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123I thyroid scintigraphy can be performed with either a low energy or medium energy collimator. The high-energy photon emissions from 123I cause septal penetration with scattered photons, which deteriorate image quality. The aim of this study is to evaluate the impact of collimator choice on 123I thyroid scintigraphy in clinical practice. Methods: Forty seven patients who received thyroid planar scintigraphy with both a low energy high resolution (LEHR) collimator and a medium energy (ME) collimator were prospectively recruited using the same imaging protocol. Image quality, collimator sensitivity, and estimation of thyroid size were assessed between LEHR and ME collimators, and were compared with thyroid ultrasonography as the gold standard. Results: Images acquired with the ME collimator demonstrate less scattered background noise, improved thyroid to background contrast, and increased sensitivity in the thyroid gland compared to images acquired by the LEHR collimator. Manual measurement of the thyroid length is more accurate by using the ME collimator. Automatic estimation of the thyroid area size by using the same thyroid cutoff threshold is larger in ME collimator images than in LEHR collimator images. Conclusion:123I thyroid scintigraphy using the ME collimator generates cleaner images with less background noise and has higher collimator sensitivity for thyroid imaging compared to the LEHR collimator. Different thyroid cutoff threshold should be used to estimate the thyroid area size and volume between low and medium energy collimators.

A 72-year-old man with a family history of prostate cancer and initial diagnosis of favorable intermediate risk prostate cancer via biopsy in 2017 elected for active surveillance. Two years later, he underwent prostate biopsy showing intermediate-risk cT1c Nx Mx lesion with Gleason score 3 + 4 = 7 (5 core positive). Transrectal ultrasound showed a prostate volume 28 mL, and the prostate-specific antigen was 8.1. Patient elected to proceed with combination radiation therapy and androgen deprivation therapy.