Quantitative 166Ho-microspheres SPECT derived from a dual-isotope acquisition with 99mTc-colloid is clinically feasible

Purpose: Accurate dosimetry is essential in radioembolization. To this purpose, an automatic protocol for healthy liver dosimetry based on dual isotope (DI) SPECT imaging, combining holmium-166 (166Ho)-microspheres and technetium-99m (99mTc)-colloid, was developed: 166Ho-microspheres used as scout and therapeutic particles and 99mTc-colloid to identify the healthy liver. DI SPECT allows for an automatic and accurate estimation of absorbed doses, introducing true personalized dosimetry. However, photon crosstalk between isotopes can compromise image quality. This study investigates the effect of 99mTc downscatter on 166Ho dosimetry, by comparing 166Ho-SPECT reconstructions of patient scans acquired before (166Ho-only) and after additional administration of 99mTc-colloid (166Ho-DI).Methods: The 166Ho-only and 166Ho-DI scans were performed in short succession by injecting 99mTc-colloid on the scanner table. To compensate for 99mTc downscatter, its influence was accounted for in the DI image reconstruction using energy window-based scatter correction methods. The qualitative assessment was performed by independent blinded comparison by two nuclear medicine physicians assessing 65 pairs of SPECT/CT. Inter-observer agreement was tested by Cohen's kappa coefficient. For the quantitative analysis, two volumes of interest within the liver, VOITUMOR and VOIHEALTHY, were manually delineated on the 166Ho-only reconstruction and transferred to the co-registered 166Ho-DI reconstruction. Absorbed dose within the resulting VOIs, and in the lungs (VOILUNGS), was calculated based on the administered therapeutic activity.Results: The qualitative assessment showed no distinct clinical preference for either 166Ho-only or 166Ho-DI SPECT (kappa=0.093). Quantitative analysis indicated that the mean absorbed dose difference between 166Ho-DI and 166Ho-only was -2.00±2.84 Gy (median 27 Gy; p-value<0.00001), -5.27±8.99 Gy (median 116 Gy; p-value =0.00035) and 0.80±1.08 Gy (median 3 Gy; p-value<0.00001) for VOIHEALTHY, VOITUMOR and VOILUNGS respectively. The corresponding Pearson’s correlation coefficient between 166Ho-only and 166Ho-DI for absorbed dose was 0.97, 0.99 and 0.82, respectively.

Influence of detectors efficiency normalization on small animal PET image quality

LabPET GE 4 (a small animal positron emission tomograph) image acquisition is done by 1536 independents channels. Differences in the rate counting of each channel must be corrected so as not compromise image quality. Equipment user manual recommends that normalization of the detectors efficiency be made as often as possible and always whenever there are hardware or software parameters changes - included, but not limited to channels parameters adjustments, electronic cards replacements, channels activation or inactivation or software update. This work evaluates the normalization effects on the image quality parameters. PET image acquisition were performed using recommended parameters by the NEMA NU 4-2008 standards. Image was reconstructed in different ways using different normalization files. The tests performed indicated that the image quality parameters do not vary significantly with different normalization data. Therefore, a daily routine of normalizations is not justified, suggesting a periodical frequency of one month or more for this procedure.