Philips 882482 User Manual Product Brochure Bright View SPECT/CT System XCT 24deb4f48194490fb1c3a77c01574e41

User Manual: Philips 882482 Product Brochure Philips BrightView SPECT/CT system XCT Philips - BrightView XCT SPECT/CT system882482

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Volume 2

Clinical case study collection

Philips BrightView XCT nuclear medicine system

Five key advantages

Cardiology

Oncology

Orthopedics

Infection

Other localization

Case parameters

Contents

BrightView XCT

A technologically advanced SPECT/CT system

designed entirely for nuclear medicine

At Philips, we are dedicated to providing innovative,

integrated solutions to give you the tools you need

to accurately diagnose abnormalities early in disease

progression. We are tirelessly focused on image quality

and exibility, throughput, and patient care. With that

in mind, we have compiled this second volume of actual

clincial case studies. Philips thanks those customers who

have collaborated with us and contributed their ndings

to this effort.

We hope that you nd this an informative reference

in your quest to provide the best in diagnostic care

for your patients.

1 Registration condence with CoPlanar

• No bed index between SPECT and CT, in most cases, for 14 cm axial coverage.

2 Flexible breathing

• Tidal respiration (60 sec) for CT-AC to match SPECT breathing

• Breathhold (12 sec) for localization

3 High resolution – low dose

• Isotropic voxels – high quality CT images when viewed

at any angle

• Sub-mm (0.33 mm) slice thickness for high resolution bone

• Flexible X-ray current (5-80 mA) to t the clinical need

4 Nuclear medicine – tailored workow

• Same capabilities as BrightView SPECT

• Plan SPECT/CT from the p-scope

• Option for in-room CT acquisition control

5 Fits the nuclear medicine space

• Fits in a small nuclear-medicine-sized room

(15'6'' x 11'7''; 4.72 x 3.53 M)

• Low system weight (4500 lb; 2045 kg)

• Separate control room not required

BrightView XCT – Fits you like no other

Five key advantages

Full Iterative Technology (FIT)

Philips introduces Full Iterative Technology (FIT) – the rst hybrid system to provide both iterative

SPECT and CT reconstruction capabilities. The advanced CT reconstruction algorithm improves

CT image quality by reducing noise and improving uniformity. FIT builds on the value of Astonish

SPECT reconstruction, iterative technology that has been proven in practice to improve image

quality and reduce dose. This leading technology provides the necessary foundation for advancing

future developments in iterative CT reconstruction.

Filtered Back Projection FIT-Iterative CT Reconstruction

Attenuation correction – SPECT acquisitionAttenuation correction – CT acquisition

Cardiology

Trusted attenuation correction

Condence in the registration accuracy between SPECT and CT

BrightView XCT has several advantages for

cardiac attenuation correction. The gantry

rotation can be set to 60 seconds to allow

for tidal respiration during multiple respiratory

cycles over a single 360° rotation. This technique

blurs the CT to match resolution of the SPECT

image, leading to excellent diaphragm alignment.

The entire heart volume is sampled in a single

14 cm axial eld of view with no stair-step

artifacts as a result of the isotropic resolution.

The CT eld of view overlaps the SPECT

eld of view so that little to no table index

is required between acquisition steps, resulting

in registration condence.

1 Cardiology case study

Patient information

•58-year-oldmale

•Evaluateformyocardialischemia

Procedure

•Tc-99mMIBIcardiacperfusionandfunction

Inferior wall attenuation correction

Courtesy of Xiamen No. 1 Hospital, Xiamen, China

Findings from SPECT/CT study

•Defectininferior-septalwallbutimproved

signicantlywithattenuationcorrection

•Normalejectionfraction

Physician impression of SPECT/CT

•Furtherinvestigationdemonstratedpatient

tobenormal

Top row – no attenuation correction

Bottom row – with attenuation correction

2 Cardiology case study

Patient information

•86-year-oldfemale

•AbnormalstressEKG(posteriorandlateral

hypokinesis);highprobabilityofischemia

Procedure

•Tc-99mMyoviewperfusionandfunction

Anterior wall attenuation correction

Courtesy of Wollongong Nuclear Medicine, New South Wales, Australia

Findings from SPECT/CT study

•Reducedperfusioninanteriorwallwhichnormalized

withCTattenuationcorrection

•Normalstudy:LVEF=68%

Physician impression of SPECT/CT

•SPECT/CTwithattenuationcorrectioncompletely

changedtheinitialhighpatientprobability

tolowprobability

Stress Uncorrected and Corrected Rest Uncorrected and Corrected

Image

quality

Radiation dose

(mAs or mGy)

AC Localization Diagnostic

Primary

NM applications

Oncology

Low dose localization

Designed entirely for nuclear medicine

BrightView XCT offers premium CT resolution

at low dose levels – a fraction of a conventional

helical CT.

Flexible breathing protocols during localization

studies allow for a breathhold CT acquisition

to be obtained in as short a time as 12 seconds.

Providing 14 cm of axial coverage in a single

breathhold helps to maintain image resolution

and required anatomic detail.

1 Oncology

Patient information

•11-year-oldfemale

•Neuroblastoma,postchemotherapyandtumor

resection;oneyearlater,tumorfoundinleftposterior

cranialfossaonMRI

•Latelytumorgrowingsopre-surgicalMIBGwasordered

Procedure

•Tc-99mMIBGscan

Neuroblastoma

Courtesy of National Center for Child Health and Development, Tokyo, Japan

Findings from SPECT/CT study

•IntracranialMIBGuptakeseenatleftposteriorcranial

fossaandsphenoidalsinus;checkofpreviousMRI

T1-CEfoundsphenoidalsinusenhancedmassaswell

asleftposteriorcranialfossamass

Physician impression of SPECT/CT

•DifculttolocalizeasmalllesionbySPECT-only;

