Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
권호 표지

Multimodality and Application Software

다중영상기기의 응용 소프트웨어

  • Im, Ki-Chun (Department of Nuclear Medicine, ASAN Medical Center)
  • 임기천 (서울아산병원 핵의학과)
  • Published : 2008.04.30
Download PDF
⟨ Previous Next ⟩

Abstract

Medical imaging modalities to image either anatomical structure or functional processes have developed along somewhat independent paths. Functional images with single photon emission computed tomography (SPECT) and positron emission tomography (PET) are playing an increasingly important role in the diagnosis and staging of malignant disease, image-guided therapy planning, and treatment monitoring. SPECT and PET complement the more conventional anatomic imaging modalities of computed tomography (CT) and magnetic resonance (MR) imaging. When the functional imaging modality was combined with the anatomic imaging modality, the multimodality can help both identify and localize functional abnormalities. Combining PET with a high-resolution anatomical imaging modality such as CT can resolve the localization issue as long as the images from the two modalities are accurately coregistered. Software-based registration techniques have difficulty accounting for differences in patient positioning and involuntary movement of internal organs, often necessitating labor-intensive nonlinear mapping that may not converge to a satisfactory result. These challenges have recently been addressed by the introduction of the combined PET/CT scanner and SPECT/CT scanner, a hardware-oriented approach to image fusion. Combined PET/CT and SPECT/CT devices are playing an increasingly important role in the diagnosis and staging of human disease. The paper will review the development of multi modality instrumentations for clinical use from conception to present-day technology and the application software.

다중영상기기는 1990년대 초에 처음 개발되어 현재 주요 영상 장비 회사에서 상품으로 개발되어 판매되고 있다. 단순한 소프트웨어적인 정합과 융합을 통해 해부학적 영상과 기능적 영상의 상호 보완하는 단계에서 발전하여 하드웨어적으로 정합하는 하드웨어의 개발은 새로운 연구의 시작이다. 다중영상기기의 발전 이전에는 해부학적 구조를 보여주는 영상 장비와 기능적 영상을 표현하는 장비가 각각 고 분해능과 고 해상도로 많은 발전을 이루어 왔다. 현재는 각 영상 장비의 특징을 살려 효과적으로 결합시킨 다중영상기기의 개발이 활발하게 이루어지고 있다. 다중영상기기는 단순하게 두 장비를 결합시키는 개념에서 기능적 영상에서 필요한 감쇠 보정을 하면서 동시에 해부학적 위치를 융합 영상 형태로 표현하는 새로운 영상 장비로 발전하고 있다 다중영상기기의 특징을 살릴 수 있는 프로토콜이 개발되고 하드웨어적으로도 상호 보완적으로 결합되고 있다. 실제로 PET/CT와 같은 다중영상기기는 임상적으로 중요한 역할을 하고 있으며 PET 영상기기를 대체하고 있다. PET/CT 스캐너는 PET에서 나오는 기능적 영상과 CT에서 나오는 해부학적 영상뿐만 아니라 융합 영상을 함께 보여 주므로 임상적으로 유용한 정보를 제공하고 있다. 현재 SPECT/CT는 아직 보급이 많이 되지 않았으나 PET/CT와 같이 임상적으로 유용한 SPECT와 CT 장비가 결합된 상품들이 나오고 있어 그 시장이 점점 성장할 것으로 기대된다. 다중영상기기는 각각의 단독 영상장비에서 갖고 있는 문제뿐만 아니라 두 영상 장비를 결합시키므로 인해 새로운 문제들이 발생하고 있다. 대표적으로 호흡에 의한 움직임, 조영제의 영향, 금속 물질의 영향과 환자의 피폭에 관한 문제가 있다. 이를 해결하기 위해 새로운 프로토콜과 프로세싱 방법이 개발되고 있다. 뇌를 동시에 촬영할 수 있는 PET/MR의 개발은 뇌 과학에 많은 발전을 줄 것으로 기대된다. PET/MR의 개발은 PET/CT 에서 촬영한 영상의 일부분을 대체할 것으로 예상된다. MR 영상이 CT 영상보다 우수한 분해능을 보이는 분야에서는 PET/MR을 이용한 검사와 연구가 활발하게 진행될 것으로 보인다. 해부학적 영상과 기능적 영상을 결합시킨 융합 영상을 함께 제공하는 다중영상기기는 환자의 질병을 진단뿐만 아니라 치료 후의 효과를 보는데 있어서 중요한 역할을 할 것으로 기대된다. 또 앞으로 검사 목적에 맞는 다양한 다중영상기기의 개발이 이루어질 것으로 기대된다.

