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1999 by CRC Press LLC
odIcuI ImugIng
79.1 Introouction
79.2 Imagc Inlormation Contcnt
Mcasurcmcnt ol Imaging Pcrlormancc
79.3 XPay Imaging
XPay Imaging Dctcctors
79.1 Computco Tomography
Pcconstruction ol an Objcct lrom Projcctions Clinical
Mcasurcmcnts
79.5 Nuclcar Mcoicinc
Mcasurcmcnt ol Physiological Iunction Mcasurcmcnt ol
Tcchnical Pcrlormancc
79.o Positron Fmission Tomography
Principlc ol Coinciocncc Dctcction Dctcctor Compostion
PFT Scanncrs
79.7 Ultrasouno Imaging
Characcristics ol Souno Wavcs in Tissuc Mooc Imagcrs
Dopplcr Tcchniqucs Color Dopplcr Imaging Mcasurcmcnt
ol Ultrasouno Instrumcnt Pcrlormancc
79.8 Magnctic Pcsonancc Imaging
MP Imaging Tcchniqucs MP Imagc Contrast MP
Instrumcntation
79.1 IntroductIon
Mcoical imaging has aovancco consiocrably sincc thc oiscovcry ol Xrays by Wilhclm Conrao Pontgcn
in 1895. Tooay, in aooition to thc continuco usc ol Xrays lor mcoical oiagnosis, thcrc arc imaging
mcthoos that usc souno (ultrasouno), magnctic lclos ano raoio wavcs (magnctic rcsonancc imaging),
ano raoionucliocs (nuclcar mcoicinc). oth projcction imaging ano crossscctional imaging arc routincly
usco clinically. This chaptcr will ocscribc thc principlcs bchino thc various imaging mooalitics currcntly
in usc, ano thc various mcasurcmcnts routincly maoc with thcm.
79.2 Imagc InformatIon Contcnt
Thc vast majority ol imaging proccourcs arc qualitativc in naturc, whcrc it is thc visual prcscntation ol
anatomy that is thc mcasurcmcnt outcomc. Thcrc arc also somc quantitativc mcasurcmcnts, which will
bc oiscussco in thc scction on nuclcar mcoicinc. Howcvcr, sincc most imaging is conccrnco only with
thc qualitativc naturc ol thc imagc, a ocscription ol thc salicnt lcaturcs ol imagc contcnt lollows.
Thcrc arc thrcc primary physical paramctcrs ol intcrcst in imagc contcnt. contrast, noisc, ano rcsolu
tion. Il thcsc thrcc lcaturcs arc known lor a givcn imagc (or imaging systcm), thcn thc cntirc physical
naturc ol thc imagc has bccn charactcrizco. Thcrc arc also psychovisual cllccts, such as conspicuity {1],
]umos J. LohhIns III
IuIc !n!\crs!y Acd!ca! Ccncr
Soun . Humos
IuIc !n!\crs!y Acd!ca! Ccncr
ruco H. Husoguvu
!n!\crs!y oI Ca!!Iorn!a, 5an
Iranc!sco
JImoIhy R. LoCrudo
IuIc !n!\crs!y Acd!ca! Ccncr
]umos . ZugzohskI
!n!\crs!y oI V!scons!n, Aad!son
RIchurd Iruyno
!n!\crs!y oI V!scons!n, Aad!son
1999 by CRC Press LLC
which allcct thc ability ol thc obscrvcr to octcct a particular lcaturc, but thcsc issucs arc oillcult to
quantitatc ano arc outsioc thc scopc ol this hanobook.
Thc lrst ol thc physical imagc lcaturcs, contrast, is oclnco as thc lraction ol thc total imagc signal
occupico by a particular objcct.
(79.1)
whcrc S is thc signal in thc arca ol intcrcst ano is thc backgrouno signal. Contrast is octcrminco by
thc propcrtics ol thc objcct bcing imagco, thc imaging mooality, thc propcrtics ol thc imagc octcctor,
postproccssing ol thc imagc (such as by oigital proccssing), ano thc contrast ol thc oisplay ocvicc.
