First Clinical Experience with
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1 First Clinical Experience with Discovery MI Digital PET/CT Martin Huellner Department of Nuclear Medicine University Hospital Zurich / University of Zurich Switzerland
2 Agenda BelNuc GE Symposium 1. Digital PET detectors 2. PET image reconstruction Time of flight Q.clear TM Impact of radiotracers and dosage 3. Dose reduction 4. Motion correction with PET: Q.freeze TM, Q.static TM 5. Metal artifact reduction 6. True whole-body acquisition MH, Nuklearmedizin USZ
3 Digital PET detectors Comparison with analog PMT Photomultiplier tubes (PMT): Used in analog PET/CT, cannot be used with PET/MR. Detection efficiency Coincidence timing res. PMT SiPM 25% 50% 550 ps 350 ps Silicon photomultipliers (SiPM): Can be used with PET/MR, allow for time-offlight reconstruction. Gain Sensitivity 7.5 cps/kbq 13.5 cps/kbq Noise Low Low Profile 100 mm 2 mm MR compatibility Technology maturity No Yes 40 yrs 8 yrs Cost Low High Based on EANM 2010 presentation by A. Ganin, former chief engineer, GE Healthcare MH, Nuklearmedizin USZ
4 Digital PET detectors SiPM Scintillator crystal array with light guides and spectral reflectors Silicon photomultiplier (SiPM) Thermal conductive pad Detector array Detector components MH, Nuklearmedizin USZ
5 Digital PET detectors Comparative count data Analog Digital Digital PET acquired after analog PET. MH, Nuklearmedizin USZ
6 Digital PET detectors GE Discovery MI Highest NEMA sensitivity of any TOF-PET/CT system* Highest NECR of any TOF-PET/CT system* Up to 2x improved volumetric resolution** Analog (4 iterations) * ITN comparison charts ** Phantom tests Digital (4 iterations) MH, Nuklearmedizin USZ
7 Digital PET detectors Image quality - Body Analog Digital 18 F-FDG 56yo male T cell lymphoma Complete remission MH, Nuklearmedizin USZ
8 Digital PET detectors Image quality - Brain Analog Digital 18 F-FDG 49yo female Memory disorders MH, Nuklearmedizin USZ
9 Agenda BelNuc GE Symposium 1. Digital PET detectors 2. PET image reconstruction Time of flight Q.clear TM Impact of radiotracers and dosage 3. Dose reduction 4. Motion correction with PET: Q.freeze TM, Q.static TM 5. Metal artifact reduction 6. True whole-body acquisition MH, Nuklearmedizin USZ
10 PET image reconstruction The goal of PET/CT imaging: Detect harmful things that might otherwise be unnoticed. 60 cm poisonous snake on image MH, Nuklearmedizin USZ
11 PET image reconstruction The goal of PET/CT imaging: Detect harmful things that might otherwise be unnoticed. Reconstruction utilities: Time of flight imaging Novel iterative reconstruction (Q.clear TM ) Accounting for different radiotracers and dosage 3 cm long bowel tumor on image 68 Ga-DOTATATE (Q.clear 450) MH, Nuklearmedizin USZ
12 PET image reconstruction Time of flight PET Higher image quality with TOF reconstruction than with non-tof reconstruction More accurate attenuation correction TOF information reduces artifacts: Caused by respiratory mismatch between emission and attenuation data Caused by metal implants Barbosa et al., Q J Nucl Med 2016 Sekine et al., JNM 2016 Delso et al., Radiology 2016 ter Voert et al., EJNM 2017 MH, Nuklearmedizin USZ
13 PET image reconstruction Time of flight PET TOF non-tof Higher image quality with TOF reconstruction than with non-tof reconstruction More accurate attenuation correction TOF information reduces artifacts: Caused by respiratory mismatch between emission and attenuation data Caused by metal implants Free-breathing Barbosa et al., Q J Nucl Med 2016 Sekine et al., JNM 2016 Delso et al., Radiology 2016 ter Voert et al., EJNM 2017 MH, Nuklearmedizin USZ
