Universal Medical Device Nomenclature System

Scanning Systems,Gamma Camera

Purpose

Gamma cameras are used to produce images of the radiation generated by radiopharmaceuticals within a patient’s body in order to examine organ anatomy and function and to visualize bone abnormalities.The wide variety of radiopharmaceuticals and procedures used allows evaluation of almost every organ system.In addition to producing a conventional planar image(a two-dimensional image of the three-dimensional ra-diopharmaceutical distribution within a patient’s body),most stationary gamma camera systems can also produce whole-body images(single head-to-toe skeletal profiles)and tomographic images(cross-sec-tional slices of the body acquired at various angles around the patient and displayed as a computer-recon-structed image).

SPECT is most commonly used for whole-body bone imaging,brain perfusion studies,and cardiac imaging; 30%of SPECT procedures are

cardiac studies.Through sequential image acquisition,the gamma camera can image blood flow to various organs,including the brain,

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Telephone+1(610)825-6000q Fax+1(610)834-1275q E-mail hpcs@https://www.wendangku.net/doc/936997472.html, Scope of this Product Comparison

This Product Comparison covers single-detector

and multidetector stationary and mobile gamma

cameras(formerly called Anger or scintillation

cameras). Most of the systems listed are capable

of single photon emission computed tomography

(SPECT),also called single photon emission to-

mography,and some are capable of dual-head

coincidence imaging with F-18fluorodeoxyglu-

cose(FDG),a radiopharmaceutical used in posi-

tron emission tomography(PET)imaging.For

more information on PET,see the Product Com-

parison titled SCANNING SYSTEMS,POSITRON

EMISSION TOMOGRAPHY.

UMDNS information

This Product Comparison covers the following

device terms and product codes as listed in ECRI’s

Universal Medical Device Nomenclature System?

(UMDNS?):

?Scanning Systems,Gamma Camera,Mobile

[16-891]

?Scanning Systems,Gamma Camera,Planar

Imaging[16-892]

?Scanning Systems,Gamma Camera,Single

Photon Emission Tomography [18-444]

Dual-head stationary gamma camera

lungs,liver,kidneys,and bones.It also helps physi-cians detect and identify lesions,such as cysts,tumors, hematomas,and infarcted tissue,as well as areas of altered osteogenesis and abnormalities of the cortex and white matter.In addition,the gamma camera can work in tandem with a computer to evaluate cardiac function and perfusion— for example,SPECT gamma cameras can perform myocardial perfusion imaging with thallium-201and technetium-99m.SPECT is also used to detect femoral head avascular necrosis, knee osteoarthritis,metastatic liver disease,temporo-mandibular joint abnormalities,and deep-seated small hemangiomas,as well as to assess bone metabo-lism in hyperparathyroidism and thyrotoxicosis.Such techniques reduce the need for interventional radiog-raphy,thereby circumventing its associated morbid-ity.Brain SPECT is being used in the prognosis of strokes,acquired immunodeficiency syndrome(AIDS) dementia complex,psychiatric diseases,and Parkin-son’s disease.One study indicates that FDG-SPECT is as effective as PET in detecting myocardial viability and diagnosing certain malignant tumors(Martin et al. 1995).

Coincidence imaging is useful for certain neurologic, oncologic,and cardiac applications.FDG tomography performed in coincidence mode has been shown to be successful in detecting occult primary tumors in head and neck carcinoma and useful in guiding endoscopic biopsies(see Périé et al. 2000).

Mobile gamma camera images facilitate the assess-ment of cardiac function and perfusion in patients with impending myocardial infarction(MI),as well as in those who have suffered acute MI.Bedside evaluation of these and other critically ill patients greatly reduces the need to transport them by stretcher to a stationary gamma camera system.

Principles of operation

The gamma camera detects and counts photons emanating from a target organ and maps individual scintillation events in a spatial configuration that cre-ates an image of the organ.Static images display data acquired at a specific point during an exam,and dy-namic images display a change in data measurements over time.A gamma camera system is composed of a collimator,a thallium-activated sodium iodide (NaI[Tl])crystal detector,photomultiplier tubes (PMTs),electronic circuitry to determine the location and magnitude of scintillation events,an imaging com-puter,and an operator console.An integral computer and/or a separate image acquisition,processing,and display workstation is also used.Whole-body imaging requires either a track-mounted movable detector that passes over the patient or a patient table that moves beneath a stationary detector.SPECT systems require a mechanical gantry to support and rotate the camera head and collimators in a circular,body-contour,or elliptical orbit.Noncircular orbits allow the camera head to be closer to the body,thereby improving spatial resolution.

Two energy-matter interactions are important to conventional gamma camera imaging:the photoelec-tric effect and Compton scattering.In photoelectric interactions,an incident(incoming)photon with slightly more energy than the binding energy of a k-shell electron encounters one of these electrons and ejects it from its orbit;because all its energy is im-parted to the orbital electron,the photon disappears in the vicinity of the nucleus.The ejected photoelec-tron possesses kinetic energy equal to the energy from the incident photon minus the energy required to eject the electron from its orbit.The resultant vacancy in the k-shell is filled by an l-or m-shell electron,which gives up energy in the form of an x-ray photon.The energy of radiation produced by the movement of elec-trons within an atom is characteristic of each element and is therefore called characteristic radiation.

Compton scattering results from a collision between a high-energy incident photon and a loosely held outer-shell electron.The incident photon transfers some of its energy to the electron,which is ejected from its orbit by the collision.Because incident photons cannot transfer all their energy to the orbiting electron, Compton scattering always produces an ion pair— a positive ion and the ejected negative electron(called a recoil electron) —and always results in the formation of a scatter photon.An incident photon frequently initiates a chain of Compton reactions and photoelec-tric absorption events,which result in the sequential degradation of photon energy.

Because gamma photons cannot be bent using lenses,as light can,a collimator is used to selectively absorb unwanted radiation; only photons traveling along the desired path are allowed to pass through to the detector.The collimator is usually made of a heavy-metal absorber such as lead,with some tung-sten or platinum parts.The basic types used in con-ventional gamma camera imaging are pinhole, parallel-hole,diverging,and converging collimators.

The pinhole collimator,which works much like a pinhole camera,is a lead cone with a small aperture at the tip.Gamma rays passing through the pinhole produce an inverted image that can be magnified or minified,depending on the length of the cone and the distance of the organ from the aperture. Pinhole colli-mators are best suited for magnification imaging of

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small, thin structures,such as the thyroid.Most have a removable aperture insert that allows changes in aperture size;a smaller aperture produces sharper images but also reduces sensitivity and increases im-aging time.

The parallel-hole collimator,the most widely used, is a disk-shaped piece of lead up to a few inches thick containing many parallel holes perpendicular to the collimator surface.The projected image is the same size as the source distribution onto the detector. Gamma rays leaving the organ almost perpendicular to the collimator face pass through to the detector; all other rays are absorbed by the walls(septa)of the collimator holes.The use of high-energy radionuclides requires thicker septa to absorb unwanted photons and to keep photons from crossing from one hole to the next;however,thicker septa are not as efficient be-cause they allow fewer photons to pass.Collimators used specifically with low-energy radionuclides have lead foil septa that are only a few tenths of a millimeter thick and thus are very fragile.Hole length and diame-ter also affect performance:collimators with long,nar-row holes provide better resolution but sacrifice efficiency.Septal materials with high atomic numbers and high density provide the best results.Lead is by far the most popular material because of its cost and availability,although tungsten,tantalum,and gold have some limited research applications.For maxi-mum versatility,gamma cameras usually come equipped with several parallel-hole collimators,in-cluding a low-energy all-purpose(LEAP)collimator for imaging photons of up to150keV,as well as low-en-ergy high-resolution(LEHR)and medium-energy all-purpose(MEAP)collimators for imaging photons of up to 1 MeV.

The diverging collimator has angled holes that di-verge from a point40to50cm behind the collimator.

A minified image of source distribution is projected onto the detector.Particularly useful when imaging large organs with a standard field of view detector(e.g., lung scanning with a portable gamma camera),the diverging collimator effectively increases the diameter of the detector field of view by approximately one-third.

The converging collimator has angled holes that converge at a point40to50cm in front of the collimator. The image is magnified but not inverted,provided that the organ is between the collimator face and the con-vergence point.At the convergence point,images are reduced;beyond it,they are magnified but inverted. Some gamma cameras have a single collimator with a removable center insert that allows both diverging and converging collimation.Specialty collimators,such as seven-pinhole,rotating slant-hole,fan beam,and coded-aperture collimators,are also available;most are used primarily for tomographic cardiac imaging.

