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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
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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.”
www.nuclear-cardiology.com