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Calibration of 22 gamma camera units was performed at 15 hospitals in southern and western Sweden to estimate 137Cs contamination in humans in a supine static geometry, with a new developed calibration protocol and phantom. The minimum detectable activities (MDAs) and the estimated committed effective doses (CEDs) were calculated for each calibration. Generic calibration factors were calculated for five predetermined groups based on the detector type and manufacturer. Group 1 and 2 included NaI-based gamma cameras from General Electrics (GEs) with a crystal thickness of 5/8′′ and 3/8′′ respectively. Group 3 and 4 included NaI-based gamma cameras from Siemens Healthineers with a crystal thickness of 3/8′′, with a similar energy window as the GE NaI-based cameras and a dual window respectively. Group 5 included semiconductor-based gamma cameras from GE with a CdZnTe (CZT) detector. The generic calibration factors were 60.0 cps kBq−1, 52.3 cps kBq−1, 50.3 cps kBq−1, 53.2 cps kBq−1 and 48.4 cps kBq−1 for group 1, 2, 3, 4, and 5 respectively. The MDAs ranged between 169 and 1130 Bq for all groups, with measurement times of 1–10 min, corresponding to a CED of 4.77–77.6 μ Sv. A dead time analysis was performed for group 1 and suggested a dead time of 3.17 μ s for 137Cs measurements. The dead time analysis showed that a maximum count rate of 232 kcps could be measured in the calibration geometry, corresponding to a CED of 108–263 mSv. It has been shown that semiconductor-based gamma cameras with CZT detectors are feasible for estimating 137Cs contamination. The generic calibration factors derived in this study can be used for gamma cameras of the same models in other hospitals, for measurements in the same measurement geometry. This will increase the measurement capability for estimating internal 137Cs contamination in the recovery phase following radiological or nuclear events. [ABSTRACT FROM AUTHOR]

Background: In recent years, fibroblast activating protein (FAP), a biomarker overexpressed by cancer-associated fibroblasts, has emerged as one of the most promising biomarkers in oncology. Similarly, FAP overexpression has been detected in various fibroblast-mediated inflammatory conditions such as liver cirrhosis and idiopathic pulmonary fibrosis. Along this trajectory, FAP-targeted positron emission tomography (PET), utilizing FAP inhibitors (FAPi) labeled with positron emitters, has gained traction as a powerful imaging approach in both cancer and inflammation. However, PET represents a high-cost technology, and its widespread adoption is still limited compared to the availability of gamma cameras. To address this issue, several efforts have been made to explore the potential of [99mTc]Tc-FAPi tracers as molecular probes for imaging with gamma cameras and single photon emission computed tomography (SPECT). Main body: Several approaches have been investigated for labeling FAPi-based compounds with 99mTc. Specifically, the mono-oxo, tricarbonyl, isonitrile, and HYNIC strategies have been applied to produce [99mTc]Tc-FAPi tracers, which have been tested in vitro and in animal models. Overall, these labeling approaches have demonstrated high efficiency and strong binding. The resulting [99mTc]Tc-FAPi tracers have shown high specificity for FAP-positive cells and xenografts in both in vitro and animal model studies, respectively. However, the majority of [99mTc]Tc-FAPi tracers have exhibited variable levels of lipophilicity, leading to preferential excretion through the hepatobiliary route and undesirable binding to lipoproteins. Consequently, efforts have been made to synthesize more hydrophilic FAPi-based compounds to improve pharmacokinetic properties and achieve a more favorable biodistribution, particularly in the abdominal region. SPECT imaging with [99mTc]Tc-FAPi has yielded promising results in patients with gastrointestinal tumors, demonstrating comparable or superior diagnostic performance compared to other imaging modalities. Similarly, encouraging outcomes have been observed in subjects with gliomas, lung cancer, breast cancer, and cervical cancer. Beyond oncological applications, [99mTc]Tc-FAPi-based imaging has been successfully employed in myocardial and idiopathic pulmonary fibrosis. Conclusions: This overview focuses on the various radiochemical strategies for obtaining [99mTc]Tc-FAPi tracers, highlighting the main challenges encountered and possible solutions when applying each distinct approach. Additionally, it covers the preclinical and initial clinical applications of [99mTc]Tc-FAPi in cancer and inflammation. [ABSTRACT FROM AUTHOR]

Background: The administration of a 166Ho scout dose is available as an alternative to 99mTc particles for pre-treatment imaging in Selective Internal Radiation Therapy (SIRT). It has been reported that the 166Ho scout dose may be more accurate for the prediction of microsphere distribution and the associated therapy planning. The aim of the current study is to compare the scintigraphic imaging characteristics of both isotopes, considering the objectives of the pre-treatment imaging using clinically geared phantoms. Methods: Planar and SPECT/CT images were obtained using a NEMA image quality phantom in different phantom setups and another body-shaped phantom with several inserts. The influence of collimator type, count statistics, dead time effects, isotope properties and patient obesity on spatial resolution, contrast recovery and the detectability of small activity accumulations was investigated. Furthermore, the effects of the imaging characteristics on personalized dosimetry are discussed. Results: The images with 99mTc showed up to 3 mm better spatial resolution, up to two times higher contrast recovery and significantly lower image noise than those with 166Ho. The contrast-to-noise ratio was up to five times higher for 99mTc than for 166Ho. Only when using 99mTc all activity-filled spheres could be distinguished from the activity-filled background. The measurements mimicking an obese patient resulted in a degraded image quality for both isotopes. Conclusions: Our measurements demonstrate better scintigraphic imaging properties for 99mTc compared to 166Ho in terms of spatial resolution, contrast recovery, image noise, and lesion detectability. While the 166Ho scout dose promises better prediction of the microsphere distribution, it is important to consider the inferior imaging characteristics of 166Ho, which may affect individualized treatment planning in SIRT. [ABSTRACT FROM AUTHOR]

The assessment of the concentration and distribution of l6N, derived from 16O in the cooling water exposed to neutron irradiation, is essential for ensuring radiation safety during nuclear reactor operation. The imaging method allows for the visualization of the intensity distribution of these l6N by capturing gamma-rays emitted during their decay process. However, the existing gamma camera is exclusively compatible with gamma-rays below 2 MeV. In this paper, a novel gamma camera featuring a thick double-conical penumbra aperture, a pixelated Lu1.8Y0.2SiO5:Ce scintillator array, and a position-sensitive photomultiplier tube is proposed to address this limitation. This innovative design offers a large field of view (FOV) and is suitable for high energy extended gamma source imaging. The optimization of key parameters of the camera was conducted, and a FOV of 60° and an angular resolution of up to 4.57° were achieved. Imaging simulations, including a simplified model of the primary loop of the pressurized-water reactor by GEANT4 code and image reconstruction using the expectation maximum algorithm, demonstrated that the proposed gamma camera could obtain a satisfactory spatial resolution for diagnosing the distribution of 16N in the primary loop of a nuclear reactor. [ABSTRACT FROM AUTHOR]

Tumor associated fibroblasts (TAFs) play a key role in tumor growth and metastatization. TAFs overexpress different biomarkers that are usually expressed at low levels in physiological conditions. Among them are the fibroblast growth factor receptors (FGFRs) that bind the fibroblast growth factors (FGFs). In particular, the overexpression of FGFR-2c in tumors has been associated with advanced clinical stages and increased metastatization. Here, we developed a non-invasive tool to evaluate, in vivo, the expression of FGFR-2c in metastatic cancer. This is based on 99mTc-labelled FGF-2. Methods: 99mTc-FGF-2 was tested in vitro and in vivo in mice bearing allografts of sarcoma cells. Images of 99mTc-FGF-2 were acquired using a new portable high-resolution ultra-sensitive gamma camera for small animal imaging. Results: FGF-2 was labeled with high specific activity but low labelling efficiency, thus requiring post-labeling purification by gel-filtration chromatography. In vitro binding to 2C human keratinocytes showed a Kd of 3.36 × 10−9 M. In mice bearing J774A.1 cell allografts, we observed high and rapid tumor uptake of 99mTc-FGF-2 with a high Tumor/Blood ratio at 24 h post-injection (26.1 %ID/g and 12.9 %ID) with low kidney activity and moderate liver activity. Conclusions: we labeled FGF-2 with 99mTc and showed nanomolar Kd in vitro with human keratinocytes expressing FGF-2 receptors. In mice, 99mTc-FGF-2 rapidly and efficiently accumulated in tumors expressing FGF-2 receptors. This new radiopharmaceutical could be used in humans to image TAFs. [ABSTRACT FROM AUTHOR]

Purpose: Handheld gamma cameras with coded aperture collimators are under investigation for intraoperative imaging in nuclear medicine. Coded apertures are a promising collimation technique for applications such as lymph node localization due to their high sensitivity and the possibility of 3D imaging. We evaluated the axial resolution and computational performance of two reconstruction methods. Methods: An experimental gamma camera was set up consisting of the pixelated semiconductor detector Timepix3 and MURA mask of rank 31 with round holes of 0.08 mm in diameter in a 0.11 mm thick Tungsten sheet. A set of measurements was taken where a point-like gamma source was placed centrally at 21 different positions within the range of 12–100 mm. For each source position, the detector image was reconstructed in 0.5 mm steps around the true source position, resulting in an image stack. The axial resolution was assessed by the full width at half maximum (FWHM) of the contrast-to-noise ratio (CNR) profile along the z-axis of the stack. Two reconstruction methods were compared: MURA Decoding and a 3D maximum likelihood expectation maximization algorithm (3D-MLEM). Results: While taking 4400 times longer in computation, 3D-MLEM yielded a smaller axial FWHM and a higher CNR. The axial resolution degraded from 5.3 mm and 1.8 mm at 12 mm to 42.2 mm and 13.5 mm at 100 mm for MURA Decoding and 3D-MLEM respectively. Conclusion: Our results show that the coded aperture enables the depth estimation of single point-like sources in the near field. Here, 3D-MLEM offered a better axial resolution but was computationally much slower than MURA Decoding, whose reconstruction time is compatible with real-time imaging. [ABSTRACT FROM AUTHOR]

