QA - QC pada fasilitas

Imaging Kedokteran Nuklir (NM)

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Fasilitas (modalitas imaging)
pada Kedokteran Nuklir (NM)

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Typical Facility

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 Layout of a
nuclear medicine department

From high to low activity

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 QA
• Keseluruhan sistem manajemen mutu berupa
tindakan sistematik dan terencana untuk
mendapatkan kualitas informasi memadai
untuk menegakkan diagnosa, dengan:
– Konsistensi kualitas citra yg baik
– Dosis radiasi serendah mungkin (ALARA)
• QA approach : aspect medical, physical,
& safety

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 QC
• Serangkaian Uji atau test berhubungan
dengan kinerja peralatan dari aspek fisis &
teknis menyangkut: kualitas citra, dosimetri &
keselamatan pasien.
• Dilakukan:
– ACCEPTANCE TEST
– Rutin Periodik / konsistensi TEST

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 Acceptance Test
• Dilakukan pada saat alat baru selesai di instal.
• Tujuan:
– Pengecekan spesifikasi
– Mendapatkan data ‘baseline’ value kinerja alat

• Dilakukan oleh:
– Vendor
– MP (Medical Physicist)
– ME (Medical Engineering)
– Technologist (Radiographer)

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 Periodik test
• Dilakukan secara berkala atau setelah perbaikan mayor.
• Tujuan:
– Kesesuaian dengan data ‘baseline’ value
– Malfungsi alat diketahui sedini mungkin
– Akurasi kinerja alat tetap terjaga
– Maintence lebih terarah & terencana

• Dilakukan oleh:
– Daily QC – Radiografer, technologist
– Complex QC : MP, ME, Vendor

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 QC imejing Kedokteran Nuklir :
• Planar scintigrafi
• Spect/ PET CT
• Radiopharmaceutical
• Dose calibrator

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Planar Scintigrafi

Whole body planar imaging,

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 Planar Scintigrafi:
• Radiotracer
•Diinjeksikan secara Intravena
•Terakumulasi pd organ tertentu
•Display sesuai jml tangkapan (uptake)
•Gambar 2D planar
• Analisa
•Sebaran uptake
•Aplikasi, contoh:
•99mTc
•E 140 keV
•Whole body planar imaging, screening tumor
•Contoh lain : uptake tyroid, renogram

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Dynamic Renal Scan

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 SPECT
Detektor gamma camera digerakkan seputar obyek yg diperiksa

Karakteristik citra: fungsional organ > anatomis

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 SPECT
(Single Photon Emission Computerized Tommography)

• Teknik
•Beberapa detector/ head gamma camera
•Bergerak mengelilingi tubuh pasien
•Data dg atenuasi yg berbeda dirubah dg algoritma
•Gambar 2D
• Analisa
•Gambar serial 2D
•Aplikasi, contoh:
•Myocardial Perfusion (nuclear cardiac stress test)
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Myocardial Perfusion

Karakteristik citra: fungsional organ > anatomis

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 ECG GATED SPET/PET

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 SPECT / CT

Kombinasi dalam satu gantry yang sama

(image fusing)
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PET (Positron Emission Tommography)
• Teknik
•Injeksi radiotracer, emisi positron dari tubuh
•+ elektron, terjadi anihilasi
•Muncul 2 foton 511 keV
•Deteksi 2 foton coincidence
•Gambar 2D
•Rekonstruksi 3 D
•Kelebihan
•SNR > SPECT
•Resolusi spatial > SPECT
•Memerlukan cyclotron !!!
Rubidium-82, Nitrogen-13 Ammonia, and F-18 fluorodeoxyglucose

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cyclotron

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Coincidence Detection PET

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 PET – CT (hybrid)
• PET :
• Hasil imaging bersifat fungsional organ / jaringan
(jaringan aktif mempunyai sinyal lebih kuat)
• informasi posisi dan anatomis kurang memadai
• CT
•Hasil imaging bersifat anatomis
•Sangat bergantung pada perbedaan penyerapan
radiasi oleh bahan (µ)
•Dengan memadukan PET-CT didapatkan informasi yg
lebih baik berhubungan dg anatomis & fisiologis.

