WFU

2009年4月16日

第一篇 SPECT/CT 臨床論文是哪一篇呢?


有位相當支持核子醫學的臨床醫師,因為論文寫作需要,問我一個問題:「請問以 SPECT/CT 發表於臨床的第一篇論文為何?」

這位臨床醫師自己也查找許多相關文獻,但是對於 pure software-based 與 dedicated hardware-based functional and anatomical mapping(FAM)image 有點混淆。

一起來考古


當然,在我還是臨床醫師的階段,也搞不清楚這些差異,更何況核子醫學原本就是比較冷門的醫學。不過,她這個問題倒是引發我「考古」的興趣。


簡單來說,FAM image 或所謂的 fusion image,可以分成 pure software-based approach 或 dedicated hybrid hardware-based approach。

影像融合的兩大方向


Pure software-based approach,原則上是「事後」再把各種影像儀器產生的影像,利用 algorithms 或軟體把各類影像融合在一起;而 dedicated hybrid hardware-based approach 則是把兩類或多類影像儀器在硬體端整合在一起,「幾近」real-time 或者盡量不移動受檢者的狀態下,把各類影像融合在一起。

當然,這只是大致上的分類,因為所謂的 hardware-based image fusion 或 hybrid hardware system for image fusion,到最後還是得靠軟體來融合、修正或校準影像。

與 pure software-based image fusion 比較起來,藉由 dedicated hardware-based image fusion 的方式可以降低諸多種類的 fusion artifacts,讓 image co-registration 的程度更好。

關於 software-based image fusion 可以參考文章「Slomka PJ, Baum RP. Multimodality image registration with software: state-of-the-art. Eur J Nucl Med Mol Imaging. 2009 Mar;36 Suppl 1:S44-55」。


查找 hardware-based SPECT/CT 的歷史資料


在此,不考古 pure software-based FAM image/image fusion 的歷史由來,也不討論 pure software-based 和 dedicated hardware-based image fusion 的差異,而是嘗試利用目前手邊可及之資料,查找 dedicated hybrid/integrated hardware 的 hardware-based SPECT/CT 的歷史資料。

還有另一項重點是,這位臨床醫師問及「臨床」應用的部分,在這個所謂的「臨床」認定上,不知道醫學歷史的專家學者是否有共識?而且到底只是談硬體本身即可?還是說硬體得加上軟體(例如影像重組)分析才算是一個 system?這些認定,我覺得相當複雜。

不過,先查找資料看看,然後記錄下來,以備不時之需。至於諸類理則學或形而上的討論,就留待大家討論吧!


到底 SPECT/CT 第一篇臨床論文是哪篇呢?


依據「O' Connor MK, Kemp BJ. Single-photon emission computed tomography/computed tomography: basic instrumentation and innovations. Semin Nucl Med. 2006 Oct;36(4):258-66」這篇內文 pp. 259 來看:

Much of the early work on the development of a combined SPECT/CT unit was performed at University of California, San Francisco, by Dr Hasegawa and colleagues. Their initial work was focused on the development of a system that could perform simultaneous CT and SPECT studies……The initial goal of this work was to explore the possibility of using the x-ray data to perform attenuation correction of the SPECT data and to provide better region of interest definition for quantification of radiopharmaceutical uptake in a lesion. Because of the 3- to 4-h image acquisition time and the need to rotate the object being scanned, this system was only suitable for animal and phantom studies. However, this work was important because it highlighted, for the first time, the potential benefits of a single device capable of performing anatomical and functional imaging. They demonstrated that such a system was capable of performing attenuation correction and could permit accurate quantification of radiotracer activity in a porcine myocardium. This group was also the first to build a combined SPECT/CT system for clinical studies. This system used a single-slice CT scanner and a single-head large field of view gamma camera and was the forerunner of today's systems that combine a multidetector row CT (MDCT) system and dual-detector SPECT system.

