Performing 18F-FDG PET studies following injections of 99mTc-sestamibi

When SPECT studies are followed by PET studies on the same day, substantial 99mTc activity may be present in patients during the PET scans. Degraded PET camera performance results unless the low-energy gamma rays are absorbed by lead shields. Spatial resolution, camera count rates, energy spectra, image contrast and noise, and image quality have been measured for phantoms with varying levels of 99mTc activity, and both with and without thin lead shields placed in front of the detectors. In addition examples of the results of twelve 18F-FDG PET cardiac studies performed within 6 h of 99mTc-sestamibi injections are reported. The presence of 99mTc (140 keV gamma rays) causes light pile-up with 511 keV photons resulting in distorted energy spectra, degraded spatial resolution, increased Compton background and reduced count-rate capability. These effects are avoided using thin lead shields. Studies performed with 99mTc activity in patients but using lead shields are of comparable quality to studies performed without 99mTc or shields. Thin lead shields effectively filter low-energy gamma rays during PET studies leading to improved count-rate capability, contrast and image quality.