Such tests of multimodality image registration should be performed at least monthly. We do not capture any email address. It should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. Nuclear medicine is a type of molecular imaging where radioactive pharmaceuticals (often called "radiopharmaceuticals") are used to evaluate the body's functions and processes. Since Nuclear Medicine diagnostic applications are growing fast, room temperature semiconductor detectors such CdTe and CdZnTe either in the form of single detectors or as segmented monolithic detectors have been investigated aiming to replace the NaI scintillator. Nuclear medicine now provides diagnostic, prognostic, predictive, and intermediate endpoint biomarkers in oncology, cardiology, neurology, and infectious and inflammatory disorders. Assuming the operator has received the appropriate system-ready message, the daily QC procedures are then performed (12). Despite obvious defect in sinogram C, reconstructed images B and D are virtually indistinguishable. 12B). Chapter 08. For such cylinder phantom studies, a 99mTc activity of about 10 mCi and at least 64 projections at 40 s per projection or longer are recommended. (D) Corrupted, deleted, or switched-off software correction tables. Level II Minimum of two years' experience as a Nuclear Medicine technologist. Note that linearity correction table has biggest effect on uniformity: if corrupted, deleted, or switched off, PMT pattern becomes grossly apparent, and IU approaches 20%. Overall, this text is a great compilation of information on nuclear instrumentation and a fantastic basic guide to how radiation detectors and imaging techniques work. Modern scintillation well counters are often equipped with a multichannel analyzer (MCA) for energy (i.e., isotope)-selective counting and an automatic sample changer for unattended counting of multiple samples. In addition to the pronounced differences in sensitivities between direct and cross planes and artifacts between adjoining detector rings (Fig. The accuracy of the CT number of water and image noise can also be evaluated using the same ROIs. For Geiger counters, the amplitude of the signal pulses is independent of the energy of the incoming radiation. In principle, differences between the geometries of the calibrated source and a patient may introduce some inaccuracy in the determination of activity concentration in situ (Eq. Measurements of the CTDI100 (p) and CTDI100 (c) are typically performed using ionization chambers or thermoluminescent dosimeters positioned in a commercially available soft-tissueequivalent acrylic phantom, cylindric in shape and either 16 or 32 cm in diameter, approximating an adult head or torso (body), respectively (Fig. The technical editors and authors, selected for their experience and in recognition of their contributions to the field, were drawn from around the world and, thus, this book represents a truly international collaboration. Ionization chambers actually measure exposure, which is then converted to absorbed dose using the f factor discussed earlier. -Camera uniformity may be evaluated either intrinsically (i.e., without collimation) or extrinsically (i.e., with collimation) (Fig. 11where Patient and Standard are the branching ratios of the positron-emitting isotope administered to a patient and added to the source, respectively. To check constancy, at least 1 NIST-traceable reference source (Table 1) should likewise be counted each day; day-to-day net (i.e., gross minus background) counting rates should agree within 10%. Quantitative Nuclear Medicine, Chapter 20. Journal of Nuclear Medicine Technology September 2010, 38 (3) . In addition to a calibration report (typically a 1-page document) specifying the reference sources used, the measurement procedure, and the measured and expected exposure rates, a dated sticker summarizing the calibration results should be affixed to the meter itself. The dose calibrator is a pressurized gas-filled ionization chamber for assaying activities in radiopharmaceutical vials and syringes and in other small sources. Low-contrast contrast resolution is evaluated using the insert and the ROIs (boxes, Fig. Each chapter concludes with a small number of references and suggested additional readings. Nuclear medicine studies are clinically used to assess most organ systems with . For each data point, the difference between the measured activity and the activity on the best-fit straight line at that point should be less than 10%. In addition, survey meters should be checked daily for constancy of response by measuring the exposure or counting rate of a long-lived reference source in a