Philips 882482 User Manual Product Brochure Bright View SPECT/CT System XCT Df2a879f418243d9a589a77c01489b87
User Manual: Philips 882482 Product Brochure Philips BrightView SPECT/CT system XCT Philips - BrightView XCT SPECT/CT system882482
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A comprehensive solution
for extremity imaging
Philips BrightView XCT with Astonish
A.J. Da Silva, PhD, Philips Healthcare – Nuclear Medicine, San Jose, CA
Radionuclide bone scanning has been a mainstay in the noninvasive evaluation of bone disease
for decades. While SPECT imaging provides better evaluation of abnormal tracer uptake than
planar scintigraphy, it still produces less than ideal anatomic localization. The introduction of hybrid
SPECT/CT devices such as BrightView XCT has added value in improved localization of skeletal
lesions and improved characterization of the tracer uptake with the additional information from
CT. This is especially important when evaluating peripheral bone disease, due to the complex
anatomy and small structures involved.
This paper describes the innovative technologies that make BrightView XCT well-suited for
extremity imaging. It also presents a variety of examples that demonstrate the clinical value
of this unique system in this diagnostically challenging area.
Clinical drivers
Hybrid techniques such as SPECT/CT have been used
clinically both for detecting malignant bone involvement
as well as for non-oncologic bone scanning.[1-5]
These include, for example, localization of infection
or inammation, evaluation of bone trauma such as
occult fracture or stress fracture, and differentiating
degenerative changes from more malignant processes.
The combination of the highly sensitive SPECT study
with the anatomic localization and characterization
of skeletal lesions provided by CT allows for subtle,
nonspecic abnormalities detected on bone scans to be
interpreted as specic focal areas of pathology. Providing
comprehensive morphological and functional information
in a single study can improve diagnostic condence and
accuracy as well as providing information that is useful
in determining appropriate clinical management.
One area where SPECT/CT imaging is proving to be
particularly helpful is in extremity imaging. While stress
fractures of the metatarsals or sesamoiditis can usually
be identied with a single planar image, other pathologies
may be more difcult to assess from planar images due
to the complex anatomy and the small structures involved
in the foot and ankle. The improved sensitivity of SPECT
imaging [6, 7] coupled with a high-resolution CT image
can be invaluable in this diagnostically challenging area.
Being able to distinguish between stress fractures
of the mid foot, degenerative joint disease in the mid
foot and hind foot, osteochondritis dissecans, tarsal
coalition, or other orthopedic pathologies is critical
to patient management. Figure 1 shows an example
where a patient was treated appropriately for
inammatory arthropathy of the right talonavicular
joint rather than incorrectly for a stress fracture which
may not have been appreciated without SPECT/CT.
An added complication when evaluating patients with
sports injuries is that many have had previous injuries
resulting in anatomical abnormalities. This only amplies
the need for high-resolution anatomical images.
Similar diagnostic challenges occur when trying to evaluate
hand and wrist pain. The American College of Radiology
recommends MRI as the study of choice in patients with
chronic wrist pain if routine radiographs are normal or
nondiagnostic.[8] However, in a recent pilot study by
Huellner et al., high-resolution SPECT/CT showed higher
specicity than MRI (1.00 versus 0.20) in the evaluation
of causative pathologies in patients with nonspecic pain
in the hand or wrist.[9] And while MRI was more sensitive
than SPECT/CT (0.86 versus 0.71), high-resolution
SPECT/CT was shown to be a useful tool in the diagnostic
work-up of the 21 patients included in the study.[9]
Diagnosis and management of diabetic foot infections
is another area where SPECT/CT is making an impact.
Foot infections are the most common problems in
persons with diabetes. They are also one of the most
common hospitalization causes and a major source
of morbidity and resource utilization for diabetic
patients. These individuals are predisposed to foot
infections because of a compromised vascular supply
secondary to diabetes. Local trauma or pressure
(often in association with lack of sensation because
of neuropathy), in addition to microvascular disease,
can result in various diabetic foot infections ranging
from simple cellulitis to chronic osteomyelitis.
