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Basic Physics of SPECT MUGA Acquisition and Display (Slides)

The document outlines the basics of Myocardial Perfusion Imaging (MPI) and Equilibrium Radionuclide Angiography (MUGA), focusing on radiopharmaceutical options, imaging protocols, and acquisition techniques. It discusses patient-centered imaging practices, radiation exposure reduction, and specific protocols for different patient sizes and technologies. Additionally, it covers the importance of gated SPECT for assessing left ventricular ejection fraction and the advantages of using CZT cameras over conventional SPECT.

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17 views

Basic Physics of SPECT MUGA Acquisition and Display (Slides)

The document outlines the basics of Myocardial Perfusion Imaging (MPI) and Equilibrium Radionuclide Angiography (MUGA), focusing on radiopharmaceutical options, imaging protocols, and acquisition techniques. It discusses patient-centered imaging practices, radiation exposure reduction, and specific protocols for different patient sizes and technologies. Additionally, it covers the importance of gated SPECT for assessing left ventricular ejection fraction and the advantages of using CZT cameras over conventional SPECT.

Uploaded by

contatoalternativo021
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Basics of MPI SPECT and MUGA Acquisition and Display

Robert Pagnanelli, BSRT(R)(N), CNMT, NCT


Disclosure:

GE Healthcare employee
Objectives
• Compare radiopharmaceutical options for MPI

• Summarize protocol options for MPI

• Review basic image acquisition for MPI

• Discuss appropriate display for MPI

• Compare RBC labeling options for MUGA


procedures

• Review basic image acquisition for MUGA


procedures

• Discuss appropriate display for MUGA procedures


Myocardial Perfusion
Imaging
Protocol Considerations
 Preferred Practice Statement on Patient-Centered Imaging
 Accurately identifying candidates for imaging
 Choosing the proper imaging procedure for the individual
 Choosing the proper imaging protocol for the individual
 Recommendations for Reducing Radiation Exposure in MPI
 Effective dose of ≤9 mSv in at least 50% of studies
 Recommended radiopharmaceutical doses are now more
detailed (patient specific) [Table 5] of ASNC SPECT: Stress,
Protocol and Tracer guidelines
 Patient size
 Conventional vs. newer technology
 One day protocol (lg. patient/conventional technology) 12/36 mCi
 One day protocol (sm. patient/new technology) 4/12 mCi
Tc-99m sestamibi / Tc-99m tetrofosmin
 Energy:
 140 keV
The higher photon energy is well suited for gamma
camera imaging

 Physical Half-life:
 6 hours
 Lipid-soluble, cationic
 Retention in mitochondria
 0.3 mSv per mCi injected
Tc-99m Labeled Agent
Imaging Protocols
 Sestamibi
 Following rest, delay of 45-60 minutes
 Following exercise injection, delay of 15-20 minutes
 Following pharmacologic stress, delay of 60 minutes

 Tetrofosmin
 Following rest, delay of 30-45 minutes
 Following exercise injection, delay of 10-15 minutes
 Following pharmacologic stress, delay of 45 minutes

 Delays of up to two hours can be utilized when


needed
One Day Rest / Stress Tc-99m
 Most commonly used protocol
 Completed in one day
 Stress images have the high dose / best
quality
 12 mSv, 10/30 mCi
 9 mSv, 8/24 mCi
Stress First Imaging
 It is especially advantageous in patients without:
 High pre-test probability of a stress perfusion
defect
 LV dysfunction
 LV dilatation
 Potentially lowers radiation dose
 By 75% with one day protocols
 By 50% with two day protocols
Stress Only

70”/235 lbs.
3 mSv
Two Day Rest / Stress Tc-99m

ASNC Guidelines, 2016


Tl-201 Thallous Chloride
 Energy: Principle emission is 68 to 80 keV, but also gamma rays at 137 keV and 167 keV

 High first pass extraction fraction (85%)

 Better linearity to blood flow compared to sestamibi and tetrofosmin

 The redistribution process begins within 10-15 minutes post injection

 Cleared by kidneys

 Analog of potassium (monovalent cation)


 Physical Half-life:
 73.1 hours

 Exposure
 3.5 mCi – 15.3 mSv
 4.4 mSv per mCi injected
ASNC Guidelines, 2016
ASNC Guidelines, 2016
Myocardial Perfusion SPECT
Protocols-Acquisition
 Position
 Supine
Routine
 Prone
Less inferior wall attenuation, more uniform
breast attenuation
Less motion artifact
May cause artifactual anteroseptal defect secondary
to  sternal attenuation
Duke Nuclear Cardiology
Myocardial Perfusion SPECT
Protocols-Acquisition

 Position
 Supine and Prone Combination
To identify breast, inferior wall and lateral chest-wall
fat attenuation artifacts
Gating is not usually performed in prone position
 Acquisition time
Supine= 20 sec step for 60 proj, for 25–30 mCi
Prone = (reduced by 20–40%) = 15 secs/step for 60
proj, for 25–30 mCi

Dorbala, S., Ananthasubramaniam, K.,


Armstrong, I.S. et al. Single Photon Emission
Computed Tomography (SPECT) Myocardial
Perfusion Imaging Guidelines:
Instrumentation, Acquisition, Processing, and
Interpretation. J. Nucl. Cardiol. 25, 1784–
1846 (2018).
https://doi.org/10.1007/s12350-018-1283-y
Myocardial Perfusion SPECT Protocols-
Acquisition

