The aim of this study is to optimise the acquisition and reconstruction for SPECT with 111In- pentetrotide with the iterative reconstruction software OSEMS. For 111In-pentetrotide SPECT, the uptake in the tumour is usually high compared to uptake in normal tissue. It may, however, be difficult to detect small tumours with the SPECT method because of high noise levels and the low spatial resolution. The liver is a common region for somatostatin-positive metastases, and to visually detect small tumours in the liver, as early as possible, is important for an effective treatment of the cancer disease. The study concentrates on the acquired number of projections, the subset size in the OSEM reconstruction and evaluates contrast as a function of noise for a range of OSEM iterations. The raw-data projections are produced using Monte Carlo simulations of an anthropomorphic phantom, including tumours in the liver. Two General Electric (GE) collimators are evaluated, the extended low-energy general-purpose (ELEGP) and the medium energy general-purpose (MEGP) collimator. Three main areas of reconstruction are investigated. First the reconstructions are performed for so called full time scans with the acquisition time used clinically. Also the effect of performing the examination in half-time or with half the injected activity is evaluated with the most optimal settings gained from the full time scans for both collimators. In addition images reconstructed without model-based compensation are also included for comparison. This study is a continuation of a previous study on 111In-pentetrotide SPECT where collimator choice and model-based compensation were evaluated for a cylindrical phantom representing small tumours in liver background. As in the previous study, ELEGP proved to be the better collimator. For ELEGP, the most optimal setting was 30 projection angles and a subset size of 6 projections in the OSEM reconstruction, and for MEGP optimal setting was 60 projections and 4 subsets. The difference between the different collimator settings were, however, rather small but proven significant. For both collimators the half-time scan including model-based compensation was better compared to the full-time reconstructions without model-based compensation.

In many medical imaging modalities, as photons travel from the emission source to the detector, they are scattered by the biological tissue. Often this scatter is viewed as a phenomenon that degrades image quality, and most research is focused on designing methods for either discarding the scattered photons or correcting for scatter. However, the scattered photons also carry information about the tissue that they pass through, which can perhaps be extracted. In this research, we investigate methods to retrieve information from the scattered photons in two specific medical imaging modalities: diffuse optical tomography (DOT) and single photon emission computed tomography (SPECT). To model the scattering of photons in biological tissue, we investigate using the Neumann-series form of the radiative transport equation (RTE). Since the scattering phenomenon are different in DOT and SPECT, the models are individually designed for each modality. In the DOT study, we use the developed photon-propagation model to investigate signal detectability in tissue. To study this detectability, we demonstrate the application of a surrogate figure of merit, based on Fisher information, which approximates the Bayesian ideal observer performance. In the SPECT study, our aim is to determine if only the SPECT emission data acquired in list-mode (LM) format, including the scattered-photon data, can be used to compute the tissue-attenuation map. We first propose a path-based formalism to process scattered photon data, and follow it with deriving expressions for the Fisher information that help determine the information content of LM data. We then derive a maximum-likelihood expectation-maximization algorithm that can jointly reconstruct the activity and attenuation map using LM SPECT emission data. While the DOT study can provide a boost in transition of DOT to clinical imaging, the SPECT study will provide insights on whether it is worth exposing the patient to extra X-ray radiation dose in order to obtain an attenuation map. Finally, although the RTE can be used to model light propagation in tissues, it is computationally intensive and therefore time consuming. To increase the speed of computation in the DOT study, we develop software to implement the RTE on parallel computing architectures, specifically the NVIDIA graphics processing units (GPUs).

