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BACK
FIGURE
1. TEMPLATE FOR STANDARD EXERCISE SPECT MYOCARDIAL PERFUSION
IMAGING REPORT
Type
of study:
MYOCARDIAL PERFUSION IMAGING WITH (SESTAMIBI
/ TETROFOSMIN / THALLIUM) SPECT AT REST AND AFTER EXERCISE,
AND GATED SPECT (AND RESTING FIRST PASS RADIONUCLIDE ANGIOGRAPHY).
History:
(e.g., 65-yr woman with known coronary artery disease and
recurrent chest pain).
Indication:
(e.g., Evaluation for coronary insufficiency; risk stratification;
evaluation of ischemia; evaluation of functional capacity; evaluation
of myocardial viability).
Procedure:
The patient exercised on treadmill (bicycle) for a total
of _____minutes, reaching stage ____ of the (Bruce; modified
Bruce, etc.) protocol, achieving an estimated workload of
____ METs. The heart rate was ____bpm at baseline, and increased
to ____bpm at peak exercise, representing 85% (or ____%)
of age-predicted maximal heart rate. The blood pressure response
was (normal / hypertensive / hypotensive). Resting blood
pressure was ____mmHg, and peak/nadir blood pressure was ____mmHg.
The
patient (did / did not) have chest pain/symptoms during
the procedure.
The
electrocardiogram (did not show / showed) ST-segment
changes diagnostic for ischemia (describe appropriate changes).
The
patient had myocardial perfusion imaging performed (using
a same day / two day, dual isotope imaging protocol), with
the injection of ____mCi of (radiopharmaceutical e) at
rest. Images were acquired by (gated) tomographic technique.
Findings:
The left ventricle was normal in size (enlarged {degree of
enlargement} / LVH was present, etc. Describe presence of transient
dilation, if present. Describe increased post stress lung uptake,
if present. Describe right ventricular abnormality, if present).
There were no myocardial perfusion defects (if abnormal,
describe: e.g., there was a large antero-apical, antero-lateral
perfusion defect on stress images, that was partially reversible
on the rest images). Mention whether artifacts were noted or
suspected as well.
By gated SPECT (or by first pass angiography)
resting (post exercise) global resting LVEF was normal
/ abnormal. LVEF was calculated (or visually estimated)
at ____%. Regional wall motion/thickening was normal, abnormal
(describe). (If appropriate one can describe right
ventricular function from the gated SPECT study).
IMPRESSION:
Normal (or mildly abnormal, moderately abnormal, or markedly
abnormal) myocardial perfusion (sestamibi / tetrofosmin
/ thallium-201) SPECT imaging after (excellent / adequate
/ fair / submaximal) exercise, showing a (small / moderate
/ large) area of [anatomic location] infarction with
or without (small / moderate / large) amount of [anatomic
location] ischemia.
[If considered pertinent add the following info:] The
patients had (yes or no) symptoms. The stress ECG was
abnormal (describe). The hemodynamic response was abnormal
(describe). Resting RV and LV function was (normal /
abnormal).
[Add
additional pertinent information that addresses the clinical
reason for performing the study, such as low/high risk study.
If appropriate mention suboptimal quality of study because of
e.g. patient's obesity, etc.].
FIGURE
2. TEMPLATE FOR STANDARD VASODILATOR / ADRENERGIC STRESS SPECT
MYOCARDIAL PERFUSION IMAGING REPORT
Type
of study:
MYOCARDIAL PERFUSION IMAGING WITH (SESTAMIBI / TETROFOSMIN
/ THALLIUM) SPECT AFTER VASODILATION WITH ADENOSINE (DIPYRIDAMOLE,
DOBUTAMINE), AND GATED SPECT (AND RESTING FIRST PASS
RADIONUCLIDE ANGIOGRAPHY).
History:
As in figure 1. Clarify why pharmacological stress was indicated.
Indication:
As in figure 1.
Procedure:
The patient had a maximal dose of 140 mcg/kg/min of adenosine
infused (state if the patient also performed low level exercise).
(If dipyridamole, give total dose infused over 4 minutes) (If
dobutamine give maximal dose in mcg/kg/min). The heart rate
was ____bpm at baseline, and was ____bpm at peak adenosine/dipyridamole
infusion. (For dobutamine state maximal heart rate as percent
of target heart rate). The blood pressure response was (normal
/ hypertensive / hypotensive). [If blood pressure response
was abnormal state: Resting blood pressure was ____mmHg, and
peak/nadir blood pressure was ____mmHg].
The
patient (did / did not) have chest pain/symptoms during
the procedure.
The
electrocardiogram did (did not) show ST-segment changes
suggestive of ischemia (describe changes if appropriate).
Imaging
procedure: As in figure 1.
Findings:
As in figure 1.
IMPRESSION:
As in figure 1.
FIGURE
3. TEMPLATE FOR STANDARD EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY
REPORT
Type
of study:
EQUILIBRIUM RADIONUCLIDE ANGIOGRAPHY AT REST (AND
EXERCISE), (and gated first pass).
History:
(e.g., 74-yr male with lung cancer)
Indication:
(e.g., assessment of global right ventricular / left ventricular
systolic / diastolic function, regional wall motion).
Procedure:
The patient's red blood cells were labeled with ____mCi of Technetium-99m
using the modified in vivo technique (using Ultratag etc.).
Imaging was performed at rest (and exercise) by planar technique
in multiple views. (By tomographic technique).
(If study is acquired during exercise describe type of exercise,
duration, hemodynamic response, symptoms and ECG).
Findings:
The right atrium was normal in size (enlarged). The right
ventricle was normal in size (enlarged {degree of enlargement}.
Resting RVEF was ____%.
The pulmonary artery was normal in size (dilated).
The left atrium was normal in size (enlarged).
The left ventricle was normal in size (enlarged {degree of
enlargement}). There was suggestion of left ventricular
hypertrophy.
Regional wall motion was normal (describe wall motion, paradoxical
septal motion, hypokinesis {mild, moderate, severe}, akinesis,
or dyskinetic segments).
Global resting LVEF was normal (mildly, moderately, severely
reduced) at ____%. (During exercise LVEF was ____%).
Resting end-diastolic volume was normal / abnormal (i.e.,
mildly, moderately, severely enlarged) at ____mls.
Resting peak diastolic filling rate was normal (abnormal)
at ____ end diastolic volumes/sec.
IMPRESSION:
Normal / abnormal rest right ventricular function.
Normal /
abnormal resting left ventricular function.
(Normal / abnormal LVEF response to exercise)
(Compare present assessment of LVEF to previous studies and
comment)
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