14 PET image reconstruction Time of flight PET TOF non-tof Higher image quality with TOF reconstruction than with non-tof reconstruction More accurate attenuation correction TOF information reduces artifacts: Caused by respiratory mismatch between emission and attenuation data Caused by metal implants Free-breathing Barbosa et al., Q J Nucl Med 2016 Sekine et al., JNM 2016 Delso et al., Radiology 2016 ter Voert et al., EJNM 2017 MH, Nuklearmedizin USZ
15 PET image reconstruction Time of flight PET Higher image quality with TOF reconstruction than with non-tof reconstruction More accurate attenuation correction TOF information reduces artifacts: Caused by respiratory mismatch between emission and attenuation data Caused by metal implants non-tof Metal artifacts TOF Barbosa et al., Q J Nucl Med 2016 Sekine et al., JNM 2016 Delso et al., Radiology 2016 ter Voert et al., EJNM 2017 MH, Nuklearmedizin USZ
16 PET image reconstruction Q.clear TM Bayesian penalized likelihood reconstruction Controls noise as part of regularization process inside the IR beta: Controls strength of regularizing term R(x): Penalty to control noise PL objective function: Chen TC et al., IEEE TNS1990 Mumcuoglu EU et al., IEEE TMI 1994 Nuyts J et al., IEEE TNS 2002 De Pierro AR et al., IEEE TMI 2001 Ahn S et al, IEEE TMI 2003 Activity-dependent noise control Subtraction: Reduces objective function as noise increases steers algorithm away from noisier images MH, Nuklearmedizin USZ
17 PET image reconstruction Q.clear TM 18 F-FDG 64yo female Metastasizing colorectal cancer MH, Nuklearmedizin USZ
18 PET image reconstruction Q.clear TM SharpIR Q.Clear F-FDG 64yo female Metastasizing colorectal cancer Would you call this lymph node? No way. Probably yes. MH, Nuklearmedizin USZ
19 PET image reconstruction Q.clear TM TOF off TOF on / SharpIR off 76yo female Metastasizing tongue carcinoma TOF on / SharpIR on TOF on / Q.clear
20 PET image reconstruction Q.clear TM Full convergence reconstruction (without deterioration of IQ by noise) Up to 2x improvement in PET accuracy (SUV mean ) and image quality (SNR) SUV max is higher than with OSEM / SharpIR Chen TC et al., IEEE TNS1990 Mumcuoglu EU et al., IEEE TMI 1994 Nuyts J et al., IEEE TNS 2002 De Pierro AR et al., IEEE TMI 2001 Ahn S et al, IEEE TMI 2003 MH, Nuklearmedizin USZ
21 PET image reconstruction Q.clear TM - Implications for different radiotracers Soft tissue Lung tissue Average positron energy: 18 F: 0.25 MeV, 68 Ga: 0.89 MeV, 15 O: 0.80 MeV Longer positron range lower resolution with high energy positron emitters Lower positron yield of 68 Ga than 18 F Reconstruction design optimized for 18 F Different background (e.g. higher background with 68 Ga-DOTATATE in the body, or with 18 F-FDG in the brain) 68 Ga 18 F Sánchez-Crespo et al., EJNM 2004 Sánchez-Crespo, Appl Radiat Isot 2012 Different Q.clear β-factors necessary for: Different radiotracers Different types of studies Different dosage MH, Nuklearmedizin USZ
22 18 F-FDG Body 18 F-FDG 68 Brain Ga-PSMA 68 Ga-DOTATATE H O N-Ammonia Q.clear b200 Q.clear b200 Q.clear b450 Q.clear b450 Q.clear b600 Q.clear b600 Q.clear b1200 Q.clear b1200 MH, Nuklearmedizin USZ
23 PET image reconstruction Q.clear TM Impact of dosage Q.clear b450 Q.clear b600 Lower dose more noise Higher b-value less noise Higher b-value preferred in low dose scans 129 MBq, 1.5 MBq/kg MH, Nuklearmedizin USZ
24 Agenda BelNuc GE Symposium 1. Digital PET detectors 2. PET image reconstruction Time of flight Q.clear TM Impact of radiotracers and dosage 3. Dose reduction 4. Motion correction with PET: Q.freeze TM, Q.static TM 5. Metal artifact reduction 6. True whole-body acquisition MH, Nuklearmedizin USZ
