Ventilation Scintigraphy Research Articles

Endobronchial coil lung volume reduction performed on patients with emphysema dominant COPD: Long term follow-up results.

Chronic obstructive pulmonary disease (COPD) is a commonly seen, preventable, and treatable disease with permanent respiratory symptoms and air entrapment that is caused by particle exposure. In case of limited response to traditional treatment protocols, lung volume reduction may be performed in patients with emphysema dominant patterns. In this study, long term follow-up results of the patients who had been operated on by minimal invasive bronchoscopic lung volume reduction surgery by coil placement were reported. Records of the patients operated on by coil placement were retrospectively investigated, and pulmonary function test (PFT), echocardiography (ECHO), six-minute walking test (6MWT), tomography images, ventilation scintigraphy, and clinical summaries were evaluated. Out of 34 initial candidates, 18 patients were included in the study. Wilcoxon signed-rank test and Spearman's rho were utilized to compare interventions and follow-up testing. The average age of 18 patients was 62 (50-74) years, and except for one patient, all were males (n= 17). Fifteen patients were operated bilaterally, and the rest were unilaterally operated, with an average of 10 coils placed per coil placement. An average of 90 days was between bronchoscopic coil placement, with a follow-up duration of 45 days in between. Mean total follow-up duration was 794 (± 424) days. Pneumonia and pneumonitis were seen in 33% of patients within the first month. Mortality from respiratory causes was found to be 11%, while mortality from all causes was found to be 22%. Statistical difference was observed regarding 6MWT after bronchoscopic volume reduction when compared the initial preoperative values. However, this difference was later lost statistically at the second follow-up performed after the completion of both sides. A benefit in improved resting saturation was observed after the second procedure, which was not evident after unilateral intervention. However, similiar to 6MWT, this benefit was lost at the second follow-up, with resting saturation instead being effected negatively. No difference was observed in PFT results; however, a correlation was seen between FEV1 and walking distance. No specific correlation had been seen in the ECHO evaluation. Benefits regarding 6MWT and resting saturation were observed in patients undergoing minimal invasive bronchoscopic lung volume reduction surgery with coils. This benefit was evident in the short term but was lost as the follow-up duration increased. A relatively high morbidity and mortality rate was also present, further stating the risky nature of pulmonary intervention, even minimally invasive procedures, on patients with COPD.

Administered dosage and effective dose estimated from 81Rb-rubidium hydroxide for lung ventilation scintigraphy using 81mKr noble gas.

The aim of this study was to estimate the administered dosage of 81mKr noble gas as calculated by the radioactivity of 81Rb-rubidium hydroxide (81RbOH). The administered dosage was regarded as the total amount of 81mKr noble gas. The radioactivity of 81mKr was calculated using the radioactivity of 81RbOH at the examination, the beginning of inhalation, the inhalation duration and the attenuation volume from the generator to the patient for 81mKr noble gas. In addition, we created an Internet survey and asked National University Hospital in Japan to respond to questions regarding the parameters of concern. Survey responses were provided by 38 hospitals (response rate was 90.5%). Twenty-seven hospitals (64.3%) examined lung ventilation scintigraphy using 81mKr noble gas. The mean administered dosage and the effective dose of lung ventilation scintigraphy using 81mKr noble gas were 35.8±22.1GBq and 0.97±0.60mSv, respectively.

V/Q SPECT and SPECT/CT in Pulmonary Embolism.

Ventilation and perfusion (V/Q) lung scintigraphy has been used in the assessment of patients with suspected pulmonary embolism for more than 50 y. Advances in imaging technology make SPECT and SPECT/CT feasible. This article will examine the application and technical considerations associated with performing 3-dimensional V/Q SPECT and the contribution of a coacquired CT scan. The literature tends to be mixed and contradictory in terms of appropriate investigation algorithms for pulmonary embolism. V/Q SPECT and SPECT/CT offer significant advantages over planar V/Q, with or without the advantages of Technegas ventilation, and if available should be the preferred option in the evaluation of patients with suspected pulmonary embolism.

