• Journal of the Korean Society of Radiology
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• v.18 no.1
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• pp.45-52
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• 2024

In this study, an AI-based algorithm was developed to prevent image quality deterioration and reading errors due to patient movement in PET/CT examinations that use radioisotopes in medical institutions to test cancer and other diseases. Using the Mothion Free software developed using, we checked the degree of correction of movement due to breathing, evaluated its usefulness, and conducted a study for clinical application. The experimental method was to use an RPM Phantom to inject the radioisotope 18F-FDG into a vacuum vial and a sphere of a NEMA IEC body Phantom of different sizes, and to produce images by directing the movement of the radioisotope into a moving lesion during respiration. The vacuum vial had different degrees of movement at different positions, and the spheres of the NEMA IEC body Phantom of different sizes produced different sizes of lesions. Through the acquired images, the lesion volume, maximum SUV, and average SUV were each measured to quantitatively evaluate the degree of motion correction by Motion Free. The average SUV of vacuum vial A, with a large degree of movement, was reduced by 23.36 %, and the error rate of vacuum vial B, with a small degree of movement, was reduced by 29.3 %. The average SUV error rate at the sphere 37mm and 22mm of the NEMA IEC body Phantom was reduced by 29.3 % and 26.51 %, respectively. The average error rate of the four measurements from which the error rate was calculated decreased by 30.03 %, indicating a more accurate average SUV value. In this study, only two-dimensional movements could be produced, so in order to obtain more accurate data, a Phantom that can embody the actual breathing movement of the human body was used, and if the diversity of the range of movement was configured, a more accurate evaluation of usability could be made.

• BMB Reports
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• v.52 no.7
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• pp.457-462
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• 2019

[18F]Fluorodeoxyglucose (FDG) PET/CT imaging has been widely used in the diagnosis of malignant tumors. ATPase family AAA domain-containing protein 2 (ATAD2) plays important roles in tumor growth, invasion and metastasis. However, the relationship between [18F]FDG accumulation and ATAD2 expression remains largely unknown. This study aimed to investigate the correlation between ATAD2 expression and [18F]FDG uptake in lung adenocarcinoma (LUAD), and elucidate its underlying molecular mechanisms. The results showed that ATAD2 expression was positively correlated with maximum standardized uptake value ($SUV_{max}$), total lesion glycolysis (TLG), glucose transporter type 1 (GLUT1) expression and hexokinase2 (HK2) expression in LUAD tissues. In addition, ATAD2 knockdown significantly inhibited the proliferation, tumorigenicity, migration, [18F]FDG uptake and lactate production of LUAD cells, while, ATAD2 overexpression exhibited the opposite effects. Furthermore, ATAD2 modulated the glycometabolism of LUAD via AKT-GLUT1/HK2 pathway, as assessed using LY294002 (an inhibitor of PI3K/AKT pathway). In summary, to explore the correlation between ATAD2 expression and glycometabolism is expected to bring good news for anti-energy metabolism therapy of cancers.

• The Korean Journal of Nuclear Medicine
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• v.39 no.1
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• pp.1-8
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• 2005

This paper is described on the development of KOTRON-13 and recent status of PET cyclotron by commercial cyclotron companies. KIRAMS has developed medical cyclotron which is KIRAMS-13. Samyoung Unitech produces KOTRON-13 with transfered technology by KIRAMS. As a part of Regional Cyclotron Installation Protect, KOTRON-13 cyclotrons and $[18F]FDG$ production modules are being installed at regional cyclotron centers in Korea. The medical concern with radiation technology has been growing for the last several years. Early cancer diagnosis through the cyclotron and PET-CT have been brought to public attention by commercial cyclotron models in the world. The new commercial cyclotron models are introduced compact low energy cyclotrons developed by CTI, GE, Sumitomo in recent. It produces different short-lived radioisotopes, such as $[^{18}F],\;[^{11}C],\;[^{13}N]\;and\;[^{15}O]$. For the better reliability acceleration particle is proton only. The characteristics of new model cyclotrons are changed to lower energy corresponding to less 13 MeV. New models have self-shielding and low power consumption. Design criteria for the different types of commercial cyclotrons are described with reference to hospital demands.

