SPECT - CT

Presenter : Dr. Khagesh Yadav (JR)

Moderator : Dr. Manishi L. Narayan (Professor & head,

Nuclear Medicine Department , Aiims Rishikesh)
Contents :

SPECT Image Reconstruction

Filters

Factors affecting SPECT images

CT basics

QC of CT
INTRODUCTION
Single Photon Emission Computed Tomography is a:

Nuclear Medicine imaging modality,

which involves the use of radionuclides injected intravenously into
the body,
to produce a 3D distribution of the gamma rays emitted by the
radionuclide,
giving physiological information about the organ of interest.
SPECT Image Reconstruction
Gamma camera head(s) rotates around patient taking images.
Images may be taken in 2 modes:
Continuous Acquisition: while camera heads are in motion
Step and Shoot: camera heads stop at defined angles to acquire
image.
Rotation may be full 360° around the body, or 180° with projection
algorithms used to construct for the other half.
SPECT Image Reconstruction
(contd.)
After acquiring the 2D projection images, the first step is to reformat the
data acquired in terms of axial position.
Each reformatted projection data is represented as a 3D function: p'(x',
z, θ),
where x is same as x location in raw projection image
z is the axial location
θ is the projection angle
The image p'(x', θ) is called a sinogram. It forms a sine wave.
The sinogram is useful in detecting artefacts, as there will be a
discontinuity in the curve, if for instance, there is patient movement.
SINOGRAM
Tomographic acquisition
DIAGRAM SHOWING SUMMING UP OF 2-D IMAGES
SPECT Image Reconstruction
(contd.)
Data collected in two-dimensional projections give planar images of
the object at each projection angle.
To obtain information along the depth of the object, tomographic
images are reconstructed using these projections.
Two common methods of image reconstruction using the acquired
data are
 backprojection method and
 the iterative method.
SPECT Image Reconstruction
(contd.)
Images are usually in transverse/axial plane, but pixels can be
reordered to produce coronal and sagittal images.
Fourier transform and mathematical filtering of data are done to
remove inherent noise in data.
End result: noise-free final image.
BACK PROJECTION (BP)
Back projection technique redistributes the number of counts at
each particular point back along a line from which they were
originally detected.
This process is repeated for all pixels and all angles. The limited
number of projection sets result in the creation of a star artifact and
the blurring of the image.
To eliminate this problem, the projections are filtered before being
back projected onto the image matrix.
FILTERED BACK PROJECTION (FBP)
It is the most widely used in clinical SPECT because of its simplicity,
speed, and computational efficiency.

It consists of two steps:

 filtering of data, and
 back projection of the filtered data
IMAGE SPECT FILTRATION
The filters used in FBP are simply mathematical equations that vary
with frequency.
They attempt to achieve different purposes, such as
 Star artifact reduction,
 Noise suppression,
 Signal enhancement and restoration.
FILTERS
RAMP FILTER: The ramp filter is a high pass filter that does not permit
low frequencies that cause blurring to appear in the image.
The Ramp is a compensatory filter as it eliminates the star artifact
resulting from simple backprojection.
A severe disadvantage of high pass filtering is the amplification of
statistical noise present in the measured counts.
In order to reduce this amplification, the ramp filter is usually
combined with a low-pass filter.
FILTERS (contd.)
SMOOTHING FILTERS: The common method to reduce or remove
statistical noise in a SPECT is the application of smoothing filters.
These filters are low-pass filters which allow the low frequencies to
be retained unaltered and block the high frequencies.
There are a number of low-pass filters that are available for SPECT
reconstruction. The most commonly used are Butterworth Filter,
Hanning Filter, Hamming Filter, Parzen Filter, and the Shepp-Logan
Filter (least smoothing, but highest resolution).
FILTERS (contd.)
A low-pass filter may smooth image to a high degree that does not
permit discerning small lesions, leading to contrast loss.
For this reason, a third class of filters, called enhancement or
restoration filters, is used in SPECT imaging
These filters enhance the signal with a simultaneous reduction of
noise without resolution loss.
Metz and Wiener are two types of resolution recovery filters that
have been used in nuclear medicine image processing.
ITERATIVE METHOD
Iterative reconstruction starts with an initial estimate of the image.

