Nuclear Medicine - PET/CT 1. All manual motion-control functions (e.g., gantry rotation, detector radial motion, and table translation) should be checked as well. As a result, the accuracy of the CT-based attenuation corrections cannot be meaningfully assessed. These QC tests and calibrations apply to both PET-only scanners and the PET subsystem of PET/CT scanners. All of the mean CT numbers thus derived should be within 5 HU of that of water, that is, 0 5 HU. Devices for Evaluating Imaging Systems, Chapter 16. Intrinsically, a point source (<1 mL in volume and containing 18.5 MBq) of 99mTc is placed 5 crystal dimensions from and centered over the uncollimated detector to provide a near-uniform photon flux impinging on the detector. Even though cracks are grossly imperceptible, artifacts produced are dramatic. The development of hybrid imaging has further increased the need for strict implementation of quality control (QC) and rendered QC more demanding. Copyright 2010-2016 International Atomic Energy Agency (IAEA). Tomographic uniformity should therefore be evaluated by high-count imaging of a 99mTc-filled cylinder source (at least 20 cm in diameter by 20 cm in length) and visually inspecting the resulting reconstructed images for the absence of perceptible nonuniformity artifacts; this should be done monthly. Intuitively, the maximum offset distance should be no greater than the FWHM spatial resolution of the higher-resolution modality, which is CT (equivalent to 1 mm for a SPECT/CT or PET/CT scanner). For those nuclear medicine instruments that interface directly with patientsthe intraoperative probe, organ uptake probe, -camera, SPECT and SPECT/CT scanner, and PET and PET/CT scannersafety features should be regularly inspected. The development of dual-modality imaging systems has revolutionized the practice of nuclear medicine. NUCLEAR MEDICINE. Laser alignment. Because intraoperative probes may not provide a display of the energy spectrum, one may not be able to visually check that the probe is properly peaked, that is, that the photopeak coincides with the preset photopeak energy window. 2). For the constancy test, a reference source, such as 57Co, 133Ba, 68Ge, or 137Cs (Table 1), is placed in the dose calibrator, and the activity reading on each scale is recorded; day-to-day readings should agree within 10%. In many hospitals, technologists are responsible for quality assurance (QA) duties. The CTDI is the basic radiation dose parameter in CT and is defined as the integral under the exposure or absorbed dose profile along the patient's longitudinal axis for a single tomographic image (2527). Nonuniform response can be corrected by acquiring data for a uniform flux of annihilation -rays (11,21). Thus, if P and 1 P represent the probabilities that random variations in a set of measurements from a Poisson distribution are, respectively, greater than or equal to or smaller than the calculated 2 value, a P value (or 1 P value) of 0.5 indicates the calculated 2 value is in the middle of the range expected for a Poisson distribution. Daily testing of a CT scanner begins with the manufacturer-prescribed x-ray tube warm-up procedure and automatic monitoring, perhaps at various tube voltage (kVp) or current (mA) settings, of the tube output and detector response. 5B). . The major advantage being that SPECT/PET data are intrinsically aligned to anatomical information from the X-ray computed tomography (CT), without the use of external markers or internal landmarks. Journal of Nuclear Medicine Technology March 2001, 29 (1) 4-11; Article Figures & Data Info & Metrics PDF Abstract Objective: The purpose of this paper is to introduce technologists to the basic principles of PET imaging and to the instrumentation used to acquire PET data. Among routine dose-calibrator QC tests, constancy must be checked daily and accuracy and linearity at least quarterly (7,18,19); daily checks of accuracy are recommended, however. * NOTE: FOR CE CREDIT, YOU CAN ACCESS THIS ACTIVITY THROUGH THE SNM WEB SITE (http://www.snm.org/ce_online) THROUGH JULY 2009. Routine Quality Control of Clinical Nuclear Medicine Instrumentation: A Brief Review, Brain Imaging Techniques: Improving the Quality, Light-Induced Radiosynthesis of 89Zr-DFO-Azepin-Onartuzumab for Imaging the Hepatocyte Growth Factor Receptor, Human Biodistribution and Radiation Dosimetry of 18F-Clofarabine, a PET Probe Targeting the Deoxyribonucleoside Salvage Pathway, Improved Nuclear Medicine Uniformity Assessment with Noise Texture Analysis, An Investigation of a Sinogram Discontinuity Artifact on Myocardial Perfusion Imaging, Extrinsic Versus Intrinsic Uniformity Correction for {gamma}-Cameras, Review of the Linogram and Sinogram: An Easy Way to Detect Off-Peak Artifacts in Myocardial Perfusion SPECT, DOI: https://doi.org/10.2967/jnumed.107.050203, From Concept to Regulatory Drug Approval: Lessons for Theranostics, Oligometastatic Prostate Cancer: Current Status and Future Challenges, http://www.acr.org/SecondaryMainMenuCategories/quality_safety/guidelines/med_phys/pet_ct_equipment.aspx. By Arumugam Ppt Pdf Free Copy Biomedical Instrumentation Principles of Medical Electronics and Biomedical Instrumentation Biomedical Instrumentation: Technology and Applications Smart . These detectors have inherently better energy resolution that scintillators . Nuclear medicine is a type of molecular imaging where radioactive pharmaceuticals (often called "radiopharmaceuticals") are used to evaluate the body's functions and processes. Among the components of a routine SPECT QC program are periodic assessment of center-of-rotation (COR) alignment, tomographic uniformity, and, for lack of a better term, overall system performance (15). Additional training material, in the form of teaching slides, has been developed for each chapter of the handbook. Image registration may be checked using a phantom with well-delineated point, line, or volume markers that are both SPECT- or PET- and CT-visible (Fig. The comprehensive look at -camera image production and at . The technical editors and authors, selected for their experience and in recognition of their contributions to the field, were drawn from around the world and, thus, this book represents a truly international collaboration. Chapter 20. Among the 10,00020,000 detector elements in a modern ring scanner, slight variations among the detector elements in thickness, light emission properties, electronics performance, and so on result in slightly different line-of-response (LOR) counting rates for the same activity. In practice, either approach is somewhat problematic because of limited count statistics (and, in the case of 3-dimensional PET, because of scatter). It is generally helpful to track the results of QC tests longitudinally (e.g., in the form of a graph of the numeric result vs. date of the test). This also includes creating a tranquil environment, so patients will be able to adhere to examination instructions. 8and, for the scan of a patient, the normalized, or corrected, number of events, Cij, in this LOR is:Eq. The calibration factor, CF, is derived by the well-counter (or absolute activity) calibration: scanning a calibrated source, that is, a volume source (often a cylinder 20 cm in diameter by 20 cm in length), with a uniform, well-defined activity concentration at the time of the scan. Radionuclide Therapy 6. Overall system performance may be evaluated using any number of commercially available fillable phantoms containing nonradioactive (cold) inserts of different sizes and visually inspecting the resulting images (Fig. Solid-state detectors use a nonair-equivalent crystal as the detection medium and thus cannot measure exposure rates; they can measure only counting rates. Imaging in Nuclear Medicine deals with photons ~140-511 keV . Chapter 01. Nuclear medicine is a medical specialty that uses radioactive tracers (radiopharmaceuticals) to assess bodily functions and to diagnose and treat disease. To confirm that the survey meter has not been contaminated (i.e., yields a reproducibly low exposure or counting rate in the absence of radioactivity), the background exposure or counting rate should be measured daily in an area remote from radioactive sources within the nuclear medicine facility, if such an area is reasonably accessible. The PET scanner normalization should be created or updated at installation, after major service, whenever deteriorating image quality suggests a new normalization is required, or otherwise at least annually. Alternatively, a uniform cylinder of a positron-emitting radionuclide can be scanned and the data thus acquired analytically corrected for attenuation; for a well-defined geometry such as a uniform cylindric source, this correction is straightforward. Instrumentation | Nuclear Medicine and Molecular Imaging | Stanford Medicine. Because tomographic image reconstruction propagates and, in fact, may amplify the effects of nonuniformities, uniformity of -camera response is another consideration in obtaining high-quality SPECT images. Periodic evaluation and, if necessary, updating of certain calibrations, most notably the normalization and the well-counter calibration, are additional components of routine PET QC. For each QC test performed, the following data, as well as the initials or signature of the individual performing the test, should be recorded on a structured and suitably annotated form: the test performed; the date and time of the test; the make, model, and serial number of the device tested; the make, model, and serial number of any reference sources used; the results of the test; and a notation