PET in Oncology Basics and Clinical Application 1st Edition

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Dr. Dr. Jiirgen Ruhlmann
PD Dr. Peter Oehr
PET-Center
Miinsterstra6e 20
53111 Bonn, Germany

Prof. Dr. H.-J. Biersack

University Clinic Bonn
Clinic and Policlinic for Nuclear Medicine
Rheinisch-Westfalische University Bonn
Sigmund-Freud-Stra6e 25
53127 Bonn, Germany

Translated from German by:

Judith F. Lee, Ph.D. and Mary W. Tannert, Ph.D.

ISBN -13: 978-3-642-64220-3 e-ISBN-13: 978-3-642-60010-4

DOl: 10.1007/978-3-642-60010-4

Library of Congress Cataloging-in-Publication Data

PET in der Onkologie. English. PET in oncology: basics and clinical application 1 [edited by] J. Ruhl-
mann, P. Oehr, and H.-J. Biersack. p. cm.
Includes bibliographical references and index. ISBN 3-540-65077-6 (hardcover: alk. paper)
1. Cancer-Tomography. 2. Tomography, Emission. I. Ruhlmann, J. (Jiirgen), 1955 - . II. Oehr, P. (Peter),
1942- . III. Biersack, H. J. IV. Title. [DNLM: 1. Neoplasms-radionuclide imaging. 2. Tomography,
Emission-Computed-methods. QZ 241 P477P 1999a]
RC270·3· T65P 4613 1999 616.99' 407575-dc21
DNLM/DLC for Library of Congress 99-26968
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Preface

Development of Positron -Emissiontomography respect to reimbursement, as well as the European

(PET) dates back to the Mid-70ieS. However, this PET consensus conferences. Nowadays, PET is a
imaging procedure gained clinical importance not well established routine procedure in lung and co-
before 1990. First clinical papers were published lorectal cancer as well as malignant melanoma,
by US researchers. The patient populations were head and neck cancer and breast cancer. Other
relatively small by that time, and European as indications are lymphoma and pancreatic cancer.
well as German authors contributed results in larger Within the next years, the diagnostic spectrum of
patient populations. These clinical papers led to a PET will be widened, especially in the field of therapy
widespread application of PET in clinical routine. follow-up and proof of vitality after chemotherapy.
The clinical relevance was documented by several The increased use of PET in oncology makes evi-
PET consensus conferences. However, the National dent, that it is necessary to train referring physians
Health Service System is very reluctant to pay for in PET. The aim of this book is to summarize the
PET studies. Even in Germany, PET is not yet a reg- basics and the clinical results of PET and to bring
ular part of the reimbursement system. On the other them of the attention of general medicine.
hand, in solitary pulmonary nodules and brain tu-
mors third party payers in United States have accep- Bonn, Spring 1999 J. Ruhlmann
ted these indications. The high popularity of PET in P.Oehr
US will certainly lead to an improved situation with H.-J. Biersack
Contents

Part I Principles l.3.3 NaI Detector Technology

for Dedicated Pet-Systems ........ . 18
l.3.4 Post Injection CS-137 Singles Trans-
1 Physical Principles ............. . 3
mission Improves Clinical Image
H. Newiger, Y. Harnisch, P. Oehr, Quality, Quantitative Accuracy and
J. Ruhlmann, B. Vollet, and S. Ziegler Enables Flexible Clinical Operation 19

