Parathyroid scintigraphy protocols in Finland in 2010

Summary

The goal of this study was to describe current clinical parathyroid scintigraphy (PS) protocols in Finland. Methods: All departments of nuclear medicine in Finland were contacted, and instructions regarding PS were requested. Results: Instructions regarding PS were received from all of the departments that perform PS (n = 19). Seven hundred and sixtynine PS studies were performed in 2009 (between 7 and 209 per hospital). Three methods of PS were used. The dual-phase method with ^99mTc-sestamibi is used in seven hospitals, the dual-tracer method with ¹²³I/^99mTc-sestamibi in eleven, and ^99mTcO4/^99mTc-sestamibi in one hospital. The activities of ^99mTc-sestamibi, ¹²³I and ^99mTcO4 were 150–800 MBq, 10–30 MBq and 50 MBq, respectively. The anterior image with parallel-hole collimators, the anterior image with pinhole collimator, the oblique angles with pinhole collimator, SPECT and hybrid CT with SPECT were acquired in 84%, 26%, 16%, 63%, and 42% of the hospitals, respectively. Because the imaging techniques were combined, one to four acquisitions were performed per patient. Scatter and attenuation correction were used in five protocols. A correction for crosstalk of ¹²³I and ^99mTc gamma energies was not used, but the amount of crosstalk was decreased by using narrow or asymmetric energy windows in all dual isotope protocols. Conclusion: 19 hospitals used 18 different study protocols. Thus, significant variability exists in the current practice of PS in Finland. The protocols should be tested with known phantoms to determine any differences in sensitivities for detecting small active structures. Further studies with phantoms are needed to determine the optimal imaging techniques. The results of these phantom studies will provide guidelines for proposing national recommendations for PS.

Zusammenfassung

Das Ziel dieser Studie war die Beschreibung aktueller klinischer Protokolle für die Nebenschilddrüsen (NSD)-Szintigraphie in Finnland. Methoden: Alle nuklearmedizinischen Abteilungen in Finnland wurden angeschrieben und um die Vorschriften für die NSD-Szintigraphie gebeten. Ergebnisse: Wir erhielten die Vorschriften aller Abteilungen, die NSD-Szintigraphien durchführen (n = 19). Im Jahr 2009 erfolgten 769 szintigraphische NSD-Untersuchungen (7 bis 209 je Krankenhaus). Drei Methoden wurden für die NSD-Szintigraphie verwendet. Die Dual-Phasen-Methode mit ^99mTc-Sestamibi wird in sieben Krankenhäusern eingesetzt, die Doppelnuklid-Methode mit ¹²³I/^99mTc-Sestamibi in elf und mit ^99mTcO4/^99mTc-Sestamibi wird in einer Klinik gearbeitet. Die Aktivitäten von ^99mTc-Sestamibi, ¹²³I bzw. ^99mTcO4 betrugen 150–800 MBq, 10–30 MBq und 50 MBq. Aufnahmen von vorne mit Parallelloch-Kollimatoren oder mit dem Pinhole-Kollimator, Schrägaufnahmen mit dem Pinhole-Kollimator, Aufnahmen mit SPECT und CT/SPECT-Hybridscanner wurden in 84%, 26%, 16%, 63% bzw. 42% der Kliniken akquiriert. Da die Methoden kombiniert wurden, erfolgten je Patient ein bis vier Datenakquisitionen. In fünf Protokollen wurde nach Streuung und Abschwächung korrigiert. Eine Korrektur der Überlagerung von ¹²³I- und ^99mTc-Gammastrahlungen fand nicht statt, jedoch wurde das Ausmaß der Überlagerungen dadurch reduziert, dass man bei allen Doppelnuklid- Protokollen enge oder asymmetrische Energiefenster verwendete. Schlussfolgerung: In 19 Krankenhäusern kamen 18 verschiedene Studienprotokolle zum Einsatz. In der aktuellen Praxis der NSD-Szintigraphie besteht daher in Finnland eine signifikante Variabilität. Die Protokolle sollten an bekannten Phantomen getestet werden, um alle Sensitivitätsunterschiede bei der Darstellung kleiner aktiver Strukturen aufzudecken. Weitere Studien an Phantomen sind erforderlich, um die optimale Bildtechnik zu definieren. Die Ergebnisse dieser Phantomstudien ermöglichen es, Richtlinien für nationale Empfehlungen für die NSD-Szintigraphie zu erstellen.

Keywords

Hyperparathyroidism - parathyroid scintigraphy - ^99mTc-sestamibi - iodine-123 - numerical data

Schlüsselwörter

Hyperparathyroidismus - Nebenschilddrüsen-Szintigraphie - ^99mTc-Sestamibi - Iod-123 - numerische Daten

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