Journal of Nuclear Cardiology

, Volume 25, Issue 6, pp 2117–2128 | Cite as

Investigation of dose reduction in cardiac perfusion SPECT via optimization and choice of the image reconstruction strategy

  • Albert Juan RamonEmail author
  • Yongyi Yang
  • P. Hendrik Pretorius
  • Piotr J. Slomka
  • Karen L. Johnson
  • Michael A. King
  • Miles N. Wernick
Original Article



We investigated the extent to which the administered dose (activity) level can be reduced without sacrificing diagnostic accuracy for three reconstruction strategies for SPECT-myocardial perfusion imaging (MPI).


We optimized the parameters of the three reconstruction strategies for perfusion-defect detection over a range of simulated administered dose levels using a set of hybrid studies (derived from 190 subjects) consisting of clinical SPECT-MPI data modified to contain realistic simulated lesions. The optimized strategies we considered are filtered backprojection (FBP) with no correction for degradations, ordered-subsets expectation-maximization (OS-EM) with attenuation correction (AC), scatter correction (SC), and resolution correction (RC), and OS-EM with scatter and resolution correction only. Each study was evaluated using a total perfusion deficit (TPD) score computed by the Quantitative Perfusion SPECT (QPS) software package. We conducted a receiver operating characteristics (ROC) study based on the TPD scores for each dose level and reconstruction strategy.


For FBP, the achieved optimum values of the area under the ROC curve (AUC) at 100%, 50%, 25%, and 12.5% of standard dose were 0.75, 0.74, 0.72, and 0.70, respectively, compared to 0.81, 0.79, 0.76, and 0.74 for OS-EM with AC–SC–RC and 0.78, 0.77, 0.74, 0.72 for OS-EM with SC–RC.


Our results suggest that studies reconstructed by OS-EM with AC–SC–RC could possibly be reduced, on average, to 25% of the originally administered dose without causing diagnostic accuracy (AUC) to decrease below that of FBP.


SPECT Myocardial perfusion imaging dose reduction optimization 



Single-photon emission computed tomography


Myocardial perfusion imaging


Filtered backprojection


Ordered-subsets expectation-maximization


Attenuation correction


Scatter correction


Resolution correction


Area under the ROC curve


Total perfusion deficit


Coronary artery disease



This work was supported by the National Institutes of Health (NIH) Grant No. R01-HL122484. P.S. was also supported by the National Institutes of Health (NIH) Grant No. R01-HL089765. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. A preliminary version of this work was presented in part at the IEEE Medical Imaging Conference, Strasbourg, 2016, and published in the conference proceedings.28


The University of Massachusetts had a research agreement with Philips Healthcare at the time some of this work was performed. Cedars-Sinai Medical Center receives royalties for the quantitative assessment of function, perfusion, and viability, a portion of which is distributed to some of the authors of this manuscript (P.S.). A.J.R., Y.Y. and M.N.W. from the Illinois Institute of Technology have nothing to disclose.

Supplementary material

12350_2017_920_MOESM1_ESM.pptx (1.6 mb)
Supplementary material 1 (PPTX 1664 kb)


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Copyright information

© American Society of Nuclear Cardiology 2017

Authors and Affiliations

  • Albert Juan Ramon
    • 1
    Email author
  • Yongyi Yang
    • 1
  • P. Hendrik Pretorius
    • 2
  • Piotr J. Slomka
    • 3
  • Karen L. Johnson
    • 2
  • Michael A. King
    • 2
  • Miles N. Wernick
    • 1
  1. 1.Illinois Institute of TechnologyMedical Imaging Research CenterChicagoUSA
  2. 2.Department of RadiologyUniversity of Massachusetts Medical SchoolWorcesterUSA
  3. 3.Department of MedicineCedars-Sinai Medical CenterLos AngelesUSA

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