BACKGROUND: Although the importance of quantitative SPECT has increased tremendously due to newly developed therapeutic radiopharmaceuticals, there are still no accreditation programs to harmonize SPECT imaging. Work is currently underway to develop an accreditation for quantitative 177Lu SPECT/CT. The aim of this study is to verify whether the positioning of the spheres within the phantom has an influence on the recovery and thus needs to be considered in SPECT harmonization. In addition, the effects of these recovery coefficients on a potential partial volume correction as well as absorbed-dose estimates are investigated.
METHODS: Using a low-dose CT of a SPECT/CT acquisition, a computerized version of the NEMA body phantom was created using a semi-automatic threshold-based method. Based on the mass-density map, the detector orbit, and the sphere centers, realistic SPECT acquisitions of all possible 720 sphere configurations of both the PET and the SPECT versions of the NEMA Body Phantom were generated using Monte Carlo simulations. SPECT reconstructions with different numbers of updates were performed without (CASToR) and with resolution modeling (STIR). Recovery coefficients were calculated for all permutations, reconstruction methods, and phantoms, and their dependence on the sphere positioning was investigated. Finally, the simulation-based findings were validated using SPECT/CT acquisitions of six different sphere configurations.
RESULTS: Our analysis shows that sphere positioning has a significant impact on the recovery for both of the reconstruction methods and the phantom type. Although resolution modeling resulted in significantly higher recovery, the relative variation in recovery within the 720 permutations was even larger. When examining the extreme values of the recovery, reconstructions without resolution modeling were influenced primarily by the sphere position, while with resolution modeling the volume of the two adjacent spheres had a larger influence. The SPECT measurements confirmed these observations, and the recovery curves showed good overall agreement with the simulated data.
CONCLUSIONS: Our study shows that sphere positioning has a significant impact on the recovery obtained in NEMA sphere phantom measurements and should therefore be considered in a future SPECT accreditation. Furthermore, the single-measurement method normally performed for PVC should be reconsidered to account for the position dependency.

OBJECTIVE: Quantitative measurements of activity in SPECT are important for radioisotope therapy planning and disease diagnosis. The aim of this manuscript is to develop a robust method to quantify the total activity in a volume-of-interest (VOI) of different quantitative SPECT reconstructions and validate the estimation accuracy.
METHODS: We customized an IEC body phantom using 3D printing technology and made six sphere inserts of 1-6 cm in diameter with at least 3 cm separation. The activity concentration within the spheres was in the range of patient lesion/organ activity. The background activity was then increased from zero to a sphere/background activity concentration of 8:1, 4:1, and 2:1. SPECT data were acquired with Philips Brightview and GE Discovery 670 SPECT/computed tomography (CT) systems under clinical acquisition protocols. Quantitative SPECT images were reconstructed with Hermes SUV-SPECT (both Philips and GE data) and GE Q.Metrix (GE data only). The quantitative SPECT reconstructions are iterative with scatter, CT attenuation correction, and resolution recovery. We quantified the total activity by expanding the sphere VOI to include a spill-out region. Background correction was applied by sampling a region outside the spill-out region. The true fractions (TFs) (total activity/true activity) were measured for all six spheres for all SPECT acquisitions.
RESULTS: The TF is close to 100% for 2-6 cm spheres for zero background, 8:1 and 4:1 sphere/background activity ratios. The TF was found to be unreliable for the 1-cm sphere because of the limit of phantom design. TF accuracy for 2:1 sphere/background ratio was degraded due to significantly large background, inadequate scatter correction and detector count loss.
CONCLUSIONS: The results demonstrated that the proposed quantification method is accurate for objects of different sizes in currently clinical quantitative reconstruction and has the potential for improving the accuracy for therapeutic treatment planning or radiation dosimetry calculations.

