Evaluation of monolithic crystal detector with dual-ended readout utilizing multiplexing method

Objective.Monolithic crystal detectors are increasingly being applied in positron emission tomography (PET) devices owing to their excellent depth-of-interaction (DOI) resolution capabilities and high detection efficiency. In this study, we constructed and evaluated a dual-ended readout monolithic crystal detector based on a multiplexing method.Approach.We employed two 12 × 12 silicon photomultiplier (SiPM) arrays for readout, and the signals from the 12 × 12 array were merged into 12 X and 12 Y channels using channel multiplexing. In 2D reconstruction, three methods based on the centre of gravity (COG) were compared, and the concept of thresholds was introduced. Furthermore, a light convolutional neural network (CNN) was employed for testing. To enhance depth localization resolution, we proposed a method by utilizing the mutual information from both ends of the SiPMs. The source width and collimation effect were simulated using GEANT4, and the intrinsic spatial resolution was separated from the measured values.Main results.At an operational voltage of 29 V for the SiPM, an energy resolution of approximately 12.5 % was achieved. By subtracting a 0.8 % threshold from the total energy in every channel, a 2D spatial resolution of approximately 0.90 mm full width at half maximum (FWHM) can be obtained. Furthermore, a higher level of resolution, approximately 0.80 mm FWHM, was achieved using a CNN, with some alleviation of edge effects. With the proposed DOI method, a significant 1.36 mm FWHM average DOI resolution can be achieved. Additionally, it was found that polishing and black coating on the crystal surface yielded smaller edge effects compared to a rough surface with a black coating.Significance.The introduction of a threshold in COG method and a dual-ended readout scheme can lead to excellent spatial resolution for monolithic crystal detectors, which can help to develop PET systems with both high sensitivity and high spatial resolution.

Image quality evaluation for a clinical organ-targeted PET camera

Introduction

A newly developed clinical organ-targeted Positron Emission Tomography (PET) system (also known as Radialis PET) is tested with a set of standardized and custom tests previously used to evaluate the performance of Positron Emission Mammography (PEM) systems.

Methods

Imaging characteristics impacting standardized uptake value (SUV) and detectability of small lesions, namely spatial resolution, linearity, uniformity, and recovery coefficients, are evaluated.

Results

In-plane spatial resolution was measured as 2.3 mm ± 0.1 mm, spatial accuracy was 0.1 mm, and uniformity measured with flood field and NEMA NU-4 phantom was 11.7% and 8.3% respectively. Selected clinical images are provided as reference to the imaging capabilities under different clinical conditions such as reduced activity of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (18F-FDG) and time-delayed acquisitions. SUV measurements were performed for selected clinical acquisitions to demonstrate a capability for quantitative image assessment of different types of cancer including for invasive lobular carcinoma with comparatively low metabolic activity. Quantitative imaging performance assessment with phantoms demonstrates improved contrast recovery and spill-over ratio for this PET technology when compared to other commercial organ-dedicated PET systems with similar spatial resolution. Recovery coefficients were measured to be 0.21 for the 1 mm hot rod and up to 0.89 for the 5 mm hot rod of NEMA NU-4 Image Quality phantom.

Discussion

Demonstrated ability to accurately reconstruct activity in tumors as small as 5 mm suggests that the Radialis PET technology may be well suited for emerging clinical applications such as image guided assessment of response to neoadjuvant systemic treatment (NST) in lesions smaller than 2 cm. Also, our results suggest that, while spatial resolution greatly influences the partial volume effect which degrades contrast recovery, optimized count rate performance and image reconstruction workflow may improve recovery coefficients for systems with comparable spatial resolution. We emphasize that recovery coefficient should be considered as a primary performance metric when a PET system is used for accurate lesion size or radiotracer uptake assessments.

Crystal scatter effects in a large-area dual-panel Positron Emission Mammography system

Positron Emission Mammography (PEM) is a valuable molecular imaging technique for breast studies using pharmaceuticals labeled with positron emitters and dual-panel detectors. PEM scanners normally use large scintillation crystals coupled to sensitive photodetectors. Multiple interactions of the 511 keV annihilation photons in the crystals can result in event mispositioning leading to a negative impact in radiopharmaceutical uptake quantification. In this work, we report the study of crystal scatter effects of a large-area dual-panel PEM system designed with either monolithic or pixelated lutetium yttrium orthosilicate (LYSO) crystals using the Monte Carlo simulation platform GATE. The results show that only a relatively small fraction of coincidences (~20%) arise from events where both coincidence photons undergo single interactions (mostly through photoelectric absorption) in the crystals. Most of the coincidences are events where at least one of the annihilation photons undergoes a chain of Compton scatterings: approximately 79% end up in photoelectric absorption while the rest (<1%) escape the detector. Mean positioning errors, calculated as the distance between first hit and energy weighted (assigned) positions of interaction, were 1.70 mm and 1.92 mm for the monolithic and pixelated crystals, respectively. Reconstructed spatial resolution quantification with a miniDerenzo phantom and a list mode iterative reconstruction algorithm shows that, for both crystal types, 2 mm diameter hot rods were resolved, indicating a relatively small effect in spatial resolution. A drastic reduction in peak-to-valley ratios for the same hot-rod diameters was observed, up to a factor of 14 for the monolithic crystals and 7.5 for the pixelated ones.

18F-FDG Dedicated Breast PET Complementary to Breast MRI for Evaluating Early Response to Neoadjuvant Chemotherapy

Purpose To compare quantitative measures of tumor metabolism and perfusion using fluorine 18 (18F) fluorodeoxyglucose (FDG) dedicated breast PET (dbPET) and breast dynamic contrast-enhanced (DCE) MRI during early treatment with neoadjuvant chemotherapy (NAC). Materials and Methods Prospectively collected DCE MRI and 18F-FDG dbPET examinations were analyzed at baseline (T0) and after 3 weeks (T1) of NAC in 20 participants with 22 invasive breast cancers. FDG dbPET-derived standardized uptake value (SUV), metabolic tumor volume, and total lesion glycolysis (TLG) and MRI-derived percent enhancement (PE), signal enhancement ratio (SER), and functional tumor volume (FTV) were calculated at both time points. Differences between FDG dbPET and MRI parameters were evaluated after stratifying by receptor status, Ki-67 index, and residual cancer burden. Parameters were compared using Wilcoxon signed rank and Mann-Whitney U tests. Results High Ki-67 tumors had higher baseline SUVmean (difference, 5.1; P = .01) and SUVpeak (difference, 5.5; P = .04). At T1, decreases were observed in FDG dbPET measures (pseudo-median difference T0 minus T1 value [95% CI]) of SUVmax (-6.2 [-10.2, -2.6]; P < .001), SUVmean (-2.6 [-4.9, -1.3]; P < .001), SUVpeak (-4.2 [-6.9, -2.3]; P < .001), and TLG (-29.1 mL3 [-71.4, -6.8]; P = .005) and MRI measures of SERpeak (-1.0 [-1.3, -0.2]; P = .02) and FTV (-11.6 mL3 [-22.2, -1.7]; P = .009). Relative to nonresponsive tumors, responsive tumors showed a difference (95% CI) in percent change in SUVmax of -34.3% (-55.9%, 1.5%; P = .06) and in PEpeak of -42.4% (95% CI: -110.5%, 8.5%; P = .08). Conclusion 18F-FDG dbPET was sensitive to early changes during NAC and provided complementary information to DCE MRI that may be useful for treatment response evaluation. Keywords: Breast, PET, Dynamic Contrast-enhanced MRI Clinical trial registration no. NCT01042379 Supplemental material is available for this article. © RSNA, 2024.

