Notes

Outline

IMAGE FUSION 2003 Rebecca Sajdak, CNMT Loyola University Medical Center

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PURPOSE OF IMAGE FUSION  Assists in radiation therapy planning  Assure lesion being evaluated is the  same lesion seen on MRI, CT  Confirms diagnostic information concerning lesions seen on CT or MRI

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Benefits Of Image Fusion  Accesses response to therapy  Guides more precise biopsy  Guides chemotherapy and radiation therapy

COMBINE FUNCTIONAL AND ANATOMICAL IMAGING

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OPTIMIZATION PARAMETERS  Data Transfer  Patient Preparation  Materials and Methods  Acquisition Parameters  Assessment of Fusion

METHODS* Transfer images via computer network utilizing DICOM -Digital Image COmmunications in Medicine Requirements:    Properly configured network connections    Compatibility of systems    Coordination with CT, MRI sections

PROCEDURE STEPS  Generate volume images for registration  Acquire and process images from PET    system  Load both image sets-adjust intensity  Auto-fuse or Select anatomic landmark, align and rotate if necessary  Generate display for viewing

DATA TRANSFER   MRI - axial image series, preferably the     AXIAL T1 post Gadolinium series   CT - only one transverse image series   RT - only one transverse image series

IMAGE PROCESSING 1. Cine raw data 2. Apply correct filters and reconstruction algorithms 3. Create computer generated volume from CT, MRI data 4. Precisely register SPECT, PET, CT, or MRI data

PET Attenuation Correction Important step to fusion Improves cardiac studies Improves visualization of deep structures Mediastinum Abdomen

No Attenuation/Attenuation Corrected

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Fused PET/CT Patient with hepatoceullular carcinoma CT scan (left) shows only liver disease PET/CT fusion (right) shows multiple disease sites in the abdomen Single scanner study

Fused PET/CT Patient with distal esophageal carcinoma Fused PET/CT shows hot lesion overlying distal esophagus Separate device study with software fusion

Fused PET/MRI 27-year-old female with malignant glioma MR suggests possible radiation necrosis Fused image shows the posterior portion of the lesion has FDG concentration (arrow) consistent with tumor Fused images from separate devices

Fused PET/CT 44-year-old female post hysterectomy and oophorectomy for cervical cancer Fused PET/CT shows recurrence in the peri-aortic nodes Fused on a single device

IMAGE VOLUME REGISTRATION

Fused PET/CT 37-year-old female with recurrent breast cancer Fused images show disease in the chest wall and mediastinum Fused on a single device

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"CASE STUDY" CASE STUDY  70 Y/O Female  S/P Left Thorocotomy  Abnormal CT scan  PET scan shows uptake left axilla,     left supraclavicular

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Tumor Localization of Pancreatic CA PET and CT

Colon Cancer Liver Metastasis

Imaging with Fiduciary Markers

Preparation Of Fiduciary Markers

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EXCESSIVE ACTIVITY IN FIDUCIARY MARKERS

FDG SCAN with FIDUCIARY MARKERS

Clinical Case  52 year old male  History of Hodgkin’s Disease  PET scan to evaluate disease  Fiduciary marking for radiotherapy

PET Scan with Fiduciary Markers

CLINICAL CASE  50 Y/O MALE WITH LUNG CA IN RIGHT    HILAR REGION  FDG SCAN ORDERED FOR RADIATION    THERAPY PLANNING  PATIENT SCANNED IN RT CRADLE    WITH FIDUCIARY MARKERS

PET IMAGES

CT & PET FUSED IN RADIATION THERAPY

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Lung Cancer Coincidence and CT

Fusion With SPECT Interactive tool to correlate two images in 3D space Prostascint- correlates anatomic to functional images Cardiac- correlates changes in perfusion from rest to stress

Clinical Case  64 y/o male with possible recurrent prostate cancer  Rising PSA=3.5, S/P Radiation Therapy  In-111 Prostascint scan and tagged RBC scan are performed with SPECT to rule out recurrent disease  Tc-99m RBC Blood pool can be fused with In-111 Prostascint for anatomic correlation

Tc-99m RBC’S/In-111 ProstaScint

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Conclusions  Image fusion can be a powerful tool if time is taken to create and follow strict protocols  Image fusion aids in diagnostic accuracy by giving anatomic and physiological correlation  Also aids in the staging and follow-up of oncology patients

References Nuclear Medicine, Robert Henkin; Mosby 1996 PET in Oncology, Basics and Clinical Applications, Springer 1999 Radiology, News Archives; Medical Image Fusion; John W. Haller, Joni Caplan