reproducible measurement geometry. Low-contrast contrast resolution. The minimum detectable activity (MDA) of each radionuclide for which a particular well counter is used is the activity that increases the gross counts over a counting time t by a value that is significantly greater than that due to random variations in the background counts over t. In this context, the conventionally applied criterion for statistical significance is a gross counting rate that exceeds the background counting rate by at least 3 SDs (11):Eq. Blank scans are performed daily by uniformly irradiating the detector elements using either the 68Ge or 137Cs transmission source (if applicable) of the scanner without any source or other attenuating object in the field of view (FOV) or with a uniform source of 511-keV annihilation photons (most commonly a 20-cm-diameter 68Ge cylinder) centered in the FOV. Among the components of a routine SPECT QC program are periodic assessment of center-of-rotation (COR) alignment, tomographic uniformity, and, for lack of a better term, overall system performance (15). Nuclear medicine is described by three elements - clinical problem, the radiopharmaceutical and the instrumentation. 13). Non-Imaging Detectors and Counters, Chapter 11. They are staggered (offset) 1 mm apart in longitudinal direction. Periodic evaluation and, if necessary, updating of certain calibrations, most notably the normalization and the well-counter calibration, are additional components of routine PET QC. Compendia of critical values of the 2 statistic, as a function of the number of measurements (n), are widely available in both graphical and tabular forms (11). For each QC test performed, the following data, as well as the initials or signature of the individual performing the test, should be recorded on a structured and suitably annotated form: the test performed; the date and time of the test; the make, model, and serial number of the device tested; the make, model, and serial number of any reference sources used; the results of the test; and a notation indicating if the test result was or was not acceptable (i.e., was or was not within the specified tolerance range). Quality control (QC), which may be defined as an established set of ongoing measurements and analyses designed to ensure that the performance of a procedure or instrument is within a predefined acceptable range, is thus a critical component of routine nuclear medicine practice. Basic Radiation Detectors Documenting of QC procedures and organized recording of the results of such procedures are requirements of a sound, compliant QC program. Summary of Recommendations for Routine QC of Clinical Nuclear Medicine Instrumentation. View Full Size | | Download Slide (.ppt) + + Nuclear medicine uses radioactive compounds called radiopharmaceuticals or radiotracers that interrogate physiologic or pathologic processes at a molecular level and provide targeted therapy for a variety of diseases. Level III A minimum of four years' experience within specialty modality in which they are seeking promotion. Accordingly, a blank (i.e., an empty counting tube or vial) should always be included to determine the current background count. At the same time, image uniformity and noise, as discussed earlier, should also be evaluated for different tube voltages (i.e., kVp) that bracket the range of values used clinically. According to information published by GE Healthcare (24), the acceptable value of the SD of the CT number in this ROI is 37 4 HU (i.e., 3341 HU). PPT - Nuclear Medicine Instrumentation PowerPoint Presentation, free download - ID:756098 Create Presentation Download Presentation Download 1 / 38 Nuclear Medicine Instrumentation 1009 Views Download Presentation Radionuclides. It is generally helpful to track the results of QC tests longitudinally (e.g., in the form of a graph of the numeric result vs. date of the test). Alternatively, sealed reusable markers composed of long-lived 57Co (for SPECT) or 68Ge (for PET) uniformly dispersed in a radioopaque resin or plastic may be used. Nuclear Medicine - PET/CT 1. Quantitative Nuclear Medicine For each source, the measured activity on each scale and its current actual activity should agree within 10%. This article should be particularly useful for residents, fellows, and other trainees in nuclear medicine, nuclear cardiology, and radiology. (Courtesy of Dr. Barbara Binkert, New York Presbyterian Hospital, New York, NY.) Intrinsically, point source is placed at least 3, and preferably 5, crystal dimensions from and centered over uncollimated detector to provide uniform photon flux (left). The energy resolution (expressed as the