1. For internal use only / Copyright © Siemens AG 2006. All rights reserved. Recent Innovations in PET and hybrid modality technologies Bernard Bendriem, Ph.D. Vice President, PET R&D 9 th International SAC Seminar on New trends on PET

2. 2 Bernard Bendriem, Ph.D., Siemens Medical Solutions Week 1 Week 7 Responder Patient alive 20 months after end of chemotherapy Week 7Week 1 Non-responder Patient survived 2 months after end of chemotherapy Lung cancer: response to therapy (Hanna, Nahmias) Courtesy of David Townsend, Ph.D. University of Tennessee Medical Center

3. 3 Bernard Bendriem, Ph.D., Siemens Medical Solutions Improving detectability and quantification 1.Hybrid imaging

4. 4 Bernard Bendriem, Ph.D., Siemens Medical Solutions Morphology Physiology Metabolism Molecules CT US MRI, MRS NM Fluorescence- Optical Dynamic, Perfusion Dynamic, Flow, Perfusion Dynamic, Flow, Perfusion, Diffusion, Molecules Perfusion, Molecules 1 molecule/cell 10 6 -10 8 molecules/cell Molecules Several molecules/cell Hybrid imaging

5. 5 Bernard Bendriem, Ph.D., Siemens Medical Solutions CT (anatomy) PET (function) PET/CT to image different aspects of disease to identify tracer uptake to simplify the image interpretation to give added value to CT and PET Why combine form and function? Fused image accurately localizes uptake into a lymph node and thus demonstrates spread of disease. Form + function Courtesy of David Townsend, Ph.D. University of Tennessee Medical Center

6. 6 Bernard Bendriem, Ph.D., Siemens Medical Solutions I-131 SPECTCT: Residu thyroidien vs. Metastases ganglionnaires University of Erlangen

7. 7 Bernard Bendriem, Ph.D., Siemens Medical Solutions standard transmission sources not required much higher statistical quality (400 MBq vs 2·10 9 MBq) much faster scan (20 s compared with 20 min) less patient movement during scan more tolerable for the patient shorter total scan duration Advantages of CT-based correction

8. 8 Bernard Bendriem, Ph.D., Siemens Medical Solutions Improving detectability and quantification 1.Hybrid imaging 2.Organ motion

9. 9 Bernard Bendriem, Ph.D., Siemens Medical Solutions  Spherical VOI that tracks with motion over 10 respiratory phases Whole-body respiratory gated PET/CT: Simulations Courtesy of Dr. Kinahan University of Washington

10. 10 Bernard Bendriem, Ph.D., Siemens Medical Solutions Respiratory motion is distributed throughout the whole body Impact is rarely on detection, but often affects quantitation Static wholebodySingle respiratory phase (1 of 7, so noisier) < 1 cc lesion on CT Whole-body respiratory gated PET/CT: Patients Courtesy of Dr. Kinahan University of Washington

11. 11 Bernard Bendriem, Ph.D., Siemens Medical Solutions Improving detectability and quantification 1.Hybrid imaging 2.Organ motion 3.Spatial resolution

12. 12 Bernard Bendriem, Ph.D., Siemens Medical Solutions The clinical importance of spatial resolution Low-REZ; 8.6 mCi; 60 min uptake 8 x 8 elements/block 6.4 mm x 6.4 mm HI-REZ; 11.2 mCi; 90 min uptake 13 x 13 elements/block 4.0 mm x 4.0 mm Sphere diameter (mm) Recovery (%) 100 50 0 10 37 28 22 17 13 2.0 3.9 1.3 3.3 3.7 8.7 4.1 8.6 Courtesy of David Townsend, Ph.D. University of Tennessee Medical Center

13. 13 Bernard Bendriem, Ph.D., Siemens Medical Solutions  8X8 crystal matrix  128 Single crystals per block PTPT 19.5mm 02 13 columns crystal block MM 0 7 8 63 15 56 2 mm HRRT Detector Block Design LYSO (10 mm) LSO (10 mm) Light Guide Smaller pixels……Research  LYSO only used for pulse shape discrimination