Στην παρούσα μελέτη παρουσιάσαμε τα αποτελέσματα της λειτουργικής απεικόνισης με SPECT αιμάτωσης εγκεφάλου σε δύο διαφορετικές παθολογικές καταστάσεις, την νόσο του Παρκινσον και τη δευτεροπαθή δυστονία. Στο πρώτο μέρος της μελέτης διερευνήσαμε την ακεραιότητα της μελανοραβδωτής οδού και την αιματική εγκεφαλική ροή στα διάφορα στάδια της νόσου Parkinson. Στη μελέτη συμμετείχαν συνολικά 53 ασθενείς (27 άνδρες, 26 γυναίκες) που πληρούσαν τα κριτήρια της Ιδιοπαθούς νόσου του Parkinson και αξιολογήθηκαν σύμφωνα με την κλίμακα Unified Parkinson Disease Rating Scale (UPDRS) καθώς και την κλίμακα Hoehn-Yahr. Οι ασθενείς χωρίστηκαν σε 4 ομάδες σύμφωνα με την κλίμακα Hoehn-Yahr. Το πρωτόκολλο μελέτης των 53 ασθενών περιελάμβανε 2 απεικονιστικές εξετάσεις: Α) το SPECT εγκεφάλου με το ραδιοφάρμακο 123Ι- Ioflupane (DaTSCAN) και Β) το SPECT αιμάτωσης εγκεφάλου με το ραδιοφάρμακο 99m Tc-ECD (Neurolite ). Η νόσος Πάρκινσον είναι ένα υποκινητικό σύνδρομο και όπως καταδείξαμε από τη μέλετη ασθενών σε διάφορα στάδια της νόσου, το πρότυπο της αιμάτωσης του εγκεφάλου είναι αυτό της σταδιακής προσβολής περιοχών του φλοιού ως συνέπεια της απόσχισης των συνδέσεων του κυκλώματος βασικών γαγγλίων με το φλοιό. Συγκεκριμένα αποδείξαμε ότι στα αρχικά στάδια της νόσου παρατηρείται υποαιμάτωση περιοχών του μετωπιαίου λοβού (κινητικών, προκινητικών και περιοχών του προμετωπαίου λοβού) ενώ σε πιο προχωρημένα στάδια η προσβολή του φλοιού επεκτείνεται σε περιοχές του βρεγματικού και κροταφικού λοβού. Επίσης βρέθηκε θετική συσχέτιση μεταξύ της ειδικής σύνδεσης του ρ/φ στον αριστερό κερκοφόρο πυρήνα και της αιματικής εγκεφαλικής ροής στην περιοχή DLPFC του προμετωπιαίου λοβού αριστερά, καθώς επίσης και μεταξύ της ειδικής σύνδεσης του ρ/φ στο αριστερό κέλυφος και της αιματικής εγκεφαλικής ροής στην πρωτοταγή κινητική περιοχή αριστερά. Στο δεύτερο μέρος της εργασίας μελετήσαμε 21 ασθενείς με Ιδιοπαθή νόσο Parkinson που πληρούσαν τα κριτήρια για χειρουργική αντιμετώπιση με εν τω βάθει εγκεφαλικό ερεθισμό (DBS). Οι ασθενείς ήταν 11 γυναίκες και 10 άνδρες, μέσης ηλικίας 63±8 χρόνια, μέσης διάρκειας της νόσου 11.5±4.8 και σταδίου 2.9±0.8 κατά Hoehn and Yahr. Οι ασθενείς αυτοί υπεβλήθησαν σε 2 ξεχωριστές μελέτες SPECT αιμάτωσης εγκεφάλου, η πρώτη πριν το χειρουργείο (meds off) και η δεύτερη 6 μήνες μετά το χειρουργείο (DBS on/ off meds). Οι δύο αυτές μελέτες συγκρίθηκαν μεταξύ τους με το πρόγραμμα Neurogam και εξετάστηκαν συγκεκριμένα οι μεταβολές στην αιματική εγκεφαλική ροή των κινητικών περιοχών του εγκεφάλου. Παράλληλα εξετάσθηκε η κινητική βελτίωση των ασθενών κλινικά και με βάση την κλίμακα mUPDRS. Τα αποτελέσματα της μελέτης ήταν πολύ καλά καθώς οι 20 ασθενείς παρουσίασαν σημαντική κλινική βελτίωση μειώνοντας την κλίμακα mUPDRS κατά 44% και τη χορηγούμενη δόση levodopa από 850 ± 108 mg πριν το χειρουργείο σε 446 ± 188 mg στο διάστημα επανελέγχου. Επίσης στους 6 μήνες παρατηρήθηκε σημαντική αύξηση της αιματικής εγκεφαλικής ροής στην προκινητική και πρωτοταγή κινητική περιοχή του εγκεφαλικού φλοιού κατά 10.9% και σημαντική συσχέτιση αυτής με την κινητική βελτίωση των ασθενών (r=.89, p<.001). Από τη μελέτη μας προκύπτει ότι το DBS είναι ικανό να άρει την υποαιμάτωση τουλάχιστον των κινητικών περιοχών του φλοιού, οδηγώντας στην κινητική βελτίωση των ασθενών. Στο τρίτο μέρος της μελέτης μας ασχοληθήκαμε με την μελέτη ασθενών με δευτεροπαθή δυστονία που αποτελεί ένα υπερκινητικό σύνδρομο με ετερογένεια όσον αφορά την αιτιολογία του. Συγκεκριμένα μελετήσαμε το αποτέλεσμα της δράσης του DBS στην περιοχική αιματική εγκεφαλική ροή των κινητικών περιοχών του φλοιού σε συνάρτηση με το κλινικό αποτέλεσμα. Στο πρωτόκολλο πριελήφθησαν 6 ασθενείς με φαρμακευτικά ανθεκτική δευτεροπαθή δυστονία που υπεβλήθησαν σε DBS. Οι ασθενείς υπεβλήθησαν σε SPECT αιμάτωσης εγκεφάλου σε δύο διαφορετκές λειτουργικές καταστάσεις μετεγχειρητικά: DBS on & DBS off κατάσταση. Οι δύο μελέτες συγκρίθηκαν μεταξύ τους με το πρόγραμμα Neurogam. Η κινητική εκτίμηση των ασθενών έγινε με την κλίμακα Burke–Fahn–Mardsen Dystonia Rating Scale (BFMDRS) στις δυο διαφορετικές καταστάσεις (DBS on & DBS off). Δύο ασθενείς έδειξαν άριστη κλινική βελτίωση στον επανέλεγχο, σε δύο άλλους τα αποτελέσματα ήταν μέτρια και σε δύο τα αποτελέσματα της επέμβασης κρίθηκαν φτωχά. Ο μέσος βαθμός βελτίωσης της κλίμακας BFMDRS ήταν 49.1% (0–90.7%). Επίσης η ανάλυση των SPECT μελετών έδειξε σημαντική μείωση της rCBF στην κατάσταση on DBS κάτι που συσχετίστηκε με την κλινική βελτίωση. Όσον αφορά το μηχανισμό δράσης του εν τω βάθη εγκεφαλικού ερεθισμού, παρά τις πολλαπλές θεωρίες που υπάρχουν, φαίνεται, τουλάχιστον από το δικό μας μικρό δείγμα ασθενών, να λειτουργεί με το να επαναρυθμίζει το υπάρχων παθολογικό λειτουργικό κύκλωμα σε ένα νέο πιο αρμονικό ρυθμό, προσφέροντας στους ασθενείς μία νέα οδό επικοινωνίας του συστήματος των βασικών γαγγλίων με το φλοιό και στις περισσότερες περιπτώσεις να καταφέρνει να προσφέρει κινητική βελτίωση. / In the present study we present the results of functional brain imaging with regional Cerebral Blood Flow