Single Photon Emission

Computed Tomography
Dr. Temis G. (RRI)
Moderator: Dr. Seife T (Associate Prof. of Medical
Physics)

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outlines
• Introduction
• Design and Principles of Operation of SPECT
• SPECT Instrumentation
• Image Acquisition and Image Reconstruction
• Quality Control in SPECT
• References

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Introduction

• Single-photon emission computed tomography (SPECT)

is one of a nuclear imaging modality.
• SPECT produces a 3-D image of the distribution of a
radioactive tracer (probe) injected into the bloodstream
and subsequently taken up by certain tissues.
• This is accomplished via the use of specialized nuclear
medicine cameras.
• The ability to assess tissue functionality and physiology
is what sets SPECT imaging apart from purely anatomic
imaging modalities such as CT, MRI, and radiography.
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Applications

• Brain Imaging
• Thyroid and Parathyroid Imaging
• Lung imaging
• Cardiac Imaging
• Kidney Imaging
• Bone Imaging
• Tumor Imaging

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Non cardiac SPECT

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Radioactivity
• A nucleus not in its stable state will adjust itself until it
is stable either by ejecting portions of its nucleus or by
emitting energy in the form of photons (gamma rays).
• This process is referred to as radioactive decay.

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• Most radionuclides decay in one or more of the following ways:
1 alpha decay,
2 beta-minus emission,
3 beta-plus (positron) emission,
4 electron capture, or
5 isomeric transition.

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Gamma Emitting Radioisotopes

• SPECT utilizes the single photons

emitted by gamma-emitting
radionuclides such as 99m Tc, 67 Ga,
111 In, and 123 I.
• Utilizes the paired 511-keV photons
arising from positron annihilation

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Radionuclide Production

• many naturally occurring radioactive nuclides exist,

• But all of those commonly administered to patients
in nuclear medicine are artificially produced
• Most radionuclides used in nuclear medicine are
produced by
• particle accelerators (e.g., cyclotrons),
• nuclear reactors(nuclear fission and neutron
activation), or
• radionuclide generators.
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Ligands

• Are biologically active substances

• Which will interact with the body tissues to deliver the
isotope to the desired location.
• For example,
Tc can be linked to a compound known as
hexamethylpropyleneamine oxime (HMPAO), which is
able to cross the blood-brain barrier.
Tc is bound 6 methoxyisobutylisonitrile (MIBI) groups
to form a tracer compound known as sestamibi.

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RADIONUCLIDES AND RADIOPHARMACEUTICALS
FOR IMAGING

In evaluating the choice of a radionuclide to be used in the

nuclear medicine laboratory, the following characteristics are
desirable:
Minimum of particulate emission
 Primary photon energy between 50 and 500keV
Physical half-life greater than the time required to prepare
material for injection
Effective half-life longer than the examination time
Suitable chemical form and reactivity
Low toxicity
Stability or near-stability of the product

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Design and Principles of Operation

• SPECT generates transverse images depicting the distribution

of x- or gamma-ray–emitting nuclides in patients.
• Standard planar projection images are acquired from an arc of
180
degrees (most cardiac SPECT) or 360 degrees (most
noncardiac SPECT) about the patient.
• The SPECT system’s digital computer then reconstructs the
transverse images using either filtered backprojection or an
iterative reconstruction method, as does the computer in an
x-ray CT system.

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Image Acquisition
• The camera head or heads of a SPECT system revolve about the
patient, acquiring projection images.
• The head or heads may acquire the images while moving (continuous
acquisition) or may stop at predefined evenly spaced angles to
acquire the images (“step and shoot” acquisition).

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• SPECT projection images are usually acquired in either a 642 or a 1282
pixel format.
• Using too small a pixel format reduces the spatial resolution of the
projection images and of the resultant reconstructed transverse images.
• When the 642 format is used, typically 60 or 64 projection images are
acquired and, when a 1282 format is chosen, 120 or 128 projection
images are acquired.
• Using too few projections creates radial streak artifacts in the
reconstructed transverse images.

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radial streak artifacts images

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• The camera heads on older SPECT systems followed circular orbits
around the patient while acquiring images.
• Circular orbits are satisfactory for SPECT imaging of the brain.
• But cause a loss of spatial resolution in body imaging
• Modern SPECT systems provide noncircular orbits (“body
contouring”) that keep the camera heads in close proximity to the
surface of the body throughout the orbit.

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SPECT cameras
• Single Head System
• Multihead system

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Types of gamma camera
• Single-headed system • Dual-headed

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Imaging instrumentation
• The detector used for scintigraphic imaging is called a gamma camera
or Anger camera.
• It was developed in the late 1950’s by Hal Anger (Anger 1958) and has
for a long time been a standard imaging device in nuclear medicine.
• The basic components of the gamma camera today are in many cases
the same as when it was invented,
• but its performance has been improved over the years,
• especially by the introduction of digital electronic components and
multiple head systems.

