Introduction

Dynamic radionuclide renal study stenography provides functional and structural information of
the kidney and urinary tract noninvasively. Our purpose in this study is to describe the
construction and test results of a dynamic renal phantom with different clinical features of
radionuclide renography. The phantom consisted of five pieces of different shaped Plexiglas
boxes: Two kidneys, one liver, two square shaped boxes sone heart and one bladderd. The
bladder was internally divided into two compartments in order to collect each kidney output
separately. The dynamic circulation of the phantom was maintained under a hydrostatic
pressure >13.3 kPa average human blood pressured. The standard dose distribution among
different organs and different renographic parameters were calculated from series of normal
patients study s91 with 99mTc-DTPA, 68 with 99mTc-ECd. All the studies were performed with
same camera Siemens Orbiter Digitrac 7500d equipped with LEAP slow energy all purposed
collimator using ADAC Pegasys II analytic package program under the same clinical procedure.
Different regions of interest sROIsd were drawn for concerning organs and counts per second
sCPSd were collected for each ROI. The series of renogram curves were generated by phantom-
studies with different flow rates for left kidney sLKd and right kidney sRKd. The renal index sRId
for an individual study was calculated as the product of two indexes: “Relative Renal Function”
sRRFds water-volume of LK/RKd and “Relative Renal Time” sRRTds Tmax of LK/RKd. The most
significant correlation was found in total CPS for LK and RK between the EC group and phantom
studies sp, 0.001d. The calculated RI values were used to simulate the patients’ study with
different clinical features. The dynamics were found reproducible. The phantom is suitable for
using in calibration and quality control protocols of the renogram procedure used in Nuclear
Medicine.

Principle
The dynamic circulation of the phantom was maintained under hydrostatic pressure as
equivalent to normal human physiologic blood pressure fi.e. 10.7–16 kPa s80–120 mmHgd,
average 13.3 kPa s100 mmHgdg. A plastic water container sCd, volume capacity 12 000 ml s12
literd, was hung at a height >40 cm Figs. 1 and 2, so that it produced an amount of hydrostatic
pressure 13.3 kPa s100 mmHgd over an area >0.3 cm the cross-section of the pipe used as an
aorta sr=0.3 cmdg. The tracer s110±10 MBq99mTcd was injected faverage volume 10 ml at a
rate 240 ml/min s4 ml/sdg direct to the heart sHd followed by a flashing of water flow ssame
volume at same flow rated. The hydrostatic pressure made the aortic flow spath length >10
cmd. It was divided into two renal arteries sr=0.2 cm; cross sectional area >0.13 cm2d and that
guided water to flow through two kidneys to bladder compartments. The minimum transit time
for the tracer to reach the kidney after injection was >2.95±0.25 sec scorresponding to an aortic
flow 130±23 ml/min; 65±11.5 ml/min flow for each kidneyd.28 Two valves sV1, V2 Fig. 2d were
used at two kidney inlets to ensure uniform kidney flow with a constant pressure, 5.3±0.02 kPa
s>40 mmHg; 40% of aortic pressured.29 The flow of water was fully controlled by the two water
taps attached at the outlet of the bladder compartments. The pressure and flow rate were
measured and verified by a vacuum/pressure gauge smodel: Omega DVG-64d and flow meter
smodel: Viton 1300d. Different parts sheart, liver, aorta, two kidneys and bladderd were
arranged within a circular area of diameter 38 cm, keeping in mind that most of the gamma
cameras have a field of view sFOVd of 38 cm diameter. The water taps sT1, T2d were out of the
FOV Fig. 2d.
Two separate loops allowed water to flow sunder the same hydrostatic pressure >13.3
kPads Fig. 2d to the entire body and to the liver through two glass bottles sG1, G2d, filled with
water s100 ml and 30 ml consecutively. A water volume of G1 and G2 was optimized by
repeated phantom studies to get an expected activity distribution in the liver and the body
background. The tracer s7.5±1 MBq, volume 10 mld26,30 was injected through a narrow pipe
at the deep sbottom of the bottled level of G1 sto ensure better mixingd immediately after the
first injection in H.
The liver flow was maintained by the third loop injecting 99mTc s3.2±0.75 MBqd26, 30
of tracer f10 ml volume, at a rate 240 ml/min s4 ml/sdg in glass bottle G2 after 5 minutes from
the first injection. The output of the liver sLd was connected to the heart-input sHd mimic to
physiologic heart liver-heart feedback process. This delayed loop played an important part in
giving a typical shape of the renogram curve.
In the present phantom, both the kidneys were embedded in water inside the big box
BB; water height from top surface to bottom=7 cm; volume>5 littered. This height was slowly
increasing maximum level 8.25 cm, total water volume>6 littered when additional water was
gradually mixing with background activity. After that level, the water was allowed to flow out of
the body compartment.

