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Tc-99m Sestamibi Myocardial Perfusion Imaging

PROCEDURE: Tc-99mSESTAMIBI MYOCARDIAL PERFUSION IMAGING
SECTION: CARDIOVASCULAR 2.1
ORIGINAL DATE: 9-30-99
DATE REVISED: 6-28-16
REVIEWED: Annual

Indications:

  • Detection of coronary artery disease.
  • Classification of left ventricular myocardium as normal, infarcted, and reversibly ischemic.
  • Documentation of myocardial perfusion abnormalities before and after interventional therapy.

Exam time length:

  • Rest study:
    1. Initially: 15 minutes for injection.
    2. 1 hour later: 20 minutes for image acquisition.
  • Stress study 
    1. Initially: 30 minutes for stress and injection.
    2. 30 – 60 minutes later: 20 minutes for stress acquisition.

Patient Preparation:

  • Patients may not have caffeine 12 hours prior to exam.
  • Patients may not have any solids 4 hours prior to stress test, may have liquids up to 2 hours before stress. 
  • NTG for Cardiolite patients
    • Stress study: stop NTG 2 hrs. prior to start of test. 
    • Rest study: Standard RD/ST, no need to stop NGT
    • Rest study: acute chest pain, stop NGT 1/2 hr prior to injection.
  • Female patients should be imaged with their bras removed.

Radiopharmaceutical & Dose:

  • Radiopharmaceutical: Tc‑99m‑Sestamibi 
  • Dose: Adjusted according to patient weight
  • One day protocol: For all patient weights.
  • REST: minimum 7 mCi, maximum 10 mCi (0.093 mCi/Kg)
  • STRESS: minimum 21 mCi, maximum 30 mCi (0.28 mCi/Kg)

Administration Technique:

  • Rest: IV placement on one day exam, injection of sestamibi. 
  • Stress: IV placement and injection of sestamibi under direction of stress test provider or according to pharmaceutical utilized.

CARDIOLITE REST/STRESS PROCESSING

Rest Study Stress Study
Minimum time interval between rest and stress studies 2 Hours 2 Hours
Time interval between tracer injection and imaging 45-60 minutes 15-60 minutes
Camera/Collimator LEHR LEHR
Patient Position Supine Supine
Energy 140keV 10% 140 keV 10%
Matrix 64 x 64 Zoom of 1.33 64 x 64 Zoom of 1.33
Pixel size 6.91 mm 6.91 mm
Number of projections 60 60
Orbit CW or CCW 180 CCW 180 CCW
Orbit type Circular Circular
Start Angle L-mode 0 degrees L-mode 0 degrees
End Angle L-mode 90 degrees L-mode 90 degrees
Time per view 20 sec : low dose/high dose (1-day) 
35 sec : =>110 (1-day)
15 sec : low dose/high dose (1-day)
20 sec : =>110 (1-day)
Gating (Y/N) No Yes
Gating frames NA 8
R to R window NA

+/- 20% (adjust for a –fib)

Uniformity and COR Yes

Yes

Prefilter Type BUTTERWORTH

BUTTERWORTH

Filter cutoff/power 0.4/10: low dose(1-day)
0.5/5 : =>110 (1-day)

0.5/5

Motion correction Repeat study if motion

Repeat study if motion

Attentuation correction Yes - CT

Yes - CT

Normal database used Y/N Yes

Yes

Reconstruction filter Ramp

Ramp

Name of Quant program used Cedars' Sinai

Cedars' Sinai

Screen Caps to make Myometrix: FBP

(These are done for a REST ONLY TEST)

Quantitative Gated SPECT
Quantitative Perfusion SPECT
Myometrix: FBP

Send to FUJI The 2 screen caps

The 4 screen caps

Send to Dr Cardio The Whole Patient Study

The Whole Patient Study

Myovation Evolution

Updated 12/11/14 JC

  • Highlight Cardiolite Study
  • Click Myovation Evolution
  • Click Attn. Corr QC
  • Proceed
  • Click on adjust registration, click on organ.
  • Check, adjust registration
  • Make any adjustments to CT position starting with sagittals. If sagittals line up, look at coronals and adjust as needed, the axials should line up.
  • Scroll thru images
  • Proceed
  • Line up heart for slicing; adjust ROI to mask bowel, if needed.
  • Hit review page
  • Screen cap slices review pages for Cardiolite and Cardiolite AC
  • File, Save and Exit.
  • Take entire study and run QGSQPS
  • Screen cap polar map review pages only
  • When done exit and save.
  • Use QGS/QPS for review.

Cardiac Doses – ACR guidelines

Weight Rest dose (0.093mCi/kg) Stress Dose (.28mCi/kg) Total (mCi)
75 7.0 - min 21.0 - min 28
80 7.4 22.4 29.8
85 7.9 23.8 31.7
90 8.4 25.2 33.6
95 8.8 26.6 35.4
100 9.3 28.0 37.3
105 9.8 29.4 39.2
110 10.0 - max 30.0 - max 40.0
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