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Alhorani Q, Alkhybari E, Rawashdeh M, Sabarudin A, Latiff RA, Al-Ibraheem A, Mohamad M. National and local diagnostic reference levels for adult 18F-FDG and CT in Jordanian PET/CT: findings and implications in practice. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:011512. [PMID: 38387102 DOI: 10.1088/1361-6498/ad2c62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/22/2024] [Indexed: 02/24/2024]
Abstract
This study aims to report the findings of Jordanian national diagnostic reference level (NDRL) survey for fluorodeoxyglucose (18F-FDG) and local diagnostic reference level (LDRL) of computed tomography (CT) used for attenuation correction and anatomical localisation (AC-AL); and AC and diagnostic CT (AC-DX) within the context of whole-body WB and half-body HB adult oncology PET/CT scanning. Two-structured questionnaires were prepared to gather the necessary information: dosimetry data, patient demographics, equipment specification, and acquisition protocols for identified18F-FDG PET/CT procedures. The NDRL and achievable dose were reported based on the 75th and 50th percentiles for18F-FDG administered activity (AA), respectively. The LDRL was reported based on the 50th percentile for (CTDIvol) and (DLP). Data from 562 patients from four Jordanian PET/CT centres were collected. The survey revealed that Jordanian NDRL for AA (303 MBq) was within the acceptable range compared to the published-peer NDRL data (240-590 MBq). However, the18F-FDG AA varied across the participated PET/CT centres. The reported LDRL CTDIvoland DLP of CT used for (AC-AL) was 4.3 mGy and 459.3 mGy.cm for HB CT scan range, and 4.1 mGy and 659.9 mGy.cm for WB CT scans. The reported LDRL for CTDIvoland DLP for HB CT was higher when compared with the United Kingdom (3.2 mGy and 310 mGy.cm). Concurrently, in the context of WB CT, the reported values (i.e. CTDIvol and DLP) were also higher than both Kuwait (3.6 mGy and 659 mGy.cm) and Slovenia (3.6 mGy and 676 mGy.cm). The reported HB CT(AC-DX) was higher than Nordic, New Zealand and Swiss NDRLs and for WB (AC-DX) CT it was higher than Swiss NDRLs. This study reported the first Jordanian NDRL for18F-FDG and LDRL for HB and WB CT associated with18F-FDG PET/CT scans. This data is useful for Jordanian PET/CT centres to compare their LDRL to the suggested DRLs and utilise it in the process of optimising CT radiation doses.
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Affiliation(s)
- Qays Alhorani
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Essam Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Mohammad Rawashdeh
- Radiologic Technology Program, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid, Jordan
- Faculty of Health Sciences, Gulf Medical University, Ajman, United Arab Emirates
| | - Akmal Sabarudin
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Rukiah A Latiff
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Akram Al-Ibraheem
- Department of Nuclear Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Mazlyfarina Mohamad
- Diagnostic Imaging & Radiotherapy Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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Olianti C, Trapani S, Secinaro A, Holm Reichkendler M. Fever of unknown origin in pediatrics: role of nuclear medicine. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2024; 68:48-57. [PMID: 38454877 DOI: 10.23736/s1824-4785.24.03546-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Fever of unknown origin (FUO) is a debated issue in numerous scientific studies in adult patients with a not jet-defined workflow in a clinical and diagnostic setting. Few works are published about pediatric patients even if FUO represents a challenging, not infrequent scenario in hospital and outpatient recovery. The fever might be the onset symptom of a transient mild infection or the beginning of a more difficult-to-diagnose and serious pathological condition. In the adult workflow 18FDG PET-CT is nowadays playing a relevant role, considering the limited spread of conventional 99mTc-HMPAO-White Blood Cells scintigraphy. It represents a robust tool for diagnosing the eventual site of infection, but it is limited by procedural complexity and long duration, up to 24 hours. The WBC-scintigraphy is also not suitable for children, only for young adults or adolescents, considering the relevant blood sample entity and the procedural risk for sensitive subjects. The most assessed clinical and diagnostic know-how on Pediatric FUO are summarized and a synthetic flow-chard is presented to support the clinical management and to choose the best diagnostic pathway.
