CT-PET calibration : physical principles and operating procedures F.Bonutti. Faustino Bonutti Ph.D. Medical Physics, Udine University Hospital.

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Medical Physics, Udine University Hospital Topics Introduction to PET

coincidence detection true, random and scatter coincidences the NECR,

1 CT-PET calibration : physical principles and operating procedures Faustino Bonutti Ph.D. Medical Physics, Udine University Hospital Topics Introduction to PET physics F-18 production β + decay and annichilation process γ γ coincidence detection true, random and scatter coincidences the NECR, image quality VS patient dose PET calibration and QC procedures the sinogram normalization and ECF calibration daily QC uniformity, sensitivity

2 PET POSITRON EMISSION TOMOGRAPHY Positron The positron (e + ) is emitted in the β + decay process: p n + e + + ν e The β + decay is forbidden for a free proton. The process must occur in a nucleus: (A,Z) (A,Z-1) + e + + ν e For example: 18 F 18 O + e + + ν e

3 Emission Emission (tomography) : the source of radiation is inside the patient: γ γ Transmission (tomography) : the source of radiation is outside the patient: x-ray Tomography Tómos = from Greek = (cross-) section Material from IAEA Educational Course Radiation Protection in Nuclear Medicine

4 How the F-18 is produced? H - H - acceleration inside the cyclotron (spiral trajectory) stripping e- e- p+ e- e- p+ e- e- H + p+ proton beam Carbon foil p + 18 O n + 18 F FDG synthesis FDG Main applications: Oncology (cancer detection and staging) Cardiology Neurology

5 FDG administration uptake time β + decays and annnihilation process 18 F 18 O + e + + ν e γ (511 kev) e + e - γ (511 kev)

6 e + range in the patient tissues e + Radioisotope e + Range (mm) 15 O N C F 2.6 Radioisotope e + E max (kev) e + E mean (kev) T 1/2 (min) e + Range (mm) Decay 15 O % β + 13 N % β + 11 C % β + 18 F % β +, 3% E.C. Fermi s Golden Rule i f p i f 2π = M h if 2 dn f de Transition matrix (dynamics) density of final states (phase space)

7 e + e - annnihilation process and γ γ coincidence detection TRUE COINCIDENCE useful for the image reconstruction γ annihilation LOR γ constant fraction discriminator constant fraction discriminator coincidence window (6 ns) SCALER True, random and scatter coincidences TRUE COINCIDENCE useful for the image reconstruction RANDOM COINCIDENCE generated from two uncorrelated events of annihilation γ annihilation LOR γ wrong LOR constant fraction discriminator coincidence window (6 ns) constant fraction discriminator Compton scattering annihilation SCATTERING COINCIDENCE one (or both) of the two 512 kev photon is scattered by the patient wrong LOR SCALER

True, random and scatter coincidences LSO CT-PET Biograph Pico3D Cylindrical phantom water + F-18 filled 2.00E+0 1.80E+0 1.60E+0 1.40E+0 1.20E+0 cps 1.00E+0 8.00E+0 6.00E+0 4.00E+0 2.00E+0 0.00E+0 0.00 5.

8 True, random and scatter coincidences LSO CT-PET Biograph Pico3D Cylindrical phantom water + F-18 filled 2.00E E E E E+0 cps 1.00E E E E E E activity (mci) TOTAL TRUE SCATTER RANDOMS NECR Random coincidences : RANDOM COINCIDENCE they don t contribute to image they increase the noise % of true coincidences How to reduce them? smaller coincidence window less activity C R = 2 τ C S 2 wrong LOR How to take into account? delayed window method

9 Scatter coincidences : don t contribute to image in the human thorax, 50% or more of the measured data may be scattered. reduce the contrast Compton scattering annihilation SCATTERING COINCIDENCE wrong LOR How to reduce them? 2D instead of 3D less activity How to take into account? scatter modelling and compensation algorithms Conventional Nuclear Medicine (planar, SPECT) N SNR = N N Positron Emission Tomography TRUE EVENTS contribute to SIGNAL and NOISE RANDOM AND SCATTERING EVENTS contribute only to NOISE NECR NECR = T T + S + 2R good LOR from TRUE wrong LOR from scatter 2 T NECR = T + S + 2R wrong LOR from random SNR = T T + S + 2R

IMAGE QUALITY NECR PET phantom for IQ 30 25 20 NEC [kcps] 15 10 10mCi inj. 20mCi inj. 5.

