MULTI-PINHOLE MODIFICATION OF A MULTI-PINHOLE MODIFICATION OF A

PHILIPS/ADAC CARDIO 60 VERTEX SPECT PHILIPS/ADAC CARDIO 60 VERTEX SPECT

SYSTEM TO PERFORM SIMULTANEOUS SYSTEM TO PERFORM SIMULTANEOUS

GATED MYOCARDIAL PERFUSION IMAGING GATED MYOCARDIAL PERFUSION IMAGING

(GMPI) WITHOUT MECHANICAL ROTATION.(GMPI) WITHOUT MECHANICAL ROTATION.

MULTI-PINHOLE MODIFICATION OF A MULTI-PINHOLE MODIFICATION OF A

PHILIPS/ADAC CARDIO 60 VERTEX SPECT PHILIPS/ADAC CARDIO 60 VERTEX SPECT

SYSTEM TO PERFORM SIMULTANEOUS SYSTEM TO PERFORM SIMULTANEOUS

GATED MYOCARDIAL PERFUSION IMAGING GATED MYOCARDIAL PERFUSION IMAGING

(GMPI) WITHOUT MECHANICAL ROTATION.(GMPI) WITHOUT MECHANICAL ROTATION.

D. L. Kirch, J.E. Koss, P.P. Steele, T.P. BublitzD. L. Kirch, J.E. Koss, P.P. Steele, T.P. Bublitz

Nuclear Cardiology ResearchNuclear Cardiology Research

Western Cardiology Associates, PCWestern Cardiology Associates, PC

Englewood, COEnglewood, CO

D. L. Kirch, J.E. Koss, P.P. Steele, T.P. BublitzD. L. Kirch, J.E. Koss, P.P. Steele, T.P. Bublitz

Nuclear Cardiology ResearchNuclear Cardiology Research

Western Cardiology Associates, PCWestern Cardiology Associates, PC

Englewood, COEnglewood, CO

MOTIVATION FOR SIMULTANEOUS MULTI-PINHOLE MYOCARDIAL PERFUSION IMAGING

MOTIVATION FOR SIMULTANEOUS MULTI-PINHOLE MYOCARDIAL PERFUSION IMAGING

PINHOLE COLLIMATION IS INEXPENSIVE, PRECISE AND PINHOLE COLLIMATION IS INEXPENSIVE, PRECISE AND

ELIMINATES NEED FOR MECHANICAL ROTATIONELIMINATES NEED FOR MECHANICAL ROTATION

LIST-MODE DATA ACQUISITION RETAINS MULTI-CHANNEL LIST-MODE DATA ACQUISITION RETAINS MULTI-CHANNEL

ENERGY INFORMATION AND ALSO RECORDS ORIGINAL ENERGY INFORMATION AND ALSO RECORDS ORIGINAL

EKG FOR OFF-LINE BEAT SELECTIONEKG FOR OFF-LINE BEAT SELECTION

HIGH COUNT IMAGES ALLOW CORRECTION FOR HIGH COUNT IMAGES ALLOW CORRECTION FOR

SCATTER AND CROSS-TALK WHICH IS NECESSARY FOR SCATTER AND CROSS-TALK WHICH IS NECESSARY FOR

SIMULTANEOUS DUAL-ISOTOPE (Tc/Tl) IMAGING AND SIMULTANEOUS DUAL-ISOTOPE (Tc/Tl) IMAGING AND

EVENTAULLY FOR PATIENT MOTION, CARDIAC CREEP EVENTAULLY FOR PATIENT MOTION, CARDIAC CREEP

AND RESPIRATIONAND RESPIRATION

IMPROVED PATIENT COMFORT AND THROUGH-PUTIMPROVED PATIENT COMFORT AND THROUGH-PUT

MULTI-PINHOLE SYSTEM DESIGN SPECIFICATIONSMULTI-PINHOLE SYSTEM DESIGN SPECIFICATIONS

BASED ON ORIGINAL SEVEN PINHOLE SYSTEMBASED ON ORIGINAL SEVEN PINHOLE SYSTEM

TWO MULTI-PINHOLE COLLIMATORS PLACE A 3 X 3 TWO MULTI-PINHOLE COLLIMATORS PLACE A 3 X 3 PATTERN OF VIEWS ON THE VERTEX EPIC DETECTORSPATTERN OF VIEWS ON THE VERTEX EPIC DETECTORS

