PET & PET/CT Instrumentation

Performance & Quality Control

James R. Halama, PhD

Medical Physicist
Section Nuclear Medicine
Loyola University Medical Center
 Positron Decay:
p+
n0
+  + + 
Proton heavy nucleus converts a proton to a neutron and
emits a positron (+) and neutrino ()

Beta Decay:
n0 p+
+  - + 
Neutron heavy nucleus converts a neutron to a proton and
emits a negatron (-) and anti-neutrino ()
 Positron Properties
• Positively charged electron (the negatron) with the
same mass
• When emitted during positron decay, has a spectrum
of kinetic energies up to the energy of decay, max
• Anti-electron –when paired with an electron
annihilates the electron, and vice versa
• Positronium – paired electron orbits positron to form
an atom-like structure for 10-10 sec before annihilation
 Positron-Electron Annihilation
511 keV e- 511 keV
+

• Simultaneous emission of two 511 gamma rays leaving in

opposite directions.
• Distance the positron travels in tissue (average range) limits
PET resolution. Depends on emitted kinetic energy.
• 180o + 1/4o variation in angular departure of the annihilation
photons limits resolution. Depends on separation distance of
the two detectors.
 Range of Positrons in Soft Tissue
Nuclide Half-Life Max + Max + range
energy (MeV) (mm) in soft
tissue

11
C 20.3 min 0.97 4.1
13
N 9.96 min 1.19 5.1
15
O 122 sec 1.73 7.3
18
F 109.8 min 0.64 2.4
68
Ga 68.3 min 2.92 8.0
82
Rb 75 sec 3.38 10
 Count Annihilations by
Coincidence Detection
2 No Coincidence
Detection for event #2

Det. 1 1
Det. 2

Coincidence
Window ()
2 1 8 nsec 1

In 8 nsec photons
travel 8 ft Yes - Count Annihilation
 Power of Coincidence Detection

1. Sensitive to only to annihilations in the volume

between two detectors – spatial resolution

2. Electronic collimation - No Lead required

3. Higher sensitivity - more counts for the same

activity compared to the gamma camera

 Time-of-Flight
10 cm
Det. 1 Det. 2

Coincidence
Window ()
1 4 nsec 1

1. In addition to recording the PET detector crystal pair, can also

record the difference in arrival time (TOF).
2. If timing resolution is 0.3 nsec, can measure origin to within 10 cm.
3. Origin location is used in reconstruction to improve image quality
for the same counts.
 One Detector Operated in
Coincidence with Many Detectors
• Each detector is operated in
coincidence with many detectors
on the opposite side of the
patient.
• Acquisition geometry identical
to fanbeam X-ray CT.
• Lines-of-response measured
over 360 degrees gives complete
projection image set for
reconstruction.
 Sinogram
0
o Left Right 0o

LOR Profile Angle

o
90

o
o 180
45

• A sinogram is
generated - one
for each slice
 Tomographic Image
Reconstruction

• Filtered backprojection – not preferred

• Iterative reconstruction by OSEM – that

incorporates, random, scatter, and
attenuation corrections
 PET Scanner Design

• Ring of detectors surrounding the patient

• Detector material – Bismuth Germanate (BGO)
chosen for high stopping power of 511 keV ’s
 Multi-Slice Scanner with
Multiple Detector Rings

Cross-
sectional slice
planes
defined by
each ring
 2D Acquisition Method

Direct-Plane Mid-Plane
• Count annihilations from within the direct plane of each
detector ring
• AND across adjacent rings & sum to form a mid-plane slice.
3D Acquisition Method

Count annihilations across all possible

slice-ring combinations.
5 Times More Sensitivity for 3D
2D 3D

Sensitivity
Sensitivity

0.8 0.8

0.6 0.6

0.4 0.4

0.2 0.2

0.0 0.0

3D sensitivity is peaked at the center

Whole Body Multiple Scan Protocols
2D Acquisition with 10% Overlap at 5 min./stop.
30 min. acquisition for 6 stops

3D Acquisition with 50% Overlap at 2 min./stop.

18 min. acquisition for 9 stops
 2D Septal Shielding
2 D

• Lead septa inserted between each ring; allows only annihilation

events to be counted from within the direct and adjacent slice
planes.
• Septa reduces dead time losses and scatter from the patient.
 No Septal Shielding for 3D
3 D

• Lead septa are removed; permits annihilation events to be

counted across multiple slices. Lead shielding on edges to block
outside photons.
• More dead time and scatter from patient.
PET Scanner Crystal Block Design

• Detector blocks arranged to

form a circle
• 8x8 blocks in a circle form 8
rings of crystals able to
acquire 15 2D slices
 PET Detector Crystals

NaI BGO LSO GSO

Stopping
0.34/cm 0.92/cm 0.87/cm 0.67/cm
Power
Light
100% 15% 75% 35%
Output
Energy
10% 25% 15% 17%
Resolution
Decay Time 240 ns 300 ns 40 ns 55 ns
 PET/CT

• Siemens Biograph (CT 2-16 slice)

• GE ST Discovery (CT 4-16 slice)
• Philips Gemini (CT 16 slice)
Attenuation Artifacts & Correction
Hot Skin

Hot Lungs

Cold Center Attenuation

Corrected image
 Coincidence Detection Requires Both
Photons to Exit

• Combined path is total thickness of patient, leading to large artifacts.