Advances in Breast PET Instrumentation

Dedicated breast PET scanners currently have a spatial resolution in the 1.5 to 2 mm range, and the ability to provide tomographic images and quantitative data. They are also commercially available from a few vendors. A review of past and recent advances in the development and performance of dedicated breast PET scanners is summarized.

Clinical Applications of Dedicated Breast Positron Emission Tomography

Breast-specific positron imaging systems provide higher sensitivity than whole-body PET for breast cancer detection. The clinical applications for breast-specific positron imaging are similar to breast MRI including preoperative local staging and neoadjuvant therapy response assessment. Breast-specific positron imaging may be an alternative for patients who cannot undergo breast MRI. Further research is needed in expanding the field-of-view for posterior breast lesions, increasing biopsy capability, and reducing radiation dose. Efforts are also necessary for developing appropriate use criteria, increasing availability, and advancing insurance coverage.

Dedicated phantom tools using traceable 68Ge/68Ga point-like sources for dedicated-breast PET and positron emission mammography scanners

Since the early 2000s, many types of positron emission tomography (PET) scanners dedicated to breast imaging for the diagnosis of breast cancer have been introduced. However, conventional performance evaluation methods developed for whole-body PET scanners cannot be used for such devices. In this study, we developed phantom tools for evaluating the quantitative accuracy of positron emission mammography (PEM) and dedicated-breast PET (dbPET) scanners using novel traceable point-like ⁶⁸Ge/⁶⁸ Ga sources. The PEM phantom consisted of an acrylic cube (100 × 100 × 40 mm) and three point-like sources. The dbPET phantom comprised an acrylic cylinder (ø100 × 100 mm) and five point-like sources. These phantoms were used for evaluating the fundamental responses of clinical PEM and dbPET scanners to point-like inputs in a medium. The results showed that reasonable recovery values were obtained based on region-of-interest analyses of the reconstructed images. The developed phantoms using traceable ⁶⁸Ge/⁶⁸ Ga point-like sources were useful for evaluating the physical characteristics of PEM and dbPET scanners. Thus, they offer a practical, reliable, and universal measurement scheme for evaluating various types of PET scanners using common sets of sealed sources.

Design and performance simulation studies of a breast PET insert integrable into a clinical whole-body PET/MRI scanner

Objective. Three different breast positron emission tomography (PET) insert geometries are proposed for integration into an existing magnetic resonance imaging (MRI) breast coil (Breast Biopsy Coil, NORAS MRI products) to be used inside a whole-body PET/MRI scanner (Biograph mMR, Siemens Healthineers) to enhance the sensitivity and spatial resolution of imaging inside the breast.Approach. Monte Carlo simulations were performed to predict and compare the performance characteristics of the three geometries in terms of the sensitivity, spatial resolution, scatter fraction, and noise equivalent count rate (NECR). In addition, the background single count rate due to organ uptake in a clinical scan scenario was predicted using a realistic anthropomorphic phantom.Main results. In the center of the field of view (cFOV), absolute sensitivities of 3.1%, 2.7%, and 2.2% were found for Geometry A (detectors arranged in two cylinders), Geometry B (detectors arranged in two partial cylinders), and Geometry C (detectors arranged in two half cylinders combined with two plates), respectively. The full width at half maximum spatial resolution was determined to be 1.7 mm (Geometry A), 1.8 mm (Geometry B) and 2.0 mm (Geometry C) at 5 mm from the cFOV. Designs with multiple scintillation-crystal layers capable of determining the depth of interaction (DOI) strongly improved the spatial resolution at larger distances from the transaxial cFOV. The system scatter fractions were 33.1% (Geometries A and B) and 32.3% (Geometry C). The peak NECRs occurred at source activities of 300 MBq (Geometry A), 310 MBq (Geometry B) and 340 MBq (Geometry C). The background single-event count rates were 17.1 × 10⁶cps (Geometry A), 15.3 × 10⁶cps (Geometry B) and 14.8 × 10⁶cps (Geometry C). Geometry A in the three-layer DOI variant exhibited the best PET performance characteristics but could be challenging to manufacture. Geometry C had the lowest impact on the spatial resolution and the lowest sensitivity among the investigated geometries.Significance. Geometry B in the two-layer DOI variant represented an effective compromise between the PET performance and manufacturing difficulty and was found to be a promising candidate for the future breast PET insert.

Correlation between MAMMI-PET findings and anatomopathological outcomes in breast cancer patients

OBJECTIVE

Imaging tests are a key element in the preoperative diagnosis of patients with breast cancer. Whole-body PET-computed tomography (PET/CT) breast studies have a limited spatial resolution, although dedicated breast PET (dbPET) devices such as the Mammography with Molecular Imaging PET (MAMMI-PET), have an increased sensitivity to detect tumor foci, especially those smaller than 2 cm. The purpose of this study is to define the validity and reliability of this new device.

METHODS

A prospective and analytical observational study was carried out in a sample of patients with histologically confirmed breast cancer who were treated at our hospital between January 2017 and November 2018. The anatomopathological study findings for the surgical pieces were used as gold standards and we calculated their concordance with the findings from the MAMMI-PET as well as the validity and reliability parameters for this test.

RESULTS

Data from 32 patients and 44 lesions (36 malignant and 8 benign) were evaluated. The mean patient age was 51.50 ± 11.68 years. Twenty patients had received neoadjuvant chemotherapy (NACT). The technique concordance rate was weak ( K  = 0.349, P  = 0.001) and was 84.3% for benign lesions and 62.6% for malignant ones. The MAMMI-PET sensitivity was 75%, whereas its specificity was 57.1%; the positive predictive value was 81.8% and the negative predictive value was 47.1%, with an overall precision of 70%. The MAMMI-PET sensitivity was higher in patients who had not undergone NACT and was significantly higher in patients with luminal B breast cancer compared to the luminal A subtype.

CONCLUSION

The MAMMI-PET device had acceptable sensitivity and a high positive predictive value for the preoperative evaluation of patients with breast cancer; it was especially useful for lesions whose diagnosis with other imaging tests had been doubtful.

Evaluation of a High-Sensitivity Organ-Targeted PET Camera

The aim of this study is to evaluate the performance of the Radialis organ-targeted positron emission tomography (PET) Camera with standardized tests and through assessment of clinical-imaging results. Sensitivity, count-rate performance, and spatial resolution were evaluated according to the National Electrical Manufacturers Association (NEMA) NU-4 standards, with necessary modifications to accommodate the planar detector design. The detectability of small objects was shown with micro hotspot phantom images. The clinical performance of the camera was also demonstrated through breast cancer images acquired with varying injected doses of 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (¹⁸F-FDG) and qualitatively compared with sample digital full-field mammography, magnetic resonance imaging (MRI), and whole-body (WB) PET images. Micro hotspot phantom sources were visualized down to 1.35 mm-diameter rods. Spatial resolution was calculated to be 2.3 ± 0.1 mm for the in-plane resolution and 6.8 ± 0.1 mm for the cross-plane resolution using maximum likelihood expectation maximization (MLEM) reconstruction. The system peak noise equivalent count rate was 17.8 kcps at a ¹⁸F-FDG concentration of 10.5 kBq/mL. System scatter fraction was 24%. The overall efficiency at the peak noise equivalent count rate was 5400 cps/MBq. The maximum axial sensitivity achieved was 3.5%, with an average system sensitivity of 2.4%. Selected results from clinical trials demonstrate capability of imaging lesions at the chest wall and identifying false-negative X-ray findings and false-positive MRI findings, even at up to a 10-fold dose reduction in comparison with standard ¹⁸F-FDG doses (i.e., at 37 MBq or 1 mCi). The evaluation of the organ-targeted Radialis PET Camera indicates that it is a promising technology for high-image-quality, low-dose PET imaging. High-efficiency radiotracer detection also opens an opportunity to reduce administered doses of radiopharmaceuticals and, therefore, patient exposure to radiation.