1.1 PET Technology ............... . 3 1.4 Quality Control ............... . 26

H. Newiger B. Vollet
l.1.1 The Physics of Positrons ......... . 3 l.4.1 Integrity Testing for PET Scanners
l.1.2 Measurement of Positron or Gamma Cameras with Integrated
Radiation .................... . 4 Coincidence Acquisition ......... . 28
l.1.3 Advantages of PET ............. . 4 l.4.2 Quality Assurance for
l.l.4 Production of Positron Emitters ... . 5 Transmission Measurement ....... . 32
1.1.5 Detectors for PET .............. . 6 l.4.3 Integrity Testing for In Vitro
l.l.6 Quantitative Imaging with PET 7 Analyzers and Activity Meters ..... . 32
l.l.7 Further Development l.4.4 Quality Assurance for Documentation
of PET Technology of Findings ................... . 33
and Reconstruction Methods ...... . 9
2 Radiopharmaceutical Technology,
1.2 Dual Head Coincidence Camera 10 Toxicity and Radiation Dosages 35
S. Ziegler J. Ruhlmann and P. Oehr
1.2.1 Comparison of the
Dual Head Coincidence Camera 2.1 Introduction .................. . 35
with Other Techniques .......... . 10
l.2.2 Measurement Problems .......... . 11
2.2 The Synthesis of 2-[18F1FDG ...... . 36

2.3 Purity of the 2-[18F1FDG Solution .. . 36

1.3 Design Considerations of NaI(Tl)
Based PET Imaging Systems 2.4 2-[18F1FDG Activity Dosages ...... . 37
Adressing the Clinical and Technical
Requirements of Wholebody PET ... 15
2.5 Radiation Exposure ............ . 38
Y. Harnisch
1.3.1 Introduction .................. . 15 2.6 Biochemical Toxicity ............ . 40
1.3.2 Digital Detectors Improve Countrate
Capability .................... . 15 2.7 Conclusions .................. . 40
VIII Contents

3 Metabolism and Transport of Glucose 5.1.1 Epidemiology ................. . 67

and FDG .................... . 43 5.1.2 Histology and Staging ........... . 67
P.Oehr 5.1.3 Prognosis .................... . 67
5.1.4 Malignant Melanoma Therapy ..... . 68
3.1 Biological Functions 5.1.5 Staging and Follow-Up .......... . 68
of Carbohydrate Metabolism ...... . 43 5.1.6 Indications ................... . 69
3.1.1 Carbohydrate Requirements 5.1.7 Summary .................... . 69
& Supply .................... . 43
3.1.2 Regulation Mechanisms ......... . 43 5.2 Head and Neck Tumors ......... . 76
3.1.3 Factors in Glucose Homeostasis ... . 44 C. Laubenbacher, R.J. Kau, e. Alexiou,
W. Arnold, and M. Schwaiger
3.2 Metabolism of Glucose, 2-DG, 2-FDG 5.2.1 Introduction .................. . 76
and 3-FDG ................... . 45 5.2.2 Significance of PET ............. . 78
3.2.1 Glucose ..................... . 45 5.2.3 Study Protocol and Interpretation
3.2.2 Metabolism of 2-DG, 2-FDG of PET ...................... . 85
and 3-FDG ................... . 46 5.2.4 Summary .................... . 87

3.3 FDG Uptake .................. . 46 5.3 Thyroid Carcinomas ............ . 89

F. Grunwald
3.3.1 Glucose Transport Systems ....... . 46
3.3.2 Glucose Transporters 5.3.1 Clinical Background ............. 89
in Cancer Diseases ............. . 50 5.3.2 Therapy. . . . . . . . . . . . . . . . . . . . .. 91
3.3.3 Kinetics of Glucose Transport ..... . 51 5.3.3 Use of FDG PET. . . . . . . . . . . . . . .. 92
3.3.4 Quantification of PET 5.3.4 Indications . . . . . . . . . . . . . . . . . . .. 98
Measurements ................ . 52 5.3.5 Results and Interpretation . . . . . . . .. 99
5.3.6 Limits of Interpretation .......... 100

