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Balancing the tradeoff between radiation dose, acquisition duration and diagnostic image quality is essential for medical imaging modalities involving ionizing radiation. Lower administered activities to the patient can reduce absorbed dose, but can result in reduced diagnostic image quality or require longer acquisition durations. In pediatric nuclear medicine, it is desirable to use the lowest amount of administered radiopharmaceutical activity and the shortest acquisition duration that gives sufficient image quality for clinical diagnosis. However, diagnostic image quality is a complex function of patient factors including body morphometry. In this study, we present a digital population of 90 computational anatomic phantoms that model realistic variations in body morphometry and internal anatomy. These phantoms were used to generate a large database of projection images modeling pediatric SPECT imaging using a 99mTc-DMSA tracer. We used an analytic projection code that models attenuation, spatially varying collimator-detector response, and object-dependent scatter to generate the projections. The projections for each organ were generated separately and can be subsequently scaled by parameters extracted from a pharmacokinetics model to simulate realistic tracer biodistribution, including variations in uptake, inside each relevant organ or tissue structure for a given tracer. Noise-free projection images can be obtained by summing these individual organ projections and scaling by the system sensitivity and acquisition duration. We applied this database in the context of 99mTc-DMSA renal SPECT, the most common nuclear medicine imaging procedure in pediatric patients. Organ uptake fractions based on literature values and patient studies were used. Patient SPECT images were used to verify that the sum of counts in the simulated projection images was clinically realistic. For each phantom, 384 uptake realizations, modeling random variations in the uptakes of organs of interest, were generated, producing 34 560 noise-free projection datasets (384 uptake realizations times 90 phantoms). Noisy images modeling various count levels (corresponding to different products of acquisition duration and administered activity) were generated by appropriately scaling these images and simulating Poisson noise. Acquisition duration was fixed; six count levels were simulated corresponding to projection images acquired using 25%, 50%, 75%, 100%, 125%, and 150% of the original weight-based administrated activity as computed using the North American Guidelines (Gelfand et al 2011 J. Nucl. Med. 52 318–22). Combined, a total number of 207 360 noisy projection images were generated, creating a realistic projection database for use in renal pediatric SPECT imaging research. The phantoms and projection datasets were used to calculate three surrogate indices for factors affecting image quality: renal count density, average radius of rotation, and scatter-to-primary ratio. Differences in these indices were seen across the phantoms for dosing based on current guidelines, and especially for the phantom modeling the newborn. We also performed an image quality study using an anthropomorphic model observer that demonstrates that the weight-based dose scaling does not equalize image quality as measured by the area under the receiver-operating characteristics curve. These studies suggest that a dosing procedure beyond weight-based scaling of administered activities is required to equalize image quality in pediatric renal SPECT. [ABSTRACT FROM AUTHOR]

Published guidelines for administered activity to pediatric patients undergoing diagnostic nuclear medicine imaging are currently obtained through expert consensus of the minimum values as a function of body weight as required to yield diagnostic quality images. We have previously shown that consideration of body habitus is also important in obtaining diagnostic quality images at the lowest administered activity. The objective of this study was to create a series of computational phantoms that realistically portray the anatomy of the pediatric patient population which can be used to develop and validate techniques to minimize radiation dose while maintaining adequate image quality. To achieve this objective, we have defined an imaging risk index that may be used in future studies to develop pediatric patient dosing guidelines. A population of 48 hybrid phantoms consisting of non-uniform B-spline surfaces and polygon meshes was generated. The representative ages included the newborn, 1 year, 5 year, 10 year and 15 year male and female. For each age, the phantoms were modeled at their 10th, 50th, and 90th height percentile each at a constant 50th weight percentile. To test the impact of kidney size, the newborn phantoms were modeled with the following three kidney volumes:  −15%, average, and  +15%. To illustrate the impact of different morphologies on dose optimization, we calculated the effective dose for each phantom using weight-based 99mTc-DMSA activity administration. For a given patient weight, body habitus had a considerable effect on effective dose. Substantial variations were observed in the risk index between the 10th and 90th percentile height phantoms from the 50th percentile phantoms for a given age, with the greatest difference being 18%. There was a dependence found between kidney size and risk of radiation induced kidney cancer, with the highest risk indices observed in newborns with the smallest kidneys. Overall, the phantoms and techniques in this study can be used to provide data to refine dosing guidelines for pediatric nuclear imaging studies while taking into account the effects on both radiation dose and image quality. [ABSTRACT FROM AUTHOR]