• Radiation Oncology Journal
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• v.35 no.4
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• pp.306-316
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• 2017

Purpose: To investigate the predictive role of maximum standardized uptake value ($SUV_{max}$) of 2-[$^{18}F$]fluoro-2-deoxy-D-glucose($^{18}F-FDG$) positron emission tomography/computed tomography (PET/CT) in nasopharyngeal cancer patients treated with intensity-modulated radiotherapy (IMRT). Materials and Methods: Between October 2006 and April 2016, 53 patients were treated with IMRT in two institutions and their PET/CT at the time of diagnosis was reviewed. The $SUV_{max}$ of their nasopharyngeal lesions and metastatic lymph nodes (LN) was recorded. IMRT was delivered using helical tomotherapy. All patients except for one were treated with concurrent chemoradiation therapy (CCRT). Correlations between $SUV_{max}$ and patients' survival and recurrence were analyzed. Results: At a median follow-up time of 31.5 months (range, 3.4 to 98.7 months), the 3-year overall survival (OS) and disease-free survival (DFS) rates were 83.2% and 77.5%, respectively. In univariate analysis, patients with a higher nodal pre-treatment $SUV_{max}$ (${\geq}13.4$) demonstrated significantly lower 3-year OS (93.1% vs. 55.5%; p = 0.003), DFS (92.7% vs. 38.5%; p < 0.001), locoregional recurrence-free survival (100% vs. 50.5%; p < 0.001), and distant metastasis-free survival (100% vs. 69.2%; p = 0.004), respectively. In multivariate analysis, high pre-treatment nodal $SUV_{max}$ (${\geq}13.4$) was a negative prognostic factor for OS (hazard ratio [HR], 7.799; 95% confidence interval [CI], 1.506-40.397; p = 0.014) and DFS (HR, 9.392; 95% CI, 1.989-44.339; p = 0.005). Conclusions: High pre-treatment nodal $SUV_{max}$ was an independent prognosticator of survival and disease progression in nasopharyngeal carcinoma patients treated with IMRT in our cohort. Therefore, nodal $SUV_{max}$ may provide important information for identifying patients who require more aggressive treatment.

• The Korean Journal of Nuclear Medicine Technology
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• v.25 no.1
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• pp.21-28
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• 2021

Purpose Brown fat, or brown adipose tissue (BAT), is involved in non-shivering thermogenesis and creates heat through glucose metabolism. BAT activation occurs stochastically by internal factors such as age, sex, and body mass index (BMI) and external factors such as temperature and environment. In this study, as a retrospective, electronic medical record (EMR) observation study, statistical analysis is conducted to confirm BAT activation and various factors. Materials and Methods From January 2018 to December 2019, EMR of patients who underwent PET/CT scan at the National Cancer Center for two years were collected, a total of 9155 patients were extracted, and 13442 case data including duplicate scan were targeted. After performing a univariable logistic regression analysis to determine whether BAT activation is affected by the environment (outdoor temperature) and the patient's condition (BMI, cancer type, sex, and age), A multivariable regression model that affects BAT activation was finally analyzed by selecting univariable factors with P<0.1. Results BAT activation occurred in 93 cases (0.7%). According to the results of univariable logistic regression analysis, the likelihood of BAT activation was increased in patients under 50 years old (P<0.001), in females (P<0.001), in lower outdoor temperature below 14.5℃ (P<0.001), in lower BMI (P<0.001) and in patients who had a injection before 12:30 PM (P<0.001). It decreased in higher BMI (P<0.001) and in patients diagnosed with lung cancer (P<0.05) In multivariable results, BAT activation was significantly increased in patients under 50 years (P<0.001), in females (P<0.001) and in lower outdoor temperature below 14.5℃ (P<0.001). It was significantly decreased in higher BMI (P<0.05). Conclusion A retrospective study of factors affecting BAT activation in patients who underwent PET/CT scan for 2 years at the National Cancer Center was conducted. The results confirmed that BAT was significantly activated in normal-weight women under 50 years old who underwent PET/CT scan in weather with an outdoor temperature of less than 14.5℃. Based on this result, the patient applied to the factor can be identified in advance, and it is thought that it will help to reduce BAT activation through several studies in the future.

