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 1. Accreditation Support Home
 2. Knowledge Base
 3. Nuclear Medicine and PET Accreditation
 4. Accreditation Testing: Nuclear Medicine/PET


PHANTOM TESTING: NUCLEAR MEDICINE (REVISED 4-20-2023)

Katie Albus
Modified on: Thu, 20 Apr, 2023 at 10:31 AM


REVISION HISTORY





INTRODUCTION


THE NUCLEAR MEDICINE ACCREDITATION PHYSICS SUBCOMMITTEE HAS DEFINED SCORING
CRITERIA FOR PLANAR (UNIFORMITY AND RESOLUTION) AND SPECT (UNIFORMITY, SPATIAL
RESOLUTION, AND CONTRAST). THESE CRITERIA ARE BASED ON RESULTS OBTAINED FROM A
VARIETY OF CAMERAS THAT ARE OPERATING SATISFACTORILY.  





DATA MUST BE COLLECTED, AND IMAGES PREPARED, ACCORDING TO THE PHANTOM
INSTRUCTIONS. IF SITES DO NOT FOLLOW THE TESTING REQUIREMENTS AS SPECIFIED IN
THESE INSTRUCTIONS, THEN SITES MAY BE REQUIRED TO RESUBMIT IMAGES OR MAY BE
SUBJECT TO FAILING THE SUBMISSION. NOTE: SPECIALTY SCANNERS MAY NOT BE CAPABLE
OF MEETING THE IMAGE ACQUISITION PARAMETERS, AND GUIDANCE IS PROVIDED WITHIN
THESE INSTRUCTIONS. CONTACT THE ACR FOR ADDITIONAL QUESTIONS OR CLARIFICATIONS. 





COMMON REASONS FOR IMAGE REJECTION:


 * PLANAR IMAGES ACQUIRED WITH INCORRECT PARAMETERS (E.G., MATRIX AND COUNTS)


 * DATA FORM DOES NOT ACCURATELY REFLECT INFORMATION FOR IMAGES SUBMITTED


 * PLANAR IMAGES SUBMITTED ARE NOT ACQUIRED AS STATIC PLANAR IMAGES (SITES
   SHOULD NOT SUBMIT THE DAILY QC RESULTS PAGE)


 * PLANAR UNIFORMITY IMAGES WITH GRAPHIC OVERLAYS


 * SCREENSHOT IMAGES WITH THE UPPER THRESHOLD NOT EQUAL TO 100% AND LOWER
   THRESHOLD NOT BETWEEN 0-5%


AS APPROPRIATE, PLANAR AND/OR SPECT PHANTOM IMAGES MUST BE OBTAINED AND
SUBMITTED FOR REVIEW USING THE PHANTOM THAT HAS BEEN APPROVED BY THE ACR
COMMITTEE ON NUCLEAR MEDICINE ACCREDITATION.





EXAMPLE PHANTOM IMAGES CAN BE REVIEWED IN THE NM/PET PHANTOM IMAGE ATLAS,
AVAILABLE AS AN ATTACHMENT IN OUR TESTING OVERVIEW ARTICLE





THE ACR-APPROVED SPECT PHANTOM IS COMMONLY USED FOR QUALITY CONTROL IN NUCLEAR
MEDICINE. FOR CAMERAS THAT ARE USED TO PERFORM PLANAR AND SPECT IMAGING STUDIES,
AN ACR-APPROVED PHANTOM SHOULD BE USED FOR EVALUATING PLANAR AND TOMOGRAPHIC
IMAGE QUALITY. THE PHANTOM IS A CYLINDER WITH AN INTERNAL HEIGHT OF 18.6 CM AND
INTERNAL DIAMETER OF 20.3 CM (FLANGELESS PHANTOM). THE LOWER PORTION OF THE
PHANTOM CONTAINS 6 SETS OF ACRYLIC RODS ARRANGED IN A PIE-SHAPED PATTERN WITH
THE FOLLOWING DIAMETERS: 4.8, 6.4, 7.9, 9.5, 11.1, AND 12.7 MM. THE UPPER
SECTION CONTAINS SIX SOLID SPHERES WITH THE FOLLOWING DIAMETERS: 9.5, 12.7,
15.9, 19.1, 25.4, AND 31.8 MM.





THE ACR HAS ALSO APPROVED A DATA SPECTRUM SMALL SPECT PHANTOM. THE PHANTOM IS A
CYLINDER WITH AN INTERNAL LENGTH OF 15 CM AND AN INTERNAL DIAMETER OF 13.9 CM
(FLANGELESS PHANTOM). THE LOWER PORTION OF THE PHANTOM CONTAINS 6 SETS OF
ACRYLIC RODS ARRANGED IN A PIE-SHAPED PATTERN WITH THE FOLLOWING DIAMETERS: 4.8,
6.4, 7.9, 9.5, 11.1, AND 12.7 MM. THE UPPER SECTION CONTAINS SIX SOLID SPHERES
WITH THE FOLLOWING DIAMETERS: 6.4, 9.5, 12.7, 15.9, 19.1, AND 25.4 MM.