SPECT (rCBF SPECT) in two different neurological disorders; Parkinson’ Disease (PD) and Secondary Dystonia. In the first case of Parkinson’s Disease, our first purpose was to investigate the differences and associations between cortical perfusion and nigrostriatal dopamine pathway in different stages of Parkinson’s disease (PD). For that purpose we recruited 53 non-demented PD patients divided into four groups according to the Hoehn and Yahr (HY) staging system. Each patient underwent two separate brain single photon emission computed tomography (SPECT) studies (perfusion and dopamine transporter binding). Perfusion images of each patient were quantified and compared with a normative database provided by the NeuroGam software manufacturers. Compared with controls, PD patients showed impairments of cerebral perfusion that increased with clinical severity. Furthermore Dopamine transporter binding in the left caudate nucleus and putamen significantly correlated with blood flow in the left dorsolateral prefrontal cortex (DLPFC) and primary motor cortex respectively. We concluded that there are significant perfusion deficits, that are associated with PD progression, implying a multifactorial neurodegeneration process apart from dopamine depletion in the substantia nigra pars compacta (SNc). Given the fact that high-frequency deep brain stimulation (DBS) of the subthalamic nucleus (STN) has become an established therapeutic approach for the management of patients with medically intractable idiopathic Parkinson’s disease (PD), our second purpose was to to assess regional cerebral blood flow (rCBF) changes related to motor improvement after Deep Brain Stimulation of the Subthalamic Nucleus (STN DBS). For that purpose we studied twenty-one PD patients (11 females and 10 males, mean age 63±8, mean disease duration 11.5±4.8, mean Hoehn and Yahr stage:2.9±0.8), that underwent two rCBF SPECT studies at rest, once preoperatively in the off-meds state and the other postoperatively (at 6±2 months) in the off-meds/on-stimulation state. Patients were classified according to the Unified Parkinson Disease Rating Scale (UPDRS) and Hoehn and Yahr (H&Y) scale. Neurogam software was used to register, quantify and compare two sequential brain SPECT studies of the same patient in order to investigate rCBF changes during STN stimulation in comparison with preoperative rCBF. The results showed that all patients presented clinical improvement during the first months after surgery resulting in a 44% reduction of the UPDRS motor score. The administered mean daily levodopa dose significantly decreased from 850 ± 108 mg before surgery to 446 ± 188 mg during off meds state (p < .001, paired t-test). At the 6 month postoperative assessment we noticed rCBF increases in the pre-supplementary motor area (pre-SMA) and the premotor cortex (PMC) (mean rCBF increase=10.9%), the dorsolateral prefrontal cortex and in associative and limbic territories of the frontal cortex (mean rCBF increase=8.2%). A correlation was detected between the improvement in motor scores and the rCBF increase in the pre-SMA and PMC (r=.89, p<.001). Our study suggests that STN stimulation leads to improvement in neural activity in the frontal motor/associative areas. The correlation between motor improvement and rCBF increase in higher order motor cortical areas suggests that even the short term stimulation achieves its therapeutic benefit by restoring the activity within these cortical regions. In the third part of our study we investigated the effect of deep brain stimulation (DBS) on regional cerebral blood flow (rCBF) in cases of secondary dystonia in correlation with clinical outcomes. For that purpose we studied six patients with medically intractable secondary dystonia who underwent DBS surgery. Burke–Fahn–Mardsen Dystonia Rating Scale (BFMDRS) was used for the assessment of dystonia, in the on & off DBS state. Single photon emission computed tomography (SPECT) of the brain was performed postoperatively in the two stimulation states (ON-DBS and OFFDBS) and the changes of rCBF in the three following brain regions of interest (ROIs): primary motor cortex, premotor and supplementary motor cortex, and prefrontal cortex were evaluated. Two patients exhibited excellent response to DBS, two patients got moderate benefit after the procedure, and in two patients, no clinical improvement was achieved. A mean improvement of 49.1% (0–90.7%) in BFMDRS total scores was found postoperatively. Brain SPECT data analysis revealed an overall decrease in rCBF in the investigated ROIs, during the ON-DBS state. Clinical improvement was significantly correlated with the observed decrease in rCBF in the presence of DBS. We concluded that when conservative treatment fails to relieve severely disabled patients suffering from secondary dystonia, DBS may be a promising therapeutic alternative. Moreover, thiat study indicates a putative role of brain SPECT imaging as a postoperative indicator of clinical responsiveness to DBS.

