SPECT-CT Technology and Facility Design

International Atomic Energy Agency
SPECT/CT TECHNOLOGY & FACILITY DESIGN L 12
Answer True or False
The most common isotope used in
SPECT/CT scans is 18F SPECT scanners work by detecting coincidences of two 511 keV gamma rays The facility design concepts are almost identical to those used in designing PET/CT facilities
Radiation Protection in PET/CT
Objective
To become familiar with basic SPECT/CT technology, and review considerations in establishing a new SPECT/CT facility
Content
SPECT cameras Image Quality & Camera QA SPECT/CT scanners Design of SPECT/CT facilities
12.1 SPECT cameras
Scintillators
Density Z (g/cc) Na(Tl) I 3.67 BGO LSO 7.13 7.4 51 75 66 Decay time (ns) 230 300 47 Light yield (% NaI) 100 15 75 Atten. length (mm) 30 11 12
GSO
6.7
59
43
22
15
Na(Tl) I works well at 140 keV, and is the most common scintillator used in SPECT cameras
Scintillation detector
Detector Photocathode cathodd Dynodes
Amplifier
PHA
Anode
Scaler
Pulse height analyzer
Pulse height (V) UL
LL
Time The pulse height analyzer allows only pulses of a certain height (energy) to be counted. counted not counted
Pulse-height distribution
NaI(Tl)
Semi-conductor detector as spectrometer
Solid Germanium or Ge(Li) detectors Principle: electron - hole pairs
(analogous to ion-pairs in gas-filled detectors) Excellent energy resolution
10
Comparison of spectrum from a Na(I) scintillation detector and a Ge(Li) semi-conductor detector
Knoll
11
Gamma camera
Used to measure the spatial and temporal distribution of a radiopharmaceutical

12
Gamma camera
(principle of operation)
Position X Position Y Energy Z
PM-tubes Detector Collimator
13
GAMMA CAMERA
14
PM-tubes
15
Gamma camera collimators
16
Gamma camera Data acquisition
Static Dynamic ECG-gated Wholebody scanning Tomography ECG-gated tomography Wholebody tomography
17
ECG-gated acquisition
R Interval n
Image n
18
Scintigraphy seeks to determine the distribution of a radiopharmaceutical
19
SPECT cameras are used to determine the three-dimensional distribution of the radiotracer
20
Tomographic acquisition
21
Tomographic reconstruction
y Count rate y
x-position x z
22
Tomographic planes
23
Myocardial scintigraphy
24
ECG GATED TOMOGRAPHY
25
12.2 Image Quality & Camera QA
Factors affecting image formation
Distribution of radiopharmaceutical Collimator selection and sensitivity Spatial resolution Energy resolution Uniformity Count rate performance Spatial positioning at different energies Center of rotation Scattered radiation Attenuation Noise
27
SPATIAL RESOLUTION
Sum of intrinsic resolution and the collimator resolution Intrinsic resolution depends on the positioning of the scintillation events (detector thickness, number of PM-tubes, photon energy) Collimator resolution depends on the collimator geometry (size, shape and length of the holes)
28
SPATIAL RESOLUTION
Object Image
Intensity
29
Resolution - distance
30 25
FWHM (mm)
20 15 10 5 0 0 2 4
High sensitivity
High resolution
6 8 10 12 14 16
FWHM
Distance (cm)
30
SPATIAL RESOLUTION - DISTANCE
Optimal
Large distance
31
Linearity
32
NON UNIFORMITY
33
NON UNIFORMITY
Cracked crystal
34
NON-UNIFORMITY
(Contamination of collimator)
35
NON UNIFORMITY RING ARTIFACTS
Good uniformity
Bad uniformity
Difference
36
NON-UNIFORMITY
Defect collimator
37
COUNT RATE PERFORMANCE
(IAEA QC Atlas) Radiation Protection in PET/CT
38
Spatial positioning at different energies

Intrinsic spatial resolution with Ga-67 Point source (count rate < 20k cps); quadrant bar pattern; 3M counts; preset energy window widths; summed image from energy windows set over the 93 keV, 183 keV and 296 keV photopeaks. (IAEA QC Atlas)
39
Spatial positioning at different energies
40
Center of Rotation
41
Tilted detector
42
Scattered radiation
Scattered photon
photon electron
43
The amount of scattered photons registered
Patient size Energy resolution of the gammacamera Window setting
44
PATIENT SIZE
45
Pulse height distribution