PHILIPS/ADAC EPIC DETECTORS HAVE EXCELLENT PHILIPS/ADAC EPIC DETECTORS HAVE EXCELLENT Tl/Tc SUPERPOSITION PERFORMANCETl/Tc SUPERPOSITION PERFORMANCE

ATLAS COMPUTERS HAVE LIST-MODE DATA ATLAS COMPUTERS HAVE LIST-MODE DATA ACQUISITION CAPABILITY PRE-ENGINEEREDACQUISITION CAPABILITY PRE-ENGINEERED

RAW LIST-MODE FILES ARE TRANSFERRED TO A 2.5 RAW LIST-MODE FILES ARE TRANSFERRED TO A 2.5 GHz PENTIUM BASED PC USING FTPGHz PENTIUM BASED PC USING FTP

ALL PROCESSING AND RECONSTRUCTION IS ALL PROCESSING AND RECONSTRUCTION IS PERFORMED ON THE PC USING INTERACTIVE DATA PERFORMED ON THE PC USING INTERACTIVE DATA LANGUAGE (IDL)LANGUAGE (IDL)

PINHOLE VS PARALLEL SPECTRAL COMPARISON

TOP VIEW SHOWING ONE SECTION OF PINHOLES

x

HEART

CHEST WALL

SHOULDER

PINHOLESCOLLIMATOR FACEPLATES

CRYSTAL DETECTOR

IMAGES PROJECTEDONTO CRYSTAL

xx

xx

x

INTERIOR VIEW OF MULTI-PINHOLE COLLIMATOR SHOWING SEPTA WHICH DIVIDE THE VIEWS AND SOME OF THE PINHOLES IN THE FACE PLATE FROM THE BACK SIDE

PHANTOM POSITIONED FOR MULTI- PINHOLE STATIC IMAGING

18

GATED MULTI-PINHOLEGATED MULTI-PINHOLEORIGINAL VIEWSORIGINAL VIEWS

ANTERIOR DETECTOR LEFT LATERAL DETECTORANTERIOR DETECTOR LEFT LATERAL DETECTOR

GATED MULTI-PINHOLEGATED MULTI-PINHOLEORIGINAL VIEWSORIGINAL VIEWS

ANTERIOR DETECTOR LEFT LATERAL DETECTORANTERIOR DETECTOR LEFT LATERAL DETECTOR

SIMULTANEOUS DUAL-ISOTOPE (TL-201/TC99m) MYOCARDIAL PERFUSION IMAGING PROTOCOL SIMULTANEOUS DUAL-ISOTOPE (TL-201/TC99m) MYOCARDIAL PERFUSION IMAGING PROTOCOL

IV SITE IS ESTABLISHED AND 6.0 mCi OF Tc AGENT INJECTEDIV SITE IS ESTABLISHED AND 6.0 mCi OF Tc AGENT INJECTED PATIENT DRINKS 8-16 oz OF CLEAR LIQUID DURING 10 min PATIENT DRINKS 8-16 oz OF CLEAR LIQUID DURING 10 min

WAIT PRIOR TO EKG HOOK-UP FOR STRESS TESTWAIT PRIOR TO EKG HOOK-UP FOR STRESS TEST INJECTION OF 4.0 mCi OF Tl-201 OCCURS 1-2 min PRIOR TO INJECTION OF 4.0 mCi OF Tl-201 OCCURS 1-2 min PRIOR TO

CESSATION OF STRESS MANEUVERCESSATION OF STRESS MANEUVER GATED, SIMULTANEOUS DUAL-ISOTOPE IMAGING IS GATED, SIMULTANEOUS DUAL-ISOTOPE IMAGING IS

PERFORMED IMMEDIATELY FOLLOWING COOL DOWN USING PERFORMED IMMEDIATELY FOLLOWING COOL DOWN USING LIST-MODE ACQUISITION OF X, Y, ENEREGY AND EKG DATALIST-MODE ACQUISITION OF X, Y, ENEREGY AND EKG DATA

IMAGE ACQUISITION TAKES ABOUT 20 MINUTES AND RESULTS IMAGE ACQUISITION TAKES ABOUT 20 MINUTES AND RESULTS IN 3 MILLION COUNTS PER VIEWIN 3 MILLION COUNTS PER VIEW