Compton cameras localize γ-ray sources in 3D space by observing evidence of Compton scattering with detectors sensitive to ionizing radiation. This thesis proposes a software system for operating a novel Compton camera device comprised of Timepix3 detectors and Katherine readouts. To communicate with readouts using UDP-based protocol, a dedicated hardware library was developed. The presented software can successfully control the acquisition of multiple Timepix3 detectors and simultaneously process their measurements in a real-time setting. To recognize instances of Compton scattering among observed interactions, a chain of algorithms is applied with explicit consideration for a possibly high volume of measured information. Unlike alternate approaches, the presented work uses a recently published charge drift time model to improve its spatial resolution. In order to achieve localization of γ-ray sources, the software performs conical back projection into a discretized cuboid volume. Results of randomized evaluation with simulated data indicate that the presented implementation is correct and constitutes a viable method of γ-ray source localization in 3D space. Experimental verification with a prototype model is in progress.

No description available.

Background One of the most used treatments for hyperthyroidism, is therapy with radioactive iodine (131I), which is accumulated in the thyroid gland. To determine the activity of 131I to be administered for a certain absorbed dose, the volume of the gland is of great importance but the historically used methods for estimating the functional volume of the gland are based on large approximations. The use of SPECT images enables increased accuracy of functional volume determination. However, there is a need for more realistic phantom studies and improved image segmentation. Aim The aim of this thesis was to find a robust method for image segmentation of the thyroid gland that could adapt to various object sizes and contrasts. The aim was also to develop an accessible and flexible 3D thyroid phantom for measurements and optimisation of parameter settings. Materials and Methods Thyroid phantoms made from playdough loaded with 99mTcO4-, were placed in a neck phantom filled with 99mTcO4- solution of various concentration. SPECT and CT acquisitions of the phantoms were performed and the SPECT images were segmented using thresholding and region growing algorithms. The thresholds in the segmentation algorithms were optimised by minimisation of cost functions consisting of Dice score, against the CT-volume, and relative SPECT volume. To find thresholds that could be used on all phantom volumes and image backgrounds, two overall cost functions were optimised for high and low backgrounds respectively. The optimised thresholds were validated on another set of playdough phantoms. They were also used on a simpler plastic can phantom for comparison of the performance relative to the method used in the clinic today. Results The optimised thresholds showed a substantial divergence between the measurements, ranging from 40 to 58 % for the thresholding algorithm and from 8 to 19 % for the region growing algorithm. The overall optimised thresholds were 55 and 48 % for high and low image backgrounds for the thresholding algorithm which was selected for the validation measurements due to its lower overall cost function and high stability. The developed method indicated a higher accuracy in functional volume determination of the thyroid gland than the standard method used. Conclusions An image segmentation method for functional volume determination of the thyroid gland, that can adapt to image contrast, was developed in this thesis. The method indicates an improved accuracy for functional volume determination of thyroid glands, but more experiments would need to be conducted. The developed thyroid phantoms enable further optimisation of image segmentation parameters for various object sizes, contrasts and shapes. The results indicate that thresholds deduced from simpler phantoms may be too uncertain which might lead to overtreatment of hyperthyroidism with 131I. It was also indicated that thresholding is more suitable than region growing for image segmentation of SPECT images.

