Clinical

Guidelines

The European Association of Nuclear Medicine

EANM guidelines for ventilation/perfusion scintigraphy – Part 1

Bajc M, et al. Eur J Nucl Med Mol Imaging 2009; 36: 1356-1370

EANM guidelines for ventilation/perfusion scintigraphy – Part 2

Bajc M, et al. Eur J Nucl Med Mol Imaging 2009; 36: 1528-1538

The Canadian Association of Nuclear Medicine

CANM Guidelines for ventilation/perfusion (V/P SPECT) in pulmonary embolism

Education

Technegas Functional Lung Imaging
Ventilation SPECT/CT using Technegas to quantify pulmonary function

Pulmonary study
V/Q SPECT using Technegas to detect pulmonary embolism

 

Testimonials

Beyond PE clinical uses - results from clinical studies

Airflow limitation assessment in chronic airway diseases
Images were kindly provided by the Hunter New England Imaging (HNEI) at John Hunter Hospital and clinical data by the Hunter Medical Research Institute (HMRI)

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Monitoring treatment response in asthmatic patients
Images and clinical data were kindly provided by the Woolcock Institute of Medical Research

 

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Lung function evaluation before lung volume reduction surgery
Images were kindly provided by Macquarie Medical Imaging (MMI) and clinical data by Macquarie Respiratory & Sleep department at Macquarie University

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Literature highlights

Edition 1 – May 2017
COPD, a new indication for using Technegas V/Q SPECT?

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Edition 3 – October 2017
Economical value of hybrid SPECT/CT in pulmonary embolism diagnosis

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Edition 2 – August 2017
V/Q SPECT/CT as first-line modality for pulmonary embolism diagnosis

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Edition 4 – December 2018
Summary of the Lancet Commissions report on redefining airways diseases

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Clinical References

SPECT-CT/VQ versus CTPA for diagnosing pulmonary embolus and other lung pathology: Pre-existing lung disease should not be a contraindication
Bhatia KD, et al. J Med Imaging Radiat Oncol 2016; 60(4): 492-497

Pre-existing lung disease should not be a relative contraindication to the use of V/Q SPECT-CT. This modality has a sensitivity of 100% and specificity of 94% with lower radiation doses compared to CTPA.

Diagnostic evaluation and management of chronic thromboembolic pulmonary hypertension: a clinical practice guideline
Mehta S, et al. Can Respir J 2010; 17(6): 301-334

We recommend nuclear V/Q lung scanning instead of CTPA as a screening test to rule out the possibility of CTEPH in patients diagnosed with PH. A normal V/Q scan effectively rules out the possibility of CTEPH.

Value of (99m)Tc-Technegas SPECT/CT for Localization of Alveolar-pleural Fistulas
Derlin T, et al. Nucl Med Mol Imaging 2016; 50(2): 164-165

99mTc-Technegas ventilation scintigraphy is an established and well-studied tool for imaging of lung ventilation and combined SPECT/CT has been shown to improve overall diagnostic accuracy in many areas of pulmonary nuclear medicine.

The Economic Value of Hybrid Single-Photon Emission Computed Tomography with Computed Tomography Imaging in Pulmonary Embolism Diagnosis
Toney LK, et al. Acad Emerg Med 2017; 24(9):1110-1123

Compared to the currently available scanning technologies for diagnosing suspected PE, SPECT/CT appears to confer superior economic value, primarily via improved sensitivity and specificity and low non-diagnostic rates. In turn, the improved diagnostic accuracy accords this modality the lowest ratio of expenses attributable to potentially avoidable complications, misdiagnosis and underdiagnosis.

Ventilation defect typical for COPD is frequent among patients suspected for pulmonary embolism but does not prevent the diagnosis of PE by V/P SPECT
Nasr A, et al. EC Pulmonology and Respiratory Medicine. 2017; 4(3): 85-91

The introduction of the tomographic technique and the implementation of Technegas as a novel ventilation agent facilitated imaging of pulmonary embolism in comparison with planar imaging and particularly in COPD patients together with the new interpretation criteria.

Reproducibility of lobar perfusion and ventilation quantification using a SPECT/CT segmentation software in lung cancer patients
Provost K, et al. J Nucl Med Technol. 2017; 45(3): 185-192

We recommend that SPECT/CT based quantification be used for all lung cancer patients undergoing pre-therapy evaluation of regional lung function.

V/Q scanning using SPECT and SPECT/CT
Roach PJ, et al. J Nucl Med 2013; 54(9): 1588-1596

Technegas is an ideal agent for ventilation SPECT because of its small particle size (30–60 nm), resulting in greater alveolar penetration and less central deposition than a nebulizer-produced aqueous radioaerosol such as 99mTc-DTPA

Current status of ventilation-perfusion scintigraphy for suspected pulmonary embolism
Metter DF, et al. AJR Am J Roentgenol 2017; 208(3): 489-494

Ventilation imaging is most often performed in conjunction with lung perfusion to characterize perfusion defects as a matched, mismatched or reverse mismatched.

The optimal tracer for ventilation studies is Technegas, an ultra fine dispersion of 99mTc-labeled carbon. Despite that Technegas is not approved for use in the United States, it is used in 79% of ventilation imaging studies performed in Canada and is also commonly used in Europe. Its main advantage is greater percentage deposition in the alveolar spaces and less undesirable adherence to the central airways, compared with droplet radioaerosols.

EANM guidelines for ventilation/perfusion scintigraphy: Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography
Bajc M, et al. Eur J Nucl Med Mol Imaging 2009; 36(8): 1356-1370

Using 99mTc-Technegas has minimized the problem of hotspots in patients with obstructive lung disease and is according to clinical experience better than the best liquid aerosols.

Identifying the heterogeneity of COPD by V/P SPECT: a new tool for improving the diagnosis of parenchymal defects and grading the severity of small airways disease
Bajc M, et al. Int J of Chron Obstruct Pulmon Dis 2017; 12: 1579-1587

V/Q SPECT, using Technegas as the ventilation imaging agent, could diagnose and grade severity of COPD and also estimate preserved lung function in 94 patients. Moreover, V/Q SPECT appears to be a unique tool to reveal the heterogeneity of COPD caused by pulmonary comorbidities such as pulmonary embolism, left heart failure, lung tumor and pneumonia. The characteristics of these comorbidities suggest their significant impact in symptoms, their influence on prognosis and their response to treatment.