging times.

METHODS

We performed a receiver-operating-characteristic (ROC) study using PEM images reconstructed with different count levels expected from injected activities between 23 and 185 MBq. Thirty patients received 2 PEM scans at postinjection times of 60 and 120 min. Half of the patients were scanned with a standard protocol; the others received one-half of the standard activity. Images were reconstructed using 100%, 50%, and 25% of the total counts acquired. Eight radiologists used a 5-point confidence scale to score 232 PEM images for the presence of up to 3 malignant lesions. Paired images were analyzed with conditional logistic regression and ROC analysis to investigate changes in interpretation.

RESULTS

There was a trend for increasing lesion detection sensitivity with increased image counts: odds ratios were 2.2 (P = 0.01) and 1.9 (P = 0.04) per doubling of image counts for 60- and 120-min uptake images, respectively, without significant difference between time points (P = 0.7). The area under the ROC curve (AUC) was highest for the 100%-count, 60-min images (0.83 vs. 0.75 for 50%-counts, P = 0.02). The 120-min images had a similar trend but did not reach statistical significance (AUC = 0.79 vs. 0.73, P = 0.1). Our data did not yield significant trends between specificity and image counts. Lesion-to-background ratios increased between 60- and 120-min scans (P < 0.001).

CONCLUSION

Reducing the image counts relative to the standard protocol decreased diagnostic accuracy. The increase in lesion-to-background ratio between 60- and 120-min uptake times was not enough to improve detection sensitivity in this study, perhaps in part due to fewer counts in the later scan.

Arrays of Segmented, Tapered Light Guides for Use with Large, Planar Scintillation Detectors

Metabolic imaging techniques can potentially improve detection and diagnosis of cancer in women with radiodense and/or fibrocystic breasts. Our group has previously developed a high-resolution positron emission tomography imaging and biopsy device (PEM-PET) to detect and guide the biopsy of suspicious breast lesions. Initial testing revealed that the imaging field-of-view (FOV) of the scanner was smaller than the physical size of the detector's active area, which could hinder sampling of breast areas close to the chest wall. The purpose of this work was to utilize segmented, tapered light guides for optically coupling the scintillator arrays to arrays of position-sensitive photomultipliers to increase both the active FOV and identification of individual scintillator elements. Testing of the new system revealed that the optics of these structures made it possible to discern detector elements from the complete active area of the detector face. In the previous system the top and bottom rows and left and right columns were not identifiable. Additionally, use of the new light guides increased the contrast of individual detector elements by up to 129%. Improved element identification led to a spatial resolution increase by approximately 12%. Due to attenuation of light in the light guides the detector energy resolution decreased from 18.5% to 19.1%. Overall, these improvements should increase the field-of-view and spatial resolution of the dedicated breast-PET system.

Simulation and evaluation of a high resolution VIP PEM system with a dedicated LM-OSEM algorithm

Over the last two decades there have been a growing number of designs for positron emission tomography (PET) cameras optimized to image the breast. These devices, commonly known as positron emission mammography (PEM) cameras allow much more spatial resolution by putting the photon detectors directly on the breast. PEM cameras have a compact geometry with a restricted field of view (FOV) thus exhibiting higher performance and lower cost than large whole body PET scanners. Typical PEM designs are based on scintillators such as bismuth germanate (BGO), lutetium oxorthosilicate (LSO) or lutetium yttrium orthosicilate (LYSO), and characterized by large parallax error due to deficiency of the depth of interaction (DOI) information from crystals. In the case of parallel geometry PEM, large parallax error results in poor image resolution along the vertical axis. In the framework of the Voxel Imaging PET (VIP) pathfinder project, we propose a high resolution PEM scanner based on pixelated solid-state CdTe detectors. The pixel PEM device with a millimeter-size pixel pitch provides an excellent spatial resolution in all directions 8 times better than standard commercial devices with a point spread function (PSF) of 1 mm full width at half maximum (FWHM) and excellent energy resolution of down to 1.6% FWHM at 511 keV photons at room temperature. The system is capable to detect down to 1 mm diameter hot spheres in warm background.

Performance Evaluation of a New Dedicated Breast PET Scanner Using NEMA NU4-2008 Standards

The aim of this work was to evaluate the performance characteristics of a newly developed dedicated breast PET scanner, according to National Electrical Manufacturers Association (NEMA) NU 4-2008 standards.

