The most specific and sensitive imaging modality for visualizing and measuring human (patho)physiology in vivo is Positron Emission Tomography (PET). PET is a firmly established biomedical imaging modality with applications in routine clinical diagnostic imaging, but also in research, including clinical trials. Over the past years, PET technology development brought new innovative PET systems to the commercial market: silicon photomultiplier (SiPM)-based or ‘digital’ PET systems, and large axial field-of-view or ‘total body’ PET systems. This thesis describes the technical performance characteristics of these new PET technologies and, in addition, associated optimization of image quality and activity administration is reported. Furthermore, clinical implications and future perspectives regarding these innovations in the field of nuclear medicine and molecular imaging and other medical disciplines are discussed

van Sluis, Joyce

English

ARTS repository - University of Groningen

   University of GroningenNew PET technologiesvan Sluis, JoyceDOI:10.33612/diss.254107383IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2022Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):van Sluis, J. (2022). New PET technologies: performance, image quality, and clinical implications. [Thesisfully internal (DIV), University of Groningen]. University of Groningen.https://doi.org/10.33612/diss.254107383CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 01-11-2023Chapter 7First-time imaging of 89Zr-trastuzumab in breast cancer using a long axial field-of-view PET/CT scannerAdrienne H. Brouwers1, Joyce van Sluis1, Johannes H. van Snick1, Carolien P. Schröder1,2, Inge O. Baas3, Ronald Boellaard1,4, Andor W.J.M. Glaudemans1, Ronald J.H. Borra1, Adriaan A. Lammertsma1, Rudi A.J.O. Dierckx1, and Charalampos Tsoumpas1 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands4Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, Free University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsEur J Nucl Med Mol Imaging. 2022;49:3593-3595. Completethesis_JoycevanSluis_21102022FINAL.indd   135 24-10-2022   09:30:22Chapter 7136Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently (1, 2), which offer numerous advantages (3). One important advantage of using LAFOV PET for imaging 89Zr-labeled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement in immunoPET imaging with the Biograph Vision Quadra (VQ) LAFOV PET/CT (Siemens Healthineers).Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq 89Zr-trastuzumab in order to assist clinical decision-making (4, 5). Patients were scanned 4 days postinjection with a Biograph mCT PET/CT (patient A) (Siemens Healthineers) or a Biograph Vision PET/CT (patient B) (Siemens Healthineers), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with the VQ. For the VQ, we chose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with European Association of Nucelar Medicine Research Ltd. (EARL) 1 standard specifications, whilst for LAFOV, we also applied vendor-recommended settings for optimized imaged quality for clinical reading (CLIN) (see Table 1) (6, 7).PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom two rows (i-p). The same intensity scale, SUV range 0-10, applies for all images, except the fused images (e, m). Additional reconstructions of the VQ data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.As can be appreciated from these first human immunoPET images on an LAFOV system, the image quality improvement (f) is most spectacular when compared withthe mCT (a). For example, in patient A, an additional small bone lesion was visualized with the VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this visual improvement in image quality was even appreciated in the 10 min image compared with the 30-45 min acquisition needed for SAFOV systems.Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred total scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the scan duration with still very acceptable image quality, even for 89Zr-labeled mAb PET/CT studies.Completethesis_JoycevanSluis_21102022FINAL.indd   136 24-10-2022   09:30:22First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1377Completethesis_JoycevanSluis_21102022FINAL.indd   137 24-10-2022   09:30:23Chapter 7138Table 1 Acquisition and reconstruction parameters for the different systems.Completethesis_JoycevanSluis_21102022FINAL.indd   138 24-10-2022   09:30:23First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1397References1. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.2. Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.3. Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.4. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.5. Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.6. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.7. Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.Completethesis_JoycevanSluis_21102022FINAL.indd   139 24-10-2022   09:30:23Completethesis_JoycevanSluis_21102022FINAL.indd   140 24-10-2022   09:30:28

