Positron emission tomography (PET) is a powerful metabolic imaging modality, which is designed to detect two anti-parallel 511 keV photons origniating from a positron-electron annihilation. However, it is possible that one or both of the annihilation photons undergo a Compton scattering in the object. This is more serious for a scanner operated in 3D mode or with large patients, where the scatter fraction can be as high as 40-60%. When one or both photons are scattered, the line of response (LOR) defined by connecting the two relevant detectors no longer passes through the annihilation position. Thus, scattered coincidences degrade image contrast and compromise quantitative accuracy. Various scatter correction methods have been proposed but most of them are based on estimating and subtracting the scatter from the measured data or incorporating it into an iterative reconstruction algorithm. By accurately measuring the scattered photon energy and taking advantage of the kinematics of Compton scattering, two circular arcs (TCA) in 2D can be identified, which describe the locus of all the possible scattering positions and encompass the point of annihilation. In the limiting case where the scattering angle approaches zero, the TCA approach the LOR for true coincidences. Based on this knowledge, a Generalized Scatter (GS) reconstruction algorithm has been developed in this thesis, which can use both true and scattered coincidences to extract the activity distribution in a consistent way. The annihilation position within the TCA can be further confined by adding a patient outline as a constraint into the GS algorithm. An attenuation correction method for the scattered coincidences was also developed in order to remove the imaging artifacts. A geometrical model that characterizes the different probabilities of the annihilation positions within the TCA was also proposed. This can speed up image convergence and improve reconstructed image quality. Finally, the GS algorithm has been adapted to deal with non-ideal energy resolutions. In summary, an algorithm that implicitly incorporates scattered coincidences into the image reconstruction has been developed. Our results demonstrate that this eliminates the need for scatter correction and can improve system sensitivity and image quality. / February 2016

The fluorinase enzyme, originally isolated from Streptomyces cattleya, has the unique ability to generate a C–F bond from aqueous fluoride ion and S-adenosylmethionine, making the fluorinase an attractive biochemical tool for radiolabelling biomolecules with fluorine-18 for application to positron emission tomography (PET). The inherent substrate specificity of the enzyme is, however, limiting, as only small modifications to the natural nucleoside substrate were known to be tolerated. This thesis describes an exploration and expansion of the substrate scope of the fluorinase enzyme, and its application to radiolabelling biomolecules for PET. The design and synthesis of a novel acetylene bearing substrate for the fluorinase, 5'-chloro-5'-deoxy-2-ethynyladenosine (ClDEA) is described. ClDEA proved an excellent substrate for the fluorinase, and the kinetics of the transformation and binding affinities of the new substrate and product were investigated. The fluorinated acetylenic product was demonstrated to undergo a copper-catalysed azide-alkyne cycloaddition (CuAAC) reaction with an azide bearing RGD peptide, and this methodology was investigated for the synthesis of a novel fluorine-18-bearing prosthetic group for the synthesis of a radiolabelled RGD peptide, which was assessed in vivo in a rat. After the demonstration that the fluorinase can be used for “last step” radiolabelling of bioactive peptides, the synthesis of dimeric and tetrameric RGD-bearing substrates for the fluorinase was investigated. These large constructs underwent efficient enzymatic fluorination, and the fluorinated products showed increased binding affinity to their targets, compared to monomeric analogues. The challenges encountered during radiolabelling of these multimers with fluorine-18 using the fluorinase are discussed. A difluoromethyl-bearing nucleoside substrate (F₂DA) was synthesised as a potential substrate in the reverse direction for the fluorinase, to further probe the substrate specificity if the fluorinase. Upon incubation with the enzyme, F₂DA did not appear to undergo reaction, despite the demonstration that F₂DA binds to the enzyme. Finally, the optimisation of a fluorinase-based protocol for the synthesis of the PET radiotracer [¹⁸F]fluoroacetate is described. The enzymatic method proved unsuitable for a small animal study due to contamination of the final product, and a chemical method was investigated and optimised as an alternative approach. [¹⁸F]Fluoroacetate synthesised using the developed chemical method was employed in an in vivo evaluation of acetyl CoA synthetase (ACSS2) activity in healthy and tumour-bearing mouse models, in an study to assess the activity of ACSS2 in breast and colon cancer models in mice.