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Affiliation(s)
- Catia Olianti
- Unit of Nuclear Medicine, Department of Image Diagnostics, Careggi University Hospital, Florence, Italy -
| | - Sandra Trapani
- Department of Medical Pediatric, Meyer Children's University Hospital IRCCS, Florence, Italy
| | - Aurelio Secinaro
- Department of Radiology, Bambino Gesù Children's Hospital, Rome, Italy
| | - Michala Holm Reichkendler
- Unit of Nuclear Medicine, Department of Image Diagnostic, Rigshospitalet University Hospital, Copenhagen, Denmark
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Salas-Ramirez M, Leube J, Lassmann M, Tran-Gia J. Effect of kilovoltage and quality reference mAs on CT-based attenuation correction in 177Lu SPECT/CT imaging: a phantom study. EJNMMI Phys 2024; 11:21. [PMID: 38407672 DOI: 10.1186/s40658-024-00622-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
INTRODUCTION CT-based attenuation correction (CT-AC) plays a major role in accurate activity quantification by SPECT/CT imaging. However, the effect of kilovoltage peak (kVp) and quality-reference mAs (QRM) on the attenuation coefficient image (μ-map) and volume CT dose index (CTDIvol) have not yet been systematically evaluated. Therefore, the aim of this study was to fill this gap and investigate the influence of kVp and QRM on CT-AC in 177Lu SPECT/CT imaging. METHODS Seventy low-dose CT acquisitions of an Electron Density Phantom (seventeen inserts of nine tissue-equivalent materials) were acquired using various kVp and QRM combinations on a Siemens Symbia Intevo Bold SPECT/CT system. Using manufacturer reconstruction software, 177Lu μ-maps were generated for each CT image, and three low-dose CT related aspects were examined. First, the μ-map-based attenuation values (μmeasured) were compared with theoretical values (μtheoretical). Second, changes in 177Lu activity expected due to changes in the μ-map were calculated using a modified Chang method. Third, the noise in the μ-map was assessed by measuring the coefficient of variation in a volume of interest in the homogeneous section of the Electron Density Phantom. Lastly, two phantoms were designed to simulate attenuation in four tissue-equivalent materials for two different source geometries (1-mL and 10-mL syringes). 177Lu SPECT/CT imaging was performed using three different reconstruction algorithms (xSPECT Quant, Flash3D, STIR), and the SPECT-based activities were compared against the nominal activities in the sources. RESULTS The largest relative errors between μmeasured and μtheoretical were observed in the lung inhale insert (range: 18%-36%), while it remained below 6% for all other inserts. The resulting changes in 177Lu activity quantification were -3.5% in the lung inhale insert and less than -2.3% in all other inserts. Coefficient of variation and CTDIvol ranged from 0.3% and 3.6 mGy (130 kVp, 35 mAs) to 0.4% and 0.9 mGy (80 kVp, 20 mAs), respectively. The SPECT-based activity quantification using xSPECT Quant reconstructions outperformed all other reconstruction algorithms. CONCLUSION This study shows that kVp and QRM values in low-dose CT imaging have a minimum effect on quantitative 177Lu SPECT/CT imaging, while the selection of low values of kVp and QRM reduce the CTDIvol.
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Affiliation(s)
- Maikol Salas-Ramirez
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - Julian Leube
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Michael Lassmann
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - Johannes Tran-Gia
- Department of Nuclear Medicine, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Camoni L, Santos A, Luporsi M, Grilo A, Pietrzak A, Gear J, Zucchetta P, Bar-Sever Z. EANM procedural recommendations for managing the paediatric patient in diagnostic nuclear medicine. Eur J Nucl Med Mol Imaging 2023; 50:3862-3879. [PMID: 37555902 PMCID: PMC10611649 DOI: 10.1007/s00259-023-06357-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 07/23/2023] [Indexed: 08/10/2023]
Abstract
PURPOSE The manuscript aims to characterize the principles of best practice in performing nuclear medicine procedures in paediatric patients. The paper describes all necessary technical skills that should be developed by the healthcare professionals to ensure the best possible care in paediatric patients, as it is particularly challenging due to psychological and physical conditions of children. METHODS We performed a comprehensive literature review to establish the most relevant elements of nuclear medicine studies in paediatric patients. We focused the attention to the technical aspects of the study, such as patient preparation, imaging protocols, and immobilization techniques, that adhere to best practice principles. Furthermore, we considered the psychological elements of working with children, including comforting and distraction strategies. RESULTS The extensive literature review combined with practical conclusions and recommendations presented and explained by the authors summarizes the most important principles of the care for paediatric patient in the nuclear medicine field. CONCLUSION Nuclear medicine applied to the paediatric patient is a very special and challenging area, requiring proper education and experience in order to be performed at the highest level and with the maximum safety for the child.
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Affiliation(s)
- Luca Camoni
- University of Brescia, 25123, Brescia, Italy.
- Nuclear Medicine Department, University of Brescia, ASST Spedali Civili Di Brescia, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Andrea Santos
- Nuclear Medicine Department, CUF Descobertas Hospital, Lisbon, Portugal
| | - Marie Luporsi
- Department of Nuclear Medicine, Institut Curie, PSL Research University, 75005, Paris, France
- LITO Laboratory INSERM U1288, Institut Curie, 91440, Orsay, France
| | - Ana Grilo
- H&TRC - Health and Technology Research Center, ESTeSL - Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, Lisbon, Portugal
- CICPSI, Faculdade de Psicologia, Universidade de Lisboa, Alameda da Universidade, Lisbon, Portugal
| | - Agata Pietrzak
- Electroradiology Department, Poznan University of Medical Sciences, Poznan, Poland
- Nuclear Medicine Department, Greater Poland Cancer Centre, Poznan, Poland
| | - Jonathan Gear
- Joint Department of Physics, Royal Marsden Hospital and Institute of Cancer Research, Sutton, UK
| | - Pietro Zucchetta
- Nuclear Medicine Department, Padova University Hospital, 35128, Padua, Italy
| | - Zvi Bar-Sever
- Department of Nuclear Medicine, Schneider Children's Medical Center, Tel-Aviv University, Petach Tikva, Israel
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Bebbington NA, Christensen KB, Østergård LL, Holdgaard PC. Ultra-low-dose CT for attenuation correction: dose savings and effect on PET quantification for protocols with and without tin filter. EJNMMI Phys 2023; 10:66. [PMID: 37861887 PMCID: PMC10589162 DOI: 10.1186/s40658-023-00585-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Ultra-low-dose (ULD) computed tomography (CT) scans should be used when CT is performed only for attenuation correction (AC) of positron emission tomography (PET) data. A tin filter can be used in addition to the standard aluminium bowtie filter to reduce CT radiation dose to patients. The aim was to determine how low CT doses can be, when utilised for PET AC, with and without the tin filter, whilst providing adequate PET quantification. METHODS A water-filled NEMA image quality phantom was imaged in three configurations with 18F-FDG: (1) water only (0HU); (2) with cylindrical insert containing homogenous mix of sand, flour and water (SFW, approximately 475HU); (3) with cylindrical insert containing sand (approximately 1100HU). Each underwent one-bed-position (26.3 cm) PET-CT comprising 1 PET and 13 CT acquisitions. CT acquisitions with tube current modulation were performed at 120 kV/50 mAs-ref (reference standard), 100 kV/7 mAs-ref (standard ULDCT for PET AC protocol), Sn140kV (mAs range 7-50-ref) and Sn100kV (mAs range 12-400-ref). PET data were reconstructed with μ-maps provided by each CT dataset, and PET activity concentration measured in each reconstruction. Differences in CT dose length product (DLP) and PET quantification were determined relative to the reference standard. RESULTS At each tube voltage, changes in PET quantification were greater with increasing density and reducing mAs. Compared with the reference standard, differences in PET quantification for the standard ULDCT protocol for the three phantoms were ≤ 1.7%, with the water phantom providing a DLP of 7mGy.cm. With tin filter at Sn100kV, differences in PET quantification were negligible (≤ 1.2%) for all phantoms down to 50mAs-ref, proving a DLP of 2.8mGy.cm, at 60% dose reduction compared with standard ULDCT protocol. Below 50mAs-ref, differences in PET quantification were > 2% for at least one phantom (2.3% at 25mAs-ref in SFW; 6.4% at 12mAs-ref in sand). At Sn140kV/7mAs-ref, quantification differences were ≤ 0.6% in water, giving 3.8mGy.cm DLP, but increased to > 2% at bone-equivalent densities. CONCLUSIONS CT protocols for PET AC can provide ultra-low doses with adequate PET quantification. The tin filter can allow 60-87% lower dose than the standard ULDCT protocol for PET AC, depending on tissue density and accepted change in PET quantification.