25 Dose reduction GE Discovery MI CT: ASiR-V TM up to 80% dose reduction compared to FBP in phantom study (MITA CT IQ) PET: Approximately 40% dose reduction in clinical routine ( 18 F-FDG) Analog PET Digital PET Sekine T et al., Radiology 2017 (ahead of print) Metastasizing pancreatoblastoma 168 MBq 3.2 msv - 47% 89 MBq 1.7 msv EANM recommendation («upper limit»): 329 MBq MH, Nuklearmedizin USZ
26 Dose reduction GE Discovery MI PET image quality CT: ASiR-V TM up to 80% dose reduction compared to FBP in phantom study (MITA CT IQ) PET: Approximately 40% dose reduction in clinical routine ( 18 F-FDG) = best = worst Sekine T et al., Radiology 2017 (ahead of print) MH, Nuklearmedizin USZ
27 Dose reduction GE Discovery MI BMI-adjusted dosage regimen for 18 F-FDG Dose reduction: 40% in BMI >25, 50% in BMI <25 18 F-FDG BMI Dosage [MBq / kg] < > (Max.: 320 MBq) Sekine T et al., Radiology 2017 (ahead of print) MH, Nuklearmedizin USZ
28 Agenda BelNuc GE Symposium 1. Digital PET detectors 2. PET image reconstruction Time of flight Q.clear TM Impact of radiotracers and dosage 3. Dose reduction 4. Motion correction with PET: Q.freeze TM, Q.static TM 5. Metal artifact reduction 6. True whole-body acquisition MH, Nuklearmedizin USZ
29 Motion correction Q.static TM, Q.freeze TM Q.freeze TM Q.static TM Respiration curve MH, Nuklearmedizin USZ
30 Motion correction Q.static TM, Q.freeze TM Bronchial carcinoma Without motion correction Q.static TM T2w Propeller FDG-PET/MR MH, Nuklearmedizin USZ
31 Motion correction Q.static TM, Q.freeze TM Bronchial carcinoma Q.static TM MH, Nuklearmedizin USZ
32 Motion correction Q.static TM, Q.freeze TM Motion correction: Higher image quality Reduction of artifacts More accurate SUV Catana C, Semin Nucl Med 2016 Liver metastases Without motion correction Q.static TM MH, Nuklearmedizin USZ
33 Agenda BelNuc GE Symposium 1. Digital PET detectors 2. PET image reconstruction Time of flight Q.clear TM Impact of radiotracers and dosage 3. Dose reduction 4. Motion correction with PET: Q.freeze TM, Q.static TM 5. Metal artifact reduction 6. True whole-body acquisition MH, Nuklearmedizin USZ
34 Metal artifact reduction Smart MAR Real-time reconstruction Projection-based technique No separate scan required Particularly useful in PSMA studies Without MAR MH, Nuklearmedizin USZ
35 Metal artifact reduction Smart MAR no MAR MAR Real-time reconstruction Projection-based technique No separate scan required Particularly useful in PSMA studies 68 Ga-PSMA Prostate carcinoma, bone metastasis MH, Nuklearmedizin USZ
36 Agenda BelNuc GE Symposium 1. Digital PET detectors 2. PET image reconstruction Time of flight Q.clear TM Impact of radiotracers and dosage 3. Dose reduction 4. Motion correction with PET: Q.freeze TM, Q.static TM 5. Metal artifact reduction 6. True whole-body acquisition MH, Nuklearmedizin USZ
37 True whole-body* acquisition * Patients <2.00m height Digital PET Analog PET What the techs love most about Discovery MI 1. Dose reduction 2. Dose reduction 3. Dose reduction 4. True whole-body acquisition No patient repositioning for whole-body scan MH, Nuklearmedizin USZ
38 Summary Clinical advantages of new digital PET/CT scanners Time of flight Q.clear TM, beta adaption for different radiotracers and dosage Dose reduction: approximately by 40% Nice to have: Motion correction capability Metal artifact reduction capability True whole-body acquisition MH, Nuklearmedizin USZ
39 Thank you! MH, Nuklearmedizin USZ
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