Journal of Nuclear Cardiology Tilkemeier et al

ASNC imaging guidelines for nuclear cardiology procedures

Publication and distribution of this document are made possible Findings

by corporate support from Astellas Pharma US, Inc; Covidien; and
GE Healthcare. Corporate supporters were not involved in the The overall quality of the study is poor/fair/good/
creation or review of information contained in this guideline. excellent. Attenuation artifact was present/absent.

APPENDIX 1: SAMPLE TEMPLATE FOR EXERCISE Left ventricular cavity is noted to be normal/
MYOCARDIAL PERFUSION IMAGING enlarged on the rest (and/or stress) studies. There is
evidence of abnormal lung activity. Additionally, the
Stress/Rest (or Rest/Stress) Single-/Dual- right ventricle is normal/abnormal (specify: ____).
Isotope SPECT Imaging with Exercise Stress
and Gated SPECT Imaging SPECT images demonstrate homogeneous tracer
distribution throughout the myocardium OR a small/
Indication
moderate/large perfusion abnormality of mild/mod-
(select one) Diagnosis of coronary disease erate/severe severity is present in the ____ (location)
Evaluation of extent and severity of coronary artery region on the stress images. The rest images reveal
disease ____. Gated SPECT imaging reveals normal myo-
Evaluation of myocardial viability cardial thickening and wall motion. OR Gated
Risk stratification—post-myocardial infarction SPECT imaging demonstrates hypokinesis/dyskin-
(MI)/preoperative/general esis/akinesis of the ____ (location). The left
Assessment of acute chest pain ventricular ejection fraction was calculated to be
____% OR the left ventricular ejection fraction was
Clinical history
normal ([;60%).
____ year old man/woman with (no) known
Impression
coronary artery disease
Cardiac risk factors include: ____ Myocardial perfusion imaging is normal/abnormal.
Previous cardiac procedures include: ____ There is a small/moderate/large area of ischemia/
Current symptomatology includes: ____ infarction in the ____ location. Overall left ventric-
ular systolic function was normal/abnormal with/
Procedure
without regional wall motion abnormalities (as
The patient performed treadmill exercise/bicycle noted above). Compared to the prior study from
exercise using a modified Bruce/Bruce/Naughton/ ____ (date), the current study reveals ____.
____ protocol, completing ____ minutes and com-
pleting an estimated workload of ____ metabolic
equivalents (METS). The test was terminated due to
fatigue/shortness of breath/chest pain/___. The heart APPENDIX 2: SAMPLE TEMPLATE FOR
rate was ____ beats per minute at baseline and PHARMACOLOGIC MYOCARDIAL PERFUSION
increased to ____ beats at peak exercise, which was IMAGING
____% of the maximum predicted heart rate. The
rest blood pressure was ___ mm/Hg and increased/ Stress/Rest (or Rest/Stress) Single-/Dual-
decreased to ___ mm/Hg, which is a normal/ Isotope SPECT Imaging with Pharmacologic
hypotensive/hypertensive response. The patient did/ Stress and Gated SPECT Imaging
did not develop any symptoms other than fatigue Indication
during the procedure; specific symptoms include
____. The resting electrocardiogram demonstrated (select one) Diagnosis of coronary disease
____ and did/did not show ST-segment changes Evaluation of extent and severity of coronary artery
consistent with myocardial ischemia. disease
Evaluation of myocardial viability
Myocardial perfusion imaging was performed at rest Risk stratification—post-MI/preoperative/general
(____ minutes following the injection of ____ mCi Assessment of acute chest pain
of ____). At peak exercise, the patient was injected
Clinical history
with ____ mCi of ____ and exercise was continued
for ____ minute(s). Gating post-stress tomographic ____ year old man/woman with (no) known
imaging was performed ____ minutes after stress coronary artery disease
(and rest). Cardiac risk factors include: ____
 Tilkemeier et al Journal of Nuclear Cardiology
ASNC imaging guidelines for nuclear cardiology procedures

Previous cardiac procedures include: ____ ventricular systolic function was normal/abnormal
Current symptomatology includes: ____ with/without regional wall motion abnormalities (as
noted above). Compared to the prior study from
Procedure
____ (date), the current study reveals ____.
Pharmacologic stress testing was performed with
adenosine/dipyridamole/dobutamine/regadenoson at
a rate of ____ for ___minutes. Additionally, low- APPENDIX 3: LEFT VENTRICULAR
level exercise was performed along with the vaso- SEGMENTATION11
dilator infusion (specify: ____). The heart rate was
____ at baseline and rose to ____ beats per minute
during the adenosine/dipyridamole/dobutamine/rega-
denoson infusion. The rest blood pressure was ___
mm/Hg and increased/decreased to ___ mm/Hg,
which is a normal/hypotensive/hypertensive
response. The patient developed significant symp-
toms, which included ____. The resting
electrocardiogram demonstrated ____ and did/did
not show ST-segment changes consistent with myo-
cardial ischemia.

Myocardial perfusion imaging was performed at rest

(____ minutes following the injection of ____ mCi
of ____). At peak pharmacologic effect, the patient
was injected with ____ mCi of ____. Gating post-
stress tomographic imaging was performed ____
minutes after stress (and rest).

Findings
The overall quality of the study is poor/fair/good/ References
excellent. Attenuation artifact was present/absent.
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