The collimator projects radiation from the organ to be imaged onto the NaI(Tl)crystal,which converts incom-ing gamma ray photons into visible light energy.The scintillation process involves a series of Compton colli-sions in the NaI(Tl)crystal,each producing a scattered photon of lesser energy and a Compton recoil electron that excites the NaI(Tl)electrons in its path and causes them to scintillate(produce a flash of light)at an inten-sity proportional to the energy of the incident photon. The scattered photon reacts with another crystal atom, produces another scattered photon and recoil electron, and causes more scintillations until the photons lose enough energy to be photoelectrically absorbed.Lower-energy photons undergo fewer interactions before ab-sorption and produce fewer scintillations.

Because most scintillations occur in the front part of the detector,thin crystals provide better resolution by bringing the light flashes closer to the PMTs.How-ever,thin crystals allow more incident photons to pass through without being absorbed;therefore,the number of scintillations is reduced.The crystals of most units are9.5mm(3/8inch)thick;however,cam-eras equipped for coincidence imaging have thicker crystals,typically15.9mm(5/8inch)thick.Crystal dimensions range from25×25cm(10×10inches)to 52×64cm(201/2×25inches).Because sodium iodide (NaI)absorbs water,a hermetically sealed aluminum housing covers the sides and front of the crystal.The back is sealed by a clear Lucite light pipe or is optically coupled directly to the face of the PMTs.

The light pulse created by the incident photon is converted into an electrical signal of quantifiable mag-nitude by the PMT array,which can be composed of37 to more than150PMTs arranged hexagonally(al-though several manufacturers use rectangular ar-rays).Each PMT has a preamplifier,a simple circuit that allows the PMT to be tuned so that each yields the same output for a given scintillation intensity,ensur-ing uniform detector performance throughout the en-tire field of view.Several cameras have an automatic tuning option that electronically balances PMT output from a single control on the operator console.

The light photons strike the photocathode in the PMT and form photoelectrons that are then directed through a series of10to12dynodes,which boost the signal.The output is sent to a position-encoding cir-cuit,which determines the two-dimensional location of the scintillation event and encodes this position as four signals:x,x-,y,and y-.These signals are com-bined to form two signals that are transmitted to a

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summation amplifier.All the light pulses viewed by the PMTs are summed into one pulse,which is trans-mitted to a pulse height analyzer(PHA)that accepts only those pulses within a predetermined range of energies.Pulses accepted by the PHA are transmitted to the cathode ray tube(CRT),and the electron gun, turned on for a few microseconds,passes a beam through deflector plates to be guided to coordinates on the CRT screen that match the actual scintillation coordinates in the crystal.

Mobile gamma cameras

In mobile gamma cameras,the system components are configured in one of two ways.In one configuration, the detector and wheeled detector stand are separate from the data processing console,which is also mounted on wheels;each component is manually pushed to the patient’s bedside and interconnected by coaxial or fiberoptic cable.In another configuration, the detector,detector stand,and data processing con-sole are integrated into a single,motor-driven, wheeled unit powered by rechargeable batteries. Either a chain drive or a friction wheel mechanism delivers power to the system’s wheels.Images stored by these systems can be transferred to a workstation via floppy disk or Ethernet connection at a later time.

The principles of operation and image acquisition for mobile cameras are identical to those for stationary models.

SPECT

Apart from some basic models and those intended only for whole-body studies,most stationary and some mobile gamma cameras can perform SPECT,a nuclear medicine technique used to create a three-dimensional representation of the distribution of an administered radiopharmaceutical.SPECT cameras detect only ra-dionuclides that produce a cascaded emission of single photons;the technology is thus distinguished from PET,which uses radionuclides that simultaneously produce two high-energy photons at180°from each other.(See the Product Comparison titled SCANNING SYSTEMS,POSITRON EMISSION TOMOGRAPHY.) FDG,a radiopharmaceutical used for PET studies, is also used as an imaging agent for SPECT.FDG-SPECT,also called511keV or positron-emitting SPECT,has been used with dual-or triple-head SPECT systems fitted with specially designed high-en-ergy collimators that optimize relative resolution and sensitivity.Clinical applications include the detection of cancerous tumors greater than or equal to2cm in diameter,studies of the viability of damaged heart tissue,and brain imaging.Some manufacturers cur-rently offer optional 511keV collimators.

SPECT systems can be configured with one,two,or three camera heads.Single-head gamma camera sys-tems have one detector mounted on a specialized me-chanical gantry that automatically rotates the camera 360°around the patient.SPECT systems acquire data in a series of multiple projections at increments of two or more degrees.(In limited-angle systems,the camera is moved a limited number of times,usually six.)From the sequence of projection,an image is reconstructed by an algorithm called filtered back projection:after nontarget data is mathematically removed or sup-pressed (filtered)for each view, the reconstructed, three-dimensional image is derived from back projec-tion,which composites the multiangled,two-dimen-sional views and projects them onto a computer matrix.The projection data is combined to produce transverse(also called axial or transaxial)slices;sagit-tal and coronal image slices can also be produced through mathematical manipulation of the data.

SPECT systems with multiple camera heads are also available.In a dual-head system,two180°-op-posed camera heads are used,and acquisition time is reduced by half with no loss of sensitivity;a triple-head SPECT system further improves sensitivity(Patton 2000).Some suppliers also offer variable-angle dual-head systems for improved positioning during cardiac, brain,and whole-body imaging.One supplier offers a triple-head system with the detectors grouped in pairs electronically for coincidence https://www.wendangku.net/doc/936997472.html,bining this configuration with improved signal processing im-proves sensitivity significantly.Imaging times can be decreased by using another SPECT configuration— a ring of detectors completely surrounding the patient.

Mobile gamma

camera

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Although multiple camera heads reduce acquisition time,they do not significantly shorten procedure/exam time because of factors such as patient preparation and data processing.

Image processing

System software allows a variety of image process-ing protocols,many of which are user defined.Some of the more popular general software applications pro-vided by manufacturers are image smoothing,nor-malization,and interpolation;image addition or subtraction;background subtraction;contrast en-hancement;cyclic display of sequential images(cine); region-of-interest construction and display;curve or histogram construction and display;and creation of alphanumeric overlays.Cardiac applications include first-pass acquisition;multigated acquisition;auto-matic edge detection;determination of end-systolic and end-diastolic volumes,stroke volume,cardiac out-put,global ejection fraction,regional ejection fraction, and pulmonary transit time;shunt quantification; thallium perfusion profiles;and rest/exercise thallium image comparison.

Electrocardiographic synchronizers are often of-fered as optional equipment for gamma cameras.They are used in gated-acquisition studies to synchronize image collection with the cardiac cycle defined by elec-trocardiogram R waves.The beginning of the R wave triggers the synchronizer to signal the start of data collection.The computer divides the interval between R waves into equal subdivisions,usually between16 and32.During each cardiac cycle,data is stored in the corresponding subdivisions so that a composite image of the cycle can be developed;a number of quantitative and qualitative assessments are then possible. Reported problems

Gamma camera systems have certain limitations in image linearity,image uniformity,intrinsic and ex-trinsic spatial resolution,and efficiency.

Because of limitations in detector electronics, straight-line objects may appear curved:areas directly in front of the PMTs are subject to pincushion distor-tion(inward bowing of lines),whereas areas between the tubes undergo barrel distortion(outward bowing), neither of which is usually clinically significant.Im-age intensity can also vary—for example,pincushion distortion tends to concentrate signals in the center of the PMT,resulting in areas of increased intensity at each PMT location.

Improperly balanced PMTs and imperfections in-herent in the NaI(Tl)crystal can also contribute to field nonuniformity.Edge packing occurs when scintillation photons near the edge of the crystal reflect off the inside of the aluminum housing into the outer-edge PMTs,resulting in a field of view outlined by a ring of increased intensity.Some cameras eliminate this ring by electronically creating an iris that masks edge packing but reduces the field of view by a few centime-ters.

Optical problems can occur if hydrated spots—small white spots caused by water absorption—de-velop on the surface of the NaI(Tl)crystal;these spots scatter or absorb light and cause a loss of light in some scintillation events.Off-peak testing can reveal these defects in aged crystals.

