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Development and validation of a patient-tailored dose regime in myocardial perfusion imaging using CZT-SPECT

  • Original Article
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Journal of Nuclear Cardiology Aims and scope

Abstract

Background

Guidelines for SPECT myocardial perfusion imaging (MPI) traditionally recommend a fixed tracer dose. Yet, clinical practice shows degraded image quality in heavier patients. The aim was to optimize and validate the tracer dose and scan time to obtain a constant image quality less dependent on patients’ physical characteristics.

Methods

125 patients underwent Cadmium Zinc Telluride (CZT)-SPECT stress MPI using a fixed Tc-99m-tetrofosmin tracer dose. Image quality was scored by three physicians on a 4-point grading scale and related to the number of photon counts normalized to tracer dose and scan time. Counts were correlated with various patient-specific parameters dealing with patient size and weight to find the best predicting parameter. From these data, a formula to provide constant image quality was derived, and subsequently tested in 92 new patients.

Results

Degradation in image quality and photon counts was observed for heavier patients for all patients’ specific parameters (P < .01). We found body weight to be the best-predicting parameter for image quality and derived a new dose formula. After applying this new body weight-depended tracer dose and scan time in a new group, image quality was found to be constant (P > .19) in all patients.

Conclusions

Also in CZT SPECT image quality decreases with weight. The use of a tracer dose and scan time that depends linearly on patient’s body weight corrected for the varying image quality in CZT-SPECT MPI. This leads to better radiation exposure justification.

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References

  1. Flotats A, Knuuti J, Gutberlet M, Marcassa C, Bengel FM, Kaufmann PA, et al. Hybrid cardiac imaging: SPECT/CT and PET/CT. A joint position statement by the European Association of Nuclear Medicine (EANM), the European Society of Cardiac Radiology (ESCR) and the European Council of Nuclear Cardiology (ECNC). Eur J Nucl Med Mol Imaging 2011;38:201-12.

    Article  PubMed  Google Scholar 

  2. Underwood SR, Anagnostopoulos C, Cerqueira MD, Ell PJ, Flint EJ, Harbinson M, et al. Myocardial perfusion scintigraphy: The evidence. Eur J Nucl Med Mol Imaging 2004;31:261-91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Hesse B, Tägil K, Cuocolo A, Anagnostopoulos C, Bardiés M, Bax J, et al. EANM/ESC procedural guidelines for myocardial perfusion imaging in nuclear cardiology. Eur J Nucl Med Mol Imaging 2005;32:855-97.

    Article  CAS  PubMed  Google Scholar 

  4. Notghi A, Williams N, Smith N, Goyle S, Harding LK. Relationship between myocardial counts and patient weight: adjusting the injected activity in myocardial perfusion scans. Nucl Med Commun 2003;24:55-9.

    Article  CAS  PubMed  Google Scholar 

  5. International Commission on Radiological Protection (ICRP). 1990 Recommendations of the International Commission on Radiological Protection. ICRP Publication 60. ICRP Publ. 60. Ann. ICRP 21, 1991.

  6. Notghi A, Sundram FX, O’Brien JW, Smith NB. Assessing the effect of increasing injection activity for myocardial perfusion imaging in overweight patients. Br J Radiol 2008;81:730-4.

    Article  CAS  PubMed  Google Scholar 

  7. Fazel R, Krumholz HM, Wang Y, Ross JS, Chen J, Ting HH, et al. Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med 2009;361:849-57.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  8. Duvall WL, Sweeny JM, Croft LB, Ginsberg E, Guma KA, Henzlova MJ. Reduced stress dose with rapid acquisition CZT SPECT MPI in a non-obese clinical population: Comparison to coronary angiography. J Nucl Cardiol 2012;19:19-27.

    Article  PubMed  Google Scholar 

  9. Cerqueira MD, Allman KC, Ficaro EP, Hansen CL, Nichols KJ, Thompson RC, et al. Recommendations for reducing radiation exposure in myocardial perfusion imaging. J Nucl Cardiol 2010;17:709-18.

    Article  PubMed  Google Scholar 

  10. De Groot EH, Post N, Boellaard R, Wagenaar NR, Willemsen AT, van Dalen JA. Optimized dose regimen for whole-body FDG-PET imaging. Eur J Nucl Med Mol Imaging Res 2013;3:63.

    Google Scholar 

  11. Gerber TC, Gibbons RJ. Weighing the risks and benefits of cardiac imaging with ionizing radiation. JACC Cardiovasc Imaging 2010;3:528-35.

    Article  PubMed  Google Scholar 

  12. Eisenberg MJ, Afilalo J, Lawler PR, Abrahamowicz M, Richard H, Pilote L. Cancer risk related to low-dose ionizing radiation from cardiac imaging in patients after acute myocardial infarction. Can Med Assoc J 2011;183:430-6.

    Article  Google Scholar 

  13. Fahey F, Stabin M. Dose optimization in nuclear medicine. Semin Nucl Med 2014;44:193-201.

    Article  PubMed  Google Scholar 

  14. Mouden M, Timmer JR, Ottervanger JP, Reiffers S, Oostdijk AHJ, Knollema S, et al. Impact of a new ultrafast CZT SPECT camera for myocardial perfusion imaging: Fewer equivocal results and lower radiation dose. Eur J Nucl Med Mol Imaging 2012;39:1048-55.