Aerosol delivery using conventional nebulizers with fixed maximal output rates is limited and unpredictable under high-flow conditions. This study measured regulated aerosol delivery to the lungs of normal volunteers using a nebulizer designed to overcome the limitations of HFNC therapy (i-AIRE (InspiRx, Inc., Somerset, NJ, USA)). This breath-enhanced jet nebulizer, in series with the high-flow catheter, utilizes the high flow to increase aerosol output beyond those of conventional devices. Nine normal subjects breathing tidally via the nose received humidified air at 60 L/min. The nebulizer was connected to the HFNC system upstream to the humidifier and received radio-labeled saline as a marker for drug delivery (99mTc DTPA) infused by a syringe pump (mCi/min). The dose to the subject was regulated at 12, 20 and 50 mL/h. Rates of aerosol deposition in the lungs (µCi/min) were measured via a gamma camera for each infusion rate and converted to µg NaCl/min. The deposition rate, as expressed as µg of NaCl/min, was closely related to the infusion rate: 7.84 ± 3.2 at 12 mL/h, 43.0 ± 12 at 20 mL/h and 136 ± 45 at 50 mL/h. The deposition efficiency ranged from 0.44 to 1.82% of infused saline, with 6% deposited in the nose. A regional analysis indicated peripheral deposition of aerosol (central/peripheral ratio 0.99 ± 0.27). The data were independent of breathing frequency. Breath-enhanced nebulization via HFNC reliably delivered aerosol to the lungs at the highest nasal airflows. The rate of delivery was controlled simply by regulating the infusion rate, indicating that lung deposition in the critically ill can be titrated clinically at the bedside. [ABSTRACT FROM AUTHOR]

Purpose: Radiolabeled PSMA-ligands play a major role in today's nuclear medicine. Since approval of [177Lu]Lu-PSMA-617 for therapy of metastatic prostate cancer, availability of 177Lu became bottleneck of supply due to the high demand. Recently, a theranostic PSMA-ligand, PSMA-GCK01, was developed which can be labeled either diagnostically with 99mTc or therapeutically with 188Re with both nuclides available from well-known generator systems. This novel tracer might aid to overcome aforementioned supply limitations. In this investigation, the biodistribution and general imaging characteristics of [99mTc]Tc-PSMA-GCK01 were compared with the diagnostic reference compound [99mTc]Tc-EDDA/HYNIC-iPSMA in patients with advanced stage prostate cancer. In addition, the binding of both ligands to PSMA was analyzed at the molecular level using molecular docking. Procedures: Two cohorts (n = 19 vs. n = 21) of patients with metastatic castration-resistant prostate cancer matched for age, tumor stage, and Gleason score underwent a planar gamma camera imaging with [99mTc]Tc-EDDA/HYNIC-iPSMA or [99mTc]Tc-PSMA-GCK01 prior to PSMA-ligand therapy for PSMA-phenotyping. The imaging data were retrospective analyzed for salivary gland, kidney, liver, soft tissue, and tumor uptake on a semi-automated ROI-analysis using HERMES Medical Solutions AB (HMS, Sweden). Results: The data sets were semi-automated quantified on a ROI-based analysis. The tumor-to-background presented equal results of [99mTc]Tc-PSMA-GCK01 compared to [99mTc]Tc-EDDA/HYNIC-iPSMA. The physiological PSMA-positive organs like salivary gland presented also equal uptake in counts/MBq (salivary gland median 9.48 [99mTc]Tc-PSMA-GCK01 vs. median 9.11 [99mTc]Tc-EDDA/HYNIC-iPSMA), while liver-to-kidney ratio presented a slight shift to the liver parenchyma using [99mTc]Tc-PSMA-GCK01 (0.83) compared to [99mTc]Tc-EDDA/HYNIC-iPSMA (0.55) with no statistical significance. This is in agreement with the results from the docking study revealing only a minor difference in the docking scores for both ligands. Conclusions: The novel theranostic tracer [99mTc]Tc/[188Re]Re-PSMA-GCK01 demonstrates comparable general imaging characteristic with the reference compound [99mTc]Tc-EDDA/HYNIC-iPSMA. These results pave the way for the PSMA-targeting imaging and theranostic agents for a broader, rather low-cost, generator applied radio-ligand therapy utilization. [ABSTRACT FROM AUTHOR]

The pinhole gamma camera is a simple and useful device for determining the radiation distribution in a certain region. Using this device, we developed a method to measure the distribution of 137Cs contamination density on surfaces using the total energy absorption peak count rate of gamma rays, where each camera pixel was projected onto the surface to determine the corresponding measured area and distance to the surface. We applied this method to measure the 137Cs contamination density of the wall, ceiling, and floor of the Unit 2 Operation Floor at the Fukushima Daiichi Nuclear Power Station in 2020 and 2022 and compared the results obtained in 2020 to those of a robot-operated, conventional, high-dose-area smear test. We found a pinhole gamma camera with the proposed method is useful for obtaining contamination density distribution results quickly, without the complexities of using a robot. [ABSTRACT FROM AUTHOR]

Purpose. Study the effects of 13-cis-retinoic acid (13-RA), a synthetic analogue of a vitamin A used for the treatment of severe acne, on the blood flow in the rat brain using technetium-99m hexamethyl propylene amine oxime (99mTc-HMPAO) imaging. Methods. A total of 30 adult male Wistar rats were divided into the control (C), low-dose (L), and high-dose (H) groups. The L and H rats were exposed subcutaneously to 0.3 and 0.5 mg, respectively, of 13-RA per kg of body weight for seven days. Brain blood flow imaging was performed using a gamma camera. Then, a region of interest (ROI) around the brain (target, T), a whole-body region (WB), and a background region (BG) was selected and delimited. The net 99mTc-HMPAO brain counts were calculated as the net target counts, NTC = T − BG / WB − BG in all groups. At the end of the 99mTc-HMPAO brain blood flow imaging, the brain, heart, kidney, lung, and liver were rapidly removed, and their uptake was determined. Brain histopathological analysis was performed using hematoxylin and eosin stains. In addition, the plasma fatty acids were studied using gas chromatography/mass spectrometry. Results. There were highly significant differences between L and H in comparison to C and across the groups. The 99mTc-HMPAO radioactivity in the brain showed increased uptake in a dose-dependent manner. There were also significant changes in the brain tissues and decreased free fatty acids among the groups compared to C. Conclusion. 13-RA increases 99mTcHMPAO brain perfusion, uptake, and function and reduces fatty acids. [ABSTRACT FROM AUTHOR]

Artifacts in nuclear medicine imaging are not uncommon. We are aware of some of these, for which we follow necessary protocols to avoid them. However, there are some unusual and unavoidable artifacts that we come across in daily imaging, which may be of concern and need to be detected and corrected on time. Hence, sharing a few such unusual artifacts we encountered while performing routine studies on positron emission tomography-computed tomography and gamma cameras, evaluating the cause and possible precautions. [ABSTRACT FROM AUTHOR]

Background: A novel semiconductor cadmium zinc telluride (CZT) gamma camera system using a block sequential regularized expectation maximization (BSREM) reconstruction algorithm is now clinically available. Here we investigate how a multi‐purpose ring‐configurated CZT system can be safely applied in clinics and describe the initial optimization process. Method: Seventy‐six patients (bone‐, cardiac‐ and lung scan) were scanned on a conventional gamma camera (planar and/or single‐photon emission computed tomography [SPECT]/SPECT‐CT) used in clinical routine and on the ring‐configurated CZT camera Starguide (GE Healthcare). These data were used to validate and optimize the Starguide system for routine clinical use. Results: Comparable image quality for the Starguide system, to that of the conventional gamma camera, was achieved for bone scan (4 min/bed position [BP] using a relative difference prior [RDP] with gamma 2 and beta 0.4, along with 10 iterations and 10 subsets), cardiac scan (8 min [stress] and 3 min 20 s [rest] using median root prior [MRP] with beta 0.07 non attenuation corrected and 0.008 attenuation corrected and 50 interations and 10 subsets for both stress and rest) and lung scan (10 min [vent] and 5 min [perf] using RDP with gamma 0.5 and beta 0.03 [vent] and 0.02 [perf] and 20 interations and 10 subsets for both vent and perf). Conclusions: It was possible to transition from a conventional gamma camera to the Starguide system as part of the clinical routine, with acceptable image quality. Images from the Starguide system were deemed to be at least as good as those from a conventional gamma camera. [ABSTRACT FROM AUTHOR]

