Abstract
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Objectives Hybrid imaging has proven to be a major innovation in medical diagnosis. In nuclear medicine hybrid imaging allows the fusion of functional information with anatomical detail, however clinical studies have mainly been been carried out with large whole body scanning instruments. We have developed and characterised a compact small field of view hybrid camera of weight approximately 1kg. The camera consists of a CsI(Tl) columnar scintillator coupled to an electron multiplying CCD. A pinhole collimator coupled with a mirror and optical camera assembly provides alignment of optical images within the same FOV as the gamma camera.
Methods Eligible patients attending the nuclear medicine clinic at Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham were invited to take part according to ethical approval by the UK National Research Ethics Committee (REC Ref No. 12/EM/0201). In addition to routine imaging following the standard injection of the radiopharmaceutical, hybrid planar images of the patient were acquired and presented in a fused optical-gamma display.
Results Patients undergoing routine imaging procedures with Tc-99m and I-123 were investigated. These included DatSCAN, bone, thyroid, lachrimal drainage and lymphatic imaging. Initial investigations of high resolution imaging using a 0.6mm crystal and 0.5mm pin hole resulted in long acquisition times of over 5 minutes. Increasing the thickness of the scintillator to 1.5mm and the diameter of the pin hole to 1mm improved the sensitivity, allowing images to be recorded within 5 minutes. Localisation of DatSCAN uptake in the striatum of patients was not visualised using the thinner crystal and 0.5mm pin hole configuration, however the small field of view system was well suited to small organ imaging. Especially good results were achieved for lymphatic, thyroid and lacrimal drainage studies, where the uptake could be clearly seen in relation to the patient surface anatomy.
Conclusions This clinical pilot study has demonstrated the first results of clinical hybrid optical-gamma imaging in a range of patients. Use of the system has raised new possibilities for small organ imaging, where the localisation of radiopharmaceutical uptake can be presented in an anatomical context using optical imaging. The compact nature of the hybrid system offers the potential for bedside investigations and further evaluation of the hybrid camera for intraoperative imaging in a surgical theatre setting is underway.
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