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Lung Perfusion Scan

PROCEDURE: LUNG PERFUSION SCAN
SECTION: PULMONARY 8.1
ORIGINAL DATE: 3–24–00
DATE REVISED: 9–22–16
REVIEWED: Annual

Indications

  • Diagnosis of pulmonary embolism
  • Evaluation of regional pulmonary perfusion
  • Evaluation of hepatopulmonary syndrome

Examination Time: 45 minutes for perfusion study

****Allow an additional 45 minutes for the post-perfusion ventilation study on all patients scanned after 9 p.m. See protocol ‘PULMONARY 8.2’.

Patient Preparation

  • Recent (within 24 hours) chest x-ray. Ask reading radiologist to view the chest x-ray prior to beginning the perfusion exam.
  • Perfuse the patient first, unless the patient would be unable to do an adequate post-perfusion ventilation study.
  • Patient MUST be injected in a recumbent position during the injection of the MAA.
  • *** Patients with Severe Pulmonary Hypertension i.e., pulmonary systolic BP of 55-60 mm/Hg, will need to have radiologists review case prior to injecting MAA. ***

For Severe Pulmonary Hypertension—Inject <150,000 particles, adjust kit. Load w/ 75
mCi Tc04- per Dr. Manske. Final per Dr. H.
Doses from Cardinal Health are to be ordered under the

  • *** Pediatric patients, Pt's with Right to Left shunts, or Pneumonectomy should receive less particles. Refer to Package Insert for details.

Equipment & Energy Windows

  • Gamma camera: Large field of view.
  • Collimator: Low energy, LEHR, parallel hole.
  • Energy window: 20% window centered at 140 KeV.

Radiopharmaceutical, Dose, & Technique of Administration

  • Radiopharmaceutical: Tc‑99m‑macro aggregated albumin.
  • Dose:
    • 5 mCi 99m‑Tc MAA (Macro aggregated albumin) if doing perfusion only, or after lung ventilation imaging. (Pediatric 0.09 mCi/kg (Dosing Range 0.9-5 mCi))
    • 2 mCi 99m‑Tc MAA if perfusion is done prior to lung ventilation imaging. (Pediatric: 0.03 mCi/kg (Dosing Range 0.4-2 mCi))
    • 5 mCi 99m‑Tc MAA if study is for Quantitative Lung or Hepatopulmonary syndrome. (Pediatric: 0.09 mCi/kg (Dosing Range 0.9-5 mCi))
  • Technique of administration: Standard intravenous injection.

Patient Position & Imaging Field

  • Patient position: Supine or sitting.
  • Imaging field: Entire lungs.

Acquisition Protocol

  • Perfuse patient first
  • Acquire images in the POST, RPO, RT LAT, RAO, ANT, LAO, LT LAT, and LPO projections.
    • Acquire each image for approximately 500 K.
  • Run imagins through Reduced Whole-body bone and static processing for IN111/Tc99m:
    1. Acquire perfusion statics. Filter using reduced statics processing for Tc99m.
    2. Acquire perfusion Tomo. Process using Vol MI Evolution Tc99m. Save MIP and save as partial volume. Save and exit.
    3. Acquire ventilation statics. No filtering needed due to higher statistics.
    4. Prepare lung analysis report using filtered perfusion statics and raw ventilation statics.

Ventilate patient

See PULMONARY 8.2


Data Processing (for Perfusion and Ventilation Static images after Reduced Processing)
Lung Analysis Processing

  1. 3 menus:
  2. Perfusion
    • a) Perfusion image review
    • b) R lung and Ref images
    • c) L lung and Ref images
    • d) Quant Perf analysis
  3. Ventilation
    • a) Static image review
    • b) R lung and Ref images
    • c) L lung and Ref images
  4. Vent/Perf
    • Static image review
    • Post/rao/rlat/rao & Ref images
    • Lpo/llat/lao/ant & Ref images

Choose menu item #2 for perfusion only lung scans and use options b and c to display the data, screen capture both.
Choose menu item #4 for VQ and use options b and c to display the data, screen capture both.
Save screen captures to Fuji, followed by images.

Optional Maneuvers

1. Quantitation:
Perfusion Only- No Ventilation required (per Dr. Manske 8/20/15)
; Unilateral or regional pulmonary function may be quantitated.

    • Views: Acquire all views as above, using only the anterior and posterior images for quantitation calculations.
    • Check with ordering physician to determine which areas of the lung he/she is interest wants ROIs drawn around.

Data Processing
References: JNM, Vol. 48, No5, May 2007

Quantitative Lung Processing

    1. On Xeleris functional imaging workstation, go to All Applications
    2. Choose pulmonary tab
    3. Choose lung analysis once you’ve highlighted your patient, hit start
    4. Under perfusion menu choose quantitative perfusion analysis
    5. Follow prompts to adjust ROI over left lung as directed by Radiologist and proceed.
    6. Follow prompts to adjust ROI over right lung as directed by Radiologist and proceed.
    7. Make a screen capture of the data.
    8. Save screen captures to Fuji, followed by images.

2. Hepatopulmonary syndrome:
Acquisition and Processing

Time interval between tracer injection & imaging: None

Collimator: LEAP

Patient position: supine

Energy: 140 keV

Matrix: 1024*256

Scan Mode: Continuous

Time/View

    • Infinia 1 + 2: 300 sec exposure per pixel, 10 cm/min;
    • Infinia 4: 240 sec exposure per pixel, 8 cm/min

Start position: Just above top of head

End position: Mid-thigh

Images taken: Anterior and Posterior WB

Screen caps to make

      • Display Anterior and Posterior WB images. 
      • Create ROI’s over entire body, lung field, and brain. 
      • Capture the statistics for WB, lungs and brain ROIs. 
      • Calculate the WB count total. 
      • Calculate Lung count total. 
      • Calculate brain count total. 
      • Subtract lung from WB, then divide by WB, report out the percentage in WB and in Lungs. 
      • Subtract brain from WB, then divide by WB, report out the percentage in brain.

Send to FUJI

      • Screencap of images with ROI overlays. 
      • Annotate statistics onto screencap: 
        • X% of total activity in Lungs. 
        • X% of total activity outside of lungs. 
        • X% of total activity in brain.

References:
N Engl J Med 2008:358:2378-87.
Eur J Gastroenterol Hepatol. 2010 Aug;22(8):1006-12.

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