Performance and Feasibility of Therapeutic Vibrating Mesh Nebulizer for Ventilation Lung Scan

PurposeThis study aimed to evaluate the performance of a therapeutic vibrating mesh-type nebulizer for the pulmonary delivery of radioaerosols for lung scintigraphy in healthy subjects.MethodsSix healthy subjects (mean age of 28.7 ± 6.2 years) inhaled 2 mL Tc-99m diethylenetriaminepentaacetic acid and normal saline solution (20 mCi) via a therapeutic vibrating mesh-type nebulizer (DK010, DELBio, Taipei, Taiwan). The nebulizer’s mass median aerodynamic diameter was between 2.3 and 5.0 µm (3.47 ± 0.37 µm), and the nebulization rate was greater than 0.2 mL/min. Scintigraphy was performed to count radioaerosols in the regions of interest to determine the total and regional lung deposition and extrathoracic airway deposition of aerosols, penetration of aerosols, and radioactivity count balance (RCB).ResultsThe total lung depositions of aerosols were 21.2% ± 5.2% (% ex-valve dose), 27.4% ± 8.0% (% ex-device dose), and 13.8% ± 4.1% (% initial dose) in the nebulizer. The extrathoracic airway deposition was 4.8% ± 1.1%. The RCB was 5.4% ± 3.0%. The ratio of outer over inner lung deposition (O/I ratio, or penetration index) was 1.89 ± 0.55.ConclusionThe delivery efficiency and penetration of aerosols to the peripheral lung, which were achieved by the DELBio DK010 vibrating mesh-type nebulizer, were similar to the commercialized jet-type nebulizers dedicated for radioaerosol lung scintigraphy nebulizer. The therapeutic vibrating mesh-type nebulizer (DELBio DK010) is feasible for radionuclide lung ventilation scintigraphy.

Airflow patterns in the trachebronchial tree of a patient with an accessory cardiac bronchus: A rare congenital anomaly

Accessory cardiac bronchus (ACB) is a rare congenital anomaly mainly located in the medial wall of the intermediate bronchus. This anomaly can present with dyspnea, recurrent infections, and hemoptysis. It usually has a blind ending, which may have an impact on airflow patterns and lobar distribution regardless of its diameter and depth. There have been very few cases with ACB. However, the airflow pattern and lobar distribution have not been well studied. In our case with ACB, the proportion of airflow in the right lung was higher than in the model without ACB, while mean airflow velocities were similar in both models. In this regard, quantitative lung ventilation scintigraphy could be better than the anatomical formula in predicting postoperative forced expiratory volume 1 in patients with accessory cardiac bronchus who will undergo lung resection.

Atypical Unilateral SARS-CoV-2 Pneumonia in a Single Lung Re-Transplanted Patient: A Case Report

BackgroundSince December 2019, the SARS-CoV-2 pandemic significantly has impacted the medical community. When infected with SARS-CoV-2, most of the patients developed bilateral pneumonia. We have herein presented the atypical case of a patient who developed unilateral SARS-CoV-2 pneumonia, affecting only the second lung allograft re-transplanted (re-LTX).Case PresentationA SARS-CoV-2 infection occurred in a 2-dose vaccinated patient with LTx with a history of second unilateral lung transplantation performed after an end-stage bronchiolitis obliterans syndrome. The first symptoms started with a flu-like syndrome, and the patient's clinical condition worsened with nonsevere acute respiratory failure requiring conventional oxygen therapy. Treatment consisted in administrating specific anti-SARS-CoV-2 monoclonal antibodies along with probabilistic antibiotherapy, anticoagulation, and steroids. On day 7, the patient was discharged from hospital. We aimed to assess this atypical unilateral pneumonia based on different explorations. A ventilation scintigraphy showed a severe ventilation decrease owing to end-stage bronchiolitis obliterans syndrome within the left first allograft, which may be associated with asymmetrical virus diffusion between the 2 lungs. We did not identify any other relevant differences with respect to the 2 donors’ clinical characteristics. Using specific immunohistochemistry staining against angiotensin converting enzyme-2 receptor, the main known receptor for SARS-CoV-2 binding on airway epithelial cells, no staining difference was observed between the 2 lung biopsies that were collected at re-LTx from each lung.ConclusionsWith the present case report, we aimed to highlight how this kind of unusual presentation may be caused by the difference of ventilation between the 2 lungs.

