Chapter 5: Quality Control in SPECT, Dedicated PET, and Hybrid CT Imaging

INTRODUCTION

Quality control (QC) of single-photon emission computed tomography (SPECT), dedicated (line source attenuation correction) positron emission tomography (PET), and hybrid computed tomography (SPECT/CT and PET/CT) nuclear cardiology procedures is a multiple-step process that begins before the patient enters the laboratory, continues during the acquisition, and ends after the patient leaves the laboratory. SPECT QC, PET QC, and hybrid CT scanner QC require the close attention of all personnel and physicians that are involved with the lab. Requirements for imaging system QC are based on Nuclear Regulatory Commission requirements, agreement state requirements, accepted imaging guidelines, and the Intersocietal Accreditation Commission Nuclear/PET (IAC Nuclear/PET) and American College of Radiology (ACR) Accreditation standards.^1–8 The terminology used, requirements, and frequency may vary slightly between the standards, the model of scanners, and the original equipment manufacturer’s (OEM) recommendations. However, the basic premise of why QC is necessary is the same in all situations: to ensure adequate camera performance, identify any potential sources of error or artifact within an acquisition, and ultimately provide the patient and referring physician with the best-quality information possible. If QC procedures are not followed, it may lead to an equivocal or falsely interpreted study, which may result in increased downstream costs, as well as poor outcomes. This chapter will review the routine QC procedures performed by the nuclear medicine technologist before, during, and after the acquisition of a nuclear cardiology study, including new instrumentation. Additional QC procedures and calibrations that are performed by camera service engineers or medical physicist will not be discussed in detail. For purposes of this chapter, all PET systems require attenuation correction with either CT or radioactive line source. In the chapter, the PET camera will be referred to as either PET/CT or dedicated (line source).

QUALITY CONTROL BEFORE THE ACQUISITION

There are several required and recommended equipment QC procedures that should be performed on each imaging system.^2,5–32 The recommended frequency of the procedures may vary among equipment manufacturers; however, all are important to ensure proper system performance (Tables 5-1, 5-2, and 5-3). These tasks consist of daily, weekly, monthly, and quarterly system testing.