El Scint Camera Protocol

CEA SCAN ACQUISITION AND PROCESSING
FOR THE EL SCINT SYSTEM

I- ACQUISITION

ENERGY SETTING: Tc99m - 140 KeV with a 20% Window.

• Whole-body Sweep: Starting at the head, scan at 8-10 cm / minute stopping at the level of the mid-thigh.

• Use: 256 x 256 Matrix
• Static Acquisition: Anterior and Posterior views of the chest, abdomen and pelvis for 10 minutes preset time.

• 128 X 128 X 16 matrix.
• 60 stops.
• 30 - 40 seconds / stop.
• Perform SPECT images of the pelvis and abdomen as indicated above.
• The SPECT acquisition with a single-head camera may appear count deficient when the 128 matrix is applied. In that case, convert the images to a 64 matrix.
• Older systems may only be able to use a 64 X 64 X 16 matrix.

• 128 X 128 X 16 matrix.
• 120 total stops.
• 30 - 40 seconds / stop.

• Pelvic SPECT: Position the camera to include the groin to above the bifurcation.
• Abdominal SPECT: Position the camera to include the entire liver allowing for some overlap from the pelvic SPECT.
• Chest SPECT: (If clinically indicated) Image is best-performed about 18 hours post infusion. Position the camera to include the entire chest and axillae. Use 64 X 64 X 16 matrix with 6-degree (64 total) stops for 60 - 70 seconds per stop.

II- PLANAR IMAGE AND RAW SPECT DATA DISPLAY

• Check each image by varying the intensity to look for any suspicious areas of uptake.
• Use a linear gray scale taking care to not remove any background.
• Film the images at two intensities: one lighter and the other dark enough to display the blood vessels intensely.

• Check each SPECT for motion and vary the intensity to look for any suspicious areas of uptake.
• Go to the Archive Index (Patient Listing).
• Scroll to find the patient’s file.
• Select the CEA-Scan study file.
• Single CLICK on "OPEN".
• Single CLICK on "CINE".
• Adjust intensity and speed as needed.
• Single CLICK on "END" to stop.

III- SPECT RECONSTRUCTION

PATIENT SELECTION:

• Double CLICK on "GENERAL APPLICATIONS".
• Double CLICK on "GENERAL SPECT SLICING".
• Single CLICK on the desired patient file to HIGHLIGHT.
• Single CLICK on "SELECT SPECT ENTRY" to be processed.
• Single CLICK on the SPECT data set (Pelvis or Upper Abdomen) to be reconstructed.
• Single CLICK on "GROUP RESELECTION".
• Single CLICK on "OK".
• Single CLICK on "BONE"(for pelvis, chest or liver without attenuation correction)
• Single CLICK on "OK".
• Adjust the yellow lines to define the reconstruction limits and include the ENTIRE FIELD of VIEW.
• Single CLICK on "OK".
• Single CLICK on the DIALOG BOX.
• Adjust the "ZOOM" value to 1.00
• Single CLICK on the "II" tab.

FILTER FILE SET-UP:

This procedure only needs to be done once. After filters have been generated and saved, skip this section and proceed to the SPECT Study Reconstruction section.

• Single CLICK on "NEW FILTER".
• ADJUST the filter choice to "BUTTERWORTH".
• ADJUST the Cutoff value to 24
• ADJUST the Power value to 80
• Keep the Enhance value at (0) Zero.
• Single CLICK on "SAVE AS".
• Enter the filter file name: CEA24_8 (for CEA-Scan cutoff of .24, order of 8).
• Single CLICK on "SAVE AS".

To generate another filter:

• Single CLICK on "NEW FILTER".
• ADJUST the filter choice to "BUTTERWORTH".
• ADJUST the Cutoff value to 26
• ADJUST the Power value to 80
• Keep the Enhance value at (0) Zero.
• Single CLICK on "SAVE AS".
• Enter the filter file name: CEA26_8 (for CEA-Scan cutoff of .26, order of 8).
• Single CLICK on "SAVE AS".

Repeat as needed to generate the desired filter combinations from values of 24, 26, 28, 30, and so on, to 46 with the power (order) kept constant at 8.

SPECT STUDY RECONSTRUCTION:

• Single CLICK on "FILTER GALLERY".
• Scroll down the list of choices.
• Single CLICK on the desired filter.
• Filter effect is displayed in the box to the right.
• The Cutoff range is 24-46.
• Select a Cut-off value that displays sharp edges of the vessels.
• When the last image displayed is optimal, Single CLICK on "OK", the Transverse image file will be generated.

**Attenuation Correction is sometimes a helpful addition to the processing upper abdominal SPECT. If Attenuation Correction is going to be applied, stop here and go to Section V, Attenuation Correction.

