2024-06-07
Large-axial field of view (LAFOV) PET/CT is a groundbreaking advancement in medical imaging technology that provides highly detailed and comprehensive scans of the entire body. The LAFOV PET/CT scanner is distinguished by its ability to capture images of the whole body in a single session, significantly reducing the time patients spend in the scanner. This is possible thanks to a much longer scanner design compared to conventional PET/CT scanners, which are limited to scanning the body in smaller sections. The extended length allows simultaneous imaging of all organs and tissues, providing a complete overview of the whole body in one scan.
The Bern team became the first site to install the Biograph Vision Quadra™ in October 2020, feeling as though they were part of a quantum leap in PET imaging. This enthusiasm drove their commitment to contribute significantly to this progress. Since then, more than 10,000 PET scans have been conducted at Inselspital across various clinical indications and research protocols. We believe this will be the medical imaging modality of the current decade, and we are only just beginning to explore the immense possibilities these devices offer. The technology will broaden clinical horizons and scientific potential, evolving into routine clinical practice.
The initial optimization phase focused on finding the scanner’s operational limits, such as reducing the dose or shortening acquisition time while maintaining exceptional image quality. One significant advantage of these devices is their high sensitivity compared to conventional PET/CT scanners. For comparison, at its ultra-high sensitivity mode with full acceptance angle, Biograph Vision Quadra offers approximately 10-fold increase in system compared to Biograph Vision™ 600.1,2
In the subsequent months, multiple installations occurred worldwide, with scanners now in Australia, Europe, and the U.S. As of now, there are more than 20 installed systems, and several additional orders are in the pipeline.
Transitioning from a conventional scanner to an LAFOV PET/CT scanner offers an excellent imaging experience with high-quality results in almost all clinical scenarios, even in suboptimal situations. However, this transition requires adjustments in workflows, particularly due to potentially shorter scan slots and the need for lower radioactivity administration. Managing these complexities is crucial, particularly with the first challenge being more difficult because it depends on local infrastructure and personnel resources.
Research is focusing on various directions, including low-dose approaches, scanning low-count radionuclides, and optimizing dynamic imaging protocols to highlight the advantages of parametric imaging. This has led to a growing global community of LAFOV-PET/CT users, researchers, and enthusiasts making constant progress in diverse areas. We investigated the feasibility of total-body parametric imaging with image derived input functions and presented the first results for healthy organs and tumor lesions.3 Recent work from us and University Medical Center Groningen in the Netherlands also showed that these parametric imaging protocols might be abbreviated to 20 minutes or potentially less with these scanners.4,5 The benefits of LAFOV PET/CT scanners for low-dose6,7,8 and late imaging9 were also demonstrated. Last but not least, recent work showed the feasibility of using LAFOV PET/CT scanners in low-count cases such as 90Y and 89Zr PET imaging.10,11,12
Total-body PET/CT is a powerful tool in modern medicine, offering a unique combination of speed, comprehensive detail, and diagnostic precision. As the technology advances, its role in enhancing patient care and advancing medical research will further grow, promising a significant impact on healthcare strategies and patient outcomes.
Axel Rominger, MD
Director and Chief Nuclear Medicine Physician
Inselspital, Bern University Hospital, Bern, Switzerland