Y-90 Mapping

1. 1. Preparation
      1. Must have Symbia T open and CT tube warmed up for patient
      2. Patient will be self-transported from interventional radiology to nuclear medicine
      3. Study must be completed within the hour of MAA injection
   2. Isotope Administration(subject to change)
      1. Patient will receive 4 mCi of Tc^99m-MAA intra-arterially, slowly over 3 minutes
   3. Camera Parameters
      1. Planar Imaging
         1. LEHR collimators
         2. Matrix: 256X256
   • Zoom: 1
   1. Camera Preset: Tc99m-NMG
   2. Detector: Both
   3. Supine
   • 10 minute statics
   1. SPECT Imaging
      1. LEHR collimators
      2. Matrix: 128X128
   • Zoom: 1
   1. Camera Preset: SC-Tc^99m-NMB
   2. Detectors: Both
   3. Orientation: Head Out
   • Patient position: Supine
   • Rotation: CW
   1. Start Angle: 0
   2. Degree Rotation: 360
   3. Views: 64
   • Time per view: 20 sec
   • Detector configuration: 180
   • Orbit: Noncircular
   1. Mode: Step and shoot
   4. Scanning Protocol
      1. The patient must be slide over to the imaging table from the stretcher
      2. Want to position the patient under the camera with the top of the lungs and the bottom of the liver on one image.
         1. If lungs and liver cannot be on one image. Take two images. One image of the liver in the field of view. The other image should be with the top of the lungs at the top of the image with some of the liver.
      3. After the planar pictures are completed, center the patients liver under the camera
      4. Perform the SPECT/CT
      5. When SPECT/CT is completed, slid the patient back onto their stretcher.
   5. Planar Data Processing
      1. We need to calculate the percent hepatic arterio-venous shunting
         1. Hepatic arterio-venous shunting =geometric mean of total lung counts/(geometric mean of total lung counts +geometric mean of total liver) counts X 100 (see worksheet)
      2. Draw a region around the whole liver
      3. Draw a region around both lungs
         1. Should like an M for the lung region
      4. SPECT/CT Reconstruction
         1. Pick the 1 bed Tc^99m protocol for processing
         2. Nuclear Medicine Parameters
            1. Filtered backprojection
            2. Butterworth cutoff of .45 and order of 5
   • Chang’s attenuation coefficient 0.15
   1. Automatic contours
   2. Projection angel is 2
   3. Edge strength of 0.5
   • Background threshold of 5
   • Kernel 3X3
   1. CT Parameters
      1. Abdomen window
      2. Body 5.0 B30s Med smooth or Body 56.0 B40s Med for hardware
   • 5 mm Slice
   7. Post processing/Display/Archive
      1. All acquired images will be adjusted for optimal viewing and appropriate labeling
      2. All SPECT images will be displayed in coronal, sagittal, and axial planes with and without CT fusion and NM MIP
      3. Images will be sent to the PAC’s system and Syngo Via for archiving/physician review