Thirty oncologic patients with metal implants (hip prosthesis, dental implants, pacemaker) were studied using CT and Cs-137 transmission scans for attenuation correction. None of the included patients had clinical signs of local inflammation of the implants. All image data were acquired using the Gemini Dual PET-CT scanner (Philips Medical systems). The GEMINI Dual is an open PET-CT system that combines a helical dual slice CT and a 3D PET scanner equipped with its own transmission source [
11]. Gantries are arranged in a separable configuration that allows the use of the 2 scanners separately when desired. The MX8000 EXP CT scanner is a dual slice system whose detector consist of 1344 Cadmium Tungstate elements. Gantry allows a patient port of 70 cm. Minimum scan time per full rotation is 0.5 s. and slice thickness can range between 0.5 mm and 10 mm. The Allegro 3D PET scanner works exclusively in 3D detection mode (no septa). It is comprised of 29 arrays of 616 GSO (gadolinium oxyorthosilicate) crystals each. Crystal dimensions are 4 × 6 × 20 mm
3. The axial field of view is 180 mm and patient port is 63 cm. The rotating point source of Cs-137 located in the gantry allows acquisition of transmission scans in 3D detection mode. Cs-137 emits single photons with energy of 662 KeV.
Patients were scanned 1 hour after injection of 4 MBq/Kg FDG. A low dose CT helical scan was performed first (scan field of 600 mm, increment of 5 mm, slice thickness 6.5 mm, pitch of 1.5, 0.75 second per rotation, matrix 512 × 512, 120 KV, 40 mAs), followed by the Cs-137 transmission scan. The high activity of the Cs-137 source (750 MBq – half-life 30 years) and the detection of single events allows fast transmissions scan. Total duration of Cs-137 transmission scan is about 4 minutes (100 cm scan length). PET emission scan is automatically started at the end point of transmission. Emission scan consists of 8 to 11 bed positions of 3 minutes each which allows to cover 77 cm to102 cm. Randoms are online subtracted during acquisition (time-delayed events). Total acquisition time per patient varied from 30 to 40 minutes.
4 sets of data were reconstructed for each patient: no AC, AC with Cs-137 point source, AC with non-segmented CT image (Acseg
-) and AC with segmented CT (Acseg
+). Acquisition data were processed with standard package delivered with the system (Petview software – Philips Medical Systems). Reconstruction without AC was performed with RAMLA 2D iterative algorithm [
12,
13]. All reconstructions with AC were performed with RAMLA 3D iterative algorithm [
12,
14]. Voxel size after reconstruction is 4 × 4 × 4 mm
3. Scatter correction is performed by fitting the tails of activity outside patient with a parabolic curve. AC with Cs-137 source is performed by segmentation of original transmission data set. Segmentation is used to divide the CT image into regions representing different tissue types (lung, soft tissue, bone). All pixels in regions corresponding to different tissues are assigned the value associated with these particular tissue types. Regions with higher attenuation coefficients than bone tissues (metal implants) are assigned to soft tissue attenuation coefficient. Natural variations in densities are reflected by merging [
15,
16] segmented image with the measured attenuation map that is first corrected such that the 'average' values of lung tissue's and soft tissue's attenuation coefficients are equal to nominal values set in reconstruction protocol file. Merging is controlled by lung and soft tissues attenuation coefficients (user defined uniformity parameters). With values set to 1.0, only the segmented image is used and no merging is performed. With values set to 0.0, only an over-smoothed mean-adjusted image of measured transmission is used. Intermediate values result in a mix between the two. Default values were used (0.50 for lungs and 1.0 for soft tissues). Computation of AC with low dose CT data requires first the down-sampling of CT scan to PET matrix size and pixel size. Then CT truncation compensation is applied to compensate artifacts resulting in using a FOV of 600 mm [
17]. Resolution matching is then performed by smoothing CT images. Gaussians filters are used with FWHMs that match PET resolution in axial and transaxial directions. CT images with pixels in Hounsfield Units (HU) are then converted to linear attenuation coefficients at 511 KeV [
18,
19]. Converted CT images are segmented to perform AC by dividing maps into regions representing tissue types, as described before. Images with ACseg
+ and ACseg
- were displayed simultaneously in three different planes (coronal, sagittal, transaxial). Two nuclear medicine physicians reviewed the data sets with a specific multi-modality registration software (Philips Syntegra). PET and CT images can be visualized independently as well as registered on the same screen in coronal, sagittal and transverse planes. Layout can be customized and different presets are available to scale the CT images (lungs, soft tissues, bone, abdomen ...). Segmented transmissions scans obtained with Cs-137 and CT were also compared.