Variations in spatial resolution are usually caused by statistical fluctuations in the distribution of light photons between PMTs.These fluctuations can be as great as one standard deviation from one scintillation to the next.Intrinsic spatial resolution also depends in part on crystal thickness;thicker crystals allow pho-tons to spread out before reaching the PMTs. In addi-tion,lower-energy gamma rays produce fewer photons, causing greater statistical fluctuations and therefore decreased spatial resolution.

Extrinsic spatial resolution is a function of collima-tor and detector resolution and,surprisingly,is less than either one alone.Because collimator resolution decreases with increasing distance from the source, extrinsic resolution also decreases.Differences in resolution between gamma cameras, although detect-able on bar-phantom performance checks,are seldom clinically significant.

A gamma camera cannot efficiently detect high-en-ergy gamma photons because they pass through the thin crystal before being absorbed and produce fewer scintillations.Detector efficiency is also limited by dead time(a period of a few microseconds during which a scintillation is processed and no other scintillations can be recorded)and pulse pileup,both of which can be clinically significant in high-count-rate dynamic studies,such as first-pass cardiac function analysis.

SPECT image quality can be limited by Compton scatter and attenuation of the radiation beam as it travels through the patient.The patient’s body size and anatomic structure(e.g.,amount of soft tissue, chest or breast size)affect the degree of scatter and https://www.wendangku.net/doc/936997472.html,pton scatter reduces the contrast in SPECT images.Recently,more advanced scatter cor-rection techniques have been introduced to minimize the effect of Compton scatter on data acquisition.At-tenuation is caused by the weakening of the radiation beam produced by the radiopharmaceutical as it

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passes through the patient’s body.Attenuation correc-tion techniques to reduce or eliminate artifacts have also been introduced by some manufacturers.These techniques use hardware that transmits a controlled radiation beam to the detector(s)during data acquisi-tion.The signals produced from the control beam and the radiation beam produced by the radiopharmaceu-tical are integrated,and patient-specific attenuation is calculated.These new attenuation correction tech-niques are primarily used in cardiac imaging.Defects in collimators can cause sensitivity loss,longer acquisition times,errors in image reconstruc-tion,and image artifacts.Collimators should be checked for proper angulation,sensitivity contrast,and center-of-rotation offset variations.

Quality control procedures should be established for planar and SPECT imaging systems to ensure proper operation and creation of the highest-quality images possible for the equipment used.Daily tests should include energy peaking and intrinsic uniformity;in-trinsic sensitivity and resolution/linearity should be tested weekly.In addition,center-of-rotation,uniform-ity correction,and motion correction testing should be performed for SPECT systems.For further informa-tion,see the American Society of Nuclear Cardiology 1996guideline article cited below (see Bibliography ).To obtain optimal image quality,careful attention should be paid to selecting the appropriate imaging protocol or test,patient position,and collimator.The crystal and the detector assembly of a mobile gamma camera can be damaged during transport through hospital corridors.

Purchase considerations

ECRI recommends that buyers consider the number of nuclear medicine studies that will be performed before deciding on a specific system configuration.Multihead systems allow faster acquisition times and better image resolution than single-head systems.However,the cost of a dual-head or triple-head system can be double or triple that of a single-head system.In addition,purchasers should keep in mind that,al-though multihead cameras have faster acquisition times,their use will not necessarily result in a signifi-cantly greater throughput because other factors, such as patient preparation time,remain unchanged.Purchasers should also consider the clinical appli-cations for which the new system will be used.For example,a dual-head camera is ideal for single-pass whole-body bone scanning and general SPECT.How-ever,for cardiac SPECT,a dual-head camera with opposing detectors offers little advantage over a sin-gle-head camera,since SPECT data is typically ac-quired in a 180°arc,with most of the data acquired by one detector.A variable-angle dual-head camera,which allows the detectors to be positioned at 90°,101°,or 180°relative to each other,offers a more efficient configuration for hospitals planning to perform a wide range of studies.Whole-body bone scans and general SPECT studies can be performed with the detectors positioned at 180°,and cardiac scans and certain other procedures can be performed with the detectors posi-tioned at 90°or 101°.Triple-head cameras are more commonly used for brain SPECT and cardiac SPECT;they can collect all image data for a heart scan in about one-third the time of a single-head camera and are well suited for nuclear medicine departments that conduct numerous stress thallium or cardiac studies.

Most cameras have a 51×38cm (20×15inch)rectangular large field of view (LFOV),and some pro-vide an ultralarge 61×38cm (24×15inch)field of view.LFOV cameras cover larger areas of the body and acquire a complete study in less time,thereby increasing patient throughput.

Hospitals planning to purchase more than one gamma camera or purchase additional cameras for a nuclear medicine department should consider whether the new equipment can interface with their existing nuclear medicine computers and other cameras and can therefore be integrated into one comprehensive network.In addition,hospitals should consider pur-chasing multiple systems from one supplier.Stand-ardizing equipment can make staff training easier,simplify servicing and parts acquisition,and provide greater bargaining leverage when negotiating the pur-chase of new equipment and/or service contract costs.

Triple-head stationary gamma

camera

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Other purchase considerations include the dimen-sions and weight of the system and humidity and temperature requirements.

Many gamma camera scanning systems incorporate the American College of Radiology/National Electrical Manufacturers Association Digital Imaging and Com-munications in Medicine(DICOM)3.0Standard into their scanning systems.The purpose of this standard is to allow digital images produced by any medical device to be stored and transferred through picture archiving and communication systems or other means, regardless of the device supplier.When purchasing a mobile gamma camera system,careful attention should be given to selecting optional features,the type and number of which can greatly affect the final pur-chase price.For instance,an onboard computer can significantly increase the cost of a system.

In addition to FDG-SPECT,some commercially available gamma camera systems are capable of coin-cidence imaging,previously limited to PET.Coinci-dence imaging with a gamma camera could provide an opportunity to expand applications of existing equip-ment and to obtain PET-like images with a multiuse system at a lower cost than that of a dedicated PET system.Hospitals should consider the acquisition cost, performance specifications,number of procedures to be performed using FDG,and availability of FDG. Certain radioisotopes emit two identical gamma rays in opposite directions;coincidence imaging techniques allow the measurement of these gamma rays.With the coincidence imaging technique,both SPECT and coin-cidence imaging(without heavy511keV collimators) can be performed using one camera.

Cost containment

Because gamma cameras entail ongoing mainte-nance and operational costs,the initial acquisition cost does not accurately reflect the total cost of ownership. Therefore,a purchase decision should be based on issues such as life-cycle cost(LCC),local service sup-port,discount rates and non-price-related benefits of-fered by the supplier,and standardization with existing equipment in the department or hospital(i.e., purchasing all gamma cameras and computers from one supplier).

An LCC analysis can be used to compare high-cost alternatives and/or to determine the positive or nega-tive economic value of a single alternative.For exam-ple,hospitals can use LCC analysis techniques to examine the cost-effectiveness of leasing or renting equipment versus purchasing the equipment outright. Because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time,LCC analysis is most useful for comparing alter-natives with different cash flows and for revealing the total costs of equipment ownership.One LCC tech-nique— present value(PV)analysis — is especially useful because it accounts for inflation and for the time value of money(i.e.,money received today is worth more than money received at a later date).Conducting a PV/LCC analysis often demonstrates that the cost of ownership includes more than just the initial acquisi-tion cost and that a small increase in initial acquisition cost may produce significant savings in long-term op-erating costs.The PV is calculated using the annual cash outflow,the dollar discount factor(the cost of capital),and the lifetime of the equipment(in years) in a mathematical equation.

The following represents a sample six-year PV/LCC analysis for a dual-detector digital gamma camera with an integral computer.