• Can calculate attenuation correction factors based on total patient
thickness. Can use Chang method – but limited to head & brain.
 Transmission Imaging by
Coincidence Detection
• Measure transmission
of 511 kev
annihilation photons
from 68Ge/68Ga

• Requires coincidence
detection of 511 kev Rotating 68Ge/68Ga Source:
gamma rays 68Ga – Positron emitter; 1 hr. T
1/2
68Ge – Electron Capture;

271 day T1/2

 Transmission Imaging with 137Cs

• Measure transmission of
662 kev photons of 137Cs

• Requires single photon

detection

Rotating 137Cs Source:

137Cs – 30 yr. T
1/2
Transmission Imaging with Helical CT

1. Continuous rotating x-ray tube and detectors

based on slip-ring technology
2. Continuous couch motion
 Attenuation Correction Maps

• 137Cs density map of

chest (low resolution
and noisy).

• X-ray CT of Chest
 X-ray CT Attenuation Correction
<CT Contrast>

Water
Fat

Soft Tissue

Bone
Air

• Attenuation scale factors for bone

1000 (tissue – water) different than soft tissue
CT# = • Attenuation for contrast different
water than bone at same HU
PET Artifacts From CT Contrast
• Presence of CT contrast during CT scan will
cause artifacts in PET attenuation corrected
images.
• Linear attenuation coefficients at 60-70 keV
of CT do not scale accurately to 511 keV for
contrast media or other objects of high
density.
• High CT contrast creates hot spot lesions in
PET images.
PET Scanner Count Rate
Performance
 Total Coincidence Count
Total = True + Scatter + Random
• Scatter accounts for ~ 15-40% of True
counts.
• Random counts may exceed the True counts
• Scatter and Random counts add a
background to the reconstructed images
resulting in less contrast.
 Detector Count Rates

Det. 1 Det. 2

Coincidence
Window ()

• Singles Rate – Single photon count rate on detectors

• Singles/Coincidence ~ 50:1
• Random Rate = (Singles Rate)2 x (Coincidence Window)
 Distribution of Randoms & Scatter

Sinogram of line source with Sinogram of line source with

scatter. Coincidence counts scatter and randoms.
recorded along-side the Random counts uniformly
source. added over the entire imaging
volume.
 Count Rate Dependencies

• True count rate is linear with the amount of

activity in the patient.
• Scatter count rate is linear with the amount of
activity in the patient.
• Random count rate is given by the square of the
amount of activity in the patient.
 Count Rate Response
500
Trues
Randoms
400
Kcts./sec

Scatter
300
Total
200
NEC
100

0
0 0.2 0.4 0.6 0.8 1

uCi/ml in Uniform Phantom

PET is Quantitative – Only True
Counts Reconstructed

True = Total - Random

1 + SF
Truecorr = True x dt x a True LOR

SF = Scatter Fraction (Scatter/True)

dt = dead time correction factor
aLOR = attenuation correction factor
 Standardized Uptake Value

Tissue FDG Concentration (Bq/ml)

SUV =
Injected Dose (Bq)/Body Mass (g)

• A unit-less value – g/ml; there is ~ 1 cc/g or 1

ml/g
• Lean Body Mass may be used instead of Body
Mass
 ROI Extraction of Tissue FDG
Concentration

• Extract maximum counts (or Bq/ml) in ROI.

• Reduces errors in drawing of ROI.
• Subject to statistical variation within ROI.
 Accuracy of SUV
• Requires accurate
– measurement of patient weight.
– measurement of injected activity and decay corrected to within 5
minutes.
– SUV calibration of the PET scanner.

• Time dependent – SUV increases over time – must scan

patients immediately after prescribed uptake time.
• Underestimated in small lesions of diameter < 3 * system
resolution (~3 * 6 mm) due to partial volume averaging of
normal tissue with lesion.
 Partial Volume (PV) Correction
• Cylinders of equal activity
concentration of decreasing
diameter
• PV correction obtained by
dividing ROI SUV by the PV
Factor.
• Data below assumes no PV
loss for 25 mm diameter
cylinder.
Hot Cylinders: Max Cts. uCi/ml SUV SUV/Bkg PV Factor
A 25 mm: 2648 0.505 2.09 2.23 1.00
B 16 mm: 2123 0.405 1.68 1.79 0.80
C 12 mm: 1961 0.374 1.55 1.65 0.74
D 8 mm: 1599 0.305 1.26 1.35 0.60
 SUV - Other Patient Factors
• Blood glucose levels
• Patient activity
– patient remains in quiet sedentary state during uptake
period of 60 min. or longer
– Note prior muscular activity

