Imaging diagnostico in Sanità Stato attuale e prospettive

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Imaging diagnostico in Sanità Stato attuale e prospettive Sandro Paini AMI & Oncology Pisa 20.12.2016

Fully digital SiPM (dsipm ) invented within Philips Research PMT APD(analog) SiPM(Analog) dsipm( Digital) 70 years 30 years 8 years New technology Solid state

Detector Module Tile Die Pixel Micro-cell 4x4 mm pixel Veyron System has 18 Modules Ring: Means a tile length of PET ring 5

How Digital Photon Counting works The Digital Photon Counter converts scintillating light directly to a digital signal

Photons Now Photons are Counted Directly Output: > no. of photons > time stamp(s) No analog post-processing necessary!

Analog vs. Digital Photon Counting Over 50 times more detectors than analog detection systems. Analog Digital Photon Counter 420 detectors

The advantages of Digital Photon Counting 1:1 coupling Dramatically higher count rate Excellent timing resolution Faster Time of Flight performance Superb SUV quantification Improved contrast resolution

How today s analog detection works Photomultiplier tubes approximate the location of an event.

How today s analog detection works Photomultiplier tubes approximate the location of an event. As the signal is amplified, the electrical noise is also amplified causing a noisy output signal The intensity of the signals are averaged in order to estimate the origin of the signal. With a noisy signal and an inaccurate localization of the signal, the output of the PMT-based system is extremely inaccurate.

Technology to Clinical Performance.

Evolution of PET Concept & slide copyright: Piotr Maniawski

Digital Photon Counting Digital Time of Flight 1:1 Coupling Improved spatial resolution* Improved timing resolution* Improved count rate performance* * Analog (GEMINI TF ) to digital comparison

Digital Photon Counting 1:1 coupling. DPC reduces the traditional tradeoffs between sensitivity gains and resolution gains. Conventional block detector limitations Optically isolated for surrounding blocks PMTs are used to localize Light collection dropoff at edges of blocks Light collection variability with position

1:1 Coupling Multiple events overlapping 1:1 coupling 1 6

1:1 Coupling Resolution Factor of 2 volumetric resolution gain 3D, (axial*radial*tangential) 64 mm 3 PMTs dsipm 1:1 Uniform detector resolution across all detector surface Digital: Constant in axial direction PMT Tubes: worse resolution under the tubes and at the edges SR Digital PMTs Axial FoV (z) Bad counts vs. good counts No bad tail ; all are good counts for Vereos dsipm 1:1 PMTs Bad counts Good counts Bad counts 1 8

1:1 Coupling Resolution Improved spatial resolution seen with conventional clinical phantoms. 4.8 mm rods Digital Micro-Jaszczak (pre-clinical) Phantom Analog* *GEMINI TF 16 Deluxe Jaszczak Phantom

Time of Flight x = position uncertainty along LOR = c. t/2 Effective Sensitivity gain = D/ x t Time Resolution, D Diameter of Object; c light speed; x - position uncertainty Time Resoltuion (ps) Non-ToF 1000 550 495 345 300 100 Spatial Unceternity (cm) 15.0 8.3 7.4 5.2 4.5 1.5 Sensitivty Gain for 20 cm 1 1.3 2.4* 2.7* 3.9 4.4 13.3 Sensitivty Gain for 30 cm 1 2.0 3.6* 4.0* 5.8 6.7 20.0 Sensitivty Gain for 40 cm 1 2.7 4.8* 5.4* 7.7 8.9 26.7 *Sensitivity gains for analog technology need to be corrected for dead times 2 4

Digital Photon Counting Digital Time of Flight 1:1 Coupling 2x improved volumetric resolution* 2x sensitivity gain* 2x improved quantitative accuracy* * Analog (GEMINI TF ) to digital comparison

Digital Photon Counting 2x improved volumetric resolution*? Earlier detection Digital Time of Flight 2x sensitivity gain*? Lower dose 1:1 Coupling 2x improved quantitative accuracy*? Responders vs non-responders * Analog (GEMINI TF ) to digital comparison

Clinical Performance.

See further Analog PET scan * *GEMINI TF 16 Images courtesy of University Hospitals Cleveland

See further Superb spatial resolution provides exceptional detail in brain images. Vereos digital PET scan Images courtesy of University Hospitals Cleveland

See further Improved image contrast in evaluation of post-operative changes. Vereos Analog digital PET PET scan scan * Images courtesy of University Hospitals Cleveland

See further Superb spatial resolution provides improved detail in brain images. Images courtesy of University Hospitals Cleveland

34

Y-90 Microspheres preliminary GEMINI TF

Y-90 Microspheres preliminary - VEREOS

Oncology case 418 Total Body PET acquisition time: 81 seconds Investigational device, limited by United States law to investigational use

Designed for patient comfort

Vereos PET/CT Wins Global Design Award Praise for digital PET continues Vereos PET/CT wins if product design award 2014! Fondly nicknamed in the industry as the Design Oscars, the if Product Design is awarded annually by the if International Forum Design after reviewing more than 2,000 applications. In its 61st year, the if seal of good design is independently awarded to outstanding achievements in product, communication, and packaging design. Philips Design was instrumental in the new industrial product design of Vereos PET/CT. The design team utilized a whiter, fresher palette in order to create a new identity. Vereos PET/CT stands apart from the crowd with its patient-focused design elements such as the light ring around the system parameter, table elements including arm rests, and a rear zone where clinical staff can store and attach accessories. This project took almost two years to complete. The result is a simplified design that improves patient comfort and increases clinical staff pride.