 Energy window—20%
126 154

 Collimator
 LEAP
 201Tl
 LEHR
 Longer bores, smaller holes and thicker
septa for better resolution (at expense of
sensitivity)
 High count rates required
 99mTc
Myocardial Perfusion SPECT
Protocols-Acquisition

 Orbit
 180°– 45° RAO 45° LPO
 180° avoids noise contamination from
posterior projections
 360°—triple-head cameras/ heads at 120
deg
Orbit
 Either circular or elliptical orbits are acceptable
 Either MUST be as close as possible to the patient
 The same type of orbit MUST be used at rest and
stress
Myocardial Perfusion SPECT Protocols-
Acquisition

 Acquisition type
 Step and shoot
 Continuous
 NEG—Minimal spatial resolution loss
 POS—higher counts
 Continuous step and shoot (vendor limited)
 Number of projections
 Tl
201

 30–32 steps over 180° with LEAP


 99mTc
 60–64 steps to prevent loss of resolution
Myocardial Perfusion and Function SPECT
Protocols-Acquisition

 Gated SPECT—should be performed on all


SPECT MPI studies
 Assessment of LVEF
 Assessment of regional wall motion and
thickening
 Improved specificity by the ability to identify
artifacts—particularly anterior wall breast
attenuation and inferior wall diaphragmatic
attenuation
Gated SPECT
Rest LVEF
Post-stress LVEF
Cannot acquire a “peak stress” LVEF
In event of severe ischemia, even with delay of
image acquisition, may show wall motion abnormality
and drop in LVEF
In normal patient, the LVEF may be slightly elevated
due to an increase in catecholamines from exercise
Evaluation of stress images
A peak stress perfusion pattern
A real time wall motion pattern
Gated SPECT

 8 vs. 16 frames
 8 frames will slightly underestimate
ejection fraction
 8 frames will double the counts per bin
 Potentially makes tracking more accurate
FIRST ACQUISITION SECOND ACQUSITION
Diaphragmatic Attenuation

STR SUPINE

STR PRONE

RST SUPINE

Duke Nuclear Cardiology


Dual-Head Conventional SPECT
Breast Attenuation Artifact
No Significant Breast Attenuation Artifact
CZT Cameras to
Conventional SPECT

 Pros
 Higher spatial resolution (~5-6mm)
 Higher energy resolution
 Higher sensitivity (<5X)
 More stability
 Less QC
 Less claustrophobia
 Efficiency and reduced radiation exposure

 Cons
 Cost
 Learning curve for physicians and technologists
 Some are limited to cardiac procedures
apex base

septum lateral
3 o’clock

inferior anterior
12 o’clock
Copyright ©2002 American Heart Association

Cerqueira, M. D. et al. Circulation. 2002;105:539-542


Cerqueira, M. D. et al. Circulation. 2002;105:539-542
Copyright ©2002 American Heart Association
Equilibrium Radionuclide
Angiography - ERNA

aka MUGA
2-3 mg

75-85% RBC labeling efficiency


90-95% RBC labeling efficiency
1-3 mL blood

95% + RBC labeling efficiency


ERNA — Acquisition
 20–25 mCi of 99mTc-RBCs

 LEHR for rest only

 R-wave triggered frames


 24–32 frames/cycle preferred for EF calc.

 200,000 counts/frame

 10–15% beat length window


 Bad beat rejection

 If a large FOV camera, use 1.5–2.0 zoom


 Pixel size <4 mm/pixel desired (2–3 mm/pixel preferred)

EF, ejection fraction; FOV, field of


view; LEHR, low-energy high
resolution
ERNA
R-Wave Gated Acquisition
ERNA—Positioning

ERNA Guidelines 2009. Corbett JR, et al. J Nucl Cardiol.


2006;13:e56-e79.
R-Wave Gated Acquisition
Unfiltered

ANT LAO LT LAT

Filtered (Spatial and Temporal)


Equilibrium Radionuclide Ventriculography

LVEF =
(Bcorr ED cts - Bcorr ES
cts)
Bcorr ED cts
X 100

Bcorr, background
corrected; cts, counts

ERNA Guidelines 2009. Corbett


JR, et al. J Nucl Cardiol.
2006;13:e56-e79.
Quantitative Blood
Pool SPECT
Gated Blood Pool SPECT Acquisition
 25-35 mCi 99mTc-RBCs
 High Resolution Collimation
 180º GSPECT, 60-64 stops, 25–30 sec
 R-wave triggered, 16-frames per cycle,
 20% window
 Rest only imaging (15-20 minute acquisition)
Quantitative Blood Pool SPECT
Processing
 Reorientation to ACC/ASNC guidelines
SAX; apex to base
VLA; RV to LV lateral wall
HLA; inferior to anterior

 Butterworth Filter
Cutoff = .55 order 7

HLA, horizontal long axis; LV, left ventricle; RV, right ventricle; SAX, short axis;
VLA, vertical long axis
Quantitative Blood Pool SPECT
Processing

 LV / RV separation
Quantitative Blood Pool SPECT
Processing
 LV & RV contours are 3D
The End

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