5.4 Pulmonary Nodules and Non-Small-

Part II Clinical Applications Cell Bronchial Carcinoma . . . . . . . .. 102
R.P. Baum, N. Presselt, and R. Bonnet
4 Patient Preparation ............. . 61 5.4.1 Epidemiology and Etiology
B. Kozak of Lung Cancer. . . . . . . . . . . . . . . .. 102
5.4.2 Prognosis, Histology and Staging . . .. 103
4.1 PET Scanning Technique 61 5.4.3 Diagnosis of Lung Cancer. . . . . . . .. 103
5.4.4 Therapy for Non-Small-Cell Bronchial
5 Clinical Indications ............. . 67 Carcinoma ...... . . . . . . . . . . . . .. 104
e. Alexiou, R. An, W. Arnold, Positron Emission Tomography. . . .. 106
5.4.5
M. Bangard, R.P. Baum, H.-J. Biersack, Clinical Indications for Positron
5.4.6
R. Bonnet, U. Bull, U. Cremerius, Emission Tomography ........... 108
e.G. Diederichs, F. Grunwald, R.J. Kau, 5.4.7 Positron Emission Tomography:
R. Kaufmann, C. Laubenbacher, Limitations and Pitfalls . . . . . . . . . .. 115
C. Menzel, P. Oehr, H. Palmedo,
N. Presselt, J. Reul, D. Rinne, 5.5 Breast Cancer . . . . . . . . . . . . . . . . .. 119
J. Ruhlmann, M. Schwaiger, P. Willkomm, H. Palmedo,
P. Willkomm, and M. Zimny M. Bangard, P. Oehr, and H.-J. Biersack
5.1 Malignant Melanoma ........... . 67 5.5.1 Introduction, Clinical Background,
D. Rinne, R. Kaufmann, Prognosis . . . . . . . . . . . . . . . . . . . .. 119
and R.P. Baum 5.5.2 Technical Aspects. . . . . . . . . . . . . .. 120
 Contents IX

5.5.3 Indications . . . . . . . . . . . . . . . . . . .. 121 5.11 PET and Neuro-Imaging:

5.5.4 Summary . . . . . . . . . . . . . . . . . . . .. 126 Diagnostic and Therapeutic
Value, Current Applications
5.6 Pancreatic Cancer . . . . . . . . . . . . . .. 128 and Future Perspective ........... 165
C.G. Diederichs J. Reul
5.6.1 Clinical Principles . . . . . . . . . . . . . .. 128 5.11.1 Introduction................... 165
5.6.2 Current Therapy . . . . . . . . . . . . . . .. 129 5.11.2 Diagnostic Neuroimaging
5.6.3 PET ......................... 129 and Tumour Classification ........ 166
5.6.4 Other Diagnostic Methods . . . . . . . .. 133 5.11.3 Diagnostic Imaging with PET ...... 169
5.6.5 Indications . . . . . . . . . . . . . . . . . . .. 134 5.11.4 Conclusion .................... 170

5.7 Colorectal Cancer . . . . . . . . . . . . . .. 135 5.12 Miscellaneous Tumors ........... 171

J. Ruhlmann and P. Oehr H.-J. Biersack, P. Willkomm, R. An,
5.7.1 Incidence, Etiology and J. Ruhlmann
and Risk Factors . . . . . . . . . . . . . . .. 135 5.12.1 Brain Tumors .................. 171
5.7.2 Diagnostics . . . . . . . . . . . . . . . . . . .. 137 5.12.2 Musculoskeletal Tumors .......... 171
5.7.3 Prognosis, Staging 5.12.3 Prostate Cancer ................ 172
and Tumor Spread .............. 138 5.12.4 Bladder Cancer. . . . . . . . . . . . . . . .. 173
5.7.4 Therapy ...................... 138 5.12.5 Kidney Tumors ................ 173
5.7.5 Positron Emission Tomography. . . .. 139 5.12.6 Esophageal Cancer .............. 174
5.12.7 Gastric Cancer ................. 175
5.8 Ovarian Cancer ................ 144 5.12.8 Liver Cancer ................. " 175
M. Zimny, U. Cremerius, and U. Biill
5.8.1 Epidemiology .................. 144 6 Cancer Screening with Whole-Body
5.8.2 Pathophysiology FDG PET ..................... 179
and Tumor Spread .. . . . . . . . . . . .. 145 S. Yasuda, M. Ide, and A. Shohtsu
5.8.3 Histology .................... , 145
5.8.4 Tumor Staging ................. 145 6.1 Background ................... 179
5.8.5 Therapy ... . . . . . . . . . . . . . . . . . .. 146
5.8.6 Diagnosis ..................... 146 6.2 Cancer Screening with Whole-Body
5.8.7 Positron Emission Tomography. . . .. 146 FDG PET ..................... 179
5.8.8 Results . . . . . . . . . . . . . . . . . . . . . .. 148
6.2.1 Subjects and Methods . . . . . . . . . . .. 179
5.9 Testicular Tumors .............. 151 6.2.2 Results . . . . . . . . . . . . . . . . . . . . . .. 181
U. Cremerius, M. Zimny, and U. Bull 6.2.3 Cancer Screening ............... 183