By providing a comprehensive view of both anatomy
and specic disease processes in the foot, dual tracer
SPECT/CT enables physicians to better diagnose
diabetic foot infections and to select appropriate
treatment for these diabetic patients.[10]
Orthopedic patients with infection surrounding
surgical hardware also prove to be diagnostically
challenging. Determining where the infection is
relative to the bone, soft tissue, and hardware
is critical in determining the appropriate patient
management. This is another area where SPECT/CT
can provide value. When necessary, dual isotope
Figure 1 Tc-99m HDP SPECT/CT study performed on an 80-year-old patient with severe
ankle pain and suspected stress fracture. BrightView XCT exam reveals markedly increased
vascularity and delayed uptake in the hind foot and demonstrated intense uptake in right
talonavicular region with severe degenerative change on low dose CT (subarticular cyst
formation, joint narrowing and periarticular sclerosis).
Clinical data courtesy of Sydney X-Ray, Sydney, Australia
2
SPECT/CT can be performed, but in many cases the
need for simultaneous bone scanning can be avoided
by the CT fusion images. One such example is illustrated
in Figure 2. In this case, a single examination on the
BrightView XCT was able to rule out the important
diagnosis of osteomyelitis, conrm soft tissue infection,
and demonstrate an occult fracture as the source of pain
in this patient. And while it was not necessary in this
case, the combination of high quality anatomical images
with functional information can be invaluable for surgical
planning if such an intervention is required.
Because of its ability to localize pathology and aid
in the planning of surgical interventions, SPECT/CT
has revitalized interest in the use of nuclear medicine
studies among orthopedists, radiologists, and surgeons.
In order to get the most value when it comes to
extremity imaging, the SPECT/CT system must be
capable of providing high-resolution SPECT and CT
images that are accurately registered to one another.
BrightView XCT (Philips Healthcare, Cleveland, OH)
is a compact variable-angle gamma camera with a high-
resolution at-panel X-ray detector system [11, 12]
for localization and attenuation correction of SPECT
data that provides these capabilities. The following
sections describe the innovative technologies that make
BrightView XCT an excellent choice for extremity
imaging as demonstrated by the numerous clinical
examples throughout this paper.
SPECT technologies
A good hybrid SPECT/CT system has to start with
a good SPECT system. Because of the nature of imaging
with parallel hole collimators, closer positioning enables
higher resolution. BrightView XCT makes use of Philips
CloseUp Technologies, such as BodyGuard automatic body
contouring,[13] ZeroGap planar imaging, and an ultra-thin
patient pallet, to keep the SPECT detectors closer to the
patient during image acquisition.
A further technological advance that improves spatial
resolution and SPECT image quality is the Astonish
reconstruction algorithm.[14] Astonish is an iterative
three-dimensional ordered subset expectation
maximization (3D-OSEM) algorithm that incorporates
depth-dependent resolution recovery into the
reconstruction using the convolution method [15]
to model the varying resolution as a function of distance
from the detector. During the acquisition of SPECT
data, the distance from the collimator to the center
of rotation is recorded for each projection angle. During
the reconstruction process, the amount of blurring is
calculated based on these measured distances and the
collimator response function. The counts are spread
over multiple pixels during both the forward- and back-
projection steps of the iterative reconstruction with
the degree of broadening determined by the collimator
response function and the distance between the pixel
and the collimator. Furthermore, Astonish incorporates
Figure 2 Tc-99m granuloscint SPECT/CT study of a 30-year-old female with persistent pain
two months following surgery for hallux valgus. The SPECT/CT study was performed on the
BrightView XCT to rule out osteomyelitis. White blood cell accumulation in the soft tissue
surrounding the head of the screw was observed, indicating a soft tissue infection. Some bone
resorption at proximal level of the screws, but no increased bone uptake and no interruption
of the bony cortex excluded osteomyelitis. Straight radiolucent line at metaphysic of
metatarsal bone marks the presence of a recent non-displaced transcortical fracture.
Clinical data courtesy of Universitair Ziekenhuis Brussel, Brussels, Belgium
3
a proprietary matched dual ltering technique within
the reconstruction process to control the accumulation
of noise.[16] By performing the smoothing within the
iterative process, Astonish can achieve exceptional noise
suppression while preserving spatial resolution. With
BrightView XCT, an attenuation map can be generated
from the CT image [17] and Astonish can use this
attenuation map to perform attenuation correction and
scatter correction [18] in addition to resolution recovery.
Spatial resolution in the SPECT image becomes
particularly important in the context of hybrid SPECT/CT
imaging, since the physician can more condently correlate
the radiotracer uptake with anatomic features discernible
in the CT image if the reconstructed activity distribution
is well dened. Recently published articles by Livieratos
et al. [19] and Knoll et al. [20] demonstrate the
improvements in spatial resolution that can be achieved
with Astonish. While these results are based on Tc-99m
imaging, Astonish can also be used with other isotopes.
