Single-photon emission computed tomography/computed tomography: basic instrumentation and innovations

Correlation of the anatomical and functional information presented by single-photon emission computed tomography (SPECT) and computed tomography (CT) can aid in the decision-making process by enabling better localization and definition of organs and lesions and improving the precision of surgical biopsies. Technical developments over the past 20 years have led to the development of better software techniques for image fusion and, more recently, to the development of modern SPECT/CT systems. While image fusion techniques have been in clinical use for many years, the first commercial SPECT/CT system was only developed in 1999. Following the commercial success of PET/CT systems that employed multidetector CT (MDCT) scanners, there has been renewed interest in the development of comparable SPECT/CT systems. This has resulted in the development of a range of SPECT/CT devices varying from a simple CT add-on to a conventional SPECT system that can provide low-dose CT images to a full MDCT scanner integrated with a SPECT system. The advantages of combining SPECT with CT are numerous and are primarily due to the anatomic referencing and the attenuation correction capabilities of CT. Depending on system design, there are varying technical issues surrounding the different SPECT/CT devices, ranging from cost, radiation dose, planning, and siting requirements to system-specific issues such as table sag and CT artifacts due to patient motion. Motion artifacts should be less prevalent with the faster acquisition times of modern scanners, but are still problematic in the thorax and have not yet been fully resolved as they pertain to the use of CT data for cardiac attenuation correction. As this technology matures, we can expect to see a range of SPECT/CT devices available on the market that range from low-dose 1-4 slice inexpensive CT upgrades of conventional SPECT systems, to SPECT systems incorporating 64 or 128 slices CT scanners. The cost of the high-end CT scanners will exceed the cost of the SPECT scanner and hence the justification for such devices will be heavily dependent on clear demonstration of their value in clinical practice.