indicating if the test result was or was not acceptable (i.e., was or was not within the specified tolerance range). As illustrated in Figure 9, sinograms are more visually discriminating than are the reconstructed images for detecting faulty detectors. (Courtesy of Dr. Osama Mawlawi, M.D. In addition to the these daily checks of CT performance, monthly or at least quarterly evaluations of laser alignment, image slice thickness, spatial resolution, linearity (i.e., CT number accuracy), and high- and low-contrast contrast resolution are needed. If, however, the mechanical and electronic CORs are not aligned, the pixel location of the COR will vary among the projection images, and the counts in each projection-image pixel will be projected across different locations in the tomographic image matrix and blurred images will result (Fig. 4. Misalignment as small as 3.2 mm (or 0.5 pixel for 64 64 image matrix) can produce perceptible blurring in SPECT images, with blurring substantially worse for misalignment of 6.4 mm (1 pixel). (Adapted from reference (15) with permission.). For the quarterly check of linearity by the so-called decay method, one begins with a high-activity (37 GBq), independently calibrated 99mTc source and assays its activity at 12-h intervals over 3 consecutive days. Degree of blurring is related to magnitude of spatial misalignment of mechanical and electronic CORs. To accelerate this slow convergence, the ordered-subset expectation maximization (OSEM) algorithm groups the projection data into subsets comprising projections uniformly distributed around the source volume. Functional Measurements in Nuclear Medicine Linearity. (A) Display for acceptable blank scan; that is, blank scan for which all detector parameters are within tolerance. They are staggered (offset) 1 mm apart in longitudinal direction. The lead bars in at least the 2 coarsest quadrants (i.e., with the 3- and 4-mm-wide bars) should be visually resolvable. Nuclear medicine is a branch or specialty of medicine and medical imaging that uses radionuclides in the diagnosis and treatment of disease. In this way, long-term trends in instrument performance, often imperceptible from one day to the next, may become apparent. The MDA should be evaluated at least annually. x- and y-position vs. angle graphs should be sinusoidal curve and straight line, respectively. Nuclear Medicine Instrumentation Quality Control: Maria Lyra Georgosopoulou & Wendy Tindale & Rigobert Klett Published online: 4 February 2010 # EANM 2010 Keywords Qualitycontrol.Qualityassurance.Nuclear medicineinstrumentation.Gammacamera.SPECT.PET. 2 values yielding a P value in the range of 0.050.95 are generally considered acceptable. Importantly, the certified activities of such reference sources must be traceable to the National Institute of Standards and Technology (NIST), formerly the National Bureau of Standards. If the mechanical and electronic CORs are aligned, the pixel location of the projection of the COR onto the projection image matrix will be the same for all projection images, and for all such images the counts in each pixel will then be projected across the appropriate row of pixels in the tomographic image matrix. Anderson Cancer Center for their contributions. Chapter 18. In cylinder phantom images, A and B, analytic postprocessing attenuation correction was applied. Such very small or very large P values are problematic, therefore, because they indicate a variation in counting-rate measurements inconsistent with a Poisson distribution and are suggestive of a counter malfunction. (Though seldom used in practice, sheet source that may be filled with different radionuclides and used to evaluate extrinsic uniformity is also shown in photograph.) Before counting samples containing a particular radionuclide, one should check the energy spectrum to verify that the counter is properly peaked, that is, that the photopeak of the radionuclide coincides with the preset photopeak energy window. 4A). High-contrast contrast resolution is expressed as the SD of the CT number (in HU) in a 10 10 mm ROI centered over the coarsest set of line cavities (i.e., the set in which the lines are 1.6 mm in width) (Fig. To check constancy, at least 1 NIST-traceable reference source (Table 1) should likewise be counted each day; day-to-day net (i.e., gross minus background) counting rates should agree within 10%. For PET systems that use 68Ge or 137Cs transmission data to derive attenuation corrections, the blank scan also provides the reference (i.e., unattenuated) transmission data for calculating such corrections. The energy resolution (expressed as the percentage full width at half maximum [FWHM] of the photopeak) should be checked at least quarterly using a reference-source radionuclide such as 57Co. Chapter 16. Each chapter concludes