Background Performance assessment of positron emission tomography (PET) scanners is crucial to guide clinical practice with efficiency. Even though clinical data are the final target, their use to characterize systems response is constrained by the lack of ground truth. Phantom tests overcome this limitation by controlling the object of study, but remain simple and are not representative of patient complexity. The objective of this study is to evaluate the accuracy of a simulation method using synthetic spheres inserted into acquired raw data prior to reconstruction, simulating multiple scenarios in comparison with equivalent physical experiments. Methods We defined our experimental framework using the National Electrical Manufacturers Association NU-2 2018 Image Quality standard, but replaced the standard sphere set with more appropriate sizes (4, 5, 6, 8, 10 and 13 mm) better suited to current PET scanner performance. Four experiments, with different spheres-to-background ratios (2:1, 4:1, 6:1 and 8:1), were performed. An additional dataset was acquired with a radioactive background but no activity within the spheres (water only) to establish a baseline. Then, we artificially simulated radioactive spheres to reproduce other experiments using synthetic data inserted into the original sinogram. Images were reconstructed following standard guidelines using ordered subset expectation maximization algorithm along with a Bayesian penalized likelihood algorithm. We first visually compared experimental and simulated images. Afterward, we measured the activity concentration values into the spheres to calculate the mean and maximum recovery coefficients (RCmean and RCmax) which we used in a quantitative analysis. Results No significant visual differences were identified between experimental and simulated series. Mann–Whitney U tests comparing simulated and experimental distributions showed no statistical differences for both RCmean (P value = 0.611) and RCmax (P value = 0.720). Spearman tests revealed high correlation for RCmean (ρ = 0.974, P value < 0.001) and RCmax (ρ = 0.974, P value < 0.001) between both datasets. From Bland–Altman plots, we highlighted slight shifts in RCmean and RCmax of, respectively, 2.1 ± 16.9% and 3.3 ± 22.3%. Conclusions We evaluated the efficiency of our hybrid method in faithfully mimicking practical situations producing satisfactory results compared to equivalent experimental data.

Background: To evaluate and compare Positron Emission Tomography (PET) devices among them, tests are performed on phantoms that generally consist in simple geometrical objects, fillable with radiotracers. On one hand, those tests bring a control over the experiment through the operator preparation but on the other hand, they are limited in terms of reproducibility, repeatability and are time-consuming, in particular, if several replications are required. To overcome these restrictions, we designed a method combining physical experiment and data insertion that aims to avoid experimental repetitions while testing multiple configurations for the performance evaluation of PET scanners.Methods: Based on the National Electrical Manufacturers Association Image Quality standard, four experiments, with different spheres-to-background ratios: 2:1, 4:1, 6:1 and 8:1, were performed. An additional acquisition was done with a radioactive background and no activity within the spheres. It was created as a baseline to artificially simulate the radioactive spheres and reproduce initial experiments. Standard sphere set was replaced by smaller target sizes (4, 5, 6, 8, 10 and 13 mm) to match current detectability performance of PET scanners. Images were reconstructed following standard guidelines, i.e. using OSEM algorithm, and an additional BPL reconstruction was performed. We visually compared experimental and simulated images. We measured the activity concentration values into the spheres to calculate the mean and maximum recovery coefficient (RCmean and RCmax ) which we used in a quantitative analysis.Results: No significant visual discrepancies were identified between experimental and simulated series. Mann-Whitney U tests comparing simulated and experimental distributions showed no statistical differences for both RCmean (P value = 0.611) and RCmax (P value = 0.720). Spearman tests revealed high correlation for RCmean (ρ = 0.974, P value < 0.001) and RCmax (ρ = 0.974, P value < 0.001) between both datasets. According to Bland-Altman plots, we highlighted slight shifts in RCmean and RCmax of respectively 2.1 ± 16.9 % and 3.3 ± 22.3 %.Conclusions: The method produced realistic results compared to experimental data. Known synthesized information fused with original data allows full exploration of the system's capabilities while avoiding the limitations associated with repeated experiments.