Performance evaluation of side-by-side optically coupled monolithic LYSO crystals

Background

Significant interest has been recently shown for using monolithic scintillation crystals in molecular imaging systems, such as positron emission tomography (PET) scanners. Monolithic‐based PET scanners result in a lower cost and higher sensitivity, in contrast to systems based on the more conventional pixellated configuration. The monolithic design allows one to retrieve depth‐of‐interaction information of the impinging 511 keV photons without the need for additional hardware materials or complex positioning algorithms. However, the so‐called edge‐effect inherent to monolithic‐based approaches worsens the detector performance toward the crystal borders due to the truncation of the light distribution, thus decreasing positioning accuracy.

Purpose

The main goal of this work is to experimentally demonstrate the detector performance improvement when machine‐learning artificial neural‐network (NN) techniques are applied for positioning estimation in multiple monolithic scintillators optically coupled side‐by‐side.

Methods

In this work, we show the performance evaluation of two LYSO crystals of 33 × 25.4 × 10 mm³ optically coupled by means of a high refractive index adhesive compound (Meltmount, refractive index n = 1.70). A 12 × 12 silicon photomultiplier array has been used as photosensor. For comparison, the same detector configuration was tested for two additional coupling cases: (1) optical grease (n = 1.46) in between crystals, and (2) isolated crystals using black paint with an air gap at the interface (named standard configuration). Regarding 2D photon positioning (XY plane), we have tested two different methods: (1) a machine‐learning artificial NN algorithm and (2) a squared‐charge (SC) centroid technique.

Results

At the interface region of the detector, the SC method achieved spatial resolutions of 1.7 ± 0.3, 2.4 ± 0.3, and 2.6 ± 0.4 mm full‐width at half‐maximum (FWHM) for the Meltmount, grease, and standard configurations, respectively. These values improve to 1.0 ± 0.2, 1.2 ± 0.2, and 1.2 ± 0.3 mm FWHM when the NN algorithm was employed. Regarding energy performance, resolutions of 18 ± 2%, 20 ± 2%, and 23 ± 3% were obtained at the interface region of the detector for Meltmount, grease, and standard configurations, respectively.

Conclusions

The results suggest that optically coupling together scintillators with a high refractive index adhesive, in combination with an NN algorithm, reduces edge‐effects and makes it possible to build scanners with almost no gaps in between detectors.

Development and Characterization of Modular Readout Design for Two-Panel Head-and-Neck Dedicated PET System Based on CZT Detectors

Cadmium zinc telluride (CZT) detectors are suitable for various applications due to the good energy resolution and the simple pixilation to achieve high spatial resolution. Our group is developing a two-panel head and neck dedicated positron emission tomography system based on CZT detectors. Each panel will consist of 150 CZT crystals (4×4×0.5 cm3) covering an area of 20×15 cm2 in an edge-on configuration to achieve high detector efficiency at 511 keV. In this work, we present the design and development of a full data acquisition chain that enables a low noise and compact readout for each panel. The initial results of the readout circuit were quantified using a 1 kHz square wave test pulse. The pulse amplitude was chosen to generate approximately the same amount of charges as a 511 keV photon would provide in CZT. The best-case FWHM electronic noise at 511 keV was measured to be 0.69% ± 0.16% (3.52 ± 0.81 in keV units after conversion). The FWHM electronic noise at 511 keV for a complete DAQ chain was 4.33% ± 0.30% (22.13 ± 1.53 in keV units).

Performance Characteristics of a Dual-Sided Position-Sensitive Sparse-Sensor Detector for Gamma-ray Imaging

Purpose

We characterize the performance of a dualsided position-sensitive sparse sensor (DS-PS3) array detector for positron emission tomography (PET). The DS-PS3 detector is designed as a high performance, cost effective PET detector for organ-specific imaging systems (e.g., brain, breast, etc.).

Methods

Two sparse 4-by-4 arrays of silicon photomultipliers (18.5% SiPM fill-factor) coupled through segmented light guide are used to readout a 15-by-15 array of 2-mm-pitch, 20-mm-long LSYO crystals. Uniform flood data were used for crystal identification, depth determination, and position-dependent energy resolution. Intrinsic-spatial and depth-of-interaction (DOI) resolutions were determined by stepping a collimated gamma-ray source over the front and side, respectively.

Results

We measured an average intrinsic spatial resolution of 2.14 ± 0.07 mm full width at half maximum (FWHM). DOI FWHM resolution varied from 2.2 mm for crystals over sensors to 5.3 mm for crystals between sensors. Average DOI resolution was 3.6 ± 0.8 mm FHWM. Average energy resolution for the detector module was 16.6% with a range of 11.3% to 25.8%.

Conclusions

We have demonstrated use of a dual-sided sparse sensor arrays to enable low-cost high-performance decoding of three-dimensional positioning within a PET detector using an 18.5% sensor fill-factor.

Development of High-Resolution Dedicated PET-Based Radiomics Machine Learning Model to Predict Axillary Lymph Node Status in Early-Stage Breast Cancer

Simple Summary

Accurate clinical axillary evaluation plays an important role in the diagnosis of and treatment planning for breast cancer (BC). This study aimed to develop a machine learning model integrating dedicated breast PET and clinical characteristics for prediction of axillary lymph node status in cT1-2N0-1M0 BC non-invasively. The performance of this integrating model in identifying pN0 and pN1 with the AUC was 0.94. We achieved an NPV of 96.88% in the cN0 and PPV of 92.73% in the cN1 subgroup. The higher true positive and true negative rate could delineate clinical subtypes and apply more precise treatment for patients with early-stage BC.

Abstract

Purpose of the Report: Accurate clinical axillary evaluation plays an important role in the diagnosis and treatment planning for early-stage breast cancer (BC). This study aimed to develop a scalable, non-invasive and robust machine learning model for predicting of the pathological node status using dedicated-PET integrating the clinical characteristics in early-stage BC. Materials and Methods: A total of 420 BC patients confirmed by postoperative pathology were retrospectively analyzed. 18F-fluorodeoxyglucose (¹⁸F-FDG) Mammi-PET, ultrasound, physical examination, Lymph-PET, and clinical characteristics were analyzed. The least absolute shrinkage and selection operator (LASSO) regression analysis were used in developing prediction models. The characteristic curve (ROC) of the area under receiver-operator (AUC) and DeLong test were used to evaluate and compare the performance of the models. The clinical utility of the models was determined via decision curve analysis (DCA). Then, a nomogram was developed based on the model with the best predictive efficiency and clinical utility and was validated using the calibration plots. Results: A total of 290 patients were enrolled in this study. The AUC of the integrated model diagnosed performance was 0.94 (95% confidence interval (CI), 0.91–0.97) in the training set (n = 203) and 0.93 (95% CI, 0.88–0.99) in the validation set (n = 87) (both p < 0.05). In clinical N0 subgroup, the negative predictive value reached 96.88%, and in clinical N1 subgroup, the positive predictive value reached 92.73%. Conclusions: The use of a machine learning integrated model can greatly improve the true positive and true negative rate of identifying clinical axillary lymph node status in early-stage BC.

