Ventilation/Perfusion Scanning Using SPECT and SPECT/CT

Targeted CE per ARRT’s Discipline, Category, and Subcategory classification:
[Note: Discipline-specific Targeted CE credits may be less than the total Category A credits approved for this course.]

Computed Tomography: 0.75
Procedures: 0.75
Neck and Chest: 0.75

Nuclear Medicine Technology: 2.25
Patient Care: 0.75
Patient Interactions and Management: 0.75
Procedures: 1.50
Other Imaging Procedures: 1.50

Registered Radiologist Assistant: 2.25
Procedures: 2.25
Thoracic Section: 2.25

Outline

1. Introduction
2. Advantages of SPECT Over Planar Imaging
3. V/Q SPECT
   1. Technique
   2. Image Acquisition, Processing, Display, and Reporting
   3. Comparison with CTPA
4. V/Q SPECT/CT
   1. Protocol, Processing, Display, and Reporting
   2. Clinical Value
   3. Combining V/W SPECT with CTPA
5. Controversies
   1. Is the Ventilation Scan Necessary
   2. Do Additional Clots Detected by SPECT Warrant Treatment
6. Non-PE Applications and Future Directions
7. Conclusion

Objectives

Upon completion of this course, students will:

1. be familiar with the advantages of V/Q SPECT vs. planar nuclear imaging for assessing PE
2. be familiar with the acronym for computed tomography pulmonary angiography
3. be familiar with the most likely source of clinically recognized PE
4. identify what percentage of all cases of sudden death can be attributed to PE
5. identify which radiopharmaceuticals are used with ventilation SPECT
6. be familiar with the acquisition time per projection for V/Q SPECT
7. be familiar with the post-reconstruction filter typically used on V/Q SPECT
8. identify which guidelines are used for reporting V/Q SPECT
9. identify which imaging test is used for initial assessment of PE in the U.S.
10. be familiar with the significant limitations of CTPA
11. be familiar with the patient’s radiation dose associated with CTPA
12. be familiar with the acceptable number of particles in a patient’s dose of MAA
13. understand what the mechanism of localization is for ^99mTc-MAA
14. identify the strengths of VQ SPECT and VQ SPECT/CT vs. CTPA
15. understand the potential of VQ SPECT/CT to assess PE
16. be familiar with the mA settings for a “low dose” CT
17. be familiar with techniques to reduce respiratory-motion misregistration using SPECT/CT
18. be familiar with the reported sensitivity by Gutte et al. when performing CTPA
19. understand what factors can improve spatial resolution on SPECT images
20. be familiar with the overall improvement in image contrast on SPECT vs planar nuclear medicine images
21. understand the requirement for testing uniformity on a SPECT system
22. identify the effect on quantification of SPECT lung images by using patient-specific attenuation
23. be familiar with PET radiopharmaceuticals being investigated to assess PE
24. identify future radiopharmaceuticals that will be used to perform radiolabeled thrombus imaging
25. be familiar with the early findings of radiolabeled thrombus-specific antibody fragments