反查參考文獻後,SPECT/CT 第一篇臨床論文應該是「Tang HR, Da Silva AJ, Matthay KK, Price DC, Huberty JP, Hawkins RA, Hasegawa BH. Neuroblastoma imaging using a combined CT scanner-scintillation camera and 131I-MIBG. J Nucl Med. 2001 Feb;42(2):237-47」。


至於 SPECT(SPECT 跟 SPECT/CT 差別在於 SPECT 沒有 X-ray CT)的第一篇臨床論文,是非常遙遠的歷史故事。

如果依據「Groch MW, Erwin WD. SPECT in the year 2000: basic principles.J Nucl Med Technol. 2000 Dec;28(4):233-44」這篇文章所述:

SPECT has become a routine procedure in most nuclear medicine departments since the concept was first introduced in the 1960s. The first single-head SPECT systems were developed in the mid 1970s using circular orbits and filtered backprojection reconstruction methods. In the 1980s, multihead SPECT systems were developed and orbits other than circular were introduced.

反查參考文獻後,SPECT 的第一篇臨床論文不是「Kuhl DE, Edwards RQ. Image separation radioisotope scanning. Radiology. 1963;80:653-662」或「Kuhl DE, Edwards RQ, Ricci AR, Yacob RJ, Mich TJ, Alavi A. The Mark IV system for radionuclide computed tomography of the brain. Radiology. 1976 Nov;121(2):405-13」,要不然就是「Keyes JW Jr, Orlandea N, Heetderks WJ, Leonard PF, Rogers WL. The Humongotron–a scintillation-camera transaxial tomograph. J Nucl Med. 1977 Apr;18(4):381-7」或「Jaszczak RJ, Murphy PH, Huard D, Burdine JA. Radionuclide emission computed tomography of the head with 99mCc and a scintillation camera. J Nucl Med. 1977 Apr;18(4):373-80」,端視相關定義為何,也或許有其他早的論文也說不定。

很謝謝這位臨床醫師的提問,但是精確的考古真的很累,還是留給醫學歷史學者慢慢考究囉!

附註: SPECT,single photon emission computed tomography;CT,computed tomography。上面的SPECT/CT 機器是大林慈濟醫院核子醫學科 GE Infinia Hawkeye 4。



2009-11-22

李友專教授:This is a very good article with nice pictures. I believe this will be very helpful to anyone who want to do some research in this field.


楊佑文老師:偶遇至此,很高興您對 SPECT 與 SPECT/CT 的歷史有興趣,我本身也是核醫從業人員,之前的研究也一直 focus 在 SPECT 上面,所以對這事情稍微有點涉獵。一般大家都公認 David Kuhl 是 SPECT 的先驅者(硬體),您可參閱「Citation for 2009 Japan Prize:Dr. David E. Kuhl (USA)」。後來 Duke 的 Ronald Jaszczak 跟 UNC 的 Benjamin Tsui 對 SPECT 的量化跟資料分析的貢獻很大,Dr. Ben Tsui 徐明華教授現在已搬到 JHU,他常回國,相信你應該有機會聽過他的演講。至於 SPECT/CT,一般則公推去年過世的 UCSF 的 Bruce Hasegawa,當初他用 GE 報廢借給他的 CT 跟 SPECT 拼在一起,有點像現在的 PET/CT 的概念,是兩段式的。Conference paper 先發表在 1991 IEEE NS/MIC 上,full paper 則在 1992 的 JNM,JNM 有一篇紀念他的文章,您可參考「Jones EF, Gould RG, VanBrocklin HF. Bruce H. Hasegawa, PhD, 1951-2008. J Nucl Med. 2008 Sep;49(9):37N-38N」。看到你這篇文章,不禁又讓人想這位老朋友。

邱建勳醫師:謝謝李教授的鼓勵,也謝謝楊老師提供這麼多的資料。未來也請多多指教、多多聯絡唷!