METHODS

The dedicated breast PET scanner consists of 4 layers of a 32 × 32 lutetium oxyorthosilicate-based crystal array, a light guide, and a 64-channel position-sensitive photomultiplier tube. The size of a crystal element is 1.44 × 1.44 × 4.5 mm. The detector ring has a large solid angle with a 185-mm aperture and an axial coverage of 155.5 mm. The energy windows at depth of interaction for the first and second layers are 400-800 keV, and those at the third and fourth layers are 100-800 keV. A fixed timing window of 4.5 ns was used for all acquisitions. Spatial resolution, sensitivity, counting rate capabilities, and image quality were evaluated in accordance with NEMA NU 4-2008 standards. Human imaging was performed in addition to the evaluation.

RESULTS

Radial, tangential, and axial spatial resolution measured as minimal full width at half maximum approached 1.6, 1.7, and 2.0 mm, respectively, for filtered backprojection reconstruction and 0.8, 0.8, and 0.8 mm, respectively, for dynamic row-action maximum-likelihood algorithm reconstruction. The peak absolute sensitivity of the system was 11.2%. Scatter fraction at the same acquisition settings was 30.1% for the rat-sized phantom. Peak noise-equivalent counting rate and peak true rate for the ratlike phantom was 374 kcps at 25 MBq and 603 kcps at 31 MBq, respectively. In the image-quality phantom study, recovery coefficients and uniformity were 0.04-0.82 and 1.9%, respectively, for standard reconstruction mode and 0.09-0.97 and 4.5%, respectively, for enhanced-resolution mode. Human imaging provided high-contrast images with restricted background noise for standard reconstruction mode and high-resolution images for enhanced-resolution mode.

CONCLUSION

The dedicated breast PET scanner has excellent spatial resolution and high sensitivity. The performance of the dedicated breast PET scanner is considered to be reasonable enough to support its use in breast cancer imaging.

Radionuclide methods and instrumentation for breast cancer detection and diagnosis

Breast cancer mammography is a well-acknowledged technique for patient screening due to its high sensitivity. However, in addition to its low specificity the sensitivity of mammography is limited when imaging patients with dense breasts. Radionuclide imaging techniques, such as coincidence photon-based positron emission tomography and single photon emission computed tomography or scintimammography, can play a role in assisting screening of such patients. Radionuclide techniques can also be useful in assessing treatment response of patients with breast cancer to therapy, and staging of patients to diagnose the disease extent. However, the performance of these imaging modalities is generally limited because of the poor spatial resolution and sensitivity of the commercially available multipurpose imaging systems. Here, we describe some of the dedicated imaging systems (positron emission mammography [PEM] and breast-specific gamma imaging [BSGI]) that have been developed both commercially and in research laboratories for radionuclide imaging of breast cancer. Clinical studies with dedicated PEM scanners show improved sensitivity to detecting cancer in patients when using PEM in conjunction with additional imaging modalities, such as magnetic resonance imaging or mammography or both, as well as improved disease staging that can have an effect on surgical planning. High-resolution BSGI systems are more widely available commercially and several clinical studies have shown very high sensitivity and specificity in detecting cancer in high-risk patients. Further development of dedicated PEM and BSGI systems is ongoing, promising further expansion of radionuclide imaging techniques in the realm of breast cancer detection and treatment.

Nuclear imaging of the breast: translating achievements in instrumentation into clinical use

Approaches to imaging the breast with nuclear medicine and∕or molecular imaging methods have been under investigation since the late 1980s when a technique called scintimammography was first introduced. This review charts the progress of nuclear imaging of the breast over the last 20 years, covering the development of newer techniques such as breast specific gamma imaging, molecular breast imaging, and positron emission mammography. Key issues critical to the adoption of these technologies in the clinical environment are discussed, including the current status of clinical studies, the efforts at reducing the radiation dose from procedures associated with these technologies, and the relevant radiopharmaceuticals that are available or under development. The necessary steps required to move these technologies from bench to bedside are also discussed.