This paper presents a machine learning-based technique for interpreting bone scintigraphy images, focusing on feature extraction and introducing a new feature selection method called GJOW. GJOW enhances the effectiveness of the golden jackal optimization (GJO) algorithm by integrating operators from the whale optimization algorithm (WOA). The technique's performance is evaluated through extensive experiments using 18 benchmark datasets and 581 bone scan images obtained from a gamma camera, including 362 abnormal and 219 normal cases. The results highlight the superior predictive effectiveness of the GJOW algorithm in bone metastasis detection, achieving an accuracy of 71.79% and specificity of 91.14%. The contributions of this study include the introduction of a new machine learning-based approach for detecting bone metastasis using gamma camera scans, leading to improved accuracy in identifying bone metastases. The findings have practical implications for early detection and intervention, potentially improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: The location and proximity to the spinal cord in spinal osteoid osteoma can increase the likelihood of an incomplete resection. Intraoperative bone scintigraphy (IOBS) can be used to verify location and complete surgical resection. Objective: To review our experience using IOBS for resection of intraspinal osteoid osteoma. Methods: IRB approved, retrospective review of IOBS-guided resection over 10 years. Patients underwent injection of 200 uCi/kg (1–20 mCi) 99mTc-MDP 3–4 h prior surgery. Portable single-headed gamma camera equipped with a pinhole collimator (3- or 4-mm aperture) was used. Images were obtained pre-operatively, at the start of the procedure, and intraoperatively. Operative notes were reviewed. Evaluation of recurrence and clinical follow-up was performed. Results: Twenty IOBS-guided resections were performed in 18 patients (median age 13.5 years, 6–22 years, 12 males). Size ranged 5–16 mm, with 38.9% (7/18) cervical, 22.2% (4/18) thoracic, 22.2% (4/18) lumbar, and 16.7% (3/18) sacral. In all cases, IOBS was able to localize the lesion. After suspected total excision, IOBS altered the surgical plan in 75% of cases (15/20), showing residual activity prompting further resection. Median length of follow-up was 6 months (range 1–156 months) with 90% (18/20) showing complete resection without recurrence. Two patients had osteoid osteoma recurrence at 7 and 10 months following the original resection, requiring re-intervention. Conclusions: IOBS is a useful tool for real-time localization and assessment of spinal osteoid osteoma resection. In all cases, IOBS was able to localize the lesion and changed surgical planning in 75% of cases. Ninety percent of patients achieved complete resection and remain recurrence free. [ABSTRACT FROM AUTHOR]

Primary hyperparathyroidism secondary to ectopic parathyroid (in anterior mediastinum) is rare in children. We report the case of a 12-year-old girl with a history of multiple fractures, renal calculi and limb deformities. She was diagnosed with hyperparathyroidism secondary to an intrathymic parathyroid adenoma. Sestamibi scan showed a lesion in the anterior mediastinum. A biochemical evaluation revealed hypercalcaemia, elevated alkaline phosphatase and parathormone levels. The lesion was marked with radioisotope and confirmed intraoperatively using a gamma camera. The child underwent thoracoscopic left thymectomy with the adenoma. Immediate decrease in calcium and parathyroid hormone values were noted intraoperatively and serial monitoring showed a downward trend. On follow-up, the child is doing well. Ectopic parathyroid adenoma is very rare. CT with radioisotope scans is helpful in diagnosis. Thoracoscopic excision of ectopic adenoma is safe in children. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to investigate the quantification performance of a 360° CZT camera for 177Lu-based treatment monitoring. Methods: Three phantoms with known 177Lu activity concentrations were acquired: (1) a uniform cylindrical phantom for calibration, (2) a NEMA IEC body phantom for analysis of different-sized spheres to optimise quantification parameters and (3) a phantom containing two large vials simulating organs at risk for tests. Four sets of reconstruction parameters were tested: (1) Scatter, (2) Scatter and Point Spread Function Recovery (PSFR), (3) PSFR only and (4) Penalised likelihood option and Scatter, varying the number of updates (iterations × subsets) with CT-based attenuation correction only. For each, activity concentration (ARC) and contrast recovery coefficients (CRC) were estimated as well as root mean square. Visualisation and quantification parameters were applied to reconstructed patient image data. Results: Optimised quantification parameters were determined to be: CT-based attenuation correction, scatter correction, 12 iterations, 8 subsets and no filter. ARC, CRC and RMS results were dependant on the methodology used for calculations. Two different reconstruction parameters were recommended for visualisation and for quantification. 3D whole-body SPECT images were acquired and reconstructed for 177Lu-PSMA patients in 2–3 times faster than the time taken for a conventional gamma camera. Conclusion: Quantification of whole-body 3D images of patients treated with 177Lu-PSMA is feasible and an optimised set of parameters has been determined. This camera greatly reduces procedure time for whole-body SPECT. [ABSTRACT FROM AUTHOR]

Background: Current guidelines of the radioiodine uptake (RAIU) test allow the use of different equipment, isotopes, activity and region-of-interest (ROI). We evaluated presence and extent of these differences in clinical practice and evaluated the effect of some of these variations on RAIU outcomes. Also, gamma camera-specific reference standards were calculated and retrospectively compared with measurements obtained during clinical RAIU tests. Materials and methods: First, questionnaires were sent to Dutch nuclear medicine departments requesting information about equipment usage, isotope, isotope formulation, activity and measurement techniques. Secondly, a neck phantom containing a range of activities in capsule or water-dissolved formulation was scanned. Counts were measured using automatic ROI, square box ROI or all counts in the image. Thirdly, clinical RAIU data were collected during 2015–2018 using three different gamma cameras. Reference standards for each scanner were calculated using regression analysis between reference activity and measured counts. Uptake measurements using this gamma camera-specific reference standard were compared with original measurements. Results: The survey demonstrated significant differences in isotope, isotope formulation, activity, use of neck phantoms, frequency and duration of reference measurements, distance to collimator, use of background measurements and ROI delineation. The phantom study demonstrated higher counts for the water-dissolved formulation than capsules using both automatic and square box ROI. Also, higher counts were found using a square box ROI than an automatic ROI. The retrospective study showed feasibility of RAIU calculations using camera-specific reference standards and good correlation with the original RAIU measurements. Conclusions: This study demonstrated considerable technical variation in RAIU measurement in clinical practice. The phantom study demonstrated that these differences could result in differences in count measurements, potentially resulting in different dose calculations for radioactive iodine therapy. Retrospective data suggest that camera-specific reference standards may be used instead of individual reference measurements using separate activity sources, which may thus eliminate some sources of variation. [ABSTRACT FROM AUTHOR]

This paper presents a machine learning-based technique for interpreting bone scintigraphy images, focusing on feature extraction and introducing a new feature selection method called GJOW. GJOW enhances the effectiveness of the golden jackal optimization (GJO) algorithm by integrating operators from the whale optimization algorithm (WOA). The technique's performance is evaluated through extensive experiments using 18 benchmark datasets and 581 bone scan images obtained from a gamma camera, including 362 abnormal and 219 normal cases. The results highlight the superior predictive effectiveness of the GJOW algorithm in bone metastasis detection, achieving an accuracy of 71.79% and specificity of 91.14%. The contributions of this study include the introduction of a new machine learning-based approach for detecting bone metastasis using gamma camera scans, leading to improved accuracy in identifying bone metastases. The findings have practical implications for early detection and intervention, potentially improving patient outcomes. [ABSTRACT FROM AUTHOR]

Glomerular filtration rates for individual kidneys can be measured semi-quantitatively by a gamma camera using [99mTc]Tc-DTPA, with limited diagnostic accuracy. A more precise measurement can be performed on a PET/CT scanner using the radiotracer [68Ga]Ga-EDTA, which has been validated in animal studies. The purpose of this study was to develop an easy kit-based synthesis of [68Ga]Ga-EDTA that is compliant with good manufacturing practice (GMP) and applicable for human use. The production of the cold kit and its labeling were validated, as were the radiochemical purity measurement and analytical procedures for determining the Na2EDTA dihydrate content in the kits. In this study, we validated a GMP kit for the simple production of [68Ga]Ga-EDTA, with the intention of applicability for human use. [ABSTRACT FROM AUTHOR]

Purpose: The preferred nuclear medicine method for identification of hyperfunctioning parathyroid glands in hyperparathyroidism (HPT) develops continuously in relation to the technological progress. Diagnostic methods based on PET/CT have during recent years evolved with new tracer possibilities competing with traditional scintigraphic methods. This investigation is a head-to-head comparison of Tc-99m-sestamibi SPECT/CT gamma camera scintigraphy (sestamibi SPECT/CT) and C-11-L-methionin PET/CT imaging (methionine PET/CT) for preoperative identification of hyperfunctioning parathyroid glands. Procedures: The study is a prospective cohort study including 27 patients diagnosed with primary hyperparathyroidism (PHPT). Two nuclear medicine physicians assessed all examinations independently and blinded. All scanning assessments were matched to the final surgical diagnosis as confirmed by histopathology. Biochemical monitoring of the therapeutical effects was performed preoperatively by PTH-measurements and followed postoperatively for up to 12 months. Comparisons were made for differences in sensitivity and positive predictive value (PPV). Results: Twenty-seven patients (18 females, 9 males; mean age (range): 58.9 years (34.1–79)) were enrolled into the study. The 27 patients had a total of 33 identified sites of lesions of which 28 (85%) turned out to be histopathological verified hyperfunctioning parathyroid glands. The sensitivity and PPV for sestamibi SPECT/CT were 0.71 and 0.95; that of methionine PET/CT was 0.82 and 1, respectively. Both sensitivity and PPV were slightly lower for sestamibi SPECT/CT than for methionine PET PET/CT (−0.11, 95% confidence interval (95% CI): −0.29 to 0.08; −0.05, 95% CI: −0.14 to 0.04, respectively), but not to a statistically significant extent (p=0.38 and p=0.31). The sensitivity and PPV for diagnostic CT were 0.64 (95% CI: 0.44 to 0.81) and 1 (95% CI: 0.81 to 1). Conclusions: Methionine PET/CT performed comparable to sestamibi SPECT/CT with respect to identification and localization of hyperfunctioning parathyroid glands prior to surgery. [ABSTRACT FROM AUTHOR]

