Simultaneous dual-isotope technetium-99m/thallium-201 cardiac SPET imaging using a projection-dependent spilldown correction factor

99mTc/123I Dual-Radionuclide Correction for Self-Scatter, Down-Scatter, and Tailing Effect for a CZT SPECT with Varying Tracer Distributions

SPECT systems distinguish radionuclides by using multiple energy windows. For CZT detectors, the energy spectrum has a low energy tail leading to additional crosstalk between the radionuclides. Previous work developed models to correct the scatter and crosstalk for CZT-based dedicated cardiac systems with similar 99mTc/123I tracer distributions. These models estimate the primary and scatter components by solving a set of equations employing the MLEM approach. A penalty term is applied to ensure convergence. The present work estimates the penalty term for any 99mTc/123I activity level. An iterative approach incorporating Monte Carlo into the iterative image reconstruction loops was developed to estimate the penalty terms. We used SIMIND and XCAT phantoms in this study. Distribution of tracers in the myocardial tissue and blood pool were varied to simulate a dynamic acquisition. Evaluations of the estimated and the real penalty terms were performed using simulations and large animal data. The myocardium to blood pool ratio was calculated using ROIs in the myocardial tissue and the blood pool for quantitative analysis. All corrected images yielded a good agreement with the gold standard images. In conclusion, we developed a CZT crosstalk correction method for quantitative imaging of 99mTc/123I activity levels by dynamically estimating the penalty terms.

Iterative deconvolution of simultaneous 99mTc and 201Tl projection data measured on a CdZnTe-based cardiac SPECT scanner

We present a method of correcting self-scatter and crosstalk effects in simultaneous technetium-99m/thallium-201 stress/rest myocardial perfusion (single photon emission computed tomography) SPECT scans. The method, which is in essence a hybrid between the triple energy window method and scatter modelling, is based on a model of spatial and spectral distribution of projection counts in several selected energy windows. The parameters of the model are determined from measurements of thin rod sources in air when no in-object scatter or attenuation effects are present. The model equations are solved using the iterative maximum likelihood expectation maximization algorithm in the projection space to find estimates of the primary photopeak counts of both radionuclides. The method has been developed particularly for a novel dedicated cardiac camera based on CdZnTe pixellated detectors, although it can also be adapted to a conventional scintillator camera. The method has been validated in anthropomorphic phantom experiments. Significant improvement in defect contrast has been observed with only moderate increase in image noise. The application of the method to patient data is illustrated.

A method for quantitative cell tracking using SPECT for the evaluation of myocardial stem cell therapy

PURPOSE

A promising SPECT-based method for evaluating stem cells therapy uses (111)In-labelled cells, transfected with a reporter gene. Cells are first transplanted to the infarct, and subsequently interrogated for transgenic expression using a systemic injection of an (131)I-labelled reporter probe. The method is impeded by the physical effects of scatter, (131)I/(111)In cross-talk, and attenuation. We hypothesize that correcting for physical effects improves detection of transgenic expression in transplanted cells when (111)In localization is available.

METHODS

Canine bone marrow mesenchymal cells (BMMCs), radiolabelled and transfected, were injected into infarcted myocardium. Next, a reporter probe was injected systemically, and 22 SPECT scans were acquired over 20 h. Finally, (99m)Tc-sestamibi was injected and imaged. The animal was killed, the heart sectioned, and counted for (131)I and (111)In in a well-counter ('gold standard'). Canine SPECTs were reconstructed in two ways: with corrections for physical effects and without corrections. The first (111)In reconstruction and the (99m)Tc reconstruction were used to define volumes-of-interest over the transplanted BMMC (VBMMC) and normal myocardium (VNM), respectively.

RESULTS

(131)I reconstructions without corrections for physical effects had negligible differential uptake. With corrections, VBMMC was consistently higher than VNM, demonstrating transgene expression. (131)I had the following VBMMC:VNM activity ratio: without correction for physical effects=0.869; with corrections=1.23; and well-counter=1.21. VNM showed the following (131)I:(111)In activity ratio: without corrections=3.07; with corrections=1.38; and well-counter=1.58.