percentage full width at half maximum [FWHM] of the photopeak) should be checked at least quarterly using a reference-source radionuclide such as 57Co. The technologist may prepare and administer radiopharmaceuticals, perform imaging procedures, enhance images utilizing a computer and analyze biologic specimens. If the source is small (compared with the mean free path of its emitted x- and -rays within the material comprising the source) and the distance between the source and meter large (compared with the dimensions of the source), then a point-source geometry is approximated and the expected exposure rate (in mR/h), , in air is given by the inverse-square law:Eq. 3where is the gross (i.e., total) counting rate of the radionuclide source, is the background counting rate, Ao is the activity (in Bq) of the radionuclide source at calibration, is the physical decay constant of the radionuclide comprising the reference source, and t is the time interval between the calibration of the radionuclide source and the current measurement. Latest information on COVID-19. The CTDI is the basic radiation dose parameter in CT and is defined as the integral under the exposure or absorbed dose profile along the patient's longitudinal axis for a single tomographic image (2527). High-contrast contrast resolution is expressed as the SD of the CT number (in HU) in a 10 10 mm ROI centered over the coarsest set of line cavities (i.e., the set in which the lines are 1.6 mm in width) (Fig. Implicit in Equation 10 is the assumption that the branching ratios, , of the positron emitter administered to the patient and added to the standard are identical. Level I must obtain ARRT or NMCTB certification within 12 months of employment. 8C vs. 8B) or band (Fig. Non-Imaging Detectors and Counters As with SPECT and PET scanners, however, less rigorous and less extensive procedures are generally performed for routine CT QC. The procedures described and their respective frequencies are presented only as general guidelines. A 4-quadrant bar phantom consists of 4 sectors of radioopaque lead bars and intervening radiolucent plastic strips 2, 2.5, 3, and 4 mm in width. One approach to evaluating the daily blank scan is simple visual inspection of its (2-dimensional) sinograms (Fig. A long-lived radionuclide comprising a reference source must match, in the frequency and energy of its x- and -ray emissions, the clinical radionuclide for which it acts as a surrogate to ensure that instrument responses to the clinical radionuclide and to its surrogate are comparable. (Adapted from reference (15) with permission.). Computers in Nuclear Medicine Diagonally arranged sets of line cavities ranges are 1.6 (lower left), 1.3, 1.0, 0.8, 0.6, and 0.5 (upper right) mm in line width and are used to evaluate spatial resolution. Computers in Nuclear Medicine, Chapter 14. The current article is a brief overview of such routine QC procedures for current nuclear medicine instrumentation, including the survey meter, dose calibrator, well counter, intraoperative probe, organ ("thyroid") uptake probe, -camera, SPECT and SPECT/CT scanner, and PET and PET/CT scanner. As illustrated in Figure 9, sinograms are more visually discriminating than are the reconstructed images for detecting faulty detectors. The advantage of phantoms having point or line markers (Fig. (B) Appearance of such artifact (arrow) in clinical SPECT image, transverse image from 99mTc-sulfur colloid liverspleen study. Such very small or very large P values are problematic, therefore, because they indicate a variation in counting-rate measurements inconsistent with a Poisson distribution and are suggestive of a counter malfunction. Associated nonuniformities are measured and used to create energy, linearity, and uniformity (or sensitivity) correction tables. For each radionuclide for which a particular well counter is used, the counter should be calibratedthat is, its efficiency (sensitivity) (in cpm/Bq), , should be determinedat installation, annually, and after any repair:Eq. The performance parameters most commonly evaluated as part of a routine -camera QC program include uniformity, spatial resolution, spatial linearity, and energy resolution and peaking. The far more rigorous and more extensive acceptance-testing procedures performed for -cameras, SPECT and SPECT/CT scanners, and PET and PET/CT scanners are beyond the scope of this article, which is not intended to supersede or replace manufacturer-recommended acceptance-testing, QC, and preventive-maintenance procedures. Chapter 14. Section shown in B includes polystyrene membrane with series of holes (10, 7.5, 5, 3, and 1 mm in diameter) that also fill with