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KEY POINTS
Single-photon emission computed tomography (SPECT) Anger instrumentation is the current technology in most cameras. Software updates can substantially improve image quality, shorten protocol length, and reduce radiation exposure.
Cadmium-zinc telluride (CZT) and other innovative Single Photon Emission Computed Tomography (SPECT) camera instrumentations offer shorter protocols, excellent image quality, and greater protocol flexibility.
Attenuation correction with SPECT can be achieved with computed tomography (CT)-based technology.
SPECT myocardial blood flow assessment is a concept in development.
Positron emission tomography (PET) instrumentation is robust and widely available with a variety of image quality improving options.
Attenuation correction is routine in PET with either line-source or CT solution. CT option can also add important information to the overall assessment.
PET myocardial blood flow assessment is now commonplace in cardiac PET laboratories.
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The changing needs of healthcare providers and patients have led to an unprecedented evolution in nuclear cardiology instrumentation. Modern instrumentation has a wide range of collimation, attenuation correction (AC) options, and many of the newest systems no longer relying on the Anger gamma camera design. Solid-state detector technologies and new aperture designs are commercially available and in widespread use. Hybrid single-photon emission computed tomography (SPECT) and positron emission tomography (PET) systems now have transmission imaging options for AC using x-ray computed tomography (CT), radionuclide, or novel fluorescence x-ray sources.
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Changes in instrumentation have been driven by revolutionary changes in the delivery of health care. In particular, there has been a shift from office-based nuclear cardiology services to hospital-based imaging. According to MedAxiom, respondents reported a dramatic shift in providers from private practices to integrated practices. In 2008, only 11% of MedAxiom respondents reported being in an integrated group (e.g., integrated into a hospital environment). By 2018, 83% of respondents reported practicing within an integrated practice.1 The integration of cardiovascular imaging into the hospital setting has significantly altered the kinds of instrumentation available to the cardiologist. This access has provided clinicians the capability for routine AC, neuronal imaging, absolute myocardial blood flood, cardiac sarcoid and amyloid imaging, cardiac metabolic imaging (glucose and fatty acid tracers), and other advanced molecular imaging techniques. This chapter will describe the instrumentation that is commonly used in nuclear cardiology for both SPECT and PET and explain some of the important advances in instrumentation that can improve image quality and reduce radiation exposure and ultimately improve patient care.
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SPECT INSTRUMENTATION
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Hal Anger, with his team at the University of California, Berkeley, had worked with the rectilinear scanners and pin-hole camera designs. In 1957, this group changed the design to allow for a uniform magnification and resolution across the field of view with increased system sensitivity. The first “Anger” scintillator camera consisted of a 4-in. sodium iodine crystal optically coupled to seven photomultiplier tubes (PMTs).2,3
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Gamma camera design has evolved significantly since 1957 with ...