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18 Pinhole (5.6MB) 18 Pinhole (5.6MB) Presentation Transcript

  • MULTI-PINHOLE MODIFICATION OF A PHILIPS/ADAC CARDIO 60 VERTEX SPECT SYSTEM TO PERFORM SIMULTANEOUS GATED MYOCARDIAL PERFUSION IMAGING (GMPI) WITHOUT MECHANICAL ROTATION. D. L. Kirch, J.E. Koss, P.P. Steele, T.P. Bublitz Nuclear Cardiology Research Western Cardiology Associates, PC Englewood, CO
  • MOTIVATION FOR SIMULTANEOUS MULTI-PINHOLE MYOCARDIAL PERFUSION IMAGING
    • PINHOLE COLLIMATION IS INEXPENSIVE, PRECISE AND ELIMINATES NEED FOR MECHANICAL ROTATION
    • LIST-MODE DATA ACQUISITION RETAINS MULTI-CHANNEL ENERGY INFORMATION AND ALSO RECORDS ORIGINAL EKG FOR OFF-LINE BEAT SELECTION
    • HIGH COUNT IMAGES ALLOW CORRECTION FOR SCATTER AND CROSS-TALK WHICH IS NECESSARY FOR SIMULTANEOUS DUAL-ISOTOPE (Tc/Tl) IMAGING AND EVENTAULLY FOR PATIENT MOTION, CARDIAC CREEP AND RESPIRATION
    • IMPROVED PATIENT COMFORT AND THROUGH-PUT
  • MULTI-PINHOLE SYSTEM DESIGN SPECIFICATIONS
    • BASED ON ORIGINAL SEVEN PINHOLE SYSTEM
    • TWO MULTI-PINHOLE COLLIMATORS PLACE A 3 X 3 PATTERN OF VIEWS ON THE VERTEX EPIC DETECTORS
    • PHILIPS/ADAC EPIC DETECTORS HAVE EXCELLENT Tl/Tc SUPERPOSITION PERFORMANCE
    • ATLAS COMPUTERS HAVE LIST-MODE DATA ACQUISITION CAPABILITY PRE-ENGINEERED
    • RAW LIST-MODE FILES ARE TRANSFERRED TO A 2.5 GHz PENTIUM BASED PC USING FTP
    • ALL PROCESSING AND RECONSTRUCTION IS PERFORMED ON THE PC USING INTERACTIVE DATA LANGUAGE (IDL)
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  • INTERIOR VIEW OF MULTI-PINHOLE COLLIMATOR SHOWING SEPTA WHICH DIVIDE THE VIEWS AND SOME OF THE PINHOLES IN THE FACE PLATE FROM THE BACK SIDE
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  • PHANTOM POSITIONED FOR MULTI- PINHOLE STATIC IMAGING
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  • GATED MULTI-PINHOLE ORIGINAL VIEWS ANTERIOR DETECTOR LEFT LATERAL DETECTOR
  • SIMULTANEOUS DUAL-ISOTOPE (TL-201/TC99m) MYOCARDIAL PERFUSION IMAGING PROTOCOL
    • IV SITE IS ESTABLISHED AND 6.0 mCi OF Tc AGENT INJECTED
    • PATIENT DRINKS 8-16 oz OF CLEAR LIQUID DURING 10 min WAIT PRIOR TO EKG HOOK-UP FOR STRESS TEST
    • INJECTION OF 4.0 mCi OF Tl-201 OCCURS 1-2 min PRIOR TO CESSATION OF STRESS MANEUVER
    • GATED, SIMULTANEOUS DUAL-ISOTOPE IMAGING IS PERFORMED IMMEDIATELY FOLLOWING COOL DOWN USING LIST-MODE ACQUISITION OF X, Y, ENEREGY AND EKG DATA
    • IMAGE ACQUISITION TAKES ABOUT 20 MINUTES AND RESULTS IN 3 MILLION COUNTS PER VIEW
    • TOTAL DURATION OF TEST IS < 90 min
  • CORRECTION OF SIMULTANEOUS DUAL-ISOTOPE IMAGES FOR SCATTER AND CROSS-TALK Tl-201 PEAK Tc-99m PEAK ESTIMATED SCATTER UNDER TL-201 PEAK ESTIMATED SCATTER UNDER TC-99m PEAK COUNTS PER CHANNEL 40 80 120 160 ENERGY, keV 167.5 keV Tl-201 PEAK
  • SIMULTANEOUS DUAL-ISOTOPE STRESS/REST TL/TC IMAGES REST SHORT AXIS SLICES STRESS SHORT AXIS SLICES REST LONG AXIS SLICES 0 O 22.5 O 45 O 67.5 O 90 O 112.5 O 135 O 157.5 O STRESS LONG AXIS SLICES
  • 0 o 22.5 o 45 o 67.5 o 90 o 112.5 o 135 o 157.5 o CONVENTION FOR ORIENTATION OF SPIN LONG-AXIS VIEWS 0 o 22.5 o 45 o 67.5 o 90 o 112.5 o 135 o 157.5 o RESTING LONG AXIS SLICES STRESS LONG AXIS SLICES
  • CENTERLINE TRACKING PERFORMED ON 8 SHORT AXIS SLICES FROM APEX TO BASE CCP CURVES DEVELOPED AT 60 POINTS THROUGH 360 o . SEARCH FOR MAXIMUM VALUE AVERAGED WITH TWO NEAREST RADIAL NEIGHBORS APEX BASE
  • CIRCUMFERENTIAL COUNT PROFILE CURVES COMPARING STRESS/REST IMAGES STRESS REST STRESS-REST DIFFERENCE
  • CINE DISPLAY OF TWO SUCCESSIVE RESTING IMAGES ACQUIRED BACK-TO-BACK “ RESTING ” DATA SET “ PSEUDO STRESS ” DATA SET
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  • CINE DISPLAY OF FRAMES 31 AND 32 “ RESTING ” STUDY “ PSEUDO STRESS ” STUDY These are the transitional frames acquired by detector #1 and detector # 2
  • SHORT AND LONG AXIS SPIN VIEWS RECONSTRUCTED BY AUTO SPECT FROM REST/REST BACK-TO-BACK STUDIES REST SHORT AXIS SLICES PSEUDO STRESS SHORT AXIS SLICES REST LONG AXIS SLICES 0 O 22.5 O 45 O 67.5 O 90 O 112.5 O 135 O 157.5 O PSEUDO STRESS LONG AXIS SLICES
  • CIRCUMFERENTIAL COUNT PROFILE COMPARISON OF BACK-TO-BACK REST/REST RSPECT STUDY
  • OFF-LINE BAD BEAT DISCRIMINATION
  • MANUAL INSERTION OF PVC’s
  • R-TO-R INTERVAL, (MILLISECONDS) R-TO-R INTERVAL HISTOGRAM SELECTED RANGE OF R-TO-R VALUES
  • GATED MULTI-PINHOLE ORIGINAL IMAGES ANTERIOR DETECTOR LEFT LATERAL DETECTOR
  • RECONSTRUCTED GATED MULTI-PINHOLE IMAGES
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  • Someday perhaps we’ll look back and say “ Performing gated tomographic myocardial perfusion studies using a rotational SPECT system was a lot like trying do a gated blood-pool study using a rectilinear scanner.” www.nuclear-cardiology.com