Real-time list-mode processing of gated cardiac blood pool examinations with forward-backward framing

List-mode processing of gated cardiac blood pool data has be shown to been more accurate than standard frame-mode processing, but it has not gained widespread clinical use because of the difficulties associated with post-processing of the acquired data. We therefore investigated the possibility of performing the list-mode processing concurrently with the acquisition of the data, i.e. real-time list-mode processing. A programme for simultaneous acquisition and processing of gated cardiac images was written in assembly code and implemented on a personal computer. The programme was tested in phantom studies, then used in 200 consecutive patient examinations. Data could be concurrently acquired from the gamma-camera and processed with forward-backward framing at a great enough speed so that no loss of information occurred at up to 40,000 counts per second, a value exceeding typical count rates observed in clinical practice. The ease-of-use and the clinical benefits of real-time list-mode processing suggest that it may become a standard method for gated examinations of the left ventricle in the near future.