<p> Presentation for *MSc </p><p>Assessment of split renal function using 99mTc-DMSA planar scintigraphy in comparison with SPECT-CT imaging : Phantom study </p><p>Candidate: Muhammad Hadzmi Bin Yahya</p><p>Supervisor: Dr Wan Nordiana Binti W Abd Rahman Medical Radiation Programme, School of Health Sciences, USM</p><p>Co-supervisor’s: Dr Norazlina Binti Mat Nawi Medical Radiation Programme, School of Health Sciences, USM</p><p>FUNDING Funding for research: Short Term 304/PPSK/61313139 Funding for student: Self-Funding/MyBrain</p><p>1. INTRODUCTION Assessment of renal split function is a procedure to evaluate the kidney function that implements radioactive materials tagged with radiopharmaceutical and later scanned using gamma camera. Dimercaptosuccinic Acid (DMSA) tagged Tc-99m (Tc-99m-DMSA) is a commonly used radiopharmaceutical to observe renal failure in clinical imaging (Yee, Lee, & Blaufox, 1981). Conventionally, renal function is observed via planar scintigraphy technique with two positioning of special camera for imaging posterior and anterior view. However, current development in Single Photon Emission Computed Tomography (SPECT) that used a special technique (cutting image in slice) for assessment of radioactive emission from a body in combination with computed tomography could provide better assessment of split renal function (Delbeke et al., 2006). </p><p>2. PROBLEM STATEMENTS </p><p>Planar scintigraphy technique imposed some limitation in term of accuracy and detection specificity in the assessment of renal split function. New generation of gamma camera uses tomography technique that can overcome this limitation and provide better diagnostic image. In particular, SPECT-CT has better spatial confinement to separate kidney from background and give more detail information compare to planar scintigraphy (Tilling, 1981). Therefore, it is important to establish whether SPECT-CT technique could provide better outcome in the assessment of split renal function.</p><p>3. GENERAL AND SPECIFIC OBJECTIVES</p><p>3.1 General Objective: To investigate split renal function assessment using 99mTc-DMSA planar scintigraphy in comparison with SPECT-CT imaging.</p><p>3.2 Specific Objectives: a) To measure the percentage uptake ratio of phantom correction kidney depth by geometric mean based on planar scintigraphy , SPECT and SPECT-CT protocol. b) To measure total kidney counts using geometric mean of anterior and posterior projections to compensate for kidney depth (planar, SPECT and SPECT- CT). c) To calculate and compare the average and maximal absolute differences between the different data acquisition (planar, SPECT and SPECT- CT). d) To evaluate the split renal function using percentage renal uptake. e) To determine feasibility of SPECT-CT imaging for renal split function assessment.</p><p>4. METHODOLOGY</p><p>Elution Tc-99m from wet generator Tc-99m will be elutes from Moly-99 source in wet generator at the Nuclear Medicine Department at Hospital USM. A vial in a shielding was push toward elution needle to allow elution process of Tc-99m into the empty vial.</p><p>Quality Control for Tc Pertechnetate Moly assay will be performed using dose calibrator to determine amount of Moly-99 activities in the eluted Tc-99m. The amount of Moly-99 should be less than 0.15 µCi/mCi Tc-99m.Second test on the concentration of aluminium ion were performed based on aluminium standard solution drops on strip paper which the value must bot exceed 10µgram/ml in elution Tc-99m. Color intensity for Tc-99m must be lower than test solution intensity to be passed the quality control procedure of free pertechnetate and not toxicity to patient. </p><p>Preparation of Tc-99m-DMSA After confirming the Tc-99m activity, the tracer will be tagged to DMSA. A sterile and shielded syringe uses to inject TC-99m into reaction vial that contain the DMSA. The reaction vial will be briskly shaken to ensure the TC-99 m-DMSA mixtures are completely dissolved. The reaction vial will be incubated in room temperature for 15 minutes. </p><p>Quality Control of Tc-99m-DMSA ITLC paper strip are used to check the quality of TC-99m-DMSA using a type of solvent (acetone). 