SPECT/CTshowslocationeasily

•Sphenoussinusuptakewasshowncorrectlyandposition

matchedMRIlesion

•Informationofasingleormultiplelesionsisveryimportant

•Biopsyofleftposteriorcraniallesionwasganglioneuroma,

notmalignancy



1 mm isotropic voxels

2 Oncology

Patient information

•70-year-oldmale

•Multifocalhepatocellularcancerpresentingfor

MAAmappingandhepatopulmonaryshuntstudy

inpreparationforY-90radioembolization

•Statuspostcoilembolizationofgastroduodenalartery,

rightgastricartery,andsupraduodenalbranchartery

Procedure

•Tc-99mMAA

MAA mapping for radioembolization

Courtesy of University of Washington Medical Center, Seattle, Washington

Findings from SPECT/CT study

•Increaseduptakeinhepaticlobesatknown

hepaticmetastases

•Largeextrahepaticfocusinleftlowerhemothorax

correspondingwithleftcardiophrenicrecessin

inferiormediastinum

•Novisualpulmonaryuptake,estimatedhepatopulmonary

shuntratio4.91%,withinnormallimits

Physician impression of SPECT/CT

•Hepatomediastinalshuntfromaberrantmediastinal

vesselarisingfromdistallefthepaticartery

•InordertoundergosafeY-90radioembolization,

patientwillneedcoilembolizationtoavoiddamage

toleftmediastinum

1 mm isotropic voxels

3 Oncology

Patient information

•58-year-oldmale

•Carcinomaofthepenis

•Localizesentinellymphnode



Procedure

•Tc-99mColloid

Carcinoma of the penis

Courtesy of Innsbruck Medical University, Tyrol, Austria

Findings from SPECT/CT study

•Moderateuptakeintherightinguinalregion

Physician impression of SPECT/CT

•SPECT/CTrevealedinguinallymphnode,notvisible

onplanar

•Sentinellymphnodewasremoved;histologyshowed

atrophiclymphnode,nosignofmalignancy

1 mm isotropic voxels

4 Oncology

Patient information

•56-year-oldfemale

•PostLu-177DOTA-TATEtherapyevaluation

ofneuroendocrinetumor

Procedure

•Lu-177DOTA-TATE

Post Lu-177 DOTA-TATE ther apy

Courtesy of Innsbruck Medical University, Tyrol, Austria

Findings from SPECT/CT study

•Somatostatinreceptorlesionislocatedinthemusculus

rectusinferior

Physician impression of SPECT/CT

•Patientwasreferredtoaspecializedophthalmologist



1 mm isotropic voxels

5 Oncology

Patient information

•81-year-oldfemale

•Breastcancer;threeweeksofleftsternal

painwithpositiveregionallymphnodes

Procedure

•Tc-99mHDPbonescan

Incidental pulmonary nodule

Courtesy of Nepean Nuclear Medicine and PET, Sydney, Australia

Findings from SPECT/CT study

•Intenseuptakeinmanubriumconsistentwithrecent

fracturewithevidenceofongoingnewboneformation;

noskeletalmetastases;end-platedegeneration

atL2-3andL4-5

•Incidentalndingofpulmonarynoduleinrightupperlobe

Physician impression of SPECT/CT

•Identiedfractureinsteadofmetastaticdisease

•Incidentalndingofpulmonarynodulewhichwillhelp

forfurthersurveillance

1 mm isotropic voxels

6 Oncology

Patient information

•73-year-oldmale

•Nonfunctioningpancreaticendocrinetumor;

pancreaticoduodenectomywithclearmargins,

negativelymphnodessixyearsago

•MultipleOctreoscans;lasttwoyears–stablefocus

ofuptakeinmidabdomenwithoutndingsonCT,

unclearsignicance

Procedure

•In-111Octreotide



Benign reactive lymph node

Courtesy of University of Washington Medical Center, Seattle, Washington

Findings from SPECT/CT study

•Focusofmidabdominaluptakeagainseen

•SPECT/CTcorrelatespreciselywithsofttissuedensity

locatedwithinthemesentaryposteriortotransverse

colon,8.3cmanteriortoL1vertebralbodyendplate

Physician impression of SPECT/CT

•SPECT/CTdemonstrateduptaketoanormal-sized

mesentericlymphnode;thishadnotbeenpossible

onplanarimages

•Uptakewithinbenignreactivelymphnodesisaknown

falsepositiveinOctreoscans

1 mm isotropic voxels

7 Oncology

Patient information

•55-year-oldfemale

•Three-monthhistoryofnonexertionalchest

discomfort,leftarmnumbness,shortnessofbreath

Procedure

•Tc-99mSestamibi

Right breast mass

Courtesy of Fletcher Allen Health Care University, Burlington, Vermont

Findings from SPECT/CT study

•Normalstresstest

•MasswithuptakeofMIBIinaxillarypartofrightbreast

seenonlowdoseCT

Physician impression of SPECT/CT

•Patientunderwentdiagnosticbreastmammography

andultrasoundfollowedbybiopsy

•Inltratingductalcarcinomaonpathology

1 mm isotropic voxels

Patient information

•4-year,10-month-oldfemale

•Metastaticneuroblastoma,surgeryunabletond

lymphnodes

•PriorMIBGscanpositiveinrightgroin,decided

torescanafterSPECT/CTinstalled,then

schedulesurgery

Procedure

•I-123MIBG

Findings from SPECT/CT study

•Discretefocusofabnormalactivityinrightgroin;

