T/CT Physical Principles and Attenuation Correction Prepared By: Hala Rabee/ID: s1811023 Supervisor: Dr-Mohammed Al-Hjouj

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SPECT/CT Physical Principles and Attenuation Correction

Prepared by : Hala Rabee/ID: s1811023
Supervisor : Dr-Mohammed Al-Hjouj 11/11/2020

OUTLINE
Spect principles
Ct principles
Spect/ct hybrid system
Attenuation correction
Quality control
Clinical applications
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SPECT PRINCIPLES
 Spect :
 Single photon radionuclides emits single gamma ray photon
 Emission radiation emitted from patient
 Computed tomography computers used to reconstruct tomographic cross sections
through the patient
 Nuclear medicine imaging technique gives physiologic information about the region of
interest due to the distribution of the radiopharmaceutical in the form of cold or hot spots.
 Radiopharmaceutical : radioactive compounds administered to the patient , they are able to

bind to certain types of tissues and emits gamma rays.
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SPECT PRINCIPLES
 Basic instrument to acquire an image:
 Gamma camera(anger camera) to detect gamma rays emerging from
the patient which reflects the distribution of the radioactivity in the patient ,
gamma camera doesn’t record any depth informations so it produces only
2D images,(single,dual, triple)
 computer builds up an image by storing events in an image matrix
which may be 64×64 , 128×128 or 256×256 pixels in size , and reconstruct
2D projections to produce full 3D images.
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SPECT PRINCIPLES
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SPECT PRINCEPLES
Spect imaging used in oncologic applications for diagnosis
Limitations:
Poor spatial resolution( ~ 1 cm ) lack of anatomical details difficulties in anatomical
localization of radiopharmaceuticals distribution
Attenuationeffect(loss of gamma rays) which distorts the acquired data Compton interaction is the
primary mechanism for attenuation.
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SPECT PRINCIPLES
 Radionuclide approach and mathematical modeling are the two methods used for attenuation correction
in spect.
1- radionuclide approach e.g. : the use of Gd-153 (half-life of 8 months) as an external beam for
deriving a bespoke attenuation map for spect data.
limitations of this approach:

 Low radiation output when the Gd-153 go through physical decay
 The coast of replacing the Gd-153 sources
2-Mathematical modeling: make assumptions about body composition

When assumptions were not met with attenuation correction data could be highly inaccurate
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CT PRINCIPLES
CT (computed tomography) uses X-rays to obtain images.
A heated cathode releases high-energy electrons, which flow to the
metal target in the anode, release their energy as X-ray radiation, X-
rays pass through tissues and hit a detector on the other side.
Transmission scans produces a 3D anatomical images with high

spatial resolution (~1 mm ).
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SPECT PRINCIPLES
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CT PRINCIPLES
 Ct basic instruments:
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CT PRINCIPLES
 Measures the average linear attenuation coefficient between tube and detectors
, CT provides information regarding changes in organ size and tissue density,
as well as their precise spatial localization and topographic landmarks
 the reconstructed images is a map of linear attenuation coefficients expressed

in ct numbers (Hounsfield units)( -1000 to +1000)
 E.g : HU of air = -1000

water = 0
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SPECT/CT HYBRID SYSTEM
 SPECT/CT (1999) is one of several hybrid systems currently on the market, comprises of two
separate technologies combined into one physical unit sharing a common imaging table in
order to:
1- Produce CT and nuclear medicine data in the same session to get precise localization of the
abnormal distribution of the radiopharmaceuticals.
2- The use of ct data in spect attenuation correction.
Acquisition of SPECT and CT data sequentially in a single patient study with the patient in a
fixed position.
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ATTENUATION CORRECTION
IN SPECT/CT
 Because the attenuation varied with energy, the attenuation data
obtained with ct need to be converted into attenuation coefficients
to match the radionuclide energy,e.g. (70 kev to 140 kev in 99mTc).
 Ct Hounsfield units cannot be directly used to correct for