Purpose: The main objective of this study was to evaluate the ability of a large field Cadmium Zinc Telluride (CZT) camera to estimate thyroid uptake (TU) on single photon emission computed tomography (SPECT) images with and without attenuation correction (Tomo-AC and Tomo-NoAC) compared with Planar acquisition in a series of 23 consecutive patients. The secondary objective was to determine radiation doses for the tracer administration and for the additional Computed Tomography (CT) scan. Methods: Cross-calibration factors were determined using a thyroid phantom, for Planar, Tomo-AC and Tomo-NoAC images. Then Planar and SPECT/CT acquisitions centered on the thyroid were performed on 5 anthropomorphic phantoms with activity ranging from 0.4 to 10 MBq, and 23 patients after administration of 79.2 ± 3.7 MBq of [99mTc]-pertechnetate. We estimated the absolute thyroid activity (AThA) for the anthropomorphic phantoms and the TU for the patients. Radiation dose was also determined using International Commission on Radiological Protection (ICRP) reports and VirtualDoseTMCT software. Results: Cross-calibration factors were 66.2 ± 4.9, 60.7 ± 0.7 and 26.5 ± 0.3 counts/(MBq s), respectively, for Planar, Tomo-AC and Tomo-NoAC images. Theoretical and estimated AThA for Planar, Tomo-AC and Tomo-NoAC images were statistically highly correlated (r < 0.99; P < 10–4) and the average of the relative percentage difference between theoretical and estimated AThA were (8.6 ± 17.8), (− 1.3 ± 5.2) and (12.8 ± 5.7) %, respectively. Comparisons between TU based on different pairs of images (Planar vs Tomo-AC, Planar vs Tomo-NoAC and Tomo-AC vs Tomo-NoAC) showed statistically significant correlation (r = 0.972, 0.961 and 0.935, respectively; P < 10–3). Effective and thyroid absorbed doses were, respectively (0.34CT + 0.95NM) mSv, and (3.88CT + 1.74NM) mGy. Conclusion: AThA estimation using Planar and SPECT/CT acquisitions on a new generation of CZT large-field cameras is feasible. In addition, TU on SPECT/CT was as accurate as conventional planar acquisition, but the CT induced additional thyroid exposure. Trial registration Name of the registry: Thyroid Uptake Quantification on a New Generation of Gamma Camera (QUANTHYC). Trial number: NCT05049551. Registered September 20, 2021—Retrospectively registered, https://clinicaltrials.gov/ct2/show/record/NCT05049551?cntry=MC&draw=2&rank=4. [ABSTRACT FROM AUTHOR]

One of the main activities of the nuclear industry is the characterisation of radioactive waste based on the detection of gamma radiation. Large volumes of radioactive waste are classified according to their average activity, but often the radioactivity exceeds the maximum allowed by regulators in specific parts of the bulk. In addition, the detection of the radiation is currently based on static detection systems where the geometry of the bulk is fixed and well known. Furthermore, these systems are not portable and depend on the transport of waste to the places where the detection systems are located. However, there are situations where the geometry varies and where moving waste is complex. This is especially true in compromised situations.We present a new model for nuclear waste management based on a portable and geometry-independent tomographic system for three-dimensional image reconstruction for gamma radiation detection. The system relies on a combination of a gamma radiation camera and a visible camera that allows to visualise radioactivity using augmented reality and artificial computer vision techniques. This novel tomographic system has the potential to be a disruptive innovation in the nuclear industry for nuclear waste management. [ABSTRACT FROM AUTHOR]

Background: The Cubresa Spark is a novel benchtop silicon-photomultiplier (SiPM)-based preclinical SPECT system. SiPMs in SPECT significantly improve resolution and reduce detector size compared to preclinical cameras with photomultiplier tubes requiring highly magnifying collimators. The NEMA NU 1 Standard for Performance Measurements of Gamma Cameras provides methods that can be readily applied or extended to characterize preclinical cameras with minor modifications. The primary objective of this study is to characterize the Spark according to the NEMA NU 1-2018 standard to gain insight into its nuclear medicine imaging capabilities. The secondary objective is to validate a GATE Monte Carlo simulation model of the Spark for use in preclinical SPECT studies. Methods: NEMA NU 1-2018 guidelines were applied to characterize the Spark's intrinsic, system, and tomographic performance with single- and multi-pinhole collimators. Phantoms were fabricated according to NEMA specifications with deviations involving high-resolution modifications. GATE was utilized to model the detector head with the single-pinhole collimator, and NEMA measurements were employed to tune and validate the model. Single-pinhole and multi-pinhole SPECT data were reconstructed with the Software for Tomographic Image Reconstruction and HiSPECT, respectively. Results: The limiting intrinsic resolution was measured as 0.85 mm owing to a high-resolution SiPM array combined with a 3 mm-thick scintillation crystal. The average limiting tomographic resolution was 1.37 mm and 1.19 mm for the single- and multi-pinhole collimators, respectively, which have magnification factors near unity at the center of rotation. The maximum observed count rate was 15,400 cps, and planar sensitivities of 34 cps/MBq and 150 cps/MBq were measured at the center of rotation for the single- and multi-pinhole collimators, respectively. All simulated tests agreed well with measurement, where the most considerable deviations were below 7%. Conclusions: NEMA NU 1-2018 standards determined that a SiPM detector mitigates the need for highly magnifying pinhole collimators while preserving detailed information in projection images. Measured and simulated NEMA results were highly comparable with differences on the order of a few percent, confirming simulation accuracy and validating the GATE model. Of the collimators initially provided with the Spark, the multi-pinhole collimator offers high resolution and sensitivity for organ-specific imaging of small animals, and the single-pinhole collimator enables high-resolution whole-body imaging of small animals. [ABSTRACT FROM AUTHOR]

Objective(s): The prevalence of coronary artery disease (CAD) is high in patients with epilepsy using antiepileptic drugs (AED). Epilepsy, AED, or the type and duration of AED use, may contribute to higher CAD risk. In this study, myocardial perfusion imaging (MPI) was compared between patients using carbamazepine and valproate. Method: Out of 73 patients receiving carbamazepine or valproate monotherapy for more than 2 years, visited at a tertiary referral clinic, 32 patients participated in a 2-day stress and rest phases MPI. For each phase, 15-25 mCi 99mTc-MIBI was injected, at peak exercise or by pharmacologic stimulation for the stress phase. SPECT with cardiac gating was done by a dual-head gamma camera and processed and quantified. Scans with at least one definite reversible hypo-perfusion segment were considered abnormal. Results: Seventeen patients received carbamazepine monotherapy and 15 valproates. Age and duration of AED use were similar between the groups. Two scans were abnormal (6.3%) both in valproate group (13.3%). Duration of AED use was higher in patients with abnormal scans. In patients receiving monotherapy >2 years, the frequency of abnormal MPI was similar between groups (P-value=0.12). In patients receiving monotherapy > 5 years, prevalence of abnormal MPI was higher in the valproate group (28.6% vs. 0.0%; P-value=0.042). Considering valproate subgroup, ischemic patients had higher duration of AED use, comparing with the normal patients (17.0±4.2 vs. 6.4±4.8, P-value=0.014). Conclusion: MPIs were abnormal in patients receiving valproate after 5 years compared to patients receiving carbamazepine. Long-term valproate use may increase the risk of CAD. [ABSTRACT FROM AUTHOR]

Pulmonary carcinoids (PCs) are part of a spectrum of well-differentiated neuroendocrine neoplasms (NENs) and are classified as typical carcinoid (TC) and atypical carcinoid (AC). TC differ from AC not only for its histopathological features but also for its "functional imaging pattern" and prognosis. ACs are more undifferentiated and characterized by higher aggressiveness. Positron emission tomography/computed tomography (PET/CT) with somatostatin analogs (SSA) labeled with Gallium-68 (68Ga-DOTA-TOC, 68Ga-DOTA-NOC, 68Ga-DOTA-TATE) has widely replaced conventional imaging with gamma camera using 111In- or 99mTc-labelled compounds and represents now the gold standard for diagnosis and management of NENs. In this setting, as already described for gastro-entero-pancreatic NENs, 18F-Fluorodeoxiglucose ([18F]FDG) in addition to 68Ga-SSA can play an important role in clinical practice, particularly for ACs that show a more aggressive behavior compared to TCs. The aim of this systematic review is to analyze all original studies collected from the PubMed and Scopus databases regarding PCs in which both 68Ga-SSA PET/CT and [18F]FDG PET/CT were performed in order to evaluate the clinical impact of each imaging modality. The following keywords were used for the research: "18F, 68Ga and (bronchial carcinoid or carcinoid lung)". A total of 57 papers were found, of which 17 were duplicates, 8 were reviews, 10 were case reports, and 1 was an editorial. Of the remaining 21 papers, 12 were ineligible because they did not focus on PC or did not compare 68Ga-SSA and [18F]FDG. We finally retrieved and analyzed nine papers (245 patients with TCs and 110 patients with ACs), and the results highlight the importance of the combined use of 68Ga-SSA and [18F]FDG PET/CT for the correct management of these neoplasms. [ABSTRACT FROM AUTHOR]

