Lung Perfusion Scan
PROCEDURE: LUNG PERFUSION SCAN
SECTION: PULMONARY 8.1
ORIGINAL DATE: 3–24–00
DATE REVISED: 9–22–16
- 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’.
- 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.
- 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.
- 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:
- Acquire perfusion statics. Filter using reduced statics processing for Tc99m.
- Acquire perfusion Tomo. Process using Vol MI Evolution Tc99m. Save MIP and save as partial volume. Save and exit.
- Acquire ventilation statics. No filtering needed due to higher statistics.
- Prepare lung analysis report using filtered perfusion statics and raw ventilation statics.
See PULMONARY 8.2
Data Processing (for Perfusion and Ventilation Static images after Reduced Processing)
Lung Analysis Processing
- 3 menus:
- a) Perfusion image review
- b) R lung and Ref images
- c) L lung and Ref images
- d) Quant Perf analysis
- a) Static image review
- b) R lung and Ref images
- c) L lung and Ref images
- 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.
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.
References: JNM, Vol. 48, No5, May 2007
Quantitative Lung Processing
- On Xeleris functional imaging workstation, go to All Applications
- Choose pulmonary tab
- Choose lung analysis once you’ve highlighted your patient, hit start
- Under perfusion menu choose quantitative perfusion analysis
- Follow prompts to adjust ROI over left lung as directed by Radiologist and proceed.
- Follow prompts to adjust ROI over right lung as directed by Radiologist and proceed.
- Make a screen capture of the data.
- Save screen captures to Fuji, followed by images.
2. Hepatopulmonary syndrome:
Acquisition and Processing
Time interval between tracer injection & imaging: None
Patient position: supine
Energy: 140 keV
Scan Mode: Continuous
- 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.
N Engl J Med 2008:358:2378-87.
Eur J Gastroenterol Hepatol. 2010 Aug;22(8):1006-12.