BACKGROUND: Cardiovascular disease, principally manifest as myocardial infarction or stroke, is the dominant cause of death worldwide and despite therapeutic advances, the global burden of these conditions continues to increase. In order to address this ongoing disease burden, there is a clear need to more effectively target the use of existing and novel diagnostic investigations and medical therapies. Emerging cardiovascular biomarkers include the biochemical, such as high-sensitivity cardiac troponin, and the radiological, such as computed tomography coronary angiography (CTCA) and 18Ffluoride positron emission tomography (PET). Cardiac troponins can now be reliably quantified in clinically stable or asymptomatic populations and provide information about myocardial pathophysiology, whilst CTCA can non-invasively quantify atherosclerotic burden and 18F-fluoride PET imaging offers insight into plaque vulnerability. Improved targeting of diagnostic investigations requires more reliable estimation of pre-test probability of coronary disease whilst optimizing the use of pharmacological or interventional treatments requires more accurate prognostic stratification. Achieving both objectives in an equitable manner across all population groups will depend upon updated clinical guidelines containing improved risk models and enhanced management pathways. The objective of this thesis was to investigate the potential clinical benefit of novel approaches to the diagnostic and prognostic assessment of coronary heart disease. EVALUATION OF THE 2016 NATIONAL INSTITUTE FOR HEALTH AND CARE EXCELLENCE (NICE) GUIDANCE ON THE ASSESSMENT OF SUSPECTED STABLE ANGINA. A post-hoc analysis was undertaken of the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial of 4,146 participants with suspected angina randomised to assessment with computed tomography coronary angiography or standard care. Patients were dichotomised according to guideline definitions into groups representing possible angina and non-anginal presentations. The primary (diagnostic) endpoint was diagnostic certainty of angina at 6 weeks and the prognostic endpoint comprised fatal and non-fatal myocardial infarction. In 3,770 eligible participants, CTCA increased diagnostic certainty more in those with possible angina (relative risk [RR] 2.22 (95% CI 1.91-2.60), p < 0.001) than those with non-anginal symptoms (RR 1.30 (1.11-1.53), p=0.002; pinteraction < 0.001). In the possible angina cohort, CTCA did not change rates of invasive angiography (p=0.481) but markedly reduced rates of normal coronary angiography (hazard ratio [HR] 0.32 (0.19-0.52), p < 0.001). In the non-anginal cohort, rates of invasive angiography increased (HR 1.82 (1.13-2.92), p=0.014) without reducing rates of normal coronary angiography (HR 0.78 (0.30-2.05), p=0.622). At 3.2 years of follow-up, fatal or nonfatal MI was reduced in patients with possible angina (3.2% to 1.9%; HR 0.58 (0.34- 0.99), p=0.045) but not in those with non-anginal symptoms (HR 0.65 (0.25-1.69), p=0.379). Overall the updated NICE guidance on patient assessment maximises the benefits of CTCA with respect to diagnostic certainty, the use of invasive coronary angiography, and reductions in fatal and non-fatal myocardial infarction. Patients with non-anginal chest pain derive minimal benefit from CTCA, which instead increases rates of invasive investigation. EXTERNAL VALIDATION OF THE PROSPECTIVE MULTICENTER IMAGING STUDY FOR EVALUATION OF CHEST PAIN (PROMISE) TOOL FOR DETERMINING MINIMAL-RISK OF CORONARY ARTERY DISEASE. The PROspective Multicenter Imaging Study for Evaluation of chest pain (PROMISE) minimal-risk tool was recently developed to identify patients with suspected stable angina at very low risk of coronary artery disease and clinical events. The external validity of this tool was investigated within the context of the Scottish Computed Tomography of the HEART multicenter randomised controlled trial of patients with suspected stable angina due to coronary artery disease. Model discrimination and calibration was determined amongst 1,764 patients in whom complete CCTA data were available and compared with the European Society of Cardiology guideline-endorsed Coronary Artery Disease Consortium (CADC) risk score. The PROMISE minimal-risk tool improved discrimination compared with the CADC model (c-statistic 0.785 vs 0.730, p < 0.001) and was improved further following re-estimation of covariate coefficients (c-statistic 0.805, p < 0.001). Model calibration