Impact of Attenuation Correction, Collimator, and Iterative Reconstruction Protocols on 67Ga SPECT/CT Quantification

Purpose: The main goal of this study was to determine the optimal collimator in the absence of medium energy collimators along with the impact of Attenuation Correction (AC) and different iterative reconstruction protocols on the quantitative evaluation of Gallium-67 (67Ga) SPECT/CT imaging. Materials and Methods: A GE Discovery 670 dual-head SPECT/CT scanner and a NEMA phantom filled with 67Ga solution were used to scan the patients. The projections were acquired with both Low Energy High Resolution (LEHR) and High Energy General Purpose (HEGP) collimators, and CT images were acquired to evaluate the effect of attenuation correction. SPECT data were reconstructed using the ordered subset expectation maximization (OSEM) method with various combinations of iterations and subsets. The performance was quantified, and a clinical study validated the phantom study. Results: Acquired images by the HEGP collimator yielded higher Contrast Recovery (CR) and Contrast to Noise Ratio (CNR) in images with AC than those without non-AC (41.6% and 74.2%, respectively). The CNR in all spheres after AC was increased by 80.4% (82.1%) for the HEGP collimator against the LEHR collimator. Also, an increase in iterations × subsets from 16 to 48 led to the Coefficient of Variation (COV) increasing by 17.2%, 16.67%, 15.50%, 14.4%, 14.2%, and 14.1% for 10 mm to 37 mm sphere diameter, respectively. Conclusion: CT-based AC and HEGP collimators can yield improved 67Ga SPECT quantification compared to Non-AC and LEHR collimators. The choice of the optimal collimator with the reconstruction protocol led to changes in the image quality and quantitative accuracy, emphasizing the need to carefully select the appropriate combination of data acquisition factors.