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      The effect of modern PET technology and techniques on the EANM paediatric dosage card

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          Abstract

          Aim

          Recent advancements in PET technology have brought with it significant improvements in PET performance and image quality. In particular, the extension of the axial field of view of PET systems, and the introduction of semiconductor technology into the PET detector, initially for PET/MR, and more recently available long-field-of-view PET/CT systems (≥ 25 cm) have brought a step change improvement in the sensitivity of PET scanners. Given the requirement to limit paediatric doses, this increase in sensitivity is extremely welcome for the imaging of children and young people. This is even more relevant with PET/MR, where the lack of CT exposures brings further dose reduction benefits to this population. In this short article, we give some details around the benefits around new PET technology including PET/MR and its implications on the EANM paediatric dosage card.

          Material and methods 

          Reflecting on EANM adult guidance on injected activities, and making reference to bed overlap and the concept of MBq.min bed −1 kg −1, we use published data on image quality from PET/MR systems to update the paediatric dosage card for PET/MR and extended axial field of view (≥ 25 cm) PET/CT systems. However, this communication does not cover the expansion of paediatric dosing for the half-body and total-body scanners that have recently come to market.

          Results

          In analogy to the existing EANM dosage card, new parameters for the EANM paediatric dosage card were developed (class B, baseline value: 10.7 MBq, minimum recommended activity 10 MBq). The recommended administered activities for the systems considered in this communication range from 11 MBq [ 18F]FDG for a child with a weight of 3 kg to 149 MBq [ 18F]FDG for a paediatric patient weight of 68 kg, assuming a scan of 3 min per bed position. The mean effective dose over all ages (1 year and older) is 2.85 mSv.

          Conclusion

          With this, recommendations for paediatric dosing are given for systems that have not been considered previously.

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          FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0

          Ronald Boellaard, Roberto Delgado-Bolton, Wim Oyen … (2014)
          The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.
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            Performance Characteristics of the Digital Biograph Vision PET/CT System

            Joyce van Sluis, Johan de Jong, Jenny Schaar … (2019)
            Article 0 comments Cited 116 times – based on 0 reviews     Review now
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              Performance of Philips Gemini TF PET/CT scanner with special consideration for its time-of-flight imaging capabilities.

              E Perkins, Suleman Surti, Daniel S Karp … (2007)
              Results from a new PET/CT scanner using lutetium-yttrium oxyorthosilicate (LYSO) crystals for the PET component are presented. This scanner, which operates in a fully 3-dimensional mode, has a diameter of 90 cm and an axial field of view of 18 cm. It uses 4 x 4 x 22 mm(3) LYSO crystals arranged in a pixelated Anger-logic detector design. This scanner was designed to perform as a high-performance conventional PET scanner as well as provide good timing resolution to operate as a time-of-flight (TOF) PET scanner. Performance measurements on the scanner were made using the National Electrical Manufacturers Association (NEMA) NU2-2001 procedures to benchmark its conventional imaging capabilities. The scatter fraction and noise equivalent count (NEC) measurements with the NEMA cylinder (20-cm diameter) were repeated for 2 larger cylinders (27-cm and 35-cm diameter), which better represent average and heavy patients. New measurements were designed to characterize its intrinsic timing resolution capability, which defines its TOF performance. Additional measurements to study the impact of pulse pileup at high counting rates on timing, as well as energy and spatial, resolution were also performed. Finally, to characterize the effect of TOF reconstruction on lesion contrast and noise, the standard NEMA/International Electrotechnical Commission torso phantom as well as a large 35-cm-diameter phantom with both hot and cold spheres were imaged for varying scan times. The transverse and axial resolution near the center is 4.8 mm. The absolute sensitivity of this scanner measured with a 70-cm-long line source is 6.6 cps/kBq, whereas scatter fraction is 27% measured with a 70-cm-long line source in a 20-cm-diameter cylinder. For the same line source cylinder, the peak NEC rate is measured to be 125 kcps at an activity concentration of 17.4 kBq/mL (0.47 microCi/mL). The 2 larger cylinders showed a decrease in the peak NEC due to increased attenuation, scatter, and random coincidences, and the peak occurs at lower activity concentrations. The system coincidence timing resolution was measured to be 585 ps. The timing resolution changes as a function of the singles rate due to pulse pileup and could impact TOF image reconstruction. Image-quality measurements with the torso phantom show that very high quality images can be obtained with short scan times (1-2 min per bed position). However, the benefit of TOF is more apparent with the large 35-cm-diameter phantom, where small spheres are detectable only with TOF information for short scan times. The Gemini TF whole-body scanner represents the first commercially available fully 3-dimensional PET scanner that achieves TOF capability as well as conventional imaging capabilities. The timing resolution is also stable over a long duration, indicating the practicality of this device. Excellent image quality is achieved for whole-body studies in 10-30 min, depending on patient size. The most significant improvement with TOF is seen for the heaviest patients.
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                Author and article information

                Contributors
                Uta Eberlein:
                ORCID: http://orcid.org/0000-0002-2577-3195
                eberlein_u@ukw.de
                Journal
                Journal ID (nlm-ta): Eur J Nucl Med Mol Imaging
                Journal ID (iso-abbrev): Eur J Nucl Med Mol Imaging
                Title: European Journal of Nuclear Medicine and Molecular Imaging
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 1619-7070
                ISSN (Electronic): 1619-7089
                Publication date (Electronic): 15 December 2021
                Publication date PMC-release: 15 December 2021
                Publication date (Print): 2022
                Volume: 49
                Issue: 6
                Pages: 1964-1969
                Affiliations
                [1 ]GRID grid.439749.4, ISNI 0000 0004 0612 2754, Institute of Nuclear Medicine, , University College London Hospitals, ; London, UK
                [2 ]GRID grid.411760.5, ISNI 0000 0001 1378 7891, Department of Nuclear Medicine, , University Hospital Würzburg, ; Würzburg, Germany
                Author information
                http://orcid.org/0000-0002-2577-3195
                Article
                Publisher ID: 5635
                DOI: 10.1007/s00259-021-05635-2
                PMC ID: 9016049
                PubMed ID: 34910233
                SO-VID: 2f178255-a922-4dca-b273-2bbd69694c10
                Copyright © © The Author(s) 2021
                License:

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 22 September 2021
                Date accepted : 24 November 2021
                Funding
                Funded by: Julius-Maximilians-Universität Würzburg (3088)
                Open Access :

                Open Access funding enabled and organized by Projekt DEAL.

                Categories
                Subject: Original Article
                Custom metadata
                issue-copyright-statement © Springer-Verlag GmbH Germany, part of Springer Nature 2022

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: pet,eanm dosage card,pet/mr systems
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: pet, eanm dosage card, pet/mr systems

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