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Overview of Quantification White Paper - xSPECT Quant

SIEMENS Symbia Intevo HEMENS SPECT/CT Overview of Quantification SIEMENS Healthineers siemens.com/healthineers HOOD05162002675255-EN | Effective Date 12/14/2017 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Contents 1. Overview of xSPECT 3 1.1 xSPECT Quant vs. Broad Quantification 4 2. Calibrations for xSPECT Quant 5 2.1 Sensitivity Calibration for xSPECT Quant 6 2.2 Cross Calibration 8 3. Calibrations for Broad Quantification 9 3.1 Sensitivity Calibration for Broad Quantification 9 3.2 Volume Sensitivity Calibration 11 4. Acquiring Data for Quantification 13 5. Reconstructing Quantitative Data 15 5.1 New xRecon Activity 15 5.1.1 Using xRecon Activity 16 5.2 Performing Quantitative Reconstruction 19 5.3 Viewing Data 19 2 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Overview of xSPECT xSPECT technology is the complete integration of SPECT and CT data during image recon- struction for sharp clinical detail and accurate measurement of disease. xSPECT Quant standardizes uptake values for reliable disease detection and evaluation of therapy response. SPECT xSPECT SPECT counts alignment Recon CT Integrated reconstruction CT counts Siemens released xSPECT Quant Tc99m and xSPECT Bone in 2013. In 2017, Siemens expanded upon the quantification portfolio with further xSPECT Quant isotope support and Broad Quantification. Support of xSPECT Quant expanded to 1 Lu177, In111, and I 123 . Broad Quantification support is for most parallel hole collimator/isotope combinations. 3 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 xSPECT Quant vs. Broad Quantification xSPECT Quant provides absolute, accurate, and reproducible quantification for Tc99m, In111, I 123 and Lu177. xSPECT Quant uses a NIST traceable calibration source, which is precisely , measured and specifically designed to calibrate the system to an absolute standard. Additionally, cross calibration measures and corrects for dose calibrator biases. xSPECT Quant is dose calibrator independent and enables standardization of a patient’s uptake across different cameras and institutions. Note: Not all xSPECT Quant tracers are available in all countries. Broad Quantification enables absolute quantification of most clinically relevant tracer2/ collimator combinations for clinical and research purposes, through a series of manual calibration procedures. The Broad Quantification calibration workflow uses a point source of a clinically used isotope measured in a local dose calibrations, as well as a the volume sensitivity calibration using a cylinder phantom of the same isotope. Broad Quantification is dose calibrator dependent. 1 Lu177 is not commercially available in some countries, including the US. Lu177 is not currently recognized by the US FDA as being safe and effective, and Siemens does not make any claims regarding its use. Due to regulatory reasons, its future availability cannot be guaranteed. Please contact your local Siemens organization for further details. 2 Commonly used isotopes for Broad Quantification: Ga67, I 123 I 131 In111, Lu177, Tc99m, and Tl201. , , For questions regarding additional isotopes, please contact the local service representative. 4 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Calibrations for xSPECT Quant In order to enable xSPECT Quant acquisitions, the system must be calibrated with the Sensitivity Calibration on a monthly basis. It is also recommended to perform Cross Calibration on a monthly basis as well. 4,9 SUV Bq/f2 SUV Standardized 2 516 SUV absolute = 2,7 SUV6 SUV quantification SUY (Bq/ml) XSPECT™ reconstruction 17mg/m, 7 SUV 9,4 m SUV 1 SUV XSPECT™ acquisition 3,8 SUV XSPECT™ calibration: Sensitivity from NIST source Standardized SUV Cross-calibration: Dose calibrator bias correction Sensitivity from dose calibrator assay 5 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Sensitivity Calibration for xSPECT Quant In order to enable xSPECT Quant acquisitions, the system must be calibrated with the Sensitivity Calibration on a monthly basis. It is also recommended to perform Cross Calibration on a monthly basis as well. Figure 1: NIST-Traceable Precision Calibration Source Depending on the xSPECT Quant features purchased (i.e. Tc99m, I 123 In111, and Lu177) and the , collimators available on the system, one or two sensitivity calibrations will need to be performed. The table below shows which sensitivity values get automatically generated when cali- brating with certain precision sources and collimators: 6 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Precision Source Collimator used Camera preset Generated Sensitivity used during during Calibration used during Calibration Calibration Collimator Camera Preset Co-57 LEHR SC-Co57-NMG LEHR SC-Tc99m-NMG SC-Tc99m-NMG Co-57 LPHR SC-Co57-NMG LPHR SC-I123-NMG SC-I123-NMG Se-75 MELP SC-Se75-LME-NMG MELP SC-In111-NMG SC-Lu177-208-NMG Table 1: Generated camera preset sensitivities per precision source / collimator combination. Complete instructions for performing the sensitivity calibration can be found in the Operator Manual. 