Single photon emission tomography (SPECT) data from myocardial perfusion imaging (MPI) are normally displayed as a set of three slices orthogonal to the left ventricular (LV) long axis for both ECG-gated (GSPECT) and non-gated SPECT studies. The total number of slices presented for assessment depends on the size of the heart, but is typically in excess of 30.  A requirement for data presentation is that images should be orientated about the LV axis; therefore, a set of radial slice would fulfill this need. Radial slices are parallel to the LV long axis and arranged diametrically. They could provide a suitable alternative to standard orthogonal slices, with the advantage of requiring far fewer slices to adequately represent the data. In this study a semi-automatic method was developed for displaying MPI SPECT data as a set of radial slices orientated about the LV axis, with the aim of reducing the number of slices viewed, without loss of information and independent on the size of the heart. Input volume data consisted of standard short axis slices orientated perpendicular to the LV axis chosen at the time of reconstruction.  The true LV axis was determined by first determining the boundary on a central long axis slice, the axis being in the direction of the y-axis in the matrix. The skeleton of the myocardium were found and the true LV axis determined for that slice. The angle of this axis with respect to the y-axis was calculated. The process was repeated for an orthogonal long axis slice. The input volume was then rotated by the angles calculated. Radial slices generated for presentation were integrated over a sector equivalent to the imaging resolution (1.2 cm); assuming the diameter of the heart is about 8cm then non-gated data could be represented by 20 radial slices integrated over an 18 degree section. Gated information could be represented with four slices spaced at 45 intervals, integrated over a 30 degree sector.

<p> Cell therapy for Parkinson's disease will greatly benefit from progress in methods aimed at visualizing the dopamine system and cell replacement techniques. Currently, cell therapy has been met with varied success, in part due to differences in cell sources, transplantation procedures, and our lack of understanding of cell fate post-transplantation. The standardization of transplantation procedures will enhance our ability to draw comparisons between studies and improve cell therapy outcomes. We developed a method to label neural stem/progenitor cells (NSPCs) with technetium-99m and then visualize the cells with single photon emission computed tomography (SPECT) subsequent to grafting in the brain. This labeling method permitted a high uptake of the tracer into the cells without causing damage to the DNA or altering cell viability. The labeling caused a significant decrease (75%) in the proliferative capacity of the SPCs and caused a trend towards an increase in neuronal differentiation. Using this technique paves the way to standardize the location of the transplant and quantify the number transplanted cells while increasing the production of neurons.</p> <p> Experiments were performed to visualize the dopamine system with [(123)I]altropane at pre-and post-transplant time points in the 6-0HDA rat model of Parkinson's disease. [(123)I]altropane binding correlated with the content of dopamine in the stria tum. However, [(123)I]altropane binding was not correlated with dopamine content in the substantia nigra and did not show a correlation with the amphetamine rotations. However, there was a significant correlation with the cylinder test and the postural instability test. When the data was assessed using linear regression, the r^2 value of the linear relationship was low indicating that [(123)I]altropane SPECT is not a good predictor of behavioural outcome due to a weak linear relationship. Our data indicates that [(123)I]altropane predicts the integrity of the striatal dopamine nerve terminals, but does not predict the integrity of the nigrostriatal system. The results are discussed in relation to the use of [(123)I]altropane in comparison to other dopamine SPECT and PET agents. </p> / Thesis / Doctor of Philosophy (PhD)

No description available.

No description available.