CONCLUSIONS

In dual-isotope SPECT, corrections for physical effects were required to detect transgene expression in cells transplanted into an infarction when localization information was available.

Monte Carlo-based down-scatter correction of SPECT attenuation maps

Combined acquisition of transmission and emission data in single-photon emission computed tomography (SPECT) can be used for correction of non-uniform photon attenuation. However, down-scatter from a higher energy isotope (e.g. 99mTc) contaminates lower energy transmission data (e.g. 153Gd, 100 keV), resulting in underestimation of reconstructed attenuation coefficients. Window-based corrections are often not very accurate and increase noise in attenuation maps. We have developed a new correction scheme. It uses accurate scatter modelling to avoid noise amplification and does not require additional energy windows. The correction works as follows: Initially, an approximate attenuation map is reconstructed using down-scatter contaminated transmission data (step 1). An emission map is reconstructed based on the contaminated attenuation map (step 2). Based on this approximate 99mTc reconstruction and attenuation map, down-scatter in the 153Gd window is simulated using accelerated Monte Carlo simulation (step 3). This down-scatter estimate is used during reconstruction of a corrected attenuation map (step 4). Based on the corrected attenuation map, an improved 99mTc image is reconstructed (step 5). Steps 3-5 are repeated to incrementally improve the down-scatter estimate. The Monte Carlo simulator provides accurate down-scatter estimation with significantly less noise than down-scatter estimates acquired in an additional window. Errors in the reconstructed attenuation coefficients are reduced from ca. 40% to less than 5%. Furthermore, artefacts in 99mTc emission reconstructions are almost completely removed. These results are better than for window-based correction, both in simulation experiments and in physical phantom experiments. Monte Carlo down-scatter simulation in concert with statistical reconstruction provides accurate down-scatter correction of attenuation maps.

Efficient simulation of SPECT down-scatter including photon interactions with crystal and lead

A major image degrading factor in simultaneous Dual Isotope (DI) SPECT or simultaneous Emission-Transmission (ECT-TCT) imaging, is the detection of photons emitted by the higher energy isotope in the energy window used for imaging the lower energy isotope. In Tc-99m/Tl-201 DI-SPECT typically tens of percents of the total detected down-scatter is caused by lead x rays. In Tc-99m/Gd-153 ECT-TCT, a comparable fraction of the down-scatter originates from Tc-99m photons which only partly deposit their energy in the detector crystal (i.e., due to crystal interactions). Efficient simulation methods which model down-scatter can be used to optimize DI-SPECT or ECT-TCT imaging acquisition or reconstruction protocols. In this paper we adapt a previously proposed efficient down-scatter simulation method, to include the interactions of photons with the detector crystal and collimator lead. To this end, point spread function tables including crystal and lead interactions are precalculated. Subsequently, photons are traced through the patient body until their last scatter position, and the precalculated responses are used to project the photons onto the detector plane, while photon attenuation in the patient is taken into account. The approach is evaluated by comparing simulated Tc-99m down-scatter projections with measured projections. Incorporation of photon interaction with crystal and lead leads to significantly improved accuracy of the shape of down-scatter responses, while differences in total counts between simulated and measured projections typically decrease from tens of percents to a couple of percents. Calculating 60 down-scatter projections of an extended distribution on a 64 x 64 x 64 grid takes about three minutes on a PC with two 1.2 GHz processors. We conclude that accurate and efficient simulation of down-scatter is now possible including the major effects of the nonuniform mass density of the patient as well as photon interactions with the crystal and collimator lead.