Effects of Detector Thickness on Geometric Sensitivity and Event Positioning Errors in the Rectangular PET/X Scanner

We used simulations to investigate the relationship between sensitivity and spatial resolution as a function of crystal thickness in a rectangular PET scanner intended for quantitative assessment of breast cancers. The system had two 20 × 15-cm² and two 10 × 15-cm² flat detectors forming a box, with the larger detectors separated by 4 or 8 cm. Depth-of-interaction (DOI) resolution was modeled as a function of crystal thickness based on prior measurements. Spatial resolution was evaluated independent of image reconstruction by deriving and validating a surrogate metric from list-mode data (d_FWHM). When increasing crystal thickness from 5 to 40 mm, and without using DOI information, the d_FWHM for a centered point source increased from 0.72 to 1.6 mm. Including DOI information improved d_FWHM by 12% and 27% for 5- and 40-mm-thick crystals, respectively. For a point source in the corner of the FOV, use of DOI information improved d_FWHM by 20% (5-mm crystal) and 44% (40-mm crystal). Sensitivity was 7.7% for 10-mm-thick crystals (8-cm object). Increasing crystal thickness on the smaller side detectors from 10 to 20 mm (keeping 10-mm crystals on the larger detectors) boosted sensitivity by 24% (relative) and degraded d_FWHM by only ~3%/8% with/without DOI information. The benefits of measuring DOI must be evaluated in terms of the intended clinical task of assessing tracer uptake in small lesions. Increasing crystal thickness on the smaller side detectors provides substantial sensitivity increase with minimal accompanying loss in resolution.

Improving PET imaging for breast cancer using virtual pinhole PET half-ring insert

A PET insert with detector having smaller crystals and placed near a region of interest in a conventional PET scanner can improve image resolution locally due to the virtual-pinhole PET (VP-PET) effect. This improvement is from the higher spatial sampling of the imaging area near the detector. We have built a prototype half-ring PET insert for head-and-neck cancer imaging applications. In this paper, we extend the use of the insert to breast imaging and show that such a system provides high resolution images of breast and axillary lymph nodes while maintaining the full imaging field of view capability of a clinical PET scanner. We characterize the resolution and contrast recovery for tumors across the imaging field of view. First, we model the system using Monte Carlo methods to determine its theoretical limit of improvement. Simulations were conducted with hot spherical tumors embedded in background activity at tumor-to-background contrast ranging from 3:1 to 12:1. Tumors are arranged in a Derenzo-like pattern with their diameters ranging from 2 to 12 mm. Experimental studies were performed using a chest phantom with cylindrical breast attachment. Tumors of different sizes arranged in a Derenzo-like pattern with tumor-to-background ratio of 6:1 are inserted into the breast phantom. Imaging capability of mediastinum and axillary lymph nodes is explored. Both Monte Carlo simulations and experiment show clear improvement in image resolution and contrast recovery with VP-PET half-ring insert. The degree of improvement in resolution and contrast recovery depends on location of the tumor. The full field of view imaging capability is shown to be maintained. Minor artifacts are introduced in certain regions.

Conceptual design and simulation study of an ROI-focused panel-PET scanner

Positron emission tomography (PET) is an important imaging modality for clincial use. Conventionally, the PET scanner is generally built to provide a roomy enough transverse field-of-view (FOV) for imaging most adults’ torsos. However, in many cases, the region-of-interest (ROI) for imaging is usually a small area inside the human body. Therefore, to fulfill a PET system which provides an FOV comparable in size to the target ROI seems appealing and more cost effective. Meanwhile, such a PET system has the potential for portable or bedside application with the reduced system size. In this work, we have investigated the feasibility of using dual-headed panel-detectors to build an ROI-focused PET scanner. A novel windowed list-mode ordered subset expectation maximization method was developed to perform the ROI image reconstruction. With this method, the ROI of the object can be reconstructed from the coincidences whose position determined by time-of-flight (TOF) measurements was inside the ROI. Monte Carlo simulation demonstrates the feasibility of detecting lesions not less than 1 cm in diameter, with a 300 ps full width at half maximum timing resolution. As a critical system performance, the impact of TOF information on image quality has been studied and the required TOF capability was assessed. With enhanced timing resolution, the distortions and artifacts were reduced effectively. The further improved TOF capability also shows a noticeable improvement of detection performance for low uptake lesions, as well as the recovery speed of lesion contrast, which is of practical significance in the lesion detection task.

Pixelated CdTe detectors to overcome intrinsic limitations of crystal based positron emission mammographs

A positron emission mammograph (PEM) is an organ dedicated positron emission tomography (PET) scanner for breast cancer detection. State-of-the-art PEMs employing scintillating crystals as detection medium can provide metabolic images of the breast with significantly higher sensitivity and specificity with respect to standard whole body PET scanners. Over the past few years, crystal PEMs have dramatically increased their importance in the diagnosis and treatment of early stage breast cancer. Nevertheless, designs based on scintillators are characterized by an intrinsic deficiency of the depth of interaction (DOI) information from relatively thick crystals constraining the size of the smallest detectable tumor. This work shows how to overcome such intrinsic limitation by substituting scintillating crystals with pixelated CdTe detectors. The proposed novel design is developed within the Voxel Imaging PET (VIP) Pathfinder project and evaluated via Monte Carlo simulation. The volumetric spatial resolution of the VIP-PEM is expected to be up to 6 times better than standard commercial devices with a point spread function of 1 mm full width at half maximum (FWHM) in all directions. Pixelated CdTe detectors can also provide an energy resolution as low as 1.5% FWHM at 511 keV for a virtually pure signal with negligible contribution from scattered events.