New PET technologies:performance, image quality, and clinical implications

NARCIS 

New PET technologies: performance, image quality, and clinical implications

Proceedings - University of Groningen

   University of GroningenNew PET technologiesvan Sluis, JoyceDOI:10.33612/diss.254107383IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2022Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):van Sluis, J. (2022). New PET technologies: performance, image quality, and clinical implications.University of Groningen. https://doi.org/10.33612/diss.254107383CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 11-12-2022Chapter 7First-time imaging of 89Zr-trastuzumab in breast cancer using a long axial field-of-view PET/CT scannerAdrienne H. Brouwers1, Joyce van Sluis1, Johannes H. van Snick1, Carolien P. Schröder1,2, Inge O. Baas3, Ronald Boellaard1,4, Andor W.J.M. Glaudemans1, Ronald J.H. Borra1, Adriaan A. Lammertsma1, Rudi A.J.O. Dierckx1, and Charalampos Tsoumpas1 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands4Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, Free University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsEur J Nucl Med Mol Imaging. 2022;49:3593-3595. Completethesis_JoycevanSluis_21102022FINAL.indd   135 24-10-2022   09:30:22Chapter 7136Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently (1, 2), which offer numerous advantages (3). One important advantage of using LAFOV PET for imaging 89Zr-labeled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement in immunoPET imaging with the Biograph Vision Quadra (VQ) LAFOV PET/CT (Siemens Healthineers).Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq 89Zr-trastuzumab in order to assist clinical decision-making (4, 5). Patients were scanned 4 days postinjection with a Biograph mCT PET/CT (patient A) (Siemens Healthineers) or a Biograph Vision PET/CT (patient B) (Siemens Healthineers), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with the VQ. For the VQ, we chose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with European Association of Nucelar Medicine Research Ltd. (EARL) 1 standard specifications, whilst for LAFOV, we also applied vendor-recommended settings for optimized imaged quality for clinical reading (CLIN) (see Table 1) (6, 7).PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom two rows (i-p). The same intensity scale, SUV range 0-10, applies for all images, except the fused images (e, m). Additional reconstructions of the VQ data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.As can be appreciated from these first human immunoPET images on an LAFOV system, the image quality improvement (f) is most spectacular when compared withthe mCT (a). For example, in patient A, an additional small bone lesion was visualized with the VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this visual improvement in image quality was even appreciated in the 10 min image compared with the 30-45 min acquisition needed for SAFOV systems.Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred total scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the scan duration with still very acceptable image quality, even for 89Zr-labeled mAb PET/CT studies.Completethesis_JoycevanSluis_21102022FINAL.indd   136 24-10-2022   09:30:22First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1377Completethesis_JoycevanSluis_21102022FINAL.indd   137 24-10-2022   09:30:23Chapter 7138Table 1 Acquisition and reconstruction parameters for the different systems.Completethesis_JoycevanSluis_21102022FINAL.indd   138 24-10-2022   09:30:23First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1397References1. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.2. Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.3. Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.4. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.5. Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.6. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.7. Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.Completethesis_JoycevanSluis_21102022FINAL.indd   139 24-10-2022   09:30:23Completethesis_JoycevanSluis_21102022FINAL.indd   140 24-10-2022   09:30:28