Imagc noisc is a mcasurc ol thc stochastic naturc ol thc imagc. All physical mcasurcmcnts, incluoing
mcoical imagcs, contain a ccrtain ocgrcc ol unccrtainty. In Xray imaging, lor cxamplc, thc physics ol
Xray proouction oictatcs that thc numbcr ol Xrays inciocnt on a unit arca pcr unit timc arc ranoom,
ano givcn by a statistical oistribution known as thc Poisson oistribution. Thc grcatcr thc imagc noisc,
thc lcss likcly it is that onc will obscrvc a givcn objcct. Thcrc is a rclationship bctwccn thc imagc noisc,
thc contrast ano arca ol an objcct, ano its likclihooo ol bcing obscrvco. This is summarizco in thc Posc
moocl.
(79.2)
whcrc N is thc numbcr ol quanta (such as Xrays) pcr unit arca nccoco to oisccrn an objcct ol contrast
C ano arca A, assuming a signaltonoisc ol |. Posc louno that a signaltonoisc ratio ol 5 is typically
rcquirco to octcct a visual objcct rcliably {2].
Pcsolution is thc ability ol an imaging systcm to rccoro laithlully thc rangc ol spatial octail in an
objcct. Pccoroing objccts with lncr spatial octail rcquircs "sharpcr` imaging octcctors. Thc rcsolving
ability ol a octcctor is largcly octcrminco by its pointsprcao lunction. Thc pointsprcao lunction
ocscribcs how wcll thc imaging apparatus can rccoro an inlnitcsimal point objcct. No octcctor is pcrlcctly
sharp, ano somc sprcao ol thc inlnitcsimal oot occurs thc worsc thc sprcao, thc lcss rcsolving thc
systcm.
Mcasurcmcnt of ImagIng Pcrformancc
A lincarsystcms approach is typically usco to quantily thc pcrlormancc ol an imaging systcm. Thc
rclations among contrast, noisc, ano rcsolution ol an imaging systcm arc customarily ocscribco by two
lunctions. thc mooulation translcr lunction (MTI) ano thc noisc powcr spcctrum (NPS), both ol which
arc lunctions ol spatial lrcqucncy. Thc MTI is thc Iouricr translorm ol thc pointsprcao lunction, ano
ocscribcs thc inhcrcnt octcrministic lrcqucncy rcsponsc ol thc systcm. Thc NPS (also rclcrrco to as thc
Wicncr spcctrum) is proportional to thc squarc ol thc Iouricr translorm amplituoc at cach lrcqucncy,
ano rcprcscnts thc variancc associatco with noisc in thc systcm at cach particular spatial lrcqucncy. Thc
ratio ol MTI ano NPS, propcrly normalizco, is thc noisc cquivalcnt quanta (NFQ), which is thc squarc
ol thc maximum availablc signaltonoisc at cach spatial lrcqucncy u.
(79.3)
Il thc NFQ is oivioco by thc numbcr ol inciocnt quanta pcr arca (c.g., thc numbcr ol Xray photons
inciocnt on thc octcctor in Xray imaging), thc rcsult is thc octcctivc quantum cllcicncy (DQF). Thc
C
S
N
|
C A
2
2
NI u
u
u
,
,
,
,
largc arca signal MTI
NPS
2
2
1999 by CRC Press LLC
zcrolrcqucncy DQF is a mcasurc ol thc lraction ol inciocnt quanta cllcctivcly usco by thc systcm.
Altcrnativcly, thc DQF may bc vicwco as thc cllcicncy with which thc systcm utilizcs thc availablc signal
tonoisc at cach spatial lrcqucncy.
Thc actual mcasurcmcnt ol MTI, NPS, ano DQF is quitc tcoious, ano will bc only bricly summarizco
hcrc. Thc intcrcstco rcaocr is cncouragco to consult thc suggcstco rclcrcnccs lor thc appropriatc octail
on thcsc mcasurcmcnts. Fxamplcs ol thcsc mcasurcmcnts will bc givcn lor Xray imaging.
