Panagiotis Papadimitroulas

Background/Objectives: Single-photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI) is widely used for non-invasive assessment of coronary artery disease under stress and rest conditions. Although deep learning has shown promise for automated SPECT MPI interpretation, most studies focus on single-tracer datasets and do not explicitly account for tracer-dependent variability. This study developed and evaluated a multi-task deep learning framework with tracer-specific prediction heads for patient-level SPECT MPI classification. Methods: A convolutional neural network with a shared feature encoder and tracer-specific heads was implemented using polar map representations from technetium-99m (Tc-99m) and thallium-201 (Tl-201) studies. Transfer learning from ImageNet was applied. Stress-only, rest-only, and dual-input configurations were evaluated using repeated patient-stratified cross-validation and independent testing. Performance was assessed using ROC-AUC and balanced accuracy. Results: For Tc-99m normal versus abnormal perfusion classification, the stress-only model achieved the highest cross-validation AUC (0.88 ± 0.067) and test AUC of 0.88 [0.67–0.99]. For Tl-201 low-risk versus intermediate/high-risk classification, stress-based models achieved the highest cross-validation AUC (0.88 ± 0.051) and test AUC of 0.80 [0.71–0.89], comparable to dual-input models. In both tracer-specific tasks, stress-phase information showed favorable performance, but the endpoints differed and should be interpreted separately. Conclusions: Stress-phase polar maps provided strong discriminative information within this single-center cohort. These findings should be interpreted in a tracer- and task-specific manner supporting stress-phase imaging as an informative input for AI-based SPECT MPI classification while underscoring the need for external validation before broader clinical generalization.

We present GATE version 10, a major evolution of the open-source Monte Carlo simulation application for medical physics, built on Geant4. This release marks a transformative evolution, featuring a modern Python-based user interface, enhanced multithreading and multiprocessing capabilities, the ability to be embedded as a library within other software, and a streamlined framework for collaborative development. In this Part 1 paper, we outline GATE’s position among other Monte Carlo codes, the core principles driving this evolution, and the robust development cycle employed. We also detail the new features and improvements. Part 2 will focus on the architectural innovations and technical challenges. By combining an open, collaborative framework with cutting-edge features, such a Monte Carlo platform supports a wide range of academic and industrial research, solidifying its role as a critical tool for innovation in medical physics.

Over the past years, we have developed GATE version 10, a major re-implementation of the long-standing Geant4-based Monte Carlo application for particle and radiation transport simulation in medical physics. This release introduces many new features and significant improvements, most notably a Python-based user interface replacing the legacy static input files. The new functionality of GATE version 10 is described in the part 1 companion paper (Sarrut et al 2025 arXiv:2507.09842). The development brought significant challenges. In this paper, we present the solutions that we have developed to overcome these challenges. In particular, we present a modular design that robustly manages the core components of a simulation: particle sources, geometry, physics processes, and data acquisition. The architecture consists of integrated C++ and Python codes. This framework allows for the precise, time-aware generation of primary particles, a critical requirement for accurately modeling positron emission tomography, radionuclide therapies, or prompt-gamma timing systems. We present how GATE 10 handles complex Geant4 physics settings while exposing a simple interface to the user. Furthermore, we describe the methodological solutions that facilitate the seamless integration of advanced physics models and variance reduction techniques. The architecture supports sophisticated scoring of physical quantities (such as Linear Energy Transfer and Relative Biological Effectiveness) and is designed for multithreaded execution. The new user interface allows researchers to script complex simulation workflows and directly couple external tools, such as artificial intelligence models for source generation or detector response. By detailing these architectural innovations, we demonstrate how GATE 10 provides a more powerful and flexible tool for research and innovation in medical physics. This paper is not intended to be a developer guide. Its purpose is to share with the research community in-depth explanations of our development effort that made the new GATE 10 possible.

Background/Objectives: Lutetium-177 is a widely used radioisotope in targeted radionuclide therapy, particularly for treating certain types of cancers relying on beta and low-energy gamma emissions, making it suitable for both therapeutic and post-therapy monitoring purposes. The purpose of this study was to evaluate the technical parameters for developing a prototype portable gamma camera dedicated to ¹⁷⁷Lu imaging applications. Methods: The well-validated GATE Monte Carlo toolkit was used to study the characteristics of the system and evaluate its performance in terms of spatial resolution, sensitivity, and image quality. For this purpose, a series of Monte Carlo simulations were executed, modeling a channel-edge aperture pinhole collimator incorporating a variety of computational phantoms. The final configuration of the prototype was standardized, incorporating the crystal size, collimator design, shielding, and the optimal FOV. After the development of the actual prototype camera, the system was also validated experimentally on the same setups as the simulations. Results: The final configuration of the prototype imaging system was standardized based on simulation results and then experimentally validated using physical phantoms under equivalent conditions. A minification of 1:5, spatial resolution of 1.0 cm, and sensitivity of 5.2 Cps/MBq at 10 cm distance source-to-collimator distance were assessed and confirmed. The experimental results agreed within 5% of simulated values. Conclusions: This study establishes the technical feasibility and foundational performance of a portable pinhole imaging system for potential clinical use in ¹⁷⁷Lu imaging workflows and thereby improving therapeutic effectiveness.

