Abstract:
In single-photon emission computed tomography (SPECT), patients with bone disorders receive a radiopharmaceutical (RP) that accumulates selectively in pathological lesions. Accurate quantification of RP uptake plays a critical role in disease staging, prognosis, and the development of personalized treatment strategies. Traditionally, the accuracy of quantitative assessment is evaluated through in vitro clinical trials using the standardized physical NEMA IEC phantom, which contains six spheres simulating lesions of various sizes. However, such experiments are limited by high costs and radiation exposure to researchers. This study proposes an alternative in silico approach based on numerical simulation using a digital twin of the NEMA IEC phantom. The computational framework allows for extensive testing under varying conditions without physical constraints. Analogous to clinical protocols, we calculated the recovery coefficient (RCmax), defined as the ratio of the maximum activity in a lesion to its known true value. The simulation settings were tailored to clinical SPECT/CT protocols involving 99mTc for patients with bone-related diseases. For the first time, we systematically analyzed the impact of lesion-to-background ratios and post-reconstruction filtering on RCmax values. Numerical experiments revealed the presence of edge artifacts in reconstructed lesion images, consistent with those observed in both real NEMA IEC phantom studies and patient scans. These artifacts introduce instability into the iterative reconstruction process and lead to errors in activity quantification. Our results demonstrate that post-filtering helps suppress edge artifacts and stabilizes the solution. However, it also significantly underestimates activity in small lesions. To address this issue, we introduce post-reconstruction correction factors derived from our simulations to improve the accuracy of quantification in lesions smaller than 20 mm in diameter.
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