Keywords

References

  1. Townsend DW, Beyer T, Blodgett TM. PET/CT scanners: a hardware approach to image fusion. Seminars in Nuclear Medicine 2003; 33(3): 193-204
  2. Hounsfield GN. Computerized transverse axial scanning (tomography). 1. Description of system. Br J Radiol 1973;46(552):1016- 22 https://doi.org/10.1259/0007-1285-46-552-1016
  3. Phelps ME, Hoffman EJ, Mullani NA, Ter-Pogossian MM. Application of annihilation coincidence detection to transaxial reconstruction tomography. J Nucl Med 1975;16(3):210-24
  4. Kuhl D, Edwards R. Image separation radioisotope scanning. Radiology 1963;80:653-61 https://doi.org/10.1148/80.4.653
  5. Nutt R. 1999 ICP Distinguished Scientist Award. The history of positron emission tomography. Mol Imaging Biol 2002;4(1):11-26 https://doi.org/10.1016/S1095-0397(00)00051-0
  6. Townsend DW. Multimodality imaging of structure and function. Phys Med Biol 2008;53(4):R1-R39 https://doi.org/10.1088/0031-9155/53/1/001
  7. O'Connor MK, Kemp BJ. Single-photon emission computed tomography/computed tomography: basic instrumentation and innovations. Semin Nucl Med 2006;36(4):258-66 https://doi.org/10.1053/j.semnuclmed.2006.05.005
  8. Townsend DW. Positron emission tomography/computed tomography. Semin Nucl Med 2008;38(3):152-66 https://doi.org/10.1053/j.semnuclmed.2008.01.003
  9. Slomka PJ. Software approach to merging molecular with anatomic information. J Nucl Med 2004;45 Suppl 1:36S-45S
  10. Baum KG, Helguera M, Krol A. Fusion Viewer: A New Tool for Fusion and Visualization of Multimodal Medical Data Sets. J Digit Imaging 2007
  11. Katakura Y. [High function PACS utilizing Osirix, an open source software]. No Shinkei Geka 2006;34(2):208-14
  12. Rosset C, Rosset A, Ratib O. General consumer communication tools for improved image management and communication in medicine. J Digit Imaging 2005;18(4):270-9 https://doi.org/10.1007/s10278-005-6703-2
  13. Im KC, Ryu J-S, Choi IS, Uh KS, Shin MJ, Kim EN, et al. Development of An Image Fusion Software on Picture Archiving and Communication System (PACS) for PET/CT [Abstract]. J Nucl Med 2005
  14. Beyer T, Townsend DW, Brun T, Kinahan PE, Charron M, Roddy R, et al. A combined PET/CT scanner for clinical oncology. Journal of Nuclear Medicine 2000;41(8):1369-79
  15. Beyer T, Kinahan PE, Townsend DW, Sashin D. The use of x-ray CT for atteunation correction of PET data. IEEE Nuclear Science Symposium and Medical Conference 1994
  16. Meltzer CC, Luketich JD, Friedman D, Charron M, Strollo D, Meehan M, et al. Whole-body FDG positron emission tomographic imaging for staging esophageal cancer comparison with computed tomography. Clinical Nuclear Medicine 2000;25(11):882-7 https://doi.org/10.1097/00003072-200011000-00005
  17. Charron M, Beyer T, Bohnen NN, Kinahan PE, Dachille M, Jerin J, et al. Image analysis in patients with cancer studied with a combined PET and CT scanner. Clinical Nuclear Medicine 2000;25(11): 905-10 https://doi.org/10.1097/00003072-200011000-00010
  18. Kluetz PG, Meltzer CC, Villemagne VL, Kinahan PE, Chander S, Martinelli MA, et al. Combined PET/CT Imaging in Oncology. Impact on Patient Management. Clin Positron Imaging 2000;3(6): 223-30 https://doi.org/10.1016/S1095-0397(01)00055-3
  19. Brambilla M, Secco C, Dominietto M, Matheoud R, Sacchetti G, Inglese E. Performance characteristics obtained for a new 3-dimensional lutetium oxyorthosilicate-based whole-body PET/CT scanner with the National Electrical Manufacturers Association NU 2-2001 standard. J Nucl Med 2005;46(12):2083-91