Ventilation and perfusion scintigraphy after lung transplantation

Study objective.Evaluation of the possibilities of ventilation and perfusion scintigraphy in detecting functional disorders and determining the severity of lung damage that may occur after organ transplantation.Material and methods.The study included 27 patients after bilateral lung transplantation; mucoviscidosis was the main cause of terminal respiratory failure in most cases (19 patients; 77.8%). The ventilation scintigraphy was performed with99mTc-pentatech using a nebulizer, and the perfusion scintigraphy was performed with99mТс-albumin macroaggregate. The investigations were performed on Infinia II and Discovery 670 NM/CT single-photon emission tomographs (GE, USA).Results.Changes in the quantitative parameters of ventilation and perfusion scintigraphy in patients after lung transplantation were studied. When analyzing the results of radionuclide studies, we identified a restoration of function after lung transplantation, and the appearance of disorders with the development of complications in the early (up to 4 months) and later (more than one year) periods after bilateral lung transplantation.Conclusion.The study has shown that the radionuclide method has wide possibilities for assessing the ventilation and perfusion functions in patients after lung transplantation, helping in the differential diagnosis of obliterating bronchiolitis and graft vascular sclerosis, in assessing the nature of alveolar-capillary diffusion disorders, and determining the extent of functional abnormalities in every individual patient. Monitoring the function of transplanted lungs using scintigraphy allows separate monitoring of ventilation and perfusion changes, which is important for the choice of treatment tactics.

PREOPERATIVE AND POSTOPERATIVE PULMONARY REHABILITATION IN PATIENTS WITH LUNG CANCER AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study was to analyze the world experience in the objective assessment of the functional state of the bronchopulmonary system in lung cancer patients with chronic obstructive pulmonary disease (COPD) using modern diagnostic tools and techniques as well as correction of ventilation disorders in the perioperative period using long-acting inhaled bronchodilators. Material and methods. A literature search was conducted using the Medline, Elibrary etc. databases. Out of 112 publications concerning the study of the incidence of lung cancer and COPD, external respiration function and rehabilitation of patients, 37 were included in this review. R esults. COPD was shown to be the major cause of postoperative non-surgical complications and the main predictor of perioperative mortality in lung cancer patients. Modern techniques for studying the function of external respiration, such as bodyplethysmography, spirography, high-resolution computed tomography, ventilation and perfusion lung scintigraphy, were highlighted. It was shown that preoperative correction of obstructive syndrome and postoperative pulmonary rehabilitation, including drug therapy with long-acting bronchodilators in combination with smoking cessation, eradication of foci of chronic infection and respiratory gymnastics were necessary to detect functional respiratory disorders in lung cancer patients with COPD. Conclusion. To date, there are no standards clinical practice guidelines for diagnostic testing and the correction of ventilation disorders in lung cancer patients with COPD in the pre- and postoperative periods. Therefore, further studies aimed at developing a diagnostic algorithm to improve the accuracy of detecting bronchial obstructive syndrome, especially in the early stages of COPD, as well as compensation for respiratory disorders using modern bronchodilator therapy are needed.

Physician Receptiveness of Ventilation-Perfusion Imaging in a Randomized Clinical Trial

Background and Hypothesis: Computed Tomography of the pulmonary arteries (CTPA) is the most common imaging modality for evaluating patients for suspected pulmonary embolism (PE), but carries the risk of acute kidney injury (AKI) from contrast media exposure. In appropriately selected patients, ventilation scintigraphy (VQ) imaging is a diagnostically equivalent alternative. We hypothesized that physician perceptions of diagnostic accuracy and study availability contribute to under-utilization of VQ imaging.
 Project Methods: Patients with suspected PE at increased risk of acute kidney injury, were randomly selected to undergo VQ instead of CTPA. Patients unable to consent, patients with a history of pulmonary surgery, and those undergoing contrastenhanced imaging for other indications were excluded. A screening chest radiograph was obtained prior to study imaging allocation. All cases were reviewed by a nuclear medicine radiologist blinded to acceptance or refusal of VQ imaging allocation. The primary outcome was defined as the rate of physician-refusal of VQ imaging. The unprompted physician-reported reason for refusal was recorded, in real-time, along with any other general responses.
 Results: Following exclusions, 42 subjects were enrolled. Notably, chest radiograph findings excluded only 2 subjects. The reviewing nuclear radiologist agreed with all study-selections for VQ appropriateness and there was no instance of nondiagnostic VQ imaging. Treating physicians refused VQ imaging randomization in 48% (20/42). Physicians also believed VQ imaging lacked sufficient diagnostic accuracy in the context of active non-pulmonary malignancy in 29% (12/42) of cases. Although CT did not identify cases not seen on chest radiograph, in 12% (5/42) cases suspected pneumonia was the reason for refusal. Statements such as “VQ is inferior [for PE],” and “VQ takes too long” were characteristic of general responses from treating providers.
 Conclusion and Potential Impact: VQ imaging remains under-utilized in patients at risk of AKI. Perceived limitations to diagnostic accuracy and study availability are contributors to under-utilization.