Thc MTI is typically mcasurco by imaging cithcr a vcry lnc slit (typically 10 to 20 m) {3o] or an
cogc {7]. Thc prollc across thc slit imagc is callco thc lincsprcao lunction (ISI). Thc Iouricr translorm
ol thc ISI givcs thc MTI in thc oircction pcrpcnoicular to thc slit. Thc ocrivativc ol valucs along thc
cogcrcsponsc lunction also givcs thc lincsprcao lunction. Dctcctor rcsponsc typically varics with cncrgy
so it is important to spccily thc conoitions unocr which MTI is mcasurco. With Xray imaging it is
typical to usc a tubc voltagc ol 70 kV with 0.5 mm Cu lltration placco in thc bcam to simulatc thc
lltcring ol thc Xray spcctrum cxpcctco lrom a paticnt, although othcr mcasurcmcnt tcchniqucs arc also
louno in thc litcraturc.
Thc NPS is mcasurco by taking an imagc ol a lat lclo, whcrc thcrc is no structurc in thc imagc othcr
than noisc. Contcmporary mcthoos ol NPS mcasurcmcnt on oigital systcms pcrlorm a twooimcnsional
Iouricr translorm on thc latlclo imagc {o], although whcn mcasuring thc NPS ol llm a scanning slit
is usco to gcncratc a oncoimcnsional NPS parallcl to thc oircction ol slit movcmcnt {810]. Altcr
appropriatc scaling, thc squarc ol thc amplituoc ol thc twooimcnsional Iouricr translorm is thc NPS.
Thcrc arc many octails rclatco to mcasuring thc NPS propcrly, incluoing climinating backgrouno trcnos,
ano thc sizc ol thc rcgion ovcr which thc Iouricr translorm is takcn. Thcsc arc all covcrco in octail in
thc rclcrcnccs {o,818].
Mcasurcmcnt ol imaging propcrtics is casicr on oigital imaging systcms than on llm, sincc llm must
lrst bc oigitizco at appropriatcly lnc sampling intcrvals or clsc corrcctco lor thc usc ol oncoimcnsional
slits {19]. Howcvcr, thc cllccts ol aliasing (lctitious lrcqucncy rcsponsc in a oigital systcm ouc to limitco
sampling) makcs thc intcrprctation ol MTI ano NPS in oigital systcms morc oillcult than with llm
{11,12,20].
79.3 X-Ray ImagIng
Xray imaging rcquircs an Xraygcncrating apparatus (tubc, high voltagc supply, ano controls) ano an
appropriatc Xray octcctor. Typical Xray octcctors incluoc photographic llm (almost always usco in
conccrt with a luorcsccnt scrccn), imagc intcnsilcrs, computco raoiography phosphor platcs, ano ncwcr
ocoicatco oigital octcctors.
Thc Xray gcncrator is basically a highvoltagc stcpup translormcr with appropriatc rcctilcation ano
control circuitry. Most contcmporary gcncrators arc thrccphasc 12pulsc, lullwavc rcctilco to givc a
vcry low voltagc ripplc (3 to 10%) {21]. Ior proccourcs rcquiring vcry last pulscs ol scvcral milliscconos
or lcss (such as coronary angiography), a tctroocbasco constantpotcntial gcncrator is usco. Thc opcrator
sclccts thc tubc kilovoltagc, tubc currcnt, ano cxposurc timc appropriatc lor thc cxamination ol intcrcst.
Xray tubcs contain a hcatco llamcnt (which scrvcs as thc cathooc) ano an anooc maoc ol a tung
stcn/rhcnium combination lor convcntional usc or molybocnum lor mammography. With thc cxccption
ol ocntal tubcs, moocrn clinical Xray tubcs almost always contain a rotating anooc to sprcao thc hcat
out ovcr a largcr arca, allowing lor a grcatcr tubc output without oamaging thc anooc. Many tubcs
contain two llamcnts, a largc onc ano a small onc, ocpcnoing on tubc output ano rcsolution rcquircmcnts
ol a particular cxam. Mcasurcmcnts on Xray tubcs ano gcncrators involvc calibrations to assurc that
kilovoltagc, tubc output, ano cxposurc timc arc in gooo agrccmcnt with thc control consolc scttings {21].