00E+05 3 1.50E+05 PNECR-MAX 4 1.00E+05 5 5.00E+04 0.00E+00 0.00E+00 5.00E+06 1.00E+07 1.50E+07 2.00E+07 2.

10 IMAGE QUALITY NECR PET phantom for IQ NEC [kcps] mCi inj. 20mCi inj (courtesy of CPS Innovation /Siemens) Activity [kbq/ml] patients with: 2.50E+05 [52-62] kg weight and [ cm] height TRUE + SCATTER RANDOM * PNECR E E+05 PNECR-MAX E E E E E E E E E+07 singles rate (cps) 6 7 COUNT-RATE ANALYSIS FROM CLINICAL SCANS IN PET WITH LSO DETECTORS F. Bonutti et al, Radiation Protection Dosimetry, (2008) MISSING ACTIVITY = 70% (for central beds) bed # bed # but: PNECR (SNR) IMPROVEMENT : 15-20% % PNECR i mprovement

11 Attenuation correction Many true coincidences are lost because of scatter (Compton or Rayleigh interactions) absorption (photoelectric interaction) wrong LOR from scatter Scattered but detected scatter contribution to data attenuation of the true LOR intensity Scattered and not detected attenuation of the true LOR intensity How much is the 511 kev every 7.2 cm of water half radiation intensity is lost: I I 2 I cm 7.2 cm no AC AC Ge68 phantom Ge68 phantom

12 CT-PET Attenuation correction - the emitter distribution is distorted. - quantification is not possible (SUV) - lung lesions may not be visible in uncorrected images. Attenuation correction Attenuation factors range from < 5 in the brain to > 150 in the body. In PET the attenuation doesn t depend on the position of the source point along that LOR: γ γ detection probability ~ γ γ detection probability ~ = ( l) dl µ ( l) dl 0 1 = µ ( l) dl 0 e µ 2 3 e e = 3 µ l) dl µ ( l) dl µ ( l e e e ( ) dl

13 CT-PET Attenuation correction Rescaling the attenuation coefficients µ with energy µ/ρ 0.3 Air Muscle Bone (cm 2 /g) CT PET Energy (kev) PET calibration and QC procedures The sinogram source sinogram LOR rappresentation phi d

PET calibration and QC procedures The normalization procedure

LSO Pico3D number of elementary detectors : (12 buckets) X (12

/Siemens) PET calibration and QC procedures uniform phantom

14 PET calibration and QC procedures The normalization procedure Ge-68 phantom, 1 2 mci BUCKET BLOCK Example : Siemens Biograph LSO Pico3D number of elementary detectors : (12 buckets) X (12 blocks) X (64 crystals) = 9216 (courtesy of CPS Innovation /Siemens) PET calibration and QC procedures uniform phantom sinogram for a un-normalized system uniform phantom sinogram for a normalized system

PET calibration and QC procedures Calibration Factor (CF) make possible quantifications (SUV) Ge-68 phantom of known activity concentration CF number of counts inside voxel PET calibration and QC

15 PET calibration and QC procedures Calibration Factor (CF) make possible quantifications (SUV) Ge-68 phantom of known activity concentration CF number of counts inside voxel PET calibration and QC procedures Calibration Factor (CF) make possible quantifications (SUV) ROI ROI activity = ROI counts x ECF β + p n + e + + ν e 18 F 18 O + ν e (branching ratio = 96.9 %) E.C. p + e - n + ν e (branching ratio = 3.1 %)

