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IQ•SPECT for the Technologist - Part 2

This course is Part 2 of a two-part series that covers IQ•SPECT features for the Symbia scanner. These features are used to improve the image quality of cardiac images.

IQ•SPECT for the Technologist Part 2 You have now completed Part 1 and Part 2 of the course IQ•SPECT for the Technologist.   You should now be able to: State the purpose of IQ•SPECT and describe how it can be used for SPECT and SPECT/CT image quality improvement  Describe the quality control procedures that should be performed prior to acquiring your first patient  List the acquisition and processing workflows used in IQ•SPECT  Demonstrate how to position a patient for a study  Demonstrate how to acquire the scan  Demonstrate how to reconstruct a study ​Recognize the differences in IQ•SPECT images when compared to other types of SPECT cardiac studies By the end of these two courses you should be able to: State the purpose of IQ•SPECT and describe how it can be used for SPECT and SPECT/CT image quality improvement  Describe the quality control procedures that should be performed prior to acquiring your first patient  List the acquisition and processing workflows used in IQ•SPECT  Demonstrate how to position a patient for a study  Demonstrate how to acquire the scan  Demonstrate how to reconstruct a study ​Recognize the differences in IQ•SPECT images when compared to other types of SPECT cardiac studies IQ•SPECT_DC Series Have been corrected in order to be displayed Process rearranges the data to give the appearance of a parallel hole collimator acquisition Allow projections for motion in 3rd Party Cardiac applications Review only, cannot be reconstructed IQ•SPECT_Raw Acquired through the collimator Not able to be viewed in native form with MI Applications To view, load data into syngo Viewing task card Can be reconstructed ​Images courtesy of Siemens Healthcare Click the tabs below to view the steps and guidelines for assessing the quality of IQ•SPECT study data. Load Raw series into syngo Viewing Task Card. Advance through the images to view image 18 (depicts LAO view). Tools menu >> Circle or Freehand. Draw ROI over lateral wall. Image statistics will be calculated. Mean counts in lateral should be at least 9 counts. Images courtesy of Siemens Healthcare ​ syngo Viewing Task Card Review Review of correct patient positioning This is an example of a patient that has been positioned too high in FOV Heart is not magnified Reconstructed images will be count poor and noisy ​Images courtesy of Siemens Healthcare Evaluation for Motion Same process for parallel hole collimator studies Y correction recommended as first step If not sufficient, then try head-misregistration and X correction If extreme motion, reacquire the data   ​Images courtesy of Siemens Healthcare Gated Projection and Summed Projection data not normalized. Patient heart rate fluctuation   Stripes in projection data   Flashing on cine Beat Normalization is automatically performed.   ​Images courtesy of Siemens Healthcare Click each tab below to view the reconstruction parameters recommended for Technetium and Thallium studies.  ​Images courtesy of Siemens Healthcare Inferior Wall Defect (Male) – No AC Applied ​Images courtesy of Siemens Healthcare Inferior Wall Defect (Male) – AC Applied ​Images courtesy of Siemens Healthcare Inferior Wall Defect - LEHR vs IQ•SPECT ​Images courtesy of Siemens Healthcare Apical  Defect - No AC  ​Images courtesy of Siemens Healthcare Apical Defect - AC ​Images courtesy of Siemens Healthcare Apical Defect - LEHR vs IQ•SPECT ​Images courtesy of Siemens Healthcare Defect at Apex ​Images courtesy of Siemens Healthcare Clinical Case Examples Case 1 – Male stress study (FBP vs. Flash3D with no AC, IQ SPECT vs. Flash3D with AC and without AC) Case 2 – Female stress study (FBP vs. Flash3D with no AC, IQ SPECT vs. Flash3D with AC and without AC) Case 3 – Application of normalization   Click the tabs below to review the differences and the new normal limits