5.9.1 Clinical Principles 6.3 Conclusions ................... 187

and Current Therapy ............ 151
5.9.2 Performing PET Scans ........... 153 PET and Radiotherapy
7 189
5.9.3 Results of PET Scans ............ 153
Val J. Lowe
5.9.4 Indications . . . . . . . . . . . . . . . . . . .. 156
7.1 Introduction . . . . . . . . . . . . . . . . . .. 189
5.10 Hodgkin's Disease
and Non-Hodgkin's Lymphomas 158
7.2 PET Before Radiation Therapy 189
C. Menzel
5.10.1 Hodgkin's Disease .............. 158 7.3 PET During Radiation Therapy 190
5.10.2 Malignant Lymphomas -
Non-Hodgkin's Lymphomas ....... 159 7.4 Reoxygenation and PET .......... 190
X Contents

7.5 PET Imaging After Completion 8 Cost Effectiveness of PET

of Radiation Therapy ............ 191 in Oncology 195
P.E. Valk
7.6 Diagnosing Recurrent Disease
with PET ..................... 191 8.1 Diagnosis and Staging of Non-Small
Cell Lung Cancer ............... 195
7.7 Timing of PET After Radiation
Therapy . . . . . . . . . . . . . . . . . . . . .. 192 8.2 Staging of Recurrent Colorectal
Cancer ...................... , 196
7.8 Summary. . . . . . . . . . . . . . . . . . . .. 193
8.3 Staging of Metastatic Melanoma .... 197

Subject Index ....................... 199

List of Contributors

Alexiou, e. Cremerius, U.
Department of Otorhinolaryngology Clinic for Nuclear Medicine
Head and Neck Surgery RWTH Aachen
Isar Right Bank Clinic, Technical University Munich PauwelsstraBe 30, 52074 Aachen, Germany
Ismaninger StraBe 22, 81675 Munchen, Germany
Diederichs, e.G.
An, R. Department of Nuclear Medicine
Clinic and Policlinic for Nuclear Medicine Ulm University Clinic
University of Bonn Robert-Koch-StraBe 8, 89070 Ulm, Germany
Sigmund-Freud-StraBe 25, 53127 Bonn
Grunwald, F.
Germany
Clinic and Policlinic for Nuclear Medicine
Arnold, W. University of Bonn
Department of Otorhinolaryngology Sigmund-Freud-StraBe 25, 53127 Bonn, Germany
Head and Neck Surgery Harnisch, Y.
Isar Right Bank Clinic, Technical University Munich ADAC, Europe
Ismaninger StraBe 22, 81675 Munchen, Germany GroBenbaumer Weg 6, 40472 Dusseldorf, Germany
Bangard, M. Ide, M.
Clinic and Policlinic for Nuclear Medicine HIMEDIC Imaging Center at Lake Yamanaka
University of Bonn Yanagihara 562-12
Sigmund-Freud-StraBe 25, 53127 Bonn Hirano, Yamanashi, 401-0502, Japan
Germany
Kau, R.J.
Baum, R. P. Department of Otorhinolaryngology
PET Center, Central Clinic Bad Berka GmbH Head and Neck Surgery
99437 Bad Berka, Germany Isar Right Bank Clinic, Technical University Munich
Biersack, H.-J. Ismaninger StraBe 22, 81675 Munchen, Germany
Clinic and Policlinic for Nuclear Medicine Kaufmann, R.
University of Bonn Department of Dermatology, Medical Center
Sigmund-Freud-StraBe 25, 53127 Bonn University of Frankfurt
Germany Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
Bonnet, R. Kozak, B.
PET Center, Central Clinic Bad Berka GmbH Nuclear Medicine and Radiology Practice
99437 Bad Berka, Germany MunsterstraBe 20, 53111 Bonn, Germany
Bull, U. Laubenbacher, C.
Clinic for Nuclear Medicine Clinic and Policlinic for Nuclear Medicine
RWTH Aachen Isar Right Bank Clinic, Technical University Munich
PauwelsstraBe 30, 52074 Aachen, Germany Ismaninger StraBe 22, 81675 Munchen, Germany
XII List of Contributors