This review examines the significant influence of Digital Twins (DTs) and their variant, Digital Human Twins (DHTs), on the healthcare field. DTs represent virtual replicas that encapsulate both medical and physiological characteristics—such as tissues, organs, and biokinetic data—of patients. These virtual models facilitate a deeper understanding of disease progression and enhance the customization and optimization of treatment plans by modeling complex interactions between genetic factors and environmental influences. By establishing dynamic, bidirectional connections between the DTs of physical objects and their digital counterparts, these technologies enable real-time data exchange, thereby transforming electronic health records. Leveraging the increasing availability of extensive historical datasets from clinical trials and real-world sources, AI models can now generate comprehensive predictions of future health outcomes for specific patients in the form of AI-generated DTs. Such models can also offer insights into potential diagnoses, disease progression, and treatment responses. This remarkable progression in healthcare paves the way for precision medicine and personalized health, allowing for high-level individualized medical interventions and therapies. However, the integration of DTs into healthcare faces several challenges, including data security, accessibility, bias, and quality. Addressing these obstacles is crucial to realizing the full potential of DHTs, heralding a new era of personalized, precise, and accurate medicine.

Background: This study investigated alternative, non-invasive methods for human papillomavirus (HPV) detection in head and neck cancers (HNCs). We compared two approaches: analyzing computed tomography (CT) scans with a Deep Learning (DL) model and using radiomic features extracted from CT images with machine learning (ML) models. Methods: Fifty patients with histologically confirmed HNC were included. We first trained a modified ResNet-18 DL model on CT data to predict HPV status. Next, radiomic features were extracted from manually segmented regions of interest near the oropharynx and used to train four ML models (K-Nearest Neighbors, logistic regression, decision tree, random forest) for the same purpose. Results: The CT-based model achieved the highest accuracy (90%) in classifying HPV status. Among the ML models, K-Nearest Neighbors performed best (80% accuracy). Weighted Ensemble methods combining the CT-based model with each ML model resulted in moderate accuracy improvements (70–90%). Conclusions: Our findings suggest that CT scans analyzed by DL models hold promise for non-invasive HPV detection in HNC. Radiomic features, while less accurate in this study, offer a complementary approach. Future research should explore larger datasets and investigate the potential of combining DL and radiomic techniques.

This study aimed to compare the commercial dosimetric software Planet^® Dose (version 3.1.1) from DOSIsoft and the open-source toolkit GATE. Dosimetry was performed for six patients receiving 200 mCi of Lutathera^® every 8 weeks for four treatment cycles. For the dose calculation with Planet^®, SPECT/CT images were acquired at 4, 24, 72 and 192 h post-injection. After the registration of all the time points to T0, the organs of interest (OOIs) were segmented. Time-activity curves were produced and the absorbed dose was calculated using the bi- and tri-exponential fitting methods. Regarding GATE simulations, the SPECT images of the 24 h time point were utilized for the radiopharmaceutical biodistribution in the OOIs and the attenuation maps were produced using the CT images. For liver and spleen, the average relative difference between GATE and Planet^® was 9.6% and 11.1% for biexponential and 12.4% and 30.5% for triexponential fitting, respectively. The right and left kidneys showed differences up to 10.7% and 10.4% for the biexponential and up to 60.6% and 11.9% for the triexponential model, respectively. The absorbed dose calculated with GATE, Planet^®(bi-exp) and Planet^®(tri-exp) was in agreement with the literature. The results of the bi-exponential fitting were similar to the GATE-resulted calculations, while the tri-exponential fitting had a higher relative difference.

Radiomics as a novel quantitative approach to medical imaging is an emerging area in the field of radiology. Artificial Intelligence offers promising tools for exploiting and analyzing radiomics. The objective of the present study is to propose a methodology for the design, development, and evaluation of Machine Learning (ML) models for the prediction of the recovery progress of skeletal muscle injury over time in rats using radiomics. Radiomics were extracted from contrast enhanced Computed Tomography (CT) data and ML algorithms were trained and compared for their predictive value based on different CT imaging parameters. Ten different ML regression algorithms were tested and the optimal combination of radiomics for each algorithm and CT imaging parameter settings combination was studied. The best ensemble learning model, trained on the 70kVp, 100mA imaging parameter dataset, achieved a Mean Absolute Error score of 1.22. The results suggest that radiomics extracted from CT images can be used as input in ML regression algorithms to predict the volume of a skeletal muscle injury in rats. Moreover, the results show that CT imaging settings impact the predictive performance of the ML regression models, indicating that lower values of tube current and peak kilovoltage contribute to more accurate predictions.