Nuclear Imaging in Critically Ill Patients

  • M. Meignan


During the 1980s impressive technological advances were made in the field of nuclear medicine. Single-photon computed emission tomography (SPECT), increased computer hardware and capabilities, the greater availability of positron emission tomography with mini cyclotrons and positron cameras (PET) have changed the conditions of radionuclide imaging. The development of the portable camera and of highly mobile computers made it possible to perform numerous studies at the bedside. New radio-pharmaceuticals labelled with 99mTc, the most suitable isotope for imaging, have been developed, giving information on metabolism or cell receptors. All these technical and pharmacological developments have been extensively described in excellent reviews and textbooks [24,29,30,32,35]. However, for the nuclear medicine physician, the critically ill patient in the intensive care unit (ICU) has some particular characteristics which limit the use of some of these technological advances. The large amount of supporting equipment needed at the bedside, such as ventilators, intravenous lines, haemodynamic catheters, cardiac and pressure monitors, often made positioning of the camera awkward. Mechanical ventilation generated technical problems for the isotopic study of ventilation. Patient status changes rapidly and the vast majority cannot be safely transported to the nuclear medicine department. Accordingly, a mobile gamma camera is often necessary. Obviously these patients can seldom be referred for a SPECT or PET study. However, up to now, mobile gamma cameras have two major limitations in their usual commercial versions: (1) their field of view is small. This is not a problem for cardiac studies but it is, despite the use of a diverging collimator, for pulmonary studies which require a large field of view; (2) the crystal is usually 1/4 inch thick. This means that the detectability of the medium- or high-energy photons from 111mIn or 131I is suboptimal.


Biliary Leakage Extravascular Lung Water Gallium Scanning False Negative Study Posterior Oblique View 
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