REVIEW 3 major objections 6 minor 52 references
First Positronium Lifetime Imaging with Scandium-44 on a Long Axial Field-of-view PET/CT
T0 review · 3 major / 6 minor · reviewed 2026-08-15 · deepseek-v4-flash
Pith's one-line read Scandium-44 does not improve positronium lifetime imaging over iodine-124 on this scanner because its 1157 keV prompt photon is unresolved and random coincidences dominate.
desk verdict A clean first measurement of 44Sc positronium lifetimes on a clinical LAFOV PET/CT that delivers a useful negative result, though the isotope comparison driving the conclusion is confounded by unmatched activity concentrations. read the letter →
The pith
A machine-rendered reading of the paper's core claim, the machinery that carries it, and where it could break.
The reading
What carries the argument
The load-bearing quantity is the positron annihilation lifetime (PAL) spectrum, in which the 1157 keV nuclear gamma of $^{44}\mathrm{Sc}$ starts a clock and the two 511 keV annihilation photons stop it; the oPs lifetime $\tau_3$ is extracted by a Bayesian fit. The spectrum's peak signal-to-background ratio (pSBR) carries the argument: about 12.6 for $^{44}\mathrm{Sc}$ in a single voxel here, compared with 55.5 reported for $^{124}\mathrm{I}$. The mechanism behind the low ratio is the scanner's energy discrimination, which collects every photon above 726 keV into one final bin, so the 1157 keV prompt photon cannot be rejected and unresolved hits swell the random background.
What would settle it
Run $^{44}\mathrm{Sc}$ in the same phantom at the same 252 kBq/ml activity concentration and 15-minute scan duration used for the $^{124}\mathrm{I}$ reference: if the voxel pSBR stays near 12.6 and the $\tau_3$ error remains several times larger, the unresolved 1157 keV photon is confirmed as the cause; if its statistics match $^{124}\mathrm{I}$, the comparison is confounded by count rate.
Extended reading notes
Core claim
This is the first oPs lifetime imaging study with $^{44}\mathrm{Sc}$ on a long axial field-of-view PET/CT, and its central finding is that the isotope's favorable decay data do not translate into usable count statistics. In the three smallest phantom spheres the fitted oPs lifetimes are $2.65\pm0.50$, $1.39\pm0.20$, and $1.76\pm0.18$ ns, and a single $4\times4\times4$ mm$^3$ voxel in the largest sphere gives $1.79\pm0.57$ ns; all are consistent with the literature water value of $1.839\pm0.015$ ns. The relative standard deviation in the time-difference background (time differences below $-2.7$ ns) stays above 20% even for voxels inside the spheres, and the average per-voxel uncertainty on $\tau_3$ across a slice is 0.53 ns. The authors conclude that, given the scanner's limited energy resolution and the current three-photon event selection, $^{44}\mathrm{Sc}$ does not seem able to outperform $^{124}\mathrm{I}$ in count statistics for oPs lifetime imaging.
Load-bearing premise
The central comparison assumes the $^{44}\mathrm{Sc}$ and $^{124}\mathrm{I}$ scans are directly comparable, even though the $^{124}\mathrm{I}$ reference used about six times higher activity concentration (252 kBq/ml versus 40.68 kBq/ml) and a different scan duration (15 minutes versus 20 minutes).
Editorial extensions
If this is right
- On this scanner and with this event selection, $^{124}\mathrm{I}$ remains the better radionuclide for oPs lifetime imaging, in spite of its far lower prompt-gamma branching ratio per positron.
- Clinical translation of $^{44}\mathrm{Sc}$ for positronium imaging will require hardware or event selection that can reject the unresolved 1157 keV photon, rather than simply more activity.
- $^{43}\mathrm{Sc}$, whose 372.9 keV prompt photon falls inside the detector's energy range, avoids this specific random-coincidence mechanism but offers no count-statistics advantage over $^{124}\mathrm{I}$.
- Random-coincidence estimation or time-thresholding reconstruction, as already proposed for other protocols, is a plausible route to recovering precision from $^{44}\mathrm{Sc}$ data.
Reading between the lines
- A matched-activity, matched-duration head-to-head of $^{44}\mathrm{Sc}$ and $^{124}\mathrm{I}$ on the same scanner would separate isotope physics from count-rate differences, since the comparison here uses 40.68 kBq/ml over 20 minutes versus 252 kBq/ml over 15 minutes.