in ejection fractions. Some differences in EFs can be expected with changing imaging techniques Known variations in calculated values between 3rd Party Cardiac software packages Differences in contour generation​ Be aware of the variability and establish new normal limits ​Images courtesy of Siemens Healthcare   65 patient's EFs reviewed Classified as low likelihood of CAD Imaged with both IQ•SPECT and LEHR Collimators EFs calculated with Cedars QGS and Corridor 4DM    Cedars Average EF = 65% Normal Lower Limit = 48% Corridor 4DM Average EF = 71% Normal Lower Limit = 59% LEHR Collimator Average EF = 65% Normal Lower Limit = 48% IQ•SPECT Average EF = 65% Normal Lower Limit = 44% LEHR Collimation  Average EF = 71%  Normal Lower Limit = 59% IQ•SPECT  Average EF = 73%  Normal Lower Limit = 58% Register Transverse first and register Coronal second Review registration of Sagittal, but rarely need to adjust. Ensure no heart extends into the lung area. Try both Warm Metal and Edges Look-up Tables for difficult cases. ​Images courtesy of Siemens Healthcare Low Dose Images Lumpy appearance Do not increase iterations and subsets Increase Gaussian smooth Small Hearts Thick wall appearance Increase number of iterations Results in thinner walls and reduced thickness at the apex   30 iterations, 3 subsets    20 iterations, 3 subsets    10 iterations, 3 subsets           ​Images courtesy of Siemens Healthcare Images courtesy of Siemens Healthcare Effects of Attenuation The effects of the different collimator geometries and reconstruction methods can be demonstrated on the Data Spectrum Cardiac Phantom. Longer attenuation path lengths from SMARTZOOM collimator geometry lead to more deep tissue attenuation and more counts from tissue closest to surface. LEHR Non AC  &  IQ•SPECT Non AC ​Images courtesy of Siemens Healthcare Attenuation Correction Attenuation correction removes most of the differences between the images. LEHR AC & IQ•SPECT AC ​Images courtesy of Siemens Healthcare The images shown here are of a normal male during a technetium stress study with no attenuation correction and no scatter correction applied. The images were acquired with LEHR collimators. One was processed with filtered back projection and the other was processed using the Flash3D algorithm. Resolution recovery in Flash3D leads to rounder shapes and more uniform wall thickness. FBP Compared to Flash3D Normal Male, Tc99m Stress Study, No AC or SC ​Images courtesy of Siemens Healthcare IQ•SPECT compared to Flash3D Normal Male, Tc99m Stress Study , No AC or SC ​Images courtesy of Siemens Healthcare IQ•SPECT Compared to Flash3D Normal Male, Tc99m Stress Study, With AC and SC ​Images courtesy of Siemens Healthcare The images below are of a normal female during a Technetium stress study acquired with LEHR collimators. The images show a comparison between filtered back projection reconstruction to Flash 3D. The images are without attenuation correction and scatter correction applied. Resolution recovery in Flash3D leads to rounder shapes and thinner, more uniform wall thickness. FBP Compared to Flash3D Normal Female, Tc99m Stress Study, No AC or SC ​Images courtesy of Siemens Healthcare IQ•SPECT Compared to Flash3D Normal Female, Tc99m Stress Study , No AC or SC ​Images courtesy of Siemens Healthcare IQ•SPECT Compared to Flash3D Normal Female, Tc99m Stress Study , With AC and SC ​Images courtesy of Siemens Healthcare The images shown here are of an IQ•SPECT stress/rest thallium study of an abnormal male with no attenuation correction and scatter correction applied. The display is not normalized but should be because of the hot gut activity. The study is unreadable prior to renormalization.  IQ•SPECT Stress/Rest Study Tl201 study of abnormal male, no AC or SC, display not normalized ​Images courtesy of Siemens Healthcare Before Normalization IQ•SPECT Stress/Rest Study Tl201 study of abnormal male, no AC or SC, display not normalized ​Images courtesy of Siemens Healthcare After Renormalization

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