2D feasibility study of joint reconstruction of attenuation and activity in limited angle TOF-PET

Several research groups are studying organ-dedicated limited angle positron emission tomography (PET) systems to optimize performance-cost ratio, sensitivity, access to the patient and/or flexibility. Often open systems are considered, typically consisting of two detector panels of various sizes. Such systems provide incomplete sampling due to limited angular coverage and/or truncation, which leads to artefacts in the reconstructed activity images. In addition, these organ-dedicated PET systems are usually stand-alone systems, and as a result, no attenuation information can be obtained from anatomical images acquired in the same imaging session. It has been shown that the use of time-of-flight information reduces incomplete data artefacts and enables the joint estimation of the activity and the attenuation factors. In this work, we explore with simple 2D simulations the performance and stability of a joint reconstruction algorithm, for imaging with a limited angle PET system. The reconstruction is based on the so-called MLACF (Maximum Likelihood Attenuation Correction Factors) algorithm and uses linear attenuation coefficients in a known-tissue-class region to obtain absolute quantification. Different panel sizes and different time-of-flight (TOF) resolutions are considered. The noise propagation is compared to that of MLEM reconstruction with exact attenuation correction (AC) for the same PET system. The results show that with good TOF resolution, images of good visual quality can be obtained. If also a good scatter correction can be implemented, quantitative PET imaging will be possible. Further research, in particular on scatter correction, is required.

A Proposed Dedicated Breast PET Lexicon: Standardization of Description and Reporting of Radiotracer Uptake in the Breast

Dedicated breast positron emission tomography (dbPET) is a new diagnostic imaging modality recently used in clinical practice for the detection of breast cancer and the assessment of tumor biology. dbPET has higher spatial resolution than that of conventional whole body PET systems, allowing recognition of detailed morphological attributes of radiotracer accumulation within the breast. ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) accumulation in the breast may be due to benign or malignant entities, and recent studies suggest that morphology characterization of ¹⁸F-FDG uptake could aid in estimating the probability of malignancy. However, across the world, there are many descriptors of breast ¹⁸F-FDG uptake, limiting comparisons between studies. In this article, we propose a lexicon for breast radiotracer uptake to standardize description and reporting of image findings on dbPET, consisting of terms for image quality, radiotracer fibroglandular uptake, breast lesion uptake.

Performance comparison of a dedicated total breast PET system with a clinical whole-body PET system: a simulation study

This paper presents a novel PET geometry for breast cancer imaging. The scanner consists of a 'stadium' (a rectangle with two semi-circles on opposite sides) shaped ring, along with anterior and posterior panels to provide high sensitivity and high spatial resolution for an imaging field-of-view (FOV) that include both breasts, mediastinum and axilla. We simulated this total-breast PET system using GATE and reconstructed the coincidence events using a GPU-based list-mode image reconstruction implementing maximum likelihood expectation-maximization (ML-EM) algorithm. The rear-panel is made up of a single layer of LSO crystals (3.2 × 3.2 × 20 mm³each), while the 'stadium'-shaped elongated ring and the anterior panel are made with dual-layered LSO crystals (1.6 × 1.6 × 6 mm³each). The energy resolution and coincidence resolving time of all detectors are assumed to be 12% and 250 ps full-width-at-half-maximum, respectively. Various sized simulated lesions (4, 5, 6 mm) having 4:1, 5:1, and 6:1 lesion-to-background radioactivity concentration ratios, mimicking different biological uptakes, were strategically located throughout a volumetric torso phantom. We compared system sensitivity and lesion detectability of the dedicated total-breast PET system to a state-of-the-art clinical whole-body PET scanner. The mean sensitivity of the total-breast PET system is 3.21 times greater than that of a whole-body PET scanner in the breast regions. The total-breast PET system also provides better contrast-recovery coefficients for lesions of all sizes and lesion-to-background ratios in the breast when compared to a reference clinical whole-body PET scanner. Receiver operating characteristics (ROC) study shows the area under the ROC curve is 0.948 and 0.924 for the total-breast system and the whole-body PET scanner, respectively, in the detection of 4 mm diameter lesions with 4:1 lesion-to-background ratio. This study demonstrates our novel geometry can provide an imaging FOV larger than conventional PEM systems to simultaneously image both breasts, chest wall and axillae with significantly improved lesion detectability in the breasts when compared to a whole-body PET scanner.

Development of a mechatronic guidance system for targeted ultrasound-guided biopsy under high-resolution positron emission mammography localization

PURPOSE

Image-guided needle biopsy of small, detectable lesions is crucial for early-stage diagnosis, treatment planning, and management of breast cancer. High-resolution positron emission mammography (PEM) is a dedicated functional imaging modality that can detect breast cancer independent of breast tissue density, but anatomical context and real-time needle visualization are not yet available to guide biopsy. We propose a mechatronic guidance system integrating an ultrasound (US)-guided core-needle biopsy (CNB) with high-resolution PEM localization to improve the spatial sampling of breast lesions. This paper presents the benchtop testing and phantom studies to evaluate the accuracy of the system and its constituent components for targeted PEM-US-guided biopsy under simulated high-resolution PEM localization.

METHODS

A mechatronic guidance system was developed to operate with the Radialis PEM system and a conventional US system. The system includes a user-operated guidance arm and end-effector biopsy device, integrating a US transducer and CNB gun, with its needle focused on a remote center of motion (RCM). Custom software modules were developed to track, display, and guide the end-effector biopsy device. Registration of the mechatronic guidance system to a simulated PEM detector plate was performed using a landmark-based method. Testing was performed with fiducials positioned in the peripheral and central regions of the simulated detector plate and registration error was quantified. Breast phantom experiments were performed under ideal detection and localization to evaluate for bias in the end-effector biopsy device. The accuracy of the complete mechatronic guidance system to perform targeted breast biopsy was assessed using breast phantoms with simulated lesions. Three-dimensional positioning error was quantified, and principal component analysis assessed for directional trends in 3D space within 95% prediction intervals. Targeted breast biopsies with test phantoms were performed and an overall in-plane needle targeting error was quantified.

RESULTS

The mean registration errors were 0.63 mm (N = 44) and 0.73 mm (N = 72) in the peripheral and central regions of the simulated PEM detector plate, respectively. A 3D 95% prediction ellipsoid shows an error volume <2.0 mm in diameter, centered on the mean registration error. Under ideal detection and localization, targets <1.0 mm in diameter can be sampled with 95% confidence. The complete mechatronic guidance system was able to successfully spatially sample simulated breast lesions, 4 mm and 6 mm in diameter and height (N = 20) in known 3D positions in the PEM image coordinate space. The 3D positioning error was 0.85 mm (N = 20) with 0.64 mm in-plane and 0.44 mm cross-plane component errors. Targeted breast biopsies resulted in a mean in-plane needle targeting error of 1.08 mm (N = 15) allowing for targets 1.32 mm in radius to be sampled with 95% confidence.