Counts
Full energy peak Scattered photons
140
The width of the full energy peak (FWHM) is determined by the energy resolution of the gamma camera. There will be an overlap between the scattered photon distribution and the full energy peak, meaning that some scattered photons will be registered.
120 100 80 60 40 20
FWHM
Tc99m
Overlapping area
120
Energy
140
0 20
46
Window width
20%
40%
10%
Increased window width will result in an increased number of registered scattered photons and hence a decrease in contrast
47
SCATTER CORRECTION
48
ATTENUATION
Register 1000 counts

0 0 -5 -10 -15 -20 20
Origin of counts
40 60 80 100 120 140
I=I0 exp(-x)
49
ATTENUATION
Contrast (2cm object) 23% 7% 2%
50
ATTENUATION CORRECTION
51
Transmission measurements Sealed source CT
52
Ficaro et al Circulation 93:463-473, 1996 Radiation Protection in PET/CT
53
NOISE
Count density
54
Gamma camera
Operational considerations Collimator selection Collimator mounting Distance collimator-patient Uniformity Energy window setting Corrections (attenuation, scatter) Background Recording system Type of examination
55
QC GAMMA CAMERA
Acceptance Uniformity P Uniformity, tomography P Spectrum display P Energy resolution P Sensitivity P Pixel size P Center of rotation P Linearity P Resolution P Count losses P Multiple window pos P Total performance phantom P Daily T
T
Weekly T
T
T T T
Yearly P P P P P P P P P P P P
P: physicist, T:technician
56
IAEA-TRS454 Quality Assurance for Radioactivity Measurement in Nuclear Medicine 2006
IAEA-TECDOC-602
Quality control of Nuclear medicine instruments 1991
IAEA QA for SPECT systems (in press)
INTERNATIONAL ATOMIC ENERGY AGENCY
IAEA
May 1991
57
QC Gamma camera
58
Energy resolution
59
Linearity
Flood source or point source (Tc-99m) Bar phantom or orthogonal-hole phantom
1. Subjective evaluation of the image. 2. Calculate absolute (AL) and differential (DL) linearity. AL: Maximum displacement from ideal grid (mm) DL: Standard deviation of displacements (mm)
60
UNIFORMITY
Flood source (Tc-99m, Co-57) Point source (Tc-99m)

Intrinsic uniformity: Point source at a large distance from the detector. Acquire an image of 10.000.000 counts With collimator: Flood source on the collimator. Acquire an image of 10.000.000 counts
61
Uniformity
1. Subjective evaluation of the image 2. Calculate Integral uniformity (IU) Differential uniformity (DU)
IU=(Max-Min)/Max+Min)*100, where Max is the the maximum and Min is the minimum counts in a pixel
DU=(Hi-Low)/(Hi+Low)*100, where Hi is the highest and Low is the lowest pixel value in a row of 5 pixels moving over the field of view Matrix size 64x64 or 128x128
62
UNIFORMITY/DIFFERENT RADIONUCLIDES
Tl 201
Tc 99m
Ga 67
I 131 All 4 images acquired with: Matrix: 256 x 256, # counts: 30 Mcounts
D BOULFELFEL Dubai Hospital
63
LINEARITY AND UNIFORMITY CORRECTIONS
Dogan Bor, Ankara Radiation Protection in PET/CT
64
OFF PEAK MEASUREMENTS
Dogan Bor, Ankara Radiation Protection in PET/CT
65
TOMOGRAPHIC UNIFORMITY
Tomographic uniformity is the uniformity of the reconstruction of a slice through a uniform distribution of activity SPECT phantom with 200-400 MBq Tc99m aligned with the axis of rotation. Acquire 250k counts per angle. Reconstruct the data with a ramp filter
66
INCORRECT MEASUREMENT
Two images of a flood source filled with a solution of Tc-99m, which had not been mixed properly
67
Spatial resolution
Measured with: Flood source or point source plus a Bar phantom
Subjective evaluation of the image

68
SPATIAL RESOLUTION
Intrinsic resolution
Screw clip
System resolution
Polyethylene tubing about 0.5 mm in internal diameter
Rigid plastic 30 mm 500 mm 60 mm 5 mm
50 mm
200 mm Lead Plastic shims