CAMERAS THAT SHOULD USE SMALL SPECT PHANTOM: GE 530C, GE 570C, MYOSPECT, MAICAM,
C!, P3000, AND CLEARVISION


OPTIONAL (CAN USE EITHER THE DELUXE OR SMALL ACR PHANTOM): C.CAM, CARDIOMD,
D-SPECT, DIGIRAD DEDICATED CARDIAC SPECT CAMERAS (E.G., CARDIUS, 2XPO, 3XPO,
X-ACT, 2020TC SPECT, SPECTPAK), CORCAM, AND VENTRI





THE FOLLOWING ARE AVAILABLE DIRECTLY FROM DATA SPECTRUM OF DURHAM, NC (ORDER
FORMS FOR THE LARGE AND SMALL PHANTOMS ARE AVAILABLE IN OUR TESTING OVERVIEW:
NUCLEAR MEDICINE AND PET ARTICLE):


 * JASZCZAK DELUXE FLANGELESS ECT PHANTOM AND PET FACEPLATE (CAN BE USED FOR
   BOTH SPECT AND PET ACQUISITIONS)


 * JASZCZAK DELUXE FLANGELESS ECT PHANTOM (FOR SPECT ONLY)


 * SMALL SPECT PHANTOM (FOR SPECT ONLY)


 * FLANGELESS PET PHANTOM (FOR PET ONLY)


 * PET FACEPLATE MADE TO FIT AN EXISTING FLANGELESS OR FLANGED JASZCZAK DELUXE
   ECT PHANTOM


ONE SET OF SITE SCANNING DATA FORMS (ATTACHED BELOW), ALONG WITH ALL PERTINENT
WORKSHEETS, SHOULD BE COMPLETED FOR EACH CAMERA SYSTEM THAT IS UNDERGOING
ACCREDITATION.





PHANTOM REQUIREMENTS BY MODULE


ALL MODULES (PLANAR ONLY OR SPECT WITH PLANAR): ALL APPLICANTS ARE REQUIRED TO
SUBMIT A TC-99M OR CO-57 INTRINSIC OR SYSTEM FLOOD FIELD IMAGE, AS WELL AS A
TL-201 AND/OR A GA-67/IN-111 FLOOD FIELD IMAGE (IF APPLICABLE). IF BOTH TL-201
AND GA-67/IN-111 ARE CURRENTLY USED, PLANAR UNIFORMITY AND PLANAR SPATIAL
RESOLUTION IMAGES ARE REQUIRED FOR BOTH ISOTOPES.





MODULE 1 (PLANAR IMAGING ONLY): IF A UNIT PERFORMS ONLY PLANAR IMAGING AND IS
ONLY APPLYING FOR ACCREDITATION IN MODULE 1 - PLANAR IMAGING, THE NUMBER AND
COMPLEXITY OF THE TESTS YOU ARE ASKED TO PERFORM, EVALUATE, AND SUBMIT FOR
REVIEW ARE DIFFERENT THAN THOSE REQUIRED FOR A UNIT THAT PERFORMS SPECT. YOU
MUST PROVIDE IMAGES DOCUMENTING THE PLANAR UNIFORMITY AND SPATIAL RESOLUTION OF
YOUR CAMERA DETECTOR(S).





IF ACCREDITATION IS REQUESTED FOR PLANAR IMAGING ONLY, INTRINSIC OR SYSTEM
SPATIAL RESOLUTION IMAGES MUST BE SUBMITTED. THE PHANTOM FOR THIS DATA IS THE
FOUR-QUADRANT BAR PHANTOM THAT YOU SHOULD ALREADY OWN AND USE ON A REGULAR
BASIS. THE SMALLEST BARS MUST BE BETWEEN 2 AND 3 MM. PLANAR IMAGES ACQUIRED WITH
THE ACR SPECT PHANTOM ARE NOT REQUIRED FOR APPLICANTS THAT ARE REQUESTING
ACCREDITATION FOR MODULE 1 ONLY BUT ARE ACCEPTABLE IN LIEU OF THE FOUR-QUADRANT
BAR PHANTOM.





THE PLANAR ONLY PROTOCOL SHOULD BE FOLLOWED FOR CAMERA SYSTEMS SEEKING
ACCREDITATION FOR THE PLANAR MODULE ONLY. IMAGES MUST BE SUBMITTED FOR ALL
DETECTORS ON SYSTEMS WITH MORE THAN ONE DETECTOR. 





FOR EACH OF THE TESTS REQUIRING THE SPECT PHANTOM, PLAN THE VARIOUS ACQUISITIONS
SO THAT THE MINIMUM TIME IS REQUIRED. PLEASE NOTE THAT IF THE ADDITIONAL
ISOTOPES INCLUDE BOTH GA-67 AND IN-111, YOU ONLY NEED ONE SUBMISSION FOR GA-67
OR IN-111. 





PLANAR ONLY PROTOCOL


ACQUISITION ONE: TC-99M (PREFERRED) OR CO-57


FIELD UNIFORMITY - EACH DETECTOR


SPATIAL RESOLUTION - EACH DETECTOR 


(FOUR-QUADRANT BAR PHANTOM)


SET THE ACQUISITION FOR TC-99M OR CO-57 AND ACQUIRE AN INTRINSIC OR SYSTEM
UNIFORMITY IMAGE USING A 256 X 256 MATRIX (WITH ZOOM 1X). FOR LARGE RECTANGULAR
FIELD CAMERAS (LONGEST DIMENSION > 32 CM), ACQUIRE 10 MILLION COUNTS. FOR LARGE
AND SMALL CIRCULAR DETECTORS AND SMALL RECTANGULAR FIELD CAMERAS (LONGEST
DIMENSION < 32 CM), ACQUIRE 5 MILLION COUNTS. FOR INTRINSIC UNIFORMITY, THE
POINT SOURCE MUST BE SET AT A DISTANCE FROM THE DETECTOR THAT IS 3-5 TIMES THE
LONGEST DIMENSION OF THE DETECTOR. FOR A 50 CM DETECTOR, THIS WOULD BE 150-250
CM FROM THE DETECTOR. INTRINSIC FLOODS ACQUIRED USING THE SIEMENS POINT SOURCE
HOLDER WILL NOT BE ACCEPTED. 


