SINGLE PHOTON EMISSION COMPUTED

TOMOGRAPHY (SPECT) MYOCARDIAL

PERFUSION IMAGING GUIDELINES:
INSTRUMENTATION, ACQUISITION AND
PROCESSING
ASNC GUIDELINESS 2018

Presented by: Moderated by:

Dr Lokeshwaran Dr Manish Ora
MK
 INTRODUCTION
• QUALITY ASSURANCE(QA) vs QUALITY CONTROL(QC):
• Quality assurance is a way of preventing mistakes or failure in
products. It is a process focused concept.
• Quality control involves the inspection of equipment to ensure
that the quality of all aspects is satisfactory. It is a product
focused concept.
• comprises set of procedure to ensure that a product or performed
services adhere to a defined set of performance criteria.
 Need for QA/QC?? in MPI
studies
• Optimizing diagnostic accuracy
• Ensure consistent and high quality MPI
SPECT instrumentation QA and
performance
 Collimators
• Prevent the interaction of photon travelling
outside the range of incident angles (as specified
by collimator design) with the detectors.
• Due to this restriction, there is loss of spatial
resolution.
• TYPES:
• Parallel hole
• Converging hole
• Pinhole
 Detectors
• Responsible for :
• Collecting the photon events
• Estimating photon energy
• Position of detection.
 Types of detectors
• Scintillation crystal (single non-pixelated crystal) with PMT array.
• Scintillation crystals(pixelated ) with PMT or solid state
photodiode array.
• Semiconductor radiation detectors.
 Energy resolution
• Scattered photon have reduced energy than the photons that
reaches the detector without intervening interactions.
• These scattered photon greatly reduces the image contrast.
• Fraction of scattered photons that can be excluded from the
acquired data based on their lower energy is dependent on the
energy resolution of the cameras.
• 99m-Tc:Symmetric window of 15%-20% around 140 Kev peak.
• 201 Tl:30% around 70 KeV and 15-20% around 167 KeV peak.
 Camera sensitivity
• Depends on:
• Number of detectors
• Collimator used with each detectors
• Detector sensitivity(intrinsic efficiency)
 Spatial resolution
• Quantifies the size of small object that can be resolved
reliably.
• Expressed as FWHM.
• Total resolution=intrinsic resolution + collimator
resolution
• In conventional Anger camera , it is a function of PMT
signal strength and position logic circuitry system.
• In pixelated solid state detectors , it is a function of
detector element size.
 System design
• Conventional SPECT
• Dedicated cardiac SPECT:
• Upright CZT camera with sweeping parallel hole
collimators(D-SPECT):
• Pixilated CZT detector arrays mounted in nine vertical
columns and placed in a 90-degree gantry geometry
• Each column consists of an array of 1024 CZT elements
(2.46 x 2.46 x 5 mm thick) arranged in a 16 x 64
element array with an approximate size of 40 x 160 mm.
• Each column is fitted with square parallel-hole high-
sensitivity collimators, such that the dimensions of each
hole are matched to the size of a single detector
element.
• The collimators are fabricated from tungsten to
eliminate the production of lead x-rays that might
interfere with technetium-201 (201Tl) imaging.
• CZT with multiple single pinhole
detectors(discovery NM 530c):
• Consists of 19 CZT detector, each 8x
8cm, coupled to single pinhole
collimator.
• In this system the detectors and the
collimators do not move during the
acquisition and images are acquired
simultaneously by all pinholes.
 Quality control
• Different evaluation steps of camera
• Factory testing
• Acceptance testing and reference testing after on site installation
• Periodic quality control
Acceptance testing
 QUALITY CONTROL TESTING
• DAILY: visual and physical inspection, collimator touch pads and
emergency stop button, energy window setting, uniformity and
sensitivity.

• WEEKLY and MONTHLY: COR, bar phantom spatial resolution and

linearity, high count flood uniformity/sensitivity correction map.

• QUARTERLY, HALY YEARLY AND ANUALLY: collimator hole angulation,

tilt angle check, tomographic spatial resolution, SPECT/CT alignment
 Daily QC
• Start –up:
• Ensure the start up/reset procedure completes without any
warning / error message.
• Visual inspection of the camera.
• Operational check of emergency stop button.
• Energy window:
• Ensures that all pulse height analyzer energy windows are
properly centered around the energy photopeak of the
radionuclide to be used.
• Performed intrinsically using a radioactive source at a
distance greater than 5-UFOV diameter away from detector
surface
• Uniformity testing:
• Verifies that the camera’s sensitivity response is uniform across
the detectors face.
• Can be tested intrinsically using point source or extrinsically using
Co-57 sheet source.
• Done immediately after verification of energy calibration of
detector.
• Extrinsic testing: Flood image that are visually inspected are
acquired in 256 x 256 matrices for 3 million counts.
• Flood images used for calculation of uniformity require 2-3 times
more counts to reduce noise. NEMA recommends 50 million total
• Integral vs differential uniformity:
• Integral uniformity is a global parameter measuring uniformity
over an extended area of detector.

