Ordered subset expectation maximization (OSEM) is the most widely used algorithm for clinical PET image reconstruction. OSEM is usually stopped early and post-filtered to control image noise and does not necessarily achieve optimal quantitation accuracy. As an alternative to OSEM, we have recently implemented a penalized likelihood (PL) image reconstruction algorithm for clinical PET using the relative difference penalty with the aim of improving quantitation accuracy without compromising visual image quality. Preliminary clinical studies have demonstrated visual image quality including lesion conspicuity in images reconstructed by the PL algorithm is better than or at least as good as that in OSEM images. In this paper we evaluate lesion quantitation accuracy of the PL algorithm with the relative difference penalty compared to OSEM by using various data sets including phantom data acquired with an anthropomorphic torso phantom, an extended oval phantom and the NEMA image quality phantom; clinical data; and hybrid clinical data generated by adding simulated lesion data to clinical data. We focus on mean standardized uptake values and compare them for PL and OSEM using both time-of-flight (TOF) and non-TOF data. The results demonstrate improvements of PL in lesion quantitation accuracy compared to OSEM with a particular improvement in cold background regions such as lungs.

A challenge for PET/CT quantitation is patient respiratory motion, which can cause an underestimation of lesion activity uptake and an overestimation of lesion volume. Several respiratory motion correction methods benefit from longer duration CT scans that are phase matched with PET scans. However, even with the currently-available, lowest dose CT techniques, extended duration CINE CT scans impart a substantially high radiation dose. This study evaluates methods designed to reduce CT radiation dose in PET/CT scanning. Methods We investigated selected combinations of dose reduced acquisition and noise suppression methods that take advantage of the reduced requirement of CT for PET attenuation correction (AC). These include reducing CT tube current, optimizing CT tube voltage, adding filtration, CT sinogram smoothing and clipping. We explored the impact of these methods on PET quantitation via simulations on different digital phantoms. Results CT tube current can be reduced much lower for AC than that in low dose CT protocols. Spectra that are higher energy and narrower are generally more dose efficient with respect to PET image quality. Sinogram smoothing could be used to compensate for the increased noise and artifacts at radiation dose reduced CT images, which allows for a further reduction of CT dose with no penalty for PET image quantitation. Conclusion When CT is not used for diagnostic and anatomical localization purposes, we showed that ultra-low dose CT for PET/CT is feasible. The significant dose reduction strategies proposed here could enable respiratory motion compensation methods that require extended duration CT scans and reduce radiation exposure in general for all PET/CT imaging.

Clinical widespread use of edge-preserving penalized-likelihood (PL) methods has been hindered by the properties of the resulting images such as blocky background noise textures, piecewise-constant appearances of organs and relative noise strengths in high and low activity regions despite their potential for improved lesion quantitation over OSEM and quadratically penalized PL. Here, we investigate the use of the convex relative difference penalty first introduced by Nuyts et at. (TNS '02) for improved quantitation over OSEM in whole-body clinical PET imaging while maintaining visual image properties similar to OSEM and therefore clinical acceptability. We perform data-independent axial smoothing modulation based on the system sensitivity profile in order to avoid excessively smooth bed-position overlap regions. We also perform data-independent transaxial smoothing modulation to avoid oversmoothing the central portions of the field-of-view that occur with the use of a constant smoothing parameter. The resulting overall smoothing modulation profile allows for improved resolution uniformity in regions with high sensitivity and improved noise uniformity between regions of low and high sensitivity. We evaluate our approach in multiple clinical datasets with lesions inserted into representative locations with time-of-flight (TOF) and non-TOF reconstructions. Such "hybrid" datasets combine clinically realistic image backgrounds with known lesionactivities. We demonstrate that using the relative difference penalty with proper smoothing modulation, superior quantitation over early-stopped and post-filtered OS EM can be achieved while maintaining clinically acceptable image quality. Furthermore, the approach lends itself to theoretical contrast recovery prediction and bias correction for improved contrast recovery consistency across lesions and further improvements in quantitation.

The desire to understand normal and disordered human brain function of upright, moving persons in natural environments motivates the development of the ambulatory micro-dose brain PET imager (AMPET). An ideal system would be light weight but with high sensitivity and spatial resolution, although these requirements are often in conflict with each other. One potential approach to meet the design goals is a compact brain-only imaging device with a head-sized aperture. However, a compact geometry increases parallax error in peripheral lines of response, which increases bias and variance in region of interest (ROI) quantification. Therefore, we performed simulation studies to search for the optimal system configuration and to evaluate the potential improvement in quantification performance over existing scanners. We used the Cramér–Rao variance bound to compare the performance for ROI quantification using different scanner geometries. The results show that while a smaller ring diameter can increase photon detection sensitivity and hence reduce the variance at the center of the field of view, it can also result in higher variance in peripheral regions when the length of detector crystal is 15 mm or more. This variance can be substantially reduced by adding depth-of- interaction (DOI) measurement capability to the detector modules. Our simulation study also shows that the relative performance depends on the size of the ROI, and a large ROI favors a compact geometry even without DOI information. Based on these results, we propose a compact ‘helmet’ design using detectors with DOI capability. Monte Carlo simulations show the helmet design can achieve four-fold higher sensitivity and resolve smaller features than existing cylindrical brain PET scanners. The simulations also suggest that improving TOF timing resolution from 400 ps to 200 ps also results in noticeable improvement in image quality, indicating better timing resolution is desirable for brain imaging.

We have previously developed a convergent penalized likelihood (PL) image reconstruction algorithm using the relative difference prior (RDP) and showed that it achieves more accurate lesion quantitation compared to ordered subsets expectation maximization (OSEM). We evaluated the detectability of low-contrast liver and lung lesions using the PL-RDP algorithm compared to OSEM. We performed a two-alternative forced choice study using a channelized Hotelling observer model that was previously validated against human observers. Lesion detectability showed a stronger dependence on lesion size for PL-RDP than OSEM. Lesion detectability was improved using time-of-flight (TOF) reconstruction, with greater benefit for the liver compared to the lung and with increasing benefit for decreasing lesion size and contrast. PL detectability was statistically significantly higher than OSEM for 20 mm liver lesions when contrast was [Formula: see text] ([Formula: see text]), and TOF PL detectability was statistically significantly higher than TOF OSEM for 15 and 20 mm liver lesions with contrast [Formula: see text] and [Formula: see text], respectively. For all other cases, there was no statistically significant difference between PL and OSEM ([Formula: see text]). For the range of studied lesion properties, lesion detectability using PL-RDP was equivalent or improved compared to using OSEM.