SET THE APPROPRIATE ENERGY AND ACQUIRE AN INTRINSIC OR SYSTEM SPATIAL RESOLUTION
PATTERN IMAGE USING A 512 X 512 MATRIX (WITH ZOOM 1X). SOME SCANNERS MAY NOT BE
CAPABLE OF ACQUISITION WITH A 512 X 512 MATRIX. FOR THESE SYSTEMS, USE THE
LARGEST MATRIX AVAILABLE ON THE SYSTEM. FOR LARGE RECTANGULAR FIELD CAMERAS
(LONGEST DIMENSION > 32 CM), ACQUIRE 5 MILLION COUNTS. FOR LARGE AND SMALL
CIRCULAR DETECTORS AND SMALL RECTANGULAR FIELD CAMERAS (LONGEST DIMENSION < 32
CM), ACQUIRE 3 MILLION COUNTS .


ACQUISITION TWO: TL-201


FIELD UNIFORMITY - EACH DETECTOR


SPATIAL RESOLUTION - EACH DETECTOR


(FOUR-QUADRANT BAR PHANTOM)


SET THE ENERGY WINDOWS FOR TL-201 THAT ARE USED CLINICALLY AND ACQUIRE AN
INTRINSIC OR SYSTEM UNIFORMITY IMAGE AS DESCRIBED ABOVE FOR TC-99M. FOR
INTRINSIC UNIFORMITY, THE POINT SOURCE MUST BE SET AT A DISTANCE FROM THE
DETECTOR THAT IS 3-5 TIMES THE LONGEST DIMENSION OF THE DETECTOR. FOR A 50 CM
DETECTOR, THIS WOULD BE 150-250 CM FROM THE DETECTOR. INTRINSIC FLOODS ACQUIRED
USING THE SIEMENS POINT SOURCE HOLDER WILL NOT BE ACCEPTED. 


SET THE ENERGY WINDOWS FOR TL-201 THAT ARE USED CLINICALLY AND ACQUIRE AN
INTRINSIC OR SYSTEM SPATIAL RESOLUTION PATTERN AS DESCRIBED ABOVE FOR TC-99M. 


ACQUISITION THREE: GA-67/IN-111


FIELD UNIFORMITY - EACH DETECTOR


SPATIAL RESOLUTION - EACH DETECTOR


(FOUR-QUADRANT BAR PHANTOM)


SET THE ENERGY WINDOWS FOR GA-67 OR IN-111 THAT ARE USED CLINICALLY AND ACQUIRE
AN INTRINSIC OR SYSTEM UNIFORMITY IMAGE AS DESCRIBED ABOVE FOR TC-99M. FOR
INTRINSIC UNIFORMITY, THE POINT SOURCE MUST BE SET AT A DISTANCE FROM THE
DETECTOR THAT IS 3-5 TIMES THE LONGEST DIMENSION OF THE DETECTOR. FOR A 50 CM
DETECTOR, THIS WOULD BE 150-250 CM FROM THE DETECTOR. INTRINSIC FLOODS ACQUIRED
USING THE SIEMENS POINT SOURCE HOLDER WILL NOT BE ACCEPTED.


SET THE ENERGY WINDOWS FOR GA-67 OR IN-111 THAT ARE USED CLINICALLY AND ACQUIRE
AN INTRINSIC OR SYSTEM SPATIAL RESOLUTION PATTERN IMAGE AS DESCRIBED ABOVE FOR
TC-99M. 


PLANAR IMAGES FOR SUBMISSION


 * SUBMIT ONLY GRAY SCALE IMAGES.


 * USE LINEAR MAPPING OF THE DISPLAY WITH THE LOWER THRESHOLD SET AT 0 (OR ≤ 5%
   OF THE MAXIMUM UPPER LEVEL) AND THE UPPER THRESHOLD SET TO 100% OR THE
   MAXIMUM COUNT.


 * ALL IMAGES SHOULD BE APPROPRIATELY LABELED WITH CAMERA HEAD NUMBER FOR
   SYSTEMS WITH MORE THAN ONE DETECTOR AND ISOTOPE IF APPLYING FOR TI-201,
   GA-67, OR IN-111. MAKE SURE THE SITE SCANNING DATA FORMS ARE FILLED OUT
   COMPLETELY AND MATCH THE ACQUIRED DATA.


 * IMAGES WITH GRAPHIC OVERLAYS WILL NOT BE ACCEPTED.


 * DICOM IMAGES ARE PREFERRED.






