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Technegas

Technegas is an ultra-fine dispersion of Technetium-labelled carbon, produced by heating Technetium-99m in a carbon crucible for a few seconds at 2,750 degrees Celsius1. The resultant gas-like Technegas, thus produced in a Technegas generator, is a cluster of nanosized (average size 30-60nm) pure carbon platelets of hexagonal shape fully encapsulating Technetium metal crystals2. The small size and hydrophobic properties together confirm ideal characteristics for gas-like behaviour and alveoli deposition into the lungs2-3.

Once inhaled by the patient suspected of having a pulmonary embolism, the patient is then imaged under a gamma camera in the ventilation part of a ventilation/perfusion single-photon emission computed tomography (V/Q SPECT) scan3. Technegas penetrates to the sub-segmental areas of the lung and is trapped by surfactant in the alveolar walls4.

Generated into a mobile generator, Technegas, used in the ventilation part of the V/Q scan, is cost-effective, simple to perform and accurate5. With the uptake in SPECT imaging, V/Q SPECT results with Technegas can be argued to be superior to planar imaging and computed tomography (CT) when comparing sensitivity, accuracy and negative predictive value6.

Diagnostic ability of CT, V/Q SPECT and Planar V/Q Scintigraphy to detect pulmonary embolism6:

CT V/Q SPECT

V/Q planar

Sensitivity

86 %

97 %

76 %

Specificity

98 %

91 %

85 %

Accuracy

93 %

94 %

81 %

Negative predictive value

90 %

98 %

81 %

Table adapted from Reinartz P et al, J Nucl Med 2004; 45: 1501-1508

Of significant interest, when compared to CT, is the low radiation dose imparted by V/Q SPECT imaging7. This is important in all patients but particularly in young women with proliferating breast tissue8.

“Lung Scintigraphy has a superior sensitivity combined with adequate specificity and low rate of non-diagnostic tests. The low radiation dose, the possibility to quantify the degree of embolism and to use the test for follow-up of treatment of embolism and its feasibility in very sick patients, contribute to the priority of lung scintigraphy over Computed Tomographic Pulmonary Angiography”9.

 

Add up the benefits using Technegas

Proven diagnostic accuracy: Sensitivity, specificity and accuracy at least equivalent of CTPA5giving the clinician interpretative confidence first time every time.

Non-invasive10: Aids patients comfort and compliance.

Detects PE: Even at subsegmental levels6,11.

Low radiation burden to the patient: V/Q SPECT with Technegas has 27 to 36 times less radiation dose to the patient breast as compared with CTPA7.

Minimal exclusion criteria: Technegas may be administered to almost all patients including:

  • Patients with renal impairment12
  • Patients with iodinated contrast allergy12
  • Patients with critical illness12
  • Diabetics12
  • Patients with chronic lung obstruction disease13
  • Young women in child-bearing age7,14
  • Pregnant women7-8

 

Why Technegas for ventilation imaging

For the Clinician For the Technologist
Quick reliable administration of Technegas

  • Rapid results at your convenience
Quick and simple automated

  • Frees up your preparation time
Gas like behaviour of Technegas coupled with the ideal energy of Tc-99m3,15

  • Excellent penetration to peripheral areas3
Rapid and easy administration (2-3 breaths suffice for most patients)15

  • Rapid results, kinder to your patient
  • Patient compliance
Images may be acquired in multiple projections14

  • Improved identification of mismatching defects
Reduced radiation exposure to operator and to patient7

  • Better environment
Long residence time16 and absence of redistribution enables acquisition of high quality SPECT images14

  • Reduces reported indeterminate scans to less than 5%17
Minimal camera time required8,19

  • Enhances your camera time management
V/Q SPECT using Technegas yields a 96% sensitivity and a 97% specificity18

  • Technegas can enhance the service you offer your clinical colleagues and your patients
Flexible solution to your needs

  • Easy to fit in with departmental scheduling
Provides a simple answer to a single question.