IAEA TECDOC 602 Radiation Protection in PET/CT
69
SPATIAL RESOLUTION
Tc-99m or other radionuclide in use Intrinsic: Collimated line source on the detector System: Line source at a certain distance Calculate FWHM of the line spread function
FWHM: 7.9 mm
70
TOMOGRAPHIC RESOLUTION
Method 1: Measurement with the Jaszczak phantom, with and without scatter (phantom filled with water and with no liquid)
Method 2: Measurement with a Point or line source free in air and Point or line source in a SPECT phantom with water
71
Sensitivity
Expressed as counts/min/MBq and should be measured for each collimator Important to observe with multi-head systems that variations among heads do not exceed 3%
72
73
Multiple Window Spatial Registration
Performed to verify that contrast is

satisfactory for imaging radionuclides, which emit photons of more than one energy (e.g. Tl-201, Ga-67, In-111, etc.) as well as in dual radionuclides studies
74
Multiple Window Spatial Registration

Collimated Ga-67 sources are used at central point, four points on the X-axis and four points on the Y axis Perform acquisitions for the 93, 184 and 300 keV energy windows Displacement of count centroids from each peak is computed and maximum is retained as MWSR in mm
75
Count Rate Performance
Performed to ensure that the time to

process an event is sufficient to maintain spatial resolution and uniformity in clinical images acquired at high-count rates
76
Count Rate Performance

Use of decaying source or calibrated copper sheets to compute the observed count rate for a 20% count loss and the maximum count rate without scatter
77
Pixel size
78
Center of rotation
Point source of Tc-99m or Co-57 Make a tomographic acquisition In x-direction the position will describe a sinusfunction. In y-direction a straight line. Calculate the offset from a fitted cosine and linear function at each angle.
Linear function Cosine function
79
Total performance
Total performance phantom. Emission or transmission. Compare result with reference image.
80
SOURCES FOR QC OF GAMMA CAMERAS
Point source Collimated line source Line source Flood source

<1 mm
Tc99m, Co57, Ga67
81
Phantoms for QC of gamma cameras
Bar phantom Slit phantom Orthogonal hole phantom Total performance phantom
82
Phantoms for QC of gamma cameras
83
QUALITY CONTROL ANALOGUE IMAGES
Quality control of film processing: base & fog, sensitivity, contrast
84
QUALITY ASSURANCE COMPUTER EVALUATION
Efficient use of computers can increase the sensitivity and specificity of an examination. * software based on published and clinically tested methods * well documented algorithms * user manuals * training * software phantoms
85
Semi-conductor detector Applications in nuclear medicine
Identification of nuclides Control of radionuclide purity
86
12.3. SPECT/CT
TYPICAL SPECT/CT CONFIGURATION
The most prevalent form of SPECT/CT scanner involves a dualdetector SPECT camera with a 1slice or 4-slice CT unit mounted to the rotating gantry; 64-slice CT for SPECT/CT also available
88
Accurate registration CT data used for attenuation

correction Localization of abnormalities Parathyroid lesions (especially for ectopic lesions) Bone vs soft tissue infections CTCA fused with myocardial perfusion for 64-slice CT scanners
SPECT/CT
89
The CT Scanner

Computed Tomography (CT) was introduced into clinical practice in 1972 and revolutionized X Ray imaging by providing high quality images which reproduced transverse cross sections of the body. Tissues are therefore not superimposed on the image as they are in conventional projections The technique offered in particular improved low contrast resolution for better visualization of soft tissue, but with relatively high absorbed radiation dose
90
The CT Scanner
X ray tube X ray emission in all directions collimators
91
A look inside a rotate/rotate CT
Detector Array and Collimator
X Ray Tube
92
A Look Inside a Slip Ring CT

Note: how most of the electronics is placed on the rotating gantry
X Ray Tube
Detector Array
Slip Ring
93
What are we measuring in a CT scanner?
We are measuring the average linear
attenuation coefficient between tube and detectors The attenuation coefficient reflects how the x ray intensity is reduced by a material
94
Conversion of to CT number
Distribution of values initially measured values are scaled to that of water to

give the CT number
95
12.5 Design of SPECT/CT facilities
Nuclear medicine application according to type of radionuclide
Radionuclide
Pure emitter
e.g. ; Tc99m, In111, Ga67, I123
Diagnostics
Therapy
()
Positron emitters (+)

e.g. : F-18

97
, - emitters
e.g. : I131, Sm153
Pure - emitters
e.g. : Sr89, Y90, Er169
emitters
e.g. : At211, Bi213
Sealed sources in nuclear medicine