CONCLUSIONS

We demonstrated the utility of our mechatronic guidance system for targeted breast biopsy under high-resolution PEM localization. Breast phantom studies showed the ability to accurately guide, position, and target breast lesions with the accuracy to spatially sample targets <3.0 mm in diameter with 95% confidence. Future work will integrate the developed system with the Radialis PEM system toward combined PEM-US-guided breast biopsy.

Energy spectra due to the intrinsic radiation of LYSO/LSO scintillators for a wide range of crystal sizes

PURPOSE

Most detectors in current positron emission tomography (PET) scanners and prototypes use lutetium oxyorthosilicate (LSO) or lutetium yttrium oxyorthosilicate (LYSO) scintillators. The aim of this work is to provide a complete set of background energy spectra, due to the scintillator intrinsic radioactivity, for a wide range of crystal sizes.

METHODS

An analytical model, developed and validated in a previous work, was used to obtain the background energy spectra of square base cuboids of different dimensions. The model uses the photon absorption probabilities of the three gamma rays (88, 202, and 307 keV) emitted following the beta decay of ¹⁷⁶ Lu to ¹⁷⁶ Hf excited states. These probabilities were obtained for each crystal size considered in this work from Monte Carlo simulations using the PENELOPE code. The probabilities are then used to normalize and shift the beta spectrum to the corresponding energy value of the simultaneous detection of one, two, or three gamma rays in the scintillator. The simulated cuboids had side lengths of 5, 10, 20, 30, 40, 50, and 60 mm and crystal thickness T = 2.5, 5, 10, 15, and 20 mm. From these results a complete set of energy spectra, including intermediate dimensions, were obtained. In addition, LYSO and LSO were compared in terms of their analytical background energy spectra for two crystal sizes. The analytical spectra were convolved using a variable Gaussian kernel to account for the energy resolution of a typical detector. A parameterization of the photon absorption probabilities for each gamma ray energy as a function of the cuboid volume to surface area ratio was obtained.

RESULTS

A data set of L(Y)SO background energy spectra was obtained and is available for the reader as 2D histograms. The model accurately predicts the structure of the energy spectra including the relative peak and valley intensities. The data allow visualizing how the structure evolves with increasing crystal length and thickness. Lutetium yttrium oxyorthosilicate and LSO present very similar background energy spectra for the range of sizes studied in this work and therefore the data generated can be confidently used for both scintillator materials. The filtered spectra showed a variable shift in the main peaks, depending on crystal size, alerting that to achieve a correct detector calibration using the background spectrum is not straight forward and requires precise data analysis and measurements. In addition, we found that square base L(Y)SO cuboids with same volume to surface area ratio have background spectra with the same structure.

CONCLUSIONS

We present the energy spectra of L(Y)SO crystal of different sizes which will be very useful for industry and research groups developing and simulating detectors for positron imaging applications in terms of calibration, quality assurance, crystal maps, detector fine gain tuning, background reduction and other applications using the long-lived ¹⁷⁶ Lu source. We analyzed the data produced in this work and found that crystal cuboids with equal volume to surface area ratio produce the same background energy spectra, a conclusion that simplifies its calculation and clarifies why the same energy spectrum is observed under different experimental setups.

Evaluating attenuation correction strategies in a dedicated, single-gantry breast PET-tomosynthesis scanner

We are developing a dedicated, combined breast positron emission tomography (PET)-tomosynthesis scanner. Both the PET and digital breast tomosynthesis (DBT) scanners are integrated in a single gantry to provide spatially co-registered 3D PET-tomosynthesis images. The DBT image will be used to identify the breast boundary and breast density to improve the quantitative accuracy of the PET image. This paper explores PET attenuation correction (AC) strategies that can be performed with the combined breast PET-DBT scanner to obtain more accurate, quantitative high-resolution 3D PET images. The PET detector is comprised of a 32 × 32 array of 1.5 × 1.5 × 15 mm3 LYSO crystals. The PET scanner utilizes two detector heads separated by either 9 or 11 cm, with each detector head having a 4 × 2 arrangement of PET detectors. GEANT4 Application for Tomographic Emission simulations were performed using an anthropomorphic breast phantom with heterogeneous attenuation under clinical DBT-compression. FDG-avid lesions, each 5 mm in diameter with 8:1 uptake, were simulated at four locations within the breast. Simulations were performed with a scan time of 2 min. PET AC was performed using the actual breast simulation model as well as DBT reconstructed volumetric images to derive the breast outline. In addition to using the known breast density as defined by the breast model, we also modeled it as uniform patient-independent soft-tissue, and as a uniform patient-specific material derived from breast tissue composition. Measured absolute lesion uptake was used to evaluate the quantitative accuracy of performing AC using the various strategies. This study demonstrates that AC is necessary to obtain a closer estimate of the true lesion uptake and background activity in the breast. The DBT image dataset assists in measuring lesion uptake with low bias by facilitating accurate breast delineation as well as providing accurate information related to the breast tissue composition. While both the uniform soft-tissue and patient-specific material approaches provides a close estimate to the ground truth, <5% bias can be achieved by using a uniform patient-specific material to define the attenuation map.

Evaluation of primary breast cancers using dedicated breast PET and whole-body PET

Metabolic imaging of the primary breast tumor with ¹⁸F-fluorodeoxyglucose ([¹⁸F]FDG) PET may assist in predicting treatment response in the neoadjuvant chemotherapy (NAC) setting. Dedicated breast PET (dbPET) is a high-resolution imaging modality with demonstrated ability in highlighting intratumoral heterogeneity and identifying small lesions in the breast volume. In this study, we characterized similarities and differences in the uptake of [¹⁸F]FDG in dbPET compared to whole-body PET (wbPET) in a cohort of ten patients with biopsy-confirmed, locally advanced breast cancer at the pre-treatment timepoint. Patients received bilateral dbPET and wbPET following administration of 186 MBq and 307 MBq [¹⁸F]FDG on separate days, respectively. [¹⁸F]FDG uptake measurements and 20 radiomic features based on morphology, tumor intensity, and texture were calculated and compared. There was a fivefold increase in SUL_peak for dbPET (median difference (95% CI): 4.0 mL⁻¹ (1.8–6.4 mL⁻¹), p = 0.006). Additionally, spatial heterogeneity features showed statistically significant differences between dbPET and wbPET. The higher [¹⁸F]FDG uptake in dbPET highlighted the dynamic range of this breast-specific imaging modality. Combining with the higher spatial resolution, dbPET may be able to detect treatment response in the primary tumor during NAC, and future studies with larger cohorts are warranted.

Update on latest advances in time-of-flight PET

This paper provides an update on time-of-flight (TOF) PET with a focus on latest hardware developments leading to current commercial PET/CT instruments. We describe advances in scintillator development, new photosensors and associated electronics readout, and detector designs for utilization in complete systems. Next, we introduce the latest commercial PET/CT scanners based on the aforementioned technologies, and discuss the detector design choices made that are relevant to differences in the system performance. Finally, we end with a discussion of the latest performance benchmarks for improved timing in PET detectors, challenges in scaling this performance to a complete system, and the outlook towards achieving a sub-50 ps coincidence timing resolution (CTR) in a PET detector.