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• Components of gamma camera
1. Camera collimator
2. Scintillation detector
3. Photomultiplier tube
4. Pre-amplifier and amplifier
5. Position circuitry
6. Pulse-Height Analyzer

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Camera collimator
• Gamma rays are emitted isotropically(in all directions).
• Using only a detector would not result in an image
• No relationship b/n the position at which the gamma rays hit the
detector and the origin of the gamma rays(in the patient).
• Used to define the direction of the detected gamma rays.
• The collimator most commonly consists of a lead plate containing a
large number of holes.
• By controlling which gamma rays are accepted the collimator forms a
projected image of the gamma ray distribution on the surface of the
NaI(TI) crystal.
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• SENSITIVITY
Refers to the ability of the imaging camera to detect the photons
generated by the nuclides.
A low-sensitivity system detects a smaller number of the
generated photons
A high-sensitivity system detects a greater number of photons.

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• RESOLUTION
Refers to the ability of the camera to distinguish between adjacent
points in the organ, permitting detection or finer detail.
The higher the resolution the closer are the points that can be
distinguished.
Using holes of longer and/or narrower bore increases resolution.

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• A collimator’s resolution may be expressed as its angle of acceptance.
• Only photons falling within the angle of acceptance can reach the
crystal
• A high-sensitivity system has a relatively low resolution.
• Bigger holes admit more photons (higher sensitivity), they reduce
the resolution (larger angle of acceptance).

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 Collimator types
• Four basic types are used with gamma camera
parallel-hole: no magnification
pinhole: magnified and inverted
diverging: minification
converging: magnified and uninverted

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Parallel-hole
• The parallel-hole collimator is the most common one.
• and it consists of a lead plate with closely packed parallel holes,
usually with hexagonal form.
• The lead “walls” between the holes are called septa.
• The hole diameter, collimator thickness and septal thickness depend
on the resolution/sensitivity and the photon energy range for which
the collimator is optimised.

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2. Detector
• The gamma camera employs a single, rectangular NaI(Tl) detector
crystal,
• Usually 6- to 12.5-mm thick with sizes of up to 60 × 40cm.
• The NaI(Tl) crystal is surrounded by a highly reflective material such as
TiO2 to maximize light output and
• It is coated with a thin Al-layer at the front side and the edges to
protect from outside light and moisture

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Detector
• The choice of thickness of the NaI(Tl) crystal is a trade-off between its
detection efficiency (which increases with increasing thickness) and,
its intrinsic spatial resolution (which deteriorates with increasing
thickness).
• Most general-purpose gamma cameras have crystal thicknesses of
approximately 9.5mm.

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Detector
• For lower-energy γ emitters,
such as 99mTc and 201Tl,
however, detection efficiency is
adequate even with 6-mm-thick
detector crystals.

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Detectors ..
• The process of converting gamma rays to light is complex,
but it can be summarized as absorption of the gamma ray
energy by the crystal, leaving its electrons in an excited
state.
• The gamma photon transfers its energy in one or more
Compton or photoelectric interactions in the crystal.
• Each of these energetic electrons produced by the gamma
ray interactions in turn distributes its energy among
electrons in the crystal leaving them in an excited state.
• As these return to their original state, some of their energy
is released as light photons
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3. Photomultiplier tube
• The photomultiplier tube is a vacuum tube with a
photocathode on the end, placed adjacent to the
crystal.
• This is coupled with a light conductive transparent gel
to the surface of the crystal.
• The transparent gel has the same refractive index as
the crystal and the photomultiplier tube (PMT) window.
• The light striking the photocathode causes it to emit
electrons, referred to as photoelectrons.

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Photomultiplier tube..
• On average, four to six light photons strike the
photocathode for each photoelectron produced.
• The number of electrons produced at the photocathode
is greatly increased by the multiplying action within the
tube.
• Round PM tubes are arranged in a hexagonal pattern to
maximize the area of the NaI(Tl) crystal that is covered.
• Typical PM tube sizes are 5cm in diameter. Most modern
cameras employ between 30 and 100 PM tubes.

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4. Preamplifiers and Amplifiers
• The current from the photomultiplier must be further
amplified before it can be processed and counted.
• Despite the multiplication within the PMT, the number of
electrons yielded by the chain of events that begins
with absorption of a single gamma ray in the crystal is
still small and must be further increased or amplified.
• Typically, this amplification is a two-stage process.