Calibration ol thc high voltagc is oonc by commcrcially availablc voltagc oiviocrs, or by spccially ocsignco
Xray llm casscttcs with calibrating lltcrs insioc. Tubc output is mcasurco by ion chambcrs, ano cxposurc
timc is mcasurco cithcr by a rotatingarm timcr tcst tool placco ovcr a llm casscttc ouring an Xray
cxposurc or by oircct plotting ol thc cxposurc vs. timc output ol an ion chambcr.
1999 by CRC Press LLC
X-Ray ImagIng Dctcctors
Thc most common octcctor lor Xray imaging is llm. Xray llm is typically placco in a sanowich bctwccn
two luorcsccnt scrccns (or onc scrccn in mammography lor improvco visibility ol small octail). Con
tcmporary scrccns arc maoc ol rarc carth compounos such as Co
2
O
2
S, ano scrvc to convcrt thc Xrays
to visiblc light which cxposcs thc llm morc cllcicntly than Xrays alonc, thus rcoucing paticnt raoiation
oosc. Thc rcsponsc ol thcsc scrccnllm combinations has gooo contrast at intcrmcoiatc cxposurc rangcs
(as givcn by thc llm y, or contrast ratio), but poor contrast at low or high cxposurcs. Thc contrast ano
latituoc ol llms arc ocscribco by thc charactcristic curvc (oltcn rclcrrco to as thc HurtcrDrillclo, or
HD curvc). Appropriatc scrccnllm combinations arc choscn basco on thc anatomy to bc imagco, sincc
scrccnllm combinations arc ocsignco with oillcrcnt contrast, latituoc, ano cxposurc scnsitivity charac
tcristics {22].
A sccono typc ol Xray octcctor is thc imagc intcnsilcr, which is usco with luoroscopy. Iluoroscopy
uscs a lowcxposurcratc Xray output to imagc a paticnt continuously, typically to propcrly position thc
paticnt lor a subscqucnt highcxposurc llm imagc. Thc imagc intcnsilcr (Iigurc 79.1) compriscs a
cylinorical glass cnclosurc, insioc ol which is an input scrccn, photocathooc, locusing clcctroocs, acccl
crating anooc, ano output scrccn {21]. Thc Xrays arc absorbco in thc input scrccn (typically CsI), giving
oll light which libcratcs clcctrons lrom thc photocathooc. Thc photoclcctrons arc thcn accclcratco to thc
output scrccn whcrc thcy strikc thc output phosphor scrccn with high cncrgy (~30 kcV), giving oll a
bright light, which is vicwco by cithcr a vioco camcra or motionpicturc (cincraoiographic) camcra.
A rcccntly ocvclopco oigital Xray octcctor is thc photostimulablc phosphor, which is rclcrrco to
commonly as computco raoiography {2325]. This octcctor uscs a spccial typc ol phosphor which storcs
about hall ol thc absorbco Xray cncrgy in mctastablc statcs, which arc rcao out latcr by lascr scanning.
Thc lascr light stimulatcs thc phosphor to cmit ultraviolct light in proportion to thc original Xray
cxposurc. Thc photostimulatco light is thcn octcctco with a photomultiplicr tubc (PMT) or soliostatc
photooctcctor ano oigitizco. Thc clinical apparatus (Iigurc 79.2) lrst oocs a prcscan ol thc imaging platc
to aojust thc input rangc ol thc analogtooigital convcrtcr basco on thc imagc histogram, thc oigitizco
signal is thcn logarithmically translormco ano storco, oisplayco on a vioco monitor, or printco on llm
lollowing optional spatial lltcring ano contrast aojustmcnt.
Thcrc arc also currcntly availablc or in ocvclopmcnt a varicty ol othcr oigital Xray octcctors, incluoing
sclcnium platc octcctors {2o], CCDcamcra octcctors with luorcsccnt scrccns {27], ano latpancl arrays
with amorphous silicon {28] or amorphous sclcnium {29] octcctor clcmcnts.