Characterization of a multi-pinhole molecular breast tomosynthesis scanner

In recent years, breast imaging using radiolabelled molecules has attracted significant interest. Our group has proposed a multi-pinhole molecular breast tomosynthesis (MP-MBT) scanner to obtain 3D functional molecular breast images at high resolutions. After conducting extensive optimisation studies using simulations, we here present a first prototype of MP-MBT and evaluate its performance using physical phantoms. The MP-MBT design is based on two opposing gamma cameras that can image a lightly compressed pendant breast. Each gamma camera consists of a 250 × 150 mm² detector equipped with a collimator with multiple pinholes focusing on a line. The NaI(Tl) gamma detector is a customised design with 3.5 mm intrinsic spatial resolution and high spatial linearity near the edges due to a novel light-guide geometry and the use of square PMTs. A volume-of-interest is scanned by translating the collimator and gamma detector together in a sequence that optimises count yield from the scan region. Derenzo phantom images showed that the system can reach 3.5 mm resolution for a clinically realistic ^99mTc activity concentration in an 11-minute scan, while in breast phantoms the smallest spheres visible were 6 mm in diameter for the same scan time. To conclude, the experimental results of the novel MP-MBT scanner showed that the setup had sub-centimetre breast tumour detection capability which might facilitate 3D molecular breast cancer imaging in the future.

Performance evaluation of developed dedicated breast PET scanner and improvement of the spatial resolution by wobbling: a Monte Carlo study

PURPOSE

Molecular imaging, particularly PET scanning, has become an important cancer diagnostic tool. Whole-body PET is not effective for local staging of cancer because of their declining efficiency in detecting small lesions. The preliminary results of the performance evaluation of designed dedicated breast PET scanner presented.

METHODS AND MATERIALS

A new scanner is based on LYSO crystals coupled with SiPM, and it consists of 14 compact modules with a transaxial FOV of 180 mm in diameter. In this study, initial GATE simulation studies were performed to predict the spatial resolution, absolute sensitivity, noise equivalent count rate (NECR) and scatter fraction (SF) of the new design. Spatial wobbling acquisitions were also implemented. Finally, the obtained projections were reconstructed using analytical and iterative algorithms.

RESULTS

The simulation results indicate that absolute sensitivity is 1.42% which is appropriate than other commercial breast PET systems. The calculated SF and NECR in our design are 20.6% and 21.8 kcps. The initial simulation results demonstrate the potential of this design for breast cancer detection. A small wobble motion to improve spatial resolution and contrast.

CONCLUSION

The performance of the dedicated breast PET scanner is considered to be reasonable enough to support its use in breast cancer imaging.

Design study of a dedicated head and neck cancer PET system

The tumor-involved regions of head and neck cancer (HNC) have complex anatomical structures and vital physiological roles. As a consequence, there is a need for high sensitivity and high spatial resolution dedicated HNC PET scanner. The purpose of this study is to evaluate and optimize system design that includes detecting materials and geometries. For the detecting material, two scanners with the same two-panel geometry based on CZT and LYSO were evaluated. For the system geometry, four CZT scanners with two-panel, lengthened two-panel, four-panel, and full-ring geometries were evaluated. A cylinder phantom with sphere lesions and an XCAT phantom in the head and neck region were simulated. The results showed that the sensitivity of the 40-mm thickness CZT system and the 20-mm thickness LYSO system were comparable. However, the multiple interaction photon events recovery accuracy of the CZT system was about 20% higher. The in-panel and orthogonal-panel spatial resolutions of CZT are 0.58 and 0.74 mm, while those of LYSO are 0.70 and 1.40 mm. For system geometry, the four-panel and full-ring scanners have a higher contrast recovery coefficient (CRC) and contrast-to-noise ratio (CNR) than the two-panel and lengthened two-panel scanners. However, a 5-mm lesion in the XCAT phantom was visualized within 6 min in the two-panel system.

Performance evaluation of a whole-body prototype PET scanner with four-layer DOI detectors

Parallax error caused by the detector crystal thickness degrades spatial resolution at the peripheral regions of the field-of-view (FOV) of a scanner. To resolve this issue, depth-of-interaction (DOI) measurement is a promising solution to improve the spatial resolution and its uniformity over the entire FOV. Even though DOI detectors have been used in dedicated systems with a small ring diameter such as for the human brain, breast and small animals, the use of DOI detectors for a large bore whole-body PET system has not been demonstrated yet. We have developed a four-layered DOI detector, and its potential for a brain dedicated system has been proven in our previous development. In the present work, we investigated the use of the four-layer DOI detector for a large bore PET system by developing the world's first whole-body prototype. We evaluated its performance characteristics in accordance with the NEMA NU 2 standard. Furthermore, the impact of incorporating DOI information was evaluated with the NEMA NU 4 image quality phantom. Point source images were reconstructed with a filtered back projection (FBP), and an average spatial resolution of 5.2  ±  0.7 mm was obtained. For the FBP image, the four-layer DOI information improved the radial spatial resolution by 48% at the 20 cm offset position. The peak noise-equivalent count rate (NECR) was 22.9 kcps at 7.4 kBq ml^-1 and the scatter fraction was 44%. The system sensitivity was 5.9 kcps MBq^-1. For the NEMA NU 2 image quality phantom, the 10 mm sphere was clearly visualized without any artifacts. For the NEMA NU 4 image quality phantom, we measured the phantom at 0, 10 and 20 cm offset positions. As a result, we found the image with four-layer DOI could visualize the 2 mm-diameter hot cylinder although it could not be recognized on the image without DOI. The average improvements in the recovery coefficients for the five hot rods (1-5 mm) were 0.3%, 4.4% and 26.3% at the 0, 10 and 20 cm offset positions, respectively (except for the 1 mm-diameter rod at the 20 cm offset position). Although several practical issues (such as adding end-shields) remain to be addressed before the scanner is ready for clinical use, we showed that the four-layer DOI technology provided higher and more uniform spatial resolution over the FOV and improved contrast for small uptake regions located at the peripheral FOV, which could improve detectability of small and distal lesions such as nodal metastases, especially in obese patients.

Initial experience of dedicated breast PET imaging of ER+ breast cancers using [F-18]fluoroestradiol

Dedicated breast positron emission tomography (dbPET) is an emerging technology with high sensitivity and spatial resolution that enables detection of sub-centimeter lesions and depiction of intratumoral heterogeneity. In this study, we report our initial experience with dbPET using [F-18]fluoroestradiol (FES) in assessing ER+ primary breast cancers. Six patients with >90% ER+ and HER2- breast cancers were imaged with dbPET and breast MRI. Two patients had ILC, three had IDC, and one had an unknown primary tumor. One ILC patient was treated with letrozole, and another patient with IDC was treated with neoadjuvant chemotherapy without endocrine treatment. In this small cohort, we observed FES uptake in ER+ primary breast tumors with specificity to ER demonstrated in a case with tamoxifen blockade. FES uptake in ILC had a diffused pattern compared to the distinct circumscribed pattern in IDC. In evaluating treatment response, the reduction of SUVmax was observed with residual disease in an ILC patient treated with letrozole, and an IDC patient treated with chemotherapy. Future study is critical to understand the change in FES SUVmax after endocrine therapy and to consider other tracer uptake metrics with SUVmax to describe ER-rich breast cancer. Limitations include variations of FES uptake in different ER+ breast cancer diseases and exclusion of posterior tissues and axillary regions. However, FES-dbPET has a high potential for clinical utility, especially in measuring response to neoadjuvant endocrine treatment. Further development to improve the field of view and studies with a larger cohort of ER+ breast cancer patients are warranted.

