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Review
. 2022 Dec 1;95(1140):20220357.
doi: 10.1259/bjr.20220357. Epub 2022 Sep 20.

Total-body PET: a new paradigm for molecular imaging

Margaret E Daube-Witherspoon  1 , Austin R Pantel  1 , Daniel A Pryma  1 , Joel S Karp  1
Affiliations
Review

Total-body PET: a new paradigm for molecular imaging

Margaret E Daube-Witherspoon et al. Br J Radiol. .

Abstract

Total body (TB) positron emission tomography (PET) instruments have dramatically changed the paradigm of PET clinical and research studies due to their very high sensitivity and capability to image dynamic radiopharmaceutical distributions in the major organs of the body simultaneously. In this manuscript, we review the design of these systems and discuss general challenges and trade-offs to maximize the performance gains of current TB-PET systems. We then describe new concepts and technology that may impact future TB-PET systems. The manuscript summarizes what has been learned from the initial sites with TB-PET and explores potential research and clinical applications of TB-PET. The current generation of TB-PET systems range in axial field-of-view (AFOV) from 1 to 2 m and serve to illustrate the benefits and opportunities of a longer AFOV for various applications in PET. In only a few years of use these new TB-PET systems have shown that they will play an important role in expanding the field of molecular imaging and benefiting clinical practice.

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Conflict of interest statement

Conflicts of Interest: MD-W has no conflicts to report. ARP has received consulting fees from Progenics and Blue Earth Diagnostics. DAP has received research funding from Siemens Healthineers, Progenics, Nordic Nanovector, Fusion Pharmaceuticals, Point Biopharma, 511 Pharma, and consulting fees from Siemens, Lantheus, Actinum, and Bayer. JSK has received research funding from Siemens Healthineers.

Figures

Figure 1.
Figure 1.
(a) Schematic showing the axial acceptance angle (θ) and accepted lines of response that increase from a standard AFOV (shaded) to a long AFOV in a TB-PET system. Geometric axial sensitivity profiles for a 200 cm long central line source (b) in air and attenuated by (c) 20 cm and (d) 35 cm cylinders for AFOVs ranging from 26 to 200 cm. Note the change in y-axis scales for the attenuated profiles. The gains in peak sensitivity relative to a 26 cm AFOV system for the source in a 20 cm cylinder are 1.8x, 2.0x, 2.0x, and 2.0x for 70-, 100-, 140-, and 200 cm AFOV, respectively; the gains in total sensitivity relative to a 26 cm AFOV system for the source in a 20 cm cylinder are 5.9x, 10.1x, 16.0x, and 25.0x for 70-, 100-, 140-, and 200 cm AFOV, respectively. The sensitivity gains are higher for the source in air and slightly lower for the source in the 35 cm cylinder (Courtesy, Dr S. Surti). AFOV, axial field of view; TB-PET, total body positron emission tomography.
Figure 2.
Figure 2.
Representative maximum intensity projection images from studies on the PennPET Explorer that demonstrate the multiple benefits of TB-PET systems with a range of AFOV. Images are shown for a (a) dynamic 18F-FDG study in a 3-ring (64 cm) configuration, (b) dynamic 18F-FDG study in a 6-ring (142 cm) configuration (courtesy, Dr C. Wiers), and (c) 89Zr-CD8 study in a 5-ring (112 cm) configuration, acquired in two bed positions to scan the 1.83 m tall subject (courtesy, Dr M. Farwell). The different temporal framing for (a) and (b) reflects the different goals of these two studies. The positioning of the subject was adjusted for each study to place the axial region of interest more centrally in the AFOV. AFOV, axial field of view; 18F-FDG, 18-fluorodeoxyglucose; TB-PET, total body positron emission tomography.
See this image and copyright information in PMC

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