• Differential uniformity is a regional parameter that measures

contrast over a small neighborhood . Performed using all 5 x5
pixel areas in both x and y direction
Non uniformity may result in generation of image which
may not depict the real scenario
 Sensitivity
• The test consists of
calculating camera
sensitivity (expressed in
terms of counts per
minute [cpm] per MBq)
of a known source,
calibrated with a dose
calibrator.
 Weekly QC tests

Resolution :
• Test consist of imaging flood
source intrinsically through a
spatial resolution phantom.
• Source can be point/ sheet
source(count rate-10-20 kcps).
• Phantoms commonly used: parallel
line equal space bar phantom and
4- quadrant phantoms
 CENTER OF ROTATION
• COR is the center point of projections recorded by
detector at all angle.
• Center of electronic matrix should always align with the
mechanical COR.
• Error results in doughnut/tuning fork artefact
 High count flood field uniformity
correction
• Anger cameras use stored high count flood field correction
maps to compensate for variation in sensitivity across the
detector FOV before reconstruction.
• To correct for uniformity 60-100 million flood image is
acquired for each detector and stored.
 CT QC procedure
• CT number calibration:
• The quantitative CT values are transformed into the attenuation coefficients or the SPECT
radiotracer.
• Any errors in CT numbers will be propagated as errors in the estimated attenuation coef ficients
for the radiotracer.
• The CT calibration is then checked daily with a water-filled cylinder, usually 24 cm in diameter
provided by the manufacturer. The manufacturer will specify the acceptable range of HU values
measured for water. In practice, if the error is greater than 5 to 10 HU (i.e., different than the
anticipated value of 0 HU), the CT system is considered to be out of calibration.
• An air calibration (or blank-scan acquisition) can be performed to determine if this corrects the
error. If it does not, the manufacturer’s field service engineer must be called. Calibration must
be checked by a qualified person on an annual basis, or after any major repair or calibration.
• Field uniformity: Using water filled phantom
 Quarterly and annual QC tests
• Collimation hole angulation:
• It is the geometric relationship of the actual collimator holes and
septa to the crystal face of the planar/SPECT scintillation camera
or to the axis of rotation of SPECT scintillation camera.
• Ideally all edges and septa in the collimators has to be exactly
perpendicular to the crystal and the axis of rotation. Any
difference in the angle is known as collimator angulation error.
• Tilt angle check:
• Refers to the detector plane
and the axis of rotation,
measured along the axis of
rotation.
• Should be 0 degree at the
beginning of tomographic
acquisition
• It can be determined from
summed projection images
over 360 degree of a point
source placed off the
 Acquisition
• Activity:
• Depends on several parameters:
• Patient body habitus
• Study protocol
• Scanner type
• Software type
• Radiotracer used
Protocol
• Acquisition type:
• Step and shoot: camera acquires a projection, then stops
recording data when moving to the next angle; this results in a
small amount of dead time because the camera is not acquiring
data while it is moving.
• Continuous’ mode: camera moves continuously and acquires each
projection over an angular increment. This eliminates dead time
and thus increases image counts at the expense of a small amount
of blurring due to the motion of the camera head while acquiring.
• Gating :
• Requires stable and consistent heart rhythm.
• 8 or 16 frames per cycle.
• Attenuation correction:
Shallow tidal breahing and tube current of 10-20 mA and tube
voltage of 80-140 kvp, scan duration-10-30 seconds. But lower
currents can also be used.
 PROCESSING
• FILTERING:
• Quality of an image is determined by signal to noise ratio.
• Higher at lower spatial frequencies and lower at higher spatial
frequency.
• Types :
• Low pass(hanning and butterworth)
• High pass(ramp filter)
• Reconstruction :
• Filter backprojection (analytical reconstruction):
• Iterative reconstruction:
• Algorithm :
• Expectation maximization
• MLEM
• MAP
• Newer trend:
• RESOLUTION RECOVERY
Attenuation correcetion for SPECT
system
• TYPES:
• RADIONUCLIDE TRANSMISSION COMPUTED TOMOGRAPHY
• CT SCANNER
• Reorientation and reslicing:
• Quantitation:
• Perfusion parameters, i.e. defect extent, severity values with polar
map display, reversibility stress-rest, percent hypo perfused
myocardium, percent ischaemic myocardium, categorical summed
scores (rest, stress and difference), and even total perfusion
deficit.
• Left ventricle (LV) global functional parameters, i.e. left ventricle
ejection fraction (LVEF), end-diastolic volume (EDV) and end-
systolic volume (ESV), and the LV regional parameters, i.e.
regional wall motion and thickening, in conjunction with phase
analysis and 3D gated surface display,
THANK YOU