• Voiding of bladder prior to scanning

• Radioactivity of prior NM study
• Presence of contrast media
Calibrations & Routine QC Tests

• Energy and linearity

• Normalization
• Dead time & Timing
• Sensitivity Calibration
• PET/CT Calibrations
 Anger Camera Logic Used in Multiple
Crystal Blocked Detectors

B A
Z
Z

D C
X
X
• Each crystal produces a unique
B+D combination of signals in the
X= A+B+C+D
PMTs.
C+D • Refer X and Z to preset values in a
Z= A+B+C+D 2D lookup table to map X and Z to
Brad Kemp
Mayo Clinic
a single crystal.
 PMT Gain, Energy & Linearity
Calibrations
• New calibrations
quarterly or that
recommended by
Vendor.
• PMT gain and energy
stability checked
Erroneous mapping of daily.
crystals leading to errors in
LOR mapping
Brad Kemp
Mayo Clinic
 Normalization – Uniformity
Correction
• Corrects for the variations in
Normalization Map
efficiency in LORs in the
sinogram.
• 2D - Direct measurement
using a low activity source.
Sinogram of Cylinder • 3D - Indirect measurement
using a uniform phantom
• Acquired quarterly or after
Before After system maintenance
Correction Correction
• Checked Daily Brad Kemp
Mayo Clinic
Timing & Dead Time Calibrations

• Coincidence timing for every LOR – performed by FSE

semi-annually or as specified by the Vendor.

• Deadtime Calibration – Performed by FSE by scanning

of 18F in a water filled phantom as the activity decays

(~12 hours). Acquire semi-annually or as specified by

the Vendor.
SUV Calibration
[ Truecorr / Bq/ml ]
• Fill water phantom with calibrated 18F
activity. Decay correct to the minute
to the time of image acquisition.
• Calculate activity concentration in
Bq/ml (9200 ml phantom).
• Acquire and reconstruct image slice of
phantom.
• Measure counts in image slice and
calculate sensitivity (cpm/Bq/ml).
• Perform SUV Calibration monthly, or
at least validate monthly.
 QC Tests for PET/CT
• PET and CT scanner alignments
– Image 18F point sources whose location seen on CT
scan
– Point source alignment to within 1 mm
– Perform weekly or vendor recommendation

• CT QC Tests
– CT number linearity
– Perform weekly or vendor reccomendation
 CT QC Tests

• Perform monthly CT# linearity test or that specified by

the vendor.
• Perform spatial & contrast resolution, slice thickness, &
dose measurements as prescribed by CT department
protocols.
PET and PET/CT Shielding
Requirements
 Isotope Dose Rates

Gamma Abundance / Dose Rate

Isotope
Emission Decay ( Sv m2 / MBq hr )

99mTc 140 keV 0.90 0.02

18F 511 keV 1.93 0.143

18F

99mTc
3.6 2.1 7.1
 Patient Dose Rates

Administered Syringe Dose Rate Patient Dose Rate

Isotope
Activity (Sv m2 / hr) (Sv m2 / hr)

99mTc
1110 MBq
22.2 10
(30 mCi)

18F
555 MBq
78.7 50.6
(15 mCi)

18F
0.5 3.6 5.1
99mTc
 Isotope Shielding

Gamma HVL lead HVL Tungsten

Isotope
Emission (11 g/cc) (18 g/cc)

99mTc 140 keV .27 mm ~ 0.2 mm

18F 511 keV 4.1 mm 2.9 mm

18F

99mTc
3.6 15 ~15
Radiation Dose – Areas of Concern

• Hot Lab
• Patient
• PET Scanner
 Hot Lab
Shielded Dose Calibrator and 5 cm L-Block
Handling the Isotope - Hand doses 100
times patient
Tungsten PET Vial Shield
9 mm stops 88%

Tungsten Syringe Shield

9 mm stops 88%
 Dose From 18F-FDG Patient
50 mSv/hr / 550 MBq dosage

1. Maximum dose to Tech. during injection

2. Uptake time (45-90 min.) – patient sitting in uptake
room – greatest dose to surroundings during this time
3. Patient Scan
a. Patient Voids prior to scan - clears 15% of 18F-FDG
b. Whole-body PET scan for 30-60 min. depending, on hardware
(2D, 3D, etc.). Transmission imaging time included. Lots of
self-shielding
Portable Shields for Patients

• Pb shields 2.5 and 5.0 cm

thick are available
• Dose reduction factors of 40
and 1900 respectively
• Problems
– Patient may move in relation to
gantry
– Shield can limit access to
patient
 Shielding for PET/CT
• CT portion substantially the same as for any CT
installation (~ ¼” lead)
• Techniques for CT - 140 kVp, 80 mAs and 125-150 cm
axial length (non-diagnostic scan)
• Patients/day less than CT only installation (may be
increased for off hour use)
• If shielded for PET – no additional shielding for CT

• If not shielded for PET – shielding designed for CT may

be required