The aim of the study was to estimate the accuracy of standardized uptake values of 18F-fluorodeoxyglucose (18F-FDG) in lung lesions during positron emission tomography combined with computed tomography (PET/CT) imaging, based on phantom studies performed for different PET/CT scanners.
UNASSIGNED: The analysis of the PET/CT with 18F-FDG data was performed for 86 patients newly diagnosed with the lung lesions: malignant tumors (n=37), benign tumors and inflammatory diseases (n=49). The criteria for inclusion in the study were developed considering the recommendations of the Fleischner Society (2017). The characteristics of the lesions on CT met the following requirements: a round shape or close to it; total size of 8 to 30 mm; solid or subsolid structure (with the exception of lesion with ground-glass opacity); a solid part size of ≥8 mm. All the patients had no signs of pleurisy, lymphadenopathy, or cancer history. PET/CT imaging with 18F-FDG was performed with three scanners: Discovery 690 (General Electric, USA), Biograph mCT 128 (Siemens, Germany), and Biograph mCT 40 (Siemens); the preparation of patients prior to the scan was standardized. To determine the reference accumulation of a radiopharmaceutical in the pathological lesion, four scans of a specialized NEMA IEC PET Body Phantom Set (USA) were performed for each scanner. For each unit, the recovery coefficients (RCs) of radioactivity, maximum and recovered (corrected) standardized uptake values (SUVs) were determined. Statistical relationship between the size of lesions, SUVmax and SUVcorrect was evaluated. Data processing was performed using MedCalc v. 19.2.0 software.
UNASSIGNED: During the phantom study, the underestimation of the radioactivity was determined in the spheres with the diameters of 10 and 13 mm, overestimation was observed in the sphere with the diameter of 28 mm. Both underestimation and overestimation of radioactivity were determined for the spheres with a diameter of 17 and 22 mm.SUVmax differed from the reference values for 85 patients (98.8%). The underestimation of these values was found for 63 patients (73.2%) due to the partial volume effect. The greatest underestimation was observed for the patients with 8 mm diameter lesions. Depending on the scanner, the underestimation of the SUVmax in these patients reached up to 54-73%. For 9 patients (25%) with malignant tumors of 9-12 mm, the utility of RC made it possible to avoid false negative results. For the lesions with a diameter of 30 mm, an overestimation of SUVmax up to 22% was determined due to the negative influence of the reconstruction algorithms.
UNASSIGNED: The use of RC eliminates the influence of the partial volume effect and reconstruction methods on the accuracy of estimating the SUVmax in lung lesions, which ensures reproducibility, increase in the information content of the method, as well as the comparability of the results of PET/CT with 18F-FDG obtained on the different models of PET/CT units with different technological characteristics.

BACKGROUND: Different gamma camera calibration factor (CF) geometries have been proposed to convert SPECT data into units of activity concentration. However, no consensus has been reached on a standardised geometry. The CF is dependent on the selected geometry and is further affected by partial volume effects. This study investigated the effect of two CF geometries and their corresponding recovery coefficients (RCs) on the quantification accuracy of 177Lu SPECT images using Monte Carlo simulations.
METHODS: The CF geometries investigated were (i) a radioactive-sphere surrounded by non-radioactive water (sphere-CF) and (ii) a cylindrical phantom uniformly filled with radioactive water (cylinder-CF). Recovery coefficients were obtained using the sphere-CF and cylinder-CF, yielding the sphere-RC and cylinder-RC values, respectively, for partial volume correction (PVC). The quantification accuracy was evaluated using four different-sized spheres (15.6-65.4 ml) and a kidney model with known activity concentrations inside a cylindrical, torso and patient phantom. Images were reconstructed with the 3D OS-EM algorithm incorporating attenuation, scatter and detector-response corrections. Segmentation was performed using the physical size and a small cylindrical volume inside the cylinder for the sphere-CF and cylinder-CF, respectively.
RESULTS: The sphere quantification error (without PVC) was better for the sphere-CF (≤ - 5.54%) compared to the cylinder-CF (≤ - 20.90%), attributed to the similar geometry of the quantified and CF spheres. Partial volume correction yielded comparable results for the sphere-CF-RC (≤ 3.47%) and cylinder-CF-RC (≤ 3.53%). The accuracy of the kidney quantification was poorer (≤ 22.34%) for the sphere-CF without PVC compared to the cylinder-CF (≤ 2.44%). With PVC, the kidney quantification results improved and compared well for the sphere-CF-RC (≤ 3.50%) and the cylinder-CF-RC (≤ 3.45%).
CONCLUSIONS: The study demonstrated that upon careful selection of CF-RC combinations, comparable quantification errors (≤ 3.53%) were obtained between the sphere-CF-RC and cylinder-CF-RC, when all corrections were applied.