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Affiliation(s)
| | - Kenneth Boye Christensen
- Department of Nuclear Medicine, Lillebaelt Hospital - University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Lone Lange Østergård
- Department of Nuclear Medicine, Lillebaelt Hospital - University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
| | - Paw Christian Holdgaard
- Department of Nuclear Medicine, Lillebaelt Hospital - University Hospital of Southern Denmark, Beriderbakken 4, 7100, Vejle, Denmark
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Al-Qahtani SM, Alidasroos MA, Alkhybari EM, Althomali MA, Alomari AH, Bawazeer OA, Hawsawi HB, Aamry AI, Asiri JA, Aloufi AA, Aljehani AD, Al-Osaimi MB, Alosaimi AK, Alsulami AK, Sabi AY, Kamli TM, Sulieman AA, Ajlouni AW. The establishment of national diagnostic reference levels for adult SPECT-CT in Saudi Arabia. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2023; 43:031505. [PMID: 37406624 DOI: 10.1088/1361-6498/ace452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/05/2023] [Indexed: 07/07/2023]
Abstract
This study aims to introduce national diagnostic reference levels (NDRLs) for adult hybrid single photon emission computed tomography (SPECT-CT) in nuclear medicine (NM) departments in the Kingdom of Saudi Arabia. The administered activity (AA) of radiopharmaceuticals, volume-weighted computed tomography dose index (CTDIvol) and dose length product (DLP) for ten hybrid SPECT/CT examinations were collected and analysed for one year. The median of AA, CTDIvoland DLP for each dose quantity was derived and the suggested national DRLs were determined based on the 75thpercentile for all identified SPECT-CT examinations. A comparison of the defined adult NDRLs in Saudi Arabia with the published data of other countries was performed. Although there are no significant variations of the proposed NDRL of AA between countries, the proposed NDRLs of the integrated CT metrics exceed the published data in most procedures. NM departments are urged to consider optimisation for both image quality and radiation protection.
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Affiliation(s)
- Saeed Mueed Al-Qahtani
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Essam M Alkhybari
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Marwan Ahmed Althomali
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ali Hamed Alomari
- Physics Department, Al-Qunfudah University College, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Omemh Abdullah Bawazeer
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Hassan B Hawsawi
- Administration of Medical Physics, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Ali Ibrahim Aamry
- Nuclear Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | | | | | | | | | | | | | - Ahmed Yahya Sabi
- Nuclear Medicine Department, King Fahad Central Hospital, Jazan, Saudi Arabia
| | - Talal Mosa Kamli
- Nuclear Medicine Department, King Fahd Central Hospital, Madinah, Saudi Arabia
| | - Abdelmoneim Adam Sulieman
- Department of Radiology and Medical Imaging, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Abdul-Wali Ajlouni
- Physics Department, College of Applied Science, Umm Al-Qura University, Makkah, Saudi Arabia
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Verfaillie G, Franck C, De Crop A, Beels L, D'Asseler Y, Bacher K. A systematic review and meta-analysis on the radiation dose of computed tomography in hybrid nuclear medicine imaging. EJNMMI Phys 2023; 10:32. [PMID: 37227561 PMCID: PMC10212852 DOI: 10.1186/s40658-023-00553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND While diagnostic reference levels (DRLs) are well-established for the radiopharmaceutical part, published DRLs for the CT component of positron emission tomography/computed tomography (PET/CT) and single photon emission computed tomography/computed tomography (SPECT/CT) are limited. This systematic review and meta-analysis provides an overview of the different objectives of CT in hybrid imaging and summarizes reported CT dose values for the most common PET/CT and SPECT/CT examinations. Also, an overview of already proposed national DRLs is given. METHODS A systematic literature search was performed to identify original articles reporting CT dose index volume (CTDIvol), dose-length product (DLP) and/or national DRLs for the most frequently performed PET/CT and/or SPECT/CT examinations. Data were grouped according to the clinical objective: diagnostic (D-CT), anatomical localisation (AL-CT) or attenuation correction (AC-CT) CT. Random-effects meta-analyses were conducted. RESULTS Twenty-seven articles were identified of which twelve reported national DRLs. For brain and tumour PET/CT imaging, CTDIvol and DLP values were higher for a D-CT (brain: 26.7 mGy, 483 mGy cm; tumour: 8.8 mGy, 697 mGy cm) than for an AC/AL-CT (brain: 11.3 mGy, 216 mGy cm; tumour: 4.3 mGy, 419 mGy cm). Similar conclusions were found for bone and parathyroid SPECT/CT studies: D-CT (bone: 6.5 mGy, 339 mGy cm; parathyroid: 15.1 mGy, 347 mGy cm) results in higher doses than AL-CT (bone: 3.8 mGy, 156 mGy cm; parathyroid: 4.9 mGy, 166 mGy cm). For cardiac (AC-CT), mIBG/octreotide, thyroid and post-thyroid ablation (AC/AL-CT) SPECT/CT pooled mean CTDIvol (DLP) values were 1.8 mGy (33 mGy cm), 4.6 mGy (208 mGy cm), 3.1 mGy (105 mGy cm) and 4.6 mGy (145 mGy cm), respectively. For all examinations, high variability in nuclear medicine practice was observed. CONCLUSION The large variation in CT dose values and national DRLs highlights the need for optimisation in hybrid imaging and justifies the clinical implementation for nuclear medicine specific DRLs.