Development of an ex vivo respiratory pediatric model of bronchopulmonary dysplasia for aerosol deposition studies

Ethical restrictions are limitations of in vivo inhalation studies, on humans and animal models. Thus, in vitro or ex vivo anatomical models offer an interesting alternative if limitations are clearly identified and if extrapolation to human is made with caution. This work aimed to develop an ex vivo infant-like respiratory model of bronchopulmonary dysplasia easy to use, reliable and relevant compared to in vivo infant data. This model is composed of a 3D-printed head connected to a sealed enclosure containing a leporine thorax. Physiological data and pleural-mimicking depressions were measured for chosen respiratory rates. Homogeneity of ventilation was assessed by 81mkrypton scintigraphies. Regional radioaerosol deposition was quantified with 99mtechnetium-diethylene triamine pentaacetic acid after jet nebulization. Tidal volumes values are ranged from 33.16 ± 7.37 to 37.44 ± 7.43 mL and compliance values from 1.78 ± 0.65 to 1.85 ± 0.99 mL/cmH2O. Ventilation scintigraphies showed a homogenous ventilation with asymmetric repartition: 56.94% ± 9.4% in right lung and 42.83% ± 9.36 in left lung. Regional aerosol deposition in lungs exerted 2.60% ± 2.24% of initial load of radioactivity. To conclude the anatomical model satisfactorily mimic a 3-months old BPD-suffering bronchopulmonary dysplasia and can be an interesting tool for aerosol regional deposition studies.

Early Shift of Lung Perfusion to the Unilateral Lung Predicts the Development of Unilateral Chronic Lung Allograft Dysfunction after Bilateral Living-Donor Lobar Lung Transplantation

Purpose In the diagnosis of chronic lung allograft dysfunction (CLAD) after living-donor lobar lung transplantation (LDLLT), lung ventilation scintigraphy using 133 Xe has been shown to be useful. However, the supply of 133 Xe has been discontinued worldwide in 2016 and a new diagnostic tool is required for CLAD after LDLLT. Generally, because CLAD has been shown to develop predominantly on one side after bilateral LDLLT, lung perfusion scintigraphy (LPS) could show a perfusion shift to the unilateral healthy lung ( Figure 1A ). Nevertheless, the usefulness of LPS in the diagnosis of CLAD after LDLLT is unknown. Methods We conducted a single-center retrospective cohort study of 58 recipients who underwent bilateral LDLLT at Okayama University Hospital between October 1998 and June 2016. The unilateral shift values in LPS were calculated, and compared between the CLAD group (N=27) and the non-CLAD group (N=31) from 5 years before the CLAD onset to 5 years after the CLAD onset. Results The median time to the CLAD onset was 2176 days (326-4763 days). The unilateral shift values in LPS of the CLAD group were significantly higher than those of the non-CLAD group during 5 years before the CLAD onset (P Figure 1B ). An ROC analysis of the performance of the unilateral shift value in LPS as a marker of CLAD yielded an AUC of 0.79 (sensitivity=0.54 and specificity=1.00 at a unilateral shift threshold level of 8.6%). The unilateral shift values in LPS were significantly correlated with the results of the forced expiratory volume in 1 second (P = 0.036, r = - 0.322) ( Figure 1C ). Conclusion In the patients with unilateral CLAD after bilateral LDLLT, LPS showed the unilateral perfusion shift to the healthy lung even during 5 years before the CLAD onset. LPS might have a potential to diagnose unilateral CLAD early after bilateral LDLLT.

Unilateral Chronic Lung Allograft Dysfunction Assessed by Biphasic Computed Tomographic Volumetry in Bilateral Living-donor Lobar Lung Transplantation.