fusionwithCTindicatesabnormalityisinroot

ofthesartorismuscle,extremelyraresiteofmetastasis

fromaneuroblastoma

Physician Impression of SPECT/CT

•Surgerywithassistanceofgammaprobeallowed

removalofasingleintramuscularmetastasis;SPECT/CT

demonstratedthefocusofMIBGdidnotcorrespond

toalymphnode

8 Oncology

Metastatic neuroblastoma

Courtesy of Clinique Universitaires St-Luc, Brussels, Belgium

1 mm isotropic voxels

9 Oncology

Patient information

•85-year-oldmale

•Penilecancer

Procedure

•Tc-99mNanocolloid

Lymphoscintigraphy of the penis

Courtesy of The Harley Street Clinic, London, UK

Findings from SPECT/CT study

•Localizationofsentinelnodesinleftandright

inguinal-femoralregions

•Measurementofdepthfromskinsurfacetaken

toassistsurgeon

Physician impression of SPECT/CT

•Helpedtoassistsurgeoninlocationofsentinellymph

nodespriortobiopsy

•Astonishreconstructionsoftwareassistsgreatlyasthe

SNIdosesareverylow,socountrecoveryreconstruction

assistsinimagequality

1 mm isotropic voxels

10 Oncology

Sarcoma in pubic symphysis

Courtesy of Sydney X-Ray, Sydney, Australia

Patient information

•Ruleoutosteitispubis

Procedure

•Tc-99mbonescan

Findings from SPECT/CT study

•Earlyanddelayedplanarimageswereconsistent

withasevereosteitispubis

•SPECT/CT,however,clearlydemonstrated 

alyticlesioninrightpubicsymphysis

Physician impression of SPECT/CT

•Ratherthancontinuedineffectivetreatmentof

suspectedosteitispubis,abiopsywasperformed

whichconrmedsarcoma;patientthenproceeded

toappropriatetreatment

1 mm isotropic voxels

11 Oncology

Patient information

•63-year-oldfemale

•Hyperparathyroidism;bilateraladrenalnodules

onCT,leftsuspiciousformalignancy

•Evaluateforpheochromocytomainoneorboth

adrenalnodules

Procedure

•I-123MIBG

Findings from SPECT/CT study

•Intenseuptakewithin3cmleftadrenalnodule

consistentwithpheochromocytoma

•Milddiffuseuptakeinrightadrenalgland,likelyphysiologic;

secondpheochromocytomacannotbeexcluded

Pheochromocytoma in adrenal nodule

Courtesy of University of Washington Medical Center, Seattle, Washington

Physician impression of SPECT/CT

•Intenseuptakeinleftadrenalregionseenonplanar

imagesbutcouldnotbecondentlylocalizedtoadrenal

gland;SPECT/CTreadilylocalizeduptake

tothesuspiciousnodule

•Givenclinicalsuspicionforbilateralpheochromocytoma,

contrastresolutionofSPECTwasnecessaryto

demonstratenosignicantuptakeinleftadrenalgland

•Successfulleftadrenalectomyanddiscontinuationof

catecholamine-blockingmedicine,conrmingcorrect

ndingofunilateralpheochromocytoma



1 mm isotropic voxels

12 Oncology

Calcication of tibial-bular ligament

Courtesy of Washington Hospital Center, Washington DC

Patient information

•63-year-oldmale

•Lungcancer,assessforbonymetastases

Procedure

Tc-99mMDPbonescan

Findings from SPECT/CT study

•Calcicationoflefttibial-bularligament

Physician impression of SPECT/CT

•SPECT/CThelpedpreciselyidentifypost-traumatic

calcicationofaligamentasetiologyofactivity

onbonescan

•Fractureand/ormetastasiswasruledout

0.33 mm isotropic voxels

13 Oncology

Patient information

•47-year-oldmale

•Thyroidcancer;evaluateformetastaticdisease

andstaging

Procedure

•I-124scan

Findings from SPECT/CT study

•SPECT/CTHead/Neck–sinuspolyp,submental

lymphnodemetastases

•SPECT/CTChest–macronodularlungmetastases

(known)

Thyroid cancer

Courtesy of Washington Hospital Center, Washington DC

Physician impression of SPECT/CT

•Preciselyidentiedsinuspolypactivityasinammatory

andnotmetastatic,identiedalargesubmentallymph

nodemetastasis,identiedknownmacronodular

pulmonarymetastases

•I-124imagingaspartofdosimetryprovideslow

resolutionSPECTimagesandrequiresproperanatomic

localizationachievedwithSPECT/CT

1 mm isotropic voxels

14 Oncology

Patient information

•47-year-oldmale

•Suspectedneuroendocrinetumorafterabdominal

lymphnodebiopsy,unknownprimary;gastroscopy,

rectalprocto-colonoscopy,andendosonocapsule

withoutpathologicndings

Procedure

•In-111Octreotidescan

Findings from SPECT/CT study

•Highintensivefocusonileumloop

•Highintensivefocusinmiddleabdomen,

areaofpathologicallymphadenopathy

Neuroendocrine tumor of ilium

Courtesy of University Hospital of Halle, Halle, Germany

Physician impression of SPECT/CT

•Clearlocalizationofpathologicalsomatostatin-

receptorbindingledtototalresectionofprimary

tumorlocatedinileum

•Pathologyshowedwelldifferentiatedneuroendocrine

carcinomaofileumwithinltrationofmesenterial

fattissue,serosa,lymphaticvessels,andlocoregional

lymphnodemetastasis

•Follow-upisplannedwithOctreoscanandevaluation

forDOTA-TATEtherapy



1 mm isotropic voxels

15 Oncology

Melanoma at the right ear

Courtesy of Innsbruck Medical University, Tyrol, Austria

Patient information

•68-year-oldmale

•Excisionofmelanomaatrightear

•Localizesentinellymphnode

Procedure

•Tc-99mColloid

Findings from SPECT/CT study

•Hotspotdorsaltorightjawangleandadditional

hotspotsdownstreamincervicalregion

Physician impression of SPECT/CT

•Sentinelnodedorsaltorightjawwasonlyvisible

onSPECT/CT,notvisibleonplanar

•Sentinellymphnodewasextractedandshowed

nosignofmalignancy

16 Oncology

Patient information

•52-year-oldmale

•Leftadrenalmass

Procedure

•I-123MIBG

Pheochromocytoma

Courtesy of Nepean Nuclear Medicine and PET, Sydney, Australia

Findings from SPECT/CT study

•AbnormallyincreasedMIBGuptakeintheleft

adrenalglandsuspiciousofpheochromocytoma

Physician impression of SPECT/CT

•Strongindicationofpheochromocytomawhich

inuencestreatment

1 mm isotropic voxels

17 Oncology

Bilateral breast cancer

Courtesy of Innsbruck Medical University, Tyrol, Austria

Patient information

•58-year-oldfemale

•Cancerinleftbreast,ductalcarcinomainsitu

rightbreast

•Localizesentinellymphnodes

Procedure

•Tc-99mColloid

Findings from SPECT/CT study

•Sentinellymphnodesinbilateralaxillaryregions;