Sealed sources used for calibration and quality control of equipment (Na-22, Mn-54, Co57, Co-60, Cs137, Cd-109, I-129, Ba-133, Am-241). Point sources and anatomical markers (Co57, Au-195). The activities are in the range 1 kBq-1GBq.
98
99Mo-99mTc
GENERATOR
99mTc
99Mo
87.6%
12.4%
- 442 keV 739 keV T = 2.75 d
140 keV T = 6.02 h

99Tc
- 292 keV T = 2*105 y

99Ru
stable
99
Technetium generator
Mo-99
66 h
Tc-99m
6h
Tc-99
NaCl AlO2 Mo-99 +Tc-99m Tc-99m
100
101
102
103
104
105
Radiopharmaceuticals
Radionuclide Pharmaceutical Organ Parameter
+ colloid
Liver
RES
Tc-99m
+ MAA
Lungs
Regional perfusion
+ DTPA
Kidneys
Kidney function
106
RADIOPHARMACEUTICALS
Radiopharmaceuticals used in nuclear medicine can be classified as follows: ready-to-use radiopharmaceuticals

e.g. 131I- MIBG, 131I-iodide, 201Tl-chloride, 111In- DTPA
instant kits for preparation of products

e.g. 99mTc-MDP, 99mTc-MAA, 99mTc-HIDA, 111In-Octreotide
kits requiring heating

e.g. 99mTc-MAG3,
99mTc-MIBI
products requiring significant manipulation

e.g. labelling of blood cells, synthesis and labelling of radiopharmaceuticals produced in house
107
Laboratory work with radionuclides
108
Administration of radiopharmaceuticals
109
Categorization of hazard
Based on calculation of a weighted activity using weighting factors according to radionuclide used and the type of operation performed.
Weighted activity < 50 MBq 50-50000 MBq >50000 MBq Category Low hazard Medium hazard High hazard
110
Weighting factors according to radionuclide
Class A
Radionuclide 75Se, 89Sr, 125I, 131I

11C, 13N, 15O, 18F, 51Cr, 67Ga, 99mTc, 111In, 113mIn, 123I, 201Tl
Weighting factor 100
1.00
3H, 14C, 81mKr 127Xe, 133Xe
0.01
111
Weighting factors according to type of operation
Type of operation or area Storage
Weighting factor 0.01
Waste handling, imaging room (no inj), waiting area, patient bed area (diagnostic)
0.10
Local dispensing, radionuclide administration, imaging room (inj.), simple preparation, patient bed area (therapy) 1.00 Complex preparation
10.0
112
Administration of 11 GBq I-131 Weighting factor, radionuclide Weighting factor, operation Total weighted activity
Weighted activity < 50 MBq 50-50000 MBq >50000 MBq
100 1
1100 GBq
Category Low hazard Medium hazard High hazard
113
Patient examination, 400 MBq Tc-99m Weighting factor, radionuclide Weighting factor, operation Total weighted activity
1 1 400 MBq
114
Patients waiting, 8 patients, 400 MBq Tc-99m per patient
Weighting factor, radionuclide Weighting factor, operation Total weighted activity
1 0.1 320 MBq

115
Category of hazard
(premises not frequented by patients) Typical results of hazard calculations
High hazard Room for preparation and dispensing radiopharmaceuticals Temporary storage of waste Medium hazard Room for storage of radionuclides Low hazard Room for measuring samples Radiochemical work (RIA) Offices
116
Category of hazard
(premises frequented by patients)
Typical results of hazard calculations
High hazard Room for administration of radiopharmaceuticals Examination room Isolation ward Medium hazard Waiting room Patient toilet
Low hazard Reception
117
Building requirements
Category of hazard Low Medium
Structural shielding
Floors
Worktop surfaces walls, ceiling cleanable cleanable
no no
cleanable continuous sheet
High
possibly
continuous cleanable one sheet folded to walls
What the room is used for should be taken into account e.g. waiting room
118
Building requirements
Category of hazard Low
Fume hood
Ventilation
Plumbing
First aid
no
normal
standard
washing
Medium
yes
good
standard
washing & decontamination facilities