  20. Mawlawi O, Podoloff DA, Kohlmyer S, Williams JJ, Stearns CW, Culp RF, et al. Performance characteristics of a newly developed PET/CT scanner using NEMA standards in 2D and 3D modes. J Nucl Med 2004;45(10):1734-42
  21. Surti S, Kuhn A, Werner ME, Perkins AE, Kolthammer J, Karp JS. Performance of Philips Gemini TF PET/CT scanner with special consideration for its time-of-flight imaging capabilities. J Nucl Med 2007;48(3):471-80
  22. Hasegawa BH, Stebler B, Rutt BK, Martinez A, Gingold EL, Barker CS, et al. A prototype high-purity germanium detector system with fast photon-counting circuitry for medical imaging. Med Phys 1991;18(5):900-9 https://doi.org/10.1118/1.596606
  23. Lang TF, Hasegawa BH, Liew SC, Brown JK, Blankespoor SC, Reilly SM, et al. Description of a prototype emission-transmission computed tomography imaging system. J Nucl Med 1992;33(10): 1881-7
  24. Kalki K, Blankespoor SC, Brown JK, Hasegawa BH, Dae MW, Chin M, et al. Myocardial perfusion imaging with a combined x-ray CT and SPECT system. J Nucl Med 1997;38(10):1535-40
  25. Blankespoor SC. Attenuation correction of SPECT using x-ray CT on an emission-transmission CT system: myocardial perfusion assessment. IEEE Trans Nucl Sci 1996;43:2263-74 https://doi.org/10.1109/23.531891
  26. Tang HR, Da Silva AJ, Matthay KK, Price DC, Huberty JP, Hawkins RA, et al. Neuroblastoma imaging using a combined CT scanner-s cintillation camera and 131I-MIBG. J Nucl Med 2001;42(2):237-47
  27. Bocher M, Balan A, Krausz Y, Shrem Y, Lonn A, Wilk M, et al. Gamma camera-mounted anatomical X-ray tomography: technology, system characteristics and first images. Eur J Nucl Med 2000;27(6): 619-27 https://doi.org/10.1007/s002590050555
  28. Patton JA, Delbeke D, Sandler MP. Image fusion using an integrated, dual-head coincidence camera with X-ray tube-based attenuation maps. J Nucl Med 2000;41(8):1364-8
  29. LaCroix KJ, Tsui BMW, Hasegawa BH, Brown JK. Inverstigation of the use of x-ray CT images for attenuation compensation in SPECT. IEEE Trans Nucl Sci 1994;41:2793-9 https://doi.org/10.1109/23.340649
  30. Bailey DL, Roach PJ, Bailey EA, Hewlett J, Keijzers R. Development of a cost-effective modular SPECT/CT scanner. Eur J Nucl Med Mol Imaging 2007;34(9):1415-26 https://doi.org/10.1007/s00259-006-0364-3
  31. Christensen NL, Hammer BE, Heil BG, Fetterly K. Positron emission tomography within a magnetic field using photomultiplier tubes and lightguides. Phys Med Biol 1995;40(4):691-7 https://doi.org/10.1088/0031-9155/40/4/014
  32. Hammer BE, Christensen NL, Heil BG. Use of a magnetic field to increase the spatial resolution of positron emission tomography. Med Phys 1994;21(12):1917-20 https://doi.org/10.1118/1.597178
  33. Shao Y, Cherry SR, Farahani K, Slates RW, Meadors K, Bowery A, et al. Development of a PET detector system compatible with MRI/NMR systems. IEEE Trans Nucl Sci 1997;46:565-70 https://doi.org/10.1109/23.775580
  34. Schlemmer H, Pichler PJ, Wienhard K, Schmand M, Nahmias C, Townsend D, et al. Simultaneous MR/PET for brain imaging: first patient scans. J Nucl Med 2007;48:45P
  35. Raylman RR, Majewski S, Lemieux SK, Velan SS, Kross B, Popov V, et al. Simultaneous MRI and PET imaging of a rat brain. Phys Med Biol 2006;51(24):6371-9 https://doi.org/10.1088/0031-9155/51/24/006
  36. Ziegler SI, Pichler BJ, Boening G, Rafecas M, Pimpl W, Lorenz E, et al. A prototype high-resolution animal positron tomograph with avalanche photodiode arrays and LSO crystals. Eur J Nucl Med 2001;28(2):136-43 https://doi.org/10.1007/s002590000438
  37. Pichler BJ, Swann BK, Rochelle J, Nutt RE, Cherry SR, Siegel SB. Lutetium oxyorthosilicate block detector readout by avalanche photodiode arrays for high resolution animal PET. Phys Med Biol 2004;49(18):4305-19 https://doi.org/10.1088/0031-9155/49/18/008