Feasibility Study of a Small Animal PET Insert Based on a Single LYSO Monolithic Tube

There are drawbacks with using a Positron Emission Tomography (PET) scanner design employing the traditional arrangement of multiple detectors in an array format. Typically PET systems are constructed with many regular gaps between the detector modules in a ring or box configuration, with additional axial gaps between the rings. Although this has been significantly reduced with the use of the compact high granularity SiPM photodetector technology, such a scanner design leads to a decrease in the number of annihilation photons that are detected causing lower scanner sensitivity. Moreover, the ability to precisely determine the line of response (LOR) along which the positron annihilated is diminished closer to the detector edges because the spatial resolution there is degraded due to edge effects. This happens for both monolithic based designs, caused by the truncation of the scintillation light distribution, but also for detector blocks that use crystal arrays with a number of elements that are larger than the number of photosensors and, therefore, make use of the light sharing principle. In this report we present a design for a small-animal PET scanner based on a single monolithic annulus-like scintillator that can be used as a PET insert in high-field Magnetic Resonance systems. We provide real data showing the performance improvement when edge-less modules are used. We also describe the specific proposed design for a rodent scanner that employs facetted outside faces in a single LYSO tube. In a further step, in order to support and prove the proposed edgeless geometry, simulations of that scanner have been performed and lately reconstructed showing the advantages of the design.

Innovations in Instrumentation for Positron Emission Tomography

PET scanners are sophisticated and highly sensitive biomedical imaging devices that can produce highly quantitative images showing the 3-dimensional distribution of radiotracers inside the body. PET scanners are commonly integrated with x-ray CT or MRI scanners in hybrid devices that can provide both molecular imaging (PET) and anatomical imaging (CT or MRI). Despite decades of development, significant opportunities still exist to make major improvements in the performance of PET systems for a variety of clinical and research tasks. These opportunities stem from new ideas and concepts, as well as a range of enabling technologies and methodologies. In this paper, we review current state of the art in PET instrumentation, detectors and systems, describe the major limitations in PET as currently practiced, and offer our own personal insights into some of the recent and emerging technological innovations that we believe will impact the field. Our focus is on the technical aspects of PET imaging, specifically detectors and system design, and the opportunity and necessity to move closer to PET systems for diagnostic patient use and in vivo biomedical research that truly approach the physical performance limits while remaining mindful of imaging time, radiation dose, and cost. However, other key endeavors, which are not covered here, including innovations in reconstruction and modeling methodology, radiotracer development, and expanding the range of clinical and research applications, also will play an equally important, if not more important, role in defining the future of the field.

A dedicated breast-PET/CT scanner: Evaluation of basic performance characteristics

PURPOSE

Application of advanced imaging techniques, such as PET and x ray CT, can potentially improve detection of breast cancer. Unfortunately, both modalities have challenges in the detection of some lesions. The combination of the two techniques, however, could potentially lead to an overall improvement in diagnostic breast imaging. The purpose of this investigation is to test the basic performance of a new dedicated breast-PET/CT.

METHODS

The PET component consists of a rotating pair of detectors. Its performance was evaluated using the NEMA NU4-2008 protocols. The CT component utilizes a pulsed x ray source and flat panel detector mounted on the same gantry as the PET scanner. Its performance was assessed using specialized phantoms. The radiation dose to a breast during CT imaging was explored by the measurement of free-in-air kerma and air kerma measured at the center of a 16 cm-diameter PMMA cylinder. Finally, the combined capabilities of the system were demonstrated by imaging of a micro-hot-rod phantom.

RESULTS

Overall, performance of the PET component is comparable to many pre-clinical and other dedicated breast-PET scanners. Its spatial resolution is 2.2 mm, 5 mm from the center of the scanner using images created with the single-sliced-filtered-backprojection algorithm. Peak NECR is 24.6 kcps; peak sensitivity is 1.36%; the scatter fraction is 27%. Spatial resolution of the CT scanner is 1.1 lp/mm at 10% MTF. The free-in-air kerma is 2.33 mGy, while the PMMA-air kerma is 1.24 mGy. Finally, combined imaging of a micro-hot-rod phantom illustrated the potential utility of the dual-modality images produced by the system.

CONCLUSION

The basic performance characteristics of a new dedicated breast-PET/CT scanner are good, demonstrating that its performance is similar to current dedicated PET and CT scanners. The potential value of this system is the capability to produce combined duality-modality images that could improve detection of breast disease. The next stage in development of this system is testing with more advanced phantoms and human subjects.

Simulation study of quantitative precision of the PET/X dedicated breast PET scanner

The goal for positron emission tomography (PET)/X is measuring changes in radiotracer uptake for early assessment of response to breast cancer therapy. Upper bounds for detecting such changes were investigated using simulation and two image reconstruction algorithms customized to the PET/X rectangular geometry. Analytical reconstruction was used to study spatial resolution, comparing results with the distance of the closest approach (DCA) resolution surrogate that is independent of the reconstruction method. An iterative reconstruction algorithm was used to characterize contrast recovery in small targets. Resolution averaged [Formula: see text] full width at half maximum when using depth-of-interaction (DOI) information. Without DOI, resolution ranged from [Formula: see text] to [Formula: see text] for scanner crystal thickness between 5 and 15 mm. The DCA resolution surrogate was highly correlated to image-based FWHM. Receiver-operating characteristic analysis showed specificity and sensitivity over 95% for detecting contrast change from 5:1 to 4:1 (area under curve [Formula: see text]). For PET/X parameters modeled here, the ability to measure contrast changes benefited from higher photon absorption efficiency of thicker crystals while being largely unaffected by degraded resolution obtained with thicker crystals; DOI provided marginal improvements. These results assumed perfect data corrections and other idealizations, and thus represent an upper bound for detecting changes in small lesion radiotracer uptake of clinical interest using the PET/X system.

Performance evaluation of a high resolution dedicated breast PET scanner

PURPOSE

Early stage breast cancers may not be visible on a whole-body PET scan. To overcome whole-body PET limitations, several dedicated breast positron emission tomography (DbPET) systems have emerged nowadays aiming to improve spatial resolution. In this work the authors evaluate the performance of a high resolution dedicated breast PET scanner (Mammi-PET, Oncovision).

METHODS

Global status, uniformity, sensitivity, energy, and spatial resolution were measured. Spheres of different sizes (2.5, 4, 5, and 6 mm diameter) and various 18 fluorodeoxyglucose ((18)F-FDG) activity concentrations were randomly inserted in a gelatine breast phantom developed at our institution. Several lesion-to-background ratios (LBR) were simulated, 5:1, 10:1, 20:1, 30:1, and 50:1. Images were reconstructed using different voxel sizes. The ability of experienced reporters to detect spheres was tested as a function of acquisition time, LBR, sphere size, and matrix reconstruction voxel size. For comparison, phantoms were scanned in the DbPET camera and in a whole body PET (WB-PET). Two patients who just underwent WB-PET/CT exams were imaged with the DbPET system and the images were compared.

