Table Of ContentTHE CLINICAL APPLICAn ONS OF SPET
Developments in Nuclear Medicine
VOLUME 25
Series Editor: Peter H. Cox
The titles published in this series are listed at the end of this volume.
The Clinical
Applications of SPET
edited by
P.H.COX
and
M.PILLAY
Department of Nuc/ear Medicine,
Dr Daniel den Hoed Cancer Centre,
Rotterdam, The Netherlands
SPRINGER SCIENCE+BUSINESS, MEDIA, B.V.
Library of Congress Cataloging-in-Publication Data
Thl cllnical appllcallons of SPET I 'dlted by P.H. Co~ ,nd M. Pllll~.
p. CI. -- COevelop ..n l$ In nuclear nelcln, v, 251
Inc 1 uees Index.
ISBN 978-94-010-4102-7 ISBN 978-94-011-0229-2 (eBook)
DOI 10.1007/978-94-011-0229-2
1. TOlollfaphy, EII$$10n, I. Co~. Pea r H. II. Pllhy, M.
III, Serll$; Oevllopunn In nuclur uelclne : 25,
[[N.M: 1. lOlography, EIlsslon-Colputed. Slngle-PhClcn. 1<11
0E998KF v, 25 19951
FlC78 .1. T62C535 1995
616,01' 515--oc20
DN.J1/rLC
for Llbrar~ cf Conljrns 94-37462
ISBN 978-94-010-4102-7
Printed on acid-Iru paper
AII Rights Reserved
e
1995 Springer Science+Business Media Do~ht
Originally published by KluwcrAcademic Publishers in 1995
Sof1co'·er reprinl or Ihe hardco,'er 151 deilion 1995
No part of the material protected by this copyright notire may be reproduced OT
utilized in any form or by any means, electronic OT mcchanical,
including photocopying, rccording or by any information storage and
rctrieval system. without written permission rrom the copyright owner.
TABLE OF CONTENTS
Foreword vii
List of Contributors viii
1. Instrumentation, hardware and methodology
M. Pillay ................................................. .
2. Software philosophy
M. Pillay .................................................. 33
3. Radiopharmaceuticals for SPET
P.R. Cox . ................................................. 51
4. Dosimetry
M. Pillay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
5. Brain SPET with drug receptors
F. Grunwald, C. Menzel and H.I. Biersack . . . . . . . . . . . . . . . . . . . . . . . . . 121
6. Cerebral perfusion studies with Technetium-99m HMPAO
P.R. Cox . ................................................ 143
7. The use of SPET in the thorax
D.H. W. Schonfeld . .......................................... 157
8. SPET of the abdomen
A.C. Perkins .............................................. 185
9. Skeletal SPET
PJ Ryan and I. Fogelman .................................... 205
10. Renal SPET
1. Buscombe and A. Hilson . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
11. Future prospects for radiopharmaceuticals, instrumentation and dosimetry
P.H. Cox and M. Pillay ...................................... 265
Index ...................................................... 275
FOREWORD
Nuclear Medicine technology tends to follow a cyclic development whereby advances in
instrumentation create possibilities which require more specific radiopharmaceuticals for their
full exploitation and these in tum create new possibilities for the accurate measurement of
biodistribution. The development of Positron Emission Tomography has provided much
information which has been of value in stimulating the development of radiopharmaceuticals
labelled with single photon emitters. The relatively high cost of PET facilities ensures that
it will only be available on a limited scale and therefore the emphasis of Nuclear Medicine
remains focused on single photon emitters.
The availability of rotating Gamma Cameras at an economical price has made Single Photon
Emission Tomography to any Nuclear Medical Unit and whilst the detail of the scans is not
as refined as from a PET Camera the quality is more than adequate to display the relevant
biodistribution data in a form which can be correlated with morphological scans obtained
with other modalities.
In this volume we have collected contributions from an international panel of experts in the
field to provide a reference source on all aspects of SPET from instrumentation through
radionuclides and pharmaceuticals to the clinical applications. It has been our endeavour to
provide information relevant to everyday practice.
In order to get the full value of some SPET studies it is necessary to make use of colour
presentations. The production of full colour figures in the text is expensive and therefore we
would like to acknowledge financial support from Sopha Medical and Nuclear Diagnostics
to enable the reproduction of the figures in chapters 7 and 8.
Finally we would acknowledge the contributions of Mrs T Busker and Mrs T Klijn for their
Secretarial help and Mrs Nettie Dekker from Kluwer for her patience and professional
guidance.
P.H.Cox Rotterdam
M.Pillay June 1994
vii
LIST OF CONTRIBUTORS
Hans l Biersack Christian Menzel
Department of Nuclear Medicine Department of Nuclear Medicine
University of Bonn University of Bonn
Sigmund-Freud-Strasse 25 Sigmund-Freud-Strasse 25
D-53127 BONN D-53127 BONN
Germany Germany
John Buscombe Alan C. Perkins
Department of Nuclear Medicine Department of Medical Physics
Guy's Hospital University Hospital
St. Thomas Street Queen's Medical Centre
LONDON SEI 9RT NOTTINGHAM NG7 2UH
U.K. U.K.