rightsidenextto4thrib,leftsideintercostalspace

of4thto5thribs

Physician impression of SPECT/CT

•Exactlocalizationofsentinelnodesusingribs

asreference

•Sentinellymphnodeswereresectedandshowed

nosignofmalignancy

1 mm isotropic voxels

18 Oncology

Patient information

•52-year-oldmale

•LeftadrenalmassonCT;evaluatefor

pheochromocytomaandmetastases

Procedure

•I-123MIBG

Left adrenal mass

Courtesy of Washington Hospital Center, Washington DC

Findings from SPECT/CT study

•Leftadrenalglandpheochromocytomawithcentral

necrosis,noevidenceofmetastaseselsewhere

Physician impression of SPECT/CT

•SPECT/CThelpedpreciselycorrelateI-123MIBG

avidtissuetothemassdescribedbutnotadequately

characterizedbythepriorCTimagesalone

1 mm isotropic voxels

19 Oncology

Hemangioendothelioma

Courtesy of Washington Hospital Center, Washington DC

Patient information

•64-year-oldfemale

•Hemangioendothelioma;posttumorresectioninvolving

proximalrighttibiaandrightmedialcuneiform

Procedure

•Tc-99mMDPbonescan

Findings from SPECT/CT study

•Right-sideddistaltibiaandrightcalcaneum 

tumorrecurrence

•Post-surgicalinammatorychangesofproximalright

tibiaandmedialcuneiform

Physician impression of SPECT/CT

•Inthesettingofpost-surgicalchangesandlyticnature

ofthetumor,SPECT/CThelpedcorrectlyidentify

tumorrecurrenceinnewsites;lyticlesionsarenot

greatlyavidwithboneagents

•SPECT/CThelpedidentifyactivity(malignancy)

inperipheryofthelyticlesions

0.33 mm isotropic voxels

20 Oncology

Patient information

•85-year-oldmale

•Prostatecancer,assessforbonymetastases

Procedure

•Tc-99mMDPbonescan

Sclerotic bony metastases

Courtesy of Washington Hospital Center, Washington DC

Findings from SPECT/CT study

•Rightpubicramusmetastasisextendingintoanterior

aspectofrightacetabulum

Physician impression of SPECT/CT

•Onplanarimages,activityappearstobeinsuperiorlipof

rightacetabulum,commonsitefordegenerativechanges

•SPECT/CThelpedpreciselyidentifylocationtoareasof

scleroticbonymetastases.Managementis100%different

1 mm isotropic voxels

21 Oncology

Multiple degenerative mutations of spine

Courtesy of University Hospital Freiburg, Germany

Patient information

•63-year-oldfemale

•Coloncarcinoma,persistingpaininspine

Procedure

•Tc-99mDPDbonescan

Findings from SPECT/CT study

•Focaluptakeinrightparamedianthoracicspineat5th,

9th,10th,and12ththoracicvertebralbodies;distinct

osteochondrosisinsameregion

•Nofocaluptakeinregionoftheboneislandin

transverseprocessof5ththoracicvertebralbody

Physician impression of SPECT/CT

•Noproofofbonemetastases;multipleobvious

degenerativemutationsinthespine

1 mm isotropic voxels

22 Oncology

Patient information

•72-year-oldmale

•Lungcancer;evaluateformetastases

Procedure

•Tc-99mMDPbonescan

Lung cancer evaluation for bone mets

Courtesy of Huadong Hospital, Shanghai, China

Findings from SPECT/CT study

•T12compressionfracture

•Rightanklejointdegeneration

Physician impression of SPECT/CT

•Nometastaseswereidentied;activetreatment

1 mm isotropic voxels

Orthopedics

Unique combination of design and technology

High resolution – low CT dose

The high resolution CT images of the BrightView XCT are

a result of the small detector element size (<200 microns).

It has been shown (Optimizing Detector Size in X-ray

Imaging; Kachelrieb & Kalender; IEEE 2005) that signicant

dose reductions can be achieved with such ne sampling.

Our design allows for very high resolution (0.33 mm thick)

CT slices, ideal for extremity bone imaging. Additionally,

high image quality is apparent with data viewed at any

angle, not just the transverse data.

1 Orthopedics

Multiple fractures in Down’s Syndrome patient

Courtesy of Sutherland Nuclear Medicine, Sydney, Australia

Patient information

•44-year-oldfemale

•Down’sSyndrome;injurytoleftfootandankle,

difcultyexplaininglocationandseverityofpain

Procedure

•Tc-99mHDPbonescan

Findings from SPECT/CT study

•Acutefractureofdistalleftbula

•Fractureofanterolaterallipofleftdistalbula

•Injury,possibleincompletefractureofbaseof2nd

metatarsal,bonecontusionofbaseof4thmetatarsal

Physician impression of SPECT/CT

•Provideddetailandclaritytotheextentofinjurythat

planarimagingwasunabletoidentify

•Diagnosisofmutiplefracturesiteshelpedpatient

managementbynecessitatingimmobilizationinapatient

thatwasunabletofullyunderstandandcooperate

0.33 mm isotropic voxels

2 Orthopedics

Patient information

•16-year-oldmale

•Suddenonsetbackpaininjuniorprofessional

footballplayer,noimprovementwithphysiotherapy;