was initially poor (c2 197.6, Hosmer-Lemeshow [HL] p < 0.001), with significant overestimation of probability of minimal risk, but improved significantly following revision of the PROMISE minimal-risk intercept and covariate coefficients (c2 5.6, HL p=0.692). HIGH-SENSITIVITY CARDIAC TROPONIN I IN THE DIAGNOSIS OF STABLE CORONARY ARTERY DISEASE In a pre-specified sub-study of the Scottish COmputed Tomography of the Heart trial, plasma cardiac troponin was measured using a high-sensitivity single molecule counting assay in 943 adults with suspected stable angina who had undergone coronary computed tomography angiography. Rates of obstructive coronary artery disease were compared with the pre-test probability determined by the European Society of Cardiology Coronary Artery Disease Consortium risk model with and without cardiac troponin concentrations. External validation was undertaken in an independent study population from Denmark comprising 487 patients with suspected stable angina. Higher cardiac troponin concentrations were associated with obstructive coronary artery disease with a 5-fold increase across quintiles (9 to 48%, p < 0.001) independent of known cardiovascular risk factors (odds ratio [OR] 1.35 [95% confidence interval (CI) 1.25-1.46] per doubling of troponin). Cardiac troponin concentrations improved the discrimination of the ESC model for identifying obstructive coronary artery disease (c-statistic 0.785 to 0.800, p=0.003) and improved classification into ESCrecommended categories of clinical risk (net reclassification improvement 0.143 [95% CI, 0.093-0.193]). The revised model achieved similar improvements in discrimination and net reclassification when applied in the external validation cohort. HIGH-SENSITIVITY CARDIAC TROPONIN I IN CARDIOVASCULAR RISK STRATIFICATION OF PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND HEIGHTENED CARDIOVASCULAR RISK. The association between plasma high-sensitivity cardiac troponin I concentration and cardiovascular events in patients with chronic obstructive pulmonary disease and heightened cardiovascular risk was examined within the context of a double-blind randomised controlled trial of inhaled corticosteroids and bronchodilators (1 placebo arm and 3 different treatment arms). Plasma cardiac troponin I concentrations were measured with a high-sensitivity assay in a subgroup of 1,599 patients. The cardiovascular endpoint was a composite of cardiovascular death, myocardial infarction, stroke, unstable angina and transient ischaemic attack during follow-up of 1.5 years. Baseline plasma cardiac troponin I concentrations were above the lower limit of detection (1.0 ng/L) in 1,559 (97.5%) patients and were unaffected by inhaled therapies at 3 months (p > 0.05 for all). Compared with the lowest tertile (cardiac troponin I ≤3.0 ng/L), patients in the highest tertile (≥ 5.5 ng/L) were at greater risk of cardiovascular events (hazard ratio 3.0, 95% confidence interval 1.5 to 6.2, p=0.002) and cardiovascular death (hazard ratio 9.6, 95% confidence interval 2.6 to 35.6, p < 0.001) after adjustment for cardiovascular risk factors. There were no differences in COPD exacerbations between tertiles even after adjustment (p > 0.05). / REPRODUCIBILITY OF CORONARY 18F-FLUORIDE PET-CT IMAGING The inter-observer and scan-rescan reproducibility of coronary 18F-fluoride PET-CT imaging was investigated in 20 patients with clinically stable but high risk multi-vessel coronary artery disease who underwent repeated 18F-fluoride PET-CT scans 11.5±4.5 days apart. Scan analysis using the currently accepted approach of normalisation to a referent coronary segment (TBRREFERENT) identified 10 (50%) patients with evidence of focal coronary 18F-fluoride uptake and demonstrated moderate agreement across observers on a per-patient level (k = 0.56). This was similar to the level of agreement achieved with visual assessment alone (k = 0.64). Reproducibility was improved by semi-quantitative reporting combining visual assessment with a threshold uptake value for determining the presence of tracer uptake (k = 0.84). Using the optimised approach achieved excellent agreement on overall segmental uptake counts (intra-class correlation = 0.97). CONCLUSION: Cardiovascular diagnostic and prognostic assessments represent a complex endeavour and established tools for risk prediction can demonstrate suboptimal predictive accuracy when evaluated in patient cohorts that are independent of the population used for model derivation.

