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Radionuclide Ventriculogram (RV)

PROCEDURE: RADIONUCLIDE VENTRICULOGRAM (RV)
SECTION: CARDIOVASCULAR 2.3
ORIGINAL DATE: 4/3/00
DATE REVISED: 8/20/15

Indications

  • Evaluate ventricular regional wall motion.
  • Quantitative ventricular ejection fractions
  • Monitor cardio toxicity of chemotherapy.
  • Differentiate pulmonary and cardiac causes of dyspnea.

Exam time length: 1 hour

Patient Preparation: None

Camera: (25 cm) field of view camera. May use large (40 cm) field of view camera with electronic magnification to a 25 cm field of view.

Collimator: LEAP or LEHR

Energy window

  • 20% window centered at 140 KeV.
    • Confirm that the window is centered on the largest “peak or hill.” The default is 20% low/ 20% high, see optional processing steps below to change window

Radiopharmaceutical & Dose:

  • Tc‑99m‑labeled red blood cells: Ultra Tag Kit.
  • 25 mCi

Administration Technique
Injection technique: Flush method:

  1. Move the patient’s arm away from his/her side so the basilic vein is not compressed.
  2. Remove tourniquet.
  3. Rapidly inject labeled red blood cells.
  4. Flush with 10 ml of saline.

MUGA ACQUISITION & ARCHIVING PARAMETERS

Time interval between tracer injection and imaging: 2 min, proper gating should be established prior to injection.

Key Parameters: Name
LAO45, LLAT, ANT

Mode: L

Matrix: 64 x 64

Zoom: 2.57

Start Angle: 0˚ LAO45, 270˚ ANT/LLT

Counts per view: 5000 LAO45, 4000 ANT/LLT

Gating (Y/N): Y

Gating frames/cycle: 24

Patient position: Supine

Body Part: CHEST

Pt. Location: Feet first supine

MUGA Triggers: R to R window
15% PVC Threshold

MUGA Corrections: Collimator
LEHR or LEAP

Energy: Tc140 10% window

Uniformity and COR: Y

EF Mode: Normal

Energy Range: Low

Energy Map Name: Tc99m

Prefilter Type: 2 consecutive 9-pt smooths of ea frame + temporal smooth between frames.

Filter cutoff/power

Attenuation correction Y/N: N

Normal database used Y/N: N

Screen caps to make: EF Summary Page

Send to FUJI: EF Summary Page

Send to Dr. Cardio: Complete exam w/ paperwork

RADIONUCLIDE VENTRICULOGRAM PROCESSING

  1. Highlight patient name and make sure all data sets are there:
    • Best Septal-LAO45
    • ANT-LLT
  2. Click ‘All Applications”. Click ↓ on Cardiac processing section. Click ‘EF Analysis’ container. Click ‘start’ button to begin processing.
  3. Under ‘Process’ icon (computer screen icon). Click ‘EF Automatic’ button.
    • a) LAO45 image will be displayed on the process screen, upper left corner.
    • b) Adjust ROI to fit around left ventricle
        • Use amplitude and phase images for guidance. ROI should fit comfortably around the LT ventricle on these images w/o touching.
    • c) When satisfied, click ‘Proceed’ button to continue processing image.
    • d) Review ROI, EF curve and data for accuracy.
    • e) Next, Click ‘Filter only’ button
        • This will bring up all three images and apply a smoothing filter for viewing aesthetics.
  4. Under ‘Review’ icon (computer screen icon). 
    • a) Click ‘EF Summary’ button to bring up completed data.
    • b) Create SCREENCAPTURE by clicking on Printer icon and click ‘Save’ button. (Take SCREENCAPTURE of this page using normal color mode.)
  5. Once SCREENCAPTURES have been saved, click ‘File’ and ‘Save and Exit’ 
  6. Select whole patient study and send to ‘Dr Cardio’ by clicking button under transfer destination.
    Highlight SCREENCAPTURE ONLY and send to ‘FUJI’ the same as above.
  7. Optional processing steps:
    • a) After checking the trigger histogram window, confirm that the window is centered on the largest “peak or hill. The default is 20% low/ 20% high.
    • b) If not centered correctly; 
      • Create an “asymmetric window” by typing in different percentages for the low and high window values to center window on the most prominent peak.
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