3D printing of radioactive phantoms for nuclear medicine imaging

Tailoring the Mass Density of 3D Printing Materials for Accurate X-ray Imaging Simulation by Controlled Underfilling for Radiographic Phantoms

Additive manufacturing and 3D printing allow for the design and rapid production of radiographic phantoms for X-ray imaging, including CT. These are used for numerous purposes, such as patient simulation, optimization of imaging procedures and dose levels, system evaluation and quality assurance. However, standard 3D printing polymers do not mimic X-ray attenuation properties of tissues like soft, adipose, lung or bone tissue, and standard materials like liquid water. The mass density of printing polymers-especially important in CT-is often inappropriate, i.e., mostly too high. Different methods can be applied to reduce mass density. This work examines reducing density by controlled underfilling either realized by using 3D printing materials expanded through foaming during heating in the printing process, or reducing polymer flow to introduce microscopic air-filled voids. The achievable density reduction depends on the base polymer used. When using foaming materials, density is controlled by the extrusion temperature, and ranges from 33 to 47% of the base polymer used, corresponding to a range of -650 to -394 HU in CT with 120 kV. Standard filaments (Nylon, modified PLA and modified ABS) allowed density reductions by 20 to 25%, covering HU values in CT from -260 to 77 (Nylon), -230 to -20 (ABS) and -81 to 143 (PLA). A standard chalk-filled PLA filament allowed reproduction of bone tissue in a wide range of bone mineral content resulting in CT numbers from 57 to 460 HU. Controlled underfilling allowed the production of radiographic phantom materials with continuously adjustable attenuation in a limited but appropriate range, allowing for the reproduction of X-ray attenuation properties of water, adipose, soft, lung, and bone tissue in an accurate, predictable and reproducible manner.

3D printed non-uniform anthropomorphic phantoms for quantitative SPECT

BACKGROUND

A 3D printing grid-based method was developed to construct anthropomorphic phantoms with non-uniform activity distributions, to be used for evaluation of quantitative SPECT images. The aims were to characterize the grid-based method and to evaluate its capability to provide realistically shaped phantoms with non-uniform activity distributions.

METHODS

Characterization of the grid structures was performed by printing grid-filled spheres. Evaluation was performed by micro-CT imaging to investigate the printing accuracy and by studying the modulation contrast ([Formula: see text]) in SPECT images for 177Lu and 99mTc as a function of the grid fillable-volume fraction (FVF) determined from weighing. The grid-based technique was applied for the construction of two kidney phantoms and two thyroid phantoms, designed using templates from the XCAT digital phantoms. The kidneys were constructed with a hollow outer container shaped as cortex, an inner grid-based structure representing medulla and a solid section representing pelvis. The thyroids consisted of two lobes printed as grid-based structures, with void hot spots within the lobes. The phantoms were filled with solutions of 177Lu (kidneys) or 99mTc (thyroids) and imaged with SPECT. For verification, Monte Carlo simulations of SPECT imaging were performed for activity distributions corresponding to those of the printed phantoms. Measured and simulated SPECT images were compared qualitatively and quantitatively.

RESULTS

Micro-CT images showed that printing inaccuracies were mainly uniform across the grid. The relationships between the FVF from weighing and [Formula: see text] were found to be linear (r = 0.9995 and r = 0.9993 for 177Lu and 99mTc, respectively). The FVF-deviations from the design were up to 15% for thyroids and 4% for kidneys, mainly related to possibilities of cleaning after printing. Measured and simulated SPECT images of kidneys and thyroids exhibited similar activity distributions and quantitative comparisons agreed well, thus verifying the grid-based method.

CONCLUSIONS

We find the grid-based technique useful for the provision of 3D printed, realistically shaped, phantoms with non-uniform activity distributions, which can be used for evaluation of different quantitative methods in SPECT imaging.