Present Value/Life-Cycle Cost Analysis

Assumptions

?Operating costs are considered for years1through6?Dollar discount factor is6.25%

?Inflation rate is6% for a full service contract ?Inflation rate is4% for disposables

?Operating and ownership costs are for1gamma camera,with2,000procedures/year in years1and

2 and 2,200procedures/year in years

3 through6?Staff costs are for2full-time nuclear medicine tech-nologists(years1through6)and1part-time technolo-gist(years3through6),including salary,benefits, payroll expenses,and continuing education

Capital Costs

?Gamma camera and computer= $600,000?Coincidence imaging in year2 = $350,000?Hardware and software upgrade for attenuation correction algorithm in year2 = $55,000

Total Capital Costs=$600,000initially;$405,000 in year2

Operating and Ownership Costs

?Service contract for years2through6= $49,000/year

?Salary and expenses for2full-time technologists in years1 through6 =$90,000/year

?Salary and expenses for1part-time technologist in years3 through6 =$20,000/year

?Cost of Nuclear Regulatory Commission licensing= $20,000/year

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?Cost for accessories,such as syringes,film,and optical disks,at$15/procedure=$30,000/year in years1 and 2; $33,000/year in years3 through 6?Cost for radiopharmaceuticals at$250/dose= $500,000/year in years1and2;$550,000/year in years3 through6

Total Operating Costs=$640,000in year1;$689,000 in year2;$762,000/year in years3through6

PV =($5,124,582) Other factors not included in the above analysis that should be considered for budgetary planning include the following:

?Costs associated with software upgrades

?Cost of utilities

?Cost of other accessories,such as phantoms and patient monitoring equipment

?Contributions to overhead

?Reimbursements received from third-party payers for standard procedures

As illustrated by the above sample PV/LCC analy-sis,the initial acquisition cost is only a fraction of the total cost of operation over six years.Therefore,before making a purchase decision based solely on the acqui-sition cost of a gamma camera,buyers should consider operating costs over the lifetime of the equipment.

For further information on PV/LCC analysis,cus-tomized analyses,and purchase decision support, readers should contact ECRI’s SELECT TM Group.

When deciding whether to upgrade current gamma cameras to obtain PET-like images,hospitals should consider the following costs:

?Up to$350,000for a coincidence upgrade to a dual-detector gamma camera

?$750,000to$900,000for a new dual-detector gamma camera that performs SPECT and coinci-dence imaging

?$800/dose for the FDG radioisotope

Hospitals can purchase service contracts or service on a time-and-materials basis from the supplier.Serv-ice may also be available from a third-party organiza-tion.The decision to purchase a service contract should be carefully considered and can be justified for several reasons.Most suppliers provide routine software up-dates,which enhance the system’s performance,at no charge to service contract customers.Furthermore, software updates are often cumulative;that is,pre-vious software revisions may be required in order to install and operate a new performance feature.Pur-chasing a service contract also ensures that preventive maintenance will be performed at regular intervals, thereby eliminating the possibility of unexpected maintenance costs.Also,many suppliers do not extend system performance and uptime guarantees beyond the length of the warranty unless the system is covered by a service contract.

ECRI recommends that,to maximize bargaining leverage,hospitals negotiate pricing for service con-tracts before the system is purchased.Depending on the added cost and the contract conditions,hospitals may want to negotiate for coverage of the crystal(s)to be included in the service contract.A few suppliers offer“no questions asked”crystal coverage,while other suppliers will cover the crystal only under certain conditions.

Additional service contract discounts may be nego-tiable for multiple-year agreements or for service con-tracts that are bundled with contracts on other systems in the department or hospital.Service con-tracts should include a guarantee of at least two pre-ventive maintenance inspections per year,a guarantee of at least 95%uptime,and specified response time to service requests.

In addition,given the current highly competitive nuclear medicine market,hospitals should negotiate for a significant discount— some suppliers may dis-count up to40%.The actual discount received will depend on the hospital’s negotiating skills and/or pre-vious experience with the supplier,the system configu-ration and options to be purchased,and the extent of concessions granted by the supplier,such as extended warranties,fixed prices for annual service contracts, and guaranteed on-site service response.Buyers should make sure that applications training is in-cluded in the purchase price of the system.Some suppliers offer more extensive on-site or off-site train-ing programs for an additional cost.

To aid in installation planning, two facilities in the United Kingdom have applied virtual-reality tech-niques to planning a gamma camera suite before pur-chase and installation.A virtual-reality computer system was used to model existing and new gamma camera rooms to identify design problems(e.g.,re-stricted bed access and camera movements due to equipment placement).The study(Penrose et al.1996) suggests that virtual reality can be used successfully for planning and installation of gamma camera suites, as well as for nuclear medicine pharmacies and mag-netic resonance imaging suites.

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Stage of development

The Anger scintillation camera was developed in the 1950s and introduced commercially in the1960s.In the late1980s,multihead SPECT cameras were intro-duced,and in early1994,FDG imaging agent for SPECT was introduced.Other significant develop-ments include decreased imaging times,faster and more powerful computers,new radiopharmaceuticals, new collimators for ultrahigh-resolution imaging,vari-able-angle capabilities,and digital features.

Many suppliers are now marketing digital gamma cameras that perform analog-to-digital conversion, either within each PMT or immediately after the sig-nal leaves the PMT.By digitizing the signal at this point,signal averaging,which affects image resolu-tion,can be computer controlled.Because digital de-tection provides more precise event-positioning information,detector performance characteristics, such as maximum count rate,intrinsic spatial resolu-tion,intrinsic energy resolution,intrinsic uniformity, and system sensitivity,are improved.Software-con-trolled operation of digital cameras also improves sys-tem reliability and allows use of remote diagnostics for servicing.

One manufacturer has introduced a mobile camera that uses new solid-state detectors constructed of cad-mium zinc telluride(CZT)that replace the crys-tal/PMT structure currently used in other cameras. The solid-state CZT detectors directly convert gamma rays to electrical pulses.The entire system is approxi-mately the size of an ultrasound scanner.The smaller detector head has a20×20cm field of view for organ-specific imaging, although whole-body data can be acquired by scanning sections.

Clinical applications research is focused on breast cancer imaging and expanded cardiology,oncology, and neurology applications.Scintimammography,a technique that uses a gamma camera to image the breasts of a patient injected with technetium-99m-ses-tamibi(a radioisotope traditionally used for cardiac imaging),was recently introduced as an adjunct to conventional mammography.Initial research suggests that scintimammography may be useful for imaging patients who have dense breasts,who have had breast surgery,or who have radiotherapy-altered breasts. Because the radioisotope identifies malignancies,scin-timammography may also prove useful for targeting malignant tumors,thereby reducing the need for bi-opsy.(See the Product Comparison titled RADIO-GRAPHIC UNITS,MAMMOGRAPHIC;STEREOTACTIC SYSTEMS,BIOPSY,MAMMOGRAPHIC for more informa-tion on mammography.)

Research into cardiac SPECT and brain SPECT is focused on the development of new imaging agents, including radiopharmaceuticals,monoclonal antibod-ies,and peptides,as well as on new applications of dual-isotope imaging with multihead cameras.Mono-clonal antibodies,which may prove useful for early detection and staging of tumors and ovarian,colorec-tal,prostate,and lung cancers,have not been used clinically on a regular basis.Peptide imaging agents are under development for tumor,thrombus, atherosclerotic plaque,and infection imaging and are more promising because they are safer and less expen-sive than monoclonal antibodies.

Additional efforts are focused on evaluating the effectiveness of FDG-SPECT compared to PET.Cur-rently,reimbursement for FDG-SPECT cannot be ob-tained using existing billing codes for nuclear medicine studies under PET.In the United States,the Centers for Medicare and Medicaid Systems(CMS)will recon-sider the reimbursement of FDG-SPECT after Decem-ber31,2002.CMS will determine if the FDG-SPECT technology is equivalent in performance and diagnos-tic quality to a full-ring dedicated PET system.

A camera system designed for standard SPECT imag-ing can be upgraded to perform FDG-SPECT,allowing the same equipment,personnel,and space to be used for all SPECT procedures,including FDG-SPECT.How-ever,the clinical usefulness of FDG-SPECT may be limited by the spatial resolution of SPECT and the need for a gamma camera system that can support the heavy (>400lb)high-energy collimators.FDG is now available from distribution centers,and small cyclotrons targeted at producing radiopharmaceuticals are also available. Continued developments in radiopharmaceuticals,as well as expanding applications,should increase the at-tractiveness of multihead SPECT.

Bibliography

American Society of Nuclear Cardiology.Imaging guidelines for nuclear cardiology procedures.In-strumentation quality assurance and performance.

J Nucl Cardiol1996May-Jun;3(3):G5-10.

Blust J.Gamma camera acceptance testing:the first quality control.J Nucl Med Technol1994Jun;22

(2):58-60.

Brice J.Dual-head SPECT lifts nuclear medicine mar-ket.Diagn Imaging1994Jan;16(1):29,33-4.

Brice J,ed.Nuclear medicine:market trends and clini-cal practices in the U.S.[Diagnostic Imaging tech-nology report;vol.2,no.2].San Francisco:Miller Freeman;1993Fall.