BACKGROUND Aortic stenosis is a common and potentially fatal condition in which fibro-calcific changes within the valve leaflets lead to the obstruction of blood flow. Severe symptomatic stenosis is an indication for aortic valve replacement and timely referral is essential to prevent adverse clinical events. Calcification is believed to represent the central process driving disease progression. 18F-Fluoride positron emission tomography computed tomography (PET-CT) and CT aortic valve calcium scoring (CT-AVC) quantify calcification activity and burden respectively. The overarching aim of this thesis was to evaluate the applications of these techniques to the study and management of aortic stenosis. METHODS AND RESULTS REPRODUCIBILITY The scan-rescan reproducibility of 18F-fluoride PET-CT and CT-AVC were investigated in 15 patients with mild, moderate and severe aortic stenosis who underwent repeated 18F-fluoride PET-CT scans 3.9±3.3 weeks apart. Modified techniques enhanced image quality and facilitated clear localization of calcification activity. Percentage error was reduced from ±63% to ±10% (tissue-to-background ratio most-diseased segment (MDS) mean of 1.55, bias -0.05, limits of agreement - 0·20 to +0·11). Excellent scan-rescan reproducibility was also observed for CT-AVC scoring (mean of differences 2% [limits of agreement, 16 to -12%]). AORTIC VALVE CALCIUM SCORE: SINGLE CENTRE STUDY Sex-specific CT-AVC thresholds (2065 in men and 1271 in women) have been proposed as a flow-independent technique for diagnosing severe aortic stenosis. In a prospective cohort study, the impact of CT-AVC scores upon echocardiographic measures of severity, disease progression and aortic valve replacement (AVR)/death were examined. Volunteers (20 controls, 20 with aortic sclerosis, 25 with mild, 33 with moderate and 23 with severe aortic stenosis) underwent CT-AVC and echocardiography at baseline and again at either 1 or 2-year time-points. Women required less calcification than men for the same degree of stenosis (p < 0.001). Baseline CT-AVC measurements appeared to provide the best prediction of subsequent disease progression. After adjustment for age, sex, peak aortic jet velocity (Vmax) ≥ 4m/s and aortic valve area (AVA) < 1 cm2, the published CT-AVC thresholds were the only independent predictor of AVR/death (hazard ratio = 6.39, 95% confidence intervals, 2.90-14.05, p < 0.001). AORTIC VALVE CALCIUM SCORE: MULTICENTRE STUDY CT-AVC thresholds were next examined in an international multicenter registry incorporating a wide range of patient populations, scanner vendors and analysis platforms. Eight centres contributed data from 918 patients (age 77±10, 60% male, Vmax 3.88±0.90 m/s) who had undergone ECG-gated CT within 3 months of echocardiography. Of these 708 (77%) had concordant echocardiographic assessments, in whom our own optimum sex-specific CT-AVC thresholds (women 1377, men 2062 AU) were nearly identical to those previously published. These thresholds provided excellent discrimination for severe stenosis (c-statistic: women 0.92, men 0.88) and independently predicted AVR and death after adjustment for age, sex, Vmax ≥4 m/s and AVA < 1 cm2 (hazards ratio, 3.02 [95% confidence intervals, 1.83-4.99], p < 0.001). In patients with discordant echocardiographic assessments (n=210), CT-AVC thresholds predicted an adverse prognosis. BICUSPID AORTIC VALVES Within the multicentre study, higher continuity-derived estimates of aortic valve area were observed in patients with bicuspid valves (n=68, 1.07±0.35 cm) compared to those with tri-leaflet valves (0.89±0.36 cm p < 0.001,). This was despite no differences in measurements of Vmax (p=0.152), or CT-AVC scores (p=0.313). The accuracy of AVA measurments in bicuspid valves was therefore tested against alternative markers of disease severity. AVA measurements in bicuspid valves demonstrated extremely weak associations with CT-AVC scores (r2=0.08, p=0.02) and failed to correlate with downstream markers of disease severity in the valve and myocardium and against clinical outcomes. AVA measurements in bicuspid patients also failed to independently predict AVR/death after adjustment for Vmax ≥4 m/s, age and gender. In this population CT-AVC thresholds (women 1377, men 2062 AU) again provided excellent discrimination for severe stenosis. CONCLUSIONS Optimised 18F-fluoride PET-CT scans quantify and localise calcification activity, consolidating its potential as a biomarker or end-point in clinical trials of novel therapies. CT calcium scoring of aortic valves is a reproducible technique, which provides diagnostic clarity in addition to powerful prediction of disease progression and adverse clinical events.