14. 14 Bernard Bendriem, Ph.D., Siemens Medical Solutions Investigation of small dopaminergic structures playing a crucial rôle in the reward circuit, such as : - Ventral striatum (Accumbens nucleus) - Midbrain (SNr & VTA)  High spatial PET imaging is promising for the exploration of subtle modifications in small and complex brain structures. VTA & SNr Ventral striatum Courtesy of Pr Syrota Service Hospitalier Frederic Joliot, Orsay High Resolution Research Tomograph

15. 15 Bernard Bendriem, Ph.D., Siemens Medical Solutions Improving detectability and quantification 1.Hybrid imaging 2.Organ motion 3.Spatial resolution 4.Number of detected photons

16. 16 Bernard Bendriem, Ph.D., Siemens Medical Solutions 2.5 min10 min15 min 79 year-old female (103 lbs) referred for restaging of colon cancer. PET/CT identifies uptake in left pelvic mass increasing since previous scan. Also interval development of soft tissue mass in right gluteal region and mild focally increased FDG activity in the region of the ninth thoracic vertebra. Scan acquired at 5 bed positions; 10 mCi, 92 min pi. 30 sec/bed 2 min/bed 3 min/bed Total scan duration (5 beds) Clinical workflow: reduced imaging times

17. 17 Bernard Bendriem, Ph.D., Siemens Medical Solutions thicker crystals extended axial FOV A D B C  (511 keV) 3D (no septa) 20 mm to 30 mm 16.2 cm to 21.6 cm sensitivity increase: 40% sensitivity increase: 77% How to improve intrinsic sensitivity?

18. 18 Bernard Bendriem, Ph.D., Siemens Medical Solutions higher sensitivity = shorter imaging per bed (or more counts) larger axial FOV = fewer bed positions for same axial coverage Standard: Extended FOV: 5 15 min 4 8 min bed # Advantages of the extended axial field-of-view

19. 19 Bernard Bendriem, Ph.D., Siemens Medical Solutions 27 year-old female (123 lbs) with metastatic melanoma. Uptake in left lower extremity and in left axillar node positive for melanoma. CT: 30 mAs, 130 kV, 5 mm slices at 0.75 mm PET: 10 mCi FDG, 108 min pi, 2 min/bed, 11 beds Total scan duration: 22 min Staging melanoma with extended field-of-view Courtesy of David Townsend, Ph.D. University of Tennessee Medical Center

20. 20 Bernard Bendriem, Ph.D., Siemens Medical Solutions Biograph 60 year-old male (187 lbs) with history of NSCLC commencing a seven week course of chemotherapy. Baseline PET/CT scan shows hypermetabolic left hilar mass consistent with known malignancy. Left anterolateral 4th and 5th rib activity is suspicious for metastases. 15.1 mCi, 90 min pi 4 min/bed, 5 beds 4i / 8s; 5f Scan duration: 20 min PET/CT Lung cancer Courtesy of David Townsend, Ph.D. University of Tennessee Medical Center

21. 21 Bernard Bendriem, Ph.D., Siemens Medical Solutions Torso phantom study Brain-torso-bladder phantom scanned with a total of 9 mCi in phantom. Activity in the torso phantom at time of scan is ~3 mCi Imaging time based on equivalent total acquisition time for whole body scan. Sphere diameters: 7.8 mm; 6.2 mm, 4.9 mm Contrast ratio in spheres: 8:1 4.9 mm 7.8 mm 6.2 mm 4.9 mm 7.8 mm 6.2 mm

22. 22 Bernard Bendriem, Ph.D., Siemens Medical Solutions scanner operational since late February 2006 scan time reduced by factor ~2 equivalently the dose can be reduced by factor of 2 improved image quality for large patients (up to 450 lbs) HI-REZ detectors resolve smaller details (kidney) melanoma scan now from head to toe in < 25 min Advantage of extended axial FOV in PET

23. 23 Bernard Bendriem, Ph.D., Siemens Medical Solutions Improving detectability and quantification 1.Hybrid imaging 2.Organ motion 3.Spatial resolution 4.Number of detected photons 5.Image reconstruction