Breast cancer screening: clinical, radiologic, and biochemical

Breast cancer screening is a highly complex and more recently a controversial topic. Conventional screening includes breast self-examination, clinical breast examination, and screening mammography. Several newer imaging modalities have been introduced into the screening armamentarium including breast magnetic resonance imaging and whole-breast automated ultrasound. Novel imaging techniques like positron emission mammography are currently under clinical investigation in the hopes of improving the sensitivity of breast cancer screening. In addition, the development of biochemical assays, which employ minimally invasive sampling are also promising.

The current status of positron emission mammography in breast cancer diagnosis

Mammography is currently the standard breast cancer screening procedure, even though it is constrained by low specificity in the detection of malignancy and low sensitivity in women with dense breast tissue. Modern imaging modalities, such as magnetic resonance imaging (MRI), have been developed in an effort to replace or complement mammography, because the early detection of breast cancer is critical for efficient treatment and long-term survival of patients. Nuclear medicine imaging technology has been introduced in the field of oncology with the development of positron emission tomography (PET), positron emission tomography/computed tomography (PET/CT) and, ultimately, positron emission mammography (PEM). PET offers the advantage of precise diagnosis, by measuring metabolism with the use of a radiotracer and identifying changes at the cellular level. PET/CT imaging allows for a more accurate assessment by merging the anatomic localization to the functional image. However, both techniques have not yet been established as diagnostic tools in early breast cancer detection, primarily because of low sensitivity, especially for sub-centimeter and low-grade tumors. PEM, a breast-specific device with increased spatial resolution, has been developed in order to overcome these limitations. It has demonstrated higher detectability than PET/CT and comparable or better sensitivity than MRI. The ability to target the lesions visible in PEM with PEM-guided breast biopsy systems adds to its usability in the early diagnosis of breast cancer. The results from recent studies summarized in this review indicate that PEM may prove to be a useful first-line diagnostic tool, although further evaluation and improvement are required.

Optical imaging in breast cancer diagnosis: the next evolution

Breast cancer is one of the most common cancers among the population of the Western world. Diagnostic methods include mammography, ultrasound, and magnetic resonance; meanwhile, nuclear medicine techniques have a secondary role, being useful in regional assessment and therapy followup. Optical imaging is a very promising imaging technique that uses near-infrared light to assess optical properties of tissues and is expected to play an important role in breast cancer detection. Optical breast imaging can be performed by intrinsic breast tissue contrast alone (hemoglobin, water, and lipid content) or with the use of exogenous fluorescent probes that target specific molecules for breast cancer. Major advantages of optical imaging are that it does not use any radioactive components, very high sensitivity, relatively inexpensive, easily accessible, and the potential to be combined in a multimodal approach with other technologies such as mammography, ultrasound, MRI, and positron emission tomography. Moreover, optical imaging agents could, potentially, be used as “theranostics,” combining the process of diagnosis and therapy.

Molecular Imaging in Breast Cancer: From Whole-Body PET/CT to Dedicated Breast PET

Positron emission tomography (PET), with or without integrated computed tomography (CT), using 18F-fluorodeoxyglucose (FDG) is based on the principle of elevated glucose metabolism in malignant tumors, and its use in breast cancer patients is frequently being investigated. It has been shown useful for classification, staging, and response monitoring, both in primary and recurrent disease. However, because of the partial volume effect and limited resolution of most whole-body PET scanners, sensitivity for the visualization of small tumors is generally low. To improve the detection and quantification of primary breast tumors with FDG PET, several dedicated breast PET devices have been developed. In this nonsystematic review, we shortly summarize the value of whole-body PET/CT in breast cancer and provide an overview of currently available dedicated breast PETs.

