title: Implementation of an automated respiratory amplitude gating technique for PET/CT: clinical evaluation.
abstract: Amplitude gating techniques have recently been shown to be better at suppressing respiratory motion artifacts than phase gating. However, most commercial PET/CT scanners are equipped with phase gating capabilities only. The objective of this article was to propose and evaluate using patient studies an automated respiratory amplitude gating technique that could be implemented on current whole-body PET/CT scanners. A primary design feature of the proposed technique is to automatically match the respiratory amplitude captured during the CT scan with a corresponding amplitude during the PET scan.
  
  
  METHODS
  The proposed amplitude gating technique consists of a CT scan, followed by a list-mode PET scan. The CT scan was acquired while the patient's respiratory motion was recorded by a monitoring device that determined the respiratory motion amplitude captured during the CT scan. A program was designed to inject triggers into the PET list stream whenever the patient's respiration crossed a preset amplitude range determined by the captured amplitude during CT. To implement this proposed amplitude gating technique in whole-body PET/CT, a PET-first protocol was necessary to minimize the respiratory baseline drift between the CT and PET scans. In this implementation, a regular PET scan was first acquired over the patient's whole body but excluding the bed position that covered the lesion of interest. The whole-body CT scan was then acquired, followed by a list-mode PET acquisition over the bed position that covered the area of interest (lesion). The proposed amplitude gating technique was tested using 13 patients with 21 lung or thoracic tumors.
  
  
  RESULTS
  In the patient studies, the gated images-when compared with the ungated images-showed statistically significant improvements, with an average 27% and 28% increase in maximum and mean standardized uptake value, respectively, for all lesions. Furthermore, the tumors in the gated images showed better contrast using visual inspection and line profiles.
  
  
  CONCLUSIONS
  The implementation of the proposed respiratory amplitude gating technique on current PET/CT scanners is feasible, and amplitude-matched CT and PET data can be automatically generated using our proposed procedures without requiring patients to hold their breath or increase their radiation exposure.
authors.affiliation: Department of Electrical and Computer Engineering, Rice University, Houston, Texas, USA.
authors.forename: Guoping
authors.initials: G
authors.lastname: Chang
authors.forename: Tingting
authors.initials: T
authors.lastname: Chang
authors.forename: Tinsu
authors.initials: T
authors.lastname: Pan
authors.forename: John W
authors.initials: JW
authors.lastname: Clark
authors.forename: Osama R
authors.initials: OR
authors.lastname: Mawlawi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016477:Artifacts; D001331:Automation; D004576:Electromyography; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008171:Lung Diseases / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D015656:Respiratory Mechanics / Q000502:physiology*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D014915:Whole-Body Counting