RESULTS

The measured absolute peak sensitivity was 2.0%. The energy resolution was 24.0% ± 1%. The integral and differential uniformity were 10% and 6% in the total field of view (FOV) and 9% and 5% in the central FOV, respectively. The measured spatial resolution was 2.0, 1.9, and 1.7 mm in the radial, tangential, and axial directions. The system exhibited very good detectability for spheres ≥4 mm and LBR ≥10 with a sphere detection of 100% when acquisition time was set >3 min/bed. For LBR = 5 and acquisition time of 7 min the detectability was 100% for spheres of 6 mm and 75% for spheres of 5, 4, and 2.5 mm. Lesion WB-PET detectability was only comparable to the DbPET camera for lesion sizes ≥5 mm when acquisition time was >3 min and LBR > 10.

CONCLUSIONS

The DbPET has a good performance for its clinical use and shows an improved resolution and lesion detectability of small lesions compared to WB-PET.

A novel semi-robotized device for high-precision 18F-FDG-guided breast cancer biopsy

PURPOSE

To assess the 3D geometric sampling accuracy of a new PET-guided system for breast cancer biopsy (BCB) from areas within the tumour with high ¹⁸F-FDG uptake.

MATERIALS AND METHODS

In the context of the European Union project MammoCare, a prototype semi-robotic stereotactic prototype BCB-device was incorporated into a dedicated high resolution PET-detector for breast imaging. The system consists of 2 stacked rings, each containing 12 plane detectors, forming a dodecagon with a 186mm aperture for 3D reconstruction (1mm³ voxel). A vacuum-assisted biopsy needle attached to a robot-controlled arm was used. To test the accuracy of needle placement, the needle tip was labelled with ¹⁸F-FDG and positioned at 78 target coordinates distributed over a 35mm×24mm×28mm volume within the PET-detector field-of-view. At each position images were acquired from which the needle positioning accuracy was calculated. Additionally, phantom-based biopsy proofs, as well as MammoCare images of 5 breast cancer patients, were evaluated for the 3D automated locating of ¹⁸F-FDG uptake areas within the tumour.

RESULTS

Needle positioning tests revealed an average accuracy of 0.5mm (range 0-1mm), 0.6mm (range 0-2mm), and 0.4mm (range 0-2mm) for the x/y/z-axes, respectively. Furthermore, the MammoCare system was able to visualize and locate small (<10mm) regions with high ¹⁸F-FDG uptake within the tumour suitable for PET-guided biopsy after being located by the 3D automated application.

CONCLUSIONS

Accuracy testing demonstrated high-precision of this semi-automatic 3D PET-guided system for breast cancer core needle biopsy. Its clinical feasibility evaluation in breast cancer patients scheduled for neo-adjuvant chemotherapy will follow.

Breast-Dedicated Radionuclide Imaging Systems

Breast-dedicated radionuclide imaging systems show promise for increasing clinical sensitivity for breast cancer while minimizing patient dose and cost. We present several breast-dedicated coincidence-photon and single-photon camera designs that have been described in the literature and examine their intrinsic performance, clinical relevance, and impact. Recent tracer development is mentioned, results from recent clinical tests are summarized, and potential areas for improvement are highlighted.

Evaluation of a Hanging-Breast PET System for Primary Tumor Visualization in Patients With Stage I-III Breast Cancer: Comparison With Standard PET/CT

OBJECTIVE

The purposes of this study were to evaluate the performance of a mammography with molecular imaging PET (MAMMI-PET) system for breast imaging in the hanging-breast position for the visualization of primary breast cancer lesions and to compare this method with whole-body PET/CT.

SUBJECTS AND METHODS

Between March 2011 and March 2014, a prospective evaluation included women with one or more histologically confirmed primary breast cancer lesions (index lesions). After injection of 180-240 MBq of (18)F-FDG, whole-body PET/CT and MAMMI-PET acquisitions were performed, index lesions were scored 0, 1, or 2 for FDG uptake relative to background. Detection and FDG uptake were compared by breast length, maximal tumor diameter, affected breast quadrants, tumor grade, and histologic and immunologic sub-types. Finally, the two PET modalities were compared for detection of index lesions.

RESULTS

For 234 index lesions (diameter, 5-170 mm), the overall sensitivity was 88.9% for MAMMI-PET and 91% for PET/CT (p = 0.61). Twenty-three (9.8%) index lesions located too close to the pectoral muscle were missed with MAMMI-PET, and 20 index lesions were missed with PET/CT. Lesion visibility on MAMMI-PET images was influenced by tumor grade (p = 0.034) but not by cancer subtype (p = 0.65).

CONCLUSION

Although in an overall evaluation MAMMI-PET was not superior to PET/CT, MAMMI-PET does have higher sensitivity for primary breast cancer lesions within the scanning range of the device. Optimization of the positioning device may increase visualization of the most dorsal lesions.

PET Imaging of Breast Cancer: Role in Patient Management

Breast cancer is the most common malignancy in females. Imaging plays a critical role in diagnosis, staging and surveillance, and management of disease. Fluorodeoxyglucose (FDG) PET the imaging is indicated in specific clinical setting. Sensitivity of detection depends on tumor histology and size. Whole body FDG PET can change staging and management. In recurrent disease, distant metastasis can be detected. FDG PET imaging has prognostic and predictive value. PET/MR is evolving rapidly and may play a role management, assessment of metastatic lesions, and treatment monitoring. This review discusses current PET modalities, focusing on of FDG PET imaging and novel tracers.

Positron Emission Mammography Image Interpretation for Reduced Image Count Levels

We studied the effects of reduced (18)F-FDG injection activity on interpretation of positron emission mammography (PEM) images and compared image interpretation between 2 postinjection imaging times.

METHODS

We performed a receiver-operating-characteristic (ROC) study using PEM images reconstructed with different count levels expected from injected activities between 23 and 185 MBq. Thirty patients received 2 PEM scans at postinjection times of 60 and 120 min. Half of the patients were scanned with a standard protocol; the others received one-half of the standard activity. Images were reconstructed using 100%, 50%, and 25% of the total counts acquired. Eight radiologists used a 5-point confidence scale to score 232 PEM images for the presence of up to 3 malignant lesions. Paired images were analyzed with conditional logistic regression and ROC analysis to investigate changes in interpretation.

RESULTS

There was a trend for increasing lesion detection sensitivity with increased image counts: odds ratios were 2.2 (P = 0.01) and 1.9 (P = 0.04) per doubling of image counts for 60- and 120-min uptake images, respectively, without significant difference between time points (P = 0.7). The area under the ROC curve (AUC) was highest for the 100%-count, 60-min images (0.83 vs. 0.75 for 50%-counts, P = 0.02). The 120-min images had a similar trend but did not reach statistical significance (AUC = 0.79 vs. 0.73, P = 0.1). Our data did not yield significant trends between specificity and image counts. Lesion-to-background ratios increased between 60- and 120-min scans (P < 0.001).

CONCLUSION

Reducing the image counts relative to the standard protocol decreased diagnostic accuracy. The increase in lesion-to-background ratio between 60- and 120-min uptake times was not enough to improve detection sensitivity in this study, perhaps in part due to fewer counts in the later scan.

Positron emission mammography in the diagnosis of breast cancer. Is maximum PEM uptake value a valuable threshold for malignant breast cancer detection?

AIM

To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax).

PATIENTS, METHODS

In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma.

RESULTS

Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001).

CONCLUSION

PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied.