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

2. 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.

3. 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 PET scans a year.

4. 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

5. 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
keV
511 keV
SPATIAL RESOLUTION
≈10-12 mm
≈5-6 mm
ATTENUATION CORRECTION
No/Yes*
Yes
AVAILABILITY
Widespread
Limited

6. 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

7. 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

8. 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.

9. 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.

10. 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

11. 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.