with a small number of references and suggested additional readings. All position displays on the gantry and computer console and all alignment lasers should likewise be visually inspected. Because the x- or -ray energy and frequency may differ somewhat between a particular radionuclide and its surrogate (i.e., reference-standard) radionuclide (Table 1), the counter efficiencies for that radionuclide and its surrogate may differ slightly as well. An alternative, and perhaps even more robust, measure of uniformity is the SD of the counts per pixel in the flood image. Nuclear medicine now provides diagnostic, prognostic, predictive, and intermediate endpoint biomarkers in oncology, cardiology, neurology, and infectious and inflammatory disorders. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. Certainly, there are numerous variations of these procedures that may comprise a sound and compliant QC program. Position Overview: The Nuclear Medicine Technologist is responsible for performing routine and specialized nuclear medicine procedures and examinations for radiological diagnosis. Nuclear Medicine Imaging Devices, Chapter 12. The HU scale is based on a linear transformation of the linear attenuation coefficient as measured by CT, in which the radiodensity of water is assigned a value of 0 HU and that of air at standard temperature and pressure a value of 1,000 HU. This type of imaging can be used on all types of living things, but NMTCB is concerned with using this technology to help diagnose and treat human beings. In addition, such probes have been used to identify and localize visually occult disease at surgery after systemic administration of a radiolabeled antibody or other tumor-avid radiotracer. Photographs on right show cracked crystal that produced corresponding image. Chapter 13. To make the images quantitative, then, the counting rate per voxel (cps), , in voxel ijk should be divided by the measured system calibration factor ([kBq/mL]/[cps/voxel]), CF, to yield the activity concentration:Eq. Chapter 05. Journal of Nuclear Medicine Technology September 2010, 38 (3) . Measurements of the CTDI100 (p) and CTDI100 (c) are typically performed using ionization chambers or thermoluminescent dosimeters positioned in a commercially available soft-tissueequivalent acrylic phantom, cylindric in shape and either 16 or 32 cm in diameter, approximating an adult head or torso (body), respectively (Fig. We do not capture any email address. Survey meters should be calibratedthat is, checked for accuracyusing suitable long-lived reference sources at installation, annually, and after any repair. However, efficiency of organ uptake probes should be measured more frequentlyfor each patientthan for a well counter, so that the probe net counting rates can be reliably converted to thyroid uptake for individual patients. 8D vs. 8B) in the sinogram indicates that a detector (crystal) element or detector block, respectively, is malfunctioning. Such a semiquantitative (i.e., visual) assessment is faster and more convenient than actual measurement of spatial resolution of the FWHM of the line-spread function. Thank you for your interest in spreading the word on Journal of Nuclear Medicine. Nuclear Medicine Imaging Devices A 5- to 10-million-count transmission image is then acquired and visually inspected. As with SPECT and PET scanners, however, less rigorous and less extensive procedures are generally performed for routine CT QC. A written description of all QC procedures, including the acceptable (or tolerance) range of the results of each such procedure and the corrective action for an out-of-tolerance result, should be included in the procedure manual of the facility; for each procedure, the written description should be signed and dated by the facility director, physicist, or other responsible individual. Image Reconstruction Chapter 17. Historically, organ uptake probes have been used almost exclusively for measuring thyroid uptake and are thus generally known as thyroid uptake probes. NIST traceability helps ensure the accuracy of the calibrated activity. Geiger counters are therefore well suited for low-level surveys, for example, checking for radioactive contamination. Basic Radiobiology Molecular Imaging Program at Stanford The PET scanner well-counter calibration should be created or updated at installation, after major service, or otherwise at least annually. The image noise is evaluated by comparing the SD of the CT number in each of the ROIs with the benchmark, or reference, SD of the scanner, established at the time of its installation: for each ROI, the SD should be no greater than twice the benchmark SD. Technologists are members of the team required to implement diagnostic imaging in nuclear medicine (NM). The appearance of a blank, or hypointense, diagonal