• The Korean Journal of Nuclear Medicine Technology
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• v.14 no.1
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• pp.18-23
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• 2010

Purpose: PET/CT combines functional and morphologic data and increases diagnostic accuracy in a variety of malignancies. Especially reconstructed Fusion PET/CT images or MIP (Maximum Intensity Projection) images from a 2-dimensional image to a 3-dimensional one are useful in visualization of the lesion. But in Fusion & MIP 3D reconstruction image, due to hot uptake by urine or urostomy bag, lesion is overlapped so it is difficult that we can distinguish the lesion with the naked eye. This research tries to improve a distinction by removing parts of hot uptake. Materials and Methods: This research has been conducted the object of patients who have went to our hospital from September 2008 to March 2009 and have a lot of urine of remaining volume as disease of uterus, bladder, rectum in the result of PET/CT examination. We used GE Company's Advantage Workstation AW4.3 05 Version Volume Viewer program. As an analysis method, set up ROI in region of removal in axial volume image, select Cut Outside and apply same method in coronal volume image. Next, adjust minimum value in Threshold of 3D Tools, select subtraction in Advanced Processing. It makes Fusion & MIP images and compares them with the image no using Region Cut Definition. Results: In Fusion & MIP 3D reconstruction image, it makes Fusion & MIP images and compares them by using Advantage Workstation AW4.3 05's Region Cut Subtraction, parts of hot uptake according to patient's urine can be removed. Distinction of lesion was clearly reconstructed in image using Region Cut Definition. Conclusion: After examining the patients showing hot uptake on account of volume of urine intake in bladder, in process of reconstruction image, if parts of hot uptake would be removed, it could contribute to offering much better diagnostic information than image subtraction of conventional method. Especially in case of disease of uterus, bladder and rectum, it will be helpful for qualitative improvement of image.

• The Korean Journal of Nuclear Medicine Technology
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• v.21 no.2
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• pp.31-36
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• 2017

Purpose Recently, the performance of PET/CT scanner has been improved and various techniques have been developed to increase the image quality such as Sensitivity and Resolution. The purpose of this study is to evaluate the usefulness of Q.Clear (a fully convergent iterative reconstruction) technique of GE Discovery IQ equipment to enhance the image quality. Materials and Methods All scans were acquired by Discovery IQ (GE Healthcare, MI, USA). In NEMA IEC Body Phantom test, Background to Hot-sphere (10 mm, 13 mm, 17 mm, 22 mm) ratio was 1:4 and scan time was 3 minutes. The images were reconstructed by VPHDs (VUE Point High-Definition + SharpIR) and Q.Clear to evaluate each Contrast. We injected 18F-FDG 187 M㏃ to PET/SPECT Performance Phantom. And then it was scanned for 4 minutes to evaluate Resolution and Uniformity. T-test statistical analysis was performed on SUVmax of small lesions less than 2 cm in 100 clinical patients regardless of disease type. Results In the NEMA IEC Body Phantom, the Contrast was $63.6{\pm}5.7%$ (VPHDs) and $75{\pm}4.8%$ (Q.Clear). In the PET/SPECT Performance Phantom, the Resolution was 9.2 mm (VPHDs) and 7.3 mm (Q.Clear). Uniformity of Q.Clear was 10.8% better than VPHDs. T-test statistic of the clinical patients showed a significant difference of p value of 0.021. Conclusion Both the phantom test and the clinical results showed that the quality of the image was improved in Q.Clear was applied. The SUVmax was highly measured in Q.Clear and the lesions were clearly distinguished visually. Therefore Q.Clear can be useful in various aspects such as dose-reduction, patients evaluation and image analysis.

• The Korean Journal of Nuclear Medicine Technology
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• v.19 no.1
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• pp.12-16
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• 2015

Purpose Principal component analysis (PCA) is a method often used in the neuroimagre analysis as a multivariate analysis technique for describing the structure of high dimensional correlation as the structure of lower dimensional space. PCA is a statistical procedure that uses an orthogonal transformation to convert a set of observations of correlated variables into a set of values of linearly independent variables called principal components. In this study, in order to investigate the usefulness of PCA in the brain PET image analysis, we tried to analyze C[11]-PIB PET image as a representative case. Materials and Methods Nineteen subjects were included in this study (normal = 9, AD/MCI = 10). For C[11]-PIB, PET scan were acquired for 20 min starting 40 min after intravenous injection of 9.6 MBq/kg C[11]-PIB. All emission recordings were acquired with the Biograph 6 Hi-Rez (Siemens-CTI, Knoxville, TN) in three-dimensional acquisition mode. Transmission map for attenuation-correction was acquired using the CT emission scans (130 kVp, 240 mA). Standardized uptake values (SUVs) of C[11]-PIB calculated from PET/CT. In normal subjects, 3T MRI T1-weighted images were obtained to create a C[11]-PIB template. Spatial normalization and smoothing were conducted as a pre-processing for PCA using SPM8 and PCA was conducted using Matlab2012b. Results Through the PCA, we obtained linearly uncorrelated independent principal component images. Principal component images obtained through the PCA can simplify the variation of whole C[11]-PIB images into several principal components including the variation of neocortex and white matter and the variation of deep brain structure such as pons. Conclusion PCA is useful to analyze and extract the main pattern of C[11]-PIB image. PCA, as a method of multivariate analysis, might be useful for pattern recognition of neuroimages such as FDG-PET or fMRI as well as C[11]-PIB image.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.2
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• pp.44-47
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• 2013