- If the detector were upgraded to resolve 1157 keV photons, $^{44}\mathrm{Sc}$'s roughly 94% prompt-gamma-per-positron branching ratio would make it the strongest candidate for oPs lifetime imaging, reversing the present conclusion.
- The practice of discarding voxels with more than 20% background error, used in the $^{124}\mathrm{I}$ study, may need to be replaced with explicit random-coincidence subtraction when high-energy prompt emitters are used.
Signed reviews
Editorial analysis
A structured set of objections, weighed in public.
Referee Report
Summary. This manuscript reports the first positronium lifetime imaging measurement with 44Sc on a commercial long-axial field-of-view PET/CT. A NEMA image-quality phantom filled with 41.7 MBq of 44Sc in water was scanned on a Biograph Vision Quadra for 20 minutes in singles mode. Three-photon events were selected with prototype software, and positron annihilation lifetime (PAL) spectra were fitted with a Bayesian procedure. The oPs lifetime is determined in the six phantom spheres and in 4x4x4 mm^3 voxels; the values are reported to be compatible with the literature water value (1.839 ns), though with large uncertainties. The main conclusion is that, because the Quadra cannot resolve the 1157 keV prompt photon of 44Sc, random three-photon coincidences dominate, and 44Sc does not outperform 124I in count statistics for oPs lifetime imaging under the present methodology.
Significance. The paper provides a useful and honest negative result for the emerging field of positronium lifetime imaging: it documents a scanner-specific limitation that will inform radionuclide selection and detector design. The strengths are the clear description of the measurement protocol, the external literature check on the oPs lifetime, the transparent reporting of large statistical uncertainties, and the explicit limitation of the conclusion to the given methodology. If the comparative claim is substantiated, the paper will help prevent futile clinical studies with 44Sc on this class of scanners.
major comments (3)
- [§4 Discussion, pSBR comparison] The central conclusion that 44Sc cannot outperform 124I rests on a cross-paper comparison with Ref. [49] that is not normalized for acquisition conditions. The 44Sc measurement used 40.68 kBq/ml for 20 min in NEMA spheres, whereas the 124I reference used 252 kBq/ml for 15 min in water tubes. The pSBR and τ3 uncertainty are count-rate dependent quantities: the true 3γE rate scales approximately linearly with activity, while the accidental-coincidence background scales with a higher power of the singles rates. The manuscript acknowledges the concentration difference but does not correct for it, so the observed gap (pSBR 12.6 vs 55.5; τ3 error about four times larger) cannot be unambiguously attributed to the unresolved 1157 keV photopeak rather than to the different count rates and geometry. I request either a matched-count-rate comparison, a quantitative model of the activity and scan-time dependence, or an explicit sensitivity analysis.
- [§2 Method / §3 Results] The paper does not report the basic count-statistics quantities needed to evaluate the central claim: the number of selected 3γE events, the estimated random-coincidence fraction, or the pSBR for each ROI. Reporting these values for the spheres and voxels would allow the reader to see how the background grows with the prompt-photon window and to compare with Ref. [49] on a like-for-like basis. As written, the random-coincidence mechanism is inferred from a single pSBR comparison rather than demonstrated from measured singles or coincidence rates.
- [§3 Results, Table 2] The statement that all measured oPs lifetimes are consistent with the literature water value deserves a more careful statistical treatment. The value for s2 is 1.39 ± 0.20 ns, about 2.25 standard deviations below the reference 1.839 ± 0.015 ns; with six spheres plus one voxel, this may still be a plausible fluctuation, but a multiple-comparison or systematic-uncertainty discussion would strengthen the validation claim.
minor comments (6)
- [Table 1] Table 1 is difficult to read: the rows for 82Rb and 124I are split across lines, and the BRγ/β+ values for 82Rb are unclear. A single row per nuclide with an additional footnote would improve clarity.
- [Fig. 1 caption] The Fig. 1 caption says 'The absence attenuation correction'; this should read 'The absence of attenuation correction'.
- [General text] In the text, 'spheres1' (Fig. 1 legend) and 'the spheres4 has a volume' (Discussion) are grammatically awkward; these should be rephrased as 'sphere s1' and 'sphere s4 has a volume'.
- [§4 Discussion] The typo '4.8, %' should be corrected to '4.8%'.
