Quantitative Imaging

Áron K. Krizsán Ph.D.

Medical Physicist
 Medical Imaging Modalities

X-ray Scintigraphy PET US

CT SPECT MRI OI

with the courtesy of Thomas Beyer, Medical University of Vienna

 Medical Imaging Modalities

X-ray  Scintigraphy  PET  Ultrasound 

CT  SPECT  MRI  Optical Imaging 

Structural Imaging
Functional Imaging Molecular Imaging
with the courtesy of Thomas Beyer, Medical University of Vienna
 Medical Imaging Modalities

PET 

Structural Imaging
Functional Imaging Molecular Imaging
with the courtesy of Thomas Beyer, Medical University of Vienna
 Comparison of medical imaging modalities

Spatial Temporal Sensitivity

Imaging Quantitative Target
resolution resolution (mol/L)

PET 1 – 4 mm sec - min 10-11 – 10-12 Physiology

yes
Molecular
Anatomy
MRI 10 – 250 m min – hours 10-3 – 10-5 relative Physiology
Molecular
Optical Imaging
Bioluminescence 3-5 mm min 10-15 – 10-17 no Molecular
FRI 2-3 mm sec - min 10-9 – 10-12 no Phys/Mol
FMT 1-3 mm min 10-6 – 10-12 yes Phys/Mol

CT 50 m Anatomy
sec – min – relative
Physiology

min Physiology
SPECT 0.3 – 1 mm 10-10 – 10-11 yes
Molecular

Anatomy
Ultrasound 30 – 500 m sec – min 10-6 – 10-9 yes
Physiology

X-ray 25 – 150 m sec – no Anatomy

Sinusas et al, Circ Cardiovasc Imag, 2008; Weissleder et al, nature 452, 2008
with the courtesy of Thomas Beyer and cmi-experts ltd.
PET is sensitive

< 10-12
mol

Balaton

PET  detecting pico-molar concentrations

with the courtesy of Thomas Beyer, Medical University of Vienna

 Quantitative Imaging

0. Attenuation and scatter corrected images

1. Synchronization of clocks
2. Calibration factor measurement (CPS  kBq/ml)
3. Activity calibrated scanner  we can use semi-quantitative
measures: % Injected Dose, SUV, SUL
4. Diagnostic value and Therapeutic follow-up
(theranostics)

Michael E. Phelps, Simon R. Cherry, Magnus Dahlbom: PET: Physics, Instrumentation and Scanners
Corrections: scatter, attenuation and random

Simon R. Cherry, James A. Sorensen, Michael E. Phelps: Physics in Nuclear Medicine

Stefan Eberl, Royal Prince Alfred Hospital, Sydney. PET workshop , 2007
 Calibration Factor
SUV kBq/ml

𝑅𝑒𝑎𝑙 𝐴𝑐𝑡𝑖𝑣𝑖𝑡𝑦 𝐶𝑜𝑛𝑐𝑒𝑛𝑡𝑟𝑎𝑡𝑖𝑜𝑛

Calibration Factor =
𝑃𝐸𝑇 𝑟𝑎𝑤 𝑖𝑚𝑎𝑔𝑒 𝑣𝑎𝑙𝑢𝑒𝑠(𝐶𝑃𝑆)
Standardized Uptake Value (SUV)
It is a way of normalizing the
SUV > 1 signal imaged at a given location
SUV = 1 for the amount of tracer
radioactivity injected into the
subject, and for the actual
SUV < 1 weight of the patient.

C T
: radioactivity in the tissue region [mCi/cm 3 ]

V 1 V T
: volume of tissue region [cm 3 ]
SUV C
=  W T
T
S W T
: weight of tissue region [g]
W D T inj D inj
: dose injected into the subject [mCi]

W S
: weight of patient [g]

Michael E. Phelps, Simon R. Cherry, Magnus Dahlbom: PET: Physics, Instrumentation and Scanners
Standardized Uptake Value (SUV)  SUV peak

M. Vanderhoek et al. THE JOURNAL OF NUCLEAR MEDICINE • Vol. 53 • No. 1 • January 2012
 SUV! But when? When not to use it?

C
T
: radioactivity in the tissue region [mCi/cm 3 ]
1
= CT  V T 
% Injected Dose/g
SUV
v W S
v
V
T
: volume of tissue region [cm 3 ]

W DT inj
W T
: weight of tissue region [g]
D inj
: dose injected into the subject [mCi]

W S
: weight of v
patient [g]
https://med.stanford.edu/radiology/news/2016/aunt-minnie-best-radiology-image.html
 Therapeutic follow-up

R. Minamimoto et al. THE JOURNAL OF NUCLEAR MEDICINE Vol. 57 No. 4 April 2016

Louise Emmet et al. J Med Radiat Sci 64 (2017) 52–60

Edward J. Hoffmann Michael E. Phelps
 1994 1998 2002
1999

Preclinical PET

Whole Body PET LSO Scintillation Crystals

PET/CT New photodetectors New reconstruction

2001 2009
APD 2008 methods

SiPM 2011

Filtered Iterative + TOF

PET/CT PET/MRI Backprojection and PSF correction

Some major advances in PET instrumentation and methods:

Whole-Body PET, 3D PET, LSO and related scintillators, preclinical PET, PET/CT,
PET/MRI, APD and SiPM photodetectors, Iterative reconstruction, PSF correction, TOF
 Signal-to-Noise (SNR) Improvement S. R. Cherry Journal of Nuclear Medicine vol. 47, pp. 1735–1745
PET – Status Quo?

Digital detectors

“Intelligent” Image
Reconstruction

Discovery MI
Digital PET
Digital PET?
Digital PET/CT
Digital PET
 Digital PET

R. Lecomte, Eur J Nucl Med Mol Imaging (2009) 36 (Suppl 1):S69–S85;

Digital PET

See further. Go beyond. Philips Healthcare, Vereos PET/CT Brochure 2015

18F-FDG BMI Injected Activity Acquisition Time

≤ 20 3.0 MBq/kg 1.5 min/bed position

60 min
20 – 30 3.5 MBq/kg 1.5 min/bed position
uptake

Q.Clear: > 30 4.0 MBq/kg 1.5 min/bed position

450 beta

22 patients per day, change every 10 minutes

Intelligens
Képrekonstrukció

Discovery MI
Revolution in Reconstruction

Steve Ross: Q.Clear White Paper, GE HealthCare 2014

Steve Ross: Q.Clear White Paper, GE HealthCare 2014
Quantitative Accuracy

Sangtae Ahn et al. Phys. Med. Biol. 60 (2015) 5733

from PET to PET/CT
 Discovery MI
PET/CT
Advantage in the
abdominal regions:

Metal Artefact
Reduction
(MAR)

• Image Quality
improvements:
reduction of CT
artefacts contributing
to the final PET images
through attenuation
correction
 Benefits for
patients with hip
surgery
Find the right instrument  Learn how to play it
Thank You!