BackgroundEarly diagnosis of unilateral chronic lung allograft dysfunction (CLAD) is difficult because the unaffected contralateral lung functions as a reservoir in bilateral living-donor lobar lung transplantation (LDLLT). We previously reported the usefulness of 133Xe ventilation scintigraphy for detection of unilateral change, but the supply of 133Xe has been stopped globally. The present study aimed to examine the usefulness of inspiratory and expiratory computed tomography (I/E CT) volumetry for detection of unilateral change in CLAD patients.MethodsThis was a retrospective single-center, observational study using prospectively collected data. A total of 58 patients who underwent bilateral LDLLT from August 2008 to February 2017 were analyzed. Respiratory function tests, I/E CT were prospectively conducted. ΔLung volume was defined as the value obtained by subtracting expiratory lung volume from inspiratory lung volume.ResultsFourteen (24%) cases were clinically diagnosed with CLAD, of which 10 (71%) were diagnosed as unilateral CLAD. ΔLung volume of bilateral lungs strongly correlated with forced vital capacity (r = 0.92, P < 0.01) and forced expiratory volume in 1 second (r = 0.80, P < 0.01). Regardless the phenotypes (bronchiolitis obliterans syndrome or restrictive allograft syndrome) of CLAD, Δlung volume onset/baseline significantly decreased compared with that in the non-CLAD group. Among the 10 unilateral CLAD patients, 3 with clinically suspected unilateral rejection yet did not show a 20% decline in forced expiratory volume in 1 second. In 2 of these, Δlung volume of unilateral lungs on the rejection side decreased by 20% or more.ConclusionsOur findings suggest that I/E CT volumetry may be useful for assessment and early diagnosis of unilateral CLAD after bilateral LDLLT.

The conclusions drawn from ventilation/perfusion single-photon emission computed tomography compared with lung perfusion single-photon emission computed tomography and chest radiography in patients with suspected pulmonary thromboembolism.

There are conflicting results from studies on whether ventilation scintigraphy can be safely omitted or replaced by chest radiography. These studies were based on planar ventilation/perfusion (V/Q) scintigraphy. We evaluated the value of the ventilation single-photon emission computed tomography (SPECT) on the final conclusion drawn from a V/Q SPECT and the possible role of the chest radiography as a surrogate for the ventilation SPECT. Raw data of V/Q SPECT images and chest radiography acquired within 48 h over an 18-month period were retrieved, reprocessed and reviewed in batches. The ventilation SPECT, perfusion SPECT and chest radiography were reviewed separately and in combination. Data on the presence and nature of defects and chest radiography abnormalities were recorded. The V/Q SPECT images were interpreted using the criteria in the EANM guideline and the perfusion SPECT and chest radiography images were interpreted using the PISAPED criteria. Agreement between the diagnosis on the V/Q SPECT review and the perfusion SPECT and chest radiography review was analysed. Overall, 21.1% of the patients were classified as 'PE present' on the V/Q SPECT review, whereas 48.9% were classified as 'PE present' on the perfusion SPECT and chest radiography review. Only 5.4% of defects observed on ventilation SPECT had matched chest radiography lung field opacity. Our study showed that the omission of a ventilation SPECT led to a high rate of false-positive diagnoses and that the ventilation scan cannot be replaced by a chest radiography.

P084] Tests of down-scatter correction in simultaneously acquired TC-99M perfusion and KR-81M ventilation scans

Purpose Lung scans are basic nuclear medicine studies, often consisting of both ventilation and perfusion studies. A gamma camera acquires the ventilation studies of a radioactive gas or aerosol inhaled by a patient, and the perfusion studies of 99mTechnetium macro aggregated albumin injected in the patient’s blood. There are several possible gasses or aerosols for ventilation scintigraphy, but 81mKrypton is usually considered the golden standard. Due to the higher gamma energy of 81mKr compared to 99mTc, ventilation and perfusion scans can be acquired simultaneously, which saves time and allows perfect image registration. Unfortunately, down-scatter of 81mKr often distorts the perfusion images significantly. A widely used method to solve this problem is to subtract a fraction of the ventilation studies from the perfusion studies. However, we suspect this to be an inadequate procedure that may even lead to further degradation of the perfusion scans. Methods In our project, we acquired studies of a patient and of homemade phantoms. While the patient underwent a lung ventilation scintigraphy, an extra energy window at 140 keV was added, leading to a scintigraphy of down-scattered photons. The homemade phantom consisted of a 50 ml 81mKr filled syringe surrounded by two water boxes, representing respectively lungs and nearby tissue. Four energy windows were acquired simultaneously: 140 keV ± 10%, 190.5 keV ± 10%, 159 keV ± 2.5% and 168 keV ± 2.5%. Results Both of the methods showed none or little overlap between the scintigraphies with energy windows at 140 keV and 190.5 keV. This supported our theory of the subtraction method being without effect in the best case. Instead, other theoretically conceived procedures were tested, but the results were insufficient. Conclusions In the case of unacceptable quality of perfusion scintigraphies caused by down-scatter from 81mKr, one has to consider other solution than the typically used subtraction method. The short half-life of 81mKr (13 seconds) may even allow acquisition of ventilation studies prior to perfusion studies.