Purpose: There are several methods of measuring SUV in PET/CT imaging including $SUV_{bw}$ which uses the body weight, $SUV_{bsa}$ which that uses body surface area and $SUV_{lbm}$ which uses lean body mass. Currently, Seoul National University Hospital uses $SUV_{bw}$ method which minimizes the variability. In this study, we compared and analyzed the correlation between $SUV_{bw}$ and $SUV_{bsa}$ according to patients' body mass index. Materials and Methods: Using Biograph mCT40 (Siemens, Germany), we conducted $^{18}F-FDG$ PET/CT imaging on 70 patients (41 males, 29 females; ages $58.04{\pm}12.44$). We classified the patients as underweight (BMI<20), normal weight (20$${\leq_-}$$BMI<25), overweight (25$${\leq_-}$$BMI<30), obese (30$${\leq_-}$$BMI<35) and severely obese (35$${\leq_-}$$BMI) according to the patient's sex, age and BIM. Then, bone, liver and lungs were set as ROI for calculation of maximum values of $SUV_{bw}$ and $SUV_{bsa}$, through Syngo.via VA11A analysis program. Results: Comparing the five groups divided according to the BMI by the standard differences between $SUV_{bw}$ to $SUV_{bsa}$, $SUV_{max}$ was measured to be $0.66{\pm}0.15$, $0.78{\pm}0.35$, $0.77{\pm}0.21$, $1.00{\pm}0.44$, $1.53{\pm}0.38$ for bones in underweight, normal weight, overweight, obese and severely obese groups, respectively. For liver, values of $SUV_{max}$ were $1.64{\pm}0.16$, $2.06{\pm}0.34$, $2.19{\pm}0.21$, $2.52{\pm}0.21$ and $2.74{\pm}0.40$ in the same order. And for lung, values of $SUV_{max}$ were $0.69{\pm}0.33$, $0.54{\pm}0.17$, $0.62{\pm}0.23$, $0.83{\pm0.29}$, $1.03{\pm}0.30$. Conclusion: By comparing and analyzing the differences between $SUV_{bw}$ and $SUV_{bsa}$ in this study, it was found that the differences between $SUV_{bw}$ and $SUV_{bsa}$ increased as patient's BMI increased. Thus, there is room for error in the values of SUV depending on the methods of calculations, and appropriate methods must be applied according to the circumstances in clinical settings.

• The Journal of the Korea Contents Association
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• v.13 no.12
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• pp.860-868
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• 2013

The purpose of this study is to ensure safety by measuring External radiation dose ratio (ERDR) by traits of patients in many ways after administering radiopharmaceutical($^{18}F$-FDG) for PET Torso scan, and to decrease ERDR of those to RI technologist, caretakers, and those who frequently exposed to radiation by arousing attention to radiation dose. Radiopharmaceutical was administered to 80 patients who conducted PET Torso from January to June, 2013. Radiation dose emitted from the patients was measured according to body shape(BMI), water hydration, height, amount of radiation administration. From the moment immediately after the radiopharmaceutical was administered, ERDR was measured by personal traits of patients. The radiation dose increased in proportion to the administered amount of the radiopharmaceutical, and there was no significant difference depending on the body shape of the patients. When water was supplied and the height was normal, the radiation dose was lower compared with the cases where water was not supplied and height was not normal. There is a need for making efforts to minimize the working time through sufficient education and mock training before those who RI technologist with sources of radiation for complying the radiation safety management rule. And they should minimize the ERDR by wearing a protective gear.