Lowe, V.J. Shohtsu, A.

PET Imaging Facility HIMEDIC Imaging Center at Lake Yamanaka
St. Louis University Health Sciences Center Yanagihara 562-12
3635 Vista Avenue at Grand Blvd. Hirano, Yamanashi, 401-0502, Japan
St. Louis, MO 63110-0250, USA
Schwaiger, M.
Menzel, C. Clinic and Policlinic for Nuclear Medicine
Clinic and Policlinic for Nuclear Medicine Isar Right Bank Clinic, Technical University
University of Bonn Ismaninger StraBe 22, 81675 Munchen
Sigmund-Freud-StraBe 25, 53127 Bonn, Germany Germany
Newiger, H. Valk, P.E.
Siemens AG Northern California PET Imaging Center
Medical Systems, Nuclear Medicine Sacramento, California, USA
HenkestraBe 127, 91052 Erlangen, Germany Vollet, B.
Oehr, P. Clinic and Policlinic for Nuclear Medicine
PET-Center Westphalian Wilhelm University
MunsterstraBe 20, 53111 Bonn, Germany Albert-Schweitzer-StraBe 33, 48129 Munster
Germany
Palmedo, H.
Clinic and Policlinic of Nuclear Medicine Willkomm, P.
University of Bonn Clinic and Policlinic for Nuclear Medicine
Sigmund-Freud-StraBe 25, 53127 Bonn, Germany University of Bonn
Sigmund-Freud-Strasse 25, 53127 Bonn
Presselt, N. Germany
PET Center
Central Clinic Bad Berka GmbH Yasuda, S.
99437 Bad Berka, Germany HIMEDIC Imaging Center at Lake Yamanaka
Yanagihara 562-12
Reul, J. Hirano, Yamanashi, 401-0502, Japan
Nuclear Medicine and Radiology Practice
MunsterstraBe 20, 53111 Bonn, Germany Ziegler, S.
Clinic and Policlinic for Nuclear Medicine
Rinne, D. Isar Right Bank Clinic, Technical University
Department of Dermatology, Medical Center Ismaninger StraBe 22, 81675 Munchen
University of Frankfurt Germany
Theodor-Stern-Kai 7, 60590 Frankfurt, Germany
Zimny, M.
Ruhlmann, J. Clinic for Nuclear Medicine
PET Center RWTH Aachen
MunsterstraBe 20, 53111 Bonn, Germany PauwelsstraBe 30, 52074 Aachen, Germany
PART I

Principles
Chapter 1

Physical Principles
H. Newiger, Y. Harnisch, P. Oehr, J. Ruhlrnann, B. Vollet, and S. Ziegler

1.1 the decay of nuclides that have a large number

PET Technology of protons in their nuclei compared with the num-
ber of neutrons. This is true of the carbon isotope
H. Newiger
HC, for example. Since the nucleus of HC is un-
stable, it decays to form the boron isotope lIB
Not long after P.A.M. Dirac predicted the exis-
by emitting one positron and one neutrino (Fig.
tence of positrons in 1927, C. Anderson was
1.l.l). While the neutrino escapes without interact-
able to prove they existed (1932). Soon people be-
ing with the surrounding material, the positron is
gan to think about medical applications for posi-
slowed down by scattering processes in the elec-
trons, since it was recognized that they had special
tron clouds of the surrounding materials - in the
properties for diagnostics.
patient's tissue, for example. As soon as it has
come to rest it captures an electron and together
1.1.1 they form a positronium for a fraction of a second.
The Physics of Positrons Then, in a process called annihilation, the posi-
tron and electron masses are converted into 2
Positrons are the anti-particles of electrons. Thus photons (annihilation radiation) that travel apart
they have the same physical properties. The only in exactly opposite directions (Fig. 1.1.2). Since the
difference is the electric charge, which in posi- entire electron and positron mass is transformed,
trons is positive. Positrons are formed during each photon has an energy of 511 keY.