BACKGROUND: The Siemens high-resolution research tomograph (HRRT - a dedicated brain PET scanner) is to this day one of the highest resolution PET scanners; thus, it can serve as useful benchmark when evaluating performance of newer scanners. Here, we report results from a cross-validation study between the HRRT and the whole-body GE SIGNA PET/MR focusing on brain imaging. Phantom data were acquired to determine recovery coefficients (RCs), % background variability (%BG), and image voxel noise (%). Cross-validation studies were performed with six healthy volunteers using [11C]DTBZ, [11C]raclopride, and [18F]FDG. Line profiles, regional time-activity curves, regional non-displaceable binding potentials (BPND) for [11C]DTBZ and [11C]raclopride scans, and radioactivity ratios for [18F]FDG scans were calculated and compared between the HRRT and the SIGNA PET/MR.
RESULTS: Phantom data showed that the PET/MR images reconstructed with an ordered subset expectation maximization (OSEM) algorithm with time-of-flight (TOF) and TOF + point spread function (PSF) + filter revealed similar RCs for the hot spheres compared to those obtained on the HRRT reconstructed with an ordinary Poisson-OSEM algorithm with PSF and PSF + filter. The PET/MR TOF + PSF reconstruction revealed the highest RCs for all hot spheres. Image voxel noise of the PET/MR system was significantly lower. Line profiles revealed excellent spatial agreement between the two systems. BPND values revealed variability of less than 10% for the [11C]DTBZ scans and 19% for [11C]raclopride (based on one subject only). Mean [18F]FDG ratios to pons showed less than 12% differences.
CONCLUSIONS: These results demonstrated comparable performances of the two systems in terms of RCs with lower voxel-level noise (%) present in the PET/MR system. Comparison of in vivo human data confirmed the comparability of the two systems. The whole-body GE SIGNA PET/MR system is well suited for high-resolution brain imaging as no significant performance degradation was found compared to that of the reference standard HRRT.

OBJECTIVE: In this study the performance characteristics of the Albira II PET sub-system and the response of the system for the following radionuclides 18F, 68Ga and 64Cu was analyzed.
METHODS: The Albira II tri-modal system (Bruker BioSpin MRI GmbH, Ettlingen, Germany) is a pre-clinical device for PET, SPECT and CT. The PET sub-system uses single continuous crystal detectors of lutetium yttrium orthosilicate (LYSO). The detector assembly consists of three rings of 8 detector modules. The transaxial field of view (FOV) has a diameter of 80mm and the axial FOV is 148mm. A NEMA NU-4 image quality phantom (Data Spectrum Corporation, Durham, USA) having five rods with diameters of 1, 2, 3, 4 and 5mm and a uniform central region was used. Measurements with 18F, 68Ga and 64Cu were performed in list mode acquisition over 10h. Data were reconstructed using a maximum-likelihood expectation-maximization (MLEM) algorithm with iteration numbers between 5 and 50. System sensitivity, count rate linearity, convergence and recovery coefficients were analyzed.
RESULTS: The sensitivities for the entire FOV (non-NEMA method) for 18F, 68Ga and 64Cu were (3.78±0.05)%, (3.97±0.18)% and (3.79±0.37)%, respectively. The sensitivity based on the NEMA protocol using the 22Na point source yielded (5.53±0.06)%. Dead-time corrected true counts were linear for activities ≤7MBq (18F and 68Ga) and ≤17MBq (64Cu) in the phantom. The radial, tangential and axial full widths at half maximum (FWHMs) were 1.52, 1.47 and 1.48mm. Recovery coefficients for the uniform region with a total activity of 8MBq in the phantom were (0.97±0.05), (0.98±0.06), (0.98±0.06) for 18F, 68Ga and 64Cu, respectively.
CONCLUSIONS: The Albira II pre-clinical PET system has an adequate sensitivity range and the system linearity is suitable for the range of activities used for pre-clinical imaging. Overall, the system showed a favorable image quality for pre-clinical applications.

OBJECTIVE: We evaluated the possibility to assess (90)Y-PET/CT imaging quantification for dosimetry in (90)Y-peptide receptor radionuclide therapy.
METHODS: Tests were performed by Discovery 710 Elite (GE) PET/CT equipment. A body-phantom containing radioactive-coplanar-spheres was filled with (90)Y water solution to reproduce different signal-to-background-activity-ratios (S/N). We studied minimum detectable activity (MDA) concentration, contrast-to-noise ratio (CNR), and full-width-at-half-maximum (FWHM). Subsequently, three recovery coefficients (RC)-based correction approaches were evaluated: maximum-RC, resolution-RC, and isovolume-RC. The analysis of the volume segmentation thresholding method was also assessed to derive a relationship between the true volume of the targets and the threshold to be applied to the PET images. (90)Y-PET/CT imaging quantification was then achieved on some patients and related with preclinical tests. Moreover, the dosimetric evaluation was obtained on the target regions.
RESULTS: CNR value was greater than 5 if the MDA was greater than 0.2 MBq/mL with no background activity and 0.5-0.7 MBq/mL with S/N ranging from 3 to 6. FWHM was equal to 7 mm. An exponential fitting of isovolume RCs-based correction technique was adopted for activity quantification. Adaptive segmentation thresholding exponential curves were obtained and applied for target volume identification in three signal-to-background-activity-ratios. The imaging quantification study and dosimetric evaluations in clinical cases was feasible and the results were coherent with those obtained in preclinical tests.
CONCLUSIONS: (90)Y-PET/CT imaging quantification is possible both in phantoms and in patients. Absorbed dose evaluations in clinical applications are strongly related to targets activity concentration.