Since its inception around 1975, Positron Emission Tomography (PET) has proved to be an important tool in medical research as it allows imaging of the brain function in vivo with high sensitivity. It has been widely used in clinical dementia research with [18F]2-Fluoro-2-Deoxy-D-Glucose (FDG) and amyloid tracers as imaging biomarkers in Alzheimer's Disease (AD). The high resolution offered by modern scanner technology has the potential to provide new insight into the interaction of structural and functional changes in AD. However, the high resolution of PET is currently limited by movement and resolution (even for high resolution dedicated brain PET scanner) which results in partial volume effects, the undersampling of activity within small structures. A modified frame-by-frame (FBF) realignment algorithm has been developed that uses estimates of the centroid of activity within the brain to detect movement and subsequently reframe data to correct for intra-frame movement. The ability of the centroid to detect motion was assessed and the added benefit of reframing data for real clinical scans with patient motion was evaluated through comparison with existing FBF algorithms. Visual qualitative analysis on 6 FDG PET scans from 4 blinded observers demonstrated notable improvements (ANOVA with Tukey test, p < 0.001) and time-activity curves were found to deliver biologically more plausible activity concentrations. A new method for Partial Volume Correction (PVC) is also proposed, PARtially-Segmented Lucy-Richardson (PARSLR),that combines the strength of image based deconvolution approach of the Lucy-Richardson (LR) Iterative Deconvolution Algorithm with a partial segmentation of homogenous regions. Such an approach is of value where reliable segmentation is possible for part but not all of the image volume or sub-volume. Its superior performance with respect to region-based methods like Rousset or voxel-based methods like LR was successfully demonstrated via simulations and measured phantom data. The approach is of particular importance for studies with pathological abnormalities where complete and accurate segmentation across or with a sub-volume of the image volume is challenging and for regions of the brain containing heterogeneous structures which cannot be accurately segmented from co-registered images. The developed methods have been shown to recover radioactivity concentrations from small structures in the presence of motion and limited resolution with higher accuracy when compared to existing methods. It is expected that they will contribute significantly to future PET studies where accurate quantitation in small or atrophic brain structures is essential.

The introduction of clinical Positron Emission Tomography (PET) in oncology in the 1990s has substantially changed the management of patients with cancer and become one of the diagnostic modalities with the fastest growth worldwide (Buck et al., 2010). The major hurdle delaying the proliferation of PET was partly due to its high initial investment and insufficient third-party reimbursement (Keppler & Conti, 2001). Hong Kong, a region with about half the economic strength of Germany, was able to sustain a higher ratio of PET-CT scanners than that of Germany. Through the study of the PET utilization in Hong Kong, this research is to (i) explore the factors contributing to this phenomenon; and (ii) find out if those factors are applicable to other developing countries. The key factors found contributed to a higher ratio of PET-CT scanners in Hong Kong were: 1) medical expertise in a regionally profound disease; 2) the direct payment culture which enables an economically efficient and a cost-effective operation; 3) the influx of patients from neighboring countries; and 4) the reputation of its medical services. Applying these factors, citizens in developing countries were able to have access to the latest and expensive medical technology.

