Effects of Respiratory Motion on Y-90 PET Dosimetry for SIRT

Respiratory motion degrades the quantification accuracy of PET imaging by blurring the radioactivity distribution. In the case of post-SIRT PET-CT verification imaging, respiratory motion can lead to inaccuracies in dosimetric measures. Using an anthropomorphic phantom filled with 90Y at a range of clinically relevant activities, together with a respiratory motion platform performing realistic motions (10–15 mm amplitude), we assessed the impact of respiratory motion on PET-derived post-SIRT dosimetry. Two PET scanners at two sites were included in the assessment. The phantom experiments showed that device-driven quiescent period respiratory motion correction improved the accuracy of the quantification with statistically significant increases in both the mean contrast recovery (+5%, p = 0.003) and the threshold activities corresponding to the dose to 80% of the volume of interest (+6%, p < 0.001). Although quiescent period gating also reduces the number of counts and hence increases the noise in the PET image, its use is encouraged where accurate quantification of the above metrics is desired.

A moving liver phantom in an anthropomorphic thorax for SPECT MP imaging

Cranio-caudal respiratory motion and liver activity cause a variety of complex myocardial perfusion (MP) artifacts, especially in the inferior myocardial wall, that may also mask cardiac defects. To assess and characterise such artifacts, an anthropomorphic thorax with moving thoracic phantoms can be utilised in SPECT MP imaging. In this study, a liver phantom was developed and anatomically added into an anthropomorphic phantom that also encloses an ECG beating cardiac phantom and breathing lungs’ phantom. A cranio-caudal respiratory motion was also developed for the liver phantom and it was synchronised with the corresponding ones of the other thoracic phantoms. This continuous motion was further divided into isochronous dynamic respiratory phases, from end-exhalation to end-inspiration, to perform SPECT acquisitions in different respiratory phases. The new motions’ parameters and settings were measured by mechanical means and also validated in a clinical environment by acquiring CT images and by using two imaging software packages. To demonstrate the new imaging capabilities of the phantom assembly, SPECT/CT MP acquisitions were performed and compared to previous phantom and patients studies. All thoracic phantoms can precisely perform physiological motions within the anthropomorphic thorax. The new capabilities of the phantom assembly allow to perform SPECT/CT MP acquisitions for different cardiac-liver activity ratios and cardiac-liver proximities in supine and, for first time, in prone position. Thus, MP artifacts can be characterised and motion correction can be performed due to these new capabilities. The impact of artifacts and motion correction on defect detection can be also investigated.

PET respiratory motion correction: quo vadis?

Positron emission tomography (PET) respiratory motion correction has been a subject of great interest for the last twenty years, prompted mainly by the development of multimodality imaging devices such as PET/computed tomography (CT) and PET/magnetic resonance imaging (MRI). PET respiratory motion correction involves a number of steps including acquisition synchronization, motion estimation and finally motion correction. The synchronization steps include the use of different external device systems or data driven approaches which have been gaining ground over the last few years. Patient specific or generic motion models using the respiratory synchronized datasets can be subsequently derived and used for correction either in the image space or within the image reconstruction process. Similar overall approaches can be considered and have been proposed for both PET/CT and PET/MRI devices. Certain variations in the case of PET/MRI include the use of MRI specific sequences for the registration of respiratory motion information. The proposed review includes a comprehensive coverage of all these areas of development in field of PET respiratory motion for different multimodality imaging devices and approaches in terms of synchronization, estimation and subsequent motion correction. Finally, a section on perspectives including the potential clinical usage of these approaches is included.

Residual Image Registration Error by Fiducial Markers in Accelerated Partial Breast Irradiation Using C-Arm Linac: A Phantom Study

Introduction: External beam accelerated partial breast irradiation (APBI) is an alternative treatment for patients with early-stage breast cancer. The efficacy of image-guided radiotherapy (IGRT) using fiducial markers, such as gold markers or surgical clips, has been demonstrated. However, the effects of respiratory motion during a single fraction have not been reported. This study aimed to evaluate the residual image registration error of fiducial marker-based IGRT by respiratory motion and propose a suitable treatment strategy.Materials & Methods: We developed an acrylic phantom embedded with surgical clips to verify the registration error under moving conditions. The frequency of the phase difference in the respiratory cycle due to sequential acquisition was verified in a preliminary study. Fiducial marker-based IGRT was then performed in 10 scenarios. The residual registration error (RRE) was calculated on the basis of the differences in the coordinates of clips between the true position if not moved and the last position.Results: The frequencies of the phase differences in 0.0–0.99, 1.0–1.99, 2.0–2.99, 3.0–3.99, and 4.0–5.0 mm were 23%, 24%, 22%, 20%, and 11%, respectively. When assuming a clinical case, the mean RREs for all directions were within 1.0 mm, even if respiratory motion of 5 mm existed in two axes.Conclusions: For APBI with fiducial marker-based IGRT, the introduction of an image registration strategy that employs stepwise couch correction using at least three orthogonal images should be considered.

Chest CT Usage in Covid-19 Pneumonia: Multicenter Study on Radiation Doses and Diagnostic Quality in Brazil

We assessed variations in chest CT usage, radiation dose and image quality in COVID-19 pneumonia. Our study included all chest CT exams performed in 533 patients from 6 healthcare sites from Brazil. We recorded patients’ age, gender and body weight and the information number of CT exams per patient, scan parameters and radiation doses (volume CT dose index—CTDIvol and dose length product—DLP). Six radiologists assessed all chest CT exams for the type of pulmonary findings and classified CT appearance of COVID-19 pneumonia as typical, indeterminate, atypical or negative. In addition, each CT was assessed for diagnostic quality (optimal or suboptimal) and presence of artefacts. Artefacts were frequent (367/841), often related to respiratory motion (344/367 chest CT exams with artefacts) and resulted in suboptimal evaluation in mid-to-lower lungs (176/344) or the entire lung (31/344). There were substantial differences in CT usage, patient weight, CTDIvol and DLP across the participating sites.