Artifacts and QC with SPECT/CT Myocardial Perfusion Imaging

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.]

Nuclear Medicine Technology: 2.50
Procedures: 2.50
Cardiac Procedures: 2.50

Registered Radiologist Assistant: 1.75
Procedures: 1.75
Thoracic Section: 1.75

Outline

1. Introduction
2. Radiotracers
3. Patient Preparation
4. Stress Induction Protocols
5. Image Acquisition Protocol
6. Image Display
7. Image Interpretation and Reporting
8. Attenuation Correction and Artifacts
   1. Artifacts of Soft Tissue Attenuation
   2. Artifacts of Subdiaphragmatic Radiotracer Activity
   3. Artifacts of Patient Motion
   4. Artifacts of Misregistration
   5. Artifacts of Left Bundle Branch Block
   6. Effects of Normal Apical Thinning
9. Conclusions

Objectives

Upon completion of this course, students will:

1. understand what role myocardial perfusion imaging (MPI) plays in assessing CAD
2. be familiar with imaging technology used to perform CT attenuation
3. identify which radiotracers are commonly used for MPI
4. understand the pharmacological properties for Thallous chloride
5. be familiar with distribution of Tc-labeled radiotracers in the myocardium
6. be familiar with other advantages of Tc-labeled radiotracers in the human body
7. be familiar with the first pass extraction fractions of the MPI radiotracers
8. be familiar with proper patient preparation for MPI
9. understand which drugs can interfere with diagnostic MPI examinations
10. be familiar with the disadvantages of patients taking Viagra prior to MPI
11. be familiar with the contraindications for performing MPI on acute MI patients
12. understand the advantages of “stress only” MPI
13. be able to calculate a patient’s maximum predicted heart rate for MPI
14. identify the preferred pharmacological stress-induction agent for MPI
15. understand the biological characteristics for adenosine
16. be familiar with drugs that can counter react dipryridamole and regadenoson
17. be familiar with using a nylon strap around the patient’s abdomen
18. be familiar with the number of ECG-gated frames for SPECT MPI
19. be familiar with the energy window used to optimize SPECT MPI
20. identify which collimator is preferred for SPECT MPI
21. identify what matrix should be used for SPECT MPI
22. know why to inspect the raw data sets for SPECT/CT MPI prior to a physician’s interpretation of the images
23. identify what malignancies may be detected on a SPECT/CT MPI
24. be familiar with a two dimensional display of radiotracer activity in the left ventricle
25. identify the areas of the myocardium displayed on a polar map
26. be familiar with organization that recommends QC protocol for SPECT imaging
27. identify the artifacts that will present with bad detector uniformity
28. understand artifacts when anatomy extends beyond the CT FOV
29. identify the traditional SPECT MPI cardiac planes
30. identify how to differentiate SPECT attenuation artifact vs. myocardial infarction
31. be familiar with a frequently used SPECT/CT MPI polar map
32. understand the segmental scoring map created from SPECT/CT MPI
33. be familiar with summed stress scores generated from SPECT/CT MPI polar maps
34. identify the factors that create attenuation artifacts on SPECT/CT MPI
35. be familiar with common sites for MPI patient-based attenuation artifacts
36. be familiar with MPI patient positioning used to reduce attenuation artifacts
37. identify the source of subdiaphragmatic radiotracer activity on SPECT/CT MPI
38. be familiar with the methods for detecting attenuation artifacts on SPECT/CT MPI
39. be familiar with SPECT/CT MPI artifacts created by left bundle branch block
40. be familiar with the cardiac planes that best demonstrate myocardial apical thinning