Objective:
This pilot study aims to assess the environmental impact of Positron Emission Tomography/Computed Tomography (PET/CT) imaging, in the context of efforts to mitigate climate change. This is studied by investigating the energy usage, waste generation, and the radiopharmaceutical production.

Methods:
Power measurements of the PET/CT scanner were conducted over four weeks and during different power settings (system on, computers off, software shutdown and energy saving mode) with a power analyzer. Various outcome measures, such as energy and cost savings per hour, energy consumption per PET/CT radiopharmaceutical procedure, and total annual energy consumption in two distinct scenarios, were calculated. Additional power measurements of reporting stations and desktop computers were performed in off-mode, sleeping mode and active mode. The data for waste disposal was collected by counting and weighing consumables used for a Fluorine-18 Fluorodeoxyglucose ([18F]FDG) procedure. Waste streams were identified and the data categorized per waste stream. The workflow for producing the [18F]FDG radiopharmaceutical was mapped out and data on the energy consumption of the cyclotron and cleanrooms and waste generation was collected. All data was finally expressed in CO2-equivalents (CO2-eq) by using emission factors.

Results:
Of the four different PET/CT power settings, the energy saving mode showed the most significant energy reduction compared to system on, resulting in ∼30% energy savings and a 0.94 kg CO2-eq emission reduction per hour. Furthermore, the energy consumption of various radiopharmaceutical procedures showed results ranging from 3.03 (2.90-3.09) to 5.15 (5.00-5.41) kWh/procedure (1.90 to 1.12 kg CO2-eq). The reporting stations and desktop computers showed both a ∼71% energy reduction in shutdown mode compared to system on. Correct waste separation of plastics and paper showed a ∼64%
CO2-eq reduction per procedure. For radiopharmaceutical production, the impact of the cyclotron’s energy consumption was found the largest (0.44 kg CO2-eq/procedure) compared to HVAC energy consumption (0.13 kg CO2-eq/procedure) and waste disposal (0.003 kg CO2-eq/procedure).The total environmental impact of [18F]FDG PET/CT imaging was measured at 2.01 kg CO2-eq per procedure, with PET/CT scanner energy consumption (62%) and cyclotron energy consumption (22%) being the primary contributors.

Conclusion:
This study showed that the environmental impact of PET/CT imaging is substantial and that it can be reduced by implementing energy saving strategies during non-operational hours, improving waste segregation for recycling and optimizing the energy efficiency of cyclotrons and cleanrooms. Furthermore, hospitals and manufacturers can even reduce the impact further by addressing opportunities such as using eco-friendly or recycled materials and incorporating green energy sources for power supply. Future research should focus on increasing energy-efficiency of scanners, cyclotron and HVAC systems, reducing the scan length and reducing low-value scanning to further decrease the environmental impact of PET/CT imaging while maintaining high diagnostic standards.

This thesis aimed to validate Beekman's patent on how collimation could virtually reduce the focal spot size of an existing small-animal cone beam Computed Tomography (CT) system to diminish the penumbra effect. The ever-remaining drive to improve the spatial resolution in CT for enhanced image quality introduces the need for small focal spot sizes, as the focal spot size is directly related to the geometric unsharpness in the image. Therefore, a collimation method was proposed to virtually reduce the focal spot of existing systems as an alternative to fully replace the current X-ray tube.

A collimator was designed, consisting of numerous tiny hexagonal-shaped holes focused at the center of the focal spot. Theoretical derivations were formulated for its dimensions, and the collimator's efficacy was validated using Monte Carlo simulations. It was concluded that it is theoretically achievable to use collimation to virtually reduce the focal spot size to an arbitrarily chosen smaller virtual focal spot for existing CT systems, significantly reducing the penumbra effect, without requiring any integral changes to the X-ray tube. However, the collimator's practical suitability and manufacturing feasibility were problematic due to its significantly low collimator sensitivity and exceptionally tiny dimensions.

Future work could build on this thesis by obtaining reconstructions from multiple projections of the virtual focal spot to quantitatively assess their theoretically improved spatial resolution. The quantitative confirmation could further establish the theoretical effectiveness of focal spot collimation for future work to enhance reconstructions to uncover valuable information previously hidden.

With multi-pinhole collimation systems, high resolutions can be reached with both SPECT and PET. Using tracers with higher-energy gamma-photons increases the effects of pinhole edge penetration, decreasing the resolution of the system. This research aims to design a collimator using 3x3 twisted pinhole clusters to be used in the VECTor system. This new cluster design should allow high-energy tracers such as 89-Zr to be imaged. The sensitivity of this new design was compared at 511 keV and 909 keV with the sensitivity of the VECTor collimator by simulating the sensitivity using GATE.

A collimator design is characterised by its degree of multiplexing and detector coverage. These values are aimed to be the same as for the VECTor collimator to ensure a fair comparison at the simulation stage. Several design approaches have been tested. The final design had the clusters placed in 5 rows on the collimator. The three inner rows had 21 clusters, the two outer rows had 15 clusters. The inner radius of the collimator was increased to prevent pinholes from intersecting.

The pinhole diameters of the final design were modified such that the resolution of the system was the same as the VECTor resolution for both 511 keV and 909 keV photons. To prevent the pinholes from intersecting, either the inner radius of the collimator had to be further increased, or the pinholes had to be smaller. It was chosen to test both options, resulting in a total of three collimator designs to be simulated. A scan lasting 1 hour was simulated with a source the size of the VECTor CFOV. This was done with 511~keV photons using 2 MBq/mL 18-F, and with 909 keV photons using 2 MBq/mL 89-Zr with their respective designs. These simulations resulted in a 1.77 times higher sensitivity to direct photons for the 511 keV collimator, and either a 2.04 or a 2.69 times higher sensitivity to direct photons for the 909 keV photons. Additionally, the total sensitivity of the 511 keV collimator did not significantly change, and the total sensitivity of the 909 keV collimator designs increased with either 8% or 40%. It is concluded that the implementation of 3x3 twisted pinhole clusters in a collimator to be used in the VECTor system has significant benefits over the current collimator when used with high-energy gamma-photons.