A compact and mobile hybrid C-arm scanner for simultaneous nuclear and fluoroscopic image guidance

Martijn M A Dietze,Marnix G E H Lam,Maryam Afifah,Frank Brontsema,Hugo W A M De Jong,Pascal Ramaekers,Arthur J A T Braat,Casper Beijst,Britt Kunnen

doi:10.1007/s00330-021-08023-4

Martijn M A Dietze, Marnix G E H Lam + Show 7 more

Open Access

https://doi.org/10.1007/s00330-021-08023-4

Copy DOI

Abstract

PurposeThis study evaluates the performance of a mobile and compact hybrid C-arm scanner (referred to as IXSI) that is capable of simultaneous acquisition of 2D fluoroscopic and nuclear projections and 3D image reconstruction in the intervention room.ResultsThe impact of slightly misaligning the IXSI modalities (in an off-focus geometry) was investigated for the reduction of the fluoroscopic and nuclear interference. The 2D and 3D nuclear image quality of IXSI was compared with a clinical SPECT/CT scanner by determining the spatial resolution and sensitivity of point sources and by performing a quantitative analysis of the reconstructed NEMA image quality phantom. The 2D and 3D fluoroscopic image of IXSI was compared with a clinical CBCT scanner by visualizing the Fluorad A+D image quality phantom and by visualizing a reconstructed liver nodule phantom. Finally, the feasibility of dynamic simultaneous nuclear and fluoroscopic imaging was demonstrated by injecting an anthropomorphic phantom with a mixture of iodinated contrast and 99mTc.ConclusionDue to the divergent innovative hybrid design of IXSI, concessions were made to the nuclear and fluoroscopic image qualities. Nevertheless, IXSI realizes unique image guidance that may be beneficial for several types of procedures.Key Points• IXSI can perform time-resolved planar (2D) simultaneous fluoroscopic and nuclear imaging.• IXSI can perform SPECT/CBCT imaging (3D) inside the intervention room.

Highlights

To date, imaging in the intervention room has primarily consisted of using fluoroscopy for mapping of the anatomy or using nuclear imaging for localization of tumors and potential metastasis
IXSI had a worse spatial resolution than the clinical scanner due to the extra source to collimator distance arising from the thickness of the flat panel detector module
Slices of the SPECT reconstructions of the NEMA image quality phantom are shown in Fig. 2c and d

Summary

Introduction

To date, imaging in the intervention room has primarily consisted of using fluoroscopy for mapping of the anatomy or using nuclear imaging for localization of tumors and potential metastasis. Following the success of diagnostic hybrid imaging, we believe that there may be added value in combining these two interventional modalities: i.e., performing fluoroscopy simultaneously with nuclear imaging. Such a hybrid modality would impact two types of procedures. The procedures that are currently done under nuclear imaging guidance but may benefit from additional fluoroscopic imaging. Simultaneous acquisition of anatomical information in these procedures would improve the interpretability of the nuclear images This may realize a similar benefit as is achieved in diagnostic hybrid imaging (e.g., SPECT/CT, PET/CT)

Objectives

Methods

Results

Conclusion