Dissertations of the University of Groningen

   University of GroningenNew PET technologiesvan Sluis, JoyceDOI:10.33612/diss.254107383IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2022Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):van Sluis, J. (2022). New PET technologies: performance, image quality, and clinical implications. [Thesisfully internal (DIV), University of Groningen]. University of Groningen.https://doi.org/10.33612/diss.254107383CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 11-09-2023Chapter 7First-time imaging of 89Zr-trastuzumab in breast cancer using a long axial field-of-view PET/CT scannerAdrienne H. Brouwers1, Joyce van Sluis1, Johannes H. van Snick1, Carolien P. Schröder1,2, Inge O. Baas3, Ronald Boellaard1,4, Andor W.J.M. Glaudemans1, Ronald J.H. Borra1, Adriaan A. Lammertsma1, Rudi A.J.O. Dierckx1, and Charalampos Tsoumpas1 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands4Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, Free University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsEur J Nucl Med Mol Imaging. 2022;49:3593-3595. Completethesis_JoycevanSluis_21102022FINAL.indd   135 24-10-2022   09:30:22Chapter 7136Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently (1, 2), which offer numerous advantages (3). One important advantage of using LAFOV PET for imaging 89Zr-labeled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement in immunoPET imaging with the Biograph Vision Quadra (VQ) LAFOV PET/CT (Siemens Healthineers).Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq 89Zr-trastuzumab in order to assist clinical decision-making (4, 5). Patients were scanned 4 days postinjection with a Biograph mCT PET/CT (patient A) (Siemens Healthineers) or a Biograph Vision PET/CT (patient B) (Siemens Healthineers), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with the VQ. For the VQ, we chose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with European Association of Nucelar Medicine Research Ltd. (EARL) 1 standard specifications, whilst for LAFOV, we also applied vendor-recommended settings for optimized imaged quality for clinical reading (CLIN) (see Table 1) (6, 7).PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom two rows (i-p). The same intensity scale, SUV range 0-10, applies for all images, except the fused images (e, m). Additional reconstructions of the VQ data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.As can be appreciated from these first human immunoPET images on an LAFOV system, the image quality improvement (f) is most spectacular when compared withthe mCT (a). For example, in patient A, an additional small bone lesion was visualized with the VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this visual improvement in image quality was even appreciated in the 10 min image compared with the 30-45 min acquisition needed for SAFOV systems.Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred total scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the scan duration with still very acceptable image quality, even for 89Zr-labeled mAb PET/CT studies.Completethesis_JoycevanSluis_21102022FINAL.indd   136 24-10-2022   09:30:22First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1377Completethesis_JoycevanSluis_21102022FINAL.indd   137 24-10-2022   09:30:23Chapter 7138Table 1 Acquisition and reconstruction parameters for the different systems.Completethesis_JoycevanSluis_21102022FINAL.indd   138 24-10-2022   09:30:23First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1397References1. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.2. Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.3. Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.4. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.5. Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.6. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.7. Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.Completethesis_JoycevanSluis_21102022FINAL.indd   139 24-10-2022   09:30:23Completethesis_JoycevanSluis_21102022FINAL.indd   140 24-10-2022   09:30:28

   University of GroningenNew PET technologiesvan Sluis, JoyceDOI:10.33612/diss.254107383IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2022Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):van Sluis, J. (2022). New PET technologies: performance, image quality, and clinical implications. [Thesisfully internal (DIV), University of Groningen]. University of Groningen.https://doi.org/10.33612/diss.254107383CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 28-12-2022Chapter 7First-time imaging of 89Zr-trastuzumab in breast cancer using a long axial field-of-view PET/CT scannerAdrienne H. Brouwers1, Joyce van Sluis1, Johannes H. van Snick1, Carolien P. Schröder1,2, Inge O. Baas3, Ronald Boellaard1,4, Andor W.J.M. Glaudemans1, Ronald J.H. Borra1, Adriaan A. Lammertsma1, Rudi A.J.O. Dierckx1, and Charalampos Tsoumpas1 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands4Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, Free University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsEur J Nucl Med Mol Imaging. 2022;49:3593-3595. Completethesis_JoycevanSluis_21102022FINAL.indd   135 24-10-2022   09:30:22Chapter 7136Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently (1, 2), which offer numerous advantages (3). One important advantage of using LAFOV PET for imaging 89Zr-labeled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement in immunoPET imaging with the Biograph Vision Quadra (VQ) LAFOV PET/CT (Siemens Healthineers).Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq 89Zr-trastuzumab in order to assist clinical decision-making (4, 5). Patients were scanned 4 days postinjection with a Biograph mCT PET/CT (patient A) (Siemens Healthineers) or a Biograph Vision PET/CT (patient B) (Siemens Healthineers), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with the VQ. For the VQ, we chose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with European Association of Nucelar Medicine Research Ltd. (EARL) 1 standard specifications, whilst for LAFOV, we also applied vendor-recommended settings for optimized imaged quality for clinical reading (CLIN) (see Table 1) (6, 7).PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom two rows (i-p). The same intensity scale, SUV range 0-10, applies for all images, except the fused images (e, m). Additional reconstructions of the VQ data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.As can be appreciated from these first human immunoPET images on an LAFOV system, the image quality improvement (f) is most spectacular when compared withthe mCT (a). For example, in patient A, an additional small bone lesion was visualized with the VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this visual improvement in image quality was even appreciated in the 10 min image compared with the 30-45 min acquisition needed for SAFOV systems.Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred total scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the scan duration with still very acceptable image quality, even for 89Zr-labeled mAb PET/CT studies.Completethesis_JoycevanSluis_21102022FINAL.indd   136 24-10-2022   09:30:22First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1377Completethesis_JoycevanSluis_21102022FINAL.indd   137 24-10-2022   09:30:23Chapter 7138Table 1 Acquisition and reconstruction parameters for the different systems.Completethesis_JoycevanSluis_21102022FINAL.indd   138 24-10-2022   09:30:23First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1397References1. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.2. Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.3. Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.4. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.5. Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.6. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.7. Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.Completethesis_JoycevanSluis_21102022FINAL.indd   139 24-10-2022   09:30:23Completethesis_JoycevanSluis_21102022FINAL.indd   140 24-10-2022   09:30:28

