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Guidance and Recommendations for the Implementation of Nuclear Cardiology in Developing Countries

Dear reader, please note that this document is the result of a Technical Meeting on: “Evidence-based Nuclear Cardiology in Ischemic Heart Disease” held in Vienna on February 21–25, 2011. It reflects the contributions of participants to the meeting and has been further expanded and updated to be published as an IAEA Human Health Series.

Contents

• FOREWORD
• CONTENTS
• 1. INTRODUCTION
  • 1.1. BACKGROUND
  • 1.2. OBJECTIVE
  • 1.3. SCOPE & STRUCTURE
• 2. INDICATIONS FOR MYOCARDIAL PERFUSION IMAGING
  • 2.1. EVALUATION OF PATIENTS WITH CHEST PAIN OR ISCHEMIC EQUIVALENT
  • 2.2. CLINICAL SITUATIONS OR SYMPTOMS OTHER THAN ISCHEMIC EQUIVALENT
  • 2.3. RISK STRATIFICATION AND PROGNOSIS ASSESSMENT
  • 2.4. POSSIBLE INDICATIONS FOR ASYMPTOMATIC PATIENTS
  • 2.5. DEFINITIONS
  • REFERENCES
• 3. STRESS MODALITIES AND PROTOCOLS FOR MPI
  • 3.1. TYPES OF STRESS
    • 3.1.1. Physical exercise
    • 3.1.2. Pharmacologic stimulation
    • 3.1.3. Patient preparation
  • 3.2. SELECTION OF STRESS TEST
  • 3.3. STRESS PROTOCOLS
    • 3.3.1. Exercise
    • 3.3.2. Dipyridamole
    • 3.3.3. Adenosine
    • 3.3.4. Selective A2a receptor agonists
    • 3.3.5. Dobutamine
    • 3.3.6. Combination of vasodilators with low workload physical exercise
  • 3.4. CONTRAINDICATIONS
  • 3.5. OPTIMIZATION OF STRESS TESTS IN MPI
  • 3.6. RADIOPHARMACEUTICALS AND IMAGING PROTOCOLS
    • 3.6.1. 99mTc-MIBI and 99mTc-Tetrofosmin
    • 3.6.2. Imaging protocols for 99mTc agents
    • 3.6.3. 201-Thallium
    • 3.6.4. Imaging protocols for 201-Tl
    • 3.6.5. Dual isotope protocols
  • REFERENCES
• 4. ACQUISITION AND PROCESSING OF MPI STUDIES
  • 4.1. ACQUISITION
    • 4.1.1. General recommendations
    • 4.1.2. Patient positioning
    • 4.1.3. Field of view
    • 4.1.4. Orbit
    • 4.1.5. Acquisition type
    • 4.1.6. Pixel and matrix size
    • 4.1.7. Acquisition time
    • 4.1.8. Gated studies
    • 4.1.9. Quality Assurance
  • 4.2. PROCESSING
    • 4.2.1. Motion correction
    • 4.2.2. Image reconstruction
    • 4.2.3. Reorientation
    • 4.2.4. Image display
    • 4.2.5. Quantification
    • 4.2.6. Perfusion defect size
    • 4.2.7. Perfusion defect severity
    • 4.2.8. Summed scores
    • 4.2.9. Polar maps
    • 4.2.10. Left Ventricular Ejection Fraction
    • 4.2.11. Regional LV function
    • 4.2.12. Left Ventricular volumes
    • 4.2.13. Transient Ischemic Dilation
    • 4.2.14. Lung-to-Heart Ratio
    • 4.2.15. Right Ventricular uptake
    • 4.2.16. Overall image quality
  • REFERENCES
• 5. INTERPRETATION AND REPORTING OF MPI STUDIES
  • 5.1. INTRODUCTION
  • 5.2. QUALITY CONTROL
  • 5.3. GATING PROCEDURE
    • 5.3.1. Reconstructed images
    • 5.3.2. Polar maps
    • 5.3.3. Gated images
    • 5.3.4. Attenuation correction
  • 5.4. IMAGE DISPLAY
    • 5.4.1. Slice display
    • 5.4.2. Polar map display
    • 5.4.3. Gated display
    • 5.4.4. Three-dimensional images and quantitative analysis
  • 5.5. ARTEFACT RECOGNITION
    • 5.5.1. Motion artefacts
    • 5.5.2. Attenuation artefacts
    • 5.5.3. Extracardiac activity
    • 5.5.4. Extravasation of tracer
    • 5.5.5. Polar plots
    • 5.5.6. Gating errors
    • 5.5.7. Hot spots
  • 5.6. IMAGE INTERPRETATION
    • 5.6.1. Perfusion defects
    • 5.6.2. High risk scan features
    • 5.6.3. Transient ischemic dilatation of the LV
    • 5.6.4. Lung uptake
    • 5.6.5. Stunning
    • 5.6.6. RV tracer uptake
    • 5.6.7. Multiple and extensive perfusion defects
  • 5.7. REPORTING AND ESSENTIAL ELEMENTS OF A COMPREHENSIVE REPORT
    • 5.7.1. Introduction
    • 5.7.2. General information
    • 5.7.3. Clinical background
    • 5.7.4. Methods
    • 5.7.5. Perfusion (rest and stress 99m-Tc perfusion imaging)
    • 5.7.6. Ventricular function:
    • 5.7.7. Ancillary findings
    • 5.7.8. Conclusions
  • REFERENCES
• APPENDIX I
• APPENDIX II
• APPENDIX III
• APPENDIX IV
• APPENDIX V
• APPENDIX VI
• APPENDIX VII
• APPENDIX VIII
• ABBREVIATIONS
• CONTRIBUTORS OF DRAFTING AND REVIEW