  38. Pichler BJ, Judenhofer MS, Catana C, Walton JH, Kneilling M, Nutt RE, et al. Performance test of an LSO-APD detector in a 7-T MRI scanner for simultaneous PET/MRI. J Nucl Med 2006;47(4):639-47
  39. Schmand M. Brain PET: first human tomograph for simultaneous (functional ) PET and MR imaging. J Nucl Med 2007;48:45
  40. Hofmann M, Steink F, Scheel V, Brady M, Schoelkopf B, Pichler BJ. MR-Based PET Attenuation Correction-Method and Validation [Abstract[Joint Molecular Imaging Conference 2007:P6
  41. Hofmann M, Steink F, Judenhofer MS, Claussen CD, Schoelkopf B, Pichler BJ. A Machine Learning Approach for Determining the PET Attenuation Map from Magnetic Resonance Images. IEEE 2006:P115
  42. Zaidi H. Is MR-guided attenuation correction a viable option for dual-modality PET/MR imaging? Radiology 2007;244(3):639-42 https://doi.org/10.1148/radiol.2443070092
  43. Zaidi H, Montandon ML, Slosman DO. Magnetic resonance imagingguided attenuation and scatter corrections in three-dimensional brain positron emission tomography. Med Phys 2003;30(5):937-48 https://doi.org/10.1118/1.1569270
  44. Tornai MP, Tai Y-C, McKinley RL, Janecek M, Wu H. Initial design considerations of a dedicated hybrid mammotomograph for fully 3D x-ray CT and high resolution PET using object magnification. J Nucl Med 2005;46:208-9
  45. Crotty DJ, Madhav P, McKinley RL, Tornai MP. Investigating novel patient bed designs for use in a hybrid dual modality dedicated 3D breast imaging system. Physics of Medical Imaging 2007;52:603-16
  46. Culver J, Akers W, Achilefu S. Multimodality molecular imaging with combined optical and SPECT/PET modalities. Journal of Nuclear Medicine 2008;49(2):169-72 https://doi.org/10.2967/jnumed.107.043331
  47. Gonzalez RC, Woods RE. Digital Image Processing. Prentice-Hall 2002:567 642
  48. Smith SM. Fast robust automated brain extraction. Human Brain Mapping 2002;17(3):143-55 https://doi.org/10.1002/hbm.10062
  49. Meikle SR, Bailey DL, Hooper PK, Eberl S, Hutton BF, Jones WF, et al. Simultaneous emission and transmission measurements for attenuation correction in whole-body PET. Journal of Nuclear Medicine 1995;36(9):1680-8
  50. Xu EZ, Mullani NA, Gould KL, Anderson WL. A segmented attenuation correction for PET.[see comment]. Journal of Nuclear Medicine 1991;32(1):161-5
  51. Oshiro Y, Gibo M, Murayama S. [Advance of diagnostic imaging in lung cancer]. Gan to Kagaku Ryoho [Japanese Journal of Cancer & Chemotherapy] 2007;34(9):1347-51
  52. Nie Y, Li Q, Li F, Pu Y, Appelbaum D, Doi K. Integrating PET and CT information to improve diagnostic accuracy for lung nodules: A semiautomatic computer-aided method. Journal of Nuclear Medicine 2006;47(7):1075-80
  53. Kinahan PE, Townsend DW, Beyer T, Sashin D. Attenuation correction for a combined 3D PET/CT scanner. Medical Physics 1998;25(10):2046-53 https://doi.org/10.1118/1.598392
  54. Kinahan PE, Hasegawa BH, Beyer T. X-ray-based attenuation correction for positron emission tomography/computed tomography scanners. Semin Nucl Med 2003;33(3):166-79 https://doi.org/10.1053/snuc.2003.127307
  55. Beyer T, Antoch G, Blodgett T, Freudenberg LF, Akhurst T, Mueller S. Dual-modality PET/CT imaging: the effect of respiratory motion on combined image quality in clinical oncology. European Journal of Nuclear Medicine & Molecular Imaging 2003;30(4):588-96 https://doi.org/10.1007/s00259-002-1097-6
  56. Osman MM, Cohade C, Nakamoto Y, Wahl RL. Respiratory motion artifacts on PET emission images obtained using CT attenuation correction on PET-CT. European Journal of Nuclear Medicine & Molecular Imaging 2003;30(4):603-6 https://doi.org/10.1007/s00259-002-1024-x
