Optimization of BMI-Based Images for Overweight and Obese Patients — Implications on Image Quality, Quantification, and Radiation Dose in Whole Body 18F-FDG PET/CT Imaging

Yassine Bouchareb*, Naima Tag, Hajir Sulaiman, Khulood Al-Riyami, Zabah Jawa, Humoud Al-Dhuhli

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Purpose: In PET/CT imaging, the activity of the 18F-FDG activity is injected either based on patient body weight (BW) or body mass index (BMI). The purpose of this study was to optimise BMI-based whole body 18F-FDG PET images obtained from overweight and obese patients and assess their image quality, quantitative value and radiation dose in comparison to BW-based images. Methods: The NEMA-IEC-body phantom was scanned using the mCT 128-slice scanner. The spheres and background were filed with F-18 activity. Spheres-to-background ratio was 4:1. Data was reconstructed using the OSEM-TOF-PSF routine reconstruction. The optimization was performed by varying number of iterations and subsets, filter’s size and type, and matrix size. The optimized reconstruction was applied to 17 patients’ datasets. The optimized BMI-, routine BMI- and the BW-based images were compared visually and using contrast-to-noise ratio (CNR) and standardized uptake values (SUV) measurements. Results: The visual assessment of the optimized phantom images showed better image quality and contrast-recovery-coefficients (CRCs) values compared to the routine reconstruction. Using patient data, the optimized BMI-based images provided better image quality compared to BW-based images in 87.5% of the overweight cases and 66.7% for obese cases. The optimized BMI-based images resulted in more than 50% reduction of radiation dose. No significant differences were found between the three series of images in SUV measurements. Conclusion: The optimized BMI-based approach using 1 iteration, 21 subsets, and 3 mm Hamming filter improves image quality, reduces radiation dose, and provides, at least, similar quantification compared to the BW-based approach for overweight and obese patients.

Original languageEnglish
Pages (from-to)180-193
Number of pages14
JournalNuclear Medicine and Molecular Imaging
Issue number4
Publication statusPublished - Aug 2023


  • Body-mass-index
  • Obese/overweight patients
  • PET reconstruction optimization
  • Quantification

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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