MODULE 2 AND/OR 3 (SPECT WITH PLANAR): IF YOUR FACILITY PERFORMS SPECT IMAGING
AND IS APPLYING FOR ACCREDITATION IN SPECT MODULE OR NUCLEAR CARDIOLOGY MODULE,
YOU MUST PERFORM, EVALUATE, AND SUBMIT BOTH PLANAR AND SPECT INFORMATION FOR
REVIEW. MOST OF THE PLANAR AND SPECT DATA ARE OBTAINED WITH THE ACR-APPROVED
PHANTOMS AVAILABLE FROM DATA SPECTRUM. SUBMISSION OF ACCREDITATION DATA USING
ANY OTHER PHANTOM WITHOUT ACR PERMISSION WILL DISQUALIFY THE SITE. THE
ACR-APPROVED PHANTOMS ARE THE DATA SPECTRUM DELUXE FLANGED OR FLANGELESS PHANTOM
AND THE DATA SPECTRUM SMALL FLANGELESS JASZCZAK PHANTOM (SMALL SPECT PHANTOM).
THE SMALL SPECT PHANTOM IS ONLY APPROVED FOR USE ON CERTAIN CAMERAS. THE
ACR-APPROVED PHANTOM WAS CHOSEN FOR THE EVALUATION OF TOMOGRAPHIC SYSTEMS
BECAUSE IT IS RELATIVELY EASY TO FILL AND SET UP FOR A SPECT STUDY AND CAN BE
USED TO MEASURE PLANAR RESOLUTION, AND TOMOGRAPHIC UNIFORMITY, SPATIAL
RESOLUTION, AND CONTRAST. THE WIDE VARIETY OF ELEMENTS FOR EVALUATING SPATIAL
RESOLUTION AND CONTRAST ARE SUFFICIENT TO ENABLE THE USER TO DETECT RELATIVELY
SUBTLE DIFFERENCES IN SYSTEM PERFORMANCE.





THE RECOMMENDED ACTIVITY FOR THE ACR-APPROVED PHANTOM IS 10-20 MCI TC-99M. THE
RECOMMENDED ACTIVITY FOR THE SMALL SPECT PHANTOM IS 5-15 MCI TC99M. LOWER
QUANTITIES MAY BE USED BUT THE IMAGING TIME WILL BE PROPORTIONATELY LONGER.
THESE ACTIVITIES ARE RECOMMENDED TO PROVIDE A GOOD COMPROMISE BETWEEN COUNT RATE
LIMITS AND ACQUISITION TIME.





FOR BOTH PHANTOMS, THE SPHERES MUST BE PLACED IN ORDER OF DECREASING SIZE AND
ALIGNED WITH THE RODS IN DECREASING SIZE.  THE SPHERE DIAMETERS MUST BE THE SAME
AS LISTED IN THE WORKSHEETS. THE REVIEWERS WILL USE THIS INFORMATION TO PROPERLY
SCORE THE IMAGES.





ACQUIRE AND PROCESS THE BEST POSSIBLE IMAGES ON YOUR SYSTEM WITHIN THE
GUIDELINES PROVIDED. ALL SETTINGS MUST BE DOCUMENTED.





THE ACR REQUIRES SEMIANNUAL BUT STRONGLY RECOMMENDS QUARTERLY TESTING OF EACH
SPECT SYSTEM WITH THE ACR-APPROVED PHANTOM DESCRIBED ABOVE, IN ADDITION TO OTHER
QC TESTS.





FOR SYSTEMS WITH MORE THAN ONE DETECTOR, PLANAR IMAGES MUST BE SUBMITTED FOR
EACH DETECTOR. PROCEED TO THE SPECT IMAGING SECTION BELOW FOR THE FOLLOWING
CAMERAS THAT ACQUIRE ONLY SPECT IMAGES:  D-SPECT, DIGIRAD DEDICATED CARDIAC
SPECT CAMERAS (E.G., CARDIUS, 2XPO, 3XPO, X-ACT, 2020TC SPECT, SPECTPAK),
VERITON, STARGUIDE, GE 530C, GE 570C, MYOSPECT, CLEARVISION, AND GVI.  





SITES PERFORMING SPECT IMAGING ARE REQUIRED TO SUBMIT TC-99M SPECT PHANTOM
IMAGES. PLEASE NOTE THAT SITES UTILIZING TL-201, GA-67, AND/OR IN-111 FOR EITHER
PLANAR OR SPECT IMAGING ARE REQUIRED TO SUBMIT BOTH PLANAR UNIFORMITY AND PLANAR
SPATIAL RESOLUTION IMAGES WITH THESE ISOTOPES (SEE THE PLANAR ONLY PROTOCOL).





PLANAR AND SPECT PROTOCOL FOR SYSTEMS APPLYING FOR SPECT ACCREDITATION


PLANAR IMAGING PROTOCOL


PLANAR FIELD UNIFORMITY - EACH DETECTOR


PLANAR SPATIAL RESOLUTION - EACH DETECTOR


(PHANTOM RODS OR BARS ARE ACCEPTABLE)


SET THE ACQUISITION FOR TC-99M OR CO-57 AND ACQUIRE AN INTRINSIC OR SYSTEM
UNIFORMITY IMAGE USING A 256 X 256 MATRIX (WITH ZOOM 1X).  FOR LARGE RECTANGULAR
FIELD CAMERAS (LONGEST DIMENSION > 32 CM), ACQUIRE 10 MILLION COUNTS. FOR LARGE
AND SMALL CIRCULAR DETECTORS AND SMALL RECTANGULAR FIELD CAMERAS (LONGEST
DIMENSION < 32 CM), ACQUIRE 5 MILLION COUNTS. FOR INTRINSIC UNIFORMITY, THE
POINT SOURCE MUST BE SET AT A DISTANCE FROM THE DETECTOR THAT IS 3-5 TIMES THE
LONGEST DIMENSION OF THE DETECTOR. FOR A 50 CM DETECTOR, THIS WOULD BE 150-250
CM FROM THE DETECTOR. INTRINSIC FLOODS ACQUIRED USING THE SIEMENS POINT SOURCE
HOLDER WILL NOT BE ACCEPTED.