Rapid SPECT simulation of downscatter in non-uniform media

A rotation-based Monte Carlo (MC) simulation method (RMC) has been developed, designed for rapid calculation of downscatter through non-uniform media in SPECT. A possible application is downscatter correction in dual isotope SPECT. With RMC, only a fraction of all projections of a SPECT study have to be MC simulated in a standard manner. The other projections can be estimated rapidly using the results of these standard MC calculations. For efficiency, approximations have to be made in RMC with regard to the final scatter angle of the detected photons. Further speed-up is obtained by combining RMC with convolution-based forced detection (CFD) instead of forced detection (FD), which is a more common variance reduction technique for MC. The RMC method was compared with standard MC for 99mTc downscatter in a 201Tl window (72 keV+/-10%) using a digital thorax phantom. The resulting scatter projections are in good agreement (maximum bias a few per cent of the largest value in the projection), but RMC with CFD is about three orders in magnitude faster than standard MC with FD and up to 25 times faster than standard MC with CFD. Using RMC combined with CFD, the generation of 64 almost noise-free downscatter projections (64 x 64) takes only a couple of minutes on a 500 MHz Pentium processor. Therefore, rotation-based Monte Carlo could serve as a practical tool for downscatter correction schemes in dual isotope SPECT.

Comparison of correction techniques for simultaneous 201Tl/99mTc myocardial perfusion SPECT imaging: a dog study

We compared two correction methods for simultaneous 201Tl/99mTc dual-isotope single-photon emission computed tomography (SPECT). Both approaches use the information from the third energy window placed between the photopeak windows of the 201Tl and 99mTc. The first approach, described by Moore et al, corrects only for the contribution of the 99mTc to the 201Tl primary 70 keV window. We developed the three-window transformation dual isotope correction method, which is a simultaneous cross-talk correction. The two correction methods were compared in a simultaneous 201Tl/99mTc sestamibi cardiac dog study. Three separate acquisitions were performed in this dog study: two single-isotope and one dual-isotope acquisition. The 201Tl single-isotope images were used as references. The total number of counts, and the contrast between the left ventricular cavity (LVC) and the myocardium, were used in 70 keV short axis slices as parameters for evaluating the results of the dual-isotope correction methods. Three consecutive short-axis slices were used to calculate averaged contrast and the averaged total number of counts. The total number of the counts was 667000+/-500 and 414500+/-400 counts for the dual isotope (201Tl+/-99mTc) and single-isotope (201Tl-only) 70 keV images, respectively. The corrected dual-isotope images had 514700+/-700 and 368000+/-600 counts for Moore's correction and our approach, respectively. Moore's method improved contrast in the dual isotope 70 keV image to 0.14+/-0.03 from 0.11+/-0.02, which was the value in the 70 keV non-corrected dual-isotope image. Our method improved the same contrast to 0.22+/-0.03. The contrast in the 201Tl single-isotope 70 keV image was 0.28+/-0.02. Both methods improved the 70 keV dual-isotope images. However, our approach provided slightly better images than Moore's correction when compared with 201Tl-only 70 keV images.

A transformation cross-talk technique for simultaneous dual radionuclide imaging: a myocardial perfusion 201Tl/99Tcm sestamibi dog SPECT study

We have developed a novel transformation method for the correction of cross-talk in simultaneous dual radionuclide single photon emission CT (SPECT) imaging. It is based on the assumption that the transformations, which transform the primary energy window images into the scatter images as viewed in the other energy windows, are known. The method was tested on a dog model. These transformations were found by measuring the point response functions (prf) in different energy windows for both radionuclides in water. The dual radionuclide correction method described takes into account the different spatial distributions of the primary and scatter cross-talk photons in different energy windows. This method also includes the sequential application of restoration filters to the resulting cross-talk corrected images. We used a dog model in three separate studies: two single radionuclide studies used as references and one dual radionuclide study. Contrast between the left ventricular cavity (LVC) and the myocardium was used in horizontal long axis (HLA) slices as a parameter to evaluate the results of the dual radionuclide correction method with restoration. The increase of the contrast in the dual radionuclide corrected images in both energy windows, i.e. 201Tl primary window (70 keV) and 99Tcm primary window (140 keV), was significant. The cross-talk corrected 70 keV dual radionuclide HLA slice had a contrast of 0.62 compared with 0.35, which was the value in the non-corrected dual radionuclide HLA slice. Restoration improved the contrast to 0.68. In the single radionuclide 201Tl image, the same contrast was 0.59, improving to 0.70 after restoration. For the dual radionuclide 140 keV HLA slice, the contrast increased from 0.69 to 0.76 after cross-talk correction. Additional increase of the contrast to 0.83 resulted from restoration filtering. In the single radionuclide 99Tcm sestamibi 140 keV HLA slice the improvement of contrast was from 0.63 to 0.86 as a result of the restoration. The transformation three-window, dual radionuclide correction method with restoration improves the quality of the simultaneous rest 201Tl/stress 99Tcm sestamibi SPECT imaging.

