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Research ArticlePRACTICE GUIDELINE

SNM Practice Guideline for Lung Scintigraphy 4.0

J. Anthony Parker, R. Edward Coleman, Erin Grady, Henry D. Royal, Barry A. Siegel, Michael G. Stabin, H. Dirk Sostman and Andrew J.W. Hilson
Journal of Nuclear Medicine Technology March 2012, 40 (1) 57-65; DOI: https://doi.org/10.2967/jnmt.111.101386
J. Anthony Parker
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R. Edward Coleman
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Erin Grady
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Henry D. Royal
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Barry A. Siegel
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Michael G. Stabin
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H. Dirk Sostman
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Andrew J.W. Hilson
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    TABLE 1

    Ventilation, Perfusion, and Radiographic Interpretive Criteria for Pulmonary Embolism

    PIOPEDModified PIOPED IIPerfusion-only modified PIOPED IIPerfusion-only PISAPED
    High LRHigh LRPE presentPE present
    >2 large mismatched (V:Q) segmental defects*≥2 large mismatched (V:Q) segmental defects*≥2 large mismatched (Q:CXR) segmental defects*≥1 wedge-shaped Q defects
    Borderline high LR
    2 large mismatched (V:Q) segmental defects*
    Intermediate LRNondiagnosticNondiagnosticNondiagnostic
    2 moderate or 1 large mismatched (V:Q) defect*Difficult to categorize as high or lowAll other findingsAll other findingsCannot classify as PE-present or PE-absent
    Borderline low LR
    1 matched (V:Q) defect, CXR-negative
    Low LR
    Nonsegmental perfusion defects†
    Q defect substantially < CXR defect
    Matched (V:Q) defects, CXR-negativeAny number of small Q defects*
    NormalVery low LRPE absentPE absent
    No Q defects‖Nonsegmental†Q defect < CXR lesion1–3 small segmental* defectsSolitary matched (V:Q:CXR) defect (≤1 segment) in mid or upper lungStripe sign‡Solitary large pleural effusion§≥2 matched (V:Q) defects, regionally normal CXRVery low probabilityNonsegmental†Q defect < CXR lesion1–3 small segmental* defectsSolitary matched (Q:CXR) defect (≤1 segment) in mid or upper lungStripe sign‡Solitary large pleural effusion§Non–wedge-shaped Q defectContour defect caused by enlarged heart, mediastinum, or diaphragmNear-normal QNormal Q
    Normal
    No Q defects
    • ↵* Or equivalent where large segmental defect, >75% of segment, equals 1 segmental equivalent; moderate defect, 25%–75% of segment, equals 0.5 segmental equivalent; small defect, <25%, is not counted.

    • ↵† For example, prominent hilum, cardiomegaly, elevated diaphragm, linear atelectasis, or costophrenic angle effusion with no other perfusion defect in either lung and no other radiographic lesion.

    • ↵‡ Peripheral perfusion in a defect (best seen on tangential view).

    • ↵§ Pleural effusion in at least one third of pleural cavity, with no other perfusion defect in either lung.

    • ↵‖ Perfusion defects exactly match shape of CXR.

    • V:Q = ventilation–perfusion; CXR = chest radiograph; PE = pulmonary embolism; LR = likelihood ratio.

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    TABLE 2

    Radiation Dosimetry in Adults

    Administered activityLargest radiation doseEffective dose*
    RadiopharmaceuticalMBqmCiOrganmGy/MBqrad/mCimSv/MBqrem/mCi
    99mTc-MAA†40–1501.1–4.1Lung0.0670.250.0110.041
    99mTc-DTPA‡20–400.54–1.1Bladder0.0470.170.00610.023
    133Xe§200–7505.4–20Lung0.00110.00410.000710.0026
    81mKr‖40–4001.1–11Lung0.000210.000780.0000270.0001
    • ↵* Data are from (31).

    • ↵† Data are from (30), page 224.

    • ↵‡ Data are from (30), page 218.

    • ↵§ Data are from (30), page 345, rebreathing for 5 min.

    • ↵‖ Data are from (30), page 160.

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    TABLE 3

    Radiation Dosimetry in Children (5 Years Old)

    Administered activityLargest radiation doseEffective dose
    RadiopharmaceuticalMBq/kgmCi/kgOrganmGy/MBqrad/mCimSv/MBqrem/mCi
    99mTc MAA*0.5–20.014–0.054Lung0.210.780.0380.14
    99mTc DTPA†0.4–0.60.011–0.016Bladder0.120.440.0200.074
    133Xe‡10–120.27–0.32Lung0.00370.0140.00270.010
    81mKr§0.5–50.014–0.14Lung0.000680.00250.0000880.00033
    • ↵* Data are from (30), page 224.

    • ↵† Data are from (30), page 218.

    • ↵‡ Data are from (30), page 345, rebreathing for 5 min.

