Within the EXPLORER Consortium, the construction of the world's first total-body PET/CT scanner has recently been completed. The 194-cm axial field of view of the EXPLORER PET/CT scanner is sufficient to cover, for the first time, the entire human adult body in a single acquisition in more than 99% of the population and allows total-body pharmacokinetic studies with frame durations as short as 1 s. The large increase in sensitivity arising from total-body coverage as well as increased solid angle for detection at any point within the body allows whole-body 18 F-FDG PET studies to be acquired with unprecedented count density, improving the signal-tonoise ratio of the resulting images. Alternatively, the sensitivity gain can be used to acquire diagnostic PET images with very small amounts of activity in the field of view (25 MBq, 0.7 mCi or less), with very short acquisition times (∼1 min or less) or at later time points after the tracer's administration. We report here on the first human imaging studies on the EXPLORER scanner using a range of different protocols that provide initial evidence in support of these claims. These case studies provide the foundation for future carefully controlled trials to quantitatively evaluate the improvements possible through total-body PET imaging.

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Background: The aim of this study is to conduct physical performance evaluation on the uMI550 whole-body PET/CT system according to the NEMA NU2-2018 standard. Methods: According to the NEMA NU2-2018, spatial resolution, sensitivity, scatter fraction, count-rate performance, accuracy of count losses and random corrections, image quality, and timing resolution were evaluated. Spatial resolution was measured by using a 22 Na point source. System sensitivity was measured by inserting an 18 F line-source in six concentric aluminum sleeves with varying diameters. Scatter fraction, count-rate performance, accuracy of count loss, and timing resolution were all calculated by analyzing dynamically acquired data of an 18 F line-source inside a polyethylene cylinder in 20 cm diameter and 70 cm length. Image quality was assessed using a NEMA IEC body phantom with a 4:1 ratio of activity concentration of spheres to the warm background. Additionally, three patient studies were performed, with one brain scan and two whole-body scans, separately. The patient images were evaluated to get a visual first impression of uMI550. Results: The tangential, radial, and axial spatial resolutions were measured as 2.91 mm, 2.98 mm, and 2.97 mm FWHM, respectively, at 1 cm radial offset. The total system sensitivity to line source at center was 10.24 cps/kBq. A NECR peak was measured as 124.4 kcps at 18.85 kBq/mL. The scatter fraction at NECR peak was 36.65%, and the maximum count-rate error at and below NEC peak was 1.55%. Contrast recovery coefficients were from 46.5 (10 mm) to 83.9% (37 mm). The timing resolution was measured as 372 ps at low count rate. Conclusion: NEMA NU-2 2018 testing was performed on the new SiPM-based uMI550 PET/CT system. The uMI550 shows a high-spatial resolution of less than 3 mm and a good timing resolution of 372 ps. It shows clinical significances on improving potentially diagnostic ability on small lesions.

Purpose: The aim of the study was to explore a fast PET scan protocol of the total-body uEXPLORER scanner by assessing the image quality consistent to that of a conventional digital PET/CT scanner both from the phantom and clinical perspectives.Methods: The phantom study using a NEMA/IEC NU-2 body phantom was performed both on a totalbody PET/CT (uEXPLORER) and a digital routine PET/CT (uMI 780), with hot sphere to background activity concentration ratio of 4:1. The contrast recovery coe cient (CRC), background variability (BV), recovery coe cient RCmax and RCmean were assessed and compared between that in uEXPLORER with the different scanning duration and reconstruction protocols and that in uMI 780 with clinical settings.The coe cient of variation (COV) of the uMI 780 with clinical settings were calculated and used as a threshold to determine the optimized scanning duration and reconstruction protocols were, which can provide a consistent image quality for the two scanners. And subsequently, the proposed protocol was validated by 30 oncological patients. Images acquired in uMI 780 with a 2-3 minute for each bed position were referred as G780. All PET raw data were reconstructed using data-cutting technique to simulate a 30s, 45s or 60s acquisition duration on uEXPLORER. The iterations were 2 and 3 for uEXPLORER, referred as G30s_3i, G45s_2i, G45s_3i, G60s_2i, and G60s_3i. A 5-point Likert scale was used in the qualitative analysis to assess the image quality. The image quality was also compared with the liver COV, the lesion target-to-background ratio (TBR), and the lesion signal-to-noise ratio (SNR).Results: In the phantom study, CRC, BV, RCmax and RCmean in uEXPLORER with different scanning duration and reconstruction iterations were compared with that in uMI 780 with clinical settings and a minor uctuation was found among different scanning durations. COV of the uMI 780 with clinical settings was 11.6% and determined protocol with a 30-45s scanning duration and 2 or 3 iterations to provide a similar image quality.In the quantitative analysis on the clinical images, there was no signi cant difference between G780 and G45s_3i. All the other groups in uEXPLORER with a 45s-and above acquisition showed a signi cantly improved image quality than that in uMI 780 with clinical settings. Comparing the liver COV, there was no signi cantly difference between G780 and G30s_3i. And no signi cant difference in lesion TBR was identi ed between G780 and G45s_2i, while uEXPLORER had a better performance in lesion SNR compared to that in uMI 780 with clinical settings.Conclusions: This study demonstrated a fast PET protocol with a 30-45s acquisition in uEXPLORER with consistent image quality to that in uMI 780 with clinical settings.

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