1. A Dynamic Cardiac Phantom for the Validation of Quantitative Nuclear Cardiology Software Nigel Williams, Ian Hadley, Alan Williams and Elinor Vinecombe Departments of Nuclear Medicine and Biomedical Engineering University Hospitals of Coventry and Warwickshire NHS Trust

2. Nuclear Cardiology Benefit of acquiring gated SPECT myocardial perfusion images is now widely accepted. Number of software packages available for data analysis Aim of this study – construct a dynamic phantom to assess accuracy of analysis software

3. Nuclear Cardiology Gated MP-SPECT – 99 Tc m -tetrofosmin / MIBI or Tl 201 _ No. projections / acquisition time similar to non- gated study –Camera acquisition triggered to R-wave. ( 8-16 frames collected per R-R interval) –Data processed using standard MP SPECT protocol. –Quantitative analysis of 3D data: Ejection Fraction Wall Motion and Thickening

4. Gated-SPECT Software Two programs at UHCW: –4D-MSPECT (Univ. of Michigan Medical Centre) –QGS+ (Cedars-Sinai Medical Centre) Both programs may be applied to gated and un- gated SPECT myocardial perfusion studies For gated studies they both –Use Reconstructed SA SPECT data –Use edge detection algorithm to define inner and outer walls of myocardium –Map changes in inner and outer walls to quantify EDV, ESV, EF, Wall Thickening and Motion.

5. Manufacturer’s Software Validation 4D-MSPECT Comparison with contrast ventriculography QGS+ Planar first pass radionuclide ventriculography

6. Dynamic Cardiac Phantom Left Ventricle –Fillable inner chamber: latex ultrasound transducer sheath –Volume changed using driven syringe –Wall constructed from foam cone covered with second sheath –Wall can be filled with solution containing 99 Tc m Pumping Mechanism –Pumping syringe driven using pneumatic actuator controlled using pressurised air. –Timing of systole and diastole strokes controlled by valves: (0.33:0.66) –Beat rate adjusted by altering flow of air. Triggering –Camera triggered using light sensor on syringe

7. Dynamic Cardiac Phantom: Development Left Ventricle

9. Dynamic Cardiac Phantom: Development Pneumatic and Filling System

11. Cardiac Simulation Eight combinations of EDV and ESV to produce a range of EFs, based on limits of phantom Ranges: EDV: 50 - 80ml ESV: 15 - 55ml EF: 35 - 80% CT and gated SPECT data collected using each combination CT data collected using iodine contrast agent in inner chamber to produce contrast between wall and inner volume

12. CT data 5mm transaxial slices collected with phantom at ED and ES (data not gated) Data analysed using Osiris and Matlab programme

13. Gated SPECT data Immediately after CT: gated SPECT. 20MBq 99 Tc m -DTPA (30ml) placed in wall. Gated SPECT protocol with 16 frames per R-R interval (204°, 34 steps per head, 3° per step, 25s per step) Beat rate at ~60bpm  25 beats per step. Images processed using standard MP-SPECT protocol Reconstructed SA data analysed with two packages

14. 4D-MSPECT

16. QGS+

17. Results: Gated SPECT (1) 4D-MSPECT: EF values within ±10% of expected result EDV and ESV volumes always underestimated

18. Results: Gated SPECT (2) QGS+: EF results more variable than 4D-MSPECT EDV and ESV very inconsistent with expect results.

19. Conclusion EDV and ESV estimates must be treated with caution. Compared to the QGS+ program the 4D-MSPECT appears to give a more accurate assessment of EF using phantom data

20. Further Work Analysis of CT data for wall thickening and motion. Comparison with g-SPECT results Assessment of software packages for quantification of defects –Insert different sized defects into foam cone. –Compare to a ‘normals’ database generated using previously collected SPECT data