This document discusses attenuation correction in PET/CT imaging and artifacts that can occur. Attenuation correction is needed in PET imaging to account for photon attenuation as it travels through tissue. PET/CT is the industry standard as it uses CT data to perform attenuation correction. However, artifacts can still occur and be propagated to the PET image, such as from IV contrast, dental hardware, or other dense objects, which can create false positives. It is important to examine non-attenuation corrected PET images to validate any unusual uptake seen on attenuation corrected images.
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
A quality control for new equipment should start with an acceptance test to verify the equipment meets the specifications given by the vendor. The acceptance test should be performed according to accepted international standards and may require the use of instruments and phantoms not available in the department. The acceptance test forms the basis of the reference tests routinely performed in the department during the life-time of the equipment according to a schedule worked out by the medical physicist in cooperation with the nuclear medicine department. Certain parameters should be tested daily, others on weekly, monthly and yearly basis.
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
Quality Assurance Programme in Computed TomographyRamzee Small
Introduction to Computed Tomography
Basic description of the components of a CT System
Introduction to Quality Assurance
Quality Assurance and Quality Control Tests in Computed Tomography base on frequency
Objective of QA/QC Test
4D-CBCT (Symmetry) - a useful tool to verify and treat traditional ITV withou...Dr. Malhar Patel
4D-CBCT is latest software gadget in field of radiation oncology. It will calculate breathing movement during treatment of lung cancer and help in delineate the target better.
This presentation will convince you that even if you do not have 4D-CT simulation, you can confidently use 4D-CBCT at optimal level.
1.Aim of Radiotherapy
The goal of radiotherapy is to deliver a prescribed dose of radiation to the Target while sparing surrounding Healthy tissues to the largest extent possible
2.Organ Motion
Intra-fraction motion
during the fraction
Heartbeat
Swallowing
Coughing
Eye movement
Inter-fraction motion
- in between the fractions
Tumour change
Weight gain/loss
Positioning deviation
Breathing
Bowel and rectal filling
Bladder filling
Muscle relaxation/tension
3. Respiratory motion affects:
Respiratory motion affects all tumour sites in the thorax, abdomen and Pelvis. Tumours in the Lung, Liver, Pancreas, Oesophagus, Breast, Kidneys, prostate
Tumour displacement varies depending on the site and organ Location
Lung tumours can move several cm in any direction during irradiation
It is most prevalent and prominent in Lung cancers
4. Problems associated with respiratory motion during RT
Image acquisition limitations
Treatment planning limitations
Radiation delivery limitations
5. Methods to Account for Respiratory Motion
1. Motion encompassing methods
2. Respiratory gating methods
3. Breath hold methods
4. Forced shallow breathing with abdominal compression
5. Real-time tumor tracking methods
Summary:
The management of respiratory motion in radiation oncology is an evolving field
IGRT provides a solution for combating organ motion in radiotherapy
Delivering higher dose to tumor and less dose to normal tissue.
Limited clinical studies, needs to be studied further
IGRT – the future of radiotherapy
A quality control for new equipment should start with an acceptance test to verify the equipment meets the specifications given by the vendor. The acceptance test should be performed according to accepted international standards and may require the use of instruments and phantoms not available in the department. The acceptance test forms the basis of the reference tests routinely performed in the department during the life-time of the equipment according to a schedule worked out by the medical physicist in cooperation with the nuclear medicine department. Certain parameters should be tested daily, others on weekly, monthly and yearly basis.
The vmat vs other recent radiotherapy techniquesM'dee Phechudi
VMAT is a new type of intensity-modulated radiation therapy (IMRT) treatment technique that uses the same hardware (i.e. a digital linear accelerator) as used for IMRT or conformal treatment, but delivers the radiotherapy treatment using a rotational or arc geometry rather than several static beams.
This technique uses continuous modulation (i.e. moving the collimator leaves) of the multileaf collimator (MLC) fields, continuous change of the fluence rate (the intensity of the X rays) and gantry rotation speed across a single or multiple 360 degree rotations
Quality Assurance Programme in Computed TomographyRamzee Small
Introduction to Computed Tomography
Basic description of the components of a CT System
Introduction to Quality Assurance
Quality Assurance and Quality Control Tests in Computed Tomography base on frequency
Objective of QA/QC Test
4D-CBCT (Symmetry) - a useful tool to verify and treat traditional ITV withou...Dr. Malhar Patel
4D-CBCT is latest software gadget in field of radiation oncology. It will calculate breathing movement during treatment of lung cancer and help in delineate the target better.
This presentation will convince you that even if you do not have 4D-CT simulation, you can confidently use 4D-CBCT at optimal level.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.
Vmat technique for Breast, Head and Neck, Brain and Craniospinal irradiation ...Biplab Sarkar
Past, present and future of VMAT technique in different sites: Breast, Head and Neck, Brain and Craniospinal irradiation for medduloblastoma and PNET treatment.
A summary of recent innovations in radiation oncology focussing on the priniciples of different techniques and their application. An overview of clinical results has also been given
This pdf is about the Positron Emission Tomography (PET) technique.
For more details visit on YouTube; @SELF-EXPLANATORY;
PET; https://youtu.be/rlwGbFGS6wg
Thanks...!