    • ↵§ Data are from (30), page 160.

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    TABLE 4

    99mTc-MAA: Dose Estimates to the Fetus

    Fetal dose
    Stage of gestationmGy/MBqrad/mCimGy*rad*
    Early0.00280.0100.11–0.420.011–0.042
    3 mo0.00400.0150.16–0.600.016–0.060
    6 mo0.00500.0180.20–0.750.020–0.075
    9 mo0.00400.0150.16–0.600.016–0.060
    • ↵* Maternal administered activity, 40–150 MBq (1.1–1.4 mCi).

    • Data are from Russell et al. (32). No information about possible placental crossover of this compound was available for use in estimating fetal doses.

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    TABLE 5

    99mTc-DTPA Aerosol: Dose Estimates to the Fetus

    Fetal dose
    Stage of gestationmGy/MBqrad/mCimGy*rad*
    Early0.00580.0210.12–0.230.012–0.023
    3 mo0.00430.0160.086–0.170.0086–0.017
    6 mo0.00230.00850.046–0.0920.0046–0.0092
    9 mo0.00300.0110.060–0.120.0060–0.012
    • ↵* Maternal administered activity, 20–40 MBq (0.54–1.1 mCi).

    • Data are from Russell et al. (32). Information about possible placental crossover of this compound was available and was considered in estimates of fetal doses.

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    TABLE 6

    133Xe: Dose Estimates to the Fetus

    Fetal dose
    Stage of gestationmGy/MBqrad/mCimGy*rad*
    Early0.000250.000920.050–0.190.0050–0.019
    3 mo0.0000290.000110.0058–0.0220.00058–0.0022
    6 mo0.0000210.0000780.0042–0.0160.00042–0.0016
    9 mo0.0000160.0000590.0032–0.010.00032–0.0012
    • ↵* Maternal administered activity, 200–750 MBq (5.4–20 mCi).

    • Data are from Russell et al. (32). No information about possible placental crossover of this compound was available for use in estimating fetal doses.

    • View popup
    TABLE 7

    81mKr: Dose Estimates to the Fetus

    Fetal dose
    Stage of gestationmGy/MBqrad/mCimGy*rad*
    Early1.8 × 10−76.7 × 10−77.2 × 10−6 to 7.2 × 10−57.2 × 10−5 to 7.2 × 10−6
    3 mo1.8 × 10−76.7 × 10−77.2 × 10−6 to 7.2 × 10−57.2 × 10−5 to 7.2 × 10−6
    6 mo2.8 × 10−71.0 × 10−61.1 × 10−5 to 1.1 × 10−41.1 × 10−6 to 1.1 × 10−5
    9 mo3.4 × 10−71.3 × 10−61.4 × 10−5 to 1.4 × 10−41.4 × 10−6 to 1.4 × 10−5
    • ↵* Maternal administered activity, 40–400 MBq (1.1–11 mCi).

    • Dose estimates to the fetus were not provided by Russell et al. (32) but were estimated using kinetic data in ICRP 53. No information about possible placental crossover of this compound was available for use in estimating fetal doses.

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Journal of Nuclear Medicine Technology: 40 (1)
Journal of Nuclear Medicine Technology
Vol. 40, Issue 1
March 1, 2012
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SNM Practice Guideline for Lung Scintigraphy 4.0
J. Anthony Parker, R. Edward Coleman, Erin Grady, Henry D. Royal, Barry A. Siegel, Michael G. Stabin, H. Dirk Sostman, Andrew J.W. Hilson
Journal of Nuclear Medicine Technology Mar 2012, 40 (1) 57-65; DOI: 10.2967/jnmt.111.101386

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SNM Practice Guideline for Lung Scintigraphy 4.0
J. Anthony Parker, R. Edward Coleman, Erin Grady, Henry D. Royal, Barry A. Siegel, Michael G. Stabin, H. Dirk Sostman, Andrew J.W. Hilson
Journal of Nuclear Medicine Technology Mar 2012, 40 (1) 57-65; DOI: 10.2967/jnmt.111.101386
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  • Article
    • PREAMBLE
    • I. INTRODUCTION
    • II. GOALS
    • III. DEFINITIONS
    • IV. COMMON CLINICAL INDICATIONS
    • V. QUALIFICATIONS AND RESPONSIBILITIES OF PERSONNEL
    • VI. PROCEDURE/SPECIFICATIONS OF THE EXAMINATION
    • VII. DOCUMENTATION/REPORTING
    • VIII. EQUIPMENT SPECIFICATION
    • IX. QUALITY CONTROL AND IMPROVEMENT, SAFETY, INFECTION CONTROL, AND PATIENT EDUCATION CONCERNS
    • X. RADIATION SAFETY IN IMAGING
    • Acknowledgments
    • XIII. APPROVAL
    • Footnotes
    • XII. REFERENCES
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