MRInormal

Procedure

•Tc-99mMDPbonescan

Early pars stress fracture

Courtesy of Frimley Park Hospital NHS Foundation Trust, Surrey, United Kingdom

Findings from SPECT/CT study

•IncreaseduptakeinL5parsinterarticularis,

normalfacetjoint

Physician impression of SPECT/CT

•Earlystressfracturenotvisualizedonotherimaging

•Criticaldiagnosisinaprofessionalfootballplayer

1 mm isotropic voxels

3 Orthopedics

Scaphoid fracture

Courtesy of The Royal Wolverhampton Hospitals NHS Trust, Surrey, United Kingdom

Patient information

•22-year-oldmale

•12weekspostscaphoidfracture,stilltender

Procedure

•Tc-99mMDPbonescan

Findings from SPECT/CT study

•Conrmedscaphoidfracturewithincompleteunion

Physician impression of SPECT/CT

•SPECT/CTprovidedinformationthatallowedmore

aggressiveorthopedictreatmentwithsubsequent

goodoutcome

•Fracturenowhealedandpatientissymptom-free

0.33 mm isotropic voxels

4 Orthopedics

Patient information

•47-year-oldmale

•Rightfootpain

Procedure

•Tc-99mHDPbonescan

Right foot pain

Courtesy of Nepean Nuclear Medicine and PET, Sydney, Australia

Findings from SPECT/CT study

•Activeandosteoblasicprocessatright2ndmetatarsal

shaftconsistentwithrecentfracture

Physician impression of SPECT/CT

•SPECT/CTconrmedfractureandexcludedinfectionand

othercauseswhichledtoappropriatemanagement

0.33 mm isotropic voxels

5 Orthopedics

Torus palatini

Courtesy of University of Washington Medical Center, Seattle, Washington

Patient information

•51-year-oldfemale

•Longhistoryofmultiplebonygrowthsinmaxilla,

mandible,hands,rightshoulder,likelyhereditary

multipleexostosis

•Bonygrowthinhardpalatecausingbleeding;

lookformalignanttransformation

Procedure

•Tc-99mMDPbonescan

Findings from SPECT/CT study

•Milduptakeinoropharynxcorrespondingtolarge

growthonCTwithwell-corticatedmarginsandsmall

medullaryspace;hasappearanceoftoruspalatini

•Minimaluptakewithinexostosesinmandible,shoulder,

andcalvarium

Physician impression of SPECT/CT

•CTclariedthehardpalategrowthwasatoruspalatini

ratherthanexostosis

•Concernofmalignanttransformationexcludeddespite

troublingclinicalhistory

1 mm isotropic voxels

6 Orthopedics

Patient information

•49-year-oldmale

•Chronicelbowpain(mostlyright);

ruleoutepicondylitisradialis

Procedure

Tc-99mMDPbonescan

Findings from SPECT/CT study

•Planarimagesshowhotspotonbilater

proximalforearm,possiblyradius

Biceps enthesopathy

Courtesy of GZA Sint-Augustinus, Antwerp, Belgium

•SPECT/CTofrightelbowaccuratelylocalizes

theintenseuptaketoradialtuberosity,compatible

withbicepsenthesopathy

•Onlysubtleincreaseduptakeatmedialandlateral

epicondyle

Physician impression of SPECT/CT

•Clearlyvisualizesfocalbonelesion–differentdiagnosis

thanorthopedicsurgeonsuspected

•Comparedtoplanarimages(difcultanatomical

interpretation),SPECT/CTgivesmoreaccuratelocalization

ofhotspotandshowsnoevidentstressfracture

0.33 mm isotropic voxels

7 Orthopedics

Osteonecrosis

Courtesy of Universitair Ziekenhuis Brussel, Brussels, Belgium

Patient information

•30-year-oldfemale

•Lupusnephretis(underimmunosuppression)

andsicklecelldiseasewithpaininrightknee,

medialaspectofrightfoot,andleftankle

Procedure

•Tc-99mMDPbonescan

Findings from SPECT/CT study

•MDPaccumulationcorrespondingwithaserpigenous

marginofincreaseddensitywhichrunsalongarc-like

radioluscentlesions,characteristicforosteonecrosis

inahealingphase

•Boneinfarctionswithintheepiphysiswithanecrotic

centerofmedullarbonesurroundedbyviablemarrow

andbone

Physician impression of SPECT/CT

•Osteonecrosiswithsignsindicatingrepair;couldbedue

toembolizationofsmallfeedingbloodvesselsrelated

tosicklecelldiseaseorinducedbycorticosteroiduse

0.33 mm isotropic voxels

8 Orthopedics

Patient information

•Rightheelpainforafewmonths

Procedure

•Tc-99mbonescan

Calcaneal fracture

Courtesy of Sydney X-Ray, Sydney, Australia

Findings from SPECT/CT study

•Intenseuptakeinrightcalcaneousalongafracture

lineposteriorlyintheCT,whichalsodemonstrated

malalignmentandimpactionofthefracture

Physician impression of SPECT/CT

•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

0.33 mm isotropic voxels

9 Orthopedics

Cervical spine pain

Courtesy of Innsbruck Medical University, Tyrol, Austria

Patient information

•59-year-oldfemale

•Cervicalspinepainx1year;fusionofC5-6

andC6-7in2003

•MRIshowednosignicantclinicalinformation

Procedure

•Tc-99mDPDbonescan



Findings from SPECT/CT study

•Pathologicbonemetabolisminfusionarea

ofC5-6andC6-7

•Easing/relaxationofthe“cage”materialused

intheoperation

Physician impression of SPECT/CT

•SPECT/CTguidedphysiciantoperformaninltration

ofcervicalspineinfusionarea

1 mm isotropic voxels

10 Orthopedics

Patient information

•80-year-old

•Severerightanklepainwithsuspectedstressfracture

Procedure

•Tc-99mbonescan

Navicular arthropathy

Courtesy of Sydney X-Ray, Sydney, Australia

Findings from SPECT/CT study

•Markedlyincreasedvascularityanddelayeduptakein

thehindfoot;demonstratedintenseuptakeinright

talonavicularregionwithseveredegenerativechange

onlowdoseCT(subarticularcystformation,joint

narrowingandPeriarticularsclerosis)

