Nuclear Medicine Procedures-3

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LUNG PERFUSION

BY

DR. ASHRAF ANAS ZYTOON MD, PHD, FJRS

MENOUFIYA UNIVERSITY - EGYPT

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RadiopharmacyRadionuclide• 99mTc• T1/2: 6 hours

• Energies: 140 keV• Type: γ, generator

Radiopharmaceutical• MAA (macroaggregated albumin) or HAM (human

albumin microspheres)

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Adult Dose Range•2–6 mCi (74–222 MBq)

Method of Administration• Before injection, the patient should cough and

take several deep breaths.• Intravenous (IV) injection.

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Indications• Evaluation for pulmonary embolism (PE).• Evaluation of pulmonary perfusion.• Evaluation of chest pain.• Evaluation of shortness of breath.• Evaluation of lungs for pre- and post-lung surgery.

Contraindications• Should not be performed on patients with

pulmonary hypertension. • Active pneumonia.• Hypersensitivity to human serum albumin.

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Patient Preparation• Identify the patient. Verify doctor's order. Explain

the procedure.• Obtain a recent (within 24 hours) chest x-ray.

EquipmentCamera• Large field of viewCollimator• Low energy, all purpose, or low energy, high

resolution

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Procedure • (Time: ~15–30 Minutes)• Images (typically): anterior, RAO, RLAT, RPO,

posterior, LPO, LLAT, and LAO.

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Lung Ventilation

(Usually Performed with Lung Perfusion)

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RadiopharmacyRadionuclide133Xe • t1/2: 5.3 days

Energies: 81 keVType: β-, γ

99mTc • t1/2: 6 hours

Energies: 140 keVType: γ, generator

Radiopharmaceutical• 133Xe: gas• 99mTc-DTPA (diethylenetriaminepentaacetic acid)

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Localization• Compartmental by inhalation into lung space.

Adult Dose Range• 133Xe: 10–20 mCi (370–740 MBq); Tb = ~30

seconds.• 99mTc-DTPA: 25–40 mCi (925–1480 MBq); Tb = >1

hour.

Method of Administration• Inhalation through mask or mouth apparatus.

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Indications• Evaluation and detection of pulmonary embolism

(PE) in conjunction with lung perfusion (mismatching defects).

• Evaluation of chronic obstructive pulmonary disease (COPD) in conjunction with lung perfusion (matching defects).

• Evaluation of shortness of breath.• Evaluation of chest pain.

Contraindications• Active pneumonia.

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Patient Preparation• Identify the patient. Verify doctor's order. Explain

the procedure.• Obtain recent (within 24 hours) chest X-ray.

EquipmentCollimator• 133Xe: Low energy, all purpose, or low energy,

high sensitivity• 99mTc-DTPA: Low energy, all purpose, or low

energy, high resolution

Procedure (Time: ~15–30 Minutes)

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Dacryoscintigraphy

(Lacrimal Study)

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RadiopharmacyRadionuclide• 99mTc • t1/2: 6 hours• Energies: 140 KeV• Type: γ, generator

Radiopharmaceutical• Na 99mTcO4- (Pertechnetate)

Localization• Passive transport, following path of tears in

nasolacrimal system from eye to nose.

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Adult Dose Range• 50–200 uCi (1.85–7.4 MBq).

Method of Administration• Application of drops using eye-dropper to one or

both eyes.

Indications• Assessment of lacrimal duct patency.• Localization of functional nasolacrimal duct

obstruction.• Assessment of epiphora (pathological watering of

eyes).

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EquipmentCollimator• Low Energy, All Purpose or Low Energy, High

Resolution, pinhole if available with 1-mm or 2-mm insert.

Computer Set-upFlow• 1–5 seconds/frame for 5 minutes.Dynamic• Obtain immediate image and, one image every 5

minutes up to 30 minutes, then every 10 minutes up to 60 minutes post application.

Procedure Apply 1 to 10 drops per eye

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