Virtual Navigator Real-Time Ultrasound Fusion Imaging with Positron Emission ...rosopeplaton
Enzo Di Mauro, Marco Solbiati, Stefano De Beni, Leonardo Forzoni, Sara D’Onofrio, Luigi Solbiati
Real-time fusion imaging technologies are
increasingly being used among interventional radiologists,
mostly Computed Tomography (CT) or Magnetic Resonance
Imaging (MRI) dataset, fused with Ultrasound (US) imaging. In
addition, fusion of Positron Emission Tomography (PET) and
CT is increasingly diffused in clinical practice, due to the wide
availability of PET scanners and the capability to make either a
direct (acquisitions performed within the same system) or an
indirect (procedure performed on an external workstation,
merging the two different sets of acquired data) fusion with CT
data. The present work describes the feasibility of real-time
fusion imaging directly between PET data and US imaging,
with CT scans being used only for PET-US fusion registration.
Data on multimodality registration precision and clinical
applications are presented as well.
Similar to Attenuation correction factor and pet/ct artefacts H&N (20)
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Novas diretrizes da OMS para os cuidados perinatais de mais qualidade
Attenuation correction factor and pet/ct artefacts H&N
1. Attenuation Correction factor
and PET/CT artefacts in Head &
Neck.
By Biprojit Nath
M.Sc. Nuclear Medicine
IIT Kharagpur & Tata Medical Center, Kolkata
2. What is Attenuation Correction?
Pdet Is independent on source location along the line joining two detectors.
μ= linear attenuation
coefficient of the tissue at
511KeV
3.
4. Steps for attenuation correction for PET
Mass attenuation coefficient μ / ρ in soft-
tissue is = 0.095cm2/g (511KeV).
HVL=0.693/ μ HVL= 7cm
Average path length for the
photon pair is longer than for a
single photon, different LOR
attenuate to different degrees.
Ge-68/ Cs-137
Comparison with
Blank Scan, i.e.
subject removed.
Attenuation Correction in practise:
Attenuation Correction factor
Detector
More attenuation(4X) Less attenuation
5. Why is PET/CT the industry standard?
PET attenuation correction using CT data!
Segmentation
Fig: Plot of the linear attenuation coefficient at 511 keV versus CT number in Hounsfield units for an
effective x-ray energy of 80 keV for soft tissues, air, water, and bone
Source: Hubbell JH, Seltzer SM: Tables of x-ray mass attenuation
coefficients and mass-energy absorption coefficients
7. Why is resolution never perfect?
Anhelation range and photon non-collinearity!
Mean free path ( range)
Range: Limits spatial resolution
(In air, positron range = several meters)
Collinearity: Assumed for Reconstruction.
Background: At the time of annihilation,
e-p pair has non-zero kinetic energy.
Conservation of momentum
Ɵ=0.25 degrees
511KeV 511KeV dx
Detector distance (D)
dx=0.5 D tan(0.25)
9. Fig1:IV contrast AC artifact: axial AC-PET image (A) shows a focal area of apparent FDG uptake in the right axilla
suspicious for a possible lymph node (arrow). Inspection of the axial CT and fused PET/CT images (B–C) show the
area of FDG activity to correlate to the IV contrast in the right axillary vein (arrows). The lack of corresponding
FDG activity on non-AC–PET image (D) proves that the apparent FDG activity is an AC artifact seen only on AC-PET
and AC–PET/CT fused
11. Fig2: Focal IV contrast AC artifact mimicking nodal spread: coronal PET image (A) shows apparent nodal spread
(arrows) adjacent and to the left of a primary squamous cell carcinoma of the larynx (arrowhead). Axial fused PET/
CT image (B) shows the apparent focal area of intense FDG uptake to correlate to part of an area of IV contrast in
the left subclavian area (arrow). Although there was apparent FDG activity on the AC-PET image (not shown), the
axial non-AC–PET image (C) shows no FDG activity in this area compatible with a focal IV contrast AC artifactF
12. Fig3: CT AC artifact from port: coronal PET, axial CT, and fused PET/CT images (A–C) show a focal area of intense
FDG accumulation (arrows) that appears to correlate to the area of a chemotherapy port in the right upper chest
wall. Inspection of the non-AC image (D) shows an area of photopenia and that this area is an AC artifact because
of the high-attenuation composition of the material in the port.
14. Fig4: Dental hardware AC artifact: coronal PET (A) demonstrates areas of intense FDG accumulation in the area
of the oral cavity (arrow). Axial fused PET/CT with AC-PET (B) shows the apparent uptake to correlate to areas of
streak artifact on CT from dental fillings. Non-AC–fused PET/CT (C) shows no activity in the corresponding area
compatible with an AC artifact
15. Summary
• Look at images with and without attenuation correction if in doubt.
• Don’t assume correct alignment always between PET and CT, at a
minimum, patient and/or bed motion is a possibility.
• Manufacturers have new methods to help with truncation and
respiratory motion artifacts.
• CT artifacts and dense objects can propagate errors into the
PET image via CTAC.
16. References:
• Sorenson, Physics in Nuclear Medicine, 4th edition.
• Bushberg, The Essential Physics of Medical Imaging, 2nd Edition,
2002.
• Paul Kinahan, PET/CT Issues: CT-based attenuation correction (CTAC),
Artifacts,and Motion Correction.
• Boldgett et al. PET/CT Protocols and Artifacts in the Head and Neck.
• Fund BioImaging 2014 lectures on PET/CT AC.
Editor's Notes
What the linear attenuation coeff will look at 511KeV!
Coronal image segment out bone and soft-tissue composite image at 511KeV.