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Affiliation(s)
- Gwenny Verfaillie
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.
| | - Caro Franck
- mVISION, Faculty of Medicine and Health Sciences, Antwerp University, Antwerp, Belgium
| | - An De Crop
- Department of Nuclear Medicine, AZ Delta, Roeselare, Belgium
- Department of Radiology, AZ Delta, Roeselare, Belgium
| | - Laurence Beels
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Yves D'Asseler
- Department of Nuclear Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Klaus Bacher
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
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Suppiah S, Mohd Rohani MF, Zanial AZ, Ahmad Shahrir AD, Khairuman KA, Vinjamuri S. A Review on the Usage of Bone Single-Photon Emission Computed Tomography/Computed Tomography in Detecting Skeletal Metastases in the Post-COVID-19 Era: Is it Time to Ditch Planar and Single-Photon Emission Computed Tomography only Gamma Camera Systems? Indian J Nucl Med 2023; 38:191-200. [PMID: 37456181 PMCID: PMC10348494 DOI: 10.4103/ijnm.ijnm_142_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/08/2022] [Indexed: 07/18/2023] Open
Abstract
Planar whole-body bone scanning (WBS) is widely used to evaluate skeletal lesions seen in cancer and noncancer cases. Frequently, degenerative, or other benign bony changes may give rise to indeterminate lesions that mimic bone metastases. In the post-COVID-19 era, there is an evolutionary phase that puts importance on global development and adaptability, which encompasses to include nuclear medicine practices worldwide. Single-photon emission computed tomography/computed tomography (SPECT/CT) can be used to improve the characterization of these lesions and help to resolve the diagnostic conundrum while reducing the need for patients to undergo multiple different examinations at various imaging departments. The fusion of SPECT and CT allows morphological characterization of functional abnormality detected by focal tracer uptake on planar scintigraphy, which provides a one-stop center imaging in nuclear medicine departments. The objective of this study was to review the diagnostic accuracy of SPECT/CT in diagnosing bone metastases in a variety of oncology and nononcology cases and to determine the feasibility of performing bone SPECT/CT in all suspected cancer cases, including cases of bone infection instead of planar imaging alone. The utilization of hybrid SPECT/CT in indeterminate bone lesions detected on planar WBS can significantly increase the diagnostic confidence and accuracy of image interpretation. Recognition of patterns of disease identified using hybrid imaging can improve the management of patients with potentially lower costs in the long term. Currently, hybrid SPECT/CT machines are becoming a norm in nuclear medicine departments, thus potentially making single planar application machines obsolete in the near future. We hypothesize that in the interest of providing a meaningful interpretation of isotope bone scans, the default protocol should involve the option of acquiring SPECT/CT images rather than relying on whole-body scans only. Departments choosing to upgrade existing equipment or those choosing to invest in only one gamma camera should proactively opt for hybrid SPECT/CT systems.
