hybrid pet ct and spect ct imaging a teaching file pdf

Hybrid Pet Ct And Spect Ct Imaging A Teaching File Pdf

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This method estimates the absorbed dose of different structures for peptide-receptor-radionuclide-therapy PRRT with the possibility of avoiding organ overlap on 2D-projections. Peptide-receptor-radionuclide-therapy PPRT is a targeted therapy that combines a short-range energy radionuclide with a substrate with high specificity for cancer cell receptors. After injection, the radiotracer is distributed throughout the entire body, with a higher uptake in tissues where targeted receptors are overexpressed.

Hybrid PET/CT and SPECT/CT Imaging

This method estimates the absorbed dose of different structures for peptide-receptor-radionuclide-therapy PRRT with the possibility of avoiding organ overlap on 2D-projections.

Peptide-receptor-radionuclide-therapy PPRT is a targeted therapy that combines a short-range energy radionuclide with a substrate with high specificity for cancer cell receptors.

After injection, the radiotracer is distributed throughout the entire body, with a higher uptake in tissues where targeted receptors are overexpressed. We implemented a hybrid method that combines information derived from both 2D and 3D images. Serial whole-body images and blood samples are acquired to estimate the absorbed dose to different organs at risk and to lesions disseminated throughout the body. The methodology could, however, be implemented with other beta-gamma radiotracers. To date, 10 patients have been enrolled into the dosimetry study with Lu-PSMA combined with drug protectors for kidneys and salivary glands mannitol and glutamate tablets, respectively.

The comparison between hybrid and full 3D approach has been tested on one patient, resulting in a 1. Treatment safety has been confirmed, with a mean absorbed dose of 0. However, PSMA receptors are also expressed in different healthy tissues where high uptake is often observed during treatments. The main organs at risk are the kidneys, red marrow, salivary and lachrymal glands.

The dose to these organs may reduce maximum injectable activity, impairing the therapeutic ratio. Post-infusion dosimetric studies are required to estimate the effective half-life i.

This scenario requires whole body information obtained by acquiring sequential post-infusion whole-body planar images 2. However, the overlap of high uptake structures e. We implemented a hybrid method capable of providing a dosimetric evaluation of the entire body thanks to 2D planar images 2 , maintaining 3D information on a selected region e.

Information obtained from other non-overlapping structures e. The blood sample method used for red marrow evaluation is described in another section. In order to test the safety and efficacy of PRRT therapies, it is important to compare single institution data with data previously published by other groups.

Thus, the described method could also be useful for the standardization of the methodologies used. Finally, it is worthy of note that the implementation of the methodology requires a high degree of collaboration between different professional figures involved i. Subscription Required. Please recommend JoVE to your librarian. Selected patients underwent dosimetry evaluation based on performance status.

All patients signed informed consent. NOTE: It is important to underline that some steps are linked specifically to the scanner used. NOTE: In this first image acquisition the patient's water equivalent thickness is evaluated. This value is used for attenuation correction of counts derived from 2D planar images acquired post Lu-PSMA injection.

NOTE: Planar post-image acquisitions are used for effective half-life and mean absorbed dose evaluation of different structures. NOTE: On day 2 h post infusion a 3D image acquisition is performed, together with the planar image acquisition. NOTE: Scatter, attenuation, and background corrections are implemented.

Single organ and lesion mass are considered for absorbed dose evaluation. For each considered structure, effective half-life is evaluated on sequential 2D whole body images by bi- or mono-exponential curve fitting of time-activity curves. Mean absorbed dose is then calculated for each structure mass. For red marrow dose evaluation, blood samples measurements are used and scaled to the patient's weight.

Dosimetry was performed for 10 patients 7 undergoing first treatment cycle, 3 second cycle. Blood samples were acquired from all but 3 patients.

One patient voided the bladder before the first post-infusion image acquisition. Injected activity was 5. With regard to curve fitting, mono or bi-exponential curve fitting was used for organ time-activity-curves. Bi-exponential curve fitting with wash-in and wash-out phases was used for salivary glands and a maximum uptake was observed around 16 h after infusion.

Bi- and mono-exponential fitting models were used. A pure wash-out phase was observed for whole body bi-exponential , red marrow bi-exponential and liver mono-exponential. With regard to the 2D planar imaging method, median effective half-life was With the 2D planar image method, median values of mean absorbed dose were 0. High intestinal uptake was observed from day 2 up to day 6, and largely overlapped the kidneys.

The time-activity curves derived from the three different methods were compared for left and right kidneys Figure 4. For this patient, the correction was valid for all time points for the right kidney Figure 4 B , whereas an underestimation of relative uptake was observed on day 1 for the left kidney Figure 4 A.

Nevertheless, a discrepancy of only 1. Figure 1: Image acquisition workflow for dosimetry evaluation. Main steps and timing of hybrid dosimetry procedure. Please click here to view a larger version of this figure. Figure 2: Sequential planar whole-body images posterior projection acquired at 1 h, h, h and h post infusion. Delineated organs: kidneys, parotid glands, submandibular glands, lachrymal glands, liver, spleen, whole body, dorsal rachis lesion red.