Which is Better - A Standalone Ventilation or Perfusion Scan or Combined Imaging to Predict Postoperative FEV1 in One Seconds in Patients Posted for Lung Surgeries with Borderline Pulmonary Reserve.

Introduction:Forced expiratory volume in one second (FEV1) is an independent predictor for respiratory morbidity. Reports are varied and controversial substantiating the use of either lung perfusion (Q) or ventilation (V) scintigraphy as a single stage investigation to predict postoperative (ppo) FEV1 in patients scheduled for lung resection surgeries. It is said that there is no additional benefit by performing both V/Q scan. As per one of the recommendations, no further respiratory function tests are required for a lobectomy if the postbronchodilator FEV1 is >1.5 l. We wanted to study the ppo FEV1 in patients with FEV1 of <1.5 L scheduled for lung surgeries. Being a high-risk population, we wanted to assess (a) whether the ppo changes by this combined V/Q imaging and (b) whether the incidence of respiratory complication in the postoperative setting of this subgroup is different, (c) and study the short- and long-term clinical outcome.Materials and Methods:Fifty-two high-risk patients (with comorbidities) and borderline preoperative FEV1 of 1.5 L or less planned for lung resection were enroled in this prospective study. V and Q scans were performed, and tracer uptake percentage was tabulated.Results:Tracer uptake in each lung was quantitated. Manual method of ROI drawing is preferred in high risk patients with reduced pulmonary reserve over the automatic method. Based on uptake patterns by V/Q scans, 4 different types of patterns were tabulated. Eighty-eight percentage of centrally placed tumors showed the difference in uptake patterns. Chronic obstructive pulmonary disease patients usually showed more modest ventilatory defects (categorised as type 2 or 3). Lung tumours produce erratic uptake patterns (Type 4) which depend heavily on their location and extent. The range of FEV1 predicted was 0.6–1.38 L/minConclusion:We recommend that combined imaging should be performed in patients with borderline pulmonary reserve to derive the benefit of surgery as it provides a realistic ppo FEV1 in patients with moderate to severely damaged lung. Centrally placed hilar or bronchial tumors (even those <2 cm in size), produce discrepancies in V/Q distribution pattern. Patient who was thought ineligible for surgery due to low baseline FEV1 may be actually be operable by this combined imaging if uptake pattern is better in V or Q scan with a good outcome. Accurate estimation of postop FEV1 in fact helps the surgical team to implement measures to prepare high risk patients to reduce postoperative complications, enable faster weaning from ventilatory support and ensure favourable prognosis.

Veteran player tips the scale — V/Q SPECT-CT proves decisive in blunt chest trauma. Case report and brief literature review

A 29-year-old patient after blunt chest trauma with right lung atelectasis and pulmonary empyema was referred for lung ventilation and perfusion scintigraphy before right-sided pneumonectomy. Radionuclide imaging revealed severely reduced perfusion and lack of ventilation in the collapsed right lung. Additionally, it showed a matching lobar perfusion-ventilation defect in the lower left lobe, which, apart from consolidation area in posterior basal segment, appeared normal in computed tomography. A normal perfusion and ventilation pattern was observed in the upper left lobe. Since it was found to be the only functioning lobe, pneumonectomy was excluded from possible treatment options.

Update on Nonsurgical Lung Volume Reduction Procedures.