TOTAL DURATION OF TEST IS < 90 minTOTAL DURATION OF TEST IS < 90 min

CORRECTION OF SIMULTANEOUS DUAL-ISOTOPE IMAGES FOR SCATTER AND CROSS-TALK

Tl-201 PEAK

Tc-99m PEAK

ESTIMATED SCATTER UNDER TL-201 PEAK

ESTIMATED SCATTER UNDER TC-99m PEAK

CO

UN

TS

PE

R C

HA

NN

EL

40 80 120 160 ENERGY, keV

167.5 keV Tl-201 PEAK

SIMULTANEOUS DUAL-ISOTOPE STRESS/REST TL/TC IMAGES

REST SHORT AXIS SLICES

STRESS SHORT AXIS SLICES

REST LONG AXIS SLICES0O 22.5O 45O 67.5O 90O 112.5O 135O 157.5O

STRESS LONG AXIS SLICES

0o

22.5o

45o

67.5o90o112.5o

135o

157.5o

CONVENTION FOR ORIENTATION OF SPIN LONG-AXIS VIEWS

0o 22.5o 45o 67.5o 90o 112.5o 135o 157.5o

RESTING LONG AXIS SLICES

STRESS LONG AXIS SLICES

CENTERLINE TRACKING PERFORMED ON 8 SHORT AXIS SLICES FROM APEX TO BASE

CCP CURVES DEVELOPED AT 60 POINTS THROUGH

360o. SEARCH FOR MAXIMUM VALUE AVERAGED

WITH TWO NEAREST RADIAL NEIGHBORS

APEX

BASE

CIRCUMFERENTIAL COUNT PROFILE CURVES COMPARING STRESS/REST IMAGES

STRESS REST

STRESS-REST DIFFERENCE

CINE DISPLAY OF TWO SUCCESSIVE RESTING IMAGES ACQUIRED BACK-TO-BACK

“RESTING” DATA SET “PSEUDO STRESS” DATA SET

CINE DISPLAY OF FRAMES 31 AND 32

“RESTING” STUDY “PSEUDO STRESS” STUDY

These are the transitional frames acquired by detector #1 and detector # 2

SHORT AND LONG AXIS SPIN VIEWS RECONSTRUCTED BY AUTO SPECT FROM REST/REST BACK-TO-BACK STUDIES

REST SHORT AXIS SLICES

PSEUDO STRESS SHORT AXIS SLICES

REST LONG AXIS SLICES0O 22.5O 45O 67.5O 90O 112.5O 135O 157.5O

PSEUDO STRESS LONG AXIS SLICES

CIRCUMFERENTIAL COUNT PROFILE COMPARISON OF BACK-TO-BACK REST/REST RSPECT STUDY

OFF-LINE BAD BEAT DISCRIMINATION

MANUAL INSERTION OF PVC’s

R-TO-R INTERVAL, (MILLISECONDS)

R-TO-R INTERVAL HISTOGRAM

SELECTED RANGE OF R-TO-R VALUES

GATED MULTI-PINHOLE GATED MULTI-PINHOLE ORIGINAL IMAGESORIGINAL IMAGES

ANTERIOR DETECTOR LEFT LATERAL DETECTORANTERIOR DETECTOR LEFT LATERAL DETECTOR

GATED MULTI-PINHOLE GATED MULTI-PINHOLE ORIGINAL IMAGESORIGINAL IMAGES

ANTERIOR DETECTOR LEFT LATERAL DETECTORANTERIOR DETECTOR LEFT LATERAL DETECTOR

RECONSTRUCTED GATED MULTI-PINHOLE IMAGES

REASONS TO CONSIDER MULTI-PINHOLEMYOCARDIAL PERFUSION IMAGING

• INCREASED STATISTICS ALLOWS SIMULTANEOUS DUALISOTOPE STUDIES TO BE PERFORMED

• LESS SUSCEPTIBLE TO ARTIFACTS DUE TO VARIABILITYIN SIZE AND POSITION OF THE HEART

• LIST-MODE ACQUISITION PERMITS OFF-LINE BEATSELECTION AND BAD-BEAT REJECTION

• IMPROVED PATIENT COMFORT AND ABILITY TO IMAGEPATIENTS OF ANY SIZE, IN ANY CONDITION

• INCREASED THROUGH-PUT AND DIAGNOSTIC ACCURACY

• ABILITY TO PERFORM HIGH-RESOLUTION GATED STUDIES(CORRECTION FOR RESPIRATION AND MOTION)

Someday perhaps we’ll look back and say

“Performing gated tomographic myocardial perfusion studies using a rotational SPECT system was a lot like trying do a gated blood-pool study using a rectilinear scanner.”

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