79.4 Computcd Tomography
A oiagnostic computco tomography (CT) scanncr compriscs an Xray tubc with collimation to provioc
thc slicc thickncss, a lincar array ol octcctor clcmcnts, ano a rcconstruction computcr. Thc Xray tubc
ano thc octcctors typically rotatc in a gantry. Thc numbcr ol octcctors usco ocpcnos on thc gcncration
ol thc scanncr. Iirstgcncration scanncrs hao only onc octcctor which was translatco across thc paticnt
with thc tubc lor cach projcction, ano thcn thc cntirc asscmbly was rotatco to acquirc thc ncxt projcction
vicw. To incrcasc acquisition spcco, scconogcncration scanncrs usco scvcral octcctors in a limitco lan
bcam gcomctry. Thirogcncration CT scanncrs, which arc thc most common in usc tooay, utilizc a largc
lan array ol octcctors (852 clcmcnts in a currcnt scanncr), which complctcly cncompasscs thc paticnt
ano allows slicc acquisition timcs ol about 1 s {21]. Thc Xray tubc ano thc octcctor lan array arc
mcchanically couplco ano rotatc togcthcr at high spcco (Iigurc 79.3).
Thc implcmcntation ol clcctronic slip rings, which allow continuous clcctric contact, has rcmovco thc
physical rcstriction imposco by thc highvoltagc cablcs ol carlicr scanncrs. Iourth ano llthgcncration
scanncrs havc a stationary, complctc ring ol octcctors (typically 1200 to 1800 octcctors). In lourth
gcncration scanncrs thc Xray tubc is rotatco alonc, whilc thc llthgcncration scanncr ocsign has a
locusco clcctron bcam which travcrscs multiplc targct rings. Iilthgcncration scanncrs can acquirc a slicc
1999 by CRC Press LLC
last cnough (50 ms pcr slicc ano 17 sliccs pcr sccono) to stop caroiac motion {30,31]. Thcsc last two
gcncrations arc not in common usc, primarily ouc to high cost. In rcccnt ycars, a hclicalscan aoaptation
ol thirogcncration scanncrs, allowing continuous acquisition ol oata ovcr a largc paticnt volumc, has
bccomc clinically popular {32,33].
Whilc thc Xray tubcs usco lor CT (tubc potcntial rangc 80 to 110 kV) arc vcry similar to gcncral
raoiographic tubcs, thc octcctors arc quitc oillcrcnt lrom convcntional raoiographic octcctors. Dctcctors
usco in CT arc oncoimcnsional photon countcrs which must bc cllcicnt ano last. Farly CT ocviccs usco
scintillation octcctors, which convcrtco thc Xray cncrgy into light photons that wcrc countco by PMTs.
Originally, singlccrystal NaI was usco, but it provco to bc insullcicnt in oynamic rangc ano hao too
much altcrglow ol scintillation light. Highprcssurc (25 atm) xcnon gas latcr rcplacco NaI as thc octcctor.
Currcntly, many CT scanncrs usc scintillating ccramics (c.g., CoWO
1
, (Y,Co)
2
O
3
.Fu ano Co
2
O
2
S.Pr,Cc)
couplco to photooioocs, ouc to thc high bulk ocnsity ol thc ccramics.
I!CURE 79.1 Schcmatic oiagram ol thc major componcnts ol an imagc intcnsilcr. Thc anooc is typically at about
30 kV, ano thc thrcc annular clcctroocs locus thc bcam ano octcrminc thc usablc arca ol thc input surlacc lor
intcnsilcrs having multiplc lormats.
1999 by CRC Press LLC
RcconstructIon of an Objcct from ProjcctIons
CT is basco on thc imagc rcconstruction thcorcm, which statcs that il onc mcasurcs cnough projcctions
ol an objcct, thc twooimcnsional oistribution ol that objcct may bc rcconstructco lrom thc projcction
oata. In CT thc quantity ol intcrcst is thc lincar attcnuation cocllcicnt, , at cach point in thc objcct.
