Advances in Nuclear Cardiac Instrumentation with a View Towards Reduced Radiation Exposure

Recent advances in nuclear cardiology instrumentation have enabled myocardial perfusion imaging (MPI) with improved image quality and faster scan times. These developments also can be exploited to reduce the effective radiation dose to the patient. In this review, we discuss these technologies including new single photon emission computed tomography (SPECT) and positron emission tomography (PET) scanners, as well as novel reconstruction software with regard to their potential for the reduction of the patient radiation dose. New advances in nuclear cardiology instrumentation will allow routine rest/stress MPI imaging with low radiation doses (<5 mSv) and fast imaging times, even by the software-only solutions. It is possible to further reduce the MPI radiation dose to less than 2 to 3 mSv range with standard acquisition times. PET perfusion imaging also can be performed with very low doses especially by the three-dimensional scanners allowing hybrid PET/computed tomographic angiography (CTA) imaging with low overall dose. In addition, stress-only protocols can be utilized to further reduce the radiation dose and the overall test time.

[1]  Piotr J. Slomka,et al.  Attenuation correction in cardiac spect: the boy who cried wolf? , 2007, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[2]  Vladimir Y. Panin,et al.  Fully 3-D PET reconstruction with system matrix derived from point source measurements , 2006, IEEE Transactions on Medical Imaging.

[3]  Luke K. Hermann,et al.  Stress-only Tc-99m myocardial perfusion imaging in an emergency department chest pain unit. , 2012, The Journal of emergency medicine.

[4]  M. Henzlova,et al.  Reduced isotope dose with rapid SPECT MPI imaging: Initial experience with a CZT SPECT camera , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[5]  Guido Germano,et al.  Advances in technical aspects of myocardial perfusion SPECT imaging , 2009, Journal of Nuclear Cardiology.

[6]  C. Bai,et al.  Prospective multicenter evaluation of rapid, gated SPECT myocardial perfusion upright imaging , 2008, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[7]  D. Townsend,et al.  Physical and clinical performance of the mCT time-of-flight PET/CT scanner , 2011, Physics in medicine and biology.

[8]  Ran Klein,et al.  Quantification of myocardial blood flow and flow reserve: Technical aspects , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[9]  M. Henzlova,et al.  The prognosis of a normal stress-only Tc-99m myocardial perfusion imaging study , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[10]  D. Berman,et al.  High-speed myocardial perfusion imaging initial clinical comparison with conventional dual detector anger camera imaging. , 2008, JACC. Cardiovascular imaging.

[11]  Piotr J. Slomka,et al.  Enhanced definition PET for cardiac imaging , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[12]  L. Volokh,et al.  Effect of detector energy response on image quality of myocardial perfusion SPECT , 2008, 2008 IEEE Nuclear Science Symposium Conference Record.

[13]  Brian F. Hutton,et al.  Choice of collimator for cardiac SPET when resolution compensation is included in iterative reconstruction , 2001, European Journal of Nuclear Medicine.

[14]  L. Feinendegen,et al.  The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. , 2009, Radiology.

[15]  M. Bottai,et al.  Comparison Between Ultrafast and Standard Single-Photon Emission CT in Patients With Coronary Artery Disease: A Pilot Study , 2011, Circulation. Cardiovascular imaging.

[16]  J. Machac,et al.  Comparison of 2-dimensional and 3-dimensional 82Rb myocardial perfusion PET imaging. , 2003, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[17]  D. Berman,et al.  Quantitative Upright–Supine High-Speed SPECT Myocardial Perfusion Imaging for Detection of Coronary Artery Disease: Correlation with Invasive Coronary Angiography , 2010, The Journal of Nuclear Medicine.

[18]  L. Feinendegen,et al.  Low-level ionizing radiation from noninvasive cardiac imaging: can we extrapolate estimated risks from epidemiologic data to the clinical setting? , 2010, JACC. Cardiovascular imaging.

[19]  V. Treyer,et al.  Validation of CT Attenuation Correction for High-Speed Myocardial Perfusion Imaging Using a Novel Cadmium-Zinc-Telluride Detector Technique , 2010, The Journal of Nuclear Medicine.

[20]  M. Mascalchi,et al.  Cardiovascular Imaging , 2012, International Journal of Computer Assisted Radiology and Surgery.

[21]  Guido Germano,et al.  "Motion-frozen" display and quantification of myocardial perfusion. , 2004, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[22]  V. Treyer,et al.  Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: first clinical validation , 2010, European Journal of Nuclear Medicine and Molecular Imaging.

[23]  S. Moore,et al.  Clinical Myocardial Perfusion PET/CT* , 2007, Journal of Nuclear Medicine.

[24]  J. Maddahi.  Viability assessment with MRI is superior to FDG-PET for viability: Pro , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[25]  C. Baird,et al.  The pilot study. , 2000, Orthopedic nursing.

[26]  E. Depuey,et al.  Wide beam reconstruction “quarter-time” gated myocardial perfusion SPECT functional imaging: a comparison to “full-time” ordered subset expectation maximum , 2009, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[27]  Guido Germano,et al.  Combined supine and prone quantitative myocardial perfusion SPECT: method development and clinical validation in patients with no known coronary artery disease. , 2006, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[28]  Valerie Treyer,et al.  Nuclear Myocardial Perfusion Imaging with a Cadmium-Zinc-Telluride Detector Technique: Optimized Protocol for Scan Time Reduction , 2010, Journal of Nuclear Medicine.

