PET is widely considered the most sensitive technique available for noninvasively studying physiology, metabolism, and molecular pathways in the living human being. However, the utility of PET, being a photon-deficient modality, remains constrained by factors including low signal-to-noise ratio, long imaging times, and concerns about radiation dose. Two developments offer the potential to dramatically increase the effective sensitivity of PET. First by increasing the geometric coverage to encompass the entire body, sensitivity can be increased by a factor of about 40 for total-body imaging or a factor of about 4-5 for imaging a single organ such as the brain or heart. The world's first total-body PET/CT scanner is currently under construction to demonstrate how this step change in sensitivity affects the way PET is used both in clinical research and in patient care. Second, there is the future prospect of significant improvements in timing resolution that could lead to further effective sensitivity gains. When combined with total-body PET, this could produce overall sensitivity gains of more than 2 orders of magnitude compared with existing state-of-the-art systems. In this article, we discuss the benefits of increasing body coverage, describe our efforts to develop a first-generation total-body PET/CT scanner, discuss selected application areas for total-body PET, and project the impact of further improvements in time-of-flight PET.Key Words: instrumentation; molecular imaging; PET/CT; instrumentation; PET; total-body imaging J Nucl Med 2018; 59:3-12 DOI: 10.2967/jnumed.116.184028Al l nuclear medicine studies in humans are limited by the trade-offs between the number of detected decay events, imaging time, and absorbed dose. The number of detected events determines the signal-to-noise ratio (SNR) in the final image, but constraints on administered activity, as well as high random event rates and dead time that occur at high activities, currently prevent acquisition of high-SNR images in short times. This in turn limits the ability to perform high-resolution, dynamic imaging studies with tracer kinetic modeling, because short-time-frame datasets are always noisy. A further limitation is that although the tracer injection is systemic and radiotracer is present in the entire body, current imaging systems contain only a small portion of the body within the field of view (FOV). For applications in which the distribution of radiotracer in the entire body or multiple organ systems is of interest, this limitation leads to further inefficiencies and makes it difficult to acquire dynamic data from all the tissues of interest. If one takes whole-body PET scanning with 18 F-FDG as an example, the total efficiency with which pairs of coincidence photons that escape the body are detected is well under 1% even on today's best scanners. Simplistically, this number can be derived by considering that the average geometric sensitivity within the FOV of a typical clinical PET scanner is under 5% and that with an axial coverage of ...

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.

Disclosure: UC Davis has a research agreement and a sales-based revenue sharing agreement with United Imaging Healthcare. No other potential conflicts of interest relevant to this article exist including employment, royalties, stock options, or patents.

The first total-body positron emission tomography (TB-PET) scanner represents a radical change for experimental medicine and diagnostic health care.

A simple methodology for the manufacture and calibration of polyacrylamide gel (PAG) for magnetic resonance imaging (MRI) radiation dosimetry is presented to enable individuals to undertake such work in a routine clinical environment. Samples of PAG were irradiated using a linear accelerator and imaged using a 0.5 T (22 MHz) Philips Gyroscan MRI scanner. The mean spin-lattice relaxation rate was measured using a 'turbo-mixed' sequence, consisting of a series of 90 degrees pulses, each followed by acquisition of a train of spin echoes. The mean sensitivity for five different batches of PAG in the range up to 10 Gy was calculated to be 0.0285 s-1 Gy-1 for the mean spin-lattice relaxation rate with a percentage standard deviation of 1.25%. The overall reproducibility between batches was calculated to be 2.69%. This methodology, which introduces the novel use of pre-filled nitrogen vials for calibration, has been used to develop techniques for filling anatomically shaped anthropomorphic phantoms.

The axial field of view (AFOV) of the current generation of clinical whole-body PET scanners range from 15–22 cm, which limits sensitivity and renders applications such as whole-body dynamic imaging, or imaging of very low activities in whole-body cellular tracking studies, almost impossible. Generally, extending the AFOV significantly increases the sensitivity and count-rate performance. However, extending the AFOV while maintaining detector thickness has significant cost implications. In addition, random coincidences, detector dead time, and object attenuation may reduce scanner performance as the AFOV increases. In this paper, we use Monte Carlo simulations to find the optimal scanner geometry (i.e. AFOV, detector thickness and acceptance angle) based on count-rate performance for a range of scintillator volumes ranging from 10 to 90 l with detector thickness varying from 5 to 20 mm. We compare the results to the performance of a scanner based on the current Siemens Biograph mCT geometry and electronics. Our simulation models were developed based on individual components of the Siemens Biograph mCT and were validated against experimental data using the NEMA NU-2 2007 count-rate protocol. In the study, noise-equivalent count rate (NECR) was computed as a function of maximum ring difference (i.e. acceptance angle) and activity concentration using a 27 cm diameter, 200 cm uniformly filled cylindrical phantom for each scanner configuration. To reduce the effect of random coincidences, we implemented a variable coincidence time window based on the length of the lines of response, which increased NECR performance up to 10% compared to using a static coincidence time window for scanners with large maximum ring difference values. For a given scintillator volume, the optimal configuration results in modest count-rate performance gains of up to 16% compared to the shortest AFOV scanner with the thickest detectors. However, the longest AFOV of approximately 2 m with 20 mm thick detectors resulted in performance gains of 25–31 times higher NECR relative to the current Siemens Biograph mCT scanner configuration.

The EXPLORER project aims to build a 2-meter long total-body PET scanner, which will provide extremely high sensitivity for imaging the entire human body. It will possess a range of capabilities currently unavailable to state-of-the-art clinical PET scanners with a limited axial field-of-view. The huge number of lines-of-response (LORs) of the EXPLORER poses a challenge to the data handling and image reconstruction. The objective of this study is to develop a quantitative image reconstruction method for the EXPLORER and compare its performance with current whole-body scanners. Fully 3D image reconstruction was performed using time-of-flight list-mode data with parallel computation. To recover the resolution loss caused by the parallax error between crystal pairs at a large axial ring difference or transaxial radial offset, we applied an image domain resolution model estimated from point source data. To evaluate the image quality, we conducted computer simulations using the SimSET Monte-Carlo toolkit and XCAT 2.0 anthropomorphic phantom to mimic a 20-minute whole-body PET scan with an injection of 25 MBq 18F-FDG. We compare the performance of the EXPLORER with a current clinical scanner that has an axial FOV of 22 cm. The comparison results demonstrated superior image quality from the EXPLORER with a 6.9-fold reduction in noise standard deviation comparing with multi-bed imaging using the clinical scanner.

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