Enhancing Interoperability and Harmonisation of Nuclear Medicine Image Data and Associated Clinical Data

Nuclear imaging techniques such as positron emission tomography (PET) and single photon emission computed tomography (SPECT) in combination with computed tomography (CT) are established imaging modalities in clinical practice, particularly for oncological problems. Due to a multitude of manufacturers, different measurement protocols, local demographic or clinical workflow variations as well as various available reconstruction and analysis software, very heterogeneous datasets are generated. This review article examines the current state of interoperability and harmonisation of image data and related clinical data in the field of nuclear medicine. Various approaches and standards to improve data compatibility and integration are discussed. These include, for example, structured clinical history, standardisation of image acquisition and reconstruction as well as standardised preparation of image data for evaluation. Approaches to improve data acquisition, storage and analysis will be presented. Furthermore, approaches are presented to prepare the datasets in such a way that they become usable for projects applying artificial intelligence (AI) (machine learning, deep learning, etc.). This review article concludes with an outlook on future developments and trends related to AI in nuclear medicine, including a brief research of commercial solutions.

Validation of a Monte Carlo simulated cardiac phantom for planar and SPECT studies

PURPOSE

This work aimed to validate Monte Carlo (MC) simulated cardiac phantoms for the evaluation of planar- and SPECT-gated-blood-pool (GBP-P and GBP-S) studies.

METHODS

A comparison of gamma camera system performance criteria measurements (energy resolution, spatial resolution, sensitivity) with MC simulations was conducted. Furthermore, the accuracy of measured and simulated volumes of two stereolithography-printed cardiac phantoms (based on 4D-XCAT phantoms) was assessed. Finally, the simulated GBP-P and GBP-S XCAT studies were validated by comparing calculated left ventricular ejection fraction (LVEF) and ventricle volume values with known parameters.

RESULTS

The simulated performance criteria compared well with measured values (energy resolution difference: 0.1 ± 0.10%; spatial resolution (full width at half maximum) difference ≤ 0.5 ± 0.8 mm and system sensitivity difference ≤ 6.2 ± 0.62cps/MBq). The measured and simulated cardiac phantoms were in good agreement; the left anterior oblique views compared well. This is supported by line profiles through these phantoms and on average, simulated counts were 5.8% lower than measured counts. The LVEF values calculated from the GBP-P and GBP-S simulated data differ from known values (2.8 ± 0.64% and 0.8 ± 0.52%). The differences between the known XCAT LV volumes and simulated GBP-S calculated volumes were -1.2 ± 1.91 ml and -1.5 ± 0.96 ml for the end-diastolic and end-systolic volumes.

CONCLUSION

The MC-simulated cardiac phantom has been validated successfully. Stereolithography-printing allows researchers to create clinically realistic organ phantoms and is a valuable tool for validating MC simulations and clinical software. By conducting GBP simulation studies with various XCAT models, the user will be able to generate GBP-P and GBP-S databases for future software evaluation.

Development of a bespoke phantom to optimize molecular PET imaging of pituitary tumors

BACKGROUND

Image optimization is a key step in clinical nuclear medicine, and phantoms play an essential role in this process. However, most phantoms do not accurately reflect the complexity of human anatomy, and this presents a particular challenge when imaging endocrine glands to detect small (often subcentimeter) tumors. To address this, we developed a novel phantom for optimization of positron emission tomography (PET) imaging of the human pituitary gland. Using radioactive 3D printing, phantoms were created which mimicked the distribution of ¹¹C-methionine in normal pituitary tissue and in a small tumor embedded in the gland (i.e., with no inactive boundary, thereby reproducing the in vivo situation). In addition, an anatomical phantom, replicating key surrounding structures [based on computed tomography (CT) images from an actual patient], was created using material extrusion 3D printing with specialized filaments that approximated the attenuation properties of bone and soft tissue.

RESULTS

The phantom enabled us to replicate pituitary glands harboring tumors of varying sizes (2, 4 and 6 mm diameters) and differing radioactive concentrations (2 ×, 5 × and 8 × the normal gland). The anatomical phantom successfully approximated the attenuation properties of surrounding bone and soft tissue. Two iterative reconstruction algorithms [ordered subset expectation maximization (OSEM); Bayesian penalized likelihood (BPL)] with a range of reconstruction parameters (e.g., 3, 5, 7 and 9 OSEM iterations with 24 subsets; BPL regularization parameter (β) from 50 to 1000) were tested. Images were analyzed quantitatively and qualitatively by eight expert readers. Quantitatively, signal was the highest using BPL with β = 50; noise was the lowest using BPL with β = 1000; contrast was the highest using BPL with β = 100. The qualitative review found that accuracy and confidence were the highest when using BPL with β = 400.

CONCLUSIONS

The development of a bespoke phantom has allowed the identification of optimal parameters for molecular pituitary imaging: BPL reconstruction with TOF, PSF correction and a β value of 400; in addition, for small (< 4 mm) tumors with low contrast (2:1 or 5:1), sensitivity may be improved using a β value of 100. Together, these findings should increase tumor detection and confidence in reporting scans.

X-ray attenuation of bone, soft and adipose tissue in CT from 70 to 140 kV and comparison with 3D printable additive manufacturing materials

Additive manufacturing and 3D printing are widely used in medical imaging to produce phantoms for image quality optimization, imaging protocol definition, comparison of image quality between different imaging systems, dosimetry, and quality control. Anthropomorphic phantoms mimic tissues and contrasts in real patients with regard to X-ray attenuation, as well as dependence on X-ray spectra. If used with different X-ray energies, or to optimize the spectrum for a certain procedure, the energy dependence of the attenuation must replicate the corresponding energy dependence of the tissues mimicked, or at least be similar. In the latter case the materials’ Hounsfield values need to be known exactly to allow to correct contrast and contrast to noise ratios accordingly for different beam energies. Fresh bovine and porcine tissues including soft and adipose tissues, and hard tissues from soft spongious bone to cortical bone were scanned at different energies, and reference values of attenuation in Hounsfield units (HU) determined. Mathematical model equations describing CT number dependence on kV for bones of arbitrary density, and for adipose tissues are derived. These data can be used to select appropriate phantom constituents, compare CT values with arbitrary phantom materials, and calculate correction factors for phantoms consisting of materials with an energy dependence different to the tissues. Using data on a wide number of additive manufacturing and 3D printing materials, CT numbers and their energy dependence were compared to those of the tissues. Two commercially available printing filaments containing calcium carbonate powder imitate bone tissues with high accuracy at all kV values. Average adipose tissue can be duplicated by several off-the-shelf printing polymers. Since suitable printing materials typically exhibit a too high density for the desired attenuation of especially soft tissues, controlled density reduction by underfilling might improve tissue equivalence.

3D printed anthropomorphic left ventricular myocardial phantom for nuclear medicine imaging applications

Background

Anthropomorphic torso phantoms, including a cardiac insert, are frequently used to investigate the imaging performance of SPECT and PET systems. These phantom solutions are generally featuring a simple anatomical representation of the heart. 3D printing technology paves the way to create cardiac phantoms with more complex volume definition. This study aimed to describe how a fillable left ventricular myocardium (LVm) phantom can be manufactured using geometry extracted from a patient image.

Methods

The LVm of a healthy subject was segmented from ¹⁸F-FDG attenuation corrected PET image set. Two types of phantoms were created and 3D printed using polyethylene terephthalate glycol (PETG) material: one representing the original healthy LVm, and the other mimicking myocardium with a perfusion defect. The accuracy of the LVm phantom production was investigated by high-resolution CT scanning of 3 identical replicas. ^99mTc SPECT acquisitions using local cardiac protocol were performed, without additional scattering media (“in air” measurements) for both phantom types. Furthermore, the healthy LVm phantom was inserted in the commercially available DataSpectrum Anthropomorphic Torso Phantom (“in torso” measurement) and measured with hot background and hot liver insert.

Results

Phantoms were easy to fill without any air-bubbles or leakage, were found to be reproducible and fully compatible with the torso phantom. Seventeen segments polar map analysis of the "in air” measurements revealed that a significant deficit in the distribution appeared where it was expected. 59% of polar map segments had less than 5% deviation for the "in torso” and "in air” measurement comparison. Excluding the deficit area, neither comparison had more than a 12.4% deviation. All the three polar maps showed similar apex and apical region values for all configurations.

Conclusions

Fillable anthropomorphic 3D printed phantom of LVm can be produced with high precision and reproducibility. The 3D printed LVm phantoms were found to be suitable for SPECT image quality tests during different imaging scenarios. The flexibility of the 3D printing process presented in this study provides scalable and anthropomorphic image quality phantoms in nuclear cardiology imaging.

EARL compliance measurements on the biograph vision Quadra PET/CT system with a long axial field of view

Background

Our aim was to determine sets of reconstruction parameters for the Biograph Vision Quadra (Siemens Healthineers) PET/CT system that result in quantitative images compliant with the European Association of Nuclear Medicine Research Ltd. (EARL) criteria. Using the Biograph Vision 600 (Siemens Healthineers) PET/CT technology but extending the axial field of view to 106 cm, gives the Vision Quadra currently an around fivefold higher sensitivity over the Vision 600 with otherwise comparable spatial resolution. Therefore, we also investigated how the number of incident positron decays—i.e., exposure—affects EARL compliance. This will allow estimating a minimal acquisition time or a minimal applied dose in clinical scans while retaining data comparability.

Methods

We measured activity recovery curves on a NEMA IEC body phantom filled with an aqueous ¹⁸F solution and a sphere to background ratio of 10–1 according to the latest EARL guidelines. Reconstructing 3570 image sets with varying OSEM PSF iterations, post-reconstruction Gaussian filter full width at half maximum (FWHM), and varying exposure from 59 kDecays/ml (= 3 s frame duration) to 59.2 MDecays/ml (= 1 h), allowed us to determine sets of parameters to achieve compliance with the current EARL 1 and EARL 2 standards. Recovery coefficients (RCs) were calculated for the metrics RC_max, RC_mean, and RC_peak, and the respective recovery curves were analyzed for monotonicity. The background’s coefficient of variation (COV) was also calculated.

Results

Using 6 iterations, 5 subsets and 7.8 mm Gauss filtering resulted in optimal EARL1 compliance and recovery curve monotonicity in all analyzed frames, except in the 3 s frames. Most robust EARL2 compliance and monotonicity were achieved with 2 iterations, 5 subsets, and 3.6 mm Gauss FWHM in frames with durations between 30 s and 10 min. RC_peak only impeded EARL2 compliance in the 10 s and 3 s frames.

Conclusions

While EARL1 compliance was robust over most exposure ranges, EARL2 compliance required exposures between 1.2 MDecays/ml to 11.5 MDecays/ml. The Biograph Vision Quadra’s high sensitivity makes frames as short as 10 s feasible for comparable quantitative images. Lowering EARL2 RC_max limits closer to unity would possibly even permit shorter frames.

Technical note: 3D-printed phantom for dedicated cardiac protocols and geometries in nuclear medicine

PURPOSE

The purpose of this study was to create and validate a 3D-printed nuclear cardiac phantom for low cost, user-friendly design and easy implementation with modern cardiac SPECT systems. This new phantom design aims to address common problems with commercial phantoms such as lengthy setup, prohibitive cost, and overly large size, while improving the overall functionality of the phantom.

METHODS

The phantom was developed using computer aided design software and fabricated with a 3D printer using optimized watertight printing protocols. The phantom design includes six low perfusion lesions within a stylized myocardium of the left ventricle that are placed in the common quantitation sectors for polar maps. The validation of this phantom was completed with two dedicated cardiac SPECT systems; a dual head gamma camera and a multi-pinhole CZT system. Multiple SPECT acquisitions were used to demonstrate the functionality of the phantom. Polar maps were reconstructed and used to score the contrast detectability based on the number of visible low contrast objects representing "lesions."

RESULTS

The images reconstructed from the various acquisitions on both SPECT systems closely resemble a clinical examination. Lesion visibility followed the expected relationships between protocol changes affecting contrast and spatial resolution. Lesion visibility improved with iterative reconstruction against filtered back projection.

CONCLUSION

A phantom of a stylized left ventricle with fillable myocardium was developed, 3D printed, and implemented for cardiac nuclear medicine. The phantom simulates the task of perfusion imaging and successfully demonstrates differences in image quality depending on imaging protocol. This study validates the 3D-printed design as a low cost and user-friendly phantom that can be easily scanned and scored using various systems, in particular those implementing a nontraditional cardio-centric geometry.