Then a set of projection data is estimated from the initial estimate

using a mathematical process called forward projection.

The resulting projections are compared with the recorded projections

and the differences between the two are used to update the
estimated image.
Iterative Method (contd.)
The iterative process is repeated until the differences between the
calculated and measured data are smaller than a specified
preselected value.
The iterative reconstruction methods include:
 algebraic methods like:
Algebraic Reconstruction Technique (ART), and
 statistical algorithms like:
Maximum Likelihood Expectation Maximization (MLEM), or
Ordered-Subsets Expectation Maximization (OSEM)
Iterative Method (contd.)
Iterative image reconstruction methods allow the incorporation of
more accurate imaging models rather than the Radon model assumed
in the FBP algorithm

These include scatter and attenuation corrections, as well as

collimator and distance response, and more realistic statistical noise
models.
Iterative Method (contd.)
PARAMETERS DETERMINING THE
CHOICE OF SPECT FILTER TYPE
Filter choice depends on:
The energy of the isotope, the number of counts and the activity
administered.
The statistical noise and the background noise level.
The type of the organ being imaged.
The kind of information we want to obtain from the images.
The collimator that is used.
FACTORS THAT AFFECT SPECT
IMAGES
The quality and accuracy of SPECT images are affected by two factors:

1. Physical factors - due to interaction of emitted photons with matter

inside the patient.
2. Instrumentation factors- related to the SPECT imaging system.
Physical Factors
1. Attenuation- Reduction of the number of primary photons passing
through a given thickness of material via photoelectric absorption and
Compton scatter.
Photons originating from different depths in patient - experience
different levels of attenuation.

2. Scatter -Photons that have been scattered before reaching the

detector provide misplaced spatial information about the origin of the
radioactive source.
The resulting image becomes blurred having low resolution.
Attenuation (including scatter)
results in:
High image noise
Poor resolution
Low contrast, and
Reconstruction artifacts and distortions.
Instrumentation Factors-
COLLIMATION-DETECTOR SYSTEM
 Most important component that determines both:
- Spatial Resolution (blurring) and
- Sensitivity (detection efficiency).
 Higher resolution collimator imply lower sensitivity, and vice versa.
 The main challenge in SPECT is finding a balance between resolution
and sensitivity.
Spatial Resolution
Spatial resolution is a measure of a camera's ability to accurately portray
spatial variations in activity concentration and to distinguish as separate
radioactive objects in close proximity.
Expressed in Full-Width at Half Maximum (FWHM) of a line source.
The overall System Spatial Resolution (Rs) is a function of collimator
resolution (Rc) and the intrinsic resolution (Ri), and given by:

Intrinsic measurements are those of crystal detector mainly - with the

collimator removed.
Resolution decreases with increasing distance of source from collimator .
Sensitivity
Sensitivity is the fraction of gamma rays emitted from the source that
produces count in the image.
It is defined by the detection efficiency of the SPECT system (E)
The overall System Efficiency (Es) is a function of collimator
efficiency (Ec), intrinsic resolution (Ri), and fraction (f) of photons
accepted by the energy discrimination circuit.
High sensitivity collimators are thinner, have larger and fewer holes,
and lower resolution.
FBP vs Iterative Method
FBP is faster than Iterative method.
Iterative reconstruction algorithms however produce accurate images
of radioactive distribution and seem to be more sensitive than FBP
technique.
Further development in iterative reconstruction methods will be very
promising in improving image quality.
FBP and Iterative-OSEM are generally both available on all SPECT
processing software developed by gamma camera manufacturers and
the nuclear medicine processing software companies.
CONCLUSION
SPECT has become an important diagnostic tool for showing
characteristic functional information of structures and the tissues.
One of the most important factors that greatly affect the quality of
clinical SPECT images is image filtering.
The selection of the optimal filter and the determination of filter
parameters for any individual case remains one of the main problems
of filtering in SPECT image processing.
Nowadays, FBP reconstruction is progressively replaced with the
OSEM- iterative reconstruction algorithm.
CT Basics and QC
INTRODUCTION
Computed Tomography is a well accepted imaging modality for
evaluation of the entire body.
Computed Tomography (CT) Scan Machines Uses X- rays, a powerful form
of Electromagnetic Radiation.
The images are obtained directly in the axial plane of varying tissue
thickness with the help of a computer.
Some pathology can be seen in saggital or coronal plane by
reconstruction of the images by computer.
CT has undergone several evolutions and nowadays multi- detectors CT
scanners have been evolved which have better application in clinical field.
ADVANTAGE OF COMPUTED
TOMOGRAPHY OVER
CONVIENTIONAL RADIOGRAPHY.
To overcome superimposition of structures.
To improve contrast of the image.
To measure small differences in tissue contrast.
PRINCIPLE OF COMPUTED
TOMOGRAPHY
The internal structure of the object can be reconstructed from
multiple projections of the object.
Mathematically principle of CT was first developed in 1917 by Radon.
Proved that image of unknown object could be produced if one had
several number of projections throughout the object.
VARIOUS PARAMETERS OF CT
 SLICE
 MATRIX
 PIXEL
 VOXEL
 CT NUMBER
 WINDOWING
 WINDOW WIDTH
 WINDOW LEVEL
 PITCH
SLICE/CUT
The cross section portion of body which is scanned for production of
CT image is called Slice.
The slice has width and therefore volume.
The width is determined by width of the x rays beam.
Cross Sectional Slices
Think like looking into the loaf of bread by cutting into the thin slices
and then viewing the slice individually.
MATRIX
The CT image is represented as the
Matrix of the number.
A two dimensional array of numbers
arranged in rows and columns is called
Matrix.
Each number represent the value of
the image at that location.
PIXEL
VOXEL
Each square in a Each individual element or number in
matrix is called a pixel the image matrix represents a three
dimensional volume element in object
called VOXEL.
CT NUMBER HOUNSFIELD
UNITS(HU)
The numbers in the image Related to different composition and
matrix is called CT NUMBER. nature of Tissue.
Each pixel has a number which The CT NUMBER is also known as
represents the x-ray Hounsfield units(HU).
attenuation in the
corresponding voxel of the Represent the density of tissue.
object. Different Tissue have different CT
number Range in HU.
TISSUE AND CT NUMBER
APPROXIMATE
WINDOWING is a system where the CT no. range of interest is spread
cover the full grey scale available on the display system

WINDOW WIDTH -Means total range of CT no. values selected for gray
scale interpretation.
It corresponds to contrast of the image.

WINDOW LEVEL- represents the CT no. selected for the centre of the
range of the no. displayed on the image.
It corresponds to brightness of image.
Pitch
The relationship between patient and tube motion is called Pitch.
It is defined as table movement during each revolution of x-ray tube
divided by collimation width.
For example: For a 5mm section, if patient moves 10mm during the
time it takes for the x-ray tube to rotate through 360°, the pitch is 2.
Increasing pitch reduces the scan time and patient dose.
Phase of CT scanning
1. Scanning the patient or data Acquisition
a) X-ray Generator
b) X-ray Tube
c) X-ray Filtration System
d) Detector System