line (Fig. Internal Dosimetry In this way, annual and other checks of efficiency can be performed using only the surrogate reference sources, without the need to dispense, assay, dilute, and aliquot each radionuclide in clinical use. None required beyond above education/certification requirements. (A) Photograph and -camera image of 4-quadrant bar phantom, with schematic diagram illustrating setup for assessment of spatial resolution using such phantom. Compendia of critical values of the 2 statistic, as a function of the number of measurements (n), are widely available in both graphical and tabular forms (11). Acceptable image uniformity may be confirmed by visual inspection (i.e., by verifying the absence of perceptible ring, streak, or other artifacts) and by quantitative region-of-interest (ROI) analysis of the reconstructed image. Chapter 04. Assuming the operator has received the appropriate system-ready message, the daily QC procedures are then performed (12). 7D and 7C, respectively (9)):Eq. Alternatively, sealed reusable markers composed of long-lived 57Co (for SPECT) or 68Ge (for PET) uniformly dispersed in a radioopaque resin or plastic may be used. If LORT is the total number of LORs and a total of NT events is acquired in the normalization scan, the average number of counts per LOR, , is simply:Eq. Reconstructed coronal images of 68Ge uniform-cylinder phantom without (A) and with (B) normalization applied. Extrinsically, uniform flood, or sheet, source of 57Co is placed directly on collimated detector (right). At installation and after service of a dose calibrator, its geometry (position and volume)-dependent response for 99mTc must be measured and volume (from 2 to 25 mL)-dependent correction factors relative to the standard volume (e.g., 10 mL) derived. Gamma Camera. Basic Physics for Nuclear Medicine, Chapter 05. Physics in the Radiopharmacy They are designed, as an additional training tool to assist in the better presentation of the content of each chapter. The integrated software of the PET scanner may also include a routine for quantitative analyses of blank scans and graphical display of the results of these analyses (Fig. The IAEA has recently published the Nuclear Medicine Physics Handbook, which is intended for teachers, students and residents involved in medical physics programmes, and aspiring to serve as primary text for academic education and clinical training of Nuclear Medicine Medical Physicists in the IAEA Member States. Nonimagingintraoperativeprobe.Gammacountingsystem. The most widely used of these are the blank scan and tomographic uniformity. Among ionization-detector survey meters, so-called cutie-pies are relatively low-sensitivity ionization chambers (i.e., are operated at a relatively low potential difference between the anode and cathode) and are designed for use where high fluxes of x- and -rays are encountered. For each data point, the difference between the measured activity and the activity on the best-fit straight line at that point should be less than 10%. According to information published by GE Healthcare (24), this difference should agree within 0.1% (1 HU) with the benchmark, or reference, low-contrast contrast resolution of the scanner, established at the time of its installation. Overall SPECT system performance should be checked at least quarterly. It is also used in the basic sciences such as biology, in drug discovery and in pre-clinical medicine. (Courtesy of Dr. Barbara Binkert, New York Presbyterian Hospital, New York, NY.) 3): mistuning (detuning), uncoupling of a PMT, a cracked crystal, or corruption or switching off of 1 or more of the correction tables of the camera. The handbook was written to address an urgent need for a comprehensive, contemporary text on the physics of nuclear medicine and has been endorsed by several international and national organizations. If -camera uniformity for any radionuclide is out of tolerance (i.e., IU or DU > 5%), the uniformity (or sensitivity) correction table of that radionuclide should be updated. 5A). 14). The reference-source activity should be sufficient to yield an exposure rate of 1,000 mR/h under the foregoing measurement conditions, and the exposure rates should be measured on each scale and, by appropriate adjustment of the sourcemeter distance, at 2 readings (20% and 80% of the maximum) on each scale. 7C) and may be evaluated with either a 18F-filled cylinder phantom or a 68Ge cylinder source. 12B). Radiation Protection One approach to evaluating the daily blank scan is simple visual inspection of its (2-dimensional) sinograms (Fig. These will yield a factor that can subsequently be used to convert the current efficiency of the surrogate to the current efficiency of the radionuclide. Chapter 12. 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