Cameras, Gamma

?2002ECRI.Duplication of this page by any means for any purpose is prohibited.9

Drane WE,Abbott FD,Nicole MW,et al.Technology for FDG SPECT with a relatively inexpensive gamma camera.Work in progress.Radiology1994 May;191(2):461-5.

Early PJ,Sodee DB.Principles and practice of nuclear medicine.2nd ed.Philadelphia:Mosby-Year Book;1995.

Eisner RL.Principles of instrumentation in SPECT.J Nucl Med Technol1985Mar;13(1):23-31.

English RJ,Brown SE.SPECT:single-photon emis-sion computed tomography:a primer.2nd ed.New York: Society of Nuclear Medicine;1990. Feldkamp MJ.SPECT quality improvement[commen-tary].J Nucl Med Technol1994Mar;22(1):35-8.

Forstrom LA,Dunn WL,O’Connor MK,et al.Techni-cal pitfalls in image acquisition,processing,and display.Semin Nucl Med1996Oct;26(4):278-94. Howarth DM,Forstrom LA,O’Connor MK,et al.Patient-related pitfalls and artifacts in nuclear medicine im-aging.Semin Nucl Med1996Oct;26(4):295-307.

Keszthelyi-Lándori S.NaI(Tl)camera crystals:imag-ing capabilities of hydrated regions on the crystal surface.Radiology1986Mar;158(3):823-6. Lummis RC,Wexler https://www.wendangku.net/doc/936997472.html,works in nuclear medi-cine.Semin Nucl Med1994Jan;24(1):66-74.

Martin WH,Delbeke D,Patton JA,et al.FDG-SPECT: correlation with FDG-PET.J Nucl Med1995 Jun;36(6):988-95.

O’Connor MK.Instrument-and computer-related problems and artifacts in nuclear medicine.Semin Nucl Med1996Oct;26(4):256-77.

Patton JA.Instrumentation for coincidence imaging with multihead scintillation cameras.Semin Nucl Med2000Oct;30(4):239-54.

Penrose JM,Trowbridge EA,Tindale WB.The virtual gamma camera room.Nucl Med Commun1996 May;17(5):367-72.

PériéS,Talbot JN,Monceaux G,et https://www.wendangku.net/doc/936997472.html,e of a coinci-dence gamma camera to detect primary tumor with 18fluoro-2-deoxy-glucose in cervical lymph node me-

tastases from an unknown origin.Ann Otol Rhinol Laryngol2000Aug;109(8):755-60.

Schraml FV,Driver DR,Randolph T,et al.PET versus SPECT for determining myocardial tissue viability using fluorine-18-fluorodeoxyglucose.J Nucl Med Technol1997Dec;25(4):272-4.Superconductor detector array could revolutionize nu-clear medicine imaging.Radiol Imaging Lett1995 Jun 1;15(10):74-5.

U.S.Department of Energy.Nuclear Regulatory Com-mission.Licenses for radiography and radiation safety requirements for radiographic operations.10 CFR Part34. 1988.

Wells CP,Buxton-Thomas M.Gamma camera pur-chasing.Nucl Med Commun1995Mar;16(3):168-

85.

Yoshizumi TT,Suneja SK,Teal JS,et al.Defective parallel-hole collimator encountered in SPECT:a suggested approach to avoid potential problems[let-ter].J Nucl Med1990Nov;31(11):1892-3.

Zickler P.Digital imaging:nuclear medicine’s new hope.Med Imaging1995Feb;10(2):42-50. Standards and guidelines

Note:Although every effort is made to ensure that the following list is comprehensive,please note that other applicable standards may exist.

American Academy of Neurology.Assessment of brain SPECT.Therapeutics and Technology Assessment Subcommittee.Neurology1996Jan;46(1):278-85. American Association of Physicists in Medicine. Com-puter-aided scintillation camera acceptance testing [report].Nuclear Medicine Committee Task Group.

Catalog9. 1981.

Quantitation of SPECT performance[report].Nu-clear Medicine Committee Task Group#4.Catalog

52.Med Phys1995Apr;22(4):401-9.

Rotating scintillation camera SPECT acceptance testing and quality control[report].Nuclear Medi-cine Committee Task Group.Catalog 22. 1987.

Scintillation camera acceptance testing and per-formance evaluation[report].Nuclear Medicine Committee.Catalog 6. 1980.

American College of Cardiology. Radionuclide scin-tirenography in the evaluation of patients with hyper-tension[position statement].Hypertensive Diseases Committee.J Am Coll Cardiol1993Mar;21(3):838-9. American College of Radiology.Cardiovascular nu-clear medicine guidelines[policy statement].1981 (reaffirmed 1991).

Single photon emission computed tomography[pol-icy statement].1986(revised 1996).

Healthcare Product Comparison System

10?2002ECRI.Duplication of this page by any means for any purpose is prohibited.

American Heart Association.Guidelines for clinical use of cardiac radionuclide imaging.Task Force on Assessment of Diagnostic and Therapeutic Cardio-vascular Procedures.Catalog G01.J Am Coll Cardiol1995Feb;25(2):521-47.

International Electrotechnical Commission.Charac-teristics and test conditions of radionuclide imaging devices: Anger type gamma cameras [standard].

IEC60789 (1992-02). 1992.

Medical electrical equipment—part1:general re-quirements for safety[standard].IEC60601-1 (1988-12).1988.

Medical electrical equipment—part1:general re-quirements for safety.Amendment1[standard].

IEC60601-1-am1(1991-11). 1991.

Medical electrical equipment—part1:general re-quirements for safety.Amendment2[standard].

IEC60601-1-am2(1995-03). 1995.

Medical electrical equipment—part1:general re-quirements for safety.Section1.Collateral standard: safety requirements for medical electrical systems.

IEC60601-1-1(1992-06).1992.

Medical electrical equipment—part1:general re-quirements for safety.Section1.Collateral standard: safety requirements for medical electrical systems.

Amendment1[standard].IEC60601-1-1-am1(1995-

11).1995.

Medical electrical equipment—part1:general re-quirements for safety.Section2.Collateral standard: electromagnetic compatibility — requirements and tests.IEC60601-1-2(2001-09).2001.

National Electrical Manufacturers Association.Per-formance measurements of scintillation cameras [standard].1986(revised2001).

Citations from other ECRI publications

Health Devices

Leaving SPECT patients unattended[hazard].1986 Jun;15(6):177-8.

Falling detector on Elscint Apex SP-4M gamma cam-era[hazard report].2000Oct;29(10):378.

Health Devices Alerts

This Product Comparison lists Health Devices Alerts (HDA)citations published since the last update of this report.Each HDA abstract is identified by an Acces-sion Number.Recalls and hazard reports include de-scriptions of the problem involved;abstracts of other published articles are referenced by bibliographic in-formation.HPCS subscribers can call the Hotline for additional information on any of these citations or to request more extensive searches of the HDA database. A4381FDA has designated Class II Recall No.Z-0294-1for certain SMV planar image gamma cameras. Incorrect sensing of the scanner’s collimator latching mechanism may cause the collimator to latch incor-rectly.Incorrect latching could cause the collimator to disengage and fall onto the collimator cart during the loading and unloading process.The distributor initi-ated a recall by letter dated September6,2000.Verify that you have received the September6,2000,letter from SMV America.Identify any affected product in your inventory.Ensure that end users of the system understand the instructions provided in the letter. Following the instructions will minimize the possibil-ity of a collimator loading incorrectly.Source:FDA Enforcement Rep2001Mar14; Distributor.