24. 24 Bernard Bendriem, Ph.D., Siemens Medical Solutions Scatter Coincidence Trues Coincidence Random Coincidence True Counts & Noise

25. 25 Bernard Bendriem, Ph.D., Siemens Medical Solutions Scatter corrected No scatter correction high residual in left ventricle scatter from liver hot lung walls FORE + OSEM, 4i x 8s, 8 mm filter 0 – 21% max window Patient MN. 297 lbs (135 kg)

26. 26 Bernard Bendriem, Ph.D., Siemens Medical Solutions Sinogram profiles Measured emission _ _ _ _ Computed scatter 52% Scatter 54% Scatter 396 MBq injection 157 min uptake Patient MN. 297 lbs (135 kg)

27. 27 Bernard Bendriem, Ph.D., Siemens Medical Solutions TOF filter FOV Back projection along the LOR Time-of-Flight Acquisition: Principles  Time-of-flight reduce noise propagation during image reconstruction process

28. 28 Bernard Bendriem, Ph.D., Siemens Medical Solutions Time Resolution (ns)  x (cm) SNR improvement (20 cm object ) SNR improvement (40 cm object) 0.11.53.75.2 0.34.52.13.0 0.57.51.62.3 1.218.01.11.5 Time-of-Flight and SNR

29. 29 Bernard Bendriem, Ph.D., Siemens Medical Solutions 60s 180s TOFNon-TOF similar CRC and noise TOF shorter scan 60s similar noise and scan time TOF higher CRC 60s similar CRC and scan time TOF lower noise 6-to-1 contrast Measurements: 27-cm lesion phantom Courtesy of Joel Karp University of Pennsylvania

30. 30 Bernard Bendriem, Ph.D., Siemens Medical Solutions non-TOF Rectal carcinoma, metastases in mesentery and bilateral iliac chains 114 kg; BMI = 38.1 12 mCi; 2 hr post-inj 3min/bed TOF Lesion contrast (SUV) improves with TOF reconstruction Gemini TF - patient study Courtesy of Joel Karp University of Pennsylvania

31. 31 Bernard Bendriem, Ph.D., Siemens Medical Solutions Improving detectability and quantification 1.Hybrid imaging 2.Organ motion 3.Spatial resolution 4.Number of detected photons 5.Image reconstruction 6.Other hybrid imaging

32. 32 Bernard Bendriem, Ph.D., Siemens Medical Solutions Lésion d’un sésamoïde (premier métatarsien)

33. 33 Bernard Bendriem, Ph.D., Siemens Medical Solutions New Hybrid imaging : MR-PET Benefits  Isocentric & simultaneous measurements  Perfect anatomical matching  Important for attenuation correction and motion correction  Good soft tissue contrast  Neuro  Abdomen  No additional ionizing radiation through MR  Enables follow up studies  Gating and Motion Correction MR  PET  Prospective and retrospective  Functional MR data adds further information  Spectroscopy, fMRI, CE dynamics (Resolution enhancement due to reduced position range at UHF)

34. 34 Bernard Bendriem, Ph.D., Siemens Medical Solutions Analogous to PET-CT MR Scanner PET Scanner MR Scanner PET Scanner MR PET Integrated System PET-Insert Upgrade of existing MR scanners possible Reduced FOV for PET Integrated development necessary No simultaneous measurement, no iso- centric measurement Reduced MR compatibility demand (only main field) MR-PET Concepts

35. 35 Bernard Bendriem, Ph.D., Siemens Medical Solutions  High resolution artifact free PET images  High resolution artifact free MR images 1.5mm 2.5mm 1.0mm 2.0mm 3.5mm 3.0mm Simultaneous dual-modality data acquisition

36. 36 Bernard Bendriem, Ph.D., Siemens Medical Solutions Improving detectability and quantification 1.Hybrid imaging 2.Organ motion 3.Spatial resolution 4.Number of detected photons 5.Image reconstruction 6.Other hybrid imaging 1.Advancement in term of higher spatial resolution, higher statistics, larger axial coverage and better image reconstruction, including TOF information and other physical characteristics of instrument. 2.New relevant hybrid imaging, new imaging protocol with organ motion correction.