Positron emission tomography (PET) is a non-invasive medical imaging technique that allows visualisation and quantification of biochemical, physiological and pharmacological processes in living subjects. This is achieved through application of radiotracers – compounds labelled with positron emitting radionuclides. Neurodegeneration is the progressive loss of neurons resulting in impairment of brain function leading to cognitive decline and can affect movement. The underlying pathology of many neurodegenerative diseases is misfolding of proteins such as α-synuclein, the key pathological hallmark of Parkinson’s disease. Also implicated in the processes of neurodegeneration is neuroinflammation, which is observed by the activation of microglia – the immune cells of the brain. Activation of microglia is associated with the upregulation of the 18 kDa mitochondrial translocator protein (TSPO). This work has involved the synthesis and characterisation of novel compounds that have the potential for being applied as radiotracers for imaging α-synuclein fibrils (project 1), or TSPO (project 2) via PET. Over the course of project 1 a library of compounds was synthesised based upon structural modifications of a lead structure identified from the literature. These compounds then underwent screening via biophysical methodologies in order to determine their affinity to α-synuclein fibrils. This stage of the work involved the development of a novel biophysical technique – microscale thermophoresis (MST). A general automated radiosynthetic method to afford the [18F]fluoro-derivatives of these compounds has also been developed, and preliminary in vitro autoradiography studies and an in vivo microPET scan has been performed. For project 2, an automated radiosynthetic method was developed to produce [18F]GE387, a lead compound identified through collaboration with GE Healthcare. This radiotracer has then been applied to preliminary in vitro autoradiography and an in vivo microPET study using rats with induced neuroinflammation alongside control rats.

L’endométriose est une pathologie chronique qui provoque des douleurs pelviennes et une infertilité. On décrit trois phénotypes d’endométriose :l’endométriose péritonéale superficielle, les kystes ovariens d’endométriose (endométriomes) et l’endométriose profonde.L’examen standard pour le diagnostic de l’endométriose est, encore aujourd’hui, la laparoscopie. Nous avons étudié, de façon prospective, l’utilité d’un examen non invasif, la tomographie par émission de positrons (PET), chez les patientes avec suspicion d’endométriose. Nous n’avons pas mis en évidence d’hyperactivité métabolique sur les images de PET pré opératoires, après injection de déoxyglucose marqué au 18F (18FDG), des lésions d’endométriose ayant été confirmées par laparoscopie. Nous avons réalisé, dans un second temps, la même étude après injection d’un analogue de la somatostatine, le DOTATATE, marqué au 68Ga, qui montre une avidité pour les récepteurs à la somatostatine (SSTR) de type 2. Dans cette dernière étude, seules les lésions d’endométriose profonde se sont révélées hyperactives sur les images pré opératoires de PET. Nous avons ensuite réalisé une étude immunohistochimique rétrospective sur différents échantillons d’endométriose superficielle, d’endométriomes et d’endométriose profonde. Nos résultats ont confirmé l’expression de SSTR de type 1 et 5 par les cellules épithéliales des trois phénotypes d’endométriose. Par contre, seules les lésions d’endométriose profonde exprimaient les SSTR de type 2.Le traitement chirurgical des endométriomes et de l’endométriose superficielle est bien codifié. Par contre, la chirurgie de l’endométriose profonde reste au cœur des débats dans la littérature. Nous avons évalué notre aptitude à appliquer les techniques de chirurgie mini-invasive aux procédures complexes telles que la résection des nodules d’endométriose profonde du septum recto-vaginal (NEPSRV). Nous avons évalué la faisabilité de la laparoscopie avec assistance robotique pour une autre procédure complexe :la dissection des ganglions para-aortiques dans le cadre des cancers du col utérin localement avancés. Nous l’avons jugée faisable et sûre pour les patientes. En l’absence de bénéfice démontré de la laparoscopie avec assistance robotique sur la laparoscopie conventionnelle pour le traitement des NEPSRV, nous avons décidé d’évaluer une nouvelle stratégie opératoire mini-invasive de résection des NEPSRV. Nous avons réalisé une analyse des 10 premières patientes opérées selon cette stratégie et avons montré une amélioration significative des symptômes et de la qualité de vie des patientes. Nous avons également étudié la morbidité post opératoire. Nous avons finalement étudié l’apport de la laparoscopie guidée par la fluorescence au traitement des NEPSRV et observé des résultats prometteurs.A l’avenir, les lésions symptomatiques d’endométriose profonde exprimant les SSTR2 pourraient être sélectionnées à l’aide d’un PET au 68Ga-DOTATATE afin d’être traitées, dans le cadre d’essais cliniques, par des analogues de la somatostatine. Ces thérapies ciblées permettaient, dans ces cas, d’éviter la chirurgie. Notre stratégie opératoire mini-invasive pourraient dès lors être appliquée aux lésions n’exprimant pas les SSTR2. / Doctorat en Sciences médicales (Médecine) / info:eu-repo/semantics/nonPublished