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Affiliation(s)
- Subapriya Suppiah
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Seri Kembangan, Malaysia
- Department of Nuclear Medicine, Nuclear Imaging Unit, Hospital Pengajar Universiti Putra Malaysia, Universiti Putra Malaysia, Seri Kembangan, Malaysia
- Pusat Pengimejan Diagnostik Nuklear, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Mohd Fazrin Mohd Rohani
- Department of Nuclear Medicine, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
| | - Ahmad Zaid Zanial
- Department of Nuclear Medicine, Kuala Lumpur Hospital, Ministry of Health Malaysia, Kuala Lumpur, Malaysia
- Department of Nuclear Medicine, Royal Liverpool and Broadgreen University Hospitals, NHS Trusts, Liverpool, England
| | - Ahmad Danial Ahmad Shahrir
- Department of Nuclear Medicine, Nuclear Imaging Unit, Hospital Pengajar Universiti Putra Malaysia, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Khairul Aliff Khairuman
- Department of Nuclear Medicine, Nuclear Imaging Unit, Hospital Pengajar Universiti Putra Malaysia, Universiti Putra Malaysia, Seri Kembangan, Malaysia
| | - Sobhan Vinjamuri
- Department of Nuclear Medicine, Royal Liverpool and Broadgreen University Hospitals, NHS Trusts, Liverpool, England
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Deriving local diagnostic reference levels for four common adult PET/CT procedures in a Saudi Arabian hospital. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Rinscheid A, Janzen T, Alikhani B, Beer AJ, Braune A, Eberhardt N, Fechner D, Förster S, Freesmeyer M, Furth C, Grunert M, Hellwig D, Costa PF, Kühnel C, Lange C, Linke R, Razlaw N, Sack T, Schmidt D, Schütze C, Starke A, Tondera L, Wengenmair H, Zöphel K, Burchert W, Lapa C. Radiation doses from low-dose CT scans in SPECT/CT and PET/CT examinations: A survey in Germany. Nuklearmedizin 2022; 61:294-300. [PMID: 35388444 DOI: 10.1055/a-1759-3900] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Recently, dose reference levels (DRLs) have been defined in Germany for auxiliary low-dose CT scans in hybrid SPECT/CT and PET/CT examinations, based on data from 2016/17. Here, another survey from 2020 was evaluated and compared with the new DRLs as well as with similar surveys from foreign countries. METHODS The survey, which had already been conducted in the Nordic countries, queried for various examinations including the following values: patient weight and height, volume CT dose index (CTDIvol), dose length product (DLP). For each examination, statistical parameters such as the third quartile (Q3) were determined from all submitted CTDIvol and DLP values. Additionally, for examinations comprising datasets from at least 10 systems, the third quartile (Q3-Med) of the respective median values of each system was calculated. Q3 and Q3-Med were compared with the newly published DRLs from Germany and values from similar studies from other countries. RESULTS Data from 15 SPECT/CT and 13 PET/CT systems from 15 nuclear medicine departments were collected. For the following examinations datasets from more than 10 systems were submitted: SPECT lung VQ, SPECT bone, SPECT&PET cardiac, PET brain, PET oncology. Especially for examinations of the thorax and heart, the new DRLs are very strict compared to this study. The CTDIvol values for examinations of the head were lower in this study than the DRLs prescribe now. CONCLUSIONS For certain examination types, there is a need for dose optimization at some clinics and devices in order to take into account the new DRLs in Germany in the future.
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Affiliation(s)
- Andreas Rinscheid
- Medizinische Physik und Strahlenschutz, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Tilman Janzen
- Medizinische Physik und Strahlenschutz, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Babak Alikhani
- Nuklearmedizinische Klinik, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Ambros J Beer
- Klinik für Nuklearmedizin, Universitatsklinikum Ulm, Ulm, Germany
| | - Anja Braune
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Carl Gustav Carus, Dresden
| | - Nina Eberhardt
- Klinik für Nuklearmedizin, Universitatsklinikum Ulm, Ulm, Germany
| | - Diana Fechner
- Abteilung für Nuklearmedizin und Klinische Molekulare Bildgebung, Universitätsklinikum Tübingen, Tübingen, Germany
| | - Stefan Förster
- Klinik und Institut für Nuklearmedizin, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | | | - Christian Furth
- Klinik für Nuklearmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Grunert
- Klinik für Nuklearmedizin, Bundeswehrkrankenhaus Ulm, Ulm, Germany
| | - Dirk Hellwig
- Abteilung für Nuklearmedizin, Universitatsklinikum Regensburg, Regensburg, Germany
| | | | - Christian Kühnel
- Klinik für Nuklearmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Catharina Lange
- Klinik für Nuklearmedizin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Rainer Linke
- Institut für Röntgendiagnostik und Nuklearmedizin, Klinikum Bremerhaven Reinkenheide gGmbH, Bremerhaven, Germany
| | - Natalia Razlaw
- Klinik für Nuklearmedizin, Universitätsklinikum Münster, Münster, Germany
| | - Tobias Sack
- Klinik für Nuklearmedizin, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Daniel Schmidt
- Abteilung für Nuklearmedizin, Universitatsklinikum Regensburg, Regensburg, Germany
| | - Christina Schütze
- Klinik und Institut für Nuklearmedizin, Klinikum Bayreuth GmbH, Bayreuth, Germany
| | - Alexander Starke
- Nuklearmedizinische Klinik, DIAKOVERE Henriettenstift, Hannover, Germany
| | - Liane Tondera
- Gemeinschaftspraxis für diagnostische und interventionelle Radiologie und Nuklearmedizin (DIRANUK), Bielefeld, Germany
| | - Hermann Wengenmair
- Medizinische Physik und Strahlenschutz, Universitätsklinikum Augsburg, Augsburg, Germany
| | - Klaus Zöphel
- Klinik für Nuklearmedizin, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Wolfgang Burchert
- Institut für Radiologie, Nuklearmedizin und Molekulare Bildgebung, Herz- und Diabeteszentrum NRW, Bad Oeynyhausen, Germany
| | - Constantin Lapa
- Klinik für Nuklearmedizin, Universitätsklinikum Augsburg, Augsburg, Germany
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11
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Bebbington NA, Zacho HD, Holdgaard PC. Lesion detection in 18F-sodium fluoride bone imaging: a comparison of attenuation-corrected versus nonattenuation-corrected PET reconstructions from modern PET-CT systems. Nucl Med Commun 2022; 43:78-85. [PMID: 34887371 DOI: 10.1097/mnm.0000000000001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES An earlier study demonstrated comparable lesion detection between attenuation-corrected (AC) and nonattenuation-corrected (NAC) 18F-sodium fluoride (NaF) PET images, which is relevant for computed tomography (CT) radiation dose-saving. However, this finding may not be applicable to newer systems. The aim was to compare lesion detection between AC and NAC NaF PET images on modern PET-CT systems. METHODS One expert and one nonexpert observer retrospectively surveyed NaF PET data in 25 breast cancer patients. At both lesion and patient level, each observer classified bone abnormalities as malignant, equivocal or benign, from NAC and AC PET images in the absence of CT. Expert interpretation of NaF PET-CT with the review of all diagnostic imaging/pathology reports for at least the subsequent 12 months provided reference standard metastases status at the patient level. Two-tailed Wilcoxon signed-rank tests measured statistically significant differences in total lesion detection between AC and NAC PET. Quadratic-weighted kappa score measured agreement in patient metastases status between observers. RESULTS On a lesion-basis, AC PET images showed significantly more lesions than NAC for both the expert (122 versus 96; P = 0.002) and nonexpert (146 versus 132; P = 0.036) observers, with a large number of patients demonstrating disparity between AC and NAC images. For metastases status at the patient level without CT, NAC PET showed slightly better diagnostic accuracy than AC due to fewer false-positive results, as fewer lesions were identified. CONCLUSION AC PET data provided superior lesion detection to NAC in NaF bone examinations and are thus required for clinical interpretation.