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Cont..
• In the first stage, a small preamplifier located close to
the photomultiplier increases the number of charges
sufficiently to allow the current to be transmitted
through a cable to the main amplifier.
• In the second stage, the current of the electrical pulse is
further increased by the main amplifier as much as a
thousand-fold.

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5. Positioning Circuit
• Determine the X and Y-position of the interaction of the
gamma ray and the crystal.
• The positioning circuit uses a “voltage divider” to weigh
the output of each tube in relation to its position on the
face of the crystal.
• A positioning circuit improves resolution by factoring
in the output from adjacent tubes.

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6. Pulse-Height Analyzer
• A pulse height analyzer is an instrument used to analyze the
frequency distribution of the spectrum of photon energies that
are captured by a gamma camera.
• The amplitude of each electrical pulse from the amplifiers is
measured in the electrical circuits of the pulse-height analyzer.
• The amplifiers are designed to ensure that the amplitude of
each pulse is proportional to the energy absorbed in the crystal
from the gamma radiation.
• Energy windows are selected to only allow certain photon
energies that fall within a preset range to contribute to the
output pulse.

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Cont..
• A plot of the number of pulses against their height—that
is, their energy—is called a pulse-height spectrum.
• The pulse-height analyzer is often used to “select” only
pulses (conventionally called Z-pulses) that correspond
to a range of the acceptable energies.
• This range is called the energy window.

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 Computers
• Nuclear medicine computers are used for the
acquisition, storage, and processing of data.
• The image data are stored in digital form (digitized) as
follows:
• For each Z-pulse that is accepted by the pulse-height
analyzer, one count is added to the storage location
that corresponds to its x, y location determined by the
positioning circuit.

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Next Step  Correction
• After the projection images are acquired, they are usually
corrected for
• nonuniformities and
• centre-of-rotation (COR) misalignments.
• Following these corrections, transverse image
reconstruction is performed using either filtered
backprojection or iterative methods.

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Attenuation Correction in SPECT

• Attenuation correction is a mechanism that removes soft tissue

artifacts from SPECT images
• Radioactivity whose x- or gamma rays must traverse long paths
through the patient produces fewer counts, due to attenuation, than
does activity closer to the surface of the patient adjacent to the
camera.
• For this reason, transverse image slices of a phantom with a uniform
activity distribution, such as a cylinder filled with a well mixed
solution of radionuclide, will show a gradual decrease in activity
toward the center.
• Attenuation effects are more severe in body SPECT than in brain
SPECT.

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• Approximate methods are available for attenuation
correction.
• One of the most common, the Chang method, presumes a
constant attenuation coefficient throughout the patient.
• Approximate attenuation corrections can overcompensate
or undercompensate for attenuation.
• However, attenuation is not uniform in the patient,
particularly in the thorax.
• These approximate methods cannot compensate for
nonuniform attenuation.

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• Several manufacturers provide SPECT cameras with sealed
radioactive sources (commonly containing Gd-153, which emits 97
and 103-keV gamma rays) to measure the attenuation through the
patient.
• Major manufacturers of nuclear medicine imaging systems provide
systems combining two scintillation camera heads capable of
planar imaging and SPECT and an x-ray CT scanner, with a single
patient bed.
• In SPECT/CT systems, the x-ray CT attenuation image data can be
used to correct the radionuclide emission data for attenuation by
the patient

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Transverse Image Reconstruction

1. Filtered backprojection consists of two steps

• First, the projection images are mathematically filtered.
• Then, to form a particular transverse image, simple
backprojection is performed of the row, corresponding to
that transverse image, of each projection image.
• A SPECT study produces transverse images covering the
entire field of view of the camera in the axial direction
from each revolution of the camera head or heads.

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• Filtered backprojection is computationally efficient.
• However, it is based upon the assumption that the projection images
are perfect projections of a three-dimensional object.
• This is far from true in scintillation camera imaging, mainly because of
• attenuation of photons in the patient,
• inclusion of Compton scattered photons in the image, and
• the degradation of spatial resolution with distance from the collimator.

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2. Iterative reconstruction
• In iterative methods, an initial activity distribution in the patient is
assumed.
• Then, projection images are calculated from the assumed activity
distribution, using a model of the imaging characteristics of the
scintillation camera and the patient.
• The calculated projection images are compared with the actual projection
images and, based upon this comparison, the assumed activity distribution
is adjusted.
• This process is repeated several times, with successive adjustments to the
assumed activity distribution, until the calculated projection images
approximate the actual projection images.

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• Is computationally less efficient than filtered backprojection.
• However,
• the increasing speed of computers,
• the small image matrix sizes used in nuclear imaging,
• and development of computationally efficient algorithms.
• In SPECT, iterative reconstruction methods are
increasingly being used instead
of filtered backprojection.