Figure 3 provides an example of a Ga-67 image acquired
on BrightView XCT and processed with Astonish. Note
the high quality of the SPECT reconstruction and the
correlation of the Ga-67 uptake with the pathologies in the
rst and second metatarsal perceptible in the CT images.
By incorporating the imaging physics into the
reconstruction process and including a method
to control noise, Astonish is less sensitive to counting
statistics than more conventional reconstruction
methods such as ltered back projection (FBP) or
standard OSEM. Thus Astonish allows reconstructions
with fewer counts without compromising image quality
or diagnostic value.[19] The reduction in counts
can result from a reduction in injected dose, when
radioactivity supply is limited or concerns around patient
exposure are paramount, or from a reduction in imaging
time. Reducing imaging time can be essential in cases
where patients have difculty remaining motionless for
extended periods of time, such as during hand or wrist
imaging in the superman position (prone position with
arms extended over the head).
Figure 3 Ga-67 SPECT/CT images of a patient with osteomyelitis and non-union of the rst
metatarsal. Patient had prior bunionectomy of the rst metatarsal that did not heal. Patient had
a combined bone and gallium scan on BrightView XCT to rule out infection. The gallium scan
shows uptake in the rst metatarsal consistent with osteomyelitis and in the second metatarsal
consistent with a stress fracture. Note the correlation of the gallium uptake in the second
metatarsal with the thickening of the cortex bone discernible in the CT image.
Clinical data courtesy of Radiological Associates of Sacramento, Sacramento, CA
4
Another unique feature of the BrightView XCT SPECT
system is the patented concurrent imaging technique [21]
that provides the ability to create multiple data sets –
each with independent matrix size, zoom, energy windows,
gating parameters, stop criteria, and data type – from
a single acquisition step. The acquired data is binned
into multiple independent image sets based on the
pre-dened acquisition protocol. Concurrent imaging
offers more exibility in acquisition protocols and
provides additional information without requiring
additional imaging time. One way to use concurrent
imaging that may be benecial for orthopedic applications
is to simultaneously acquire full eld and zoomed planar
images, for example, imaging both hips/femurs in the
full eld image yet concurrently acquiring a zoomed
hip/femur for better detail. This provides ner spatial
sampling of the site of interest while simultaneously
providing the contra-lateral side for comparison. Other
ways to use concurrent imaging that may also be of
interest in this area are to acquire simultaneously
128 × 128 matrix and 64 × 64 matrix SPECT data
in low count studies or to acquire simultaneous
dual isotope images (e.g., Tc-99m/In-111 or Tc-99m/Ga-67).
Figure 4 presents an example of a simultaneous dual
isotope study acquired with concurrent imaging on
BrightView XCT that was instrumental in guiding the
physician to the appropriate treatment for a patient
presenting with ulcers on the right heel and left lower shin.
Finally, while this paper focuses mainly on SPECT/CT
imaging, it’s worth noting that SPECT imaging of the
extremities may not always be feasible. For example,
some patients may be unable to extend their arms
over their head as required to acquire adequate SPECT
images of their hands, wrists or elbows. In these cases,
planar scintigraphy may be the only option. Fortunately,
the BrightView XCT offers some unique features, such
as ZeroGap planar imaging, exible positioning of the
SPECT detectors, and the ability to stow the X-ray
at panel into the gantry when not in use, that allow
high quality planar images of the hands, wrists or
elbows to be acquired with the patient in a comfortable
seated position.
Figure 4 Simultaneous dual isotope study performed on an 80-year-old female
with ulcers on right heel and left lower shin to rule out osteomyelitis. Tc-99m
HDP bone scan (left image set) and Ga-67 scan (right image set) were acquired
simultaneously on BrightView XCT using concurrent imaging. The bone scan is highly
suspicious for osteomyelitis of right calcaneus inferiorly, but the gallium scan shows
mild gallium uptake in calcaneum distinct from the HDP uptake region, excluding
osteomyelitis. Antibiotics were changed to reect a non-osseous infection.
Clinical data courtesy of Wollongong Nuclear Medicine, New South Wales, Australia
5
CT technologies
When it comes to SPECT/CT imaging of the extremities,
high-resolution CT imaging is essential. Small focal
abnormalities in the feet and ankles or hands and wrists
must be well localized in order to make specic orthopedic
diagnoses on the basis of their location. For example,
the ability to localize activity within a bone or at an
articular surface allows one to distinguish between
fractures and joint disease. Furthermore, the radiographic
appearance of a bone lesion may provide information
that inuences diagnosis and patient management.