Fig. 1.1.1. • v
Schematic diagram
of positron decay o ~+

o electron
o positron~ "

• neutrino v
protonp
o neutron

p ~ n + P++ V
4 Chapter 1 Physical Principles

Fig. 1.1.2.
Coincidence detection of the
two photons formed during
annihilation

1.1.2 ity of PET (factors 10 -100). In addition, sensitiv-

Measurement of Positron Radiation ity is not necessarily limited by the desired reso-
lution. The latter only depends either on the size
When the two photons are detected by two oppo- of the individual detectors for the block detector
site detectors (coincidence, see Fig. 1.1.2), then the design or the intrinsic resolution for the large area
site of annihilation can be located at a point on the . detector design. In PET sensitivity and resolution
line (coincidence line) connecting the two detec- do not affect each other as much as in single
tors (electronic collimation). Since the two detec- photon tomography (SPECT).
tors will only detect an event at precisely the same Another advantage of PET involves the existing
time if annihilation has occurred precisely in the positron emitters (Table 1.1.1). Most biomolecules
middle between the two detectors, the coinci- can be labeled using carbon (1lC), nitrogen (I3N),
dence window that is used establishes how great oxygen (IsO) and fluorine (I8F) so that their bio-
the time difference can be between the arrival of chemical properties are not altered. In addition,
the two photons. Normally all events that are de- the metabolism of these tracers is frequently
tected within 12 ns are recorded. known. This means that for 18F-FDG (fluorodeox-
yglucose), for example, the glucose metabolism
1.1.3 can be calculated from the basic activity distribu-
Advantages of PET tion (modeling, Patlak plot). Since a calculation of
this type requires the input function, which is ob-
Because of the electronic collimation PET does tained using blood samples, it is frequently cus-
not require collimators as they are necessary in tomary in clinical studies to limit calculations
single photon measurements with gamma cam- to quantification based on the standard uptake
eras. This results in a significantly higher sensitiv- value (SUV). For this purpose the activity mea-
 1.1 PET Technology 5

Table 1.1.1. Characteristics of the most common positron emitters

Positron Emitter Half Life [min) Product Maximum Energy Maximum Linear Mean Linear
of Positron [MeV) Range [mm) Range [mm)
llC 20.4 llB 0.96 5.0 0.3
13N 9.9 13C 1.19 5.4 1.4
150 2.1 15N l.72 8.2 l.5
18F 110 180 0.64 2.4 0.2
68Ga 68 68Zn l.89 9.1 l.9
82Rb 1.3 82Kr 3.35 15.6 2.6

sured in a pixel is normalized for the injected ac- 1.1.4

tivity and the patient weight. Production of Positron Emitters
Today's tomographs, which have a resolution
of 4-6 mm, nearly achieve the maximum resolu- As shown in Table 1.1.1, all positron emitters have
tion that is physically possible. Thus improvement a relatively short half life. Only l8p, which has a
below a certain value is not possible since the po- half life of 110 min, can be transported over cer-
sitrons travel a finite distance between the emis- tain distances. But even in this case it has been
sion point and the site of annihilation (see mean found that in order to utilize the tracer clinically,
range in Table 1.1.1). In addition, the residual transport times cannot exceed about one half life
pulses of the electron-positron pair prevent the of the nuclide; otherwise on-site production in a
two photons from traveling in precisely opposite cyclotron is required. This means that l8p_PDG,
directions. Because of these two effects, a limit re- for example, cannot be transported over dis-
solution of 2 - 3 mm will apply physically to tances greater than about 200 km. The shorter
whole-body tomographs. lived positron emitters like He, l3N or 15 0 must