ACR PHANTOM (RECOMMENDED): FILL THE PHANTOM WITH AN AQUEOUS SOLUTION OF TC-99M,
TAKING CARE TO ENSURE THAT IT IS THOROUGHLY MIXED. IT IS ADVISABLE TO PERFORM
THE TC-99M STUDIES FIRST, AND THEN FILL THE PHANTOM WITH TL-201 OR GA-67/IN-111
AFTER THE TC-99M HAS DECAYED. PLACE THE PHANTOM ON TOP AND IN THE CENTER OF THE
DETECTOR. THE RODS SHOULD BE AT THE FLAT BOTTOM OF THE CYLINDER AND CLOSEST TO
THE COLLIMATOR. USE THE HIGHEST RESOLUTION LOW ENERGY PARALLEL HOLE COLLIMATOR
THAT IS USED CLINICALLY.  THE LOW-ENERGY HIGH RESOLUTION (LEHR) COLLIMATOR IS
PREFERRED. IF YOU ARE USING THE ACR PHANTOM TO ACQUIRE THE PLANAR RESOLUTION FOR
OTHER ISOTOPES, USE THE COLLIMATOR THAT IS ROUTINELY USED FOR THE INDICATED
RADIONUCLIDE. SET THE ENERGY WINDOW TO THE WINDOW USED FOR CLINICAL
ACQUISITIONS. THE MATRIX SIZE SHOULD BE 256 X 256.  THE COUNT RATE SHOULD NOT
EXCEED 50 KCPS. IF A 256 X 256 MATRIX IS NOT AVAILABLE ON THE SYSTEM, USE THE
HIGHEST MATRIX AVAILABLE. ACQUIRE A STATIC IMAGE USING A ZOOM FACTOR OF 1 FOR
600,000 COUNTS.


FOUR-QUADRANT BAR: SET THE APPROPRIATE ENERGY AND ACQUIRE AN INTRINSIC OR SYSTEM
RESOLUTION PATTERN IMAGE USING A 512 X 512 MATRIX (WITH ZOOM 1X).  SOME SCANNERS
MAY NOT BE CAPABLE OF ACQUISITION WITH A 512 X 512 MATRIX. FOR THESE SYSTEMS,
USE THE LARGEST MATRIX AVAILABLE ON THE SYSTEM. FOR LARGE RECTANGULAR FIELD
CAMERAS (LONGEST DIMENSION > 32 CM), ACQUIRE 5 MILLION COUNTS. FOR LARGE AND
SMALL CIRCULAR DETECTORS AND SMALL RECTANGULAR FIELD CAMERAS (LONGEST DIMENSION
< 32 CM), ACQUIRE 3 MILLION COUNTS.


PLANAR IMAGES FOR SUBMISSION


 * SUBMIT ONLY GRAY SCALE IMAGES.


 * USE LINEAR MAPPING OF THE DISPLAY WITH THE LOWER THRESHOLD SET AT 0 (OR ≤ 5%
   OF THE MAXIMUM UPPER LEVEL) AND THE UPPER THRESHOLD SET TO 100% OR THE
   MAXIMUM COUNT.


 * ALL IMAGES SHOULD BE APPROPRIATELY LABELED WITH CAMERA HEAD NUMBER FOR
   SYSTEMS WITH MORE THAN ONE DETECTOR AND ISOTOPE IF APPLYING FOR TI-201,
   GA-67, OR IN-111. MAKE SURE THE SITE SCANNING DATA FORMS ARE FILLED OUT
   COMPLETELY AND MATCH THE ACQUIRED DATA. 


 * IMAGES WITH GRAPHIC OVERLAYS WILL NOT BE ACCEPTED. 


 * DICOM IMAGES ARE PREFERRED.









SPECT IMAGING PROTOCOL


 * QC INFORMATION: CENTER-OF-ROTATION AND FLOOD UNIFORMITY CALIBRATIONS ARE
   REGULARLY PERFORMED ON SPECT SYSTEMS. FILL IN THE APPROPRIATE DATA FIELDS
   BASED ON THE MOST RECENT CALIBRATIONS.


 * THE ACR PHANTOM USED FOR THE SPECT TESTS MUST BE DESCRIBED ON THE SITE
   SCANNING DATA FORMS.


 *  FOR MORE INFORMATION, PLEASE SEE THE ACR’S SPECT PHANTOM VIDEO.


POSITIONING OF ACR PHANTOM FOR TOMOGRAPHY:


PLACE THE PHANTOM ON THE PATIENT SUPPORT (BED, CHAIR, ETC.) SO THAT IT IS
POSITIONED LENGTHWISE, CORRESPONDING TO THE PRIMARY PATIENT AXIS. THE PHANTOM’S
LONG AXIS MUST BE PARALLEL TO THE ROTATIONAL (Z)-AXIS OF THE DETECTOR SYSTEM
WITH THE PHANTOM LEVEL. PHANTOMS WITH FLANGES MAY REQUIRE EXTRA SUPPORT FOR
LEVELING. THE PHANTOM SHOULD BE POSITIONED IN THE CENTER OF THE FIELD OF VIEW OF
THE DETECTOR(S).






NOTE: FOR CAMERAS THAT ARE ONLY CAPABLE OF ROTATING THROUGH 180 DEGREES AND HAVE
THE DETECTORS IN A FIXED RELATIVE ANGLE OF 90 DEGREES, SPECIAL CAUTION MUST BE
EXERCISED IN THE ORIENTATION OF THE SPHERES AND RODS. YOU MAY USE YOUR CARDIAC
ACQUISITION PROTOCOL. ENSURE THAT THE PHANTOM CONFIGURATION IS CONSISTENT
(LARGEST SPHERE ADJACENT TO LARGEST RODS, SECOND-LARGEST SPHERE ADJACENT TO
SECOND-LARGEST RODS, ETC.). POSITION THE PHANTOM ON THE IMAGING TABLE SUCH THAT
THE LARGEST SPHERE WILL BE IN APPROXIMATELY THE 10 O'CLOCK POSITION IN THE
RECONSTRUCTED IMAGE. WHEN SET UP PROPERLY, THE LARGEST SPHERE WILL BE IN THE
UPPER LEFT OF THE PHANTOM WHEN VIEWED FROM THE FOOT OF THE TABLE. IF YOU ARE
IMAGING FROM 0 TO 180 DEGREES, THE LARGEST SPHERE SHOULD BE AT THE 12 O'CLOCK
POSITION. SEE THE IMAGES BELOW FOR GUIDANCE.







COLLIMATOR: 


USE THE HIGHEST RESOLUTION LOW-ENERGY PARALLEL HOLE COLLIMATOR THAT IS ROUTINELY
USED FOR CLINICAL STUDIES.


ACQUISITION:


 * SELECT THE APPROPRIATE ISOTOPE AND ACQUIRE A SPECT STUDY WITH THE WINDOW
   SETTING, ORBIT SHAPE, AND DETECTOR MOTION (STEP-AND-SHOOT OR CONTINUOUS
   MOTION FOR ROTATING SPECT CAMERAS) THAT IS USED CLINICALLY.


 * TOTAL COUNTS - FOR SPECT ACQUISITIONS THE SUM OF THE COUNTS FROM ALL IMAGES
   (FOR ALL HEADS ON MULTIPLE DETECTOR SYSTEMS) SHOULD BE APPROXIMATELY 32
   MILLION COUNTS FOR THE DELUXE PHANTOM AND 20 MILLION COUNTS FOR THE SMALL
   SPECT PHANTOM. A SAMPLE CALCULATION TO DETERMINE THE NUMBER OF SECONDS PER
   IMAGE TO USE WHEN ACQUIRING THE SPECT DATA IS PROVIDED BELOW. ALTERNATIVELY,
   USE THE TABLE BELOW TO DETERMINE THE NUMBER OF COUNTS IN THE FIRST IMAGE FOR
   CAMERAS THAT MAY BE SET TO ACQUIRE THE FIRST IMAGE FOR A SET NUMBER OF COUNTS
   AND THE REST OF THE IMAGES FOR THE SAME TIME.


 * COUNT RATE SHOULD NOT EXCEED 50 KCPS.


 * USE A 128 X 128 MATRIX REGARDLESS OF WHICH PHANTOM IS USED. ACQUIRE 120 (OR
   128) VIEWS OVER 360 DEGREES FOR ROTATING SPECT CAMERAS. SOME CARDIAC SPECT
   SYSTEMS CANNOT ACQUIRE A SINGLE SET OF PROJECTIONS OVER 360 DEGREES. FOR
   THESE SYSTEMS, THE PHANTOM SHOULD BE ACQUIRED WITH THE MAXIMUM NUMBER OF
   ROTATIONAL STEPS FOR THE STANDARD ROTATIONAL ARC. THIS IS GENERALLY 60 OR 64
   STEPS OVER 180 DEGREES. CAMERAS THAT DO NOT ROTATE SHOULD USE THE ANGULAR
   SAMPLING THAT IS USED CLINICALLY.


 * A CIRCULAR OR NON-CIRCULAR ORBIT CAN BE USED. IF A CIRCULAR ORBIT IS USED,
   THEN THE RADIUS OF ROTATION SHOULD BE AS CLOSE AS POSSIBLE TO 20 CM. FOR
   EITHER ACQUISITION TYPE, THE CENTER OF THE PHANTOM MUST BE CLOSE TO THE
   AXIS-OF-ROTATION SO THAT THE DISTANCE FROM THE FACE OF THE COLLIMATOR(S) TO
   THE PHANTOM DOES NOT CHANGE SIGNIFICANTLY DURING ROTATION. THE SMALL PHANTOM
   SHOULD BE PLACED AT THE OPTIMAL CLINICAL IMAGING POSITION FOR CAMERAS THAT DO
   NOT ROTATE AROUND THE PATIENT.


 * FOR AN ACQUISITION MATRIX OF 128 X 128, PIXEL SIZE SHOULD BE NEAR 2.7 TO 3.3
   MM. SOME SYSTEMS WILL REQUIRE AN ACQUISITION ZOOM FACTOR (UP TO A MAXIMUM OF
   1.6) TO ACHIEVE THE APPROPRIATE PIXEL SIZE.


SAMPLE CALCULATION FOR SPECT ACQUISITION


CALCULATION OF THE TIME PER VIEW TO ACQUIRE APPROXIMATELY 32M COUNTS IN THE
SPECT STUDY: IF THE SYSTEM YOU ARE USING SHOWS THE COUNT RATE PRIOR TO STARTING
THE SPECT ACQUISITION, USE THE PROCEDURE GIVEN BELOW. IF THE COUNT RATE IS NOT
SHOWN, JUST PRIOR TO STARTING THE SPECT STUDY, ACQUIRE A PLANAR ACQUISITION FOR
10 SECONDS (BE SURE THE IMAGING TABLE IS NOT BETWEEN THE DETECTOR YOU ARE USING
AND THE PHANTOM) AND DIVIDE THE ACQUIRED COUNTS BY 10 TO GET THE RATE IN COUNTS
PER SECOND. 