- [§2 Method] The fitting priors are taken from Ref. [49] without being restated; since the lifetime validation depends on the fit, a short statement of the priors or a prior-sensitivity check would improve reproducibility.
- [References] Ref. [25] is a preprint; if a peer-reviewed version exists, it should be cited instead.
Circularity Check
No load-bearing circularity; only a minor self-citation for the 124I benchmark and fit priors, which does not force the conclusion.
full rationale
The paper's derivation chain is not circular. The oPs lifetimes in Table 2 are obtained by fitting the measured PAL spectra; the Bayesian priors are taken from the authors' earlier work (Refs. [25, 33, 49]), but the lifetimes are then checked against the independent literature value for water (Ref. [53]), so the central measurement does not reduce to its priors. The headline negative result about count statistics rests on the measured pSBR (12.6 vs 55.5), on the quoted tau3 uncertainties, and on the physical argument that the 1157 keV prompt photon lies beyond Quadra's 726 keV resolved energy range; these are measured event rates and detector properties, not a parameter that was fit and then renamed a prediction. The 124I comparator is a self-citation (Ref. [49]) and the acquisition conditions differ in activity concentration and scan time, which is a legitimate comparability and validity concern but not a circularity concern, because the 124I values are an external empirical benchmark rather than an input to the 44Sc fit. No uniqueness theorem, no ansatz-only citation, and no definitional identification of input and output are present. The paper explicitly bounds its conclusion to 'the given methodology' and points to alternative event-selection methods, so the claim is not presented as an inevitable consequence of the cited priors. Overall, there is no load-bearing circularity; at most a minor self-citation that does not force the conclusions.
Assumptions & free parameters
free parameters (3)
- τ3 (ortho-positronium lifetime) =
e.g., 1.79 ± 0.57 ns for the voxel; values in Table 2
- τ1, τ2 (shorter PAL lifetimes) =
not reported
- BR1, BR2, BR3 (branching ratios) =
e.g., for s1: BR1 0.072, BR2 0.659, BR3 0.269
assumptions (4)
- domain assumption PAL spectrum can be described by a multi-exponential model with Bayesian priors from Ref [49]
- domain assumption Background in the PAL spectrum is represented by time differences less than -2.7 ns
- domain assumption 44Sc nuclear decay data (Table 1) accurately describe branching ratios and energies
- domain assumption The literature value 1.839 ± 0.015 ns for water (Ref [53]) is correct
Cite this review
Pith. "Pith review of First Positronium Lifetime Imaging with Scandium-44 on a Long Axial Field-of-view PET/CT." pith.science (2026). https://pith.science/paper/WJL4XZ2R
@misc{pith2026250613460,
author = {Pith},
title = {Pith review of: First Positronium Lifetime Imaging with Scandium-44 on a Long Axial Field-of-view PET/CT},
year = {2026},
howpublished = {\url{https://pith.science/paper/WJL4XZ2R}},
note = {Machine review of arXiv:2506.13460}
}
read the original abstract
Purpose: 44Sc has been successfully produced, synthesized, labeled and first-in-human studies were conducted some years ago. The decay properties of 44Sc, together with being close to a clinical implementation, make it an ideal candidate for in vivo positronium lifetime measurements. In this study, we investigate the count statistics for ortho-positronium (oPs) measurements with 44Sc. Method: A NEMA image quality phantom was filled with 41.7 MBq of 44Sc dissolved in water and scanned on a commercial long-axial field-of-view PET/CT. Three-photon events were identified using a prototype feature of the scanner and dedicated software. The lifetime of oPs was determined in the phantom spheres and in 4x4x4 mm^3 voxels. Results: All measured oPs lifetimes are compatible, within the uncertainties, with the literature values for water. The oPs lifetime is 2.65+-0.50, 1.39+-0.20 and 1.76+-0.18 ns in the three smallest spheres of the phantom and 1.79+-0.57 ns for a single voxel in the central region of the largest sphere. The relative standard deviation in the background regions of the time difference distributions, i.e., for time differences smaller than -2.7 ns, is above 20% - even for voxels inside the phantom spheres. Conclusions: Despite the favorable physical properties of 44Sc, the count statistics of three-photon events remains a challenge. The high prompt-photon energy causes a significant amount of random three-photon coincidences with the given methodology and, therefore, increases the statistical uncertainties on the measured oPs lifetime.
Reference graph
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Reviewed August 15, 2026 · model on record in the stance chip above.
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