Main Effects of Obesity on Nuclear Medicine Imaging and Possible Remedies

Obesity-related difficultyImpact on imagingPossible remedy
Body configurationAttenuationProper preparation such as adequate hydration (higher amount)
Increase of injected activity
Delayed acquisition in some studies
Increased time of acquisition
Access to veinsPossible infiltrationUse of more experienced nuclear medicine technologist
Patient discomfortUse of intravenous team
Help from an anesthesiologist
Use of ultrasound-guided peripheral intravenous access injection method
Patient mobilityPossible fall injuriesUse of greater caution
Use of accessory gadgets
Imaging of patient on stretcher (mobile camera may be needed)
Adequate communication with patient
Positioning for acquisitionDifficulty in achieving proper positionsAttention to proper and secured positioning
Use of pillow, splints, or other means to ensure patient's comfort and thus minimize motion
Body contouringVariable distances from camera at different parts of bodyManual adjustment of camera head to obtain adequate images
Patient girthCompton scatterUse of narrower or asymmetric energy window
Insufficient count statisticsIncrease of acquisition time
Beam-hardening artifact on CT.Use of caution during reading and quantification
Reduced sensitivity to peripheral lesionsComparison with non–attenuation-corrected images
Acquisition of additional spot image studies
Diaphragmatic attenuation (cardiac)Masking of underlying organ activity (inferior wall artifact)Use of prone acquisition in myocardial perfusion
Use of attenuation correction
Breast attenuation (cardiac)Masking of underlying organ activity (anteroseptal-lateral wall defect)Breast lifting and binding
Use of attenuation correction
Fat crease and steatopygiaEdge effect/attenuationManipulation of crease and reimaging, or addition of SPECT
Masking of bone details and creation of false findingsAddition of extra views or SPECT