Characterization of a high-resolution hybrid DOI detector for a dedicated breast PET/CT scanner

The aim of this study is to design and test a new high-resolution hybrid depth of interaction (DOI) detector for a dedicated breast PET/CT scanner. Two detectors have been designed and built. The completed detectors are based on a 14 × 14 array of 1.5 × 1.5 × 20 mm(3) unpolished lutetium orthosilicate scintillation crystals, with each element coated in a 50 μm layer of reflective material. The detector is read out from both ends using a position-sensitive photomultiplier tube (PSPMT) and a large active area (20 × 20 mm(2)) avalanche photodiode (APD) to enable acquisition of DOI information. Nuclear instrumentation modules were used to characterize the detectors' performances in terms of timing, intrinsic spatial resolution (ISR) and energy resolution, as well as DOI resolution with a dual-ended readout configuration. Measurements with the APD were performed at a temperature of 10 °C. All crystals were identified at all depths, even though the signal amplitude from the PSPMT decreases with depth away from it. We measured a timing resolution of 2.4 ns, and an average energy resolution of 19%. The mean ISR was measured to be 1.2 mm for crystals in the central row of the array for detectors in the face-to-face position. Two off-center positions were measured corresponding to 26° and 51° oblique photon incidence, and the mean ISR at these positions was 1.5 and 1.7 mm, respectively. The average DOI resolution across all crystals and depths was measured to be 2.9 mm (including the beam width of 0.6 mm). This detector design shows good promise as a high-resolution detector for a dedicated breast PET/CT scanner.

Investigating the limit of detectability of a positron emission mammography device: a phantom study

PURPOSE

A new positron emission mammography (PEM) device (PEM Flex Solo II, Naviscan Inc., San Diego, CA) has recently been introduced and its performance characteristics have been documented. However, no systematic assessment of its limit of detectability has been evaluated. The aim of this work is to investigate the limit of detectability of this new PEM system using a novel, customized breast phantom.

METHODS

Two sets of F-18 infused gelatin breast phantoms of varying thicknesses (2, 4, 6, and 8 cm) were constructed with and without (blank) small, shell-less contrast objects (2 mm thick disks) of varying diameters (3-14.5 mm) [volumes: 0.15-3.3 cc] and activity concentration to background ratio (ACR) (2.7-58). For the phantom set with contrast objects, the disks were placed centrally inside the phantoms and both phantom sets were imaged for a period of 10 min on the PEM device. In addition, scans for the 2 and 6 cm phantoms were repeated at different times (0, 90, and 150 min) post phantom construction to evaluate the impact of total activity concentration (count density) on lesion detectability. Each object from each phantom scan was then segmented and placed randomly in a corresponding blank phantom image. The resulting individual images were presented blindly to seven physician observers (two nuclear medicine and five breast imaging radiologists) and scored in a binary fashion (1-correctly identified object, 0-incorrect). The sensitivity, specificity, and accuracy of lesion detectability were calculated and plots of sensitivity versus ACR and lesion diameters for different phantom thicknesses and count density were generated.

RESULTS

The overall (mean) detection sensitivity across all variables was 0.68 (95% CI: [0.64, 0.72]) with a corresponding specificity of 0.93 [0.87, 0.98], and diagnostic accuracy of 0.72 [0.70, 0.75]. The smallest detectable object varied strongly as a function of ACR, as sensitivity ranged from 0.36 [0.29, 0.44] for the smallest lesion size (3 mm) to 0.80 [0.75, 0.84] for the largest (14.5 mm).

CONCLUSIONS

The detectability performance of this PEM system demonstrated its ability to resolve small objects with low activity concentration ratios which may assist in the identification of early stage breast cancer. The results of this investigation can be used to correlate lesion detectability with tumor size, ACR, count rate, and breast thickness.

Initial clinical test of a breast-PET scanner

INTRODUCTION

The goal of this initial clinical study was to test a new positron emission/tomography imager and biopsy system (PEM/PET) in a small group of selected subjects to assess its clinical imaging capabilities. Specifically, the main task of this study is to determine whether the new system can successfully be used to produce images of known breast cancer and compare them to those acquired by standard techniques.

METHODS

The PEM/PET system consists of two pairs of rotating radiation detectors located beneath a patient table. The scanner has a spatial resolution of ∼2 mm in all three dimensions. The subjects consisted of five patients diagnosed with locally advanced breast cancer ranging in age from 40 to 55 years old scheduled for pre-treatment, conventional whole body PET imaging with F-18 Fluorodeoxyglucose (FDG). The primary lesions were at least 2 cm in diameter.

RESULTS

The images from the PEM/PET system demonstrated that this system is capable of identifying some lesions not visible in standard mammograms. Furthermore, while the relatively large lesions imaged in this study where all visualised by a standard whole body PET/CT scanner, some of the morphology of the tumours (ductal infiltration, for example) was better defined with the PEM/PET system. Significantly, these images were obtained immediately following a standard whole body PET scan.