2. Reconstruction
a) Simple back projection
b)Iterative method
c)Analytical method

3. Display
DATA ACQUISTION
The scanning process begins with data acquisition
Data Acquisition refers to a method by which the patient is
systematically scanned by the X ray tube and detectors to collect
enough information for image reconstruction.
Major components of Data Acquisition System(DAS)
a) X-ray Generators
Generators are located on rotating scan frames within the CT gantry to
accommodate slip Ring.
b) X-ray Tube
Rotating anode x-ray tube with unique cooling.
Small focal spot size (0.6mm) to improve spatial resolution.
Anode heating capacity:1MHU to 7MHU
Cooling rate:1MHU per minute.

c) X-ray Beam Filtration System

CT employs monochromatic beam but radiation from CT X-ray tube is polychromatic.
so, X-ray beam is shaped by compensation filter.
a) Pre patient Collimators: Reduces the patient dose.
b) Post patient Collimators: Reduces the scattered radiation detectors.
Overall Functions of Collimators.
To decrease scatter radiation
To reduce patient dose
To improve image quality
Collimator width determines
the slice thickness
d) Detectors
The detectors gather information by measuring the x-ray transmission
through the patient.
Two types:
• Scintillation crystal detector
(Cadmium tungstate+ Si Photodiode)
Can be used in third and fourth generation scanners

• Xenon gas ionisation chamber

Can be used in third generation scanners only
Generations of CT scan
First Generation
Narrow pencil beam
Single detector
Detector used is made up of Nal.
Translate -Rotate movements of
Tube- detector combination
Scan time-5mins.
Designed only for evaluation of
brain.
 Second Generation
Narrow fan beam
Linear detector array(5 to30)
Translate-Rotate movements of
Tube-Detector combination
Fewer linear movements are
needed as there are more
detectors to gather the data.
Between linear movements, the
gantry rotated 30°
Scan time~30secs(advantage over
first generation)
Third Generation
Rotate(tube) Rotate(detectors) Motion.
Pulsed wide fan beam.
Arc of detectors(600-900)
Detectors are perfectly aligned with the
X-Ray tube
Both Xenon and scintillation crystal
detectors can be used
Scan time< 5secs
Disadvantage: Ring Artifacts due to
electronic drift between many
detectors.
Fourth Generation
Complete circular array of about
1200 to 4800 stationary detectors
Single x-ray tube rotates with in the
circular array of detectors
Wide fan beam to cover the entire
patient
Scan time of newer scanners is about
1½ s or, <2s.
Designed to address ring artifacts by
keeping detector assembly stationary.
Disadvantage: High cost.
Fifth Generation
stationary/stationary
Developed specifically for cardiac
tomographic imaging
No conventional x-ray tube; large
arc of tungsten encircles patient
and lies directly opposite to the
detector ring
Electron beam steered around
the patient to strike the annular
tungsten target
Capable of 50-msec scan times;
can produce fast-frame- rate CT
movies of the beating heart
Quality control of CT
QC tests for CT are mainly intended to verify the operational stability
of the equipment, after acceptance and commissioning tests have
been performed.

DAILY TEST
MONTHLY TEST
ANNUAL TEST are done as follow:
Quality control of CT
Software
Spatial/geometry accuracy tests
Correct data transfer
Image Registration
Image reconstruction
Tests should verify that the software accurately reconstructs known
phantoms
QC CT test phanton
References :
• Bailey, D.L., Humm, J.L., & Todd-Pokropek, A. Aswegen, A. van (Ed.).
(2014). Nuclear Medicine Physics: A Handbook for Teachers and Students
Endorsed by: American Association of Physicists in Medicine (AAPM),
Asia–Oceania Federation of Organizations for Medical Physics (AFOMP),
Australasian College of Physical Scientists and Engineers in Medicine
(ACPSEM), European Federation of Organisations for Medical Physics
(EFOMP), Federation of African Medical Physics Organisations (FAMPO),
World Federation of Nuclear Medicine and Biology (WFNMB).
International Atomic Energy Agency (IAEA): IAEA.
• Physics and radiobiology of Nuclear Medicine – G.B. Saha
• Handbook of Basic Quality Control Tests for Diagnostic Radiology - IAEA