  57. Osman MM, Cohade C, Nakamoto Y, Marshall LT, Leal JP, Wahl RL. Clinically significant inaccurate localization of lesions with PET/CT: frequency in 300 patients.[see comment]. Journal of Nuclear Medicine 2003;44(2):240-3
  58. Romer W, Chung M, Chan A, Townsend DW, Torok F, McCook B, et al. Single-detector helical CT in PET-CT: assessment of image quality. AJR American Journal of Roentgenology 2004;182(6): 1571-7 https://doi.org/10.2214/ajr.182.6.1821571
  59. Nehmeh SA, Erdi YE, Ling CC, Rosenzweig KE, Squire OD, Braban LE, et al. Effect of respiratory gating on reducing lung motion artifacts in PET imaging of lung cancer. Med Phys 2002;29(3): 366-71 https://doi.org/10.1118/1.1448824
  60. Hamill JJ, Bosmans G, Dekker A. Respiratory-gated CT as a tool for the simulation of breathing artifacts in PET and PET/CT. Med Phys 2008;35(2):576-85 https://doi.org/10.1118/1.2829875
  61. Nehmeh SA, Erdi YE, Pan T, Pevsner A, Rosenzweig KE, Yorke E, et al. Four-dimensional (4D) PET/CT imaging of the thorax. Med Phys 2004;31(12):3179-86 https://doi.org/10.1118/1.1809778
  62. Chi PC, Mawlawi O, Nehmeh SA, Erdi YE, Balter PA, Luo D, et al. Design of respiration averaged CT for attenuation correction of the PET data from PET/CT. Med Phys 2007;34(6):2039-47 https://doi.org/10.1118/1.2733810
  63. Pan T, Mawlawi O, Luo D, Liu HH, Chi PC, Mar MV, et al. Attenuation correction of PET cardiac data with low-dose average CT in PET/CT. Med Phys 2006;33(10):3931-8 https://doi.org/10.1118/1.2349843
  64. Pan T, Mawlawi O, Nehmeh SA, Erdi YE, Luo D, Liu HH, et al. Attenuation correction of PET images with respiration-averaged CT images in PET/CT. J Nucl Med 2005;46(9):1481-7
  65. Antoch G, Jentzen W, Freudenberg LS, Stattaus J, Mueller SP, Debatin JF, et al. Effect of oral contrast agents on computed tomography-based positron emission tomography attenuation correction in dual-modality positron emission tomography/computed tomography imaging. Invest Radiol 2003;38(12):784-9
  66. Carney JP, Townsend DW, Rappoport V, Bendriem B. Method for transforming CT images for attenuation correction in PET/CT imaging. Med Phys 2006;33(4):976-83 https://doi.org/10.1118/1.2174132
  67. Antoch G, Kuehl H, Kanja J, Lauenstein TC, Schneemann H, Hauth E, et al. Dual-modality PET/CT scanning with negative oral contrast agent to avoid artifacts: introduction and evaluation. Radiology 2004;230(3):879-85 https://doi.org/10.1148/radiol.2303021287
  68. Kamel EM, Burger C, Buck A, von Schulthess GK, Goerres GW. Impact of metallic dental implants on CT-based attenuation correction in a combined PET/CT scanner. Eur Radiol 2003;13(4):724-8 https://doi.org/10.1007/s00330-002-1564-2
  69. Goerres GW, Schmid DT, Eyrich GK. Do hardware artefacts influence the performance of head and neck PET scans in patients with oral cavity squamous cell cancer? Dentomaxillofac Radiol 2003; 32(6):365-71 https://doi.org/10.1259/dmfr/77741718
  70. Mirzaei S, Guerchaft M, Bonnier C, Knoll P, Doat M, Braeutigam P. Use of segmented CT transmission map to avoid metal artifacts in PET images by a PET-CT device. BMC Nucl Med 2005;5(1):3 https://doi.org/10.1186/1471-2385-5-3
  71. ICRP. Managing Patient Dose in Computed Tomography ed J Valentin (Oxford: Pergamon). 2000
  72. ICRP. Radiation Dose to Patients from Radiopharmaceuticals: Addendum 2 to ICRP Publication 53 (Oxford: Pergamon). 1999
  73. Hays MT, Watson EE, Thomas SR, Stabin M. MIRD dose estimate report no. 19: radiation absorbed dose estimates from (18)F-FDG. J Nucl Med 2002;43(2):210-4