核医学技術 00 : 000-000（2016)―Japanese Society of Nuclear Medicine Technology Working Group Report.―

Key Point of Acquisition, Processing and Display forStandardized Images with Clinical Usefulness(Myocardial SPECT)
Working Group for Investigation and Research on Nuclear Medicine Image Quantiﬁcationand Standardization, Japanese Society of Nuclear Medicine Technology
Yasuhiko Masuda

Akio Nagaki

Department of Radiological Technology, Asahikawa Red

Department of Radiology, Kurashiki Central Hospital

Cross Hospital

Yasuhisa Kawabuchi

Nobuyoshi Ohya

Department of Radiology, Kanazawa Municipal

Division of Radiology, Department of Medical Technology,

Hospital

Kyushu University Hospital

Tetsuro Katafuchi

Satomi Teraoka

Department of Radiological Technology, School of Health

FUJIFILM RI Pharma Co., Ltd.

Science, Gifu University of Medical Science

Masamichi Yanagisawa

Hideharu Niida

Nihon Medi-Physics Co., Ltd.

Nihon Medi-Physics Co., Ltd.

Chairman of Scientiﬁc Committee, Japanese Society of Nuclear Medicine Technology
Masuo Hayashi
Department of Radiology, Osaka Medical College Hospital

Chairman of strategic planning Committee, Japanese Society of Nuclear Medicine Technology
Hiroyuki Tsushima
Department of Radiological sciences, Ibaraki Prefectural University of Health Sciences

Key words : Nuclear Medicine Technology, Nuclear Medicine Manufacturers, Standardization,
Quantiﬁcation, SPECT Imaging, Whole Body Imaging

evidence-based• Introduction

nuclearmedicine(EBNMT) on a national basis.

technology

The Working Group

Nuclear medicine images today are not as

has distributed questionnaires to members of thestandardized as images, provided by computed

Japanese Society of Nuclear Medicine Technology

tomography (CT) and magnetic resonance imaging(JSNMT),(MRI).

devicemanufacturers,

andprinterRather, an inﬁnite variety of images may be

manufacturers, the results of which have been

provided by different institutions, depending on the

published in the JSNMT journal Nuclear Medicine

facilities in each institution.

The Working Group forTechnology, and on the JSNMT website (in Japanese).

Investigation and Research on Nuclear Medicine

In the survey of JSNMT members, 87% responded

Image Quantiﬁcation and Standardization started

that there is a need for guidelines on standardized

work in 2002 with the aims of improving the reliability

acquisition, processing, and display, indicating thatand objectivity of nuclear medicine images to create

great hope is being placed on the Working Group’s1Key Point of Acquisition, Processing and Display for Standardized Images with Clinical Usefulness (Myocardial SPECT) (Masuda, et al)

stenosis of coronary artery lesions to determine

activities and results.
The survey of device manufacturers showed thatappropriate treatment, response to treatment, and risk

although there is a shared recognition of the need forassesment.1) Appropriate testing methods and high-standardization, some manufacturers also expressed

quality technologies are required to implement suchthe desire for users to understand their devices.

EBM, and acquisition conditions such as acquisition

This report summarizes the standard images andtime and pixel size, preprocessing ﬁlters, processing

some of the pitfalls of myocardial perfusion single-

conditions such as scatter/attenuation correction, andphoton emission computerized tomography (SPECT)

display conditions such as gradation, display scales,from the ﬁnal report of the Working Group.

and color scales are all important in myocardialchecklist has also been included at the end.

A

We hope

SPECT.

that readers will refer to these standard images andIn this section, we describe the techniques andchecklist during image acquisition, processing, display,knowledge required for myocardial SPECT image

and evaluation in their own institutions.

acquisition, processing, and display and we provide

Speaking on

behalf of the JSNMT it is our hope that this report will

standard images for myocardial SPECT.

provide a valuable reference for the appropriate

1. Devices used for myocardial SPECT

performance of nuclear medicine testing in order to

Myocardial SPECT image acquisition using aestablish EBNMT.

single-detector gamma camera was performed in most

• Myocardial SPECT

institutions over a 180°scan range from RAO45°to

Evidence-based medicine (EBM) relating to the

LPO45°to shorten acquisition time in supine position.

application of stress myocardial perfusion SPECT in

The development of dual-detector and triple-detector

coronary artery disease has been established in areas

gamma cameras has enabled 180°or 360°scan using

such as the diagnosis of ischemic heart disease, theL-shaped detectors with 90°or 76°angles between

determination of treatment to evaluate the severity ofthem.