Purpose: We investigated the design of a prompt gamma camera for real‐time dose delivery verification and the partial mitigation of range uncertainties. Methods: A slit slat (SS) camera was optimized using the trade‐off between the signal‐to‐noise ratio and spatial resolution. Then, using the GATE Monte Carlo package, the camera performances were estimated by means of target shifts, beam position quantification, changing the camera distance from the beam, and air cavity inserting. A homogeneous PMMA phantom and the air gaps induced PMMA phantom were used. The air gaps ranged from 5 mm to 30 mm by 5 mm increments were positioned in the middle of the beam range. To reduce the simulation time, phase space scoring was used. The batch method with five realizations was used for stochastic error calculations. Results: The system's detection efficiency was 1.1×10−4PGsEmittedPGs(1.8×10−5$1.1 \times {10}^{-4}\frac{{\rm PGs}}{{\rm Emitted}\ {\rm PGs}}\ (1.8 \times {10}^{-5}$ PGs/proton) for a 10 × 20 cm2 detector (source‐to‐collimator distance = 15.0 cm). Axial and transaxial resolutions were 23 mm and 18 mm, respectively. The SS camera estimated the range as 69.0 ± 3.4 (relative stochastic error 1‐sigma is 5%) and 67.6 ± 1.8 mm (2.6%) for the real range of 67.0 mm for 107 and 108 protons of 100 MeV, respectively. Considering 160 MeV, these values are 155.5 ± 3.1 (2%) and 152.2 ± 2.0 mm (1.3%) for the real range of 152.0 mm for 107 and 108 protons, respectively. Considering phantom shift, for a 100 MeV beam, the precision of the quantification (1‐sigma) in the axial and lateral phantom shift estimation is 2.6 mm and 1 mm, respectively. Accordingly, the axial and lateral quantification precisions were 1.3 mm and 1 mm for a 160 MeV beam, respectively. Furthermore, the quantification of an air gap formulated as gapdet=0.98×gapreal${{\rm gap}}_{det}=0.98 \times {{\rm gap}}_{{\rm real}}$, where gapdet${{\rm gap}}_{det}$ and gapreal are the estimated and real air gap, respectively. The precision of the air gap quantification is 1.6 mm (1 sigma). Moreover, 2D PG images show the trajectory of the proton beam through the phantom. Conclusion: The proposed slit‐slat imaging systems can potentially provide a real‐time, in‐vivo, and non‐invasive treatment monitoring method for proton therapy. [ABSTRACT FROM AUTHOR]

Sentinel lymph node biopsy (SLNB) is a standard practice for staging cutaneous melanoma. High false-negative rates have an increased interest in adjunctive techniques for localizing SLNs. Mobile gamma cameras (MGCs) represent potential tools to enhance SLNB performance. An institutional review board approval was obtained for this study (ClinicalTrials.gov ID NCT01531608). After obtaining informed consent, 20 eligible melanoma patients underwent 99mTc sulfur colloid injection and standard lymphoscintigraphy with a fixed gamma camera (FGC). A survey using a 20 cm square MGC, performed immediately preoperatively by the study surgeon, was used to establish an operative plan while blinded to the FGC results. Subsequently, SLNB was performed using a gamma probe and a novel 6 cm diameter handheld MGC. A total of 24 SLN basins were detected by FGC. Prior to unblinding, all 24 basins were identified with the preoperative MGC and the operative plan established by preoperative MGC imaging was confirmed accurate by review of the FGC images. All individual sentinel lymph nodes were identified during intraoperative MGC imaging, and in 5/24 (21%) cases, surgeon-reported additional clinically useful information was obtained from the MGC. Preoperative MGC images provide information consistent with FGC images for planning SLNB and in some cases provide additional information that aided in surgical decision-making. [ABSTRACT FROM AUTHOR]

Purpose: Monte Carlo (MC) simulation in Nuclear Medicine is a powerful tool for modeling many physical phenomena which are difficult to track or measure directly. MC simulation in SPECT/CT imaging is particularly suitable for optimizing the quantification of activity in a patient, and, consequently, the absorbed dose to each organ. To do so, validating MC results with real data acquired with gamma camera is mandatory. The aim of this study was the validation of the calibration factor (CF) and the recovery coefficient (RC) obtained with SIMIND Monte Carlo code for modeling a Siemens Symbia Intevo Excel SPECT-CT gamma camera to ensure optimal 99 m Tc and 177 Lu SPECT quantification. Methods: Phantom experiments using 99 m Tc and 177 Lu have been performed to measure spatial resolution and sensitivity, as well as to evaluate the CF and RC from acquired data. The geometries used for 2D planar imaging were (1) Petri dish and (2) capillary source while for 3D volumetric imaging were (3) a uniform filled cylinder phantom and (4) a Jaszczack phantom with spheres of different volumes. The experimental results have been compared with the results obtained from Monte Carlo simulations performed in the same geometries. Results: Comparison shows good accordance between simulated and experimental data. The measured planar spatial resolution was 8.3 ± 0.8 mm for 99 m Tc and 11.8±0.6 mm for 177 Lu. The corresponding data obtained by SIMIND for 99 m Tc was 7.8±0.1 mm, while for 177 Lu was 12.4±0.4 mm. The CF was 110.1±5.5 cps/MBq for Technetium and 18.3±1.0 cps/MBq for Lutetium. The corresponding CF obtained by SIMIND for 99 m Tc was 107.3±0.3 cps/MBq, while for 177 Lu 20.4±0.7 cps/MBq. Moreover, a complete curve RCs vs Volume (ml) both for Technetium and Lutetium was determined to correct the PVE for all volumes of clinical interest. In none of the cases, a RC coefficient equal to 100 was found. Conclusions: The validation of quantification parameters shows that SIMIND can be used for simulating both gamma camera planar and SPECT images of Siemens Symbia Intevo using 99 m Tc and 177 Lu radionuclides for different medical purposes and treatments. [ABSTRACT FROM AUTHOR]

OBJECTIVE Limb lymphedema in horses can be debilitating and painful. Pneumatic compression therapy has shown significant benefits for people suffering from lymphedema. The objective of this study was to determine the effect of a novel, equine-specific pneumatic compression device on the lymphatic flow of healthy horse forelimbs as determined by Tc-99m sulfur colloid lymphoscintigraphy. ANIMALS 6 healthy Thoroughbreds. PROCEDURES In a randomized crossover design, horses underwent bilateral forelimb lymphoscintigraphy following subcutaneous injection of Tc-99m sulfur colloid at the coronary band as untreated control or with pneumatic compression therapy using the EQ Press. Lateral, static images were obtained of the distal limb (time 0 to 60 minutes) and proximal limb (time 30 to 60 minutes) using a standard gamma camera. Lymphatic flow was determined by assigning a score to the time point at which Tc-99m sulfur colloid was first visualized at the level of the accessory carpal bone (1 to 7) in the distal limb and the cubital lymph node (1 to 4) in the proximal limb. RESULTS EQ Press treatment led to a significantly faster lymphatic flow of Tc-99m sulfur colloid to the predetermined ana- tomic locations of the accessory carpal bone (P = .002) in the distal limb and the cubital lymph node (P = .001) in the proximal limb. CLINICAL RELEVANCE Pneumatic compression therapy as provided by an equine-specific device encouraged lymphatic flow in healthy, nonedematous equine forelimbs. These data support further study of the EQ Press for pneumatic compression therapy in horses clinically affected by lymphedema and lymphatic drainage disorders. [ABSTRACT FROM AUTHOR]

Planar whole-body bone scanning (WBS) is widely used to evaluate skeletal lesions seen in cancer and noncancer cases. Frequently, degenerative, or other benign bony changes may give rise to indeterminate lesions that mimic bone metastases. In the post-COVID-19 era, there is an evolutionary phase that puts importance on global development and adaptability, which encompasses to include nuclear medicine practices worldwide. Single-photon emission computed tomography/computed tomography (SPECT/CT) can be used to improve the characterization of these lesions and help to resolve the diagnostic conundrum while reducing the need for patients to undergo multiple different examinations at various imaging departments. The fusion of SPECT and CT allows morphological characterization of functional abnormality detected by focal tracer uptake on planar scintigraphy, which provides a one-stop center imaging in nuclear medicine departments. The objective of this study was to review the diagnostic accuracy of SPECT/CT in diagnosing bone metastases in a variety of oncology and nononcology cases and to determine the feasibility of performing bone SPECT/CT in all suspected cancer cases, including cases of bone infection instead of planar imaging alone. The utilization of hybrid SPECT/CT in indeterminate bone lesions detected on planar WBS can significantly increase the diagnostic confidence and accuracy of image interpretation. Recognition of patterns of disease identified using hybrid imaging can improve the management of patients with potentially lower costs in the long term. Currently, hybrid SPECT/CT machines are becoming a norm in nuclear medicine departments, thus potentially making single planar application machines obsolete in the near future. We hypothesize that in the interest of providing a meaningful interpretation of isotope bone scans, the default protocol should involve the option of acquiring SPECT/CT images rather than relying on whole-body scans only. Departments choosing to upgrade existing equipment or those choosing to invest in only one gamma camera should proactively opt for hybrid SPECT/CT systems. [ABSTRACT FROM AUTHOR]