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Quality Control in SPECT
• Quality control is critical aspect of SPECT.
• The primary purpose of a quality control is to verify that the
images obtained reflect the distribution of radiopharmaceuticals
within a patient.
• Equipment malfunctions or maladjustments can
• markedly degrade the spatial resolution of SPECT images and
• produce significant artifacts, some of which may mimic pathology.
• Upon installation, a SPECT camera should be tested by a medical
physicist.
• Following acceptance testing, a quality control program should be
established periodically.

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X and Y Magnification
• The X and Y magnification factors, often called X and Y gains, relate distances
in the object being imaged, in the x and y directions, to the numbers of pixels
between the corresponding points in the resultant image.
• The X magnification factor is determined from an image of two point sources
placed against the camera’s collimator a known distance apart along a line
parallel to the x-axis:

• The Y magnification factor is determined similarly but with the sources parallel
to the y-axis.
• The X and Y magnification factors should be equal.
• If they are not, the projection images will be distorted in shape in non tranverse
image.

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Alignment of Projection Images to the Axis of
Rotation
• The axis of rotation (AOR) is an imaginary reference line about which the head or
heads of a SPECT camera rotate.
• If a radioactive line source were placed on the AOR,
• each projection image would depict it as a vertical straight line near the center of
the image
• this projection of the AOR into the image is called the center-of-rotation
(COR).
• The location of the COR in each projection image must be known to correctly
calculate the three-dimensional activity distribution from the projection images.
• However, there may be misalignment of the COR with the centers of the projection
images.
• This misalignment may be mechanical or electronic.

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 Center-of-rotation (COR) misalignment in SPECT. Small misalignments cause
blurring (center), whereas large misalignments cause point sources to
appear as “tiny doughnut” artifacts (right). Such “tiny doughnut” artifacts
would only be visible in phantom studies and are unlikely to be seen in
clinical images

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• If a COR misalignment is not corrected,
• it causes a loss of spatial resolution in the resultant
transverse images.
• If the misalignment is large, it can cause a point source
to appear as a tiny “doughnut artifact.
• Scintillation camera manufacturers provide software to
assess and correct the effects of COR misalignment.

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Uniformity
• The uniformity of the camera head or heads is important
• The artifact caused by a nonuniformity appears in transverse
images as a ring centered about the AOR.
• Multihead SPECT systems can produce partial ring artifacts when
projection
images are not acquired by all heads over a 360-degree arc.
• Clinically, ring artifacts are most apparent in high-count density
studies, such as liver images.
• However, ring artifacts may be most harmful in studies such as
myocardial perfusion images

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 Image of a cylinder filled witha uniform radionuclide solution,
showing a ring
artifact due to a nonuniformity. The artifact is the dark ring toward
the center
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• modern scintillation cameras have digital circuits using lookup
tables.
• However, these correction circuits cannot correct
nonuniformity due to local variations in detection efficiency,
such as dents or manufacturing defects in the collimators.
• If not too severe, nonuniformities of this latter type can be
largely corrected.
• A very high-count uniformity image is acquired.
• The ratio of the average pixel count to the count in a specific
pixel in this image serves as a correction factor for that pixel.

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Camera Head Tilt
• The camera head or heads must be aligned with the axis of rotation
(AOR); for most types of collimators, this requires that faces of the heads
be exactly parallel to the AOR.
• If they are not, a loss of spatial resolution and contrast will result from
out-of-slice activity being backprojected into each transverse image slice.
• The loss of resolution and contrast in each transverse image slice will be
less toward the center of the slice and greatest toward the edges of the
image.
• Some SPECT cameras require the head tilt to be manually adjusted for
each acquisition, whereas other systems set it automatically.
• The accuracy of the automatic systems should be periodically tested.

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 The camera head on the left is parallel to the axis of rotation (AOR), causing the counts
collected in a pixel of the projection image to be backprojected into the corresponding
transverse image slice of the patient. The camera head on the right is tilted, causing counts
from activity outside of a transverse slice (along the grey diagonal lines of response) to be
backprojected into the transverse image slice (orange colored vertical slice )

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SPECT Quality Control Phantoms
• There are commercially available phantoms that may be
filled with a solution of Tc-99m or other radionuclide.
• These phantoms are very useful for the semiquantitative
assessment of
• spatial resolution,
• image contrast, and
• uniformity
• They are used for acceptance testing of new systems and
periodic testing, typically quarterly, thereafter.

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References

• Dr Seife’s nuclear medicine physics lecture note

• Essential Physics of Medical Imaging, 3E 2012
• Nuclear Medicine Physics_ The Basics
• Essentials of Nuclear Medicine Imaging_ Expert Consult
• Previous seminar slides

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 Thanks

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