Peter H. Cox M. Pillay
Department of Nuclear Medicine Department of Nuclear Medicine
Dr. Daniel den Hoed Cancer Center Dr. Daniel den Hoed Cancer Center
P.O. Box 5201 P.O. Box 5201
3008 AE ROTTERDAM 3008 AE ROTTERDAM
The Netherlands The Netherlands
I. Fogelman Paul l Ryan
Department of Nuclear Medicine Department of Nuclear Medicine
Guy's Hospital Medway Hospital
St. Thomas Street Windmill Road
LONDON SEI 9RT Gillingham, Kent ME7 5NY
U.K. U.K.
Frank GrUnwald D.H.W. Schonfeld
Department of Nuclear Medicine Department of Radiology
University of Bonn Dr. Daniel den Hoed Clinic
Sigmund-Freud-Strasse 25 P.O. Box 5201
'1-53127 BONN 3008 AE ROTTERDAM
Germany The Netherlands
Andrew lW. Hilson
Department of Nuclear Medicine
Royal Free Hospital
Pond Street, Hampstead
LONDON NW3 2QG
U.K.
viii
CHAPTER 1
INSTRUMENTATION, HARDWARE AND METHODOLOGY
M. Pillay
Historical Development
Having described the process of imaging the physiological distribution of radioactive Iodine
(1-131) in the thyroid gland in 1952, Mayneord [1] set in motion the idea of nuclear medicine
imaging as we know it today.
The first development of a motorised detector was devised by Cassen [2], using a single hole
collimated calcium tungstate detector with a pen chart recorder. Hofstadter improved on the
detector efficiency by activating high density sodium iodide crystals with traces of thallium.
Soon the single hole collimator was replaced by a multi-hole parallel collimator. Since the
intensity of light produced in the crystal is proportional to the interacting gamma energy, the
pen chart mapping was replaced by a pulse amplifier and cold-cathode tube to produce an
image on photographic paper [3]. Rectilinear scanners quickly passed from mere
experimental laboratory fancies to routine imaging devices.
The early 1960's saw rectilinear scanners using 5 inch Na(I) crystals with a large variety of
collimators. Larger Na(I) crystals were also used for whole body scanning.
HalO. Anger's first significant contribution to the development of gamma cameras was a 64
separate detector system (4 rows of 16) and used the transmission of 60 keY photons of Am-
241 mounted on the ceiling above the detector system.
1
P.H. Cox and M. Pillay (eds.), The Clinical Applications of SPET, 1-32.
© 1995 Kluwer Academic Publishers.
2 THE CLINICAL APPLICATIONS of SPET
In 1956 Anger built the first gamma camera and demonstrated it in 1958. Since then the
development and refinement of gamma ray imaging devices was set forth in leaps and bounds
by several manufacturers of whom Nuclear Chicago took the lead.
Over the years, a number of different types of gamma cameras were manufactured such as
the multi-crystal camera (Baird company), and cameras using wire chambers and gas
scintillation proportional chambers.
The first attempts at nuclear medicine tomography produced section rectilinear scanners with
focusing collimators and multi-pinhole collimators. The next significant point of progress wa~
limited angle tomography with the use of Fresnel zone plates and later patient rotation
tomography whereby the activity source (patient) was rotated in the field of view of the
gamma camera.
Due to the rapid technological progress, the need for multi-crystal cameras which were able
to acquire data at rapid rates for blood flow studies, became an extravagance affordable by
few. The refinement of being able to grow large NaI(TI) crystals coupled to the development
of smaller photomultiplier tubes and more stable gantries, saw the manufacture of larger
gamma cameras capable of high count rates. Table 1 summarises the physical characteristics
of some well known scintillation material.
INSTRUMENTATION, HARDWARE AND METHODOLOGY 3
scintillator NaI(Tl) CsI CsI(TI) CsF BaF2 BGO
BiGe
4 3
0
12
Density g/cm-3 3.67 4.51 4.51 4.64 4.88 7.13
absorption length (lIe in cm 2.9 1.8 1.8 2.3 2.3 1.1
for 511 keY
photon fraction (511 keV) 0.16 0.21 0.21 0.2 0.21 0.43
emission wavelength Ama. nm 410 305 565 390 310 480
(220)
photon yield (300K) 40 6-8 45 2-3 6.5 (2) 2-3
(ph/MeV) x 10J
decay time constant 230 10 1000 2-3 630 300
(nanoseconds) (0.6-
0.8)
refractive index at A max 1.85 1.80 1.80 1.48 1.56 2.15
melting point (K) 924 894 894 955 1628 1323
hygroscopic y slightly slightly very n n
~E/E (%) (662keV) 7.0 ? 10 18.5 10 15
Table 1. Physical properties of some of the commonly used scintillation material.
A typical gamma camera today consists of a NaI(TI) crystal 40x60 cm and a choice of
3.2mm to 13mm thicknesses. The thickness is dependant on the energy range required
(generally 9.5mm). The thinner crystals for energy range of 60-250 keY produce better
resolution with a trade off against photon detection efficiency.
The light yield of the NaI(TI) crystal following photon interaction is extremely small and is
enhanced by the optical coupling of photomultiplier tubes (PMT) on the opposite side of the
crystal either directly or through light guides. The light detection efficiency at the surface of
the PMT is in the region of 10% (10 photoelectrons for every 100 incident photons). The
dynode series within the PMT multiply the impinging photoelectrons manifold and thus