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Affiliation(s)
- Natalie Anne Bebbington
- Molecular Imaging, Siemens Healthcare A/S, Bredskifte Alle, Aarhus
- Department of Clinical Medicine, Aalborg University, Aalborg
| | - Helle Damgaard Zacho
- Department of Clinical Medicine, Aalborg University, Aalborg
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg
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12
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Mattsson S, Leide-Svegborn S, Andersson M. X-RAY AND MOLECULAR IMAGING DURING PREGNANCY AND BREASTFEEDING-WHEN SHOULD WE BE WORRIED? RADIATION PROTECTION DOSIMETRY 2021; 195:339-348. [PMID: 33855370 PMCID: PMC8507446 DOI: 10.1093/rpd/ncab041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 05/15/2023]
Abstract
Some of the ethically most sensitive issues in radiation protection arise at imaging of pregnant-and potentially pregnant-patients and of newborn. This article reviews the current literature and recommendations on imaging during pregnancy and breastfeeding. Risks related to alternative non-ionizing radiation methods are also considered. With few exceptions, exposure of the fetus through radiography, computed tomography (CT) and nuclear medicine imaging can be limited to safe levels, although studies such as abdominal-pelvic CT cannot avoid significant exposure to fetuses. Eight to 10 weeks post-conception, the fetus has a thyroid which starts to concentrate iodide having crossed the placenta barrier resulting in unacceptably high doses to the fetal thyroid after administration of 131I- and even 123I-iodide and other radiopharmaceuticals with a high content of free radioiodine. Many radiopharmaceuticals are excreted through breast milk. Breastfeeding interruption recommendations should be followed to keep the effective dose to the infant below 1 mSv.
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Affiliation(s)
- Sören Mattsson
- Medical Radiation Physics Malmö, Department of Translational Medicine, Lund University, Malmö, SE-205 02 Malmö, Sweden
| | - Sigrid Leide-Svegborn
- Medical Radiation Physics Malmö, Department of Translational Medicine, Lund University, Malmö, SE-205 02 Malmö, Sweden
- Radiation Physics, Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Malmö, SE-205 02 Malmö, Sweden
| | - Martin Andersson
- Medical Radiation Physics Malmö, Department of Translational Medicine, Lund University, Malmö, SE-205 02 Malmö, Sweden
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Cancer Center, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SE-413 45 Gothenburg, Sweden
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13
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Bebbington NA, Jørgensen T, Dupont E, Micheelsen MA. Validation of CARE kV automated tube voltage selection for PET-CT: PET quantification and CT radiation dose reduction in phantoms. EJNMMI Phys 2021; 8:29. [PMID: 33743091 PMCID: PMC7981373 DOI: 10.1186/s40658-021-00373-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 02/25/2021] [Indexed: 11/20/2022] Open
Abstract
Background Applied tube voltage (kilovolts, kV) and tube current (milliampere seconds, mAs) affect CT radiation dose and image quality and should be optimised for the individual patient. CARE kV determines the kV and mAs providing the lowest dose to the patient, whilst maintaining user-defined reference image quality. Given that kV changes affect CT values which are used to obtain attenuation maps, the aim was to evaluate the effect of kV changes on PET quantification and CT radiation dose using phantoms. Method Four phantoms (‘Lungman’, ‘Lungman plus fat’, ‘Esser’ and ‘NEMA image quality’ (NEMA IQ)) containing F-18 sources underwent 1 PET and 5 CT scans, with CARE kV on (automatic kV selection and mAs modulation) and in semi mode with specified tube voltages of 140, 120, 100 and 80 kV (mAs modulation only). A CARE kV image quality reference of 120 kV/50 mAs was used. Impact on PET quantification was determined by comparing measured activity concentrations for PET reconstructions from different CT scans with the reconstruction using the 120 kV reference, and dose (DLP, CTDIvol) differences calculated by comparing doses from all kV settings with the 120 kV reference. Results CARE kV-determined optimal tube voltage and CARE kV ‘on’ dose (DLP) savings compared with the 120 kV reference were: Lungman, 100 kV, 2.0%; Lungman plus fat, 120 kV, 0%; Esser, 100 kV, 9.3%; NEMA IQ, 100 kV, 3.4%. Using tube voltages in CARE kV ‘semi’ mode which were not advised by CARE kV ‘on’ resulted in dose increases ≤ 65% compared with the 120 kV reference (greatest difference Lungman plus fat, 80 kV). Clinically insignificant differences in PET activity quantification of up to 0.7% (Lungman, 100 kV, mean measured activity concentration) were observed when using the optimal tube voltage advised by CARE kV. Differences in PET quantification of up to 4.0% (Lungman, 140 kV, maximum measured activity concentration) were found over the full selection of tube voltages in semi mode, with the greatest differences seen at the most suboptimal kV for each phantom. However, most differences were within 1%. Conclusions CARE kV on can provide CT radiation dose savings without concern over changes in PET quantification.