University of Groningen

   University of GroningenNew PET technologiesvan Sluis, JoyceDOI:10.33612/diss.254107383IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2022Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):van Sluis, J. (2022). New PET technologies: performance, image quality, and clinical implications. [Thesisfully internal (DIV), University of Groningen]. University of Groningen.https://doi.org/10.33612/diss.254107383CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 30-04-2023Chapter 7First-time imaging of 89Zr-trastuzumab in breast cancer using a long axial field-of-view PET/CT scannerAdrienne H. Brouwers1, Joyce van Sluis1, Johannes H. van Snick1, Carolien P. Schröder1,2, Inge O. Baas3, Ronald Boellaard1,4, Andor W.J.M. Glaudemans1, Ronald J.H. Borra1, Adriaan A. Lammertsma1, Rudi A.J.O. Dierckx1, and Charalampos Tsoumpas1 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands4Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, Free University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsEur J Nucl Med Mol Imaging. 2022;49:3593-3595. Completethesis_JoycevanSluis_21102022FINAL.indd   135 24-10-2022   09:30:22Chapter 7136Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently (1, 2), which offer numerous advantages (3). One important advantage of using LAFOV PET for imaging 89Zr-labeled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement in immunoPET imaging with the Biograph Vision Quadra (VQ) LAFOV PET/CT (Siemens Healthineers).Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq 89Zr-trastuzumab in order to assist clinical decision-making (4, 5). Patients were scanned 4 days postinjection with a Biograph mCT PET/CT (patient A) (Siemens Healthineers) or a Biograph Vision PET/CT (patient B) (Siemens Healthineers), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with the VQ. For the VQ, we chose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with European Association of Nucelar Medicine Research Ltd. (EARL) 1 standard specifications, whilst for LAFOV, we also applied vendor-recommended settings for optimized imaged quality for clinical reading (CLIN) (see Table 1) (6, 7).PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom two rows (i-p). The same intensity scale, SUV range 0-10, applies for all images, except the fused images (e, m). Additional reconstructions of the VQ data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.As can be appreciated from these first human immunoPET images on an LAFOV system, the image quality improvement (f) is most spectacular when compared withthe mCT (a). For example, in patient A, an additional small bone lesion was visualized with the VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this visual improvement in image quality was even appreciated in the 10 min image compared with the 30-45 min acquisition needed for SAFOV systems.Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred total scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the scan duration with still very acceptable image quality, even for 89Zr-labeled mAb PET/CT studies.Completethesis_JoycevanSluis_21102022FINAL.indd   136 24-10-2022   09:30:22First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1377Completethesis_JoycevanSluis_21102022FINAL.indd   137 24-10-2022   09:30:23Chapter 7138Table 1 Acquisition and reconstruction parameters for the different systems.Completethesis_JoycevanSluis_21102022FINAL.indd   138 24-10-2022   09:30:23First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1397References1. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.2. Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.3. Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.4. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.5. Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.6. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.7. Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.Completethesis_JoycevanSluis_21102022FINAL.indd   139 24-10-2022   09:30:23Completethesis_JoycevanSluis_21102022FINAL.indd   140 24-10-2022   09:30:28