CONCLUSIONS

The initial testing of the new PEM/PET system demonstrated that the new system is capable of producing good quality breast-PET images compared standard methods.

Performance characterization of a new high resolution PET scintillation detector

Performance of a new high resolution PET detection concept is presented. In this new concept, annihilation radiation enters the scintillator detectors edge-on. Each detector module comprises two 8 × 8 LYSO scintillator arrays of 0.91 × 0.91 × 1 mm(3) crystals coupled to two position-sensitive avalanche photodiodes (PSAPDs) mounted on a flex circuit. Appropriate crystal segmentation allows the recording of all three spatial coordinates of the interaction(s) simultaneously with submillimeter resolution. We report an average energy resolution of 14.6 ± 1.7% for 511 keV photons at FWHM. Coincident time resolution was determined to be 2.98 ± 0.13 ns FWHM on average. The coincidence point spread function (PSF) has an average FWHM of 0.837 ± 0.049 mm (using a 500 μm spherical source) and is uniform across the arrays. Both PSF and coincident time resolution degrade when Compton interactions are included in the data. Different blurring factors were evaluated theoretically, resulting in a calculated PSF of 0.793 mm, in good agreement with the measured value.

Molecular and Functional Imaging of Breast Cancer

Background

Significant efforts have been directed toward developing and enhancing imaging methods for the early detection, diagnosis, and characterization of small breast tumors. Molecular and functional imaging sets the stage for enhancement of current methodology.

Methods

Current imaging modalities are described based on the molecular characteristics of normal and malignant tissue. New molecular imaging methods that have the potential for clinical use are also discussed.

Results:

Dynamic contrast-enhanced magnetic resonance imaging is more sensitive than mammography in BRCA1 carriers. It is used in screening and in the early evaluation of neoadjuvant therapy. Positron emission mammography is 91% sensitive and 93% specific in detecting primary breast cancers. Sentinel node scintigraphy is a key component of axillary lymph node evaluation. Other imaging modalities being studied include Tc99m sestamibi, radiolabeled thymidine or uridine, estrogen receptor imaging, magnetic resonance spectroscopy, and diffusion magnetic resonance imaging.

Conclusions

Molecular and functional imaging of the breast will likely alter clinical practice in diagnosing and staging primary breast cancer and assessing response to therapy since it will provide earlier information regarding the underlying biology of individual breast cancers, tumor stage, potential treatment strategies, and biomarkers for early evaluation of treatment effects.

Design study of a high-resolution breast-dedicated PET system built from cadmium zinc telluride detectors

We studied the performance of a dual-panel positron emission tomography (PET) camera dedicated to breast cancer imaging using Monte Carlo simulation. The proposed system consists of two 4 cm thick 12 x 15 cm(2) area cadmium zinc telluride (CZT) panels with adjustable separation, which can be put in close proximity to the breast and/or axillary nodes. Unique characteristics distinguishing the proposed system from previous efforts in breast-dedicated PET instrumentation are the deployment of CZT detectors with superior spatial and energy resolution, using a cross-strip electrode readout scheme to enable 3D positioning of individual photon interaction coordinates in the CZT, which includes directly measured photon depth-of-interaction (DOI), and arranging the detector slabs edge-on with respect to incoming 511 keV photons for high photon sensitivity. The simulation results show that the proposed CZT dual-panel PET system is able to achieve superior performance in terms of photon sensitivity, noise equivalent count rate, spatial resolution and lesion visualization. The proposed system is expected to achieve approximately 32% photon sensitivity for a point source at the center and a 4 cm panel separation. For a simplified breast phantom adjacent to heart and torso compartments, the peak noise equivalent count (NEC) rate is predicted to be approximately 94.2 kcts s(-1) (breast volume: 720 cm(3) and activity concentration: 3.7 kBq cm(-3)) for a approximately 10% energy window around 511 keV and approximately 8 ns coincidence time window. The system achieves 1 mm intrinsic spatial resolution anywhere between the two panels with a 4 cm panel separation if the detectors have DOI resolution less than 2 mm. For a 3 mm DOI resolution, the system exhibits excellent sphere resolution uniformity (sigma(rms)/mean) < or = 10%) across a 4 cm width FOV. Simulation results indicate that the system exhibits superior hot sphere visualization and is expected to visualize 2 mm diameter spheres with a 5:1 activity concentration ratio within roughly 7 min imaging time. Furthermore, we observe that the degree of spatial resolution degradation along the direction orthogonal to the two panels that is typical of a limited angle tomography configuration is mitigated by having high-resolution DOI capabilities that enable more accurate positioning of oblique response lines.