For example, rapidly growing aggressive metastases tend
to be lytic (low density), whereas sclerotic (high density)
metastases are considered to indicate a slower tumor
growth rate.[1] Sclerosis may also be a sign of repair
after treatment. Thus high-resolution CT can have
a major advantage in the characterization of skeletal
lesions by providing comprehensive morphological
information that can impact therapeutic decision making.
Figure 5 illustrates one example where, in the setting
of post-surgical changes and lytic nature of the tumor,
BrightView XCT helped to correctly identify tumor
recurrence in new sites.
BrightView XCT uses a at-panel cone-beam CT
(CBCT) component mounted on the same rotatable
gantry as the SPECT detectors to produce high-resolution
CT images. The CBCT component consists of an
X-ray source and a at-panel X-ray detector shown
schematically in Figure 6. The amorphous silicon at-panel
detector is based on similar technology as that used
for digital X-ray detectors. X-rays are absorbed by
an efcient cesium-iodide (CsI) scintillator that converts
X-rays to light that can then be absorbed by the amorphous
silicon detector. The detector pixel is very small
(0.194 mm × 0.194 mm), which allows it to reproduce
ne details in the object being imaged. The large active
detector area (30 cm × 40 cm) consists of more than
3 million detector pixels arranged in rows and columns,
as illustrated in Figure 6.
The high resolution of the at-panel detector is a key
feature that enables the projection data to be acquired
isotropically, or evenly sampled in all directions.
The advantage of this isotropic sampling is that image
resolution is maintained when the data is viewed from
Figure 5 Tc-99m MDP SPECT/CT study performed on
a 64-year-old female with resected hemangioendothelioma.
Images were acquired on BrightView XCT post tumor resection
involving proximal right tibia and right medial cuneiform.
SPECT/CT revealed right-sided distal tibia and right calcaneum
tumor recurrence in the periphery of the lytic lesions.
Post-surgical inammatory changes of proximal right tibia
and medial cuneiform were also observed.
Clinical data courtesy of Washington Hospital Center, Washington DC
X-ray
photons
Photo
diodes
Visible light
photons
Electrons
Electronic
image data
Amorphous
silicon
Scintillation
layer
Target
X-ray
tube
Figure 6 Schematic depiction of the X-ray imaging process
with the at-panel detector system (top image). Close-up of
the cesium-iodide (CsI) scintillator layer (lower left image) that
converts the X-ray photons to optical photons. Close-up section
of the amorphous silicon detector (lower right image) that
converts the optical photons to electric charge that forms the
electronic image data. Each detector pixel is 0.194 mm × 0.194 mm.
6
Figure 7 CT images of the foot acquired on a conventional spiral CT system. In-plane (transverse)
pixel size is 0.75 mm × 0.75 mm and slice thickness is 3 mm. Note the degradation in observed
spatial resolution in the sagittal view (right image) compared to the transverse view (left image)
due to the anisotropic voxel size.
Figure 8 High-resolution, low-dose CT images of
a 32-year-old female acquired with BrightView XCT
(CTDIVOL = 3.75 mGy). Patient had chronic right
wrist pain after distal radius fracture ve months
prior to SPECT/CT study. CT images reveal a star-like,
residual, not yet fused fracture of the distal articular
surface of the radius.
Clinical data courtesy of Cantonal Hospital Lucerne,
Lucerne, Switzerland
any angle. So unlike conventional spiral CT images
which typically have poorer resolution in the sagittal
and coronal views due to the thicker slices compared
to the in-plane transverse pixel size (see Figure 7),
XCT images viewed in the sagittal or coronal planes
(or other oblique angles) have the same resolution
as the transverse images because of the isotropic voxels.
This is particularly important in extremity imaging since
patient positioning constraints may dictate unusual
display angles when imaging hands and feet as well as
knee joints. It is also important in the context of SPECT/CT
imaging since SPECT data also have isotropic voxels
and are routinely reviewed in transverse, sagittal,
and coronal views.
