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Minimizing Activity and Dose with Enhanced Image quality by Radiopharmaceutical Administrations

Final Report Summary - MADEIRA (Minimising Activity and Dose with Enhanced Image quality by Radiopharmaceutical Administrations)

The MADEIRA project funded by the European Commission under contract No. 212100 within the 7th framework program has been a research project in the field of optimising medical imaging procedures in particular in nuclear medical imaging. It was performed by 7 partners, 6 from various member states of the EU (Germany, Italy, Sweden, Spain, Slovenia) and one partner from the USA.

There were three main approaches to the project goal of optimising nuclear medical imaging in terms of achievable spatial and temporal resolution as well as the exposure to the patient undergoing certain investigations:
- Biokinetic investigations and modelling to achieve knowledge about radiation exposures from such measures and optimise time schemes for it.
- Development of a new add-on hardware to existing PET systems for optimal read-out scenarios with higher spatial resolution in such investigations.
- Optimisation of new reconstruction techniques for gaining three-dimensional information from PET or SPECT imaging and their evaluation.

In addition to those scientific approaches the MADEIRA project initiated a large number of dissemination and education approaches very important to optimise medical imaging in general but also to allow a fast implementation of the results obtained. Among these one conference has been organised as well as three training courses. In addition one scientific text book was produced and two further ones are envisaged.

The project was able to provide new insight into the biokinetics of medical nuclear imaging procedures, to calculate relevant dose distributions in the body and to optimise time-schemes for better signal-to-noise ratios in the images for less radioactivity to be administered. The modelling, data gathering and uncertainty determination methodology developed within the framework of the MADEIRA project is intended for further developments to be used in personal dose assessment and dose optimisation on the individual patient level, so as a first step for personalising nuclear medical imaging (personalised medicine).

The add-on PROBE system for the PET system could finally be built and has been successfully been tested in a prototype surrounding. It will be necessary to perform further tests also in clinical systems, but the main concept and its feasibility could be approved. The predicted optimisation of the resolution could be achieved so that the next level of evaluation will hopefully be focussed on clinically relevant procedures requiring improved spatial resolution.

Within the image processing approach there was a lot of success in developing methods for testing the various approaches after adopting them to nuclear medical imaging procedures. A complete framework for such comparisons have been developed. Besides that software tool a new test phantom for nuclear imaging to test effectiveness and for quality assurance could be developed for which a patent application could be filed. Another patent application was filed for a completely new reconstruction scheme for nuclear medical imaging developed within the MADEIRA consortium. The conference as well as the training courses have been a great success story of the MADEIRA project and we are confident that the book series will be, too.

Putting the pieces together, the MADEIRA developments will provide possibilities to achieve images with higher spatial resolution and better signal-to noise ratios while decreasing radioactivity administered to the patient depending on the investigation by at least a factor of three we believe. There is a large number of especially clinical research activities to be conducted as a consequence of the MADEIRA project. It is a pity that this cannot be done within the framework of another EC funded proposal, but single partners will go on.

The project was managed very effectively using institutions like an Executive Board (EB) and a General Assembly (GA) in cooperation with the project management and coordination.

When dealing with cancer and other serious illnesses any improvement in the efficacy and availability of proper diagnostic procedures turns out into a benefit for the patients. Early diagnosis reduces mortality and increases not only the success probability of a therapy, but also the quality of life of the successfully treated patients. It may also have beneficial effects on minimising the high therapy costs. Diagnosis that provides information about;
- three-dimensional regional distribution of the cancer and of its functional activity;
- three-dimensional functional imaging of other illnesses
- type and staging of the disease to be treated in each specific case
- outcome of the therapy
is therefore very important.

Three-dimensional (3D) functional nuclear medicine imaging satisfies the above requirements. Especially the combination of today's PET and SPECT systems with CT scanners allows simultaneous acquisition of anatomical and functional information within one single diagnostic session, and this results in a more precise combination of the complementary information as well as in a reduced inconvenience for the patient. The use of these imaging procedures, which are based on the detection of radiation emitted by (or traversing/scattered from) the patient is however associated with a sometime significant radiation exposure of the patient. The introduction and continuous development of new diagnostic procedures based on CT, PET and SPECT imaging resulted thus in the last years in a rapid growth of the individual dose caused by medical exposures. The minimization of the dose to the patient is unfortunately often still considered a second-order problem, as image quality, and velocity and easiness of the examination are generally the criteria leading to the introduction of new procedures. The radiation protection issue is highly topical also for nuclear medical diagnosis, since in this case radiopharmaceuticals are administered to the patient, meaning not only a radiation exposure to the presumably cancerous tissue but also to the surrounding healthy tissues and to the other organs where the administered radioactive agent is distributed and deposited.

The aim of the MADEIRA project was to improve the efficacy and safety of 3D functional imaging by optimising the spatial resolution, the signal-to-noise ratio and the knowledge of the temporal variation of the radiopharmaceuticals' uptake in and clearance from tumour and healthy tissues. Specifically, it was intended to:
- develop a specific detector array system (magnifier probe) to be used as an add-on to conventional PET or PET/CT devices;
- develop and optimise two physics-based image processing tools for noise reduction and for image reconstruction and adapt them to nuclear medicine imaging;
- develop new time schemes for application and imaging of radiopharmaceuticals using pharmacokinetic modelling techniques;
- improve dose assessment by combination of realistic pharmacokinetic models to calculate activity distribution in the body and anthropomorphic voxel phantoms to calculate energy deposition in the tissues.

The approach developed in the frame of the Project will enable to guarantee or even improve the quality of the diagnostic information reducing the amount of administered activity, i.e. reducing the exposure to ionizing radiation and specifically the dose to the healthy tissues of the patient.

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