Best practice for the nuclear medicine technologist in CT-based attenuation correction and calcium score for nuclear cardiology

Abstract The use of hybrid systems is increasingly growing in Europe and this is progressively important for the final result of diagnostic tests. As an integral part of the hybrid imaging system, computed tomography (CT) plays a crucial role in myocardial perfusion imaging diagnostics. Throughout Europe, a variety of equipment is available and also different university curricula of the nuclear medicine technologist are observed. Hence, the Technologist Committee of the European Association of Nuclear Medicine proposes to identify, through a bibliographic review, the recommendations for best practice in computed tomography applied to attenuation correction and calcium score in myocardial perfusion imaging, which courses in the set of knowledge, skills, and competencies for nuclear medicine technologists. This document aims at providing recommendations for CT acquisition protocols and CT image optimization in nuclear cardiology

EANM procedural guidelines for myocardial perfusion scintigraphy using cardiac-centered gamma cameras

Abstract An increasing number of Nuclear Medicine sites in Europe are using cardiac-centered gamma cameras for myocardial perfusion scintigraphy (MPS). Three cardiac-centered gamma cameras are currently the most frequently used in Europe: the D-SPECT (Spectrum Dynamics), the Alcyone (Discovery NM 530c and Discovery NM/CT 570c; General Electric Medical Systems), and the IQ-SPECT (Siemens Healthcare). The increased myocardial count sensitivity of these three cardiac-centered systems has allowed for a decrease in the activities of radiopharmaceuticals injected to patients for myocardial perfusion imaging and, consequently, radiation exposure of patients. When setting up protocols for MPS, the overall objective should be to maintain high diagnostic accuracy of MPS, while injecting the lowest activities reasonably achievable to reduce the level of radiation exposure of patient and staff. These guidelines aim at providing recommendations for acquisition protocols and image interpretation using cardiac-centered cameras. As each imaging system has specific design and features for image acquisition and analysis, these guidelines have been separated into three sections for each gamma camera system. These recommendations have been written by the members of the Cardiovascular Committee of EANM and were based on their own experience with each of these systems and on the existing literature

Procedural recommendations of cardiac PET/CT imaging:standardization in inflammatory-, infective-, infiltrative-, and innervation (4Is)-related cardiovascular diseases: a joint collaboration of the EACVI and the EANM

With this document, we provide a standard for PET/(diagnostic) CT imaging procedures in cardiovascular diseases that are inflammatory, infective, infiltrative, or associated with dysfunctional innervation (4Is). This standard should be applied in clinical practice and integrated in clinical (multicenter) trials for optimal procedural standardization. A major focus is put on procedures using [18F]FDG, but 4Is PET radiopharmaceuticals beyond [18F]FDG are also described in this document. Whilst these novel tracers are currently mainly applied in early clinical trials, some multicenter trials are underway and we foresee in the near future their use in clinical care and inclusion in the clinical guidelines. Finally, PET/MR applications in 4Is cardiovascular diseases are also briefly described. Diagnosis and management of 4Is-related cardiovascular diseases are generally complex and often require a multidisciplinary approach by a team of experts. The new standards described herein should be applied when using PET/CT and PET/MR, within a multimodality imaging framework both in clinical practice and in clinical trials for 4Is cardiovascular indications.</p

Continuous-spectrum Emission Tomography (CET) for quantifying the absorbed dose of in-vivo bremsstrahlung

Introduction: Personalized dosimetry based on quantitative images of radiopharmaceutical distribution in the body can substantially improve the effectiveness of radionuclide thera- py. Current nuclear medicine imaging systems are optimized for diagnostic radionuclides and suboptimal for bremsstrah- lung X- rays emitted by therapeutic radionuclides.Materials and methods: We present a novel molecular imaging modality, called CET (based on elements from CT, SPECT and PET) and specifically designed for collimating and detecting the high-energy secondary body generated bremsstrahlung X-ray photons. To efficiently detect incoming high-energy X-ray photons, conventional NaI SPECT detectors are replaced with high-density scintillators from PET. A first step in the design of the complete system is the evaluation of monolithic high- resolution detectors for this modality. LYSO, the most com- monly used PET scintillator, is intrinsically radioactive due to the presence of Lu-176. This leads to a continuous background in the energy spectrum, making this scintillator not suitable for CET. Therefore simulations (using the input of the continuous Spectrum of Y-90) and measurements of high-density thick PET BGO crystals are compared to the results of conventional NaI detectors. CET also combines these detectors with pinhole collimators (from small animal SPECT), with small accep- tance angles and minimal penetration.These are specifically designed for a wide energy spectrum and with the primary aim to reduce scatter and collimator penetration. To efficiently construct these complex collimators with high stopping power, additive manufacturing (3D printing) of tungsten powder will be used. Since no scatter windows can be used for X-rays, quantitative reconstructions will be obtained by modeling the remaining contamination in Monte Carlo-based image recon- struction. Finally Monte Carlo or other approaches will pro- vide the information on the absorbed radiation dose.Results. A BGO detector of 2 inch has a high stopping power of more than 70% for all energies up to 1 MeV. The conventional 3/8 inch NaI works well at low energies but has only 17 % stop- ping power at 1 MeV. The main advantage of BGO comes from the high amount of direct photo-electric interactions and resulting smaller amount of Compton interactions arriving in lower energy window. A disadvantage of BGO is the small- er amount of scintillation light resulting in reduced energy resolution at lower energies (>30% at 100 keV and 15 % at 1 Mev).Conclusions. All components for building a CET system with specific use in radionuclide therapy have been identified and can be combined into a new molecular multimodality imaging system

EANM procedural guidelines for PET/CT quantitative myocardial perfusion imaging

The use of cardiac PET, and in particular of quantitative myocardial perfusion PET, has been growing during the last years, because scanners are becoming widely available and because several studies have convincingly demonstrated the advantages of this imaging approach. Therefore, there is a need of determining the procedural modalities for performing high-quality studies and obtaining from this demanding technique the most in terms of both measurement reliability and clinical data. Although the field is rapidly evolving, with progresses in hardware and software, and the near perspective of new tracers, the EANM Cardiovascular Committee found it reasonable and useful to expose in an updated text the state of the art of quantitative myocardial perfusion PET, in order to establish an effective use of this modality and to help implementing it on a wider basis. Together with the many steps necessary for the correct execution of quantitative measurements, the importance of a multiparametric approach and of a comprehensive and clinically useful report have been stressed. © 2020, The Author(s)