Lesser institutions are now using single-

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Figure 1

SPECT images of a normal volunteer acquired by 180°and 360°scan

2

核医学技術Vol. 00 No. 0（2016)detector gamma cameras, as they have been replaced

triple-detector devices, 360°scan is generally used.

by dual-detector gamma cameras.

These cameras

The main difference between images acquired by 180°

are capable of 180°scan by means of detectors joinedand 360°scan is that 180°scan provides high contrast

at 90°angle or 360°scan by opposing detectors at 180°

and high spatial resolution, whereas with 360°scan theangles, depending on the choice of institutions.

images are stable, with little distortion in the inferior

For

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Figure 2

Standardized images acquired on triple-detector by 360°scan

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Figure 3

Standardized images acquired on L-shaped detectors by 180°scan

3Key Point of Acquisition, Processing and Display for Standardized Images with Clinical Usefulness (Myocardial SPECT) (Masuda, et al)
Table 1

Acquisition and processing conditions of standardized images of 201TlCl myocardial SPECT

Scanner
Scan conditions
Detector formation
Scan angle
Collimator
Energy Window
Sampling angle
Scan time
Matrix
Pixel size
Reconstruction parameters
Preprocess filter
Reconstruction filter
Attenuation correction
Scatter correction
Display parameters (gray)Concentration curve
Display scale

GCA9300A/PI (Toshiba)

E.CAM (SIEMENS)

triangle shape by a triple detector
360°
LEHR
71 keV±10%
6°30 sec/step
64×64
6.4 mm

L-shape by a dual detector
180°
LEHR
70 keV±10% and 166 keV±7%5.6°
40 sec/step
64×64
6.1 mmButterworth [order= 8, cutoff= 0.41
cycles/cm]
Ramp
(-)
(-)

Butterworth [order= 5, cutoff= 0.42
cycles/cm]
Ramp
(-)
(-)

square10-100%square10-100%and posterior walls (shown in ﬁgure 1).2) In thiseither under stress or at rest.

report, we provide the standardized images for triple-

comprise exercise stress on a treadmill or ergometer, or

detector 360°scan (shown in ﬁgure 2), standardized

pharmacological stress with an agent such asimages for 180°scan with a dual-detector gamma

adenosine, dipyridamole, or dobutamine.

The stress test may

camera using L-shaped detectors with 90°angle

In terms of the radiopharmaceuticals and doses used(shown in ﬁgure 3), and acquisition conditions

for myocardial SPECT, when 201TlCl is used as a

(Table 1).

myocardial perfusion agent the dose is normally 111
MBq, and for 99mTc-MIBI and 99mTc-tetrofosmin it isIn general, a low-energy high-resolution (LEHR) or

generally 296-740 MBq.

low-energy general-purpose (LEGP) collimator is used
for both201

Tl and99m

123

I-BMIPP is used toassess myocardial fatty acid metabolism and 123I-

Tc, although an LEGP
201

Tl in particular as the

MIBG to assess myocardial sympathetic nerve

count rate is insufﬁcient for short acquisition times orfunction, with a dose of 111 MBq generally used inelectrocardiogram (ECG) -synchronized acquisition

each case.

The imaging start time and pretreatmentforagentscollimator is often used for(gated SPECT).