Thc transmission ol Xrays through an objcct ol thickncss x can bc statco as
(79.1)
whcrc I(0) is thc inciocnt intcnsity. Fach ray lrom thc local spot ol thc tubc to a oiscrctc octcctor clcmcnt
is a mcasurc ol thc linc intcgral ol thc attcnuation cocllcicnt through thc paticnt.
(79.5)
whcrc r rcprcscnts thc rclcrcncc lramc ol onc ol thc many projcctions through thc paticnt.
Imagc rcconstruction rcquircs a mcthoo to invcrt Fquation 79.5, in orocr to cxtract (x,y) ol thc objcct
lrom thc mcasurco projcction vicws, i. Thc mathcmatical principlcs ol imagc rcconstruction lrom an
I!CURE 79.2 Schcmatic oiagram ol a typical photostimulablc phosphor computco raoiography systcm.
I x I e
x
,
,
0
i x
I x
I
x y Jy
r
r
r r r ,
,
,
,
[
ln ,
0
1999 by CRC Press LLC
inlnitc numbcr ol projcctions through an objcct wcrc ocvclopco by Paoon in 1917 {31]. An approximatc
solution to thc Paoon invcrsion, known as backprojcction, was latcr ocvclopco bccausc ol thc ncco lor
rapio computation ol imagcs in clinical CT. ackprojcction involvcs smcaring thc oata lrom cach pro
jcction through thc twooimcnsional spacc ol thc paticnt, ano summing ovcr all projcctions. Simplc
backprojcction yiclos an cstimatc ol thc paticnt structurcs, but is plaguco by artilacts ouc to thc approx
imatc naturc ol thc rcconstruction proccourc. Thcsc artilacts arc succcsslully rcmovco, howcvcr, by
prclltcring thc projcction oata bclorc backprojccting. Thc oncoimcnsional prclltcring is typically pcr
lormco in lrcqucncy spacc by multiplying by a ramp lunction. This tcchniquc is known as lltcrco
backprojcction, ano rcsults in morc accuratc rcconstructions ol paticnt anatomy {35].
Thcrc arc scvcral conoitions that can rcoucc thc quality ol imagc rcconstruction. Iirst, an insullcicnt
numbcr ol angular projcctions or incomplctc sampling ol thc objcct can lcao to aliasing in thc rccon
structco vicw. Sccono, partial volumc cllccts occur whcn thc objcct is not ol homogcncous composition
in a particular voxcl, causing thc rcconstructco pixcl valuc (CT numbcr) to bc not rcprcscntativc ol thc
tissuc. Thiro, il thc acquisition is not last cnough, paticnt motion lcaos to a ghosting artilact in thc
rcconstructco imagc. Iast, bcam harocning occurs whcn a highocnsity structurc, such as thc skull,
signilcantly changcs thc bcam cncrgy spcctrum. Thc rcsult is rcoucco intcnsity ol aojaccnt structurcs.
cam harocning can bc rcoucco by slightly altcring thc shapc ol thc rcconstruction lltcr to improvc thc
rcconstruction lor a particular tissuc typc.
To prcscnt thc rcconstructco oata in oigital lormat, thc CT numbcr (also known as thc Hounslclo
unit, HU) was ocvclopco.
(79.o)
I!CURE 79.3 Oricntation ol componcnts in a typical thirogcncration CT scanncr.
CT numbcr
pixcl watcr
watcr
1000
1999 by CRC Press LLC
Using this normalization, pixcl valucs in a CT imagc arc storco as 12bit intcgcrs bctwccn 1000 ano
3095. A pixcl containing only watcr woulo havc a CT numbcr cqual to 0, whilc onc containing bonc or
musclc woulo havc a positivc valuc ano onc with only lat or air woulo havc a ncgativc valuc.
ClInIcal Mcasurcmcnts
Thc rcconstructco imagcs arc only as accuratc as thc oata input to thc algorithm, thcrclorc, a rigorous
calibration ano quality assurancc program is vital to thc pcrlormancc ol a oiagnostic CT scanncr.
Calibration gcncratcs a basclinc rclcrcncc in air lor thc scanncr ano calibration valucs lor cvcry possiblc
scan paramctcr. Dctcctor channcl variation ano intcraction, along with Xray tubc local spot sizc ano
position arc quantilco. A phantom is usco to mcasurc octcctor rcsponsc lor typical bcam wioths (1, 3,
5, 7, ano 10 mm) ano tubc potcntials (80, 100, 120, ano 110 kV). Thc positioning accuracy ol thc scanncr
is also chcckco.
Quality assurancc sccks to cstablish ano maintain consistcnt imagc quality {3o,37]. A spccializco
Plcxiglas phantom is usco to monitor thc lowcontrast octcctability ano highcontrast rcsolution ano
noisc charactcristics ol thc systcm. Thc lowcontrast portion ol thc phantom consists ol a sct ol holcs ol
oillcrcnt oiamctcr in a thin polystyrcnc slab. Thc 0.75mmthick polystyrcnc, whcn submcrgco in watcr
ano scannco with a 10 mm slicc thickncss, yiclos low contrast in thc holcs ol about 1% (10 HU). Thc
minimum octcctablc oiamctcr is thcn louno. Thc highcontrast rcsolution part ol thc phantom contains
scvcral rcpcating, cqually sizco bar/spacc pattcrns (spaccs lllco with watcr, contrast ~12% or 120 HU)
with bar wioths lrom 0.5 to 1.o mm. Thc MTI is computco as a plot ol thc highcontrast lrcqucncy
rcsponsc {38]. Thc noisc ano unilormity ol thc scan arc asscssco with a homogcncous scction ol thc
phantom. An POI is placco in thc homogcncous arca ano thc stanoaro ocviation is calculatco, which
shoulo bc approximatcly 3 HU.
79.5 Muclcar McdIcInc
Nuclcar mcoicinc tcchniqucs {39,10] usc raoiopharmaccuticals which arc injcctco into thc booy to
monitor or mcasurc physiological lunction. Ccntral to nuclcar mcoicinc is thc rolc ol thc raoiopharma
ccutical as a traccr, that is, an agcnt with a prcoictablc physiological action that is introoucco without
pcrturbing thc lunction ol thc systcm. An cxtcrnal octcctor is usco to rccoro raoioactivity cmanating
lrom thc paticnt to octcrminc thc spatial oistribution (ano oltcn tcmporal changcs in conccntration) ol
thc raoiopharmaccuticals in spccilc organs or tissucs. Fach raoiopharmaccutical has an cxpcctco bio
oistribution which a raoiologist cvaluatcs to oiagnosc thc mcoical status ol a paticnt. Thc raoiopharma
ccutical can bc labclco cithcr with positroncmitting raoionucliocs, which prooucc annihilation photons,
or can bc labclco with "singlcphoton` raoionucliocs which cmit yrays (or somctimcs Xrays). This
scction consiocrs only singlcphotoncmitting raoionucliocs, cxamplcs ol which arc givcn in Tablc 79.1.
Thc scintillation camcra {11,12] is thc most common ocvicc lor imaging thc oistribution ol singlc
photon cmitting raoionucliocs In \I\o (Iigurc 79.1). Thc scintillation camcra incorporatcs a largclclo
(c.g., 10 by 50 cm) positionscnsitivc photon octcctor with a collimator having a largc numbcr ol small
parallcl holcs (1 to 2 mm oiamctcr, 1 cm lcngth) so that only photons travcling pcrpcnoicular to thc
octcctor surlacc arc rccoroco. Photons cmittco by thc paticnt ano passing through thc collimator arc
absorbco by a 1cmthick sooium iooioc scintillator couplco to an array ol PMTs. Thc PMT signals arc
proccssco to gcncratc signals proportional to thc (x,y)cooroinatcs ol thc intcraction sitc ol thc photon
in thc crystal. In aooition, thc photomultiplicr tubc signals arc intcgratco to calculatc thc photon cncrgy.
Fvcnts lalling within a spccilco rangc (typically 7.5%) arouno thc cxpcctco raoionuclioc photon cncrgy
arc rccoroco, whcrcas thosc outsioc ol this rangc arc rcjcctco as unwantco scattcr or backgrouno cvcnts.
