Purpose: Evaluate EF response to exercise.

Dose: 25.0-30.0 mCi Tc99m labeled red blood cells- ULTRATAG I.V.

Collimators: HR and GAP or LEAP (HS)

Patient preparation: Patient should be off beta-blocker medication. Clothes should be appropriate to perform bicycle exercise.

Equipment: EKG gate, some I.V. apparatus, exercise table, ergometer, crash cart with monitor, stethoscope, blood pressure cuff, log sheet for BP, etc.

Procedure:

1. After injecting 30.0 mCi of Tc99m labeled RBC, perform resting MUGA (LV) study. Perform at least Anterior and LAO 45 degree MUGA acquisition.

2. When rest study is complete, change GAP or LEAP (high sensitive) collimator on the camera.

3. Place an extra set of EKG electrodes to the patient and connect them to the EKG monitor on crash cart or other monitoring device.

4. Set up gated MUGA acquisition protocol for multiple studies.

5. After getting best separation for LV, acquire baseline LAO 45 degree study for 2 minutes.

6. Without moving patient position, plug in the ergometer to the exercise table on semi-supine table or to the upright bicycle.

7. Make sure the patient is comfortable and shoes can paddle without interference. Immobilize the table or bicycle.

8. Do not forget to take resting blood pressure, heart rate and EKG strip before starting exercise.

9. Once the cardiologist or physician present start the stress by setting a workload to 25 kV or appropriate load decided by the physician. Instruct patient to start pedal in such a way that RPM rate meter should be in the green range (60-80rpm).

10. Workload should be increase every 3 minutes to 50 kV, 75 kV, and 100 kV or as determine by the physician.

11. After every 1st minute in to each stage of stress, start 2 minute gated acquisition. Make sure patient keep his chest as much immobile as possible to acquire adequate study. Also take blood pressure, heart rate and run EKG strip 1 minute in to each stage.

12. Remember- the patient should keep pedaling throughout the study, not stopping until appropriate endpoints (i.e. fatigue, hypotension, S-T segment depression, angina) are reached or stopped by the physician.

13. After peak stress acquisition, if patient can still keep going on stress, position camera to anterior view and perform one more 2 minutes peak stress anterior image.

14. As soon as exercise is terminated, acquire one more 2 minutes post stress LAO 45 degree image.

15. If physician want, you can also re stress patient with all views in anterior position.

16. Process each level (including pre-exercise, each workload and post exercise) LVEF and note all data for doctor to review.

MYOCARDIAL PERFUSION IMAGING

RESTING MUGA IMAGING

BONE IMAGING

BRAIN IMAGING

GI IMAGING

RENAL IMAGING

ENDOCRINE IMAGING

INFECTIOUS DISEASE IMAGING

ONCOLOGY IMAGING

MISCELLANEOUS IMAGING

NUCLEAR MEDICINE