123

I has a 529 keV peak in addition

these

vary

according

to

their

to the main peak at 159 keV, and the effect of down

pharmacodynamics, and the following points should bescatter must therefore be taken into account, meaning

noted.
At rest, 201TlCl is slightly affected by washout andthat the use of low‒medium energy general-purpose
Collimators

early images may be obtained in 15-30 min after

should be chosen with reference not only to their 5%

administration, with late images also obtained 3-4 hpenetration energy, but also to the balance between

later in some cases.

sensitivity and resolution.

obtained in 5-10 min after administration to take into

(LMEGP)

collimators

ispreferable.

account of the effect of upward creep,3) and late

2. Acquisition conditions for myocardial
SPECT
Myocardial

SPECT

involves

administering

Under stress, early images areimages are acquired 3-4 h later to evaluate
redistribution.

To avoid the uptake of 201TlCl in theagastrointestinal tract, patients should fast for 3-4 hradiopharmaceutical agent and performing imaging,

before imaging as pretreatment and during imaging,4Vol. 00 No. 0（2016)

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with only water intake permitted.
High levels of

99m

Tc-MIBI and

Table 2 Scanner type and acquisition parametersof myocardial SPECT

99m

Tc-tetrofosmin

Single (7%) > dual (63%)[L-shape > opposing] >tripleScan angle
180°
>180°
Gated SPECT
55%
Collimator
LEHR or LEGP
Matrix64×64
Pixel size
5-7 mmMatrix64×64
Sampling angle
5-6°
Scan time
21-40 sec/frame
Allowance of heart rate ±20%Interval of R-R
8 (60%)>16 (25%)
Analysis software
QGS, pFAST
Attenuation correction (‒)
Scatter correction(‒)

accumulation in the hepatobiliary system precedes the

Scanner

myocardial uptake during the early stage after theadministration, causing artifacts, and imaging istherefore

generallyadministration.

performed

30-60

m

after

The disposition of these two agents is

not exactly the same.4) The acquisition for 99mTctetrofosmin can be performed slightly earlier, since it
has a comparatively high cardiac-hepatic uptake ratecompared to 99mTc-MIBI.

The consumption of fatty

foods such as milk or chocolate after the administrationof 99mTc myocardial perfusion agent is effective inpromoting excretion from the hepatobiliary system.
Food consumption prior to administration may
conversely promote excretion from the liver and gall

R-R divisions in gated SPECT is normally set at eight

bladder.

for 201Tl and 16 for 99mTc.

When imaging is performed twice with a99m

Tc agent, either on the base of stress-rest or rest-

Energy window settings are generally 71 keV ±stress protocols, an interval of 3-4 h should be left

10%-15% for 201Tl.

between the ﬁrst and second administrations, and thekeV±10% increases the acquisition count by aroundsecond dose should be 2-3 times higher than the ﬁrst

10%.

5)

Acquisition with an added 167

The setting for 99mTc is generally 140 keV±

10% and that for 123I is generally 159 keV±10%.

dose.

When using

123

In

I-BMIPP, early images are obtained

2008, when this report was published, the majority ofin 15-20 min after administration, and late images

institutions did not perform scatter or attenuation

may be obtained 3-4 h later.

correction (Table 2).8) Currently, more institutions

Fasting before

administration is required as pretreatment.

For

123

I-

are

using

SPECT-CT

scanners

inperforming

MIBG, early images are acquired in 15-20 min after

myocardial perfusion imaging with the same position

administration and late images 3-4 h later.

as needed for SPECT acquisition.

The useCT scanningof reserpine, tricyclic antidepressants, and labetalol

results in additional radiation exposure, and care ishydrochloride may inhibit the myocardial uptake ofrequired when setting acquisition conditions.

123

I-MIBG.

