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04.03.2019 | Original Article

Patient-specific SPECT imaging protocols to standardize image noise

Journal of Nuclear Cardiology
PhD Sarah G. Cuddy-Walsh, Duncan C. Clackdoyle, MSc Jennifer M. Renaud, PhD R. Glenn Wells
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s12350-019-01664-5) contains supplementary material, which is available to authorized users.
The original version of this article was revised: The originally published version of this article contained typographical errors in the units of photon sensitivity. The units of counts · MBq−1 · min−1 and kcounts · mCi−1 · min−1 were mistakenly recorded as counts · MBq · min and kcounts · mCi · min respectively.
The authors of this article have provided a PowerPoint file, available for download at SpringerLink, which summarizes the contents of the paper and is free for re-use at meetings and presentations. Search for the article DOI on


Cuddy-Walsh receives research funding from the M. Hildred Blewett Fellowship of the American Physical Society,, and scholarship funding from the Queen Elizabeth II Graduate Scholarship in Science and Technology and the Kiwanis Club of Ottawa Medical Foundation and Dr. Marwah at Carleton University. Renaud is a consultant for Jubilant DraxImage Inc. and receives royalties from the sales of FlowQuant software. Wells receives research support and honoraria from GE Healthcare for speaking at meetings and receives research funding from NSERC Grant RGPIN 2016-05-658.
A correction to this article is available online at https://​doi.​org/​10.​1007/​s12350-019-01685-0.

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In addition to acquired photon counts, image noise depends on the image reconstruction algorithm. This work develops patient-specific activity or acquisition time protocols to standardize the average noise in a reconstructed image for different patients, cameras, and reconstruction algorithms.


Image noise was calculated for images from 43 patients acquired on both a conventional and a multiple-pinhole cardiac SPECT camera. Functions were found to relate image noise to radiotracer activity, scan time, and body mass and were validated by normalizing the image noise in a test set of 58 patients.


There was a 3.6-fold difference in photon sensitivity between the two cameras but a 16-fold difference in activity-scan time was necessary to match the noise levels. Image noise doubled from 45 to 128 kg for the conventional camera (12.8 minutes) and tripled for the multiple-pinhole camera (5 minutes) for 350 MBq (9.5 mCi) 99mTc-tetrofosmin. It was 16.3% and 6.1% respectively for an average sized patient.


A linear scaling of activity with respect to the patient weight normalizes image noise but the scaling factors depend on the choice of camera and image reconstruction parameters. Therefore, equivalent numbers of acquired photon counts are not sufficient to guarantee equivalent image noise.

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