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Background  Personalization of  177 Lu-based radionuclide therapy requires implementation of dosimetry methods that are both accurate and practical enough for routine clinical use. Quantitative single-photon emission computed tomography/computed tomography (QSPECT/CT) is the preferred scanning modality to achieve this and necessitates characterizing the response of the camera, and calibrating it, over the full range of therapeutic activities and system capacity. Various methods to determine the camera calibration factor ( CF ) and the deadtime constant (τ) were investigated, with the aim to design a simple and robust protocol for quantitative  177 Lu imaging.    Methods  The SPECT/CT camera was equipped with a medium energy collimator. Multiple phantoms were used to reproduce various attenuation conditions: rod sources in air or water-equivalent media, as well as a Jaszczak phantom with inserts. Planar and tomographic images of a wide range of activities were acquired, with multiple energy windows for scatter correction (double or triple energy window technique) as well as count rate monitoring over a large spectrum of energy. Dead time was modelled using the paralysable model.  CF  and τ were deduced by curve fitting either separately in two steps ( CF  determined first using a subset of low-activity acquisitions, then τ determined using the full range of activity) or at once (both  CF  and τ determined using the full range of activity). Total or segmented activity in the SPECT field of view was computed. Finally, these methods were compared in terms of accuracy to recover the known activity, in particular when planar-derived parameters were applied to the SPECT data.    Results  The SPECT camera was shown to operate as expected on a finite count rate range (up to ~ 350 kcps over the entire energy spectrum).  CF  and τ from planar (sources in air) and SPECT segmented Jaszczak data yielded a very good agreement ( CF  < 1% and τ < 3%). Determining  CF  and τ from a single curve fit made dead-time-corrected images less prone to overestimating recovered activity. Using triple-energy window scatter correction while acquiring one or more additional energy window(s) to enable wide-spectrum count rate monitoring (i.e. ranging 55–250 or 18–680 keV) yielded the most consistent results across the various geometries. The final, planar-derived calibration parameters for our system were a  CF  of 9.36 ± 0.01 cps/MBq and a τ of 0.550 ± 0.003 μs. Using the latter, the activity in a Jaszczak phantom could be quantified by QSPECT with an accuracy of 0.02 ± 1.10%.    Conclusions  Serial planar acquisitions of sources in air using an activity range covering the full operational capacity of the SPECT/CT system, with multiple energy windows for wide-spectrum count rate monitoring, and followed by simultaneous determination of  CF  and τ using a single equation derived from the paralysable model, constitutes a practical method to enable accurate dead-time-corrected QSPECT imaging in a post- 177 Lu radionuclide therapy setting.

Comprehensive SPECT/CT system characterization and calibration for 177Lu quantitative SPECT (QSPECT) with dead-time correction