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Affiliation(s)
- Natalie A Bebbington
- Siemens Healthcare A/S, Bredskifte Alle 15, 8210, Aarhus V, Denmark. .,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, 9000, Aalborg, Denmark.
| | - Troels Jørgensen
- Department of Nuclear Medicine, Zealand University Hospital, Køge, Denmark
| | - Erik Dupont
- Department of Biomedical Engineering, Region Zealand, Roskilde, Denmark
| | - Mille A Micheelsen
- Department of Nuclear Medicine, Zealand University Hospital, Køge, Denmark
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14
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Yang J, Sohn JH, Behr SC, Gullberg GT, Seo Y. CT-less Direct Correction of Attenuation and Scatter in the Image Space Using Deep Learning for Whole-Body FDG PET: Potential Benefits and Pitfalls. Radiol Artif Intell 2021; 3:e200137. [PMID: 33937860 PMCID: PMC8043359 DOI: 10.1148/ryai.2020200137] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 11/04/2020] [Accepted: 11/13/2020] [Indexed: 05/14/2023]
Abstract
PURPOSE To demonstrate the feasibility of CT-less attenuation and scatter correction (ASC) in the image space using deep learning for whole-body PET, with a focus on the potential benefits and pitfalls. MATERIALS AND METHODS In this retrospective study, 110 whole-body fluorodeoxyglucose (FDG) PET/CT studies acquired in 107 patients (mean age ± standard deviation, 58 years ± 18; age range, 11-92 years; 72 females) from February 2016 through January 2018 were randomly collected. A total of 37.3% (41 of 110) of the studies showed metastases, with diverse FDG PET findings throughout the whole body. A U-Net-based network was developed for directly transforming noncorrected PET (PETNC) into attenuation- and scatter-corrected PET (PETASC). Deep learning-corrected PET (PETDL) images were quantitatively evaluated by using the standardized uptake value (SUV) of the normalized root mean square error, the peak signal-to-noise ratio, and the structural similarity index, in addition to a joint histogram for statistical analysis. Qualitative reviews by radiologists revealed the potential benefits and pitfalls of this correction method. RESULTS The normalized root mean square error (0.21 ± 0.05 [mean SUV ± standard deviation]), mean peak signal-to-noise ratio (36.3 ± 3.0), mean structural similarity index (0.98 ± 0.01), and voxelwise correlation (97.62%) of PETDL demonstrated quantitatively high similarity with PETASC. Radiologist reviews revealed the overall quality of PETDL. The potential benefits of PETDL include a radiation dose reduction on follow-up scans and artifact removal in the regions with attenuation correction- and scatter correction-based artifacts. The pitfalls involve potential false-negative results due to blurring or missing lesions or false-positive results due to pseudo-low-uptake patterns. CONCLUSION Deep learning-based direct ASC at whole-body PET is feasible and potentially can be used to overcome the current limitations of CT-based approaches, benefiting patients who are sensitive to radiation from CT.Supplemental material is available for this article.© RSNA, 2020.
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15
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Hansen SL, Bebbington NA. Estimation of CARE Dose 4D quality reference mAs conversion factors for child to adult reference patient in child protocols on Siemens Symbia SPECT-CT systems. Nucl Med Commun 2021; 42:107-112. [PMID: 33079892 PMCID: PMC7725139 DOI: 10.1097/mnm.0000000000001312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/15/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES CARE Dose 4D modulates mAs through several mechanisms according to patient size and shape, whilst maintaining user-defined reference image quality on Siemens Symbia single-photon emission computed tomography (SPECT)-computed tomography (CT) systems. A 20 kg child reference was used in child protocols prior to software version VB10 and a 75 kg adult thereafter. Quality reference mAs conversion factors are estimated for delivering equivalent mAs to children between two comparable SPECT-CT systems using adult and child references for topogram-based patient-size-related dose level adaptations. METHODS A child phantom was scanned using child protocols on a Siemens Symbia T16 (child reference) and a Siemens Symbia Intevo Bold (adult reference). On each system, scans of the thorax, abdomen and pelvis were acquired with arms up and down, at 80 and 110 kVp. Quality reference mAs settings of 10-50 were used on the Symbia T16 and 40-200 on the Symbia Intevo Bold. These data were used to propose quality reference mAs (adult/child reference) conversion factors according to scan range, arm position and tube voltage. RESULTS Quality reference mAs for child protocols using the adult reference should multiply the child quality reference mAs by the following factors, to give comparable delivered mAs: arms up 80 kV: 3.8 (thorax), 3.8 (abdomen), 4.3 (pelvis); arms up at 110 kV: 3.8 (thorax), 4.1 (abdomen), 4.6 (pelvis); arms down at 80 kV: 4.0 (thorax), 3.7 (abdomen), 3.9 (pelvis); arms down at 110 kV: 4.3 (thorax), 4.0 (abdomen), 4.2 (pelvis). CONCLUSION Conversion factors for child to adult dose modulation references are proposed, allowing comparable delivered mAs to a child.Video abstract: http://links.lww.com/NMC/A178.
