Phantom and Clinical Evaluation of the Bayesian Penalized Likelihood Reconstruction Algorithm Q.Clear on an LYSO PET/CT System

Teoh, Eugene J.; McGowan, Daniel R.; Macpherson, Ruth E.; Bradley, Kevin M.; Gleeson, Fergus V.

doi:10.2967/jnumed.115.159301

Cited by 265Medical Imaging Techniques and ApplicationsRadiation Dose and ImagingCardiac Imaging and Diagnostics

Phantom and Clinical Evaluation of the Bayesian Penalized Likelihood Reconstruction Algorithm Q.Clear on an LYSO PET/CT System

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Teoh, Eugene J., McGowan, Daniel R., Macpherson, Ruth E., Bradley, Kevin M., Gleeson, Fergus V.·2015·Journal of Nuclear Medicine

DOI 10.2967/jnumed.115.159301PMC PMC4558942

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Abstract

UNLABELLED: Q.Clear, a Bayesian penalized-likelihood reconstruction algorithm for PET, was recently introduced by GE Healthcare on their PET scanners to improve clinical image quality and quantification. In this work, we determined the optimum penalization factor (beta) for clinical use of Q.Clear and compared Q.Clear with standard PET reconstructions. METHODS: A National Electrical Manufacturers Association image-quality phantom was scanned on a time-of-flight PET/CT scanner and reconstructed using ordered-subset expectation maximization (OSEM), OSEM with point-spread function (PSF) modeling, and the Q.Clear algorithm (which also includes PSF modeling). Q.Clear was investigated for β (B) values of 100-1,000. Contrast recovery (CR) and background variability (BV) were measured from 3 repeated scans, reconstructed with the different algorithms. Fifteen oncology body (18)F-FDG PET/CT scans were reconstructed using OSEM, OSEM PSF, and Q.Clear using B values of 200, 300, 400, and 500. These were visually analyzed by 2 scorers and scored by rank against a panel of parameters (overall image quality; background liver, mediastinum, and marrow image quality; noise level; and lesion detectability). RESULTS: As β is increased, the CR and BV decreases; Q.Clear generally gives a higher CR and lower BV than OSEM. For the smallest sphere reconstructed with Q.Clear B400, CR is 28.4% and BV 4.2%, with corresponding values for OSEM of 24.7% and 5.0%. For the largest hot sphere, Q.Clear B400 yields a CR of 75.2% and a BV of 3.8%, with corresponding values for OSEM of 64.4% and 4.0%. Scorer 1 and 2 ranked B400 as the preferred reconstruction in 13 of 15 (87%) and 10 of 15 (73%) cases. The least preferred reconstruction was OSEM PSF in all cases. In most cases, lesion detectability was highest ranked for B200, in 9 of 15 (67%) and 10 of 15 (73%), with OSEM PSF ranked lowest. Poor lesion detectability on OSEM PSF was seen in cases of mildly (18)F-FDG-avid mediastinal nodes in lung cancer and small liver metastases due to background noise. Conversely, OSEM PSF was ranked second highest for lesion detectability in most pulmonary nodule evaluation cases. The combined scores confirmed B400 to be the preferred reconstruction. CONCLUSION: Our phantom measurement results demonstrate improved CR and reduced BV when using Q.Clear instead of OSEM. A β value of 400 is recommended for oncology body PET/CT using Q.Clear.

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Inter-method SUV differences may no longer be significant at beta values of 300 to 600, which have been rated as optimal for visual reading of [18F]FDG-PET images by human readers.
“However, this difference is directly dependent on the user-defined penalization factor beta during PL reconstruction, and at beta values of 300 to 600, which have been rated as optimal for visual reading of [18F]FDG-PET images by human readers [107,112,113], inter-method SUV differences may no longer be significant [41,108,111].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [107]
The Results (page not specified) report that two readers most often preferred beta 400 for visual assessment of oncologic 18F-FDG PET/CT images. They do not establish the full 300–600 range as optimal: beta 600 was not included in the clinical reader comparison. The Discussion reports a nonsignificant contrast-recovery difference at beta 500 for the smallest phantom sphere, but that is not a finding that inter-method SUV differences become nonsignificant. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Several authors have reported improved SNR and image quality with PL reconstruction for different radiopharmaceuticals, including [18F]FDG, [18F]F-PSMA-1007, [68Ga]Ga-PSMA-11, [68Ga]Ga-DOTATATE, and 89Zr-labelled tracers.
“several authors have reported improved SNR and image quality with different radiopharmaceuticals, such as [18F]FDG [107,112,113], [18F]F-PSMA-1007 [143], [68Ga]Ga-PSMA-11 [169,170], [68Ga]Ga-DOTATATE [171] or 89Zr-labelled tracers [172].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [107]
The citation is attached to [18F]FDG, not to the other tracers listed. The Discussion reports better image quality and lower noise with Q.Clear in clinical [18F]FDG scans, but the paper does not report a signal-to-noise ratio (SNR) measurement; it measures contrast recovery and background variability instead. Page numbers are unavailable in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measured
Using a commercially available PL reconstruction (GE Q.Clear), phantom studies have shown that PL reconstruction can increase CR of standardized sphere inserts compared to conventional TOF and PSF reconstruction.
“Using a commercially available PL reconstruction (General Electric [GE] Q.Clear), several phantom studies have shown that PL reconstruction can increase the CR of standardized sphere inserts compared to conventional TOF and PSF reconstruction [41,46,101,107,108].”
From Influences on PET Quantification and Interpretation (2022) · cites this paper as [107]

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Authors: Teoh, E. J., McGowan, D. R., Macpherson, R. E., Bradley, K. M., & Gleeson, F. V.
Affiliations: Churchill Hospital (GB)
ORCID: Teoh, Eugene J.
McGowan, Daniel R.
Macpherson, Ruth E.
Bradley, Kevin M.
Gleeson, Fergus V.
Venue: Journal of Nuclear Medicine
Publisher: Society of Nuclear Medicine
Published: 2015-07-09
Volume: 56
Issue: 9
Pages: 1447-1452
ISSN: 0161-5505 (ISSN-L)
2159-662X
DOI: 10.2967/jnumed.115.159301
PMC: PMC4558942
OpenAlex: W2161249702
Cited by: 265
References: 22
Citations by year: 2026: 14 · 2025: 30 · 2024: 26 · 2023: 32 · 2022: 27 · 2021: 39 · 2020: 28 · 2019: 21 · 2018: 16 · 2017: 19 · 2016: 9 · 2015: 2 · 2012: 1
FWCI: 12.43
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Nuclear Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: Cancer Research UK (16466)
National Institute for Health and Care Research (NIHR-HCS-D12-03-13)
Topics: Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Medical Imaging Techniques and Applications
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Radiation Dose and Imaging
Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
Keywords: Q.Clear, Bayesian penalized likelihood reconstruction, PET image reconstruction, OSEM, point spread function modeling, 18F-FDG PET/CT, image quality, lesion detectability, contrast recovery, background variation, time-of-flight PET, lung cancer, mediastinal lymph nodes, liver metastasis
MeSH terms: Machine Learning, Algorithms, Bayes Theorem, Humans, Image Enhancement, Image Interpretation, Computer-Assisted, Pattern Recognition, Automated, Sensitivity and Specificity, Tomography, X-Ray Computed, Reproducibility of Results, Likelihood Functions, Phantoms, Imaging, Positron-Emission Tomography, Multimodal Imaging

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Phantom and Clinical Evaluation of the Bayesian Penalized Likelihood Reconstruction Algorithm Q.Clear on an LYSO PET/CT System

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