Fig. 1.1.3.
The RDSlll compact cyclo-
tron developed by CTI,
Knoxville, Tennessee (USA)
6 Chapter 1 Physical Principles

Fig. 1.1.4.
The ECAT EXACT scanner
marketed by Siemens,
Erlangen, Germany

be produced on site or very close to their in- or a certain area of a larger crystal. The resulting
tended use. light distribution in the attached photomultipliers
Today this can be done with powerful and com- indicates the crystal were the photon entered the
pact cyclotrons (e.g. CTI's RDS 111, Fig. 1.1.3), detector system or the place on the crystal were it
which even can be installed in larger diagnostic was hit. One of the reasons for the use of BGO in
institutions. They can produce about 3 Ci of 18F
in an hour which can be synthesized into about
1 Ci of 18FDG, sufficient for more than 20 patient ECAT
investigations in various distances from the place
of the cyclotron. Many of the synthesis processes
today are highly automated and synthesis units as
e.g. for 18FDG are commercially available.

1.1.S
Detectors for PET

Today's PET scanners (Fig. 1.1.4) can be used for

routine clinical applications. The current detector
designs differently adress the challenge of provid-
ing high resolution and high sensitivity at the
same time. The most common design are BGO
(Bismuth Germanium Oxide) block detectors
(Fig. 1.1.5), combining individual BGO scintilla-
tion crystals in blocks attached to a number of
photomultiplier tubes. The scintillation light gen-
erated by the interaction of the 511 keY photons
with the crystal is distributed over several crystals Fig. U.S. Structure of block detectors
 1.1 PET Technology 7

Table 1.1.2. Properties of the most important scintillators for PET

Parameter NaI(Tl) YSO BGO LSO

Density [g/em 3 ] 3.67 4.54 7.13 7.4
Mean path length a [em] 2.88 2.58 1.05 1.16
Hygroscopic? Yes No No No
Easy to handle? No Yes Yes Yes
Decay time [ns] 230 70 300 40
Light yield a [NaI(Tl)=lOO] 100 118 15 75
Energy resolution (%)a 7.8 <7 10.1 < 10
a At 511 keY.

PET was it's high density leading to an almost consecutively and the data is put together into
complete absorption of all incident 511 keY one whole-body image of the patient.
photons (see table 1.1.2). Other detector materials
nowadays used as NaI{Tl) (see chapter Haemisch)
1.1.6
or under evaluation as LSO (Luthetium Orthosi-
Quantitative Imaging with PET
likate). LSO, although more expensive, seems to
be promising because it favourably combines In order to obtain quantitative information using
the high stopping power of BGO with the high
PET it is necessary to consider a number of para-
light output and energy resolution of NaI{Tl).
meters that will affect the accuracy of PET studies.
In PET scanners these blocks of detectors or the
Not only the individual detectors must be cali-
large area detectors are arranged in rings (Fig. brated and matched, which is generally done by
1.1.6) or partial rings around the patient allowing
a normalization scan, several other factors need
to measure the entire volume in between simulta- to be considered. These factors are listed below.
neously. The axial field of view (AFOV) of cur-
rently available PET -scanners ranges between 15
and 25 cm. For the acquisition of larger parts of Random Coincidences
the body several of these AFOV's are measured
The coincidence logic of PET scanners is limited
to detection of two photons within the coinci-
dence time window. It is not possible to determine
directly whether these two photons are the result
of the same annihilation or whether two annihila-
tions occurred randomly "at the same time."
Therefore a certain fraction of the measured co-
incidences must be attributed to this type of ran-
dom or accidental coincidences. These random
coincidences add a homogenous noise to the im-
age background which can be subtracted. If the
countrate of each single detector and the exact co-
incidence timing window for each detector pair
are known precisely it is principally possible to
Fig. 1.1.6. Multiple detector rings permit simultaneous data calculate the fraction of random coincidences.
acquisition for an entire body volume However, this is not practical due to the large