[29]  Russell D Folks,et al.  Prompt-gamma compensation in Rb-82 myocardial perfusion 3D PET/CT , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[30]  T. Ruddy,et al.  Half-Time SPECT Myocardial Perfusion Imaging with Attenuation Correction , 2009, Journal of Nuclear Medicine.

[31]  Linda K. Shaw,et al.  Clinical results of a novel wide beam reconstruction method for shortening scan time of Tc-99m cardiac SPECT perfusion studies , 2007, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[32]  D. Berman,et al.  New Imaging Protocols for New Single Photon Emission CT Technologies , 2010, Current cardiovascular imaging reports.

[33]  H. Malcolm Hudson,et al.  Accelerated image reconstruction using ordered subsets of projection data , 1994, IEEE Trans. Medical Imaging.

[34]  A. Einstein,et al.  Reduced isotope dose and imaging time with a high-efficiency CZT SPECT camera , 2011, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[35]  M. Bottai,et al.  High diagnostic accuracy of low-dose gated-SPECT with solid-state ultrafast detectors: preliminary clinical results , 2011, European Journal of Nuclear Medicine and Molecular Imaging.

[36]  L. Husmann,et al.  Diagnostic accuracy of computed tomography coronary angiography and evaluation of stress-only single-photon emission computed tomography/computed tomography hybrid imaging: comparison of prospective electrocardiogram-triggering vs. retrospective gating. , 2009, European heart journal.

[37]  J. Case,et al.  A multicenter evaluation of a new post-processing method with depth-dependent collimator resolution applied to full-time and half-time acquisitions without and with simultaneously acquired attenuation correction , 2009, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[38]  L. Husmann,et al.  Semiconductor Detectors Allow Low-Dose–Low-Dose 1-Day SPECT Myocardial Perfusion Imaging , 2011, The Journal of Nuclear Medicine.

[39]  Faezeh Atri,et al.  Original Article , 2008 .

[40]  J. Mahmarian.  Stress only myocardial perfusion imaging: Is it time for a change? , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[41]  Arik Wolak,et al.  Stress thallium-201/rest technetium-99m sequential dual isotope high-speed myocardial perfusion imaging. , 2009, JACC. Cardiovascular imaging.

[42]  M. Henzlova,et al.  The future of SPECT MPI: Time and dose reduction , 2011, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[43]  Oliver Gaemperli,et al.  New reconstruction algorithm allows shortened acquisition time for myocardial perfusion SPECT , 2008, European Journal of Nuclear Medicine and Molecular Imaging.

[44]  Piotr J. Slomka,et al.  Motion frozen 18F-FDG cardiac PET , 2010, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[45]  D. Berman,et al.  Multicenter trial of high-speed versus conventional single-photon emission computed tomography imaging: quantitative results of myocardial perfusion and left ventricular function. , 2010, Journal of the American College of Cardiology.

[46]  A. Pazhenkottil,et al.  Nuclear myocardial perfusion imaging with a novel cadmium-zinc-telluride detector SPECT/CT device: first validation versus invasive coronary angiography , 2011, European Journal of Nuclear Medicine and Molecular Imaging.

[47]  J. Knuuti.  Integrated positron emission tomography/computed tomography (PET/CT) in coronary disease , 2009, Heart.

[48]  S. Nekolla,et al.  PET/CT challenge for the non-invasive diagnosis of coronary artery disease. , 2010, European journal of radiology.

[49]  P. Raggi,et al.  Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: multicenter comparison with standard dual detector cameras , 2009, Journal of Nuclear Cardiology.

[50]  E. Gordon DePuey,et al.  A comparison of the image quality of full-time myocardial perfusion SPECT vs wide beam reconstruction half-time and half-dose SPECT , 2011, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[51]  H. Sipilä,et al.  Cardiac Positron Emission Tomography/Computed Tomography Imaging Accurately Detects Anatomically and Functionally Significant Coronary Artery Disease , 2010, Circulation.

[52]  N. Zafrir,et al.  Feasibility of myocardial perfusion SPECT with prone and half-time imaging , 2011, Nuclear medicine communications.

[53]  J. Case,et al.  Multicenter investigation comparing a highly efficient half-time stress-only attenuation correction approach against standard rest-stress Tc-99m SPECT imaging , 2008, Journal of nuclear cardiology : official publication of the American Society of Nuclear Cardiology.

[54]  Daniel S Berman,et al.  Agreement of visual estimation of coronary artery calcium from low-dose CT attenuation correction scans in hybrid PET/CT and SPECT/CT with standard Agatston score. , 2010, Journal of the American College of Cardiology.

[55]  R. Jaszczak,et al.  Pinhole collimation for ultra-high-resolution, small-field-of-view SPECT. , 1994, Physics in medicine and biology.

[56]  N. Schramm,et al.  High-resolution SPECT using multi-pinhole collimation , 2002, IEEE Nuclear Science Symposium Conference Record.

[57]  F. Beekman,et al.  Design and simulation of a high-resolution stationary SPECT system for small animals. , 2004, Physics in medicine and biology.

[58]  S. Blum,et al.  Normal stress-only versus standard stress/rest myocardial perfusion imaging: similar patient mortality with reduced radiation exposure. , 2010, Journal of the American College of Cardiology.

[59]  Martin A Lodge,et al.  Human Biodistribution and Radiation Dosimetry of 82Rb , 2010, The Journal of Nuclear Medicine.