An imagc is intcgratco lrom inoivioual cvcnts at thc calculatco position ano spccilco cncrgy, rcprcscnting
octcctco photons cmittco by thc raoiopharmaccutical. Thc camcra acquircs a planar projcction imagc ol
thc raoiopharmaccutical oistribution in thc paticnt with a spatial rcsolution ol about 1 cm. Thc imagc
also can bc acquirco tomographically by rotating thc scintillation camcra arouno thc axis ol thc paticnt.
1999 by CRC Press LLC
This tcchniquc is callco singlcphoton cmission computco tomography (SPFCT) ano proouccs cross
scctional imagcs rcprcscnting thc raoiopharmaccutical conccntration within thc paticnt.
Mcasurcmcnt of PhysIologIcal FunctIon
Paoionuclioc imagcs can bc intcrprctco visually or quantitativcly. Ior cxamplc, thc raoiopharmaccutical
{
99m
Tc]mcthylcnc oiphosphonatc (MDP) is incorporatco into thc bonc matrix by ostcoblastic activity
{13]. A raoiologist will inspcct a nuclcar mcoicinc imagc lor sitcs ocmonstrating local uptakc ol
99m
Tc
MDP to octcrminc thc cxtcnt ano ocgrcc ol trauma, inlammation, ocgcncration, mctastatic oiscasc, or
othcr skclctal oiscasc proccsscs. Typically,
99m
TcMDP imagcs arc intcrprctco visually but arc not analyzco
to octcrminc thc quantity ol raoiotraccr incorporatco into thc skclcton.
Othcr nuclcar mcoicinc stuoics arc asscssco quantitativcly in thc scnsc that valucs cxtractco lrom thc
imagc rcprcscnt thc raoioactivity conccntration (ano physiological lunction) in a spccilc organ or tissuc
rcgion. Myocaroial pcrlusion imaging with {
99m
Tc]hcxatris2mcthoxyisobutylisonitrilc (MII) is an
cxamplc ol onc such "quantitativc` nuclcar mcoicinc stuoy lor asscssing a paticnt suspcctco ol having
coronary artcry oiscasc {111o]. {
99m
Tc]MII is a lipophilic cation which accumulatcs in myocaroial
tissuc roughly in proportion to blooo low {17]. Imagc oata arc acquirco using SPFCT to rcconstruct
tomograms ol thc myocaroial conccntration ol {
99m
Tc]MII which arc analyzco to asscss rcgional
myocaroial blooo low. Although absolutc mcasurcmcnts (Ci/g) ol tissuc activity arc oillcult (il not
impossiblc) to obtain with SPFCT, thc imagcs arc intcrprctco "quantitativcly` by cxtracting pixcl valucs
lrom thc imagc to ocrivc oiagnostic inlormation {18], rathcr than rclying on "qualitativc` visual intcr
prctation ol thc imagcs. Typically,
99m
TcMII is imagco in thc "shortaxis` vicw which prcscnts thc lclt
vcntricular myocaroium in a scrics ol annuli (or "ooughnuts`). Thc imagc is analyzco using a "circum
lcrcntial prollc` rcprcscnting thc raoionuclioc conccntration at o angular incrcmcnts arouno cach
annular slicc ol thc myocaroium {19]. Thc cxtractco valucs arc comparco with stanoaro valucs obtainco
lrom paticnts in whom athcrosclcrotic oiscasc has bccn cxcluoco by coronary angiography, thcrcby
TABIE 79.1 Fxamplcs ol Traccrs Usco in Nuclcar Mcoicinc
Proccss Traccr Pcl.
looo Ilow
Dillusiblc
133
Xc 57
{
99m
Tc]HMPAO 58
Dillusiblc (trappco) {
123
I]IMP (brain) 58
201
Tl (hcart), 11,59
{
99m
Tc]MII 17
Nonoillusiblc (trappco) {
99m
Tc]macroaggrcgatco albumin,
labclco microsphcrcs