water when phantom is filled, providing low contrast between holes and polystyrene. These detectors have inherently better energy resolution that scintillators . Chapter 11. According to information published by GE Healthcare (24), this difference should agree within 0.1% (1 HU) with the benchmark, or reference, low-contrast contrast resolution of the scanner, established at the time of its installation. Internal Number: PETCT006441. Therefore, if calibrated for exposure rates (mR/h), Geiger-counter calibration results apply only to the particular radionuclides comprising the reference source used in the calibration procedure. Alternatively, a uniform cylinder of a positron-emitting radionuclide can be scanned and the data thus acquired analytically corrected for attenuation; for a well-defined geometry such as a uniform cylindric source, this correction is straightforward. Duties and Responsibilities of this Level. A written description of all QC procedures, including the acceptable (or tolerance) range of the results of each such procedure and the corrective action for an out-of-tolerance result, should be included in the procedure manual of the facility; for each procedure, the written description should be signed and dated by the facility director, physicist, or other responsible individual. 2 values yielding a P value in the range of 0.050.95 are generally considered acceptable. Additional protocols for acceptance testing of PET and PET/CT scanners are currently being developed by Task Group 126 of the AAPM and by the International Atomic Energy Agency, respectively. Linearity. If necessary, the activity should be adjusted to yield a measured counting rate of no greater than 25,000 cycles per second (cps), to avoid dead-time counting losses and counting-raterelated image degradation. (Adapted from reference (29) with permission.) (Courtesy of Dr. Osama Mawlawi, M.D. The handbook provides a comprehensive overview of the knowledge required in physics, instrumentation and data processing for the practice of medical physics in modern nuclear medicine. However, if 1 of the lines appears as gray rather than black, the slice thickness in millimeters equals the number of black lines plus one half, with 0.5 mm of slice thickness contributed by the cavity appearing as the gray line. The MLEM algorithm suppresses statistical noise, but large numbers of iterations typically are required for convergence and, therefore, processing times are long. Surrogate radionuclides commonly used in nuclear medicine and their physical properties and applications are summarized in Table 1. Gamma Camera. (9) have provided recommendations on acceptable values of this parameter, ranging from 0.11 to 0.27 for the smallest (i.e., the 15.4-mm-diameter) to 0.53 to 0.73 for the largest (i.e., the 31.8-mm-diameter) sphere. This also includes creating a tranquil environment, so patients will be able to adhere to examination instructions. 7C). Nuclear medicinea vital component of the rapidly emerging field of molecular imagingis a medical specialty that uses small amounts of radioactive materials bound to special compounds (radiopharmaceuticals) in combination with imaging instrumentation that examine molecular processes in the body to detect and evaluate disease, such as brain For the accuracy test (also sometimes known as the energy linearity test), NIST-traceable reference sources of at least 2 of the radioisotopes listed in Table 1 are separately placed in the dose calibrator and the activity reading on each scale recorded. The more familiar Geiger counters (or Geiger-Mueller counters) are operated at a high potential difference, providing a high electron amplification factor and thus high sensitivity. In addition to the these daily checks of CT performance, monthly or at least quarterly evaluations of laser alignment, image slice thickness, spatial resolution, linearity (i.e., CT number accuracy), and high- and low-contrast contrast resolution are needed. In this way, annual and other checks of efficiency can be performed using only the surrogate reference sources, without the need to dispense, assay, dilute, and aliquot each radionuclide in clinical use. Anderson Cancer Center for their contributions. 7D and 7C, respectively (9)):Eq. Conversely, a P value of less than 0.01 or greater than 0.99, respectively, indicates that there is only a 1% chance that a Poisson distribution would yield an 2 value as large as or as small as that actually calculated. why do my ribs hurt after covid vaccine, Activity should agree within 10 % September 2010, 38 ( 3 ) Appearance of such artifact arrow. 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