EXAMPLE:





R = COUNT RATE IN COUNTS PER SECOND FOR ONE OF THE DETECTORS


N = NUMBER OF VIEWS (120 OR 128, WHICHEVER IS AVAILABLE OR WHICHEVER YOU WANT TO
USE IF BOTH ARE AVAILABLE)


T = TIME FOR THE FIRST VIEW






ASSUME R = 28,000 COUNTS PER SECOND. ASSUME N = 120 VIEWS.




ROUND TIME UP TO THE NEXT WHOLE NUMBER IF THE FRACTION OF A SECOND IS GREATER
THAN 0.5. ROUND TIME DOWN TO THE NEXT WHOLE NUMBER IF THE FRACTION OF A SECOND
IS LESS THAN 0.5.




IF THE SYSTEM HAS TWO DETECTORS, THE TOTAL ACQUISITION TIME WILL BE
APPROXIMATELY ONE-HALF OF THE TIME FOR A SINGLE DETECTOR SYSTEM. IF THE SYSTEM
HAS THREE DETECTORS, THE TOTAL ACQUISITION TIME WILL BE APPROXIMATELY ONE-THIRD
OF THE TIME FOR A SINGLE DETECTOR SYSTEM.





TABLE FOR THE NUMBER OF COUNTS TO ACQUIRE WHEN ACQUIRING THE FIRST IMAGE BY
COUNTS AND THE REST BY TIME


  TOTAL NUMBER OF PROJECTIONS - ROTATION ARC (IN DEGREES)


NUMBER OF COUNTS IN FIRST IMAGE


DELUXE PHANTOM- 32 M COUNTS


SMALL PHANTOM - 20 M COUNTS


120-360


267,000


167,000


128-360


250,000


156,000


60-180


534,000


334,000


64-180


500,000


312,000




RECONSTRUCTION:


 * RECONSTRUCTION WITH FILTERED BACK PROJECTION IS RECOMMENDED USING THE
   BUTTERWORTH FILTER THAT IS AVAILABLE ON MOST COMMERCIAL SYSTEMS. FOR THE
   BUTTERWORTH FILTER, SUGGESTED PARAMETERS ARE A CUTOFF OF 0.55 AND A SLOPE OF
   6, WHICH IS OPTIMAL FOR MANY SYSTEMS (FOR SOME VENDORS THE CUTOFF WILL BE
   CLOSE TO 0.35); HOWEVER, PARAMETER VALUES CAN BE ADJUSTED TO OPTIMIZE
   CONTRAST OF SPHERES AND SHARPNESS OF SMALLEST VISIBLE RODS IN THE TRANSAXIAL
   SLICES. LOWER CUTOFF NUMBERS WILL RESULT IN A SMOOTHER IMAGE WITH LESS NOISE
   AND LESS DETAIL. SITES MAY USE THE CLINICAL RECONSTRUCTION METHOD AND FILTER
   THEY ARE CURRENTLY USING WITH PARAMETERS OPTIMIZED FOR THE ACR PHANTOM. NOTE
   THAT USING ITERATIVE RECONSTRUCTION METHODS MAY RESULT IN THE APPEARANCE OF
   EDGE ARTIFACTS IN THE RECONSTRUCTED IMAGES THAT COULD RESULT IN A LOWER
   UNIFORMITY SCORE. REVIEW YOUR IMAGES CAREFULLY FOR THIS TYPE OF ARTIFACT
   PRIOR TO SUBMISSION. 


 * ATTENUATION CORRECTION IS REQUIRED FOR CAMERAS THAT ROTATE 360 DEGREES. FOR
   MOST CAMERAS, THE EFFECTIVE LINEAR ATTENUATION COEFFICIENT FOR TC-99M IS 0.11
   TO 0.12/CM. USE THE UNIFORM PART OF THE PHANTOM TO DEFINE THE BOUNDARY FOR
   ATTENUATION CORRECTION. PLEASE NOTE THAT ON MOST SYSTEMS, THE ATTENUATION
   CORRECTION IS APPLIED AS A SEPARATE STEP IN THE RECONSTRUCTION PROGRAMS OR A
   SEPARATE PROGRAM OUTSIDE OF THE RECONSTRUCTION. THE OPERATOR IS USUALLY
   REQUIRED TO SET THE BOUNDARIES AND TO APPLY ATTENUATION CORRECTION. SITES
   SUBMITTING DATA FROM CAMERAS THAT CAN ACQUIRE ONLY 180 DEGREES OF DATA (I.E.,
   CARDIAC ONLY CAMERAS) ARE NOT REQUIRED TO APPLY ATTENUATION CORRECTION TO THE
   DATA.


 * THE FILTER AND PARAMETERS AS WELL AS THE SLICE THICKNESS AND ATTENUATION
   COEFFICIENT MUST BE DOCUMENTED ON THE SITE SCANNING DATA FORM. 


 * DISPLAY THE FIRST IMAGE OF THE RAW SPECT DATA. RECORD THE TOTAL COUNTS IN THE
   IMAGE ON THE SITE SCANNING DATA FORM. 


 * DISPLAY ALL TRANSAXIAL RECONSTRUCTED IMAGES WITH A SLICE THICKNESS 0.6-0.9 CM
   BY SUMMING 2 OR 3 SLICES. FOR MOST LARGE FOV CAMERAS, SUMMING 2 SLICES WILL
   GENERATE THE APPROPRIATE THICKNESS.


