**Hull University Teaching Hospitals NHS Trust - Nuclear Medicine** 


<WRAP onlyprint>
Uncontrolled if printed
</WRAP>

[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wiki/data/meta/examcodes/database.db|SELECT sop AS "SOP Code",title AS "Title",reviewdate AS "Review Date" FROM sops WHERE sop='REF005'|0]] 
<WRAP onlyprint>
\\  
</WRAP>
^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|    Prof G Avery            | ARSAC Licence Holder     |                                                           |   2024-06-18          |

====== REF005 - Lung Ventilation/Perfusion Imaging ======
See [[referral_criteria:ref000-how_to_refer_to_huthnm|REF000 - Referring to Nuclear Medicine (HUTH)]] for details of how to refer.
===== Description =====
Lung ventilation can be assessed by imaging deposition of a radioactive aerosol (Tc99m DTPA) inhaled by the patient. Lung perfusion can be assessed by imaging of the distribution of Technetium-99m labelled macro-aggregates of albumin (MAA) following intravenous injection. Mismatches in ventilation and perfusion can be used to diagnose pulmonary emboli.

Three dimensional images are usually acquired combined with low dose CT (SPECT/CT).

[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wiki/data/meta/arsac/database2019.db|SELECT fullname AS "ARSAC Licence Holders", investigation AS "Indication" FROM practitionerlicences INNER JOIN practitioners,procedurecodes,praclicproc,nuclides,chemicalforms ON practitionerlicences.practitioner=practitioners.id AND praclicproc.plicid=practitionerlicences.id AND praclicproc.procid=procedurecodes.id AND procedurecodes.nuclide_id=nuclides.id AND procedurecodes.chemicalform_id=chemicalforms.id AND practitionerlicences.certificateactive='Y' WHERE procedure_code='99mTc-40-75' OR procedure_code='99mTc-5-70'  AND date('now')<=expirydate  ORDER BY expirydate|0]]

\\  

^                              ^ Radiopharmaceutical  ^  CT component of SPECT/CT  |
^Typical Radiation Dose (mSv)  |  2.3    |  1.7   |

===== Staff Entitled to Refer =====
All UK registered medical practitioners

===== Supplementary Drugs =====
Sodium chloride for parenteral use (0.9% w/v).

===== Contraindications =====
Patients with right to left cardiac shunt must be discussed with an ARSAC licence holder.

If the patient has pulmonary hypertension, this must be indicated on the request because the technique needs to be modified in these patients.

===== Clinical Indications =====

|Suspected pulmonary embolism [([[https://doi.org/10.2967/jnmt.111.101386|SNM Practice Guideline for Lung Scintigraphy 4.0. Journal of Nuclear Medicine Technology March 2012, 40 (1) 57-65]])][([[https://doi.org/10.1007/s00259-019-04450-0|Bajc, M., Schümichen, C., Grüning, T. et al. EANM guideline for ventilation/perfusion single-photon emission computed tomography (SPECT) for diagnosis of pulmonary embolism and beyond. Eur J Nucl Med Mol Imaging 46, 2429–2451 (2019)]])]  **A contemporaneous high quality erect chest radiograph must be available so that other clinical conditions that can causes ventilation/perfusion defects are not overlooked.**   |
|Document the degree of resolution of pulmonary embolism[(#1)]  |
|Pre-operative assessment eg: lung volume reduction, bronchial carcinoma[(#1)]  |
|Evaluate the cause of pulmonary hypertension[(#1)]  |
|Lung transplant evaluation[(#1)]  |
|Evaluate chronic pulmonary parenchymal disorders such as cystic fibrosis[(#1)]  |
|Confirm the presence of bronchopleural fistula[(#1)]  |
|Evaluate congenital heart or lung disease such as cardiac shunts, pulmonary arterial stenoses, and arteriovenous fistulae and their treatment[(#1)]  |
|Hepatopulmonary syndrome[([[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7080996/|Zhao et al. Technetium-99m-labeled macroaggregated albumin lung perfusion
scan for diagnosis of hepatopulmonary syndrome: A prospective study comparing brain uptake and whole-body uptake. World J Gastroenterol 2020 March 14; 26(10): 1088-1097]])] |