A4536FDA has designated Class II Recall Nos.Z-0769/0771-1for certain Siemens single photon emission gamma cameras.Under specific conditions,Icon and e.soft workstations can incorrectly orient acquired pa-tient data in SPECT mode in the above systems.This problem occurs only when switching from Coincidence mode to SPECT mode on the e.cam system via the Patient Positioning Monitor(PPM)while an acquisition protocol is running on the Icon and e.soft workstations. The incorrect orientation may cause the displayed image to be reversed either left to right or top to bottom.This problem does not occur when switching the mode in the reverse direction.The manufacturer issued a safety alert/advisory letter dated April20,2001.Verify that you have received the April20,2001,safety alert/advisory letter and acknowledgment form from Siemens Medical. To avoid the potential for incorrect orientation of patient data when using computed tomography(CT)systems with Icon workstations,the manufacturer states that you must include the following steps in your clinical routine when switching from Coincidence mode to SPECT mode:(1)Select the“File/Quit”menu option.(2) Switch from Coincidence mode to SPECT mode via the PPM.(3)Remove the coincidence collimators from the e.cam.(4)Install the desired noncoincidence collimators for the next patient acquisition.(5)Relaunch the Icon acquisition software by double-clicking on the“ICON”application on the desktop.When using CT systems with e.soft workstations,the manufacturer states that you must include the following steps when switching from Coincidence mode to SPECT mode:(1)Before removing the coincidence collimators,switch from Coincidence mode to SPECT mode via the PPM.(2)Remove the coincidence collimators from the e.cam system.(3)Install the desired noncoincidence collimators for the next pa-tient acquisition.(4)Launch the desired acquisition

Cameras, Gamma

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workflow for the next patient.Source:FDA Enforce-ment Rep2001Sep5;Manufacturer.

Health Technology Trends

One,two,or three heads for SPECT?1991Dec;3(12):8. Hospital gets PET-like images without PET scanner.

1994Jul;7(6):4-5.

Gamma camera used to obtain PET-like images;re-sults mixed.1995Apr;8(4):3.

New smaller,lighter solid-state gamma camera revo-lutionizes nuclear medicine.1999Jan;11(1):11-2. Supplier information

Chart A:Mobile Gamma Cameras

Digirad

Digirad Corp[328751]

9350Trade Pl

San Diego CA 92126-6334

Phone: (858)578-5300, (800)947-6134

Fax:(858)549-7714

E-mail:info@https://www.wendangku.net/doc/936997472.html,

Internet:https://www.wendangku.net/doc/936997472.html,

Mediso

Mediso Ltd[186785]

Alsotorkvesz uitz14

H-1022Budapest

Hungary

Phone: 36 (1) 3993030

Fax:36 (1) 3993040

E-mail:info@mediso.hu

Philips

Philips Medical Systems (Asia Pacific)

Cardiac&Monitoring Systems Div[398048]

24/Fl Cityplaza One

1111King’s Road

Taikoo Shing

Hong Kong SAR

People’s Republic of China

Phone: 852 ********

Fax:852 ********

Internet:https://www.wendangku.net/doc/936997472.html,

Philips Medical Systems (Europe)

Cardiac&Monitoring Systems Div[398047]

Herrenberger Strasse124

D-71034Boeblingen

Germany

Phone: 49 (7031)4641552

Fax:49 (7031)4644096

Internet:https://www.wendangku.net/doc/936997472.html,

Philips Medical Systems North America [102120] 22100Bothell Everett Hwy

PO Box3003

Bothell WA98041-3003

Phone:(425)487-7000, (800)526-4963

Fax:(425)485-6080

E-mail:info@https://www.wendangku.net/doc/936997472.html,

Internet: https://www.wendangku.net/doc/936997472.html,

Chart B:Stationary Gamma Cameras

GE Medical Systems

GE Medical Systems Asia[300443]

4-7-127 Asahigaoka

Hino-shi

Tokyo

Japan

Phone:81 (3)425855451

Internet: http://www.gemedical.co.jp

GE Medical Systems Co Inc(Malaysia)[401861] UBN Tower25/Fl

No10 Jalan P Ramlee

50250Kuala Lumpur

Malaysia

Phone:60 (3)2382344

Fax:60 (3)2389315

E-mail:info@https://www.wendangku.net/doc/936997472.html,

Internet: https://www.wendangku.net/doc/936997472.html,

GE Medical Systems Europe [171319]

283rue de la Miniere

boite postale34

F-78533Buc Cedex

France

Phone:33 (1)30704040

Fax:33 (1)30709998

Internet: http://www.gemedicalsystems

https://www.wendangku.net/doc/936997472.html,/frfr/

GE Medical Systems Information Technologies [393577]

8200W Tower Ave

Milwaukee WI53223-3219

Phone:(414)355-5000

Fax:(414)355-3790

Internet: https://www.wendangku.net/doc/936997472.html,

Mediso

Mediso Ltd[186785]

Alsotorkvesz uitz14

H-1022Budapest

Hungary

Phone:36 (1)3993030

Fax:36 (1)3993040

E-mail:info@mediso.hu

Healthcare Product Comparison System

12?2002ECRI.Duplication of this page by any means for any purpose is prohibited.

NeuroPhysics

NeuroPhysics Corp[234813]

900 Mount Laurel Circle

Shirley MA01464

Phone: (978)425-6371

Fax:(978)425-6154

E-mail:info@https://www.wendangku.net/doc/936997472.html,

Internet:https://www.wendangku.net/doc/936997472.html,

Philips

Philips Medical Systems (Asia Pacific)

Cardiac&Monitoring Systems Div[398048]

24/Fl Cityplaza One

1111King’s Road

Taikoo Shing

Hong Kong SAR

People’s Republic of China

Phone: 852 ********

Fax:852 ********

Internet:https://www.wendangku.net/doc/936997472.html,

Philips Medical Systems (Europe)

Cardiac&Monitoring Systems Div[398047]

Herrenberger Strasse124

D-71034Boeblingen

Germany

Phone: 49 (7031)4641552

Fax:49 (7031)4644096

Internet:https://www.wendangku.net/doc/936997472.html,

Philips Medical Systems North America [102120] 22100Bothell Everett Hwy

PO Box 3003

Bothell WA98041-3003

Phone: (425)487-7000, (800)526-4963

Fax:(425)485-6080

E-mail:info@https://www.wendangku.net/doc/936997472.html,

Internet:https://www.wendangku.net/doc/936997472.html,

Siemens

Siemens AG

Siemens Medical Solutions[401832]

Hartmannstrasse48

91052Erlangen

Germany

Phone: 49 (9131)844190

Fax:49 (9131)845400

E-mail:jochen.kirsch@https://www.wendangku.net/doc/936997472.html,

Internet:https://www.wendangku.net/doc/936997472.html,

Siemens Canada Ltd[174735]

2185Derry Rd W

Mississauga ON L5N7A6

Canada

Phone: (905)819-8000, (888)303-3353

Fax:(905)819-5777

E-mail:doug.morton@siemens.ca

Internet:http://www.siemens.ca

Siemens Medical Solutions USA Inc

Nuclear Medicine Group [399200]

2501N Barrington Rd

Hoffman Estates IL 60195-5203

Phone: (847)304-7700, (800)767-2313

Fax:(847)304-7707

E-mail:bkm@med.siemens.de

Internet:https://www.wendangku.net/doc/936997472.html,/med

Toshiba

Toshiba America Medical Systems Inc[101894]

2441Michelle Dr

PO Box 2068

Tustin CA92780-7047

Phone: (714)730-5000, (800)421-1968

Fax:(714)832-2570

E-mail:jpowers@https://www.wendangku.net/doc/936997472.html,

Internet:https://www.wendangku.net/doc/936997472.html,

Toshiba Medical Systems Co Ltd[139511]

3-26-5Hongo

Bunkyo-ku

Tokyo113-0033

Japan

Phone: 81 (3) 38182061

Fax:81 (3) 38157215

Internet:https://www.wendangku.net/doc/936997472.html,

Toshiba Medical Systems Europe bv [160817]

Zilverstraat1

NL-2718 RP Zoetermeer

The Netherlands

Phone: 31 (79)3689222

Fax:31 (79)3689444

Internet:https://www.wendangku.net/doc/936997472.html,

Toshiba Medical Systems Singapore [307328]

211 Henderson Rd #08-02

Henderson Industrial Park

Singapore159552

Republic of Singapore

Phone: 65 2729766

Fax:65 2726083

Internet:https://www.wendangku.net/doc/936997472.html,

Cameras, Gamma

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Note:The following company did not provide us with any product information in time for publication.Its address is listed as a service to our readers.

Gamma Medica Inc

19355Business Center Dr

Suite 8

Northridge CA 91324

Phone: (818)709-2468, (877)426-2633

Fax:(818)709-2464

E-mail:info@https://www.wendangku.net/doc/936997472.html,

Internet:https://www.wendangku.net/doc/936997472.html,

About the chart specifications

This report includes two charts.Chart A covers mobile gamma cameras;Chart B covers stationary models.

Many of the performance characteristics listed in the charts are measured according to National Electri-cal Manufacturers Association standards.The purpose of these standards is to provide a uniform set of criteria by which manufacturers can measure and report their respective systems’performance.These standards are not intended for use in acceptance testing at the instal-lation site or as part of routine quality control testing by the user.