Purpose: Preclinical aerosol studies using animals are essential for evaluating toxic or therapeutic effects on human respiratory tract. Macaques are relevant animal models for respiratory studies, but they are sensitive, expensive and difficult-to-access. Methods: In the context of preliminary studies before animal experiments, we set up an alternative in vitro anatomical model of macaque airways to reduce, refine and replace (3Rs) the animals. We printed an in vitro anatomical cast until the third bronchial division from X-ray computed tomography data of a healthy cynomolgus macaque. This in vitro model was then connected to a respiratory pump to mimic macaque's breathing. We assessed the relevance of this in vitro model, by comparing aerosol deposition patterns obtained with the anatomical model and in three macaques using planar gamma camera imaging. DTPA-99mTechnetium aerosols were produced using three jet nebulizers, generating three different particle sizes: 13.1, 3.2 and 0.93 µm in terms of the mass median aerodynamic diameter (MMAD). Results: The data showed no statistical differences between the animal and anatomical in vitro models in terms of total aerosol deposited in the airways. However, the distribution of the deposition in the airways showed a higher deposited fraction in the upper respiratory tract in the animals than the in vitro model for all particle sizes. Conclusions: The anatomical printed model appears to be a relevant in vitro tool to predict total aerosol deposition in macaque airways. [ABSTRACT FROM AUTHOR]

Purpose. Study the effects of 13-cis-retinoic acid (13-RA), a synthetic analogue of a vitamin A used for the treatment of severe acne, on the blood flow in the rat brain using technetium-99m hexamethyl propylene amine oxime (99mTc-HMPAO) imaging. Methods. A total of 30 adult male Wistar rats were divided into the control (C), low-dose (L), and high-dose (H) groups. The L and H rats were exposed subcutaneously to 0.3 and 0.5 mg, respectively, of 13-RA per kg of body weight for seven days. Brain blood flow imaging was performed using a gamma camera. Then, a region of interest (ROI) around the brain (target, T), a whole-body region (WB), and a background region (BG) was selected and delimited. The net 99mTc-HMPAO brain counts were calculated as the net target counts, NTC = T − BG / WB − BG in all groups. At the end of the 99mTc-HMPAO brain blood flow imaging, the brain, heart, kidney, lung, and liver were rapidly removed, and their uptake was determined. Brain histopathological analysis was performed using hematoxylin and eosin stains. In addition, the plasma fatty acids were studied using gas chromatography/mass spectrometry. Results. There were highly significant differences between L and H in comparison to C and across the groups. The 99mTc-HMPAO radioactivity in the brain showed increased uptake in a dose-dependent manner. There were also significant changes in the brain tissues and decreased free fatty acids among the groups compared to C. Conclusion. 13-RA increases 99mTcHMPAO brain perfusion, uptake, and function and reduces fatty acids. [ABSTRACT FROM AUTHOR]

[Display omitted] Knowledge regarding the gastrointestinal physiology after sleeve gastrectomy and Roux-en-Y gastric bypass is urgently needed to understand, prevent and treat the nutritional and pharmacological complications of bariatric surgery. To investigate the effect of sleeve gastrectomy and Roux-en-Y gastric bypass on gastrointestinal motility (e.g., transit and pressure), pH, and intestinal bile acid concentration. An exploratory cross-sectional study was performed in six participants living with obesity, six participants who underwent sleeve gastrectomy, and six participants who underwent Roux-en-Y gastric bypass. During the first visit, a wireless motility capsule (SmartPill©) was ingested after an overnight fast to measure gastrointestinal transit, pH, and pressure. During the second visit, a gastric emptying scintigraphy test of a nutritional drink labeled with 99mTc-colloid by a dual-head SPECT gamma camera was performed to measure gastric emptying half-time (GET 1/2). During the third visit, two customized multiple lumen aspiration catheters were positioned to collect fasting and postprandial intestinal fluids to measure bile acid concentration. Immediate pouch emptying (P = 0.0007) and a trend for faster GET 1/2 (P = 0.09) were observed in both bariatric groups. There was a tendency for a shorter orocecal transit in participants with sleeve gastrectomy and Roux-en-Y gastric bypass (P = 0.08). The orocecal segment was characterized by a higher 25th percentile pH (P = 0.004) and a trend for a higher median pH in both bariatric groups (P = 0.07). Fasting total bile acid concentration was 7.5-fold higher in the common limb after Roux-en-Y gastric bypass (P < 0.0001) and 3.5-fold higher in the jejunum after sleeve gastrectomy (P = 0.009) compared to obesity. Postprandial bile acid concentration was 3-fold higher in the jejunum after sleeve gastrectomy (P = 0.0004) and 6.5-fold higher in the common limb after Roux-en-Y gastric bypass (P < 0.0001) compared to obesity. The anatomical alterations of sleeve gastrectomy and Roux-en-Y gastric bypass have an important impact on gastrointestinal physiology. This data confirms changes in transit and pH and provides the first evidence for altered intraluminal bile acid concentration. [ABSTRACT FROM AUTHOR]

Background: Conventional calibration of the gamma camera consists of the calculation of calibration factors (CFs) (ratio of counts/cc and true concentration activity) as the function of the volume of interest (VOI). However, such method shows inconsistent results when the background activity varies. The aim of the present study was to propose a new calibration method by considering the sphere-to-background counts/voxel ratio (SBVR) in addition to the VOI for CFs calculation. A PET cylindrical flood phantom, a NEMA IQ body phantom, a Data spectrum Torso Phantom (ECT/TOR/P) and a LK-S Kyoto Liver/Kidney phantom were used. The NEMA IQ phantom was used to calibrate the camera and to produce CFs for the different spheres volumes and for varying sphere-to-background activity ratios. The spheres were filled with a uniform activity concentration of 177Lu, while the background was first filled with cold water and activity was added between each SPECT scan. SPECT imaging was performed for 30-s, 20-s, and 10-s exposure per view. The calculated CFs were expressed as function of the sphere volume and SBVR. The obtained CFs were validated for an additional NEMA IQ acquisition with different activities in spheres and background and for the Torso and Liver/Kidney phantoms with inserted NEMA IQ spheres. The quantification accuracy was compared with the conventional method not taking SBVR into consideration. Results: The relative errors in quantification using the NEMA IQ phantom with the new calibration method were 0.16%, 5.77%, 9.34% for the large, medium and small sphere, respectively, for a time per view of 30-s. The conventional calibration method gave errors of 3.65%, 6.65%, 30.28% for 30-s. The LK-S Kyoto Liver/Kidney Phantom resulted in quantification errors of 3.40%, 2.14%, 11.18% for the large, medium and small spheres, respectively, for 30-s; compared to 11.31%, 17.54%, 14.43% for 30-s, respectively, for the conventional method. Similar results were obtained for shorter acquisitions times with 20-s and 10-s time per view. Conclusion: These results suggest that SBVR allows to improve quantification accuracy. The shorter time-per-view acquisitions had similar relative differences compared to the full-time acquisition which allows shorter imaging times with 177Lu and improved patient comfort. The SBVR method is simple to set up and can be proposed for standardization. [ABSTRACT FROM AUTHOR]

(1) Background: Gamma cameras have wide applications in industry, including nuclear power plant monitoring, emergency response, and homeland security. The desirable properties of a gamma camera include small weight, good resolution, large field of view (FOV), and wide imageable source energy range. Compton cameras can have a 4π FOV but have limited sensitivity at low energy. Coded-aperture gamma cameras are operatable at a wide photon energy range but typically have a limited FOV and increased weight due to the thick heavy metal collimators and shielding. In our lab, we previously proposed a 4π-view gamma imaging approach with a 3D position-sensitive detector, with which each detector element acts as the collimator for other detector elements. We presented promising imaging performance for 99mTc, 18F, and 137Cs sources. However, the imaging performance for middle- and high-energy sources requires further improvement. (2) Methods: In this study, we present a new gamma camera design to achieve satisfactory imaging performance in a wide gamma energy range. The proposed gamma camera consists of interspaced bar-shaped GAGG (Ce) crystals and tungsten absorbers. The metal bars enhance collimation for high-energy gamma photons without sacrificing the FOV. We assembled a gamma camera prototype and conducted experiments to evaluate the gamma camera's performance for imaging 57Co, 137Cs, and 60Co point sources. (3) Results: Results show that the proposed gamma camera achieves a positioning accuracy of <3° for all gamma energies. It can clearly resolve two 137Cs point sources with 10° separation, two 57Co and two 60Co point sources with 20° separation, as well as a 2 × 3 137Cs point-source array with 20° separation. (4) Conclusions: We conclude that the proposed gamma camera design has comprehensive merits, including portability, 4π-view FOV, and good angular resolution across a wide energy range. The presented approach has promising potential in nuclear security applications. [ABSTRACT FROM AUTHOR]