Clinical imaging characteristics of the positron emission mammography camera: PEM Flex Solo II

We evaluated a commercial positron emission mammography (PEM) camera, the PEM Flex Solo II. This system comprises two 6 x 16.4 cm detectors that scan together covering up to a 24 x 16.4 cm field of view (FOV). There are no specific standards for testing this detector configuration. We performed several tests important to breast imaging, and we propose tests that should be included in standardized testing of PEM systems.

METHODS

We measured spatial resolution, uniformity, counting- rate linearity, recovery coefficients, and quantification accuracy using the system's software. Image linearity and coefficient of variation at the edge of the FOV were also characterized. Anecdotal examples of clinical patient data are presented.

RESULTS

The spatial resolution was 2.4 mm in full width at half maximum for image planes parallel to the detector faces. The background variability was approximately 5%, and quantification accuracy and recovery coefficients varied within the FOV. Positioning linearity began at approximately 13 mm from the edge of the detector housing. The coefficient of variation was significantly higher close to the edge of the FOV because of limited sensitivity in these image planes.

CONCLUSION

A reconstructed spatial resolution of 2.4 mm represented a significant improvement over conventional whole-body PET scanners and should reduce the lower threshold on lesion size and tracer uptake for detection in the breast. Limited-angle tomography and a lack of data corrections result in spatially variable quantitative results. PEM acquisition geometry limits sampling statistics at the chest-wall edge of the camera, resulting in high variance in that portion of the image. Example patient images demonstrate that lesions can be detected at the chest-wall edge despite variance artifacts, and fine structure is visualized routinely throughout the FOV in the focal plane. The PEM Flex camera should enable the functional imaging of breast cancer earlier in the disease process than whole-body PET.

Ductal Carcinoma in Situ: State of the Science and Roadmap to Advance the Field

Purpose

Ductal carcinoma in situ (DCIS) is the fourth leading cancer for women in the United States. Understanding of the biology and clinical behavior of DCIS is imperfect. This article highlights the current knowledge base and the scientific roadmap needed to advance the field.

Methods

This article is based on work done by and consultations obtained from leading experts in the field over a 6-month period that culminated in a full-day symposium designed to systematically review the most pertinent MEDLINE published reports and develop a roadmap to elucidate the molecular steps of carcinogenesis, reduce the extent or prevent the need for therapies, eliminate recurrences, and reduce morbidity.

Results

Expression profiling of pure DCIS will help elucidate the molecular characteristics that distinguish high-risk lesions from clinically irrelevant lesions. The development of new methods of extracting RNA from processed tissues may provide opportunities for research. Mammography often underestimates the pathologic extent of DCIS; other imaging methods need to be investigated for detection and monitoring of disease stability or progression. Novel biologic agents are being delivered in neoadjuvant clinical trials, and alternative methods for breast irradiation are being studied. Future trials of treatment versus no treatment for biologically selected cases of DCIS should be developed.

Conclusion

There is a critical need for a concerted international effort among patients with DCIS, clinicians, and basic scientists to conduct the research necessary to improve fundamental understanding of the biology and clinical behavior of DCIS and prevent development of invasive breast cancer.

Breast cancer imaging: a perspective for the next decade

Breast imaging is largely indicated for detection, diagnosis, and clinical management of breast cancer and for evaluation of the integrity of breast implants. In this work, a prospective view of techniques for breast cancer detection and diagnosis is provided based on an assessment of current trends. The potential role of emerging techniques that are under various stages of research and development is also addressed. It appears that the primary imaging tool for breast cancer screening in the next decade will be high-resolution, high-contrast, anatomical x-ray imaging with or without depth information. MRI and ultrasonography will have an increasingly important adjunctive role for imaging high-risk patients and women with dense breasts. Pilot studies with dedicated breast CT have demonstrated high-resolution three-dimensional imaging capabilities, but several technological barriers must be overcome before clinical adoption. Radionuclide based imaging techniques and x-ray imaging with intravenously injected contrast offer substantial potential as a diagnostic tools and for evaluation of suspicious lesions. Developing optical and electromagnetic imaging techniques hold significant potential for physiologic information and they are likely to be of most value when integrated with or adjunctively used with techniques that provide anatomic information. Experimental studies with breast specimens suggest that phase-sensitive x-ray imaging techniques can provide edge enhancement and contrast improvement but more research is needed to evaluate their potential role in clinical breast imaging. From the technological perspective, in addition to improvements within each modality, there is likely to be a trend towards multi-modality systems that combine anatomic with physiologic information. We are also likely to transition from a standardized screening, where all women undergo the same imaging exam (mammography), to selection of a screening modality or modalities based an individual-risk or other classification.