attenuation in emission scans.
 This is usually done using a bilinear scaling
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IN SPECT/CT
 Bilinear (scaling) transformation is applied, the image values produced by CT
are approximately linearly related to the physical attenuation coefficient of the
corresponding tissue type, so it is possible to estimate the attenuation map of
the patient at a given radionuclide energy.
 By multiplying the entire CT image by the ratio of attenuation coefficients of
water, bone, air as a scaling factors.
 The resulting attenuation map at a given radionuclide energy used in the image
reconstruction algorithms used in spect.
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IN SPECT/CT
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IN SPECT/CT
 The benefits of using CT for attenuation correction as opposed to a radionuclide transmission
source:
 less noise/high resolution anatomical images
 faster acquisition
 no influence on CT data by the SPECT radionuclide photons
 no need to replace decayed transmission sources
 Functional-anatomical overlay(image fusion)
Normalization of the matrix size ( decrease the resolution of the ct image to match the spect
image)
Spect image = 64×64
Ct image = 512×512
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SPECT/CT REGISTRATION
 Proper spatial registration between transmission and emission scans is an
important part of quality in hybrid SPECT/CT systems.
 Patient movement between acquisition of the SPECT and CT images will lead
to misregistration produces an incorrect attenuation map.
 Movement can result from respiratory and cardiac motion, sagging of the
emission table, and patient motion between SPECT and CT acquisitions.
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QUALITY ASSURANCE
 Verify the accuracy of registration techniques used in SPECT/CT
before the final attenuation-corrected SPECT image reconstruction
and display.
 Manually by using a phantoms filled with radioisotopes
 Quality control programme( adjustment of the misregistration)
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SPECT/CT HYBRID SYSTEM
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CT DOSE REQUIREMENT
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CLINICAL SPECT/CT SYSTEM
 The typical clinical spect/ct system available have a dual head-head scintillation cameras
positioned in front of the CT scanner and sharing a common imaging table.
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 There are 2 approaches to clinical SPECT/CT applications:
1- The CT scanner consists of a low-output x-ray tube (2.5 mA) with 4 linear arrays of
detectors 4 slices of (5-mm) in (13.6 s) a moderate contrast spatial resolution of more than
3 lp/cm/radiation dose > 5 mGy
Not for diagnostic procedures but for attenuation correction and
anatomic correlation with emission scans
The slow scan speed is actually an advantage in regions where there is physiologic motion
because the CT image blurring from the motion is comparable to that of the emission scans,
resulting in a good match in fused images.
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 2- the use of a high-output x-ray tube with variable tube currents (20–345
mA), slice thicknesses of 0.6–10 mm.
 high contrast spatial resolutions of 13–15 lp/cm
 4–5 times the radiation dose of the first one(20 mGy)

 used for diagnostic procedures, these systems can also be operated in a lower-
radiation-dose mode by reducing the x-ray tube current( for attenuation
correction scans)
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SPECT/CT CLINICAL
APPLICATIONS
 SPECT/CT in Oncology, Endocrine Imaging, and Infection
 E.g. In prostate cancer the use of 111indium-labeled capromab pendetide has been reported
to be signiﬁcantly more sensitive than CT or MR in detection of lymph node metastasis and a
further improvement in false-positive rates by 46 % .
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Finally it’s the end
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T/CT Physical Principles and Attenuation Correction Prepared By: Hala Rabee/ID: s1811023 Supervisor: Dr-Mohammed Al-Hjouj

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1

SPECT/CT Physical Principles and Attenuation Correction

Supervisor : Dr-Mohammed Al-Hjouj 11/11/2020

 Radiopharmaceutical : radioactive compounds administered to the patient , they are able to

limitations of this approach:

2-Mathematical modeling: make assumptions about body composition

Transmission scans produces a 3D anatomical images with high

 the reconstructed images is a map of linear attenuation coefficients expressed

 E.g : HU of air = -1000

2- The use of ct data in spect attenuation correction.

 Ct Hounsfield units cannot be directly used to correct for

 This is usually done using a bilinear scaling

 Manually by using a phantoms filled with radioisotopes

 Quality control programme( adjustment of the misregistration)

 4–5 times the radiation dose of the first one(20 mGy)

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