Each delineated organ has a corresponding background region. This figure has been modified from Sarnelli et al. Figure 3: Transmissive and blank anterior scan obtained with 57 Co flood. Delineated organs as described in Figure 2. For the hybrid method, the time activity curve is rescaled on the basis of the image acquired 24 h post injection. The transient intestine uptake overlapping the kidneys is also shown on planar images C.

The method described enables whole body dosimetry to be performed for PRRT therapies and is a valid compromise between 2D whole-body and 3D dosimetry information in that it provides valuable information without significantly increasing image acquisition load.

The implementation of the methodology requires a high degree of collaboration between different subjects involved i. Our method could be further optimized.

The number of image acquisitions could be reduced by avoiding the pre-injection transmission scan and evaluating the attenuation correction directly on whole-body CT or SCOUT images With regard to red marrow, as suggested by other authors 12 , the absorbed dose could be evaluated on the basis of vertebra uptake rather than on blood samples. The contribution of bone lesions to the red marrow absorbed dose should also be taken into account.

The DVH provides more accurate information on dose evaluation than that of the mean absorbed dose and could be useful for comparisons with external beam radiotherapy dose constraints in terms of biological equivalent dose. The method was developed for Lu-PSMA radiotracer but can also be used with other beta-gamma radiotracers.

Our thanks go to the professional figures involved in the protocol i. The authors acknowledge Alessandro Savini and Simone Marzoni for their help in the video recording. The work was partially financed by the Italian Minister of Health. Belli, M.

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Provide feedback to your librarian. If you have any questions, please do not hesitate to reach out to our customer success team. Login processing JoVE Journal Medicine. Log in or Start trial to access full content. Set low energy high resolution collimators LEHR. Open the image protocol acquisition on the workstation and select transmission scan whole body planar image acquisition. Check the table velocity e. Keep these values equal for the blank scan acquisition.

Check that the option Body Contour is disabled. Position the patient on the couch feet-first supine with arms at-rest along the side of the body. Use this position for all the images.

If necessary, use available supports arm support, knee wedge, pillow, blanket. Take note of the exact position of the patient, using the scale number along the couch: vertex head position, knee position, foot position, couch height, all supports used. Take note of the patient's weight and height.

Raise the couch so that the patient is positioned at the FOV center and with head at the detector center. Position the 57 Co flood support on the posterior camera and then the 57 Co flood itself on the support. Start image acquisition. At the end of image acquisition, remove the 57 Co flood and support.

Press Unload on the teach pendant. Help the patient to get up. Repeat the image acquisition in the same way but without the patient positioned on the couch.

NOTE: Couch velocity, table height and camera distance should be set at the same value as the previous transmission image. Post-infusion Image Acquisition: Planar Image NOTE: Planar post-image acquisitions are used for effective half-life and mean absorbed dose evaluation of different structures.

Exchange Programme for Hybrid Imaging Fellowships 2020

Metrics details. This paper is the first in a series of invited perspectives by four pioneers of Nuclear Medicine imaging and physics. A medical physicist and a Nuclear Medicine clinical specialist each take a backward look and a forward look at the contributions of Medical Physics to Nuclear Medicine. Contributions of Medical Physics are presented from the early discovery of radioactivity, development of first imaging devices, computers and emission tomography to recent development of hybrid imaging. There is evidence of significant contribution of Medical Physics throughout the development of Nuclear Medicine.

Any application with another CV will not be considered. The successful candidate will be asked to provide additional documents to the training centre for administrative purposes. The training centre will help the fellow with all organisational details. Corinne Balleyguier includes two main departments: nuclear medicine department and radiology department. Imaging in radiology and nuclear medicine is focused on cancer patients, from screening to post treatment imaging.

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Dominique Delbeke, Ora Israel (eds): Hybrid PET/CT and SPECT/CT Imaging: A Teaching File

The fusion was done in a Dicom workstation in sagital, axial and coronal reconstruction. The findings were evaluated by 2 Nuclear Medicine physicians and 2 radiologists of the staff of FSFB in an independent way. CT showed facet joint osteoarthrities in 27 Bone scan showed facet joint osteoarthrities in 29 The imaging fusion showed coincidence findings main lesion in CT with high uptake in scintigraphy in 34 patients

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The programme is structured and mentored, and is offered at one of these two sites:. The indications for hybrid imaging are rapidly evolving with the development of new tracers, refined scanning equipment and an increasing amount of scientific data. Patients with oncologic diseases are still the major group but hybrid imaging in cardiac and neurologic diseases are increasing.

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4 comments

Kayleigh F.

The aim of our study was to probe the mindsets of radiological and nuclear medicine professionals in regard to current hybrid imaging practice and to assess relevant training aspirations and perceived shortfalls, particularly amongst young professionals.

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