With a single 360° rotation of the BrightView XCT gantry,
a 47 cm diameter transverse eld of view (FoV) and
a 14.4 cm axial length along the patient can be imaged
with CT. Seven hundred and twenty X-ray projections
are acquired for each spin during the 12- or 24-second
rotation time, depending on the protocol. Extremity
imaging is usually performed using the 24-second
rotation speed since this protocol allows for a greater
range of exposures and these areas are generally not
affected by respiratory motion. The maximum dose
for this protocol is 15 mGy, but given the low biological
sensitivity to radiation of the extremities, this
corresponds to an effective patient dose of only
0.5 mSv, assuming a k-value of 0.0023 mSv mGy-1 cm-1
(i.e., the k-value for the adult head) which should
be a conservative estimate. This corresponds to
approximately one tenth of the effective dose from
the injected radiopharmaceutical used for the SPECT
portion of the exam. Furthermore, the maximum CT
dose is not always required; high-resolution CT images
of the hands and wrists can be acquired with one quarter
of this dose, as illustrated in Figure 8.
7
The at-panel system enables reconstruction with
a 1 mm isotropic voxel size for the entire CT FoV
and as small as 0.33 mm isotropic voxel size for
a high-resolution sub-volume reconstruction from
the same acquisition. Like other BrightView XCT case
studies presented throughout this paper, the clinical
value of this high-resolution isotropic imaging capability
is demonstrated in Figure 9 through Figure 13. Figure 9
and Figure 10 are two examples where the high-resolution
CT imaging capabilities of BrightView XCT allowed for
the identication of fractures that were not observed
with conventional CT or radiographs.
Figure 11 is an example where BrightView XCT provided
information that allowed more aggressive orthopedic
treatment with subsequent good outcome, while Figure
12 is a case that demonstrates that the quality of the
high-resolution CT images provided by BrightView XCT
can obviate the need for additional imaging studies, and
Figure 13 is an example where these high-resolution CT
images were used to plan a surgical intervention.
The studies discussed here clearly point out that the
high-resolution CT images provided by BrightView XCT
can improve the characterization of indeterminate bone
lesions, and the additional CT information inuences
patient management.
Figure 9 Tc-99m DPD SPECT/CT study performed on a 65-year-old male
with traumatic fracture of right thigh with osteomyelitis 2.5 years prior to exam.
Status post several curettages and reconstruction with bone replacement with
new onset of pain. BrightView XCT study was performed when X-rays and
conventional CT did not identify new pathology. SPECT/CT study revealed very
ne fracture/ssure line seen on CT with high bone-agent uptake directly around
this fracture line identifying a new insufciency fracture/ssure within the formerly
fractured and infected area of the right thigh. Patient subsequently underwent
surgery to receive a new femoral osteosynthesis.
Clinical data courtesy of Cantonal Hospital Lucerne, Lucerne, Switzerland
Figure 10 Tc-99m HDP SPECT/CT study of a 64-year-old female with right midfoot pain for one week.
BrightView XCT study was performed when no evidence of fracture was observed on radiographs.
SPECT/CT study revealed acute fracture of base of second right metatarsal.
Clinical data courtesy of Sutherland Nuclear Medicine, Sydney, Australia
8
Figure 11 Tc-99m MDP SPECT/CT study performed on a 22-year-old male
12 weeks post scaphoid fracture due to continued tenderness. BrightView XCT
study conrmed scaphoid fracture with incomplete union. After more
aggressive orthopedic treatment, fracture healed and patient is symptom-free.
Clinical data courtesy of The Royal Wolverhampton Hospitals NHS Trust, Surrey, UK
Figure 12 Tc-99m HPD SPECT/CT study performed on a patient with
right heel pain for a few months. BrightView XCT study revealed intense
uptake in right calcaneus along a fracture line posteriorly in the CT, which also
demonstrated malalignment and impaction of the fracture. Patient was managed
appropriately for the stress fracture and orthopedic review was arranged to
assess the malalignment of the fracture. No further imaging was required.
Clinical data courtesy of Sydney X-Ray, Sydney, Australia
Figure 13 Tc-99m DPD SPECT/CT study performed on a 60-year-old
female with metastasis from breast cancer. Patient was imaged with BrightView
XCT one year after bisphosphonate-associated osteonecrosis in the maxilla
region to evaluate for osteomyelitis and to plan for further surgical intervention.
BrightView XCT images provided accurate localization of persistently increased
bone metabolism compatible with osteonecrosis or osteomyelitis in the jaw and
appropriate planning of the extent of surgery to reconstruct the affected area.
