Frequency and severity of myocardial perfusion abnormalities using Tc-99m MIBI SPECT in cardiac syndrome X

BACKGROUND: Cardiac syndrome X is defined by a typical angina pectoris with normal or near normal (stenosis <40%) coronary angiogram with or without electrocardiogram (ECG) change or atypical angina pectoris with normal or near normal coronary angiogram plus a positive none-invasive test (exercise tolerance test or myocardial perfusion scan) with or without ECG change. Studies with myocardial perfusion imaging on this syndrome have indicated some abnormal perfusion scan. We evaluated the role of myocardial perfusion imaging (MPI) and also the severity and extent of perfusion abnormality using Tc-99m MIBI Single Photon Emission Computed Tomography (SPECT) in these patients. METHODS: The study group consisted of 36 patients with cardiac syndrome X. The semiquantitative perfusion analysis was performed using exercise Tc-99m MIBI SPECT. The MPI results were analyzed by the number, location and severity of perfusion defects. RESULTS: Abnormal perfusion defects were detected in 13 (36.10%) cases, while the remaining 23 (63.90%) had normal cardiac imaging. Five of 13 (38.4%) abnormal studies showed multiple perfusion defects. The defects were localized in the apex in 3, apical segments in 4, midventricular segments in 12 and basal segments in 6 cases. Fourteen (56%) of all abnormal segments revealed mild, 7(28%) moderate and 4 (16%) severe reduction of tracer uptake. No fixed defects were identified. The vessel territories were approximately the same in all subjects. The Exercise treadmill test (ETT) was positive in 25(69%) and negative in 11(30%) patients. There was no consistent pattern as related to the extent of MPI defects or exercise test results. CONCLUSION: Our study suggests that multiple perfusion abnormalities with different levels of severity are common in cardiac syndrome X, with more than 30 % of these patients having at least one abnormal perfusion segment. Our findings suggest that in these patients microvascular angina is probably more common than is generally believed

Scatter Correction for Heart SPECT images Using TEW method

Radionuclide imaging has the potential to be used in quantitative analysis of the regional function of organs. However, quantification of SPECT images is degraded by many factors such as Compton photon scattering. This could have a destructive effect on clinical reports so it is important to do scatter correction to get better quality SPECT images. We intended to determine how scatter correction with the TEW method can help physicians who look at heart SPECT images, get better reports. This study used the TEW method for scatter correction, which was proposed by Ogawa et al., (9) using the two narrow windows on either side of the photopeak (20 % down and 20 % up of the photopeak respectively). Injection of radiopharmaceutical 99mTc was used for medical imaging. In the Shariati Hospital, Tehran, we studied a total of 80 patients with heart disease indications (43 men and 37 women) over the ages of 30–80 years. Contrast and sharpness were considerably improved after scatter correction so physicians could look at defects better. In a few cases scatter correction changed heart defect reports to normal. Using TEW, sensitivity and specificity increased from 86 % to 94 % and from 61 % to 84 % respectively. This method was simple to use in clinics. PACS numbers: 87.57.u

Validation of a prototype optical computed tomography system

In radiation cancer treatments, the most of the side effects could be minimized using a proper dosimeter. Gel dosimeter is the only three-dimensional dosimeter and magnetic resonance imaging (MRI) is the gold standard method for gel dosimeter readout. Because of hard accessibility and high cost of sample reading by MRI systems, some other alternative methods were developed. The optical computed tomography (OCT) method could be considered as the most promising alternative method that has been studied widely. In the current study, gel dosimeter scanning using a prototype optical scanner and validation of this optical scanner was performed. Optical absorbance of the irradiated gel samples was determined by both of conventional spectrophotometer and the fabricated OCT system at 632 nm. Furthermore, these irradiated vials were scanned by a 1.5 T MRI. The slope of the curves was extracted as the dose-response sensitivity. The R2-dose sensitivity measured by MRI method was 0.1904 and 0.113 for NIPAM and PAGAT gels, respectively. The optical dose sensitivity obtained by conventional spectrophotometer and the fabricated optical scanner was 0.0453 and 0.0442 for NIPAM gels and 0.0244 and 0.0242 for PAGAT gels, respectively. The scanning results of the absorbed dose values showed that the new OCT and conventional spectrophotometer were in fair agreement. From the results, it could be concluded that the fabricated system is able to quantize the absorbed dose values in polymer gel samples with acceptable accuracy

Dosimetric properties of new formulation of PRESAGE ®

Aim: Tin-base catalyst is one of the widely used organometallic catalysts in polyurethane technology. The purpose of this study was to evaluate the effect of tin organometallic catalyst in the radiation response and radiological properties of a new formula of PRESAGE®. Materials and Methods: In the study, two types of PRESAGE were fabricated. A very little amount of dibutyltindillaurate (DBTDL) (0.07% weight) was used as a catalyst in the fabrication of new PRESAGE (i.e., PRESAGE with catalyst), which components were: 93.93% weight polyurethane, 5% weight tetrachloride, and 1% weight leucomalachite green (LMG). For PRESAGE without catalyst, 94% weight polyurethane, 4% weight tetrachloride, and 2% weight LMG were used. Radiochromic response and postirradiation stability of PRESAGEs were determined. Also, radiological characteristics of PRESAGEs, such as mass density, electron density, mass attenuation coefficient, and mass stopping power in different photon energies were assessed and compared with water. Results: The absorption peak of new PRESAGE compared to PRESAGE without catalyst was observed without change. Sensitivity of new PRESAGE was higher than PRESAGE without catalyst and its stability after the first 1 h was relatively constant. Also, Mass attenuation coefficient of new PRESAGE in energy ranges <0.1 MeV was 10% more than water, whereas the maximum difference of mass stopping power was only 3%. Conclusions: Tin organometallic catalyst in very low concentration can be used in fabrication of radiochromic polymer gel to achieve high sensitivity and stability as well as good radiological properties in the megavoltage photon beam