   University of GroningenNew PET technologiesvan Sluis, JoyceDOI:10.33612/diss.254107383IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2022Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):van Sluis, J. (2022). New PET technologies: performance, image quality, and clinical implications. [Thesisfully internal (DIV), University of Groningen]. University of Groningen.https://doi.org/10.33612/diss.254107383CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 13-02-2023Chapter 7First-time imaging of 89Zr-trastuzumab in breast cancer using a long axial field-of-view PET/CT scannerAdrienne H. Brouwers1, Joyce van Sluis1, Johannes H. van Snick1, Carolien P. Schröder1,2, Inge O. Baas3, Ronald Boellaard1,4, Andor W.J.M. Glaudemans1, Ronald J.H. Borra1, Adriaan A. Lammertsma1, Rudi A.J.O. Dierckx1, and Charalampos Tsoumpas1 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands4Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, Free University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsEur J Nucl Med Mol Imaging. 2022;49:3593-3595. Completethesis_JoycevanSluis_21102022FINAL.indd   135 24-10-2022   09:30:22Chapter 7136Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently (1, 2), which offer numerous advantages (3). One important advantage of using LAFOV PET for imaging 89Zr-labeled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement in immunoPET imaging with the Biograph Vision Quadra (VQ) LAFOV PET/CT (Siemens Healthineers).Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq 89Zr-trastuzumab in order to assist clinical decision-making (4, 5). Patients were scanned 4 days postinjection with a Biograph mCT PET/CT (patient A) (Siemens Healthineers) or a Biograph Vision PET/CT (patient B) (Siemens Healthineers), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with the VQ. For the VQ, we chose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with European Association of Nucelar Medicine Research Ltd. (EARL) 1 standard specifications, whilst for LAFOV, we also applied vendor-recommended settings for optimized imaged quality for clinical reading (CLIN) (see Table 1) (6, 7).PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom two rows (i-p). The same intensity scale, SUV range 0-10, applies for all images, except the fused images (e, m). Additional reconstructions of the VQ data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.As can be appreciated from these first human immunoPET images on an LAFOV system, the image quality improvement (f) is most spectacular when compared withthe mCT (a). For example, in patient A, an additional small bone lesion was visualized with the VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this visual improvement in image quality was even appreciated in the 10 min image compared with the 30-45 min acquisition needed for SAFOV systems.Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred total scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the scan duration with still very acceptable image quality, even for 89Zr-labeled mAb PET/CT studies.Completethesis_JoycevanSluis_21102022FINAL.indd   136 24-10-2022   09:30:22First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1377Completethesis_JoycevanSluis_21102022FINAL.indd   137 24-10-2022   09:30:23Chapter 7138Table 1 Acquisition and reconstruction parameters for the different systems.Completethesis_JoycevanSluis_21102022FINAL.indd   138 24-10-2022   09:30:23First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1397References1. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.2. Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.3. Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.4. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.5. Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.6. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.7. Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.Completethesis_JoycevanSluis_21102022FINAL.indd   139 24-10-2022   09:30:23Completethesis_JoycevanSluis_21102022FINAL.indd   140 24-10-2022   09:30:28