3. Points to note for myocardial SPECT
acquisition

The standard settings for data acquisition are matrix
size 64×64, pixel size 5-7 mm, step angle 5°
, and
-6°
acquisition time within 20-40 s in each direction, but if

Although the myocardial SPECT acquisition countpossible an acquisition time of around 40 s isor acquisition time per projection is dependent on thepreferred.6) Recently, many institutions have started

dose of the nuclide used and the patient’s constitution,

7)

and thethe conditions should be set so that a sufﬁcientacquisition count setting is important in order to obtainmyocardial count can be obtained even in late imaging

a highly accurate evaluation of left ventricularwith 201TlCl, which is affected by washout from thefunction.

myocardium.

to perform gated SPECT at the same time,

When using a polar map (bullseye) display

To investigate the acquisition count,to calculate the washout rate, it is necessary to conﬁrm

the region of interest (ROI) is set in the myocardial

whether or not correction is being performed forregion on the LAO45°planner image from SPECT

acquisition time and nuclide decay.

projection data, and the myocardial projection count is

The number of5Key Point of Acquisition, Processing and Display for Standardized Images with Clinical Usefulness (Myocardial SPECT) (Masuda, et al)

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Figure 4

Investigation of acquisition counttime if 201TlCl is used, or increasing the dose if 99mTc
is used as the myocardial agent.

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This deﬁnition of ≥100 counts is also derived from the concept that thestatistical noise included in the acquisition count can be
kept within 10%, and as the scatter component also
varies depending on collimator performance, it does
not represent a uniform determination.

When gated

SPECT is used, the acquisition count must be
investigated for non-gated SPECT with all the R-R
divisions added together.
During actual acquisition, the patient is securely
immobilized with a belt to restrict body movements,
Figure 5

Relationship between statistical error
and acquisition countand measures such as aids to maintain the body
position with both arms raised are also required.
Scanning is also performed at close range with ameasured (Figure 4).

The acquisition count should

diameter of rotation of 200-250 mm to improve its

ideally be over 100 counts per pixel to reduce forresolution.

statistical error inﬂuence (Figure 5), but acquisition

4. Myocardial SPECT processing conditions

time should be set at 15-20 min as scanning in a
posture with both arms raised for a prolonged period of

Myocardial SPECT image reconstruction is often

time may result in the generation of artifacts due tocarried out by ﬁltered back projection (FBP), but whenbody movements.

99m

Tc is used as the myocardial agent it may cause

With large patients, however, thesettings must be adjusted to ensure a constantstreak artifacts due to hotspots in areas such as theacquisition count by prolongation of the acquisition

liver, gall bladder, and small intestine, and an
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Figure 6

Effect of Butterworth ﬁlter by means of cutoff frequency change

increasing number of institutions are therefore using

is reduced by 30%-40%. Next, attenuation correction

ordered subset expectation maximization (OSEM).

using a method such as Chang’s method that assumes a

It has recently become possible to use algorithms thathomogenous absorber is problematic, as the thoracic

incorporate spatial resolution correction for OSEM,

region contains many organs that are heterogeneous

enabling shorter acquisition times and reduced doses.

absorbers, including the lungs, spine, heart, andmammary glands.

The ﬁlters used in myocardial SPECT image

Recent developments include thereconstruction generally comprise Butterworth ﬁltering

production of an attenuation map by X-ray CT orfor preprocessing and ramp ﬁltering for image

another method for the use of the CT-based

reconstruction.

attenuation

With Butterworth ﬁltering, a highcorrection(CTAC)

incorporatedincutoff frequency yields better resolution but more

OSEM, and segmentation with scatter and photopeak

noise, whereas a low cutoff frequency yields poorer

window data for attenuation correction (SSPAC).13)

resolution but smoother images (Figure 6), and the

It is crucial to perform appropriate scatter correction atsettings must therefore take into account the device

the same time as attenuation correction.

resolution, acquisition count, and noise elimination.
performed in myocardial SPECT, but the anatomical

5. Points to note for myocardial SPECT
processing

complexity of the thoracic region means that their use

The projection data obtained from myocardial

Scatterrequiresandattenuation

caution.

The

correction

tripleenergyare

also

SPECT are checked for body movement in cine mode

window(TEW)12) method used in scatter correction improves

prior to image reconstruction.

the contrast between the cardiac cavity and themainly seen as defects in SPECT images (Figure 7).

myocardium, but the inferior wall is corrected to lower

Therefore, correction to remove body movement

values.

artifacts must be performed if the device has with a

It is also necessary to be aware that the count7

Body movements areKey Point of Acquisition, Processing and Display for Standardized Images with Clinical Usefulness (Myocardial SPECT) (Masuda, et al)

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Figure 7

Case of false positive because of body movement TlCl : defect on inferior wall caused by patient
movement as he felt nausea provoked by drug stress Tc-TF (re-test on another day) : normal

body movement correction program.

