1

LUNG PERFUSION

BY

DR. ASHRAF ANAS ZYTOON MD, PHD, FJRS

MENOUFIYA UNIVERSITY - EGYPT

2

RadiopharmacyRadionuclide• 99mTc• T1/2: 6 hours

• Energies: 140 keV• Type: γ, generator

Radiopharmaceutical• MAA (macroaggregated albumin) or HAM (human

albumin microspheres)

3

Adult Dose Range•2–6 mCi (74–222 MBq)

Method of Administration• Before injection, the patient should cough and

take several deep breaths.• Intravenous (IV) injection.

4

5

Indications• Evaluation for pulmonary embolism (PE).• Evaluation of pulmonary perfusion.• Evaluation of chest pain.• Evaluation of shortness of breath.• Evaluation of lungs for pre- and post-lung surgery.

Contraindications• Should not be performed on patients with

pulmonary hypertension. • Active pneumonia.• Hypersensitivity to human serum albumin.

6

Patient Preparation• Identify the patient. Verify doctor's order. Explain

the procedure.• Obtain a recent (within 24 hours) chest x-ray.

EquipmentCamera• Large field of viewCollimator• Low energy, all purpose, or low energy, high

resolution

7

Procedure • (Time: ~15–30 Minutes)• Images (typically): anterior, RAO, RLAT, RPO,

posterior, LPO, LLAT, and LAO.

8

Lung Ventilation

(Usually Performed with Lung Perfusion)

9

RadiopharmacyRadionuclide133Xe • t1/2: 5.3 days

Energies: 81 keVType: β-, γ

99mTc • t1/2: 6 hours

Energies: 140 keVType: γ, generator

Radiopharmaceutical• 133Xe: gas• 99mTc-DTPA (diethylenetriaminepentaacetic acid)

10

Localization• Compartmental by inhalation into lung space.

Adult Dose Range• 133Xe: 10–20 mCi (370–740 MBq); Tb = ~30

seconds.• 99mTc-DTPA: 25–40 mCi (925–1480 MBq); Tb = >1

hour.

Method of Administration• Inhalation through mask or mouth apparatus.

11

12

Indications• Evaluation and detection of pulmonary embolism

(PE) in conjunction with lung perfusion (mismatching defects).

• Evaluation of chronic obstructive pulmonary disease (COPD) in conjunction with lung perfusion (matching defects).

• Evaluation of shortness of breath.• Evaluation of chest pain.

Contraindications• Active pneumonia.

13

Patient Preparation• Identify the patient. Verify doctor's order. Explain

the procedure.• Obtain recent (within 24 hours) chest X-ray.

EquipmentCollimator• 133Xe: Low energy, all purpose, or low energy,

high sensitivity• 99mTc-DTPA: Low energy, all purpose, or low

energy, high resolution

Procedure (Time: ~15–30 Minutes)

14

Dacryoscintigraphy

(Lacrimal Study)

15

RadiopharmacyRadionuclide• 99mTc • t1/2: 6 hours• Energies: 140 KeV• Type: γ, generator

Radiopharmaceutical• Na 99mTcO4- (Pertechnetate)

Localization• Passive transport, following path of tears in

nasolacrimal system from eye to nose.

16

Adult Dose Range• 50–200 uCi (1.85–7.4 MBq).

Method of Administration• Application of drops using eye-dropper to one or

both eyes.

Indications• Assessment of lacrimal duct patency.• Localization of functional nasolacrimal duct

obstruction.• Assessment of epiphora (pathological watering of

eyes).

17

EquipmentCollimator• Low Energy, All Purpose or Low Energy, High

Resolution, pinhole if available with 1-mm or 2-mm insert.

Computer Set-upFlow• 1–5 seconds/frame for 5 minutes.Dynamic• Obtain immediate image and, one image every 5

minutes up to 30 minutes, then every 10 minutes up to 60 minutes post application.

Procedure Apply 1 to 10 drops per eye

18