There has been a surge of interest in endoscopic lung volume reduction (ELVR) strategies for advanced COPD. Valve implants, coil implants, biological LVR (BioLVR), bronchial thermal vapour ablation, and airway stents are used to induce lung deflation with the ultimate goal of improving respiratory mechanics and chronic dyspnea. Patients presenting with severe air trapping (e.g., inspiratory capacity/total lung capacity (TLC) < 25%, residual volume > 225% predicted) and thoracic hyperinflation (TLC > 150% predicted) have the greatest potential to derive benefit from ELVR procedures. Pre-LVRS or ELVR assessment should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. ELVR procedures are currently available in selected Canadian research centers as part of ethically approved clinical trials. If a decision is made to offer an ELVR procedure, one-way valves are the first option in the presence of complete lobar exclusion and no significant collateral ventilation. When the fissure is not complete, when collateral ventilation is evident in heterogeneous emphysema or when emphysema is homogeneous, coil implants or BioLVR (in that order) are the next logical alternatives.

Elevated uric acid levels: a predictor of pulmonary hypertension

Background: Pulmonary hypertension is a chronic, progressive and a fatal disease. Uric Acid is elevated in case of myelo and lymphoproliferative diseases, decreases uric acid excretion or as a part of metabolic syndrome (insulin resistance). It is also said to be associated in patients with heart failure leading to severe symptoms and fatality. This study was conducted to identify if elevated uric acid levels can be a predictor of pulmonary hypertension. Methods: After taking the detailed demographic data of 62 patients, a thorough clinical and physical examination, postero-anterior chest X-rays, pulmonary function testing, ventilation or perfusion scintigraphy and Electro Cardiograph was also done for all the patients. Blood was drawn for testing uric acid, creatinine and total bilirubin levels. Results: Out of the 62 patients, 43.5% were males and 56.5% were females. Out of the NYHA classes, most of the patients 58% belonged to the Class II, 34% to class III and 8% to Class IV. . The total bilirubin and creatinine levels were higher in patients with hyperuricemia than that of the controls. The blood saturation levels were significantly lower with only 67% and heart rate was on average more than 89 beats per minute. A positive correlation with NYHA class and MPAP, and a negative correlation with LVEF and RVEF were observed. Conclusions: In conclusion, the results of this study establish that hyperuricemia is common in patients with severe PH.

Bronchoscopic treatment options for chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a major cause of high mortality and morbidity worldwide. Symptoms of the disease are usually related with the results of pulmonary dynamic hyperinflation. Treatment options are classified as invasivenoninvasive and mostly tend to be palliative. Lung volume reduction techniques are invasive part of the treatment and can be performed by surgical or bronchoscophic methods. Because of the low complication rates bronchoscophic methods became more popular in recent years. Patients presenting with severe air trapping and thoracic hyperinflation have the greatest potential to derive benefit from volume reduction procedures. Assessment of patients should ideally include cardiological evaluation, high resolution CT scan, ventilation and perfusion scintigraphy, full pulmonary function tests, and cardiopulmonary exercise testing. There are three main groups of bronchoscophic volume reduction, direct effect on lung parenchyma, airway bypass and blocking the airways. Indications and contraindications are different for each modality and device. Patients who have deterioration despite habitual changes and medical therapies should be evaluated for volume reduction procedures.

Safety management of nuclear medicine personnel with visualisation of air dose rate.

Many people are anxious about radiation exposure for the reason that radiation cannot be seen. With the aim of devising a way for medical personnel to perform their medical duties without worry about radiation exposure, we attempted safety management using a system that displays the air dose of radiation in real time. Measurements were made in a lung ventilation scintigraphy examination room with the use of Xe-133. An SCI-type RI detector from Hamamatsu Photonics, which displays the air dose rate in real time, was used for the measurements. These radiation measurements were continued from the start to finish of the examination. The measurements were made in two locations, on the patient inhalation tube side and on the opposite side. Measurements were made on the patient tube side in 24 tests and on the opposite side in 12 tests. The maximum air dose rate was 3.7 ± 2.1 μSv/h on the patient tube side and 1.1 ± 0.5 μSv/h on the opposite side. Thus, the level on the opposite side was about 1/5 that of the tube side. To accurately perform lung ventilation scintigraphy, a medical worker needs to observe the patient's breathing status up close. Because of this, some medical workers are worried about radiation exposure during tests. The simplest way to reduce exposure would be to maintain a distance from the examination tube that is the source of radiation. The measurements in this study were made to encourage medical workers' recognition of this fact. Displaying specific numbers not only serves as basic data for managing staff operations, but is also thought to reassure workers through visualization.