However, it isof any misalignment.

It is particularly important toimpossible to correct for changes in posture or

pay attention to inconsistencies at the diaphragmatic

repeated severe coughs or deep breaths of the patientlevel or apex as a result of the heartbeat or respiration.

during acquisition.

At best, correction can only deal

6. Myocardial SPECT image display

with misalignments in the X and Y directions for each

Myocardial SPECT images are often displayed both

set of projection data.

in gray and in color.

The Butterworth ﬁlter is a smoothing ﬁlter that uses

It is also important to set thethe combination of a cutoff frequency and order toappropriate gradient scale to express the relationshipeliminate or reduce the high-frequency component,

between count and concentration, whether linear or

creating smoother images.

square.

When determining thecutoff frequency, a simple method is to start by

Filmless operation has recently become standard,

calculating the SPECT full width at half minimum

and for the gray display of myocardial SPECT images,(FWHM) and regard components above a frequency of

it is now normal to make the concentration curve for

0.5/FWHM (cycles/cm) as noise, but visual evaluation

the exponential or quadratic function (square) betweenof the clinical data before making a ﬁnal judgmentcount and concentration with the upper level of theshould not be forgotten.

display scale at around 100%-110% and the lower

It is still possible to correct for count reduction bylevel at around 10%-20% (Figure 8).9) The cutoff

attenuating the lower wall of the myocardium on

for the lower level is adjusted by the power of theimages after scatter/attenuation correction, but thisnumber.
For the color display of myocardial SPECT images,

may result in false positives by reducing the counts ofMany institutions now

a linear gradient is used with the upper level of theuse a combination of conventional uncorrected images

display scale at 100% and the lower level at 0% as

and CTAC images.

standard.

the anterior wall or the apex.

CTAC is a procedure whereby

Areas of healthy myocardial perfusion,

attenuation maps produced by X-ray CT are

mild, moderate, or severe ischemia, and occlusion cancompared with SPECT images to conﬁrm the absence

be distinguished by variations in the color of color
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Cardiac Option of the NMI Proﬁle as part of theIntegrating the Healthcare Enterprise initiative, and

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this should be used as reference.

VLA, SA, and HLA

myocardial SPECT images are displayed so that theirmaximum myocardial counts are consistent.

If a

99m

Tc myocardial agent is used, the concentration

display may not be the same in patients with highuptake outside the myocardium, and care is required toensure that the maximum counts in each of thedisplayed images are the same.
Figure 8

Effective measures for

dealing with this involve excluding extramyocardial

Concentration curve and display scaleof myocardial SPECT

hotspots from the obtained SPECT images duringreconstruction, masking hotspots on images after

codes, and the determination may change as the result

reconstruction,10) and truncation processing for countsof major variations in the upper and lower levels.

exceeding the maximum myocardial count.11)
If the secondary capture SPECT images are

Particular care is required as the mistaken use of a non-transmitted to a picture archiving and communication

linear gradient may result in misdiagnosis.
In myocardial SPECT image display, it is importantsystem (PACS) and viewed on a diagnostic display afterthat the evaluation of ischemia and viability beappropriate processing on the display of a nuclear

performed accurately, and that the right ventricle andmedicine image processing device, it is vital that thethe background are also visualized to provide

brightness and gradient properties of both theinformation on cardiac function.

When a linear

processing device display and the diagnostic display are

gradient is used, the background concentration is highconsistent to ensure that the images are displayed

and the depiction of ischemic areas is difﬁcult (Figure

uniformly.

9).

The task of establishing uniformity of

Increasing the lower level to 40% removes data

display is one that should be solved by technicians

about the right ventricle together with the backgroundthemselves in order to provide high-quality images(Figure 10).

with good reproducibility.

