Application of the Intraoperative Dual Photon Emission Computed Tomography System in Sentinel Lymph Node Detection: A Simulation Study

The sentinel lymph node (SLN) hypothesis is applied as part of the standard procedure for identifying early-stage breast cancer. Thus, an imaging system that can locate SLNs in operating rooms is desired. Many 2-D probe imaging systems and a freehand single-photon emission-computed tomography (fhSPECT) system have been proposed. However, 2-D probe imaging systems are affected by shine-through and shadowing effects. Here, we propose an alternative to 3-D imaging systems, i.e., a dual-photon emission computed tomography (DuPECT) system, which integrates both preoperative and intraoperative information to locate SLNs using cascade isotopes such as Se-75. The system consists of a LaBr3-based probe and planar head, a collimation system, and a coincidence circuit. For each disintegration, the slat and parallel-hole collimator define a plane and a line, respectively, which represent the possible flight paths of each photon. SLNs can be located using the line-plane intersection. Here, the performance is evaluated using Monte Carlo software developed in our laboratory, integrated with SimSET and GATE software. A measurement study indicates that the randoms rate increases with increased initial activities, while the scatter rate is lower than 1.2 count/s for various activities. In a simulated imaging study, four injection sites and two LNs placed at various depths are minimally distinguishable. However, the LNs are clearly identifiable in the absence of injection sites. Our results indicate that the proposed three-dimensional imaging system has the potential to identify injection sites and various SLNs. However, difficulties with low sensitivity for LN detection, especially in the presence of activity from injection sites, and the choice of appropriate radioisotope must be overcome for its clinical usage.