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J Nucl Med. 2006; 47 (Supplement 1):187P
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Oral Presentations - Physicians/Scientists/Pharmacists

Instrumentation & Data Analysis Track

Whole-body respiratory gated PET/CT

Paul Kinahan1, Hubert Vesselle1, Lawrence Macdonald1, Adam Alessio1, Steven Kohlmyer2 and Thomas Lewellen1

1 Department of Radiology, University of Washington, Seattle, Washington 2 GE Healthcare, Waukesha, Wisconsin


Objectives: We assess the functionality of a respiratory gated PET/CT protocol that is both clinically feasible and applicable to whole-body imaging. There are potential benefits of respiratory gated PET to reduce blurring artifacts that impact lesion detectability and quantitation. Previous PET/CT scanners allowed clinical acquisition of respiratory gated data, but required a secondary acquisition constrained to a single 15 cm field-of-view (FOV). It is hard to predict if and where motion will impact nodule detection or quantitation, and thus which FOV of the patient to image. This has limited the routine use of respiratory gated PET/CT. In addition the impact of respiratory motion on lesion detection and quantitation is not understood.

Methods: The Discovery STE (DSTE) PET/CT scanner (GE Healthcare) allows for simultaneous acquisition of a traditional whole-body scan and a listmode coincidence file. All patients routinely scanned with our whole-body PET protocol also have pulmonary monitoring provided by the Real-time Position Management (RPM) respiratory gating system (Varian Medical Systems), which provides phase-based trigger signals that are injected into the listmode coincidence data stream. The listmode coincidence file is then retrospectively processed to generate multi-FOV percentage gated data. We have also used computer simulations to assess the effect of respiratory motion on lesion detection and quantitation.

Results: We have acquired over one hundred respiratory-gated PET images, which clearly demonstrate distributed respiratory motion throughout the whole body images. The location and amount of motion was patient-dependent. Respiratory motion of tumors can clearly be visualized. In addition, respiratory motion of the lung, liver and heart can be captured and assessed across the entire patient image volume. Computer simulations demonstrate that respiratory motion degrades lesion quantitation, although the magnitude of the effect depends in a complex manner on location and magnitude of respiratory motion.

Conclusions: Routine whole-body respiratory gated PET imaging is now possible. Although not all patients have respiratory motion that significantly impacts the PET image, this procedure allows non-invasive acquisition of respiratory gated data for those cases where it might be clinically relevant. Optimization of the binning protocol and assessment of the clinical impact is ongoing.

Copyright © 2006 by the Society of Nuclear Medicine.