Verification of the Accuracy of the Delivered Dose in Pelvic and Breast Cancer Radiotherapy by in-vivo Semi-Conductor Dosimetry

Introduction: Delivering maximum dose to tumor and minimum dose to normal tissues is the most important goal in radiotherapy. According to ICRU, the maximum acceptable uncertainty in the delivered dose compared to the prescribed dose should be lower than 5%, and this is because of the relationship between absorbed dose, tumor control and normal tissue damage. Absorbed dose accuracy is investigated by an in vivo dosimetry method. In this paper, we compared absorbed dose in the tumors of the breast and pelvic region against the calculated dose. The amount of deviations and the factors that cause this deviation in dose delivery to patients and some methods for decreasing them were evaluated. Materials and methods: The entrance and exit doses of 36 pelvic-region cancer patients and 38 breast cancer patients who were treated by cobalt-60 teletherapy were measured using p-type diodes. It should be noted that the transmission method was used to assess the dose at isocenter. Two ionization chambers (0.6 cc and 0.3 cc) were used for calibration and determination of the correction coefficients in water and slab phantoms. Deviations between calculated and measured doses of entrance, exit and midline points were calculated and the results were shown using histograms. Results: The average and standard deviation for entrance, exit and midline points for pelvis cancer were assessed to be about 0.10%, -1.86% and -1.35% for mean deviation and 5.03%, 7.32% and 5.86% for standard deviation, respectively. The corresponding data for breast cancer were 0.78%, 5.29% and 3.59% for mean deviation and 5.97%, 10.23% and 9.86%, respectively. There was no significant difference between the calculated and measured doses (p > 0.1), except exit dose in breast cancer (p < 0.05). The temperature and angle of incidence correction factors were neglected due to their less than 1% deviations. Discussion and Conclusions: Some error sources are patient setup error, patient motion and dose calculation algorithm error (due to ignoring inhomogeneity and patient curvature). As no significant deviations were found in midline dose, the method used has an acceptable accuracy. In vivo dosimetry can perform a basic role in the quality control of radiotherapy departments

Optical computed tomography in PRESAGE ®

With the advent of new complex but precise radiotherapy techniques, the demands for an accurate, feasible three-dimensional (3D) dosimetry system have been increased. A 3D dosimeter system generally should not only have accurate and precise results but should also feasible, inexpensive, and time consuming. Recently, one of the new candidates for 3D dosimetry is optical computed tomography (CT) with a radiochromic dosimeter such as PRESAGE®. Several generations of optical CT have been developed since the 90s. At the same time, a large attempt has been also done to introduce the robust dosimeters that compatible with optical CT scanners. In 2004, PRESAGE® dosimeter as a new radiochromic solid plastic dosimeters was introduced. In this decade, a large number of efforts have been carried out to enhance optical scanning methods. This article attempts to review and reflect on the results of these investigations

Investigation of the Spatial Resolution of MR-Based Polymer Gel Dosimetry versus Film Densitometry using Dose Modulation Transfer Function

Introduction: The conventional methods of dosimetry are not capable of dosimetry in such a small volume of less than one cubic millimeter. Although the polymer gel dosimetry method based on magnetic resonance imaging (MRI) could achieve three dimensional dosimetry with high resolution, a spatial resolution evaluation based on gel dose modulation transfer function has not been investigated yet. Therefore, in this study, the spatial resolution of two systems of film densitometry and polymer gel dosimetry based on MRI has been evaluated by using the dose modulation transfer function (DMTF).   Material and Methods: Kodak therapy verification films and MAGICA polymer gel samples were positioned below a brass absorption grid with different periodic slices (a/2= 280, 525, 1125 μm), which was placed in a water bath container to avoid regions of dose build-up just below the absorption grid and then irradiated with Cobalt-60 photons on a Theratron external-beam treatment unit. Dose variation under the brass grid was determined using a calibration curve, while transverse relaxation time (T2) as the selective parameter in a dose image based on multiple echo MRI with 1.5 Tesla GE Signa Echo Speed system (FOV=10 cm, matrix size=512 ×512, pixel size =0.199×0.199 mm2, TE = 20, 40, 60, 80 ms, TR=4200 ms, NEX = 4, slice thickness=2 mm, gap=1 mm) was calculated. DMTF from the modulation depths of T2 and variation in film optical density after calibration would be achieved. The results of polymer gel were compared with film. Results: After deriving the dose distribution profile under the absorption grid, minima and maxima at the smallest period of a = 560 μm could scarcely be resolved, but the modulations due to a=2250 μm and a = 1050 μm grids could be discerned. The modulation depth for a=2250 μm grid was set to 100% and the other modulations were subsequently referred to this maximum modulation. For film densitometry at a = 1050 μm, the modulation depth was reduced to 35% (30% for MR based polymer gel dosimetry; MRPD) and at a = 560 μm the modulation in dose was reduced to about 9% of the maximum amplitude (7% for MRPD). The DMTF for the two systems at 200 micron spatial resolution for the 2250, 1050 and 560 μm grids (0.4, 0.9 and 1.7 line pairs per mm) were equal to 1, 0.35 and 0.09 for film densitometry and 1, 0.30 and 0.07 for polymer gel. Discussion and Conclusions: Based on the results of this study, the decrease in DMTF at higher frequencies in a system in its operating resolution limit, is dependent on the type of the dosimetry system. Therefore, the assessment of DMTF for film densitometry system implied a higher spatial resolution in comparison with polymer gel dosimetry at 200 micron spatial resolution