1 ml acetone of 20% NaCl is placed in an empty glass vial. ITLC-SA chromatography strip places in vial of 20% NaCl until the solvent migrated to top of strip paper. The chromatography papers are cut into sections (1 & 2) and the activity will be measured using dose calibrator. The percentage purity of TC-99m-DMSA complex of must be more than 90%. </p><p>Phantom Construction NEMA/IEC (NU 2-007) body phantom will be filled with water and a pair of plastic bottles that represent pair of human kidney. The phantom will be constructed with specific height, width and depth which are 24.1 cm, 30.5 cm and 24.1 cm. The pair of plastic bottles sizes is chosen to be close to human kidney size which is of height 10 cm and 4 cm diameter. </p><p>Location of Kidney Phantom Normal localization of pair plastic bottles (kidney phantom) is placed at same height level regarding cranio-caudal direction in same depth anterior and posterior view. Second localization of plastic bottles is dystopic geometry which is 5 cm bellow for left bottle and 8 cm ventrally to the right bottle. </p><p>Data Acquisition of Tc-99m in phantom The phantom background compartment and kidney phantom will be filled with radioactive source Tc-99m. 20 MBq of Tc-99m radioactive source will be added to phantom background and kidney will be filled with different activities of Tc-99m. Planar and SPECT acquisition will be performed using GE NM/CT 670 PRO machine. For planar acquisition (anterior and posterior projection), 300 kcts, low energy high resolution collimator (LEHR) , matrix sixe 256x256 pixels will be used. Meanwhile, SPECT acquisition consist 120 projections, 25s per projection, LEHR collimator and matrix 128 x 128 pixels. In this SPECT acquisition, scan will be performed with attenuation and without attenuation correction. </p><p>Calculation for planar scintigraphy (method A) Region of interest (ROI) on both projection and background study will be manually created. Using subtracting average value of corresponding background ROI will corrected for ROI kidney phantom study. Geometric mean of both projection use total kidney counts to compensate the value of kidney depth. Split renal function calculation based on these formulas: </p><p>(Equation 1) </p><p>(Equation 2) </p><p>Calculation for SPECT (method B1) and SPECT CT (method B2) </p><p>Locally developed software uses for tomography images assessment for data collection of method B1 and B2. This software employs the following algorithm for proper kidney segmentation and counts extraction from desired volumes of interest (VOIs). The spatial binary mask use to determine voxel belonging to VOI. Only the voxel with higher intensity get true mask value and contribute to the VOI. This step functions to separate kidney and background of phantom and apply spatial confinement to separate both kidneys (right and left kidney). All the voxel inside the sphere are true mask but outside the sphere are false mask. The spherical mask is conforming as a kidney but final step software is applied to fully conform. The VOI of particular kidney are representing true mask. Both formulas use for calculation total counts of volume of interest split renal function. </p><p>(Equation 3) Right = </p><p>(Equation 4) Left = </p><p>Data evaluation Normal kidney has split renal function ratio in the range of interval 50/50% - 55/45% and more than 55/45% as pathological finding. For normal kidney has normal localization on both planar and SPECT images with smooth outlines, no focal loss of renal parenchyma or contraction. </p><p>5.FLOW CHART </p><p>6.EXPECTED OUTCOMES</p><p>Split renal function assessment using SPECT-CT imaging provides better results and analysis of renal problem compare to planar scintigraphy.</p><p>7. GANTT CHART</p><p>Year 2016 2017 2018 Month O N D J F M A M J J A S O N D J F M</p><p>Topic Selection / Proposal Preparation / / Presentation of proposal / Phantom preparation / / Data Collection / / / Data Analysis / / / Thesis writing and / / / / / / / / / publication Thesis submission /</p><p>References</p><p>Biodex (2016). 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