The following terms are used in the charts: Crystal dimensions,cm(in):A single dimension for this specification represents a diameter.

UFOV,cm(in):Useful field of view—for a hexagonal or circular crystal,the circular area with a diameter the same as that of the largest inscribed circle in a colli-mated field of view;for a rectangular crystal,the rectangular area with dimensions the same as those of the largest inscribed rectangle in a collimated field of view.In the charts,a single number indicates a diameter for a circular or hexagonal crystal.

Spatial resolution:The ability to accurately determine the original location of a gamma event in an x-y plane. System sensitivity,LEAP,counts/min/μCi:The ability to efficiently convert gamma photons to count and position data for imaging.

Intrinsic energy resolution,FWHM,140keV:The ability to accurately isolate and identify the radionuclide photopeak and distinguish it from secondary or scattered radiation events.

Intrinsic spatial linearity,mm:Integral linearity is the ability to present x-y data without positional distor-tion.Differential linearity is a measure of the posi-tional distortion over a predefined distance. Intrinsic uniformity,uncorrected:Integral uniformity is the detector’s ability to maintain a constant count

density over a predefined distance when exposed to

a uniform or homogeneous gamma photon flux over

the field of view.Differential uniformity is a meas-ure of the rate of count density change over a prede-fined distance.

Collimators:The following abbreviations are used to describe the collimators offered with the gamma cam-era. Acronyms not defined below may be proprietary collimators specific to a certain manufacturer.

511keV—Collimators for511keV(FDG-SPECT) imaging

FB—Fan beam,a specialized converging collimator HE—High energy

HEGP—High-energy general-purpose

HEHR—High-energy high-resolution

HR—High resolution

LE—Low energy

LEAP—Low-energy all-purpose

LEGP—Low-energy general-purpose

LEHR—Low-energy high-resolution

LEHS—Low-energy high-sensitivity

LEUHR—Low-energy ultrahigh-resolution

LEUHS—Low-energy ultrahigh-sensitivity

MEAP—Medium-energy all-purpose

MEGP—Medium-energy general-purpose

MEHR—Medium-energy high-resolution

SHEGP—Superhigh-energy general-purpose

UHE—Ultrahigh energy

UHR—Ultrahigh resolution

WRME—Wide-range medium-energy

List price,std configuration:Some of the pricing infor-mation in these charts has been derived from list prices reported to ECRI’s in-house information serv-ices by healthcare institutions and by suppliers.A footnote identifies these prices.In these instances, suppliers have declined to provide HPCS directly with prices and may not have confirmed the infor-mation.These prices are estimates and may or may not reflect discounts,options,special packages,and multiple-unit sales.They are provided for the con-venience of our readers.

Healthcare Product Comparison System

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Other abbreviations:

ADC—Analog-to-digital converter

BTU—British thermal unit

CD—Compact disc

CD-R—Recordable compact disc

CD-RW—Rewritable compact disc

CE mark—Conformite Europeene mark

CFOV—Central field of view

cps—Counts per second

CPU—Central processing unit

DICOM—American College of Radiology/National Electrical Manufacturers Association Digital Im-aging and Communications in Medicine Standard

ECG—Electrocardiogram

ETL—ETL Testing Laboratories

FDA—U.S.Food and Drug Administration

FDG—Fluorodeoxyglucose

FOV—Field of view

FTP —File Transfer Protocol

FWHM—Full width at half maximum—the measure of the width of a point or line spread function across points50%down each side from the peak

FWTM—Full width at tenth maximum—the measure of the width of a point or line spread function across points90%down each side from the peak

GMP—Good Manufacturing Practices

IEC—International Electrotechnical Commission

ISO—International Organization for Standardiza-tion

MDD—Medical Devices Directive

mph —Miles per hour

NEMA—National Electrical Manufacturers Asso-ciation

PACS—Picture archiving and communication systems

PET —Positron emission tomography

PHA—Pulse height analyzer

PMT —Photomultiplier tube

QC—Quality control

QGS—Quantitative gated SPECT

RAM—Random-access memory

RFOV—Rectangular field of view

SPECT—Single photon emission computed tomography

SVGA —Super Video Graphics Array

TCP/IP —Transmission Control Protocol/Internet Protocol

TVGA—Top-extended Video Graphics Array

UL—Underwriters Laboratories

VCR—Videocassette recorder

VGA—Video Graphics Array

WORM—Write once,read many

Note:The data in the charts derive from suppli-ers’specifications and have not been verified through independent testing by ECRI or any other agency. Because test methods vary,different products’specifi-cations are not always comparable.Moreover,prod-ucts and specifications are subject to frequent changes. ECRI is not responsible for the quality or validity of the information presented or for any adverse conse-quences of acting on such information.

When reading the charts,keep in mind that,unless otherwise noted,the list price does not reflect supplier discounts.And although we try to indicate which fea-tures and characteristics are standard and which are not,some may be optional,at additional cost.

For those models whose prices were supplied to us in currencies other than U.S.dollars,we have also listed the conversion to U.S.dollars to facilitate com-parison among models.However,keep in mind that exchange rates change often.

Need to know more?

For further information about the contents of this Product Comparison,contact the HPCS Hotline at+1 (610)825-6000,ext.5265;+1(610)834-1275(fax);or hpcs@https://www.wendangku.net/doc/936997472.html, (e-mail).

Cameras, Gamma

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Healthcare Product Comparison System

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Cameras, Gamma

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Healthcare Product Comparison System

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Cameras, Gamma

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Healthcare Product Comparison System

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中国历史上的民族关系与国家认同

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⑤中国共产党的正确领导 A. ②③④⑤ B. ①②④⑤ C. ①②③④⑤ D. ①②③ 【答案】B 4．（湖北省襄阳市初2018年中考思想品德试题）解决台湾问题、实现祖国统一,是中华儿女共同的心愿。两岸关系和平发展的政治基础是 A. 坚持社会主义制度 B. 坚持一个中国原则 C. 坚持民族区域自治 D. 坚持公有制为主体 【答案】B 【解析】此题旨在考查学生对维护国家统一的认识，主要考查学生的认知能力。根据所学，解决台湾问题、实现祖国统一,是中华儿女共同的心愿。两岸关系和平发展的政治基础是坚持一个中国原则，所以ACD不符合题意，正确答案选B。 5．（山东省威海市2018年中考思想品德试题）2017年10月，(56个民族儿女寄语十九大》系列短片一周访问量突破5亿人次，成为有效宣传民族团结的重磅之作。这（） ①有利于巩固平等、团结、互助、和谐的新型民族关系②反映了各族人民实现同步富裕的愿望 ③是落实全国人民代表大会制度的有效方式④有利于增强中华民族的凝聚力 A. ①④ B. ②③ C. ①③④ D. ①②③④ 【答案】A 【解析】本题考查的是我国的民族关系这个知识点的理解。《56个民族儿女寄语十九大》系列短片反映了我国各族人民的平等、团结、互助、和谐的新型民族关系，宣传民族团结对于增强中华民族的凝聚力具有重要作用，故①④符合题意；共同富裕不是同步富裕，故②错误；③中的人民代表大会制度在题目中没有体现；故选A。 6．（2018年江苏省宿迁市中考思想品德试题）深化民族团结进步教育、铸牢中华民族共同体

