Radionuclide Ventriculogram (RV)
PROCEDURE: RADIONUCLIDE VENTRICULOGRAM (RV)
SECTION: CARDIOVASCULAR 2.3
ORIGINAL DATE: 4-3-00
DATE REVISED: 6-28-16
Refer to Policy Nuclear Medicine/Administration 1.45 "RBC and WBC administration procedure"
- 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: May use large (40 cm) field of view camera with electronic magnification to a 25 cm field of view.
Collimator: LEAP or LEHR
- 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
Injection technique: Flush method:
- Move the patient’s arm away from his/her side so the basilic vein is not compressed.
- Remove tourniquet.
- Rapidly inject labeled red blood cells.
- 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.
Name: LAO45, LLAT, ANT
Matrix: 64 x 64
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
R to R window: 15% PVC Threshold
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.
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
- Highlight patient name and make sure all data sets are there:
- Best Septal-LAO45
- Click ‘All Applications”. Click ↓ on Cardiac processing section. Click ‘EF Analysis’ container. Click ‘start’ button to begin processing.
- 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.
- 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.)
- Once SCREENCAPTURES have been saved, click ‘File’ and ‘Save and Exit’
- 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.
- 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.