Introduction: Normal population data is necessary for the quantification of myocardial perfusion studies (MPS). In Iran, data embedded in the Cedars Cardiac Suite, from young Californian volunteers, is used. We generated an Iranian female dataset and compared it with the original one. Methods: Thirty-one females aged 20-45 years without coronary artery disease risks were recruited. They underwent two-day exercise stress (Bruce protocol) and rest gated SPECT MPS. [99mTc]Tc-MIBI was injected (15 mCi) and imaging for stress and rest phases were started 60 and 90 min later, respectively, in supine and prone positions. A dual head gamma camera was used, ProSPECT (PNP, Tehran, Iran). Polar plots were extracted and a normal database generated. Results: Visually, none of the participants presented a reversible perfusion defect. Index for transient ischemic dilation was 1.1±0.15 and 1.1±0.14, respectively for prone and supine positions; lung heart uptake ratio 0.3±0.1 and 0 . 28±0.1; ejection fraction 69.8±7.8 and 70±8; peak filling rate 2.9±0.75 and 2.9±0.95 end-diastolic volume/sec; and time to peak filling rate at 178±44.5 and 203±49.5 millisecond. Compared to the original prone Californian normal database, total perfusion defect for stress and rest was 12.1±6.7 and 5.3±5.2, and for the supine position 10.1±0.5.4 and 4.0±3.4, respectively. Conclusion: Iranian normal database for MPS was generated with a remarkable difference from the original normal data. [ABSTRACT FROM AUTHOR]

The aim of this work is the rationale for using radiological method of examination in diagnosing and monitoring the mandibular osteomyelitis treatment. A total of 60 patients with traumatic (first group) and odontogenic (second group) mandibular osteomyelitis were examined. Among them, there were 24 (40%) males and 36 (60%) females aged between 20 and 45 years. The patients received intravenous injection of Technefor (99MTc) with the radiation activity of 300-400 megabecquerel 3- 4 hours before scintigraphy. The mandible radiopharmaceutical uptake was measured using a computerized gamma camera. The level of 99MTc accumulation in the bone tissue was quantified by gamma-radiation. A patient was examined on the day of hospital admission and on day 14 after surgical treatment of osteomyelitis of the mandible. Our studies have shown that all forms of traumatic and odontogenic osteomyelitis are accompanied by significant changes in 99MTc uptake in the mandible, however, both 99MTc uptake and its decrease after surgical treatment were most obvious in odontogenic osteomyelitis. The increase in 99MTc uptake in traumatic mandibular osteomyelitis was 38,1% (up to 1669,9 gammaradiation pulses), 140,9% (up to 2913,7 gamma-radiation pulses) and 129% (up to 2772,7 gamma-radiation pulses) in the acute, subacute and chronic stages of the disease, respectively. The increase in 99MTc uptake in odontogenic mandibular osteomyelitis was 160,0% (up to 3144,1 gamma-radiation pulses), 218,1% (up to 3846,6 gamma-radiation pulses) and 275,2% (up to 4537,6 gamma-radiation pulses) in the acute, subacute and chronic stages of the disease, respectively. The increase in 99MTc uptake was due to blood flow enhancement, metabolic disorders, activation of osteoblast and osteoclasts in the bone tissue. The decrease in 99MTc uptake after the treatment indicated the positive response to treatment. Scintigraphic examination was more sensitive and specific in comparison to X-ray diagnostics of mandibular ostemyelitis. The sensitivity of scintigraphic findings ranged from 60.0% to 100%, and the specificity was 100% at different stages of ostemyelitis. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to develop a Personal Computer (PC) based tool to estimate the center of rotation (COR) offsets from COR projection datasets using methods mentioned in IAEA-TECDOC-602. Materials and Methods: Twenty-four COR studies were acquired on Discovery NM 630 Dual head gamma camera fitted with parallel hole collimator, and COR offsets were estimated with the software available at the terminal for processing a COR study. These COR projection images were exported in DICOM. A MATLAB script (software program) was written to estimate COR offset using Method A (using opposite pair of projections) and Method B (using curve fitting method) as mentioned in IAEA-TECDOC-602. Our program read the COR study (in DICOM) and estimated COR offsets using Method A and Method B. The accuracy of the program was verified using simulated projection dataset of a point source object acquired at 6° interval in the range of 0°-360° angle. Bland Altman plot was used for analyzing the agreement between the COR offsets estimated using (1) Method A and Method B mentioned in IAEA-TECDOC-602, and (2) Our program and vendor program available at Discovery NM 630 acquisition terminal. Results: On simulated data, offset from center of gravity (COG) in X direction (COGX) and COG in Y direction (COGY) estimated using Method A was constant (same) at each pair of angles while using Method B, it was found to be in the range (-2 x 10-10, 1 x 10-10) which is negligible. Most of the differences (23 out of 24) between the result of Method A and Method B, and between the results of our program and vendor program was found to be within 95% confidence interval (mean ± 1.96 standard deviation). Conclusions: Our PC-based tool to estimate COR offsets from COR projection datasets using methods mentioned in IAEA-TECDOC-602 was found to be accurate and provides results in agreement with vendor's program. It can be used as an independent tool to estimate COR offset for standardization and calibration purposes. [ABSTRACT FROM AUTHOR]

Introduction: In this pilot study, we have proposed and evaluated pipelined application of the dynamic stochastic resonance (DSR) algorithm and block-matching 3D (BM3D) filter for the enhancement of nuclear medicine images. The enhanced images out of the pipeline were compared with the corresponding enhanced images obtained using individual applications of DSR and BM3D algorithm. Materials and Methods: Twenty 99m-Tc MDP bone scan images acquired on SymbiaT6 SPECT/CT gamma camera system fitted with low-energy high-resolution collimators were exported in DICOM format to a personal computer and converted into PNG format. These PNG images were processed using the proposed algorithm in MATLAB. Two nuclear medicine physicians visually compared each input and its corresponding three enhanced images to select the best-enhanced image. The image quality metrics (Brightness, Global Contrast Factor (GCF), Contrast per pixel (CPP), and Blur) were used to assess the image quality objectively. The Wilcoxon signed test was applied to find a statistically significant difference in Brightness, GCF, CPP, and Blur of enhanced and its input images at a level of significance. Results: Images enhanced using the pipelined application of SR and BM3D were selected as the best images by both nuclear medicine physicians. Based on Brightness, Global Contrast Factor (GCF), CPP, and Blur, the image quality of our proposed pipeline was significantly better than enhanced images obtained using individual applications of DSR and BM3D algorithm. The proposed method was found to be very successful in enhancing details in the low count region of input images. The enhanced images were bright, smooth, and had better target-to-background ratio compared to input images. Conclusion: The pipelined application of DSR and BM3D algorithm produced enhancement in nuclear medicine images having following characteristics: bright, smooth, better target-to-background ratio, and improved visibility of details in the low count regions of the input image, as compared to individual enhancements by application of DSR or BM3D algorithm. [ABSTRACT FROM AUTHOR]

Several imaging modalities have been employed to quantify lung dose and the distribution of the dose of orally inhaled aerosols in vivo. Two-dimensional (2D, or planar) imaging using gamma scintigraphy is the most widely used of these modalities. Two-dimensional gamma scintigraphy studies are accomplished using a single- or dual-headed gamma camera. The formulation to be tested is admixed with the gamma emitting radioisotope 99mtechnetium, which serves as a surrogate for the drug. This article provides details as to how 2D gamma scintigraphy images should be acquired and analyzed using recently standardized methods. Based on the new guidelines, the investigator should confirm that the drug formulation is unchanged with the addition of the radioisotope, determine the amount of radioactivity needed for inhalation to obtain appropriate radioactivity counts in the lungs, perform quality control procedures for the gamma camera, identify the lung borders of the study subject using a reference image such as an X-ray computed tomography scan, a ventilation scan, or a transmission scan, acquire a lung transmission image to correct for attenuation of radioactivity by lung tissue, instruct the subject how to inhale the radiolabel-drug mixture and record associated breathing parameters, acquire anterior and/or posterior views of the lungs and any other regions of interest (i.e., oropharynx, stomach) and assess the acquired images for total and regional dose to the lungs. Total dose should be assessed after identification of the right lung border and appropriate correction for tissue attenuation. Regional dose should be quantified as a normalized outer/inner deposition ratio (O/I) and expressed as the penetration index (PI). Mass balance should be performed as needed. By following the standardized methods, 2D gamma scintigraphy data from studies in different laboratories may be compared and combined, leading to multi-center studies and more rapid development of new medications and devices for inhaled therapies. [ABSTRACT FROM AUTHOR]

Purpose: Measurement of the dwell time and moving speed of a high‐activity iridium‐192 (Ir‐192) source used for high‐dose‐rate (HDR) brachytherapy is important for estimating the precise dose delivery to a tumor. For this purpose, we used a cerium‐doped yttrium aluminum perovskite (YA1O3:YAP(Ce)) gamma camera system, combined with a list‐mode data acquisition system that can acquire short‐time sequential images, and measured the dwell times and moving speeds of the Ir‐192 source. Methods: Gamma photon imaging was conducted using the gamma camera in list mode for the Ir‐192 source of HDR brachytherapy with fixed dwell times and positions. The acquired list‐mode images were sorted to millisecond‐order interval time sequential images to evaluate the dwell time at each position. Time count rate curves were derived to calculate the dwell time at each source position and moving speed of the source. Results: We could measure the millisecond‐order time sequential images for the Ir‐192 source. The measured times for the preset dwell times of 2 s and 10 s were 1.98 to 2.00 s full width at half maximum (FWHM) and 10.0 s FWHM, respectively. The dwell times at the first dwell position were larger than those at other positions. We also measured the moving speeds of the source after the dwells while moving back to the afterloader and found the speed increased with the distance from the edge of the field of view to the last dwell position. Conclusion: We conclude that millisecond‐order time sequential imaging of the Ir‐192 source is possible by using a gamma camera and is useful for evaluating the dwell times and moving speeds of the Ir‐192 source. [ABSTRACT FROM AUTHOR]