    Article  PubMed  Google Scholar 

  15. Buechel RR, Herzog BA, Husmann L, Burger IA, Pazhenkottil AP, Treyer V, et al. Ultrafast nuclear myocardial perfusion imaging on a new gamma camera with semiconductor detector technique: First clinical validation. Eur J Nucl Med Mol Imaging 2010;37:773-8.

    Article  PubMed  Google Scholar 

  16. Esteves FP, Raggi P, Folks RD, Keidar Z, Askew JW, Rispler S, et al. Novel solid-state-detector dedicated cardiac camera for fast myocardial perfusion imaging: Multicenter comparison with standard dual detector cameras. J Nucl Cardiol 2009;16:927-34.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Duvall WL, Croft LB, Godiwala T, Ginsberg E, George T, Henzlova MJ. Reduced isotope dose with rapid SPECT MPI imaging: Initial experience with a CZT SPECT camera. J Nucl Cardiol 2010;17:1009-14.

    Article  PubMed  Google Scholar 

  18. Hume R. Prediction of lean body mass from height and weight. J Clin Pathol 1966;19:389-91.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  19. Hallynck T, Soep H, Thomis J, Boelaert J, Daneels R, Dettli L. Should clearance be normalised to body surface or to lean body mass? Br J Clin Pharmacol 1981;11:523-6.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Oddstig J, Hedeer F, Jögi J, Carlsson M, Hindorf C, Engblom H. Reduced administered activity, reduced acquisition time, and preserved image quality for the new CZT camera. J Nucl Cardiol 2013;20:38-44.

    Article  PubMed  Google Scholar 

  21. Bocher M, Blevis IM, Tsukerman L, Shrem Y, Kovalski G, Volokh L. A fast cardiac gamma camera with dynamic SPECT capabilities: Design, system validation and future potential. Eur J Nucl Med Mol Imaging 2010;37:1887-902.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Heller GV, Links J, Bateman TM, Ziffer JA, Ficaro E, Cohen MC, et al. American Society of Nuclear Cardiology and Society of Nuclear Medicine joint position statement: Attenuation correction of myocardial perfusion SPECT scintigraphy. J Nucl Cardiol 2004;11:229-30.

    Article  PubMed  Google Scholar 

  23. Garcia EV, Faber TL, Esteves FP. Cardiac dedicated ultrafast SPECT cameras: New designs and clinical implications. J Nucl Med 2011;52:210-7.

    Article  PubMed  Google Scholar 

  24. Gambhir SS, Berman DS, Ziffer J, Nagler M, Sandler M, Patton J, et al. A novel high-sensitivity Rapid-acquisition single-photon cardiac imaging camera. J Nucl Med 2009;50:635-43.

    Article  PubMed  Google Scholar 

  25. Sharir T, Ben-Haim S, Merzon K, Prochorov V, Dickman D, Ben-Haim S, et al. High-speed myocardial perfusion imaging initial clinical comparison with conventional dual detector anger camera imaging. JACC Cardiovasc Imaging 2008;1:156-63.

    Article  PubMed  Google Scholar 

  26. Higley B, Smith FW, Smith T, Gemmell HG, Das Gupta P, Gvozdanovic DV, et al. Technetium-99m-1,2-bis[bis(2-ethoxyethyl) phosphino]ethane: Human biodistribution, dosimetry and safety of a new myocardial perfusion imaging agent. J Nucl Med 1993;34:30-8.

    CAS  PubMed  Google Scholar 

  27. Jain D, Wackers FJ, Mattera J, McMahon M, Sinusas AJ, Zaret BL. Biokinetics of technetium-99m-tetrofosmin: Myocardial perfusion imaging agent: Implications for a 1-day imaging protocol. J Nucl Med 1993;34:1254-9.

    CAS  PubMed  Google Scholar 

  28. Nakazato R, Berman DS, Hayes SW, Fish M, Padgett R, Xu Y, et al. Myocardial perfusion imaging with a solid-state camera: Simulation of a very low dose imaging protocol. J Nucl Med 2013;54:373-9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

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Disclosures

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Authors and Affiliations

  1. Department of Nuclear Medicine, Isala Hospital, Zwolle, The Netherlands

    J. D. van Dijk MSc, P. L. Jager MD, PhD, M. Mouden MD, J. de Boer MD, PhD & A. H. J. Oostdijk MD

  2. MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands

    J. D. van Dijk MSc & C. H. Slump PhD

  3. Department of Cardiology, Isala hospital, Zwolle, The Netherlands

    M. Mouden MD & J. P. Ottervanger MD, PhD

  4. Department of Medical Physics, Isala hospital, PO Box 10400, 8000 GK, Zwolle, The Netherlands

    J. A. van Dalen PhD

Authors
  1. J. D. van Dijk MSc
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  2. P. L. Jager MD, PhD
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  3. M. Mouden MD
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  4. C. H. Slump PhD
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  5. J. P. Ottervanger MD, PhD
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  6. J. de Boer MD, PhD
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  7. A. H. J. Oostdijk MD
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  8. J. A. van Dalen PhD
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Correspondence to J. D. van Dijk MSc.

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van Dijk, J.D., Jager, P.L., Mouden, M. et al. Development and validation of a patient-tailored dose regime in myocardial perfusion imaging using CZT-SPECT. J. Nucl. Cardiol. 21, 1158–1167 (2014). https://doi.org/10.1007/s12350-014-9942-0

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  • DOI: https://doi.org/10.1007/s12350-014-9942-0

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