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EJNMMI Phys. 2019 Dec 26;6(1):29. doi: 10.1186/s40658-019-0268-5.

Towards standardization of absolute SPECT/CT quantification: a multi-center and multi-vendor phantom study.

Author information

1
Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. steffie.peters@radboudumc.nl.
2
Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands.
3
Department of Medical Physics, Albert Schweitzer Hospital, Dordrecht, The Netherlands.
4
Department of Radiology, Section of Medical Physics, Leiden University Medical Center, Leiden, The Netherlands.
5
Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, The Netherlands.
6
Department of Nuclear Medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands.
7
Department of Radiology and Nuclear Medicine, Radboudumc, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.

Abstract

Absolute quantification of radiotracer distribution using SPECT/CT imaging is of great importance for dosimetry aimed at personalized radionuclide precision treatment. However, its accuracy depends on many factors. Using phantom measurements, this multi-vendor and multi-center study evaluates the quantitative accuracy and inter-system variability of various SPECT/CT systems as well as the effect of patient size, processing software and reconstruction algorithms on recovery coefficients (RC).

METHODS:

Five SPECT/CT systems were included: Discovery™ NM/CT 670 Pro (GE Healthcare), Precedence™ 6 (Philips Healthcare), Symbia Intevo™, and Symbia™ T16 (twice) (Siemens Healthineers). Three phantoms were used based on the NEMA IEC body phantom without lung insert simulating body mass indexes (BMI) of 25, 28, and 47 kg/m2. Six spheres (0.5-26.5 mL) and background were filled with 0.1 and 0.01 MBq/mL 99mTc-pertechnetate, respectively. Volumes of interest (VOI) of spheres were obtained by a region growing technique using a 50% threshold of the maximum voxel value corrected for background activity. RC, defined as imaged activity concentration divided by actual activity concentration, were determined for maximum (RCmax) and mean voxel value (RCmean) in the VOI for each sphere diameter. Inter-system variability was expressed as median absolute deviation (MAD) of RC. Acquisition settings were standardized. Images were reconstructed using vendor-specific 3D iterative reconstruction algorithms with institute-specific settings used in clinical practice and processed using a standardized, in-house developed processing tool based on the SimpleITK framework. Additionally, all data were reconstructed with a vendor-neutral reconstruction algorithm (Hybrid Recon™; Hermes Medical Solutions).

RESULTS:

RC decreased with decreasing sphere diameter for each system. Inter-system variability (MAD) was 16 and 17% for RCmean and RCmax, respectively. Standardized reconstruction decreased this variability to 4 and 5%. High BMI hampers quantification of small lesions (< 10 ml).

CONCLUSION:

Absolute SPECT quantification in a multi-center and multi-vendor setting is feasible, especially when reconstruction protocols are standardized, paving the way for a standard for absolute quantitative SPECT.

KEYWORDS:

SPECT/CT; absolute quantification; performance evaluation; recovery coefficient

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