In this study, we propose a hybrid coded-aperture and Compton camera based on cerium-doped Gd3Al2Ga3O12 (GAGG:Ce) scintillator arrays coupled with Multi-Pixel Photon Counter (MPPC) arrays. The sensitive detector of the gamma camera consists of a single GAGG:Ce crystal coupled with a single-chip MPPC unit module. An impedance bridge circuit and a 64-channel data acquisition system were employed to record the code-aperture events and Compton coincidence events. After the calibration of position and energy, the total energy resolution for 662 keV gamma-rays from 137Cs was 6.6%. The hybrid camera had the characteristics of mechanical collimation and electronic collimation at the same time. In the code aperture mode, the reconstructed images were obtained by direct deconvolution and maximum likelihood expectation maximization (MLEM) methods. In the Compton imaging mode, the energy-dependent method was applied to order the sequence of Compton scatter events. The simple back-projection algorithm and list-mode MLEM algorithm were adopted for image reconstruction. Practical performances demonstrated that the angular resolutions in two modes were measured as 5.2° and 11.4°, respectively. In addition, the hybrid camera had a desirable imaging capability in a wide energy range (32 keV–2.6 MeV) and a wide field of view (∼210° in the horizontal direction). As for the sensitivity, the camera had a commercially available sensitivity level of localizing a 137Cs point source, producing ∼0.026 µSv/h in 5 min. Furthermore, the function of distinction for different radiation sources was preliminarily realized. [ABSTRACT FROM AUTHOR]

Acute respiratory distress syndrome (ARDS) is accompanied by a dramatic increase in lung hyaluronic acid (HA), leading to a dose-dependent reduction of pulmonary oxygenation. This pattern is associated with severe infections, such as COVID-19, and other important lung injury etiologies. HA actively participates in molecular pathways involved in the cytokine storm of COVID-19-induced ARDS. The objective of this study was to evaluate an imaging approach of radiolabeled HA for assessment of dysregulated HA deposition in mouse models with skin inflammation and lipopolysaccharide (LPS)-induced ARDS using a novel portable intensified Quantum Imaging Detector (iQID) gamma camera system. HA of 10 kDa molecular weight (HA10) was radiolabeled with 125I and 99mTc respectively to produce [125I]I-HA10 and [99mTc]Tc-HA10, followed by comparative studies on stability, in vivo biodistribution, and uptake at inflammatory skin sites in mice with 12-O-tetradecanoylphorbol-13-acetate (TPA)-inflamed ears. [99mTc]Tc-HA10 was used for iQID in vivo dynamic imaging of mice with ARDS induced by intratracheal instillation of LPS. [99mTc]Tc-HA10 and [125I]I-HA10 had similar biodistribution and localization at inflammatory sites. [99mTc]Tc-HA10 was shown to be feasible in measuring skin injury and monitoring skin wound healing. [99mTc]Tc-HA10 dynamic pulmonary images yielded good visualization of radioactive uptake in the lungs. There was significantly increased lung uptake and slower lung washout in mice with LPS-induced ARDS than in control mice. Postmortem biodistribution measurement of [99mTc]TcHA10 (%ID/g) was 11.0 ± 3.9 vs. 1.3 ± 0.3 in the ARDS mice (n = 6) and controls (n = 6) (P < 0.001), consistent with upregulated HA expression as determined by enzyme-linked immunosorbent assay (ELISA) and immunohistochemistry (IHC) staining. [99mTc]Tc-HA10 is promising as a biomarker for evaluating HA dysregulation that contributes to pulmonary injury in ARDS. Rapid iQID imaging of [99mTc]Tc-HA10 clearance from injured lungs may provide a functional template for timely assessment and quantitative monitoring of pulmonary pathophysiology and intervention in ARDS. [Display omitted] [ABSTRACT FROM AUTHOR]

A comprehensive review of applying Taguchi's optimization methodology to medical facilities was evaluated in this study. Taguchi's optimization methodology is one kind of robust designation and is reputed for integrating multiple factors to pursue one goal. According to Taguchi's suggestion, the efficient and reliable arrangement of experimental groups with numerous factors shortened the observed timing and provided bountiful statistical data. Although this method is widely used in mechanical, civil, and chemical engineering fields, it became adopted in medical facilities only in the last decade. Most of Taguchi's analyses focused on optimizing the imaging quality for diagnosis. The medical facilities include regular X-ray, cardiac X-ray, CT (computed tomography), CTA (computed tomography angiography), LINAC (medical linear accelerator), or gamma camera scans. The images were all manipulated according to various radiation-induced interactions; thus, the optimization process of imaging resolution can offer an essential contribution to this kind of facility. In this study, we summarized the Taguchi-related papers in medical facilities and evaluated common principles in organizing the unique orthogonal array, assigning various signal-to-noise ratios, using quantified gauges, and ranking or grading the obtained imaging quality in the datum analysis process. The further elaboration on how to preset the user demanded goal in the optimization process, the necessity of focusing on cross interaction among factors, dynamic analysis superiority over static one preset in Taguchi's analysis, and how to preset an ideal signal-to-noise ratio to satisfy the researcher demand, the importance of verification or testification in clinical cases or the assistance of ANOVA to depict a complete concept of applying Taguchi's optimization methodology. [ABSTRACT FROM AUTHOR]

Experiments designed to image in vivo deposition of radiolabel-drug mixtures are useful for estimating inhaled drug delivery and for assessing bioequivalence of delivery devices. Validation of the radiolabel-drug mixture is vital to ensure that subsequent imaging is reflective of drug deposition. Application of gamma attenuation corrections allows both total and regional lung deposition of drug to be estimated by two-dimensional (2D) imaging. Imaging methods are also useful for measuring in vivo mucociliary clearance (MC) function. Such measures allow assessment of the efficacy of drugs designed to improve clearance of airway secretions in airway disease. MC rates can be measured by controlled inhalation and gamma camera monitoring of radiolabeled aerosols containing non-permeating tracers. While in vivo MC rates reflect the function of the mucociliary apparatus, they are also dependent on regional deposition patterns of the inhaled aerosol. [ABSTRACT FROM AUTHOR]

Here we proposed the most recent innovations in the use of Breast Specific Gamma Imaging with 99mTc-sestamibi for the management of breast cancer patients. To this end, we reported the recent discoveries concerning: a) the implementation of both instrumental devices and software, b) the biological mechanisms involved in the 99mTc-sestamibi uptake in breast cancer cells, c) the evaluation of Breast Specific Gamma Imaging with 99mTc-sestamibi as predictive markers of metastatic diseases. In this last case, we also reported preliminary data about the capability of Breast Specific Gamma Imaging with 99mTc-sestamibi to identify breast cancer lesions with high propensity to form bone metastatic lesions due to the presence of Breast Osteoblast-Like Cells. [ABSTRACT FROM AUTHOR]

This work presents a novel stereo coded aperture gamma camera based on four detection modules placed within four quadrants. Each module includes 48 × 48 strips of Bi4Ge3O12 scintillators, 24 × 24 pieces of silicon photomultipliers (SiPMs), and a set of data acquisition circuits. All signals from the SiPMs are individually extracted and finally simplified into 144 outputs to calculate the positions and energies of gamma-rays. Two masks of modified uniformly redundant arrays are fixed in the front of the top-right and bottom-left modules and two anti-masks are fixed in the top-left and bottom-right modules to achieve simultaneous imaging without dual measure. Once the projections of radioactive sources are determined, their source-to-detector distances can be estimated by our new multocular ranging algorithm. A series of lab and field experiments, including flood histogram and energy spectrum testing, field-of-view and angular resolution testing, real-time imaging, long-distance imaging, and ranging ability testing, with different radioactive sources, such as 137Cs, 22Na, 241Am, 60Co, 133Ba, and 75Se, have been completed to evaluate the comprehensive ability of the stereo gamma camera. The results show that the stereo gamma camera has a strong ability for the three-dimensional localization of radioactive sources over long distances with a high image sensitivity. So far, the stereo gamma camera has been successfully used in practical nuclear security and safety tasks although the angular resolution and the ranging algorithm robustness should be more optimized in the future. [ABSTRACT FROM AUTHOR]

In the fields of radiation environment monitoring and unknown radioactive materials search, locating the far-field gamma-ray sources with high accurate coordinates is an important and necessary capability for a gamma imager. However, traditional coded gamma-ray imaging systems only provide 2-D radiation images without distance information. In this work, a four-eyes stereo gamma camera is proposed, which consists of four independent coded aperture detectors with an adjacent spacing of 286 mm. Each detector is comprised of pixelated scintillators with a pixel array of 44 $\times44$ , forming a global detection area of 140 $\times140$ mm2. The ranging capability is related to the resolution and the adjacent spacing of the detectors. With the setup of the above device, the traditional binocular-based ranging method has a short measurement range and a large measurement deviation. Here, a min-area distance measurement algorithm based on a four-eyes stereo gamma camera is proposed, combined with “manual” fine sampling and Gaussian fitting method to successfully achieve the high-precision localization of the far-field source. The simulation results show that compared with the traditional binocular-based ranging method, the min-area method based on a four-eyes stereo camera lengthens the range from 20 m to more than 50 m and improves the ranging accuracy within 20 m by more than six times. The accuracy of 20 and 50 m is less than 1.4 m (7.13%) and 10.5 m (21%), respectively. The reliability of the simulation results has been verified by experiments. Furthermore, the ranging capability of this algorithm for multipoint sources in the far field has been verified. [ABSTRACT FROM AUTHOR]