78430 Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed to

Name of the Procedure:

Myocardial Imaging, Positron Emission Tomography (PET), Perfusion Study (including ventricular wall motion(s) and/or ejection fraction(s), when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography (CT).

Summary

This procedure involves using a PET scan to create detailed images of the heart's blood flow and function. It can be performed while the patient is at rest or during stress (induced by exercise or medication). A CT scan is also done simultaneously to provide more comprehensive information about the heart's structure.

Purpose

The procedure helps diagnose and evaluate the severity of coronary artery disease and other heart conditions by assessing blood flow to the heart muscle. The images can show areas of reduced blood flow and help determine the heart’s ejection fraction, which indicates how well the heart is pumping.

Indications

• Chest pain or discomfort suggesting coronary artery disease.
• Evaluation of myocardial viability in patients with known heart conditions.
• Assessment of the effectiveness of therapies like coronary artery bypass grafting or angioplasty.
• Patients with unexplained shortness of breath or abnormal stress tests.

Preparation

• Fasting for at least 4-6 hours before the procedure.
• Patients may need to avoid caffeine and certain medications for a specified time before the test.
• Inform the doctor of any allergies, especially to contrast material, and any existing medical conditions.

Procedure Description

1. Patient Preparation: Insert an IV line for the radiotracer injection. The patