Intraoperative Gamma Cameras: A Review of Development in the Last Decade and Future Outlook

Setting-up a training programme for intraoperative molecular imaging and sentinel node mapping: how to teach? How to learn?

BACKGROUND

The current expansion of image-guided surgery is closely related to the role played by radio-guided surgery in supporting the sentinel node (SN) procedure during more than three decades. The so-called triple approach (lymphoscintigraphy, gamma probe detection and blue dye) was not only essential in the seminal validation of the SN procedure but also a first collective learning effort based on skill transfer and outcome-related evaluation which laid the fundaments to delineate the field of intraoperative molecular imaging (IMI) based on a similar multimodality approach and multidisciplinary practice.

METHODS

These elements are also becoming valid in the current incorporation of SPECT/CT and PET/CT to existing and new protocols of IMI procedures and SN mapping concerning other clinical applications. On the other hand, there is a growing tendency to combine novel modern technologies in an allied role with gamma guidance in the operating room following the development of hybrid tracers and multimodal detection approaches. Against this background, learning initiatives are required for professionals working in this area.

RESULTS

This objective has led to a group of European practitioners with large experience in SN mapping and IMI applications to give shape to a programme made up out of specific learning modules aimed to be used as a conductive thread in peripherical or centralised training instances concerning the topic.

CONCLUSION

The presented work, written as a tutorial review, is placed in an available prior-art context and is primarily aimed at medical and paramedical practitioners as well as at hardware and software developers.

3D-localization of single point-like gamma sources with a coded aperture camera

Objective.3D-localization of gamma sources has the potential to improve the outcome of radio-guided surgery. The goal of this paper is to analyze the localization accuracy for point-like sources with a single coded aperture camera.Approach.We both simulated and measured a point-like241Am source at 17 positions distributed within the field of view of an experimental gamma camera. The setup includes a0.11mmthick Tungsten sheet with a MURA mask of rank 31 and pinholes of0.08mmin diameter and a detector based on the photon counting readout circuit Timepix3. Two methods, namely an iterative search including either a symmetric Gaussian fitting or an exponentially modified Gaussian fitting (EMG) and a center of mass method were compared to estimate the 3D source position.Main results.Considering the decreasing axial resolution with source-to-mask distance, the EMG improved the results by a factor of 4 compared to the Gaussian fitting based on the simulated data. Overall, we obtained a mean localization error of0.77mmon the simulated and2.64mmon the experimental data in the imaging range of20-100mm.Significance.This paper shows that despite the low axial resolution, point-like sources in the nearfield can be localized as well as with more sophisticated imaging devices such as stereo cameras. The influence of the source size and the photon count on the imaging and localization accuracy remains an important issue for further research.

Seracam: characterisation of a new small field of view hybrid gamma camera for nuclear medicine

BACKGROUND

Portable gamma cameras are being developed for nuclear medicine procedures such as thyroid scintigraphy. This article introduces Seracam® - a new technology that combines small field of view gamma imaging with optical imaging - and reports its performance and suitability for small organ imaging.

METHODS

The count rate capability, uniformity, spatial resolution, and sensitivity for 99mTc are reported for four integrated pinhole collimators of nominal sizes of 1 mm, 2 mm, 3 mm and 5 mm. Characterisation methodology is based on NEMA guidelines, with some adjustments necessitated by camera design. Two diagnostic scenarios - thyroid scintigraphy and gastric emptying - are simulated using clinically relevant activities and geometries to investigate application-specific performance. A qualitative assessment of the potential benefits and disadvantages of Seracam is also provided.

RESULTS

Seracam's performance across the measured characteristics is appropriate for small field of view applications in nuclear medicine. At an imaging distance of 50 mm, corresponding to a field of view of 77.6 mm × 77.6 mm, spatial resolution ranged from 4.6 mm to 26 mm and sensitivity from 3.6 cps/MBq to 52.2 cps/MBq, depending on the collimator chosen. Results from the clinical simulations were particularly promising despite the challenging scenarios investigated. The optimal collimator choice was strongly application dependent, with gastric emptying relying on the higher sensitivity of the 5 mm pinhole whereas thyroid imaging benefitted from the enhanced spatial resolution of the 1 mm pinhole. Signal to noise ratio in images was improved by pixel binning. Seracam has lower measured sensitivity when compared to a traditional large field of view gamma camera, for the simulated applications this is balanced by advantages such as high spatial resolution, portability, ease of use and real time gamma-optical image fusion and display.

CONCLUSION

The results show that Seracam has appropriate performance for small organ 99mTc imaging. The results also show that the performance of small field of view systems must be considered holistically and in clinically appropriate scenarios.

Evaluation of Improved Imaging Properties with Tungsten-Based Parallel-Hole Collimators: A Monte Carlo Study

Objectives  The purpose of a parallel-hole collimator in a scintillation camera system is to transmit only those photons that have an emission angle close to the direction of the hole. This makes it possible to receive spatial information about the origin of the emission, that is, radioactivity decay. The dimension, shape, and intrahole thickness determine the spatial resolution and, by a tradeoff, sensitivity. The composition of the collimator material also plays an important role in determining a proper collimator. In this study, we compared tungsten alloys as a potential collimator material replacement for the conventional lead antimony material used in most of the current camera systems. Materials and Methods  Monte Carlo simulations of a commercial scintillation camera system with low energy high resolution (LEHR), medium-energy (ME), and high-energy (HE) collimators of lead, tungsten, and tungsten-based alloy were simulated for different I-131, Lu-177, I-123, and Tc-99m sources, and a Deluxe rod phantom using the SIMIND Monte Carlo code. Planar images were analyzed regarding spatial resolution, image contrast in a cold source case, and system sensitivity for each collimator configuration. The hole dimensions for the three collimators were those specified in the vendor's datasheet. Results  Using Pb, W, and tungsten alloy (Wolfmet) as collimator materials, the full width at half maximum (FWHM) measures for total counts (T) for LEHR with Tc-99m source (6.9, 6.8, and 6.8 mm), for ME with Lu-177 source (11.7, 11.5, and 11.6 mm), and for HE with I-131 (6.2, 13.1, and 13.1 mm) were obtained, and the system sensitivities were calculated as 89.9, 86.1, and 89.8 cps T /MBq with Tc-99m source; 42.7, 17.4, and 20.9 cps T /MBq with Lu-177 source; and 40.1, 69.7, and 77.4 cps T /MBq with I-131 source. The collimators of tungsten and tungsten alloy (97.0% W, 1.5% Fe, 1.5% Ni) provided better spatial resolution and improved image contrast when compared with conventional lead-based collimators. This was due to lower septal penetration. Conclusion  The results suggest that development of a new set of ME and HE tungsten and tungsten alloy collimators could improve imaging of I-131, Lu-177, and I-123.

Toward "super-scintillation" with nanomaterials and nanophotonics

Following the discovery of X-rays, scintillators are commonly used as high-energy radiation sensors in diagnostic medical imaging, high-energy physics, astrophysics, environmental radiation monitoring, and security inspections. Conventional scintillators face intrinsic limitations including a low extraction efficiency of scintillated light and a low emission rate, leading to efficiencies that are less than 10 % for commercial scintillators. Overcoming these limitations will require new materials including scintillating nanomaterials ("nanoscintillators"), as well as new photonic approaches that increase the efficiency of the scintillation process, increase the emission rate of materials, and control the directivity of the scintillated light. In this perspective, we describe emerging nanoscintillating materials and three nanophotonic platforms: (i) plasmonic nanoresonators, (ii) photonic crystals, and (iii) high-Q metasurfaces that could enable high performance scintillators. We further discuss how a combination of nanoscintillators and photonic structures can yield a "super scintillator" enabling ultimate spatio-temporal resolution while enabling a significant boost in the extracted scintillation emission.

Assessment of the axial resolution of a compact gamma camera with coded aperture collimator

PURPOSE

Handheld gamma cameras with coded aperture collimators are under investigation for intraoperative imaging in nuclear medicine. Coded apertures are a promising collimation technique for applications such as lymph node localization due to their high sensitivity and the possibility of 3D imaging. We evaluated the axial resolution and computational performance of two reconstruction methods.

METHODS

An experimental gamma camera was set up consisting of the pixelated semiconductor detector Timepix3 and MURA mask of rank 31 with round holes of 0.08 mm in diameter in a 0.11 mm thick Tungsten sheet. A set of measurements was taken where a point-like gamma source was placed centrally at 21 different positions within the range of 12-100 mm. For each source position, the detector image was reconstructed in 0.5 mm steps around the true source position, resulting in an image stack. The axial resolution was assessed by the full width at half maximum (FWHM) of the contrast-to-noise ratio (CNR) profile along the z-axis of the stack. Two reconstruction methods were compared: MURA Decoding and a 3D maximum likelihood expectation maximization algorithm (3D-MLEM).

RESULTS

While taking 4400 times longer in computation, 3D-MLEM yielded a smaller axial FWHM and a higher CNR. The axial resolution degraded from 5.3 mm and 1.8 mm at 12 mm to 42.2 mm and 13.5 mm at 100 mm for MURA Decoding and 3D-MLEM respectively.

CONCLUSION

Our results show that the coded aperture enables the depth estimation of single point-like sources in the near field. Here, 3D-MLEM offered a better axial resolution but was computationally much slower than MURA Decoding, whose reconstruction time is compatible with real-time imaging.