Intraoperative Tumor Detection: Relative Performance of Single-Element, Dual-Element, and Imaging Probes with Various Collimators

Accurate tumor staging depends on finding all tumor sites, and curative surgery requires the removal of all cancerous tissue from those sites. One technique for locating tumors is to inject patients before surgery with a radiotracer that is preferentially taken up by cancerous tissue. Then, an intraoperative gamma-sensitive probe is used to locate the tumors. Small (< 1-cm diameter) tumors, often undetectable by external imaging and by the standard surgical inspection with sight and touch, can be found with probes. Simple calculations and measurements with radioactive tumor models show that small tumors should be detected by single-element probes, but often such probes fail to detect these small tumors in practice. This discrepancy is often caused by the use of a uniform background to predict probe performance. Real backgrounds are nonuniform and can decrease probe performance dramatically. Dual-element, coincidence, or imaging probes may solve the background problem. We devised a method to predict probe performance in a realistic background which includes variations in normal organ uptakes. We predict the relative performance of both existing probes and those in the design stage so that optimal detector and collimator configurations can be determined. The procedure includes a Monte-Carlo-calculated point-response function, a numerical torso phantom, and measured biodistributions of a monoclonal antibody. The Hotelling Trace Value, a measure of tumor-detection performance, is computed from the probe responses in simulated studies.