Physician impression of SPECT/CT

•Patienttreatedappropriatelyforinammatory

arthropathyofrighttalonavicularjointratherthan

incorrectlyforastressfracturewhichmaynothave

beenappreciatedwithoutSPECT/CT

0.33 mm isotropic voxels

11 Orthopedics

Sacroiliitis

Courtesy of Fletcher Allen Health Care University, Burlington, Vermont

Patient information

•40-year-oldmale

•Chronicbackpainradiatingtolowerextremities,

ruleoutoccultfractures,assessactivediseaseand

guidelevelforfacetinjectionorMBB+/-RFA

•MRIshowedL4-5discdegenerationandfacet

arthropathyL4-5,L5-S1

Procedure

•Tc-99mbonescan

Findings from SPECT/CT study

•Nosignicantuptakeinfacetjointsnordiscogenic

endplatechanges

•IntenseuptakeassociatedwithSIjointsconsistent

withsacroiliitis

Physician impression of SPECT/CT

•Patientreferredfromortho/spineclinic

torheumatologyclinic

1 mm isotropic voxels

12 Orthopedics

Patient information

•47-year-oldmale

•Lowbackpaininconstructionworker,increasing

throughouttheday

•MRIshowedL3-4,L4-5,L5-S1discdegeneration,

lateralbulgesL3-4,L4-5

•BonescantoguidefacetblocksorMBB+/-RFA

andpossiblefusion

Procedure

•Tc-99mbonescan

Guide facet block or medial branch block

Courtesy of Fletcher Allen Health Care University, Burlington, Vermont

Findings from SPECT/CT study

•PlanaruptakeincreasedL5-S1butcouldbemistaken

forfacetjoints

•SPECT/CTclearlyidentiesincreaseduptake

correspondingtodiscogenicendplatechangesL5-S1

Physician impression of SPECT/CT

•Patientwasofferedmedialbranchblockwith

radiofrequencyablationofmedialbranchifdiagnostic

MBBiseffective

•IfMBBisineffective,L5-S1spinalfusionwillbeoffered

1 mm isotropic voxels

13 Orthopedics

Facet joint arthropathy

Courtesy of Washington Hospital Center, Washington DC

Patient information

•61-year-oldmale

•Right-sidedbackpain

Procedure

•Tc-99mMDPbonescan

Findings from SPECT/CT study

•Right-sidedL4-5facetjointarthropathy

•Noevidenceofspondylolysis,spondylolisthesis,

orparsfracture

Physician impression of SPECT/CT

•Demonstrationofinammatoryprocessversusfracture

asetiologyofbackpain

•Guidedreferringphysiciantoconservativemedical

management

1 mm isotropic voxels

14 Orthopedics

Patient information

•34-year-oldmale

•Six-weekhistoryofleftproximaltibiapain,

queryAVNorosteomyelitis

Procedure

•Tc-99mHDPbonescan

Stress fracture of tibia

Courtesy of Wollongong Nuclear Medicine, New South Wales, Australia

Findings from SPECT/CT study

•IntenseHDPuptakeinleftproximaltibia,associated

withfracturelineseeninthelowdoseCT

•Recentstressfractureofleftproximaltibia

Physician impression of SPECT/CT

•SPECT/CTallowedclearlocalizationanddiagnosis

offracture,rulingoutAVNandosteomyelitis

0.33 mm isotropic voxels

15 Orthopedics

Pseudoarthrosis

Courtesy of Sutherland Nuclear Medicine, Sydney, Australia

Patient information

•52-year-oldmale

•Rightshinpain,nocleartrauma

Procedure

•Tc-99mHDPbonescan

Findings from SPECT/CT study

•Exostosisatmedialmarginofrighttibiawithavid

uptakeatitsbase,correlatestoincompletefusion/

pseudoarthrosisratherthanacuteinjury

•Secondfocusofnewboneformationand

correspondingpseudoarthrosis

Physician impression of SPECT/CT

•WithoutSPECT/CT,delayedimageswouldhave

beendiagnosedasstressfractureoftibia

•SPECT/CThelpednditwasanoldinjurywith

incompletefusionandcorrespondingpseudoarthrosis

ratherthanacuteinjury,thereforechanged

patient’streatment

0.33 mm isotropic voxels

16 Orthopedics

Patient information

•73-year-oldfemale

•Knownstressfracturesoffemorarelated

tolong-termbiphosphonatetherapy;increasing

lowbackpain

Procedure

•Tc-99mHDPbonescan

Atypical insufciency fractures

Courtesy of Wollongong Nuclear Medicine, New South Wales, Australia

Findings from SPECT/CT study

•Presenceofreactiontoresolvingstress/insufciency

fracturesinlateralcorticalmarginsofbothdistalfemora

•EvidenceofbilateralL5-S1facetjointandL4-5right

facetjointarthropathy

Physician impression of SPECT/CT

•Revealedatypicalinsufciencyfracturesofbothfemora,

secondarytolong-termbiphosphonatetherapy–anew,

recentlydescribed,andcontroversialcondition

0.33 mm isotropic voxels1 mm isotropic voxels

Infection

Isotropic voxels

Localization – CT acquisition Localization – SPECT acquisition

High quality images regardless of viewing angle

By acquiring in isotropic voxels, BrightView XCT provides

the same high resolution in all orientations of the CT

images. Coronal and sagittal slices will have the same

resolution as the transverse slices, without the stair-step

artifact common to non-isotropic techniques.