• ADJUST the SLICE THICKNESS on the data sets to 2 pixels.
• ADJUST the yellow lines to define the reconstruction limits and include the ENTIRE FIELD of VIEW.
• Single CLICK on "OK". This generates and displays the 3 orthogonal views with the 3-D display.
• Review the images:
• If Images are too smooth, use a filter with a higher cut off.
• If the images are too grainy, use a filter with a lower cut off.
• If the images are optimal, continue as below to save the images

IV- SAVING SPECT IMAGES

• Single CLICK on "CLOSE" to save the file.
• To NAME the SAVED FILE.
• Double CLICK on "ARCHIVES"
• Double CLICK on "LOCAL MAIN"
• Scroll down to the desired patient.
• Double CLICK on patient
• Single CLICK on "REPORT"
• Single CLICK on "SELECTED".
• Single CLICK on "REPORT PARAMETERS".
• Enter the file name. For example (PEL 3hr35/8) is a good name for a pelvic SPECT performed at 3hrs using a 35 cutoff and order of 8; or (LIV 4hr35/8) for upper abdominal SPECT performed at 4 hrs using a 35 cutoff and order of 8.
• Single CLICK on "OK"
• If Attenuation Correction is not being applied to the image, skip to Section VII, SPECT Display and Triangulation.

V- ATTENUATION CORRECTION

Occasionally the liver will display a dark rim particularly on lateral edge of right lobe. If there is question of a lesion at the edge, Attenuation Correction may help differentiate between a reconstruction artifact and disease. Process the SPECT with and without attenuation correction. To generate images with attenuation correction-choose the LIVER option for reconstruction. To generate images without attenuation correction-choose the BONE option for reconstruction.

• When the Transverse image file has been generated.
• ADJUST the SLICE to visualize the ENTIRE LIVER.
• ADJUST the INTENSITY to visualize the BODY CONTOUR.
• Single CLICK on "ATTENUATION LIMITS".
• ADJUST the ELLIPSE to fit the BODY CONTOUR.
• Keep the u=.125 default.
• Single CLICK on "OK".

• ADJUST the SLICE THICKNESS on the data sets to 2 pixels.
• ADJUST the yellow lines to define the reconstruction limits and include the ENTIRE FIELD of VIEW.
• Single CLICK on "OK". This generates and displays the 3 orthogonal views with the 3-D display.
• Review the images:
• If Images are too smooth, use a filter with a higher cut off.
• If the images are too grainy, use a filter with a lower cut off.
• If the images are optimal, continue as below to save the images

VI- SAVING ATTENUATION CORRECTED IMAGES

• Single CLICK on "CLOSE" to save the file.
• To NAME the SAVED FILE.
• Double CLICK on "ARCHIVES"
• Double CLICK on "LOCAL MAIN"
• Scroll down to the desired patient.
• Double CLICK on patient
• Single CLICK on "REPORT"
• Single CLICK on "SELECTED".
• Single CLICK on "REPORT PARAMETERS".
• Enter the file name. For example (LIV 4hr35/8AC) for upper abdominal SPECT performed at 4 hrs using a 35 cutoff and order of 8 with Attenuation Correction.
• Single CLICK on "OK"

VII- SPECT DISPLAY-TRIANGULATION

• Go to "PATIENT FILE".
• Go to "ARCHIVES".
• Scroll down to the desired patient.
• Go to "REPORT LIST".
• Double CLICK on the desired report file, e.g. PEL 3hr35/8.
• The rotating 3D image and orthogonal views will appear.
• Adjust the display rate of the 3D image as needed.
• Single CLICK on "TRIANGULATION" to enable.
• Adjust the crosshairs to cycle through the coronal images and simultaneously display the corresponding transverse and sagittal views.
• The display range will only be available between the red lines to the left of the triangulation.
• To change the available display range, click once on "RESELECT".
• Adjust the red line range by dragging them up or down.
• Click on "TRIANGULATE" and repeat as needed.
• Film all suspicious areas.
• End triangulation, if needed.

VIII- FILMING THE STUDY

• Move the mouse arrow directly over the transverse data set.
• RIGHT Single CLICK on the mouse.
• Single CLICK on "EXPAND" and FILM
• RIGHT Single CLICK on the mouse.
• Single CLICK on "SHRINK".
• Move the mouse arrow directly over the coronal data set.
• RIGHT Single CLICK on the mouse.
• Single CLICK on "EXPAND" and FILM
• RIGHT Single CLICK on the mouse.
• Single CLICK on "SHRINK".
• Move the mouse arrow directly over the sagittal data set.
• RIGHT Single CLICK on the mouse.
• Single CLICK on "EXPAND" and FILM
• RIGHT Single CLICK on the mouse.
• Single CLICK on "SHRINK".

This procedure was not developed by, or is not meant as an endorsement by Elscint of CEA-Scan.  These suggested parameters are based on the experience of various users with this type of equipment and are not a substitute for the physician's or technologist's professional experience or knowledge. Users are ultimately responsible for determining if this procedure is usable with their equipment and standard practices. It is assumed that Quality Control of the imaging equipment is performed according to the manufacturer's recommendations. Please refer to the full product prescribing information and consult your equipment manufacturer's updated user's manual prior to the first use of CEA-Scan.

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