   University of GroningenNew PET technologiesvan Sluis, JoyceDOI:10.33612/diss.254107383IMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:2022Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):van Sluis, J. (2022). New PET technologies: performance, image quality, and clinical implications.University of Groningen. https://doi.org/10.33612/diss.254107383CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 20-11-2022Chapter 7First-time imaging of 89Zr-trastuzumab in breast cancer using a long axial field-of-view PET/CT scannerAdrienne H. Brouwers1, Joyce van Sluis1, Johannes H. van Snick1, Carolien P. Schröder1,2, Inge O. Baas3, Ronald Boellaard1,4, Andor W.J.M. Glaudemans1, Ronald J.H. Borra1, Adriaan A. Lammertsma1, Rudi A.J.O. Dierckx1, and Charalampos Tsoumpas1 1Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands2Department of Medical Oncology, University of Utrecht, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands4Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam University Medical Centers, Free University of Amsterdam, De Boelelaan 1117, 1081 HV Amsterdam, The NetherlandsEur J Nucl Med Mol Imaging. 2022;49:3593-3595. Completethesis_JoycevanSluis_21102022FINAL.indd   135 24-10-2022   09:30:22Chapter 7136Long axial field-of-view (LAFOV) PET/CT scanners have been introduced recently (1, 2), which offer numerous advantages (3). One important advantage of using LAFOV PET for imaging 89Zr-labeled monoclonal antibodies (mAbs), i.e., immunoPET, is the substantial increase in sensitivity compared with standard axial field-of-view (SAFOV) PET/CT systems, which may lead to a remarkable image quality improvement. This first study showcases such improvement in immunoPET imaging with the Biograph Vision Quadra (VQ) LAFOV PET/CT (Siemens Healthineers).Two patients suffering from metastatic HER2-positive breast cancer were administered with 37 MBq 89Zr-trastuzumab in order to assist clinical decision-making (4, 5). Patients were scanned 4 days postinjection with a Biograph mCT PET/CT (patient A) (Siemens Healthineers) or a Biograph Vision PET/CT (patient B) (Siemens Healthineers), according to local standard operating procedures with overall scan durations of 45 min and 32 min, for, respectively, mCT and Vision. Following the clinical scans, patients were scanned with the VQ. For the VQ, we chose to apply a long scan duration of 30 min (patient A) and 32 min (patient B) to improve image quality rather than shortening the overall scan duration, as compared to Vision. For SAFOV systems, the acquisition and reconstruction parameters complied with European Association of Nucelar Medicine Research Ltd. (EARL) 1 standard specifications, whilst for LAFOV, we also applied vendor-recommended settings for optimized imaged quality for clinical reading (CLIN) (see Table 1) (6, 7).PET/CT images of patient A are shown in the top two rows (a-h), for patient B in the bottom two rows (i-p). The same intensity scale, SUV range 0-10, applies for all images, except the fused images (e, m). Additional reconstructions of the VQ data were obtained, mimicking 3-min (d, h, l, p) and 10-min (c, g, k, o) acquisitions, illustrating more pragmatic scan durations.As can be appreciated from these first human immunoPET images on an LAFOV system, the image quality improvement (f) is most spectacular when compared withthe mCT (a). For example, in patient A, an additional small bone lesion was visualized with the VQ in the pelvic area (f), which was not visible with the SAFOV system (a). Even when compared to the Vision (i), the VQ image (n) shows improved quality without applying any filter after reconstruction. Moreover, this visual improvement in image quality was even appreciated in the 10 min image compared with the 30-45 min acquisition needed for SAFOV systems.Thus, this image shows that the large axial FOV system provides substantial improvement in image quality when applying currently preferred total scan durations on SAFOV systems (45 min for mCT, 32 min for Vision). Additionally, with the new LAFOV system, there is room for further reduction of the scan duration with still very acceptable image quality, even for 89Zr-labeled mAb PET/CT studies.Completethesis_JoycevanSluis_21102022FINAL.indd   136 24-10-2022   09:30:22First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1377Completethesis_JoycevanSluis_21102022FINAL.indd   137 24-10-2022   09:30:23Chapter 7138Table 1 Acquisition and reconstruction parameters for the different systems.Completethesis_JoycevanSluis_21102022FINAL.indd   138 24-10-2022   09:30:23First-time imaging of 89Zr-trastuzumab in breast cancer using an LAFOV PET/CT scanner1397References1. Badawi RD, Shi H, Hu P, Chen S, Xu T, Price PM, et al. First human imaging studies with the EXPLORER total-body PET scanner. J Nucl Med. 2019;60:299–303.2. Prenosil GA, Sari H, Fürstner M, Afshar-Oromieh A, Shi K, Rominger A, et al. Performance characteristics of the Biograph Vision Quadra PET/CT system with long axial field of view using the NEMA NU 2–2018 standard. J Nucl Med. 2022;63:476–84.3. Slart RHJA, Tsoumpas C, Glaudemans AWJM, Noordzij W, Willemsen ATM, Borra RJH, et al. Long axial field of view PET scanners: a road map to implementation and new possibilities. Eur J Nucl Med Mol Imaging. 2021;48:4236–45.4. Dijkers EC, Oude Munnink TH, Kosterink JG, Brouwers AH, Jager PL, de Jong JR, et al. Biodistribution of 89Zr-trastuzumab and PET imaging of HER2-positive lesions in patients with metastatic breast cancer. Clin Pharmacol Ther. 2010;87:586–92.5. Bensch F. 89Zr-trastuzumab PET supports clinical decision making in breast cancer patients, when HER2 status cannot be determined by standard work up. Eur J Nucl Med Mol Imaging. 2018;45:2300–6.6. Boellaard R, Delgado-Bolton R, Oyen WJG, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42:328–54.7. Kaalep A, Huisman M, Sera T, Vugts D, Boellaard R. Feasibility of PET/CT system performance harmonisation for quantitative multicentre 89Zr studies. EJNMMI Phys. 2018;5:26.Completethesis_JoycevanSluis_21102022FINAL.indd   139 24-10-2022   09:30:23Completethesis_JoycevanSluis_21102022FINAL.indd   140 24-10-2022   09:30:28

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New PET technologies:performance, image quality, and clinical implications

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