Quantification of radiotracer uptake with a dedicated breast PET imaging system

Tomographic breast imaging techniques can be used to quantify radiotracer uptake in breast and tumor tissue. However, physical processes common to PET imaging can confound accurate quantification. In this investigation, we assessed the effects of these phenomena and tested correction schemes for our new positron emission mammography-tomography system (PEM-PET). The PEM-PET scanner utilizes two sets of rotating planar detector heads. Each unit consists of a 4 x 3 array of Hamamatsu H8500 flat panel position sensitive photomultipliers coupled to a 96 x 72 array of 2 x 2 x 15 mm3 LYSO detector elements (pitch = 2.1 mm). Image reconstruction is performed with a 3D-OSEM algorithm parallelized to run on a multiprocessor computer system. The reconstructed field-of-view is 15 x 15 x 15 cm3. Much of the testing procedures were based on NEMA-NU2/2001 protocols. Count rate losses due to pulse pile-up, image contamination due to acceptance of random coincidences and Compton scatter, and image artifacts produced by photon attenuation were measured. It was found that the system was susceptible to count rate losses when moderate levels of radiation were present in the scanner due to the current design of the event trigger electronics. Application of corrections for Compton scattering, photon attenuation and dead time resulted in improved estimations of 18F concentration in simplified phantom studies. Results from these preliminary studies indicate that the PEM-PET scanner will be useful for the quantification of radiotracer uptake in breast tumors, possibly facilitating early assessment of cancer treatments.

Clinical Imaging Characteristics of the Positron Emission Mammography PEM Flex Solo II

Positron emission mammography (PEM) uses two opposing gamma-ray imagers and limited-angle tomography techniques to image radiotracer distributions within the breast. Due to their smaller size and closer proximity to the source, dedicated PEM cameras can provide better spatial resolution and count sensitivity than whole-body positron emission tomographs. We performed several clinical imaging tests on a commercially available PEM camera, the PEM Flex Solo II. This system is comprised of two opposing 6 cm × 16.4 cm detectors that scan in unison to cover up to a 24 cm × 16.4 cm field of view (FOV). We measured spatial resolution, uniformity, recovery coefficients (RC), and quantification using the system clinical software. Image linearity and coefficient of variation (CV) at the edge of the FOV were also characterized. Anecdotal examples of clinical patient data are presented. Spatial resolution is 2.4 mm FWHM for image planes parallel to the detector faces; background variability is 6%; quantification and RC varied within the FOV; positioning linearity began at ~ 13 mm from the edge of the detector housing; CV increased rapidly at the edge of the FOV due to limited sampling in these image planes.

Design considerations for a limited angle, dedicated breast, TOF PET scanner

Development of partial ring, dedicated breast positron emission tomography (PET) scanners is an active area of research. Due to the limited angular coverage, generation of distortion and artifact-free, fully 3D tomographic images is not possible without rotation of the detectors. With time-of-flight (TOF) information, it is possible to achieve the 3D tomographic images with limited angular coverage and without detector rotation. We performed simulations for a breast scanner design with a ring diameter and an axial length of 15 cm and comprising a full (180 degrees in-plane angular coverage), 2/3 (120 degrees in-plane angular coverage) or 1/2 (90 degrees in-plane angular coverage) ring detector. Our results show that as the angular coverage decreases, improved timing resolution is needed to achieve distortion-free and artifact-free images with TOF. The contrast recovery coefficient (CRC) value for small hot lesions in a partial ring scanner is similar to a full ring non-TOF scanner. Our results indicate that a timing resolution of 600 ps is needed for a 2/3 ring scanner, while a timing resolution of 300 ps is needed for a 1/2 ring scanner. We also analyzed the ratio of lesion CRC to the background pixel noise (SNR) and concluded that TOF improves the SNR values of the partial ring scanner, and helps to compensate for the loss in sensitivity due to reduced geometric sensitivity in a limited angle coverage PET scanner. In particular, it is possible to maintain similar SNR characteristic in a 2/3 ring scanner with a timing resolution of 300 ps as in a full ring non-TOF scanner.