A Tomografia por Emissão de Pósitrons (PET - Positron Emission Tomography) é uma modalidade de imagens para o diagnóstico em Medicina Nuclear. São utilizados radiofármacos emissores de pósitrons que possibilitam obter imagens que representam o processo bioquímico dessas substâncias no órgão ou tecido de interesse in vivo. São detectados, em coincidência, os fótons provenientes da aniquilação pósitron/elétron, que ocorre dentro do corpo do paciente. Esta informação é posteriormente utilizada para a reconstrução do objeto em estudo. Atualmente, existem dois tipos de equipamentos capazes de realizar estudos tomográficos por emissão de pósitrons: o dedicado e a câmara PET/SPCET. Este trabalho abordou este último tipo, que permite também a realização de exames habituais de Medicina Nuclear, que usam emissores de fótons. Existem dificuldades inerentes ao método de aquisição destas imagens que afetam a quantificação de índices ou atividade. Elas estão relacionadas ao fato de a emissão de radiação obedecer a uma distribuição de Poisson, às interações físicas da radiação com o corpo do paciente e com o detector, ao ruído devido à natureza estatística destas interações e de todo o processo de detecção, assim como à metodologia de aquisição dos exames (preparo e posicionamento do paciente, taxa de contagens etc.). Correções são propostas na literatura que não são totalmente implementadas pelos fabricantes: de espalhamento, de atenuação, de eventos aleatórios, do tempo morto, de decaimento, da resolução espacial e de outras características do equipamento. O objetivo deste trabalho foi o de realizar um estudo dos métodos aplicados por dois fabricantes, assim como algumas influências das características técnicas das câmaras PET/SPECT na obtenção do índice de SUV (Standardized Uptake Value). Para isso, dados de simuladores físicos, dispostos em várias montagens, foram obtidos com uma câmara no modo 3D e outra no modo 20. Constatou-se também que a forma das fontes usadas para calibração influencia no resultado final e impõe novos desafios para a quantificação em uma situação clínica. Por fim, no momento da quantificação, a região de interesse deve ser escolhida de acordo com aquela usada para a determinação dos coeficientes de correção e calibração. Verificou-se que é viável realizar quantificações com câmaras PET/SPECT, inclusive o índice SUV. Para tanto, além das correções citadas anteriormente, é imprescindível ter o equipamento bem ajustado, assim como a obtenção de coeficientes para normalização da sensibilidade e correção do efeito de volume parcial. / Positron Emission Tomography (PET) is a Nuclear Medicine imaging modality for diagnostic purposes. Pharmaceuticals labeled with positron emitters are used and images which represent the in vivo biochemical process within tissues can be obtained. The positron/electron annihilation photons are detected in coincidence and this information is used for object reconstruction. Presently, there are two types of systems available for this imaging modality: the dedicated systems and those based on gamma camera technology. In this work, we utilized PET/SPECT systems, which also allows for the traditional Nuclear Medicine studies based on single photon emitters. There are inherent difficulties which affect quantification of activity and other indices. They are related to the Poisson nature of radioactivity, to radiation interactions with patient body and detector, noise due to statistical nature of these interactions and to all the detection processes, as well as the patient acquisition protocols. Corrections are described in the literature and not all of them are implemented by the manufacturers: scatter, attenuation, randoms, decay, dead time, spatial resolution, and others related to the properties of each equipment. The goal of this work was to assess these methods adopted by two manufacturers, as well as the influence of some technical characteristics of PET/SPECT systems on the estimation of SUV. Data from a set of phantoms were collected in 3D mode by one camera and 20, by the other. We concluded that quantification is viable in PET/SPECT systems, including the estimation of SUVs. This is only possible if, apart from the above mentioned corrections, the camera is well tuned and coefficients for sensitivity normalization and partial volume corrections are applied. We also verified that the shapes of the sources used for obtaining these factors play a role on the final results and should be dealt with carefully in clinical quantification. Finally, the choice of the region of interest is critical and it should be the same used to calculate the correction factors.