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Affiliation(s)
- Sofie L. Hansen
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen
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16
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Annunziata S, Bauckneht M, Albano D, Argiroffi G, Calabrò D, Abenavoli E, Linguanti F, Laudicella R. Impact of the COVID-19 pandemic in nuclear medicine departments: preliminary report of the first international survey. Eur J Nucl Med Mol Imaging 2020; 47:2090-2099. [PMID: 32462398 PMCID: PMC7251803 DOI: 10.1007/s00259-020-04874-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 01/18/2023]
Abstract
PURPOSE Coronavirus disease-19 (COVID-19) pandemic is challenging the availability of hospital resources worldwide. The Young Group of the Italian Association of Nuclear Medicine (AIMN) developed the first international survey to evaluate the impact of COVID-19 in nuclear medicine (NM). The aim of this study was to perform a preliminary report of the ongoing survey. METHODS A questionnaire of thirty questions was prepared for all NM professionals addressing three main issues: (1) new scheduling praxes for NM diagnostic and therapeutic procedures, (2) assistance of patients with diagnosed or suspected COVID-19, and (3) prevention of COVID-19 spreading in the departments. An invitation to the survey was sent to the corresponding authors of NM scientific papers indexed in SCOPUS in 2019. Personal data were analysed per individual responder. Organisation data were evaluated per single department. RESULTS Two-hundred and ninety-six individual responders from 220 departments were evaluated. Most of the responders were from Europe (199/296, 67%). Approximately, all departments already changed their scheduling praxes due to the pandemic (213/220, 97%). In most departments, scheduled diagnostic and therapeutic procedures were allowed but quantitatively reduced (112/220, 51%). A significant reduction of diagnostic and therapeutic procedures (more than 20%) affected 198/220 (90%) and 158/220 (72%) departments, respectively. Incidental COVID-19 signs in NM exams occurred in 106/220 departments (48%). Few departments were closed or shifted to assist patients with COVID-19 (36/220, 16%). Most of the responders thought that pandemic would not permanently change the work of NM departments in the future (189/296, 64%). CONCLUSIONS According to this preliminary report of the first international survey, COVID-19 heavily impacted NM departments and professionals. New praxes for NM procedures, assistance, and prevention of COVID-19 have been applied during the pandemic.
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Affiliation(s)
- Salvatore Annunziata
- Nuclear Medicine Unit, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144, Rome, Italy.
| | - Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | | | - Diletta Calabrò
- Nuclear Medicine, DIMES University of Bologna, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Elisabetta Abenavoli
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Flavia Linguanti
- Nuclear Medicine Unit, Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Riccardo Laudicella
- Department of Biomedical and Dental Sciences and of Morpho-Functional Imaging, Nuclear Medicine Unit, University of Messina, Messina, Italy
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17
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Bertolini V, Palmieri A, Bassi MC, Bertolini M, Trojani V, Piccagli V, Fioroni F, Cavuto S, Guberti M, Versari A, Cola S. CT protocol optimisation in PET/CT: a systematic review. EJNMMI Phys 2020; 7:17. [PMID: 32180029 PMCID: PMC7076098 DOI: 10.1186/s40658-020-00287-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/10/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose Currently, no consistent guidelines for CT scans used within PET/CT examinations are available. This systematic review provides an up-to-date overview of studies to answer the following questions: What are the specific CT protocols used in PET/CT? What are the possible purposes of requiring a CT study within a PET/CT scan? Is the CT protocol obtained from a dosimetric optimisation study? Materials and method PubMed/MEDLINE, Cochrane Library, Embase and Scopus were systematically searched for relevant studies in accordance with the PRISMA statement. The literature search was conducted from January 2007 until June 2019. Data derived from studies were standardized in order to reduce possible biases, and they were divided into clinically homogeneous subgroups (adult, child or phantom). Subsequently, we divided the CT protocol intents into 3 types (anatomic localization only, attenuation correction only and diagnostic purpose). A narrative approach was used to summarise datasets and to investigate their heterogeneity (due to medical prescription methodology) and their combination in multiseries CT protocols. When weighted computed tomography dose index (CTDIw) was available, we calculated the volumetric computed tomography dose index (CTDIvol) using the pitch value to make the results uniform. Eventually, the correlation between protocol intents and CTDIvol values was obtained using a Kruskal–Wallis one-way ANOVA statistical test. Result Starting from a total of 1440 retrieved records, twenty-four studies were eligible for inclusion in addition to two large multicentric works that we used to compare the results. We analyzed 87 CT protocols. There was a considerable range of variation in the acquisition parameters: tube current–time product revealed to have the most variable range, which was 10–300 mAs for adults and 10–80 mAs for paediatric patients. Seventy percent of datasets presented scans acquired with tube current modulation, 9% used fixed tube current and in 21% of them, this information was not available. Dependence between mean CTDIvol values and protocol intent was statistically significant (p = 0.002). As expected, in diagnostic protocols, there was a statistically significant difference between CTDIvol values of with and without contrast acquisitions (11.68 mGy vs 7.99 mGy, p = 0.009). In 13 out of 87 studies, the optimisation aim was not reported; in 2 papers, a clinical protocol was used; and in 11 works, a dose optimisation protocol was applied. Conclusions According to this review, the dose optimisation in PET/CT exams depends heavily on the correct implementation of the CT protocol. In addition to this, considering the latest technology advances (i.e. iterative algorithms development), we suggest a periodic quality control audit to stay updated on new clinical utility modalities and to achieve a shared standardisation of clinical protocols. In conclusion, this study pointed out the necessity to better identify the specific CT protocol use within PET/CT scans, taking into account the continuous development of new technologies.
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Affiliation(s)
- V Bertolini
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - A Palmieri
- Nuclear Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M C Bassi
- Medical Library, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M Bertolini
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy.
| | - V Trojani
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy.,Medical Physics Specialization School, Università degli Studi di Bologna, Bologna, Italy
| | - V Piccagli
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - F Fioroni
- Medical Physics Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - S Cavuto
- Research and Statistics Infrastructure, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - M Guberti
- Health Care Professionals Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - A Versari
- Nuclear Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
| | - S Cola
- Nuclear Medicine Unit, Azienda USL-IRCCS, Reggio Emilia, Italy
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