7 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Cross Calibration Cross calibration is a sensitivity measurement using a point source of the clinical isotope measured in the local dose calibrator (Figure 2). The measured sensitivity is saved and later used by the system during clinical acquisitions to remove the dose calibrator bias by comparing it to the system sensitivity measured with the precision source and adjusting the injected dose that is entered at the time of the patient exam. Figure 2: Cross Calibration Cross calibration is performed for each preset/collimator combination and dose calibra- tor used for quantitative studies. The cross calibration step is optional but recommended for accurate SUV quantification. The prepared point source count rate should be between 5 and 30kcts/sec per detector. Recommended Approximate Activities Camera Preset to Calibrate Isotope Activity Tc99m 1-5mCi SC-Tc99m-NMG In111 1-5mCi SC-In111-NMG I 123 1-5mCi SC-I123-NMG Lu177 10-30mCi SC-Lu177-208-NMG Table 2: Recommended point source activity to perform Cross Calibration. Complete instructions for performing the cross calibration can be found in the Operator Manual. 8 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Calibrations for Broad Quantification In order to enable Broad Quantification acquisitions, the following calibrations need to be performed in the order below on a regular basis: Sensitivity Calibration measures the system's ability to detect the radioactivity (CP) compared to 1 the true amount of radioactivity (Bq). It is recommended to perform this calibration on a monthly basis. Volume Sensitivity Calibration generates a volume sensitivity factor (VSF) using a phantom with 2 clinically-relevant isoptope and collimator. This calibration needs to be completed once for each isotope/collimator combination. Sensitivity Calibration for Broad Quantification The sensitivity calibration uses a point source of the clinically used isotope made onsite. Sensitivity calibration needs to be performed for each isotope/collimator combination being quantified with the Broad Quantification feature. Figure 3: Point source for sensitivity calibration. 9 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 The following rules apply when creating user defined energy window presets for Broad Quantification: The camera preset has at least one lower-scatter window • All scatter windows are adjacent to the corresponding photopeak. • The camera preset has only one isotope defined. Multi-isotope camera presets are not • allowed for sensitivity calibration. Each window group in the camera preset contains only one photopeak. • No Bremsstrahlung isotopes. • Below are the recommended activities to achieve a count rate between 5 and 30kcts/sec per detector for some clinically relevant isotopes: Isotope Activity Tc99m 1-5mCi In111 1-5mCi I 123 1-5mCi Lu177 10-30mCi I 131 1-5mCi Table 3: Recommended activity for optimum count rate. Complete instructions for performing the sensitivity calibration for Broad Quantification can be found in the Operator Manual. 10 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Volume Sensitivity Calibration The Volume Sensitivity Calibration is performed by filling a large uniform cylinder phan- tom with the desired clinical isotope and performing a quantitative SPECT/CT acquisition. Note: The same collimator and energy window preset need to be used for the Sensitivity and Volume Sensitivity Calibration. Volume Sensitivity Calibration has to be performed once for each preset/collimator com- bination used for quantification. It is recommended to use a large phantom with the fol- lowing requirements: Standard quality-control phantom • No inserts • Approximate diameter of 20cm • Nominal volume of 6000-7000ml • Figure 4: Phantom placement for volume sensitivity calibration. 11 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 The phantom should produce a count rate between 5 and 30 kcts/sec per detector. Setup of the phantom can be found in Release Information user instructions. The approximate amount of activity needed depends on the isotope. For example: Isotope Activity Tc99m 5-10mCi In111 5mCi I 123 5mCi I 131 5mCi Table 3: Recommended activity for optimum count rate. Complete instructions for performing the volume sensitivity calibration for Broad Quantification can be found in the Operator Manual. 