Simultaneous technetium-99m/thallium-201 SPECT imaging with model-based compensation for cross-contaminating effects

Simultaneous acquisition of dual-isotope SPECT data offers a number of advantages over separately acquired data; however, simultaneous acquisition can result in cross-contamination between isotopes. In this work we propose and evaluate two frameworks for iterative model-based compensation of cross-contamination in dual-isotope SPECT. The methods were applied to cardiac imaging with technetium-99m-sestamibi and thallium-201, and they were compared with a subtraction-based compensation method using a cross-talk estimate obtained from an auxiliary energy window. Monte Carlo simulations were performed to carefully study aspects of bias and noise for the methods, and a torso phantom with cardiac insert was used to evaluate the performance of the methods for experimentally acquired data. The cross-talk compensation methods substantially improved lesion contrast and significantly reduced quantitative errors for simultaneously acquired data. Thallium image normalized mean square error (NMSE) was reduced from 0.522 without cross-talk compensation to as low as 0.052 with model-based cross-talk compensation. This is compared with a NMSE of 0.091 for the subtraction-based compensation method. The application of a preliminary model for cross-talk arising from lead fluorescence x-rays and collimator scatter gave promising results, and the future development of a more accurate model for collimator interactions would probably benefit simultaneous Tc/Tl imaging. Model-based compensation methods provide feasible cross-talk compensation in clinically acceptable times, and they may ultimately make simultaneous dual-isotope protocols an effective alternative for many imaging procedures.

Relevance of accurate Monte Carlo modeling in nuclear medical imaging

Monte Carlo techniques have become popular in different areas of medical physics with advantage of powerful computing systems. In particular, they have been extensively applied to simulate processes involving random behavior and to quantify physical parameters that are difficult or even impossible to calculate by experimental measurements. Recent nuclear medical imaging innovations such as single-photon emission computed tomography (SPECT), positron emission tomography (PET), and multiple emission tomography (MET) are ideal for Monte Carlo modeling techniques because of the stochastic nature of radiation emission, transport and detection processes. Factors which have contributed to the wider use include improved models of radiation transport processes, the practicality of application with the development of acceleration schemes and the improved speed of computers. In this paper we present a derivation and methodological basis for this approach and critically review their areas of application in nuclear imaging. An overview of existing simulation programs is provided and illustrated with examples of some useful features of such sophisticated tools in connection with common computing facilities and more powerful multiple-processor parallel processing systems. Current and future trends in the field are also discussed.

The influence of backscatter material on 99mTc and 201Tl line source responses

SPECT projections are contaminated by scatter, resulting in reduced image contrast and quantitative errors. When tissue is present behind the source, some of the detected photons backscatter via this tissue. Particularly in dual-isotope SPECT and in combined emission-transmission SPECT, backscatter constitutes a major part of the down-scatter contamination in lower-energy windows. In this paper, the effects of backscatter material were investigated. Planar images of 99mTc and 201Tl line sources between varying numbers of Perspex slabs were analysed using the photopeak windows and various scatter windows. In the 99mTc photopeak window no significant change in total counts due to backscatter material was measured. In the 201Tl photopeak window an increase of about 10% in total counts was observed. In the scatter windows an even more explicit influence of backscatter material was measured. For instance, at a forward depth of 10 cm, total counts of a 99mTc source detected in the 72 keV window eventually doubled with increasing backscatter material, compared with the situation without backscatter material. The backscatter contribution plateaued when more than 5-10 cm of scatter material was placed behind the source. In conclusion, backscatter should be taken into account, particularly in model-based down-scatter correction methods in dual-isotope SPECT and combined emission-transmission SPECT.