Clinical data courtesy of Inselspital Bern University Hospital, Bern, Switzerland
9
Figure 14 Tc-99m HDP SPECT/CT study of an 11-year-old female with anterolateral
pain on weight-bearing after fall with left ankle inversion. BrightView XCT exam reveals
low-grade left distal bula growth plate fracture and low-grade left talar head contusion.
Clinical data courtesy of Sutherland Nuclear Medicine, Sydney, Australia
System considerations
The BrightView XCT, with its at-panel-based CBCT
component, presents a unique SPECT/CT system that
is well suited for extremity imaging. The large gantry
aperture provides an open patient experience during
the CT scans. Keeping the patient relaxed and
comfortable during imaging can help reduce unwanted
patient motion, both during and between scans.
Because the CBCT component is mounted on the same
rotatable gantry as the SPECT detectors, the CT and
SPECT images can be acquired with little or no table
translation between the two scans. This coplanar design
reduces the misalignment between the CT and SPECT
images since there is little opportunity for misalignment
due to bed motion or differential table sag between the
SPECT and CT imaging positions. Accurate alignment
of the two image sets is critical when trying to localize
the radiopharmaceutical uptake in the SPECT images
to the anatomy visualized in the CT images, as
illustrated in Figure 14. Due to the well-localized activity
distribution within the SPECT image, the high spatial
resolution of the CT image, and the accurate registration
of the two image sets, the physician was able to
denitively localize the bula injury to the growth plate
rather than an adjacent area. Furthermore, the relatively
short scan time of the SPECT/CT study (in comparison
to multiple pinhole views) was more comfortable and
bearable for this very young patient. Figure 15 shows
another example where accurate correlation of focal
radionuclide activity to the joint spaces rather than
bony structures allowed the patient to be treated for
an inammatory etiology rather than the fracture that
was initially suspected.
10
Figure 15 Tc-99m HDP SPECT/CT study of a 43-year-old female patient with
right foot pain, status post trauma. BrightView XCT study was performed to
assess for possible fracture. SPECT images revealed multiple foci (at least three)
of activity within the mid-portion of the right foot that correlated to the joint
spaces on CT images. No evidence of fracture or activity correlated to bony
structures was observed.
Clinical data courtesy of Washington Hospital Center, Washington, DC
Acknowledgements
The author would like to thank the following institutions
for providing clinical data: Sydney X-Ray, Sydney, Australia;
Universitair Ziekenhuis Brussel, Brussels, Belgium;
Radiological Associates of Sacramento, Sacramento, CA;
Wollongong Nuclear Medicine, New South Wales,
Australia; Washington Hospital Center, Washington DC;
Another advantage of the unique co-planar design
of the BrightView XCT is that the system has a smaller
footprint and system weight compared to SPECT/CT
systems that use a separate CT gantry. The compact
design allows the system to t into a standard nuclear
medicine-sized room, which can help reduce installation
costs. Furthermore, an in-room CT control option
allows the operator to remain in the room and closer
to the patient, and avoids the costs associated with
a separate control room. With a design that’s tailored
towards nuclear medicine, the BrightView XCT brings
all the capabilities of the BrightView SPECT system
together with a at-panel CBCT component that
provides low-dose, high-resolution CT images with
isotropic voxels. SPECT/CT planning is done from
the nuclear medicine p-scope, as simple as planning
for a SPECT-only procedure.
Summary
High-resolution CT integrated with SPECT offers
a major advantage in the characterization of peripheral
bone disease. It improves diagnostic condence and
therapeutic decision making by providing comprehensive
morphological and functional information in a single study.
BrightView XCT with Astonish provides a comprehensive
solution for SPECT/CT imaging of the extremities.
The unique at-panel X-ray detector system provides
high-resolution CT images with isotropic voxels.
Concurrent imaging offers more exibility in acquisition
protocols and provides additional information without
requiring additional imaging time. Astonish provides
improved SPECT resolution and the ability to process
lower count data without compromising image quality.
The unique coplanar design of the gantry is compact,
yet offers an open patient experience for better comfort
and compliance. Moreover, the coplanar design reduces
the risk of misalignment between the SPECT and CT
images. Together, these features create a hybrid SPECT/CT
system that is ideally suited for the evaluation and
management of patients with peripheral bone disease.
Cantonal Hospital Lucerne, Lucerne, Switzerland;
Sutherland Nuclear Medicine, Sydney, Australia;
The Royal Wolverhampton Hospitals NHS Trust,
Surrey, United Kingdom; and Inselspital Bern
University Hospital, Bern, Switzerland.
11
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