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 Hybride PET - CT

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Hibride : more Useful & complementary clinical information
Lung cancer

colorectal cancer
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 PET
Umumnya digunakan 18 F

PET-CT (hybrida)

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 practical
QC Planar Scintigrafi:
• Daily
•Uniformity (flood field, with and wit out collimator)
•Background
•Energy Window setting
• weekly
•Spatial resolution
•linearity
•Periodik ,< 1 yr
•Collimator performance
•Count rate linearity
•Energy resolution

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 uniformity

•Mengukur respon camera dari radiasi yg uniform pada permukaan detector

•Idealnya respon detector adalah citra yang uniform

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Energy window setting

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 Spatial resolution

•Mengukur kemampuan camera memisahkan visualisasi dari struktur obyek yg

berdekatan
•Dari obyek berbentuk garis

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 SPATIAL RESOLUTION
Object Image

Intensity

•Mengukur kemampuan camera memisahkan visualisasi dari struktur obyek yg

berdekatan
•Dari obyek berbentuk titik 38
 Resolution - distance

Optimal Large distance

FWHM

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 Linearity

•Mengukur kemampuan camera memvisualisasikan sumber

berbentuk garis ≥ dalam dua arah

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Pixel size

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Contoh hasil pengujian:

NON UNIFORMITY

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 NON UNIFORMITY

Cracked crystal

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 NON-UNIFORMITY

(Contamination of collimator)

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 NON UNIFORMITY
RING ARTIFACTS

Good uniformity Bad uniformity

Difference

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 NON-UNIFORMITY

Defect collimator
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 NOISE

Count density

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 QC PET/ SPECT CT:
• Acceptance test
- Very important to set reference
values against which routine tests
values will be compared
• Constancy tests
- Daily tests
- Weekly tests
- Quarterly tests
- Yearly tests

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 Center of Rotation

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Tilted detector

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 CT acceptance test:
• Electricity safety
• Mechanical safety
• Laser safety
• Radiation safety
• Mechanical Accuracy
- Alignment of indicating lights with scan,
- Couch travel accuracy
- Gantry tilt accuracy
• Dosimetry
- CT Dose Index
- Dose profile
• Imaging Performance
• Noise & Field Uniformity
• CT Number linearity
• Spatial Resolution
• Distance accuracy
• Image Artefact
- Radiation Survey
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 • Mechanical Performance
- Alignment : light vs scan
- Couch travel accuracy
- Gantry tilt accuracy

0.50 Max gantry tilt 56

 Dosimetry
Measurement in water phantom
Measurement in air

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Imaging Performance

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 Survey Radiasi
• Perisai radiasi sekunder pd CT
• Controlled area
P : 10 mR/ week
• Uncontrolled area
P : 2 mR/ week

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 QC PET/ SPECT CT:
• Daily Checks
- Blank scan
- CT number calibration
• Weekly
- Registration
- Spatial resolution
• Quarterly
- Distortion
- Sensitivity Good blank Bad
- Set up and normalization scan block
- CT, HU-physical density calibration
• Annually
- CT QC

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 Annual QC
• CT number accuracy
• CT number uniformity
• CTDI
• Irradiated slice thickness (dose profile)
• High contrast spatial resolution
• Imaged slice thickness
• Light and scan plane alignment accuracy
• Table top incrementation
• Couch travel accuracy (spiral scan)

• ImPACT, IPEM 77

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Image resolution vs mA.s

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Radiopharmaceutical

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 QC on FDG
• 20-30 minutes following production
• QC for sterility, pyrogens, radiochemical purity,
radionuclide purity, chemical purity, pH, clarity
and particulates

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 99mTc Radionuclide Purity
• the Mo/ Tc generator equate Tc
• The set limit is 0.15μCi of Mo
activity per 1.0 mCi of Tc activity in the
administered dose.

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 Technetium generator

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 Use of Reference Standard

FDG

100% radiochemical
purity

Glucose

FDG Spike with known standard

to identify peak

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Terima kasih !!!

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