Neste trabalho foi feito um estudo do perfil tomográfico da emissão da linha do átomo de hidrogênio, H-alfa (?=656,28 nm) no plasma do TCABR, um tokamak de porte médio em operação no Laboratório de Física de Plasmas do Instituto de Física da Universidade de São Paulo. Nosso trabalho centrou-se no estudo dos efeitos da introdução de um eletrodo polarizado na borda do plasma no tokamak TCABR. O eletrodo pode ser introduzido até 1,5 cm para dentro da coluna do plasma, sem causar disrupturas para polarização positiva de 0 até +350V, e situado no plano equatorial do tokamak. Perfis tomográficos de H-alfa com e sem polarização foram medidos. A comparação dos perfis mostra um aumento da densidade de linha na posição central, quando a emissividade H-alfa diminui. A análise dos perfis tomográficos de H-alfa, tempo de confinamento das partículas e também do estudo de reciclagem das partículas neutras, indica que o plasma entra no regime de alto confinamento (modo-H). Cálculos de turbulência e de transporte na borda do plasma (SOL), feitos medindo o potencial flutuante e a corrente de saturação de íons, mostram uma diminuição forte no espectro de potência e de transporte. Também foram feitos estudos do novo regime de descargas com elétrons fugitivos (\"runaway electron\"), descoberto no tokamak TCABR. As características distintivas deste regime são um plasma de baixa temperatura fracamente ionizado, destacado do limitador devido a processos de recombinação, e instabilidade de relaxação com fortes picos de emissão H-alfa correlacionados com instabilidade dente de serra da densidade eletrônica de linha. No presente trabalho fazemos a descrição das condições experimentais para a geração destas descargas. A produção dos elétrons fugitivos é analisada; mostrando que a geração de elétrons fugitivos somente pode ser explicada pelo mecanismo de avalanche. A confirmação de baixa temperatura do plasma é obtida de uma análise do perfil tomográfico da emissão H-alfa. Esta emissão não pode ser explicada por excitação de elétrons no plasma. A recombinação, de outro lado, dá uma explicação plausível para a dependência temporal da emissão, em particular para alta densidade de partículas neutras. / A study of the tomography profile of the emission of the line of Hydrogen, atomic H-alpha line (?=656.28 nm), was carried out in TCABR, a medium-size tokamak in operation at the Laboratory of Plasma Physics of the Institute of Physics of the University of São Paulo. Our work focuses on the study of the effects of due to the introduction of a biased electrode in the plasma edge of the TCABR tokamak. The electrode could be introduced up to 1.5 cm inside the plasma, without plasma disruptions for positive voltages from 0 to +350V, and was located on the equatorial plane of the plasma column. Tomography profiles of H-alpha with and without bias were measured. Comparison of the profiles shows an increase of the central line-averaged density, while the emissivity of the line H-alpha decreases. The analysis of the tomography profiles of H-alpha, time of confinement of particles and also the study of recycling of the neutral particles, indicate that the confined plasma enters the H-mode regime. Calculations of turbulence and transport at the Scrape-Off-Layer, using measured floating potentials and ion saturation currents, show a strong decrease in the power spectra and transport. The H-alpha tomography was also employed to study the new regime of runaway discharges that has been discovered in the TCABR tokamak. The distinctive features of this regime are weakly ionized low-temperature plasma detached from the limiter due to the recombination process, and a relaxation instability with strong spikes of H-alpha emission correlated with sawtooth relaxation of the line density. In the present thesis we report experimental data on conditions for generation of these discharges. The runaway electron production is analyzed; show that generation of runaway electrons can only be explained by the runaway avalanche mechanism. The confirmation of low plasma temperature is a obtained from an analysis of the tomography profile of H-alpha emission. This emission cannot be explained by excitation by plasma electrons. Recombination, on the other hand, gives a rather plausible explanation for the time dependency of the emission, in particular at high neutral densities.