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Research ArticleImaging

Determining the Minimal Required Ultra-Low-Dose CT Dose Level for Reliable Attenuation Correction of 18F-FDG PET/CT: A Phantom Study

David W. Cheng, Monica Ghita, David Menard and Ming-Kai Chen
Journal of Nuclear Medicine Technology June 2022, 50 (2) 126-131; DOI: https://doi.org/10.2967/jnmt.121.262943
David W. Cheng
1Jacobi Medical Center, Bronx, New York;
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Monica Ghita
2Department of Radiology, School of Medicine, Virginia Commonwealth University, Richmond, Virginia;
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David Menard
3Division of Nuclear Medicine, Department of Diagnostic Radiology, Yale New Haven Hospital, New Haven, Connecticut; and
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Ming-Kai Chen
4Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
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Abstract

Our purpose was to investigate the minimal required submillisievert ultra-low-dose CT dose level and the corresponding tube current and voltage for reliable attenuation correction and semiquantitation in 18F-FDG PET/CT in an effort toward radiation dose reduction. Methods: We performed a PET/CT investigational study using a National Electrical Manufacturers Association torso phantom containing 6 spheres (10, 13, 17, 22, 28, and 37 mm in diameter) filled with a fixed concentration of 60 kBq/mL and a background of 15 kBq/mL of 18F-FDG. Two sets of PET images, separated by 2 h, were acquired for 3 min at a single bed position using 3-dimensional mode in a Discovery 690 scanner. Several sets of CT images were acquired for attenuation correction with different combinations of tube voltage (80, 100, and 120 kVp) and effective mAs (tube current–time product divided by pitch), using the maximum beam collimation (64 × 0.625 mm). The lowest CT dose acquisition technique available on this scanner is 10 mA, 0.4 s, and 1.375 for the tube current, tube rotation time, and pitch, respectively. The CT radiation dose was estimated on the basis of CT dose index volume measurements performed following the standard methodology and the Imaging Performance Assessment of CT Scanners (ImPACT) calculator. Each of the CT techniques was applied for attenuation correction to the same PET acquisition, using ordered-subset expectation maximization with 24 subsets and 2 iterations. The maximal and average radioactivity (kBq/mL) and SUVs of the spheres were measured. The minimal ultra-low-dose CT dose level for attenuation correction was determined by reproducible SUV measurements (±10%) compared with our reference CT protocol of 100 kVp and 80 mA for a 0.5-s rotation. Results: The minimal ultra-low-dose CT dose level for reproducible quantification in all spheres (<10% relative difference) was determined to be 0.3 mSv for a combination of 100 kVp and 10 mA at a 0.5-s rotation and a helical pitch of 0.984 (0.26 mGy measured CT dose index volume). From these results. we could confidently determine the CT parameters for reliable attenuation correction of PET images while significantly reducing the associated radiation dose. Conclusion: Our phantom study provided guidance in using ultra-low-dose CT for precise attenuation correction and semiquantification of 18F-FDG PET imaging, which can further reduce the CT dose and radiation exposure to patients in clinical PET/CT studies. On the basis of the data, we can further reduce the radiation dose to the submillisievert level using an ultra-low-dose CT protocol for reliable attenuation correction in clinical 18F-FDG PET/CT studies.

  • research methods
  • adaptive statistical iterative reconstruction (ASIR)
  • attenuation correction CT
  • phantom study
  • reliable SUV quantitation
  • submillisievert CT

Footnotes

  • Published online Nov. 8, 2021.

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Journal of Nuclear Medicine Technology: 50 (2)
Journal of Nuclear Medicine Technology
Vol. 50, Issue 2
June 1, 2022
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Determining the Minimal Required Ultra-Low-Dose CT Dose Level for Reliable Attenuation Correction of 18F-FDG PET/CT: A Phantom Study
David W. Cheng, Monica Ghita, David Menard, Ming-Kai Chen
Journal of Nuclear Medicine Technology Jun 2022, 50 (2) 126-131; DOI: 10.2967/jnmt.121.262943

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Determining the Minimal Required Ultra-Low-Dose CT Dose Level for Reliable Attenuation Correction of 18F-FDG PET/CT: A Phantom Study
David W. Cheng, Monica Ghita, David Menard, Ming-Kai Chen
Journal of Nuclear Medicine Technology Jun 2022, 50 (2) 126-131; DOI: 10.2967/jnmt.121.262943
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Keywords

  • Research Methods
  • adaptive statistical iterative reconstruction (ASIR)
  • attenuation correction CT
  • phantom study
  • reliable SUV quantitation
  • submillisievert CT
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