1 Infection

Patient information

•60-year-oldmale

•Rightsidepelvicpain;CTshowedmass

onrightside,ruleoutinfectedpelvicgraft

Procedure

•In-111WBCscan

Pelvic graft infection

Courtesy of North Carolina Baptist Hospital, Winston-Salem, North Carolina

Findings from SPECT/CT study

•Increasedactivityinrightgroinadjacenttograft

(femoralarteryanastomosis)correspondingto

edemaandcellulitisinrightgroin,likelyinfection

Physician impression of SPECT/CT

•SPECT/CTshowedtheuptakewasnotover

theboneandconrmedtheCTndings

1 mm isotropic voxels

2 Infection

Foot and shin ulcers

Courtesy of Wollongong Nuclear Medicine, New South Wales, Australia

Patient information

•80-year-oldfemale

•Ulcersonrightheelandleftlowershin;

ruleoutosteomyelitis

Procedure

•Tc-99mHDPbonescanandGa-67scan

Findings from SPECT/CT study

•Bonendings–highlysuspiciousforosteomyelitisof

rightcalcaneousinferiorly;mayrepresentperiosteal

reactionofleftshinbutmaybeosteomyelitis

•Galliumndings–mildGalliumuptakeincalcaneum,

faintuptakeinshin

•Combined–doesnotsuggestosteomyelitis

Physician impression of SPECT/CT

•SPECT/CTdemonstratedsuperblocalizationofGallium

distinctfromMDPuptakeregion,excludingosteomyelitis

•Antibioticswerechangedtoreectanon-osseousinfection

0.33 mm isotropic voxels

Gallium scanBone scan

3 Infection

Patient information

•10-year-oldfemale

•Localizedpaininleftcalcaneousmedioposteriorly

withlow-gradefever

Procedure

•Tc-99mHDPbonescan

Apophysitis verses Brodie’s abscess

Courtesy of Nepean Nuclear Medicine and PET, Sydney, Australia

Findings from SPECT/CT study

•Consistentwithleftcalcanealapophysitis

•NoevidenceofBrodie’sabscess

Physician impression of SPECT/CT

•AbletoexcludeBrodie’sabscess,thereforechanged

managementofpatient

0.33 mm isotropic voxels

4 Infection

Osteomyelitis with sequester

Courtesy of GZA Sint-Augustinus, Antwerp, Belgium

Patient information

•5-year-oldmale

•Fever,painofdistalthigh,limping;ruleoutosteomyelitis

Procedure

•Tc-99mMDPbonescan

Findings from SPECT/CT study

•Planarimagesshowhyperemiaanddiffuse

increaseduptakeindistalrightfemur

•SPECT/CTconrmsincreaseduptakeofdistalfemoral

growthplatewithacentraldefect;onlowdoseCT,

thereisaclearcentralendomedullaryirregularlesion

suspectforabscessorbonesequester

Physician impression of SPECT/CT

•Classicbonescandiagnosisofosteomyelitis

•SPECT/CTshowedadditionofintra-osseoussequester,

whichrequiresmoreintensiveantibiotictherapyand

follow-up(possiblesurgery)

0.33 mm isotropic voxels

5 Infection

Patient information

•30-year-oldfemale

•Persistentpaintwomonthsfollowingsurgery

forhaluxvalgus;ruleoutosteomyelitis

Procedure

•Tc-99mGranuloscint

Findings from SPECT/CT study

•WBCaccumulationinsofttissuesurrounding

headofthescrew

Occult fracture

Courtesy of Universitair Ziekenhuis Brussel, Brussels, Belgium

•Someboneresorptionatproximallevelofthescrews,

noincreasedboneuptakenorinterruptionofthebony

cortex;osteomyelitiswasexcluded

•Straightradioluscentlineatmetaphysisofmetatarsal

bonemarkspresenceofrecentnon-displaced

transcorticaloccultfracture

Physician impression of SPECT/CT

•Thissingleexaminationrulesouttheimportantdiagnosis

ofosteomyelitis,conrmssofttissueinfection,and

demonstratesanoccultfractureassourceofthepain

0.33 mm isotropic voxels

Other localization

Workow tailored for nuclear medicine

Continue working the way you already do

Having all of the capabilities of the popular BrightView

SPECT camera, BrightView XCT simplies workow

to help improve clinical results and lower lifecyle costs.

The low complexity design is compact, tting

in a standard nuclear-medicine-sized room. An in-room

CT control option allows you to be closer to your patient

and avoid the costs associated with a separate control

room. SPECT/CT planning is done from the nuclear

medicine p-scope, as simple as planning

for a SPECT-only procedure.

Compact, low complexity design suitable

for a standard nuclear-medicine-sized room

1 Other localization

Patient information

•72-year-oldmale

•Gaspingandchestpain

Procedure

•Tc-99mMAAlungperfusion

Pulmonary embolism

Courtesy of Afliated Hospital of Xuzhou Medical College, Jiangsu, China

Findings from SPECT/CT study

•Signicantdefectinthelingularsegmentofthesuperior

lobeoftheleftlung;pulmonaryembolismshould

beconsidered

Physician impression of SPECT/CT

•BasedontheSPECT/CTndings,thrombolysistherapy

wasrecommended

1 mm isotropic voxels

2 Other localization

Biliary leak

Courtesy of North Carolina Baptist Hospital, Winston-Salem, North Carolina

Patient information

•59-year-oldmale

•Abdominalpainpostrecentcholecystectomy;

displacedtubepostsurgery

Procedure

•Tc-99mHIDA

Findings from SPECT/CT study

•Extraluminalactivityextendingfromgallbladderfossa

wasnotedintherightparacolicgutterandpelvis;

positivebiliaryleak

Physician impression of SPECT/CT

•SPECT/CTshowedtheleakandextentoftheleak;

