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@ARTICLE{Wendler2010EJNMMI,
  author = {Thomas Wendler and Ken Herrmann and Andreas Schnelzer and Tobias
	Lasser and Joerg Traub and Olivier Kutter and Alexandra Ehlerding
	and Klemens Scheidhauer and Tibor Schuster and Marion Kiechle and
	Markus Schwaiger and Nassir Navab and Sibylle I Ziegler and Andreas
	K Buck},
  title = {First demonstration of 3-D lymphatic mapping in breast cancer using
	freehand SPECT.},
  journal = {Eur J Nucl Med Mol Imaging},
  year = {2010},
  month = {Mar},
  __markedentry = {[wendler]},
  abstract = {PURPOSE: Freehand SPECT is a 3-D tomographic imaging modality based
	on data acquisition with a hand-held detector that is moved freely,
	in contrast to conventional, fixed gamma camera systems. In this
	pilot study, the feasibility of freehand SPECT for 3-D lymphatic
	mapping in breast cancer was evaluated. METHODS: A total of 85 patients
	(age: 29-88 years) with an initial diagnosis of invasive breast cancer
	and no clinical evidence of nodal involvement prospectively underwent
	sentinel lymph node (SLN) biopsy. Preoperative lymphatic mapping
	(35-87 MBq (99m)Tc-Nanocoll) included tomographic imaging with a
	SPECT/CT device (Siemens Symbia T6) serving as reference. Initially,
	the freehand SPECT approach was assessed in a pilot study consisting
	of 50 patients. The quality of each freehand SPECT acquisition was
	assessed and ranked as good, intermediate or poor. In another series
	comprising a further 35 patients (validation study), a guidance system
	for the acquisition was implemented based on the results of the pilot
	study, ensuring acquisitions with good quality. For 3-D tomographic
	image reconstruction, ad hoc models and iterative reconstruction
	algorithms were used in all 85 patients. To allow for adequate comparison,
	SPECT/CT data and freehand SPECT data were registered within the
	same coordinate system. RESULTS: In the pilot study, freehand SPECT
	enabled mapping of 24 of 83 SLNs in 20 of 44 patients (3 dropouts,
	3 patients without SLN either in SPECT/CT or in freehand SPECT).
	Using SPECT/CT as reference, the accuracy of freehand SPECT was 77.8\%
	(7/9 nodes) in scans with good quality, while for intermediate and
	poor quality scans, the accuracy was reduced to 34.3 and 12.8\%,
	respectively. In the validation study, quality feedback improved
	the results significantly and freehand SPECT enabled the mapping
	of at least one SLN in 87.5\% of the patients (28/32 - 3 dropouts).
	Compared to the reference method, freehand SPECT showed a sensitivity
	of 83.3\% (35/42 nodes). False-negative findings were related to
	insufficient scanning time, insufficient coverage of the axillary
	region, close proximity of the SLN to the injection site and low
	tracer uptake in the SLNs. CONCLUSION: In this preliminary study,
	we could demonstrate that 3-D localization of SLNs is feasible using
	freehand SPECT technology. Prerequisites for acquisition of a good
	scan quality, most likely allowing precise SLN mapping, have been
	defined. This approach has high potential to allow image-guided biopsy
	and further standardization of SLN dissection, thus bringing 3-D
	nuclear imaging into the operating room.},
  doi = {10.1007/s00259-010-1430-4},
  institution = {Chair for Computer Aided Medical Procedures (CAMP), Technische Universität
	München, Boltzmannstr. 3, 85748, Garching bei Muenchen, Germany,
	wendler@tum.de.},
  language = {eng},
  medline-pst = {aheadofprint},
  pmid = {20354851},
  url = {http://dx.doi.org/10.1007/s00259-010-1430-4}
}