  • Allows accurate and quick decisions even in case of lung obstructive disease13
Exceptional image quality14

  • Facilitates image interpretation
Minimal radiation burden for the patient7

  • May reduce radiation induced sequelae
Reference
  1. Fawdry RM, et al. Initial experience with Technegas – a new ventilation agent. Australas Radiol 1988; 32(2): 232-238
  2. Senden TJ, et al. The physical and chemical nature of Technegas. J Nucl Med 1997; 38: 1327-1333
  3. Roach PJ, Schembri GP and Bailey DL. V/Q scanning using SPECT and SPECT/CT. J Nucl Med 2013; 54: 1588-1596
  4. Mortensen J and Gutte H. SPECT/CT and pulmonary embolism. Eur J Nucl Med Mol Imaging 2014; 41(Suppl1): 81-90
  5. Roach PJ, Bailey DL, Harris BE. Enhancing lung scintigraphy with single-photon emission computed tomography. Semin Nucl Med 2008; 38: 441–449
  6. Reinartz P, et al. Tomographic imaging in the diagnosis of pulmonary embolism: A comparison between V/Q lung scintigraphy in SPECT technique and multislice spiral CT. J Nucl Med 2004; 45: 1501-1508
  7. Isidoro J, et al. Radiation dose comparison between V/P-SPECT and CT-angiography in the diagnosis of pulmonary embolism. Phys Med 2017; 41: 93-96
  8. Bajc et al. V/P SPECT as a diagnostic tool for pregnant women with suspected pulmonary embolism. Eur J Nucl Mol Imaging 2015; 42: 1325-1330
  9. Bajc et al. Comparison of ventilation/perfusion scintigraphy and helical CT for diagnosis of pulmonary embolism; strategy using clinical data and ancillary findings. Clin Physiol Funct Imaging 2002; 22(6): 392-397
  10. Sánchez-Crespo A, et al. A technique for lung ventilation-perfusion SPECT in neonates and infants. Nucl Med Commun 2008; 29(2): 173-177
  11. Grüning T, et al. Three-year experience with VQ SPECT for diagnosing pulmonary embolism: diagnostic performance. Clin Imaging 2014; 38(6): 831-835
  12. Miles S, et al. A comparison of single-photon emission CT lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism. Chest 2009; 136: 1546-1553
  13. Nasr A, Lindqvist A and Bajc M. Ventilation defect typical for COPD is frequent among patients suspected for pulmonary embolism but does not prevent the diagnosis of PE by V/P SPECT. EC Pulmonology and Respiratory Medicine 2017; 4(3): 85-91
  14. Hess S and Madsen PH. Radionuclide diagnosis of pulmonary embolism. Adv Exp Med Biol 2017; 906: 49-65
  15. Bajc M and Jonson B. Ventilation/perfusion SPECT for diagnosis of pulmonary embolism and other diseases. Int J Mol Imaging 2011; 682949
  16. Bajc M, et al. EANM guidelines for ventilation/perfusion scintigraphy. Part 1. Pulmonary imaging with ventilation/perfusion single photon emission computed tomography. Eur J Nucl Med Mol Imaging 2009; 36: 1356-1370
  17. Le Roux P, Robin P, Salaun P. New developments and future challenges of nuclear medicine and molecular imaging for pulmonary embolism. Thromb Res: [Epub ahead of print]
  18. Lemb M and Pohlabeln H. Pulmonary thromboembolism: a retrospective study on the examination of 991 patients by ventilation/perfusion SPECT using Technegas. Nuklearmedizin 2001; 40(6): 179-186
  19. Freeman LM, Glaser J and Haramati LB. Planar ventilation-perfusion imaging for pulmonary embolism: the case for outcomes medicine. Semin Nucl Med 2012; 42: 3-10

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Ultralute

Pending market authorisation – not yet available for use

Ultralute is a revolutionary innovation that allows Nuclear Medicine departments to increase the productivity of their Tc-99m generator. It does this by allowing you to elute any amount of activity in approximately 1.5ml. By increasing the concentration of Tc-99m from an elution, the decay profile and the growth of Tc-99m from a Mo-99m/Tc 99m generator can be better utilised.

 

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