The use of inappropriate gradient andPersonal preferences on

display scales may affect the visual evaluation of thethe part of the interpreting physician or requesting

contrast and size of lesions.

physician may have a major effect on the ﬁnal decision.
However, we hope that technicians will offer technical

7. Points to note for myocardial SPECT
display

explanations and be willing to strive to achieveconsensus,

Myocardial SPECT images are displayed in a total

with

the

aim

of

promotingthestandardization of displays based on the adviceof 9-16 divisions of 5-7 mm per slice, with the verticalcontained in these guidelines.

long axis (VLA) from the septum to the lateral wall, theAssociation of Radiological Systems Standards has

short axis (SA) from the base of the heart to the apex,

published a method for using the JIRA TG8-QC

and the horizontal long axis (HLA) from the inferior

pattern for the visual evaluation of displays.

wall to the anterior wall (Figure 11).

refer to the Quality Assurance (QA) Guidelines for

As myocardial

PleaseMedical Imaging Display Systems.15)

SPECT compares early and late images, diagnosis iseasier if the SPECT slice cross sections for these earlyand late images are in the same position.

The Japan Industries

8. Color display optimization

A standard

Color display optimization should start with thelayout for myocardial SPECT displays has been

careful choice of which color scale to use.

proposed in the Nuclear Medicine Image (NMI) with
9InKey Point of Acquisition, Processing and Display for Standardized Images with Clinical Usefulness (Myocardial SPECT) (Masuda, et al)

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Figure 9

Relationship between SPECT images representation and Butterworth ﬁlter use
at linear gradient (Difficulty of detection because of high B.G. concentration)

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Figure 10

Relationship between SPECT images and display scale at square gradient(Depleted color scale of the right ventricle and the background)10Vol. 00 No. 0（2016)

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Figure 11

How to reformat and display myocardial SPECT

shades of low-count regions into borderline ones andnormal regions into high-count ones, which may make

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a major difference to the impression given by the color
scale for diagnosis (see Figure 3 in color).
The ﬁrst step involved in appropriate color display is
to talk to the doctor who will perform the diagnosis
before selecting the display color codes.

Most nuclear

medicine images are displayed in rainbow colors fromblack to red at 0%-100% for the relative values of thecounts, but if the 100% level is not present in the
Figure 14

myocardial

Comparison of myocardial polar map
with regard to the color scaleregion(becauseofextramyocardial

hotspots), it may appear that myocardial uptake has
decreased.

The use of a code other than red, such as

white or pink (rainbow white, rainbow pink) for 100%
myocardial perfusion SPECT, priority should usually

regions makes it possible to conﬁrm the presence of thebe given to whether or not the visualization of defects

100% level in the myocardial region.

corresponds to the diagnostic criteria used by thecolor gradient other than a linear gradient (such as ainterpreting physician or requesting physician.

The use of aForsquare gradient) for the color display results in major

example, simply changing the color scale on achanges in color tone distribution, and care is required

myocardial polar map (bullseye) display may have aas this may affect diagnosis.

major effect on the diagnosis (see Figure 14 in color).

(see in color), in general, when rainbow colors (theThe color codes displayed are input as counts, withﬁgure shows PRISM colors) are used, regions where

their output expressed as 8-bit (256-gradient) values

the count has dropped to 50% are depicted in green

corresponding to red (R), green (G), or blue (B).

(red triangular arrow).

It is

As shown in Figure 4

The doctor who performs thepossible to create numerous different color scales bydiagnosis should be aware of the level of the decrease inallocating different count‒gradient properties to R, G,

count expressed by the rainbow shades.

and B, (see Figure 1 in color).

They can also be

display, there is no major breakdown of the rainbow

converted to black-and-white grayscale by allocatingshades even if the lower level is cut at around 10%, but

the same count-gradient properties (see Figure 2 in

if a square gradient is used, the shades break down andcolor).

regions with a decreased count may be overestimated.