16 PET calibration and QC procedures Calibration Factor (CF) make possible quantifications (SUV) ROI SUV = ROI activity concentration mean (body) activity concentration PET calibration and QC procedures ECF behavior (Emission Calibration Factor) ECF behavior 3.00E E E+06 ECF 1.50E E E E+00 01/01/ /12/ /12/ /12/ /01/ /12/ /12/2009 time (Siemens Biograph LSO Pico3D)

17 PET calibration and QC procedures After normalization, the software gives the χ 2 If you normalize the system every 1-2 months, typical χ 2 are If you do it less frequently, the χ 2 goes up χ χ 2 behavior days Optimal frequency may depend on the system In our Departement we do normalization at least every 2 months PET calibration and QC procedures The need for normalization come out from the daily QC test For this test, usually a Ge-68 cylindric phantom is used (1-2 mci)

18 PET calibration and QC procedures After the daily QC test, give a look to the sinograms : PET calibration and QC procedures SUV tests : with a single Ge-68 phantom (we do it monthly) CT PET Ge-68 phantom

PET calibration and QC procedures SUV tests : with two single Ge-68 phantom (we do it every 6 months) CT PET new Ge-68 phantom old Ge-68 phantom 1 2 mci 0.3 0.

19 PET calibration and QC procedures SUV tests : with two single Ge-68 phantom (we do it every 6 months) CT PET new Ge-68 phantom old Ge-68 phantom 1 2 mci mci PET calibration and QC procedures SUV tests : with two F-18 bottles (we do it yearly) Check the SUV results on the workstationsd using the different available tools new F-18 phantom old F-18 phantom 1 2 mci mci CT PET LEO2 min max averg LEO3 min max averg ESOFT min max averg tool "elissoide" tool "3D isocontour" tool "multiframe polygon" tool "multiframe contour" tool "elissoide" tool "3D isocontour" tool "multiframe polygon" tool "multiframe contour" tool "elissoide" tool "3D isocontour" tool "multiframe polygon" tool "multiframe contour"

PET calibration and QC procedures Uniformity test : with Ge-68 phantom (we do it every 3 months) Uniformity Specification (from CPS/Siemens standards): The measured volume RMS variation will be < 10%

20 PET calibration and QC procedures Uniformity test : with Ge-68 phantom (we do it every 3 months) Uniformity Specification (from CPS/Siemens standards): The measured volume RMS variation will be < 10% NEMA : NU vol < 15% PET calibration and QC procedures Sensitvity test : with Ge-68 phantom (we do it every 3 months) Sensitivity Specification (from CPS/Siemens standards): The measured system sensitivity will be > counts/sec/µci/ml NEMA : S meas > 95% S ref

21 Daily : CT calibration and QC procedures X-ray tube check-up and calibration Every 3 months : Noise, constancy and uniformity of CT numbers CT numbers linearity, contrast scale High and low contrast spatial resolution Slice thickness Table accuracy movement Laser alignement Every 6 months : Dose (in head and body CT phantoms) CT-PET calibration and QC procedures Yearly : attenuation correction check Ge-68, no AC Ge-68, AC S.D. average avedev

22 CT-PET calibration and QC procedures Yearly : CT-PET co-registration check PET/CT UDINE SCAN PROTOCOL 62 mas; 130 kv p CT PET Survey CT X-Ray FUSION scatter correction attenuation correction WB PET: 20 min 370 MBq CT PET γγ γγ e+ e- Annihilation PET Fused PET/CT

Radionuclide Imaging MII Positron Emission Tomography (PET)

Radionuclide Imaging MII Positron Emission Tomography (PET) Radionuclide Imaging MII 3073 Positron Emission Tomography (PET) Positron (β + ) emission Positron is an electron with positive charge. Positron-emitting radionuclides are most commonly produced in cyclotron