1. Functional (Gated & 1 st Pass) and other Cardiac Imaging

2. Coronary Artery Perfusion  Left main coronary artery –Left anterior descending artery  I. V. septum  L. V. anterior wall –Left circumflex  Left atrium  L. V. posterior  L. V. lateral wall  Right coronary artery  Right atrium  Right ventricle  L. V. inferior wall

4. Gross Anatomy of the Heart

5. Mechanical Activity  Systole – ventricular contraction  Diastole – ventricular relaxation

6. Electrical Activity

7. 1 st pass protocol Patient Preparation  NPO 4-12 hours  No caffeine Procedure  Anterior or 45 LAO  Gated or non-gated  LFOV camera  LEHR collimator  20 mCi pertechnetate, DTPA, Sestamibi  Good bolus ( <1.0 ml) – follow with saline flush  List mode (16 frames/cycle) or Frame mode (20-35 frames/sec)  64x64 matrix  1-2 minutes total acquisition time.

8. 1 st Pass

9. Shunt?

10. MUGA (Multiple Gated Acquisition) Provides functional information Patient preparation  NPO 4-12 hours  No caffeine Blood preparation  In-vivo –Inject cold PYP followed ~20 minutes later by 20-30 mCi Tc-99m  In-vivtro (modified In-vivo) –Inject cold PYP; withdraw 3-5 mLanticoagulated blood into 10 mL syringe containing ~25 mCi Tc-99m; incubate 10 minutes then re-inject.  In-vitro commercial kits (UltraTag) RBC)

11. MUGA Imaging Procedure  ECG  Anterior and ~45 LAO (best septal separation) w. caudal tilt  8 to 16 frames/second  64x64 matrix  10 minutes/view

12. Processing  EF (ejection fraction) = (ED-ES)/ED x 100 ED = end-diastolic volume ES = end-systolic volume  SV (stroke volume) = ED-ES  CO (cardiac output) = SV x heart rate

13. Functional Imaging (MUGA)

14. Myocardial Infarct Imaging 15-30 mCi Tc-99m Pyrophosphate  Of historical interest – replaced by serum enzyme testing

15. Positron Emission Tomography  Myocardial perfusion –Rubidium-82 chloride –Nitrogen-13 ammonia –Oxygen-15 water  Myocardial metabolism –Fluoride-18 FDG –Carbon-11 palmitate –Carbon-11 acetate