Freehand SPECT in low uptake situations

3D functional imaging in the operating room can be extremely useful for some procedures like SLN mapping or SLN biopsies. Freehand SPECT is an example of such an imaging modality, combining manually scanned, hand-held 1D gamma detectors with spatial positioning systems in order to reconstruct localized 3D SPECT images, for example in the breast or neck region. Standard series expansion methods are applied together with custom physical models of the acquisition process and custom filtering procedures to perform 3D tomographic reconstruction from sparse, limited-angle and irregularly sampled data. A Freehand SPECT system can easily be assembled on a mobile cart suitable for use in the operating room. This work addresses in particular the problem of objects with low uptake (like sentinel lymph nodes), where reconstruction tends to be difficult due to low signal to noise ratio. In a neck-like phantom study, we show that four simulated nodes of 250 microliter volume with 0.06% respectively 0.03% uptake of a virtual 70MBq injection of Tc99m (the typical activity for SLN procedures at our hospital) in a background of water can be reconstructed successfully using careful filtering procedures in the reconstruction pipeline. Ten independent Freehand SPECT scans of the phantom were performed by several different operators, with an average scan duration of 5.1 minutes. The resulting reconstructions show an average spatial accuracy within voxel dimensions (2.5mm) compared to CT and exhibit correct relative quantification.