SPECT IMAGES FOR SUBMISSION


 * SUBMIT THE COMPLETE SET OF TRANSAXIAL SLICES (0.6 TO 0.9 CM THICK). DO NOT
   SUBMIT MORE THAN 28 SLICES ON A SINGLE PAGE. IMAGE SIZE SHOULD BE ADJUSTED
   WITH THE DISPLAY ZOOM SO THAT EACH IMAGE OCCUPIES ABOUT 80% OF THE IMAGE
   FRAME.


 * DICOM RECONSTRUCTED AXIAL SLICES REFRAMED TO THE CORRECT SLICE THICKNESS MAY
   BE UPLOADED IN LIEU OF SCREEN CAPTURES.


 * SUBMIT A COMPOSITE OF UP TO 12 SUMMED IMAGES THROUGH THE ROD SECTION. FOR THE
   SMALL SPECT PHANTOM, SUM 5 IMAGES.


 * SUBMIT ONLY GRAY SCALE IMAGES.


 * USE LINEAR MAPPING OF THE DISPLAY WITH THE LOWER THRESHOLD SET AT 0 (OR ≤ 5%
   OF THE MAXIMUM UPPER LEVEL) AND THE UPPER THRESHOLD SET TO 100 % OR THE
   MAXIMUM COUNT.


 * ALL IMAGES SHOULD BE APPROPRIATELY LABELED. SLICE NUMBER(S) OR POSITION
   LOCATION SHOULD BE INCLUDED ON SECONDARY CAPTURE IMAGES THAT ARE SUBMITTED.
   MAKE SURE SITE SCANNING DATA FORMS ARE FILLED OUT COMPLETELY AND MATCH THE
   DATA SUBMITTED. 


 * FOR MULTI-DETECTOR CAMERAS, SEPARATE SPECT DATA SETS FOR EACH DETECTOR SHOULD
   NOT BE SUBMITTED.


 * ONLY THE TRANSAXIAL IMAGES SHOULD BE SUBMITTED. DO NOT SUBMIT SAGITTAL OR
   CORONAL IMAGES. DO NOT SUBMIT SECONDARY CAPTURE IMAGES THAT DISPLAY THE THREE
   ORTHOGONAL PLANES (TRANSAXIAL, SAGITTAL AND CORONAL) ON ONE PAGE.





EVALUATION OF THE IMAGES SUBMITTED 


UNIFORMITY, NOISE, AND THE PRESENCE OF ARTIFACTS ARE EVALUATED QUALITATIVELY BY
INSPECTION OF PLANAR IMAGES AND RECONSTRUCTED TOMOGRAPHIC SECTIONS.  PLANAR
SPATIAL RESOLUTION IS JUDGED BY IDENTIFYING THE SMALLEST BARS IN A RESOLUTION
PHANTOM THAT CAN BE VISUALIZED ON CAMERAS USED FOR PLANAR IMAGING ONLY. FOR
TOMOGRAPHIC SYSTEMS, THE SMALLEST “COLD” RODS IN THE ACR-APPROVED PHANTOM ARE
USED. COLLIMATOR TYPE (E.G., GENERAL PURPOSE, HIGH RESOLUTION) IS CONSIDERED IN
SCORING THE SPATIAL RESOLUTION. THE RECONSTRUCTED TRANSAXIAL SLICES CONTAINING
THE "COLD" SPHERES ARE USED TO VISUALLY EVALUATE IMAGE CONTRAST BASED ON
IDENTIFYING THE SMALLEST “COLD” SPHERE SEEN AT HIGH CONTRAST. AS WITH THE
EVALUATION OF SPATIAL RESOLUTION, COLLIMATOR TYPE IS CONSIDERED WHEN THE SCORE
FOR CONTRAST IS DETERMINED.












REVISION HISTORY FOR THIS ARTICLE


DATE


SECTION


DESCRIPTION OF REVISION(S)


12-12-19


ALL


ARTICLE CREATED; FAQS INCORPORATED; NO CRITERIA CHANGES


9-23-2020



ADDED LINK TO PHANTOM IMAGE ATLAS


11-30-2020



ADDED LINK TO NM EQUIPMENT EVALUATION SUMMARY FORM


2-4-2021



ADDED CLEARVISION GVI TO LIST OF CAMERAS THAT ARE UNABLE TO ACQUIRE PLANAR
IMAGES


5-6-2022


ALL


CLARIFICATION OF INSTRUCTIONS (NO NEW REQUIREMENTS)


6-22-2022


PLANAR AND SPECT PROTOCOL FOR SYSTEMS APPLYING FOR SPECT ACCREDITATION


PHANTOM RODS AND BARS ARE ACCEPTABLE FOR PLANAR SPATIAL RESOLUTION - EACH
DETECTOR


ACR PHANTOM (RECOMMENDED)


8-29-2022


MODULE 2 AND/OR 3 (SPECT WITH PLANAR)


REMOVED EXCEPTION FOR DIGIRAD DEDICATED CARDIAC CAMERAS


11-9-2022



GRAMMATICAL EDIT


11-18-22


INTRODUCTION


ATTACHED PHANTOM ORDER AND SITE SCANNING DATA FORMS


12-6-22


INTRODUCTION


MOVED PHANTOM ORDER FORMS TO TESTING OVERVIEW: NM/PET ARTICLE


4-20-2023



EDITED 2020TC SPECT AND ADDED SPECTPAK







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