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Review Week 3

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Review Week 3

.5 to 10 um DTPA size
If smaller they are exhaled and not deposited in the lungs
If larger then 2-3 um they are deposited in the air way
25 to 27 mCi for DTPA
When using the nebulizer system the patient is getting 5 to 10% of the dose.
The biological half-life of DTPA in the lungs is typically 1 hour
Stomach and the kidneys can show up on a DTPA ventilation study
Trachea and the large airways can be seen on the DTPA study

GAS gas imaging agents
Xe133, 127Xe, 81 Krm
5.2 days, 81 keV
Compartmental localization at the begging and then Passive Diffusion through membrane and is in the lungs due to its lipophilic nature
No particle size of 133Xe, it is a gas
It accumulates in the lungs of some patients because it is fat soluble and may accumulate in patients with fatty livers
Typically a 10 to 20 mCi dose
Single breath, equilibrium and Wash out
Lungs sit closer to the back * Pt breaths in in only Xe133 during the single breath phase * During equilibrium the pt breaths in Xe and oxygen * During the washout phase it is only air
Normal study would have a Uniform distribution
What scan cause diffusely delayed 133xe washout from a normal pt lungs?
Difficulty breathing though the xe133 breathing apparatus
The stomach and the liver can show up on a patient with normal lungs
Washout phase increases sensitivity for obstructive airway disease during the washout phase; there will be specific places where the Xe does not wash out
Xe is best for use with COPD pt
Which part should be obtained first during V/Q?
Ventilation is perfomed first due to its lower photon energy
Xe trapping systems should be installed on the floor because it is heavier than air

Perfusion
Diameter of average capillary is 7 micrometers; particle rage is 10 -90 micrometers; 0% >150 micrometers
Leagal: 90% of all particles 10-90 with nothing over 150
Nenate: 50k
1-18: 150-350k
Pulmonary HTN: 150k
“normal” patients: 200-700k

1/1000 to 1/100,000 for capillaries and arterioles (how much of the lung is occluded
If there is too few particles it will have a blotch picture and therer is a statically invalid study
There is hemodynamic obstruction if there are too many particles administered

Pts with known shunting and P. HTN and children will receive less particles
500k counts is the minium number of counts that will be valid
If blood clots form in the syringe then there will be hotspots in the lungs

Tech should agitate the syringe before injecting into the patient to prevent sedimentation of the particles

The heart and the lung hila will be the photopenic areas of the lungs; also a pacemaker

Normal ventilation and abnormal perfusion is PE, mismatched

Difference between segmental and non segmental? Segmental in a defect reflects the vascual territory of a perfusion branch

PIOPED - prospective investigation of pulmonary embolism diagnosis

What are the 4 diagnostic categories for diagnosing PE on a VQ scan? Low, high, intermediate, normal probility indeterminate probility is non-diagnotic

What is the most common cause of a false-positive VQ scan? Unresolved chronic pulmonary embolism; our test is geared toward acute PE

The patient needs to be injected supine for an even distribution but can be imaged in any position

Imaging can begin immedietly

Small particles go to the liver. Large particels will break down and are removed by the liver and the spleen

If the perfusion is first and it is nomal then you do not need to do the ventilation

The biological half life of MAA in the lungs is approx. imate 1.5 to 3 hours

Quantification
Do not need chest xray

OTHER
CSF study – intrathecal
Ictal state is during sizure
HMPAO crosses
Graves – enlarged but homogenious in activity
Can’t do a thyroid uptake with pertech
When we do obliques on the thyroid, we are looking for nodules
Single cold nodule on the thyroid is cancer
MIBG; were looking at the medulla
Xerostomia – Sialography, salivery glands

Have to be actively bleeding with Sulfer colloid

RBC tagged for GI bleed is for intermintine bleeding

Hematibllarg scan is for hepatocytes

Hemangiomia, RBC tagged

Anterior is the best view for the horseshoe kidney

Captopril is best for dialated vs obstruction

Osseous phase of bone scan is 3 hours

In111 pentrotiotide acts as an analog to smomstatin

MIBG acts an an analog to neroepinephrine

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