民族关系与祖国统一

民族关系与祖国统一 摘要：中国是一个统一的多民族国家，而我国现阶段民族矛盾凸显，在当前形 势下，研究民族问题才能更好地解决各民族之间存在的矛盾。祖国统一是各族人民的最高利益，民族问题是我们这个多民族国家中至关重要的政治和社会关系，正确处理民族关系，使各族人民和睦相处、和衷共济、和谐发展，是增强中华民族凝聚力、实现祖国统一的重要保证。 关键词：民族平等，民族团结，民族互助，民族精神，各民族共同繁荣，祖国 统一 统一的多民族国家，这是我国的一项基本国情。民族工作是党和国家工作的重要组成部分。少数民族的发展事关建设有中国特色社会主义事业的成败。没有少数民族的发展，就不可能有中华民族的振兴。搞好民族关系、维护祖国统一，是我国各族人民的共同责任。 但随着西藏打砸抢事件、新疆7.5事件、昆明恐怖分子事件等关于民族问题的事件发生，如何更好的解决我国的民族问题，实现新的社会主义民族大团结作为一个重要课题摆在我们面前。本文就民族关系与祖国统一展开论述。 （一）民族平等 什么是民族平等？民族平等目前是不完全的，那么民族平等是指什么呢？民族平等意味着民族不分大小，也不分社会发展程度的高低，在社会生活中应该是一律平等的。我们国家有五十六个民族，有的民族人口多，有的民族人口少，有的民族经济文化相对发达，有的相对欠发达。但是无论人口多少、民族大小、发展先后，所有的民族在社会生活中都应该是平等的。所以我们的社会主义民族关系应该是平等的民族关系。 民族平等是一般民主要求的一个重要内容。但在私有制社会里，民族之间通常是统治与被统治、压迫与被压迫的关系，无论是国内的或国际的民族关系，一般说来是不平等的。因为建立在生产资料私有制基础上的阶级剥削制度，是造成一般的社会不平等和民族不平等的根源。中国共产党一贯坚持民族平等，把它作为处理国内民族问题的一项基本原则。在2005年5月召开的中央民族工作会议上，以胡锦涛为总书记的中央领导集体提出：“各民族不分人口多少、历史长短、发展程度高低，一律平等。国家为少数民族创造更多更好的发展机会和条件，保障各民族的合法权利和利益，各族人民都有义务维护宪法和法律的尊严”、“平等、团结、互助、和谐是我国社会主义民族关系的本质特征，汉族离不开少数民族，少数民族离不开汉族，各少数民族之间也相互离不开。各民族人民要互相尊重、互相学习、互相合作、互相帮助，不断巩固和发展全国各族人民的大团结，构建社会主义和谐社会。” （二）民族团结 在社会主义初级阶段民族团结是相对的。为什么说是相对的？在现实生活中，民族团结受到诸多因素的影响。比如，各民族之间相互了解、沟通、交流还是不充分的，民族隔阂、民族壁垒依然存在。党的十七大报告明确强调：“要牢牢把握各民族共同团结奋斗、共同繁荣发展的主题，保障少数民族合法权益，巩固和发展平等团结互助和谐的社会主义民族关系。”在改革开放的新形势下，在高校开展民族团结教育，对于不断巩固各民族人民的大团结和维护祖国统一，不

第六章 中国各民族与国家统一

一、单项选择题（20题） 1．我国统一多民族国家形成于 A. 秦朝 B. 汉朝 C. 元朝 D. 唐朝 2．“各个少数民族对中国的历史都作过贡献”。表述者是 A. 孙中山 B. 毛泽东 C. 周恩来 D. 邓小平 3．我国各族人民的最高利益是 A. 和谐社会 B. 民族自决 C. 共产主义 D. 祖国统一 4．建立元朝的统治者是 A.汉族 B.蒙古族 C.满族 D.契丹族 5．建立清朝的统治者是 A.汉族 B.蒙古族 C.满族 D.鲜卑族 6．率部打响武昌起义第一枪、曾任国民革命军左路军第一路司令的邓玉鳞的民族成分是A．壮族 B．汉族 C．土家族 D．蒙古族 7．全国重点文物保护单位江孜宗山抗英遗址位于 A．西藏自治区 B．广东省 C．广西壮族自治区 D．云南省 8．由蒙古族于1957年创建的“乌兰牧骑”闻名全国。“乌兰牧骑”是蒙古语，意思是A．文工团

B．文艺工作者 C．红色文化工作队 D．草原艺术团 9．统一的多民族国家秦朝建立于 A．公元221年 B．公元前221年 C．春秋时期 D．商朝后期 10．历史上的北魏王朝建立者 A．东胡族 B．肃慎族 C．契丹族 D．鲜卑族 11．历史上的西夏王朝建立者 A．党项族 B．女真族 C．契丹族 D．乌桓族 12．历史上的辽朝建立者 A．党项族 B．女真族 C．契丹族 D．乌桓族 13．土尔扈特人曾经迁至伏尔加河流域。1771年，在渥巴锡汗率领下毅然东归，返回祖国。土尔扈特人是 A．蒙古族 B．锡伯族 C．鄂伦春族 D．达斡尔族 14．察布查尔锡伯自治县位于 A．黑龙江省 B．辽宁省 C．吉林省 D．新疆维吾尔自治区 15．清朝康熙年间的雅克萨之战是 A．抗击日本侵略者 B．抗击美国侵略者 C．抗击英国侵略者 D．抗击沙俄侵略者 16．历史上的隆吐山保卫战（1888年）是抗击 A．日本侵略者 B．美国侵略者 C．英国侵略者 D．沙俄侵略者

+中国统一多民族国家及民族关系的历史演进

《汉藏经济文化交流史》导论 陈崇凯 一、中国统一多民族国家及民族关系的历史演进 “古老的东方有一条龙，它的名字叫中国，古老的东方有一群人，他们都是龙的传人。”每当唱起这首歌，每一个中国人，不管他生活在祖国大陆还是海外，不管他属于汉族，还是藏、蒙、维吾尔等56个民族中的哪个民族，都会涌现出一种中华民族认同的炽热感情，都会为自己拥有中国这个历史悠久的统一多民族国家而骄傲。 我们中国“是一个由多数民族结合而成的拥有广大人口的国家。”①她经历了漫长的古代发展过程，始终保持着历史的延续性，是世界上唯一没有中断、一脉相承的古老文明之国。中国在古代就是一个统一的多民族国家。中国各民族的先民们，自古以来就生活在西起帕米尔高原，东到包括台湾在内的太平洋西岸，北起沙漠戈壁，南到南海诸岛，西南起喜马拉雅山脉，东北至黑龙江的辽阔版图内，以自己的辛勤劳动和智能共同开发、缔造伟大的祖国。 中国作为统一的多民族国家是中华五千年文明史的产物，是包括藏族在内的56个民族认同并凝聚而成的民族共同体——中华民族的政治实体，而中国这个政治实体，又是以56个民族形成的不可分割的民族实体——中华民族为基础的。历史是不以人们主观意识为转移的客观存在，问题是人们对历史的认识总是受到时代等诸多因素的制约，是有其局限性的。新中国建立前中国史的著述且不说，建国后力图以马克思主义唯物史观来研究中国历史的论著，应该说是硕果累累，但从总体上看，都相当程度地忽略了对中国历史发展总进程的论述，忽略了对中国各民族在全国大一统形成发展中的地位的论述。这不能不说是一大缺憾。近年来，在这方面终于有了新的重要突破。1988年社会学、民族学大师费孝通教授在香港中文大学作学术演讲，“驾轻就熟地运用丰富的资料，特别是考古学、语言学、人类学、民族学和历史学等方面的资料，在几万年的文化史和近千万平方公里国土这一对时与空所构成的宏大坐标系统里纵横骋驰，深刻地追溯了中华民族格局的成因并指出了这一格局的最大特点，即一体中包含着多元，多元中拥戴着的一体。”②“中华民族多元一体格局”理论的推出，在国内外学术界引起广泛反响，被誉为中华民族研究的新探索，是正确认识中国统一多民族国家历史演进总体格局的钥匙。 费孝通教授指出：“中华民族作为一个自觉的民族实体，是近百年来中国和西方列强对抗中出现的，但作为一个自在的民族实体则是几千年的历史过程所形成的。”③这个精辟的结论，既切合中华民族的形成发展史，也切合中国统一多民族国家的形成发展史。国家与民族是两个不同又有联系的概念，从宏观上看，这两个范畴又是可以一致的。中国几千年的历史发展过程，就是中华民族的形成发展过程，也就是中国统一的多民族国家形成确立的过程。“多元一体”理论的内涵十分丰富，它的要点为：第一，中华民族从起源到形成是多元一体的，中国作为统一的多民族国家，从孕育、形成到发展、确立，也是多元一体的历史演进。第二，在历史造就的中华民族共同体中，存在一个凝聚中心，即生活在中原地区的汉族，它以儒学为核心融合佛、道形成的炎黄传统文化成为中华民族的精神纽带。第三，各民族间存在的你中有我，我中有你的血肉联系，各民族区域经济文化的互补交融，终于凝聚确立为不可分割的统一的多民族国家。第四，中华民族和中国多民族的统一国家是个历史范畴，其历史演进过程不能随意人为割断。中华民族是中国的构成实体，中国版图是其活动存在的疆域，都是沿着“多元一体”的历史轨迹演进的，在历史上是前后承续相对稳定的。