Variation of the RGB color codes changes the11

In a linear

Key Point of Acquisition, Processing and Display for Standardized Images with Clinical Usefulness (Myocardial SPECT) (Masuda, et al)With the exception of color codes close to monotone,

medicine devices is resulting in the clinical use of moresuch as GE color and Hotmetal, a linear gradient isandrecommended for rainbow colors.

correction techniques, raising the importance of

more

image

reconstruction

methods

andpressing ahead with the standardization of imaging

9. Conclusions

protocols designed for these new devices.

Myocardial count is the most important factor in

In addition, amid a global trend to try to reduce the

myocardial SPECT acquisition, and the acquisition

doses of radiopharmaceuticals, it is now time totime and dose should be adjusted to obtain around 100

reconsider imaging protocols for low-dose scanning,

counts per pixel.

particularly of children.

As the preprocessing ﬁlter settings

for myocardial SPECT processing take into account

The JSNMT will both continue to consider thethe SPECT device acquisition count and resolution,

standardization of imaging protocols and publish

good images cannot be produced unless a sufﬁcientreports.

myocardial count can be obtained.

Immobilizing theto the standardization of nuclear medicine scanningpatient and reducing the SPECT diameter of rotation

techniques, not only in Japan but in other Asianare effective for reducing image artifacts andcountries and worldwide.

improving resolution.

The quality of myocardial

10. Reference

SPECT is determined by the projection data, and it
therefore goes without saying that if the acquired data

1) Nakata T, Chikamori T : ACC/AHA/ASNC
guidelines for the clinical use of cardiac radionuclide

are poor, this will result in degraded reconstructedimaging and the 67 japanese cases. Tokyo, 2004.
2) Kashikura K, Kobayashi H, Momose M, et al : Effectof reconstruction arc in myocardial SPECT

images.
The heart is surrounded by heterogeneous absorbers,
and given the addition of the heart’s own beat andimaging̶comparison between 180 degrees and 360
degrees arc̶. Kaku Igaku, 33(4) : 375-382, 1996.
3) Yokono S, Saitoh N, Hamaguchi Y : Evaluation of
Artifact due to Upward Creep in Exercise Myocardial

respiratory movements, highly accurate scatter andattenuation correction are currently difﬁcult in
myocardial SPECT.

It is our hope that this report will contribute

Even if scatter correction is

SPECT. Nihon Hoshasen Gijutsu Gakkai Zasshi, 53(5) : 573-577, 1997.
4) Münch G, Neverve J, Matsunari I, et al : Myocardial

carried out, an additional CT scan for the purpose of
attenuation correction should be performed, and thisshould be compared with the conventional uncorrected

Technetium-99m-Tetrofosmin and Technetium-99m-

images.

Sestamibi Kinetics in Normal Subjects and Patientswith Coronary Artery Disease. J Nucl Med, 38(3) :The clinical evaluation of myocardial SPECT
images following the more widespread introduction of428-432, 1997.
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Igaku, 30(10) : 1191-1201, 1993.
6) Japanese Society of Nuclear Medicine : Current
utilization of gated SPECT in Japan. Kaku Igaku, 40(5) : 205-212, 2003.

SPECT-CT devices and new image reconstruction
algorithms will be important for improving thediagnostic performance of myocardial SPECT, and at
the very least gradation and display scale settings anddisplay evaluation are essential for the adequate
assessment of ischemia and viability.

7) Murakami T : Introduction (Symposium I: Usefulness
of Cardiac Function Assessment by Gated SPECT)(The 59th Annual Scientiﬁc Congress). Nihon

10. Final thoughts
Imaging protocols for nuclear medicine devices have
The

Hoshasen Gijutsu Gakkai Zasshi, 60 (3) : 327-349,
2004.
8) Niida H, Ohya N, Katafuchi T, et al : Questionnaire

emergence of combination CT and MRI and nuclear

Report for Practical Conditions of Nuclear Medicine

yet to be fully standardized not only in Japan, but alsoin European countries and North America.

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Processing, Display and Output. Japanese Society of
Nuclear Medicine Technology, 24 : 95-118, 2004.

Maps From Scatter and Photopeak Window Data.
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