Fig 1
  Types Of Phantom
 Imaging Phantoms: Conventional X-ray Imaging Applications. ...
 Computer Tomography Phantom Applications. ...
 Mammography Phantoms. ...
 Phantoms for Ultrasound Experimentation and Quality Control. ...
 Phantoms for Magnetic Resonance Imaging. ...
 Nuclear Medicine and PET Phantoms.
 Zubal Phantom In Liver Segment.
 The Dynamic Renal Phantom
We will discuss about Renal Dynamic Phantom.

Working With Renal Dynamic Phantom

At the beginning of the experiment, all individual parts of the phantom except BBd were
completely filled with water. Then water was allowed to circulate all over the system under
hydrostatic pressure through three loops heart–aorta flow, body–flow and liver–flow. The
phantom was placed under the gamma camera including the heart–liver–kidney– bladder
within the field of view sFOVd fully satisfying the clinical protocols. A Siemens Orbiter Digitrac
7500 gamma camera equipped with a low energy all-purpose sLEAPd collimator was used for
repeated studies. Each study was acquired with a 1283128 matrix in dynamic mode s1s 360
frames, 60 s330 frames; total time=31 mind. ROI counts were collected as before from all
concerned organs and data was analyzed with the same software program.
 A series of renogram curves total 225d were generated for different pair of flow rates
sfor LK and RKd within a range of 5 ml/min to 75 ml/min e.g.
5/75,5/70...10/75,10/70...75/75,75/70...ml/mind. For convenience, the ratio of each flow pair
was considered as LK/RK; i.e. LK was in the numerator all the time.
 A careful selection of the ROI is necessary to avoid excluding renal tissue or including
liver or spleen tissue. It was proposed in some studies that the error can be eliminated
significant by background subtraction if the ROIs were drawn slightly larger than the true kidney
size.5 Although various types of ROIs had been proposed by different investigators,31,32 lateral
ROI was recommended by the specialists.

Results
Figure 3(a) shows the curves generated with the same flow rate for both kidneys. As the
renogram curves were identical, only one curve for each flow rate was plotted. Figure 5 shows
plotting with a fixed flow rate s70 ml/mind in one kidney sLKd, and another sRKd gradually
decreasing s5 ml/mindin consecutive studies. The Tmax values for different pairs of flow rates
s5/75,10/70,15/65....ml/mind are shown in Figs. 6(a) and 6(b).
The RI values calculated from phantom studies are tabulated for all probable pair flow
s225 studies in Table II.
 Table III shows the average CPS per pixel for different organs sL–R kidneys, liver,
bladder, background normalized with respect to the corresponding heart-pixel counts for all the
groups. The normalized pixel counts for L–R kidneys and the bladder in the DTPA group were
found to be lower than those of the EC group, but the values for liver and background were
found higher. In general, the L–R kidney and bladder values of phantom studies were found to
be a little higher than those of the DTPA group but lower than those of the EC group. The values
for the liver and background of the phantom studies were found lower exception: the total CPS
is larger than that of the ECd than of both the DTPA and EC groups.

Table IV shows the level of significance associated with the correlation

coefficient srd calculated in terms of the total CPS values between two data sets of two
corresponding groups for all the concerned organs. A very high significant correlation sp,0.001d
was found both for the left and right kidneys between the EC group–phantom studies. A
significant correlation sp,0.01d was found for the liver and BKG between the EC group–
phantom studies and also for the liver between the DTPA–EC group as well.
 The renographic parameters Tmax, ½ peak time, percentage of tracer flow for L–R
kidneys for three groups and the percentage of difference of corresponding values between the
phantom and the other two groups are summarized in Table V. The phantom data are averaged
from consecutive phantom studies s10 times.

The coefficient of variation sCVd of the repeated symmetric studies with the phantom
Table VI expressed precision error. The considering parameters were Tmax, 1/2 peak time,
percent of flow %, maximum and total CPS values per pixel normalized with respect to the
heart-pixel count.
 The average values of different renographic parameters and the corresponding standard
deviations sSDd calculated from repeated s5 time’s case studies case: 1–2d, and the % of
difference with those of clinical data.

Conclusion
The dynamic tracer distribution over different organs of the phantom mimics that of the
physiologic renal system. This phantom can provide a quantitative measure of kidney
flow/excretion and is good for use in different purposes in Nuclear Medicine. Its working
principle is simple and user-friendly. All these properties of the phantom show its suitability of
use for standardization and quality control of the renogram procedures by multicenter
comparison among different Nuclear Medicine departments.