12 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Acquiring Data for Quantification Patient data for Quantification can be acquired after the necessary calibrations have been performed. Template workflows are available on the Optional Workflow CD. These workflows can be customized as necessary. Steps to Perform a SPECT/CT acquisition for absolute quantification: 1. Install Collimators that were previously calibrated. 2. Select a patient from the Patient Browser and launch the desired workflow from the Workflow Template Browser. Note: Only SPECT/CT workflows with Tomo or Wholebody Tomo Acquisition plus CT Acquisition can be used for quantitative acquisitions. 3. Review the Stop Conditions tab. a. Verify Advanced Data has been selected. 4. Review the Camera Parameters tab. a. Matrix Size – 256 x 256 b. Verify correct Camera Preset used during calibrations. Note: To verify the camera preset was previously calibrated, open the Sensitivity Calibration workflow and navigate to Static Acquisition Activity > Series Information > Available Calibration (see figure below). Acquisition Analyzer Display /Analysis Data Selector Patient: | Acquisition Display Detector 1: Detector 2: Study: 99m Technetium 99m Technetium Series: Static Series Information|Camera Parameters |Stop Conditions |Sourc 1 Series: Reconstruction folder, which can be used and customized as necessary. These workflows must include a reconstruction activity called xRecon which is used for recon- structing quantitative data. The same workflows can be used for either single bed or multi-bed SPECT/CT data. New xRecon Activity xRecon is a new activity for reconstructing xSPECT data that is flexible and easy to use. xRecon This activity reconstructs both xSPECT Quant and xSPECT Bone volumes using scatter and attenuation correction. This activity optionally allows Flash3D reconstruction. Multi- bed SPECT/CT acquisition data are reconstructed together into one single 3D image and the CT frame of reference, which greatly reduces seams and stitching errors in the bed overlap regions. For users who upgraded from VB10 to VB20: xRecon needs to replace AutoRecon as the reconstruction activity in all xSPECT • Reconstruction workflows. The VB20 Optional Workflow CD contains xSPECT Reconstruction Workflows to aid in the transition. OSCG reconstruction is now titled xSPECT Reconstruction in the xRecon activity. • OSCG + Enhanced reconstruction is now titled xSPECT Reconstruction with Zone • Preset: Bone. 15 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Using xRecon Activity xRecon has 3 tabs: Settings, Results, and Advanced. Settings Results Advanced Reconstruction 1 Bone Scan 05/13/2014 SCAC % % 50 HU 51 36 331s Compressed 0 Start Recon Edit Parameters Raw Data Inputs WB Bone Scan-Scan 5, 12:35:57 PM Body 2:5 B31 eFoV. 12:47:54 PM WB Bone Scan-Scan 4, 12:25:15 PM WB Bone Scan-Scan 3, 12:14:46 PM WB Bone Scan-Scan 2, 12:04:21 PM WB Bone Scan-Scan 1. 11:53:56 AM Settings Tab This tab allows the user to: View progress of reconstruction • Review the reconstruction method used • Update the parameter settings • Edit dose information • The first xRecon activity in a workflow will have the parameters set to Ultra-Fast. This first xRecon activity is used to complete a quick reconstruction of the raw nuclear medicine data for image registration in the next activity. In the second xRecon activity in a workflow there are four options for parameter settings: Fast, Standard, Best, or User-Defined (Figure 7). The second xRecon activity is used for the actual reconstruction since the evaluation of the NM and CT data overlay has been completed within the Image Registration activity. The parameter settings named Ultra-Fast, Fast, Standard, and Best have predetermined reconstruction parameters based on the total acquired counts, reconstruction method, collimator used, and parameter settings selected. 16 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Settings Results Corrected Dose Reconstruction 2 370.000MBq 2/17/2015 12:00AM Reconstruction 1 Bone Scan - A3D 2/18/2015 SCAC Bone Scan - A3D 2/18/2015 NSCNAC Edit Dose Info ... In queue .. 100 ONCOLOGY - TX ONCOLOGY - TX Reconstruction Method OSCG Reconstruction Method OSCG RT ORGAN Attenuation Correction ON Attenuation Correction ON Scatter Correction ON Scatter Correction ON Parameter Setting User-Defined Standard OTCGO20 Fast Standard Best User-Defined Anterior Start Recon Show Image Show Image Raw Data Input Bone Scan - A3D 2/18/2015 Bed 1 Bone Scan - A3D 2/18/2015 Bed 2 CTAC - Bone 3.0mm B30 CTAC - Bone 1.0mm B30 Figure 7: Parameter setting options. The user can modify the Date, Time, and Dose values for a quantitative acquisition by selecting the Edit Dose Info button. Results Tab The results tab shows the fusion display, attenuation map, and zone map (if applicable) for each reconstruction job. This tab also allows the user to apply a mask. Settings Results Advanced Bone Scan 05/13/2014 SCAC males Apply Mask Display O Recon Tomo Mu Map Job Figure 8: Results tab for xRecon activity. 