washing & decontamination facilities
High
yes
may need may need special forced special ventilation plumbing facilities facilities
119
Design Objectives
Safety of sources Optimize exposure of staff, patients and general public Prevent uncontrolled spread of contamination Maintain low background where most needed Fulfil requirements regarding pharmaceutical work
120
VENTILATION
Laboratories in which unsealed sources, especially radioactive aerosols or gases, may be produced or handled should have an appropriate ventilation system that includes a fume hood, laminar air flow cabinet or glove box The ventilation system should be designed such that the laboratory is at negative pressure relative to surrounding areas. The airflow should be from areas of minimal likelihood of airborne contamination to areas where such contamination is likely All air from the laboratory should be vented through a fume hood and must not be recirculated either directly, in combination with incoming fresh air in a mixing system, or indirectly, as a result of proximity of the exhaust to a fresh air intake
121
VENTILATION
Sterile room negative pressure filtered air Injection room
Laminar air flow cabinets Work bench Dispensation negative pressure Fume hood Corridor
Passage
122
Continous monitoring av air pressure gradients
Alarm system
123
Fume hood
The fume hood must be constructed of smooth, impervious, washable and chemical-resistant material. The working surface should have a slightly raised lip to contain any spills and must be strong enough to bear the weight of any lead shielding that may be required The air-handling capacity of the fume hood should be such that the linear face velocity is between 0.5 and 1.0 metres/second with the sash in the normal working position. This should be checked regularly
124
Sinks
If the Regulatory Authority allows the release of aqueous waste to the sewer a special sink shall be used. Local rules for the discharge shall be available. The sink shall be easy to decontaminate. Special flushing units are available for diluting the waste and minimizing contamination of the sink.
125
Washing facilities
The wash-up sink should be located in a low-traffic area adjacent to the work area Taps should be operable without direct hand contact and disposable towels or hot air dryer should be available An emergency eye-wash should be installed near the hand-washing sink and there should be access to an emergency shower in or near the laboratory
126
Shielding
Much cheaper and more convenient to shield the source, where possible, rather than the room or the person Structural shielding is generally not necessary in a nuclear medicine department. However, the need for wall shielding should be assessed e.g. in the design of a therapy ward (to protect other patients and staff) and in the design of a laboratory housing sensitive instruments (to keep a low background in a well counter, gamma camera, etc)
127
Layout of a nuclear medicine department
From high to low activity
128
SUMMARY OF SPET/CT
SPECT cameras are scintillation cameras, also called gamma cameras, which image one gamma ray at a time, with optimum detection at 140 KeV, ideal for gamma rays emitted by Tc-99m SPECT cameras rotate about the patient in order to determine the three-dimensional distribution of radiotracer in the patient SPECT/CT scanners have a CT scanner immediately adjacent to the SPECT camera, enabling accurate registration of the SPECT scan with the CT scan, enabling attenuation correction of the SPECT scan by the CT scan and anatomical localization of areas of unusually high activity revealed by the SPECT scan
129

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International Atomic Energy Agency

SPECT/CT TECHNOLOGY & FACILITY DESIGN L 12

Answer True or False

The most common isotope used in

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

International Atomic Energy Agency

12.1 SPECT cameras

Radiation Protection in PET/CT

Detector Photocathode cathodd Dynodes

Radiation Protection in PET/CT

Pulse height analyzer

Pulse height (V) UL

Radiation Protection in PET/CT

Semi-conductor detector as spectrometer

Solid Germanium or Ge(Li) detectors Principle: electron - hole pairs

(analogous to ion-pairs in gas-filled detectors) Excellent energy resolution

Radiation Protection in PET/CT

Used to measure the spatial and temporal distribution of a radiopharmaceutical

PM-tubes Detector Collimator

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Gamma camera collimators

Radiation Protection in PET/CT

Gamma camera Data acquisition

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Scintigraphy seeks to determine the distribution of a radiopharmaceutical

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

ECG GATED TOMOGRAPHY

Radiation Protection in PET/CT

International Atomic Energy Agency

12.2 Image Quality & Camera QA

Factors affecting image formation

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

SPATIAL RESOLUTION - DISTANCE

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

NON UNIFORMITY RING ARTIFACTS

Radiation Protection in PET/CT

COUNT RATE PERFORMANCE

(IAEA QC Atlas) Radiation Protection in PET/CT

Spatial positioning at different energies

Radiation Protection in PET/CT

Spatial positioning at different energies

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

Radiation Protection in PET/CT

The amount of scattered photons registered