CTonlyshowedleakaroundliver

1 mm isotropic voxels

3 Other localization

Lymphatic uid leak

Courtesy of Osaka City University Hospital, Osaka, Japan

Patient information

•59-year-oldfemale

•Esophagealcancer;two-weekleakage

oflymphaticuidafteresophagectomy

Procedure

•Tc-99mHAS-D

Findings from SPECT/CT study

•Uptakeofleakpointwasfoundinmiddleofthe

mediastinum,placedbetweenthebronchusandaorta

Physician impression of SPECT/CT

•Thesurgicalligationofmainlymphductwaseasily

plannedasaresultofaccurateregionalidentication

ofthelymphoidleakpointbySPECT/CT

1 mm isotropic voxels

4 Other localization

Hyperparathyroidism

Courtesy of Nepean Nuclear Medicine and PET, Sydney, Australia

Patient information

•46-year-oldfemale

•Hyperparathyroidism;assessforparathyroidadenoma

Procedure

•Tc-99mSestamibi

Findings from SPECT/CT study

•Moderatefocalretentionpresentatsuperoposterior

aspectofleftthyroidlobe

Physician impression of SPECT/CT

•Identiedandlocalizedparathyroidadenomawhich

helpedwithsurgicalplanning

1 mm isotropic voxels

5 Other localization

Lung perfusion with unusual anatomy

Courtesy of University of Washington Medical Center, Seattle, Washington

Patient information

•27-year-oldfemale

•Complexcongenitalheartdisease;transpositionof

greatarteries,dexocardia,bilateralsuperiorvenacava

•SinglefunctionalventricleandmultiplepulmonaryAVMs

•Newonsetofpalpitationsanddyspnea;evaluatefor

worseningofR-Lshunt

Procedure

•Tc-99mMAAperfusionandTc-99mDTPAventilation

Findings from SPECT/CT study

•Signicantlydecreasedperfusiontoentirerightlung,

focallymoresevereperfusiondefectinlateralaspect

ofrightupperlobeseenbetteronSPECT/CT

•32%right-to-leftshuntlikelyexplainsthepatient’s

symptoms

Physician impression of SPECT/CT

•SPECT/CTprovidedadditionalanatomicinformation

tobetterunderstandtheperfusioninpatientwith

unusualanatomy

•Planarimageswerechallengingtointerpret

1 mm isotropic voxels

6 Other localization

Venogram

Courtesy of Osaka City University Hospital, Osaka, Japan

Patient information

•74-year-oldfemale

•Illustrateaccurateregionsanddegrees

ofvenousembolismsofthelowerlimb

Procedure

•Tc-99mMAAvenogram



Findings from SPECT/CT study

•Beforewarfarization,manyuptakeswerefoundinboth

lowerlimbsalongtheveinsontheSPECT/CT;found

tobevenousembolisms

•Twoweeksafterwarfarization,feweruptakesofboth

lowerlimbswereillustratedthanbeforethetreatment

Physician impression of SPECT/CT

•Warfarizationtreatmentwasinitiatedasaresultof

accurateregionalidenticationanddegreeofvenous

embolismontheSPECT/CT

•Aftertreatment,thecomparisonSPECT/CTeasily

showedatherapeuticresponsesowarfarizationwas

abletobestopped

1 mm isotropic voxels

Initial

study

Follow-up

study

7 Other localization

GI bleeding

Courtesy of Wollongong Nuclear Medicine, New South Wales, Australia

Patient information

•70-year-oldfemale

•GIbloodlossresultinginanemia,requiringblood

transfusions;multipleeffortstoidentifysource

including2xendoscopy

Procedure

•Tc-99mtaggedRBCs

Findings from SPECT/CT study

•Noactivebleedinearlyphase

•At24hours,abnormalactivityinentiretransverse

colon,halfwayalongascendingcolonandentire

descendingcolonpriortosigmoidjunction;

ultrasoundconrmationwasrecommended

Physician impression of SPECT/CT

•SPECT/CTprovidedaspecictargettoallow

subsequentendoscopicconrmationofsourceof

bleeding;endoscopydemonstratedlesioninascending

colonregion(hemangioma/angiodysplasia)

1 mm isotropic voxels

8 Other localization

Hyperparathyroidism

Courtesy of Washington Hospital Center, Washington DC

Patient information

•54-year-oldfemale

•Hyperparathyroidism;identifyparathyroidadenoma

Procedure

•Tc-99mSestamibi

Findings from SPECT/CT study

•ExtrathyroidalMIBIfocusposteromedial

toupperpoleofleftthyroidlobe

•Noevidenceofectopicparathyroidtissue

inmediastinum

Physician impression of SPECT/CT

•SPECT/CThelpedpreciselyidentifyparathyroid

adenomalocation

•Precisesurgicalguidancewasachievedforresection

1 mm isotropic voxels

Case study acquisition parameters

Case study CT scan parameters SPECT scan parameters Page

1Cardiology 5mA;60seconds Astonish;4iterations,8subsets,Hanninglter1.0 7

2Cardiology 5mA;60seconds Astonish;4iterations,8subsets,Hanninglter1.0 8

1Oncology 2mA;12seconds Astonish;2iterations,12subsets,Hanninglter1.2 10

2Oncology 30mA;12seconds Astonish;2iterations,16subsets,Hanninglter1.0 11

3Oncology 20mA;24seconds Astonish;2iterations,16subsets,Hanninglter1.2 12

4Oncology 80mA;24seconds Astonish;2iterations,15subsets,Hanninglter1.2 13

5Oncology 20mA;12seconds Astonish;4iterations,8subsets,nolter 14

6Oncology 30mA;12seconds Astonish;3iterations,8subsets,nolter 15

7Oncology 5mA;60seconds MLEM;Butterworth;cutoff0.66,Order5.0,30iterations 16

8Oncology 5mA;12seconds OSEM;Butterworth;cutoff0.50,Order5.0,16iterations,8subsets 17

9Oncology 20mA;12seconds Astonish;3iterations,16subsets,nolter 18

10Oncology 80mA;24seconds Astonish;4iterations,8subsets,nolter 19

11Oncology 20mA;12seconds Astonish;2iterations,16subsets,Hanninglter1.0 20

12Oncology 80mA;24seconds Astonish;2iterations,16subsets,Hanninglter2.0 21

13Oncology 20mA;12seconds Astonish;4iterations,8subsets,Hanninglter2.0 22

14Oncology 20mA;12seconds Astonish;2iterations,16subsets,Hanninglter1.0 23

15Oncology 20mA;24seconds Astonish;4iterations,16subsets,Hanninglter1.2 24

16Oncology 20mA;12seconds Astonish;3iterations,8subsets,nolter 25