Radionuclide Imaging MII Single Photon Emission Computed Tomography (SPECT)

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1 Radionuclide Imaging MII 3073 Single Photon Emission Computed Tomography (SPECT)

2 Single Photon Emission Computed Tomography (SPECT) The successful application of computer algorithms to x-ray imaging in CT has led to their application to radionuclide techniques and to the advent of SPECT and PET. The most obvious advantage of tomography is improved image contrast because it focuses on a thin slice of an organ, thus minimizing overlying and underlying activity that may obscure a lesion or area of interest. In addition, SPECT and PET permit absolute 3D localization of radiopharmaceutical distribution with the possibility of quantification and 3D cinematic representation of the organ imaged. The detector head of a SPECT camera can rotate either stepwise (transverse or rotational tomography) or continuously (fixed ring detector) about the patient to acquire multiple views.

3 SPECT images are produced from multiple 2D projections by rotating one or more gamma cameras around the body to achieve complete 360 angular sampling of photons from the body. Reconstruction methods are similar to those used in x- ray CT, which provide 3D data sets allowing the tracer biodistribution to be displayed. The advantages of SPECT over planar scintigraphy are: 1. improvement of contrast between regions of different function. 2. better spatial localisation. 3. improved detection of abnormal function. 4. importantly, greatly improved quantification. Clinical applications of SPECT include evaluation of function of the brain, heart, skeleton, liver, lungs and kidneys.

4 Image acquisition The detector is capable of orbiting around a stationary patient on a special imaging table, with the camera face continually directed toward the patient. The camera head rotates around a central axis called the axis of rotation (AOR). The distance of the camera face from this central axis is referred to as the radius of rotation (ROR). Tomographic projection views are most often acquired over an arc of 360 o or 180 o. The 360 o arc is regularly used for most organs, whereas the 180 o arc is common for organs that are positioned on one side of the body, such as the heart. View of the heart are obtained in a 180 o arc extending from the right anterior oblique position to the left posterior oblique position.

5 180 o cardiac SPECT

6 Over a full 360 o arc, 64 or 128 projections are usually collected. For a given dose of radiopharmaceutical, better images are generated using the higher count statistics from longer acquisitions (standard acquisition times per projection view are s). The standard method for collection of tomographic projection views is called step-and-shoot acquisition. Each projection is acquired at each angular stop (position). There is a short pause (few seconds) between views, to allow for the automatic rotation of the camera head to the next stop. In continuous acquisition, data are collected over one or several sequential 360 o rotations (no pauses, rotation is continuous.

7 Step-and-shoot acquisition

8 Continuous acquisition

9 An acquisition time that allows adequate image statistics is mandatory for production of diagnostic images. This is in large part determined by count rate, matrix size and number of projections per orbit. Obviously, the longer the acquisition, the more counts collected and the better the image resolution. Generally, the more projection views obtained, the better the image resolution possible. For practical reasons, a compromise must be reached regarding the number of stops (projection views) and the acquisition time

10 In each projection view, a sufficient counts per pixel must be obtained for optimum image reconstructions. Therefore, fewer views obtained at longer times are generally used in count-poor studies, such as perfusion brain imaging, whereas a greater number of images at shorter times may be used for count-rich examinations, such as sulfur colloid liver scans. In typical clinical applications, about 32 stops per 180 o rotation (64 stops per 360 o ) are obtained to produce acceptable images. Under most circumstances, image resolution is directly proportional to matrix size. The two

11 Most acquisitions are performed with a circular orbit. But, in cross section, the human body is more nearly elliptical than circular. Thus, some cameras are designed to rotate in elliptical orbits (body contour), which allow the camera head to be as close as possible to the imaged organ (the closer the camera, the better image statistics and resolution). Minor artifacts and inconsistencies can be tolerated in planar imaging, but they cause major problems with SPECT. Therefore, a system with excellent energy resolution is needed to permit adequate rejection of

12 Attenuation correction Photons attenuated by overlying soft tissues are a major source of artifactual defects on both planar and SPECT imaging. Thus, some form of correction to prevent these artifacts is desirable (attenuation correction). In the past, attenuation correction was routinely performed by calculation techniques (applying a correction factor that takes into account source depth and the tissue attenuation coefficient). However, more recent methods use a patient-

13 The external source rotates on the opposite of the patient from the camera detector during SPECT imaging, producing a transmission images as the external photons pass through the patient. This images are noisy, but good enough to perform attenuation correction when applied to the emission image of the organ of the interest.

14 Image reconstruction Reconstruction is the process of creating transaxial slices from projection views. The image data are combined and manipulated by the computer using mathematic algorithms to reconstruct a 3D image of the organ scanned. The most common method to accomplish this is known as back projection. Unfortunately, simple back projection produces a composite image with significant artifacts that seriously degrade the quality of the image, rendering it clinically unusable. For this reason,

15 A modern computers have become more computationally powerful, iterative algorithms for reconstruction have been used in place of filtered back projection. Such processing can give better image quality compared with that of the filtered back projection algorithm. However, although other reconstruction technique exist, the filtered back projection algorithm remains the most commonly used method in commercially available SPECT systems, primarily because of its speed and simplicity. Once reconstructed, the tomographic views are

16 Image filtering Image filtering of raw data has become a standard nuclear technique for producing processed images that are visually pleasing and yet preserve the integrity of the acquired data. Essentially, filtering algorithms improve image quality by reducing noise. Filters are mathematic operations designed to enhance, smooth, or suppress all of part of digital data, ideally without altering their validity. In SPECT, image filtering not only enhances the data presentation but also is a basic

17 Image display After being processed, the acquired data may be displayed visually as a 3D representation of the part of the body imaged. This is usually presented cinematically as an image of the body turning continually in space, the so called rotating man image or maximum intensity projection. This view is useful in 3D localization and also in determining whether any significant patient motion occurred during the acquisition.

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