Quantitative Nuclear Medicine Imaging Eva Medel Báez, M.S. Instituto Mexicano del Seguro Social FCFM- BUAP FM-BUAP WiN Mexico Chapter IAEA Expert

PET scan was not an available option. Case Study 1 The Role of End-of-Therapy PET. 15 year old female with initial PET presenting adenomegalias. Hodgkin Lymphoma diagnosis. Received 4 cycles of CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab). At the end of her Chemo treatment there were only two options: CT + Biopsy. To wait for symptoms to show up and then make a decision. PET scan was not an available option.

PET Imaging need @ IMSS Puebla Only in 2014, 107 new hematologic patients needed at least one PET scan. From those, just 6 were performed. Also in 2014, 1200 oncologic patients needed one initial PET scan and at least 1-3 follow up. The financial resources are limited to offer only 10-12 PET scans a year.

PET Imaging need @ IMSS Puebla Locate the site of the cancer Determine the size of the tumor Differentiate benign from malignant growths Discover if the cancer has spread Select treatments that are likely to be appropriate Monitor the success of therapy Detect any recurrent tumors

ATTENUATION CORRECTION Case Study 2 PET Report: No tumor activity at the moment. SPECT vs PET Imaging ATTRIBUTE SPECT PET DETECTION Single γ´s Coincident γ´s RADIONUCLIDES 99mTc, 67Ga, 111In 18F, 82Rb, 13N Eγ 70-300 keV 511 keV SPATIAL RESOLUTION ≈10-12 mm ≈5-6 mm ATTENUATION CORRECTION No/Yes* Yes AVAILABILITY Widespread Limited

Quantitative Imaging SUV (Standard Uptake Value) calculation. Quantitative changes in the SUVMAX provide a much better prediction of treatment outcome than visual interpretation. Energy Peaking, Dose calibrator linearity Image Uniformity Detector´s sensitivity Detector´s resolution Collimator´s integrity

Measurement of activity in human organs and tissues (Body and Organ Monte Carlo Models). Effective Dose and Organ Dose. Quantitative planar and SPECT imaging. Quantitative imaging protocols. Image processing

Our resources… 2 gamma cameras Dosimetry phantoms Professionals in Medicine, Physics, Radiation Safety and Security, Particle detectors, Image fusion, Monte Carlo Methods for particle transport, Image processing.

Our Contribution… Radiation Dosimetry for photon and electron beams Image fusion and image procesing Radiation instrumentation and phantom measurements Training on Radiation Emergency Assistance Training on Medical Management of Radiation Incident Victims Dx and Tx of internal contamination with radionuclides.

Our goals… Incorporate our quantitative analysis of planar and SPECT imaging into PET imaging. Improve performance of equipment Improve image quality Protect patient from adverse effects of radiation Protect staff from adverse effects of radiaton Be able to analyze: Metabolic Tumor Volume Imaging Tumor Proliferation Integrated PET/MRI

Conclusion In many situations, absolute quantification is desirable to obtain a truthful representation of the biological process or metabolic function being imaged. To assume a responsability to the patient-to ensure quality diagnostic images and timely treatment. Implying health care professionals specially trained towards an advance Nuclear Medicine center.