17 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Advanced Tab The advanced tab is most commonly used during the initial workflow configuration to setup the reconstruction options. This tab can be hidden once the reconstruction prefer- ences have been determined within the activity. Settings Results Advanced Prepare for Registration Enable 2nd Reconstruction Job Advanced Options - Reconstruction Job 1 Advanced Options - Reconstruction Job 2 Exam Type Skeletal Exam Type Skeletal Reconstruction Method Flash3D Reconstruction Method Flash3D Zone Preset None Zone Preset None Parameter Setting Fast Parameter Setting User-Defined Reconstruction Parameters Reconstruction Parameters Iterations: 25 Subsets: 2 Iterations: 30 Subsets: 2 Filtering 3D Gaussian FWHM : 10.00 mm Filtering 3D Gaussian FWHM: 10.00 mm Apply Scatter Correction Apply Scatter Correction Scatter Estimation Scatter Estimation Apply To: Photopeak 1 Energy Windows .. Apply To: Photopeak 1 Energy Windows ... Window Weights Automatic Window Weights Automatic Lower Window Weight 0.50 Lower Window Weight 0.50 Filtering 2D Gaussian FWHM : 20.00 mm Filtering 2D Gaussian FWHM: 20.00 mm Apply Attenuation Correction Apply Attenuation Correction Attenuation Coefficients Determination Attenuation Coefficients Determination Apply To: Photopeak 1 Apply To: Photopeak 1 Energy Settings Isotope Energy value 99m Technetium Energy Settings Isotope Energy value 99m Technetium O User Defined User Defined Beam Model Beam Model . Narrow . Narrow Filtering 3D Gaussian FWHM : 0.00 mm Filtering 3D Gaussian FWHM: 0.00 mm Figure 9: Advanced tab for xRecon activity. The main options found in the advanced tab are Exam Type, Reconstruction Method, Zone Preset, and Parameter Setting. Each advanced method defines the following option (i.e. Exam Type > Reconstruction Method > Zone Preset > Parameter Setting). Each of these – options can be further defined by the user. Exam Type: The exam type should be selected based on the type of study being per- • formed. For all exam types, the reference time for decay correction is the injection time, except for WholeBody – Theranostics where it is the acquisition start time. Reconstruction Method: Recon supports two reconstruction methods: Flash3D and • xSPECT Reconstruction (previously OSCG). Zone Preset: The only exam type which enables this option is Skeletal. The three pre- • sets available are Skeletal, Water Phantom, and Phantom with Contrast. When reconstructing xSPECT Bone patient data, the Skeletal zone preset should • be used. Water Phantom and Phantom with Contrast Zone Presets should only be used • when performing phantom studies. 18 SPECT/CT – Overview of Quantification | White Paper HOOD05162002675255-EN | Effective Date 12/14/2017 Parameter Settings: The first xRecon activity in a workflow will be set to Ultra-Fast. • The second xRecon activity will have four options to choose from: Fast, Standard, Best, and User Defined. Selecting User Defined enables editing of the following parameters: Reconstruction Parameters • Scatter Estimation • Window Weights • Filtering • Attenuation Coefficients Determination • Energy Settings • Beam Model • Filtering • Performing Quantitative Reconstruction Select the patient from the Patient Browser and the desired workflow template from • the Workflow Template Browser. The workflow will open and progress through the activities. Review images for registration and quality – make adjustments as necessary. • Click complete when satisfied with images. • Viewing Data If all the steps needed to acquire quantitative data have been completed, reconstructed data will be available in PET format. These images can be reviewed in viewing applica- tions such as Volumetric Analysis, TrueD, and syngo.via. Similar to PET, tracer uptake can be quantified by drawing volumes of interest (VOIs) to determine SUV or Bq/mL. 19 The products/features and/or service offerings (here mentioned) are not commercially available in all countries and/or for all modalities. If the services are not marketed in countries due to regulatory or other reasons, the service offering cannot be guaranteed. Please contact your local Siemens organization for further details. Siemens Healthineers Headquarters Siemens Healthcare GmbH Henkestr. 127 91052 Erlangen, Germany Phone: +49 9131 84-0 siemens-healthineers.com Published by Siemens Healthcare GmbH · ©Siemens Healthcare GmbH, 2018

  • Overview of Quantification White Paper - xSPECT Quant