Absolute Quantification in Diagnostic SPECT/CT: The Phantom Premise

The application of absolute quantification in SPECT/CT has seen increased interest in the context of radionuclide therapies where patient-specific dosimetry is a requirement within the European Union (EU) legislation. However, the translation of this technique to diagnostic nuclear medicine outside this setting is rather slow. Clinical research has, in some examples, already shown an association between imaging metrics and clinical diagnosis, but the applications, in general, lack proper validation because of the absence of a ground truth measurement. Meanwhile, additive manufacturing or 3D printing has seen rapid improvements, increasing its uptake in medical imaging. Three-dimensional printed phantoms have already made a significant impact on quantitative imaging, a trend that is likely to increase in the future. In this review, we summarize the data of recent literature to underpin our premise that the validation of diagnostic applications in nuclear medicine using application-specific phantoms is within reach given the current state-of-the-art in additive manufacturing or 3D printing.

3D printing 18F radioactive phantoms for PET imaging

Purpose

Phantoms are routinely used in molecular imaging to assess scanner performance. However, traditional phantoms with fillable shapes do not replicate human anatomy. 3D-printed phantoms have overcome this by creating phantoms which replicate human anatomy which can be filled with radioactive material. The problem with these is that small objects suffer to a greater extent than larger objects from the effects of inactive walls, and therefore, phantoms without these are desirable. The purpose of this study was to explore the feasibility of creating resin-based 3D-printed phantoms using ¹⁸F.

Methods

Radioactive resin was created using an emulsion of printer resin and ¹⁸F-FDG. A series of test objects were printed including twenty identical cylinders, ten spheres with increasing diameters (2 to 20 mm), and a double helix. Radioactive concentration uniformity, printing accuracy and the amount of leaching were assessed.

Results

Creating radioactive resin was simple and effective. The radioactive concentration was uniform among identical objects; the CoV of the signal was 0.7% using a gamma counter. The printed cylinders and spheres were found to be within 4% of the model dimensions. A double helix was successfully printed as a test for the printer and appeared as expected on the PET scanner. The amount of radioactivity leached into the water was measurable (0.72%) but not visible above background on the imaging.

Conclusions

Creating an ¹⁸F radioactive resin emulsion is a simple and effective way to create accurate and complex phantoms without inactive walls. This technique could be used to print clinically realistic phantoms. However, they are single use and cannot be made hollow without an exit hole. Also, there is a small amount of leaching of the radioactivity to take into consideration.

Radioactive 3D printing for the production of molecular imaging phantoms

Quality control tests of molecular imaging systems are hampered by the complexity of phantom preparation. It is proposed that radioisotopes can be directly incorporated into photo-polymer resins. Use of the radio-polymer in a 3D printer allows phantoms with more complex and reliable activity distributions to be produced whilst simplifying source preparation. Initial tests have been performed to determine the practicality of integrating Tc-99m into a photo-polymer and example phantoms produced to test suitability for quality control. Samples of build and support resins were extracted from the print cartridges of an Objet30Pro Polyjet 3D printer. The response of the resin to external factors including ionising radiation, light and dilution with Tc-99m pertechnetate were explored. After success of the initial tests the radio-polymer was used in the production of different phantoms. Radionuclide dose calibrator and gamma camera acquisitions of the phantoms were used to test accuracy of activity concentration, print consistency, uniformity and heterogeneous reproducibility. Tomographic phantoms were also produced including a uniform hot sphere, a complex configuration of spheres and interlacing torus's and a hot rod phantom. The coefficient of variation between repeat prints of a 12 g disk phantom was 0.08%. Measured activity within the disks agreed to within 98 ± 2% of the expected activity based on initial resin concentration. Gamma camera integral uniformity measured across a 3D printed flood field phantom was 5.2% compared to 6.0% measured with a commercial Co-57 flood source. Heterogeneous distributions of activity were successfully reproduced for both 2D and 3D imaging phantoms. Count concentration across regions of heterogeneity agreed with the planned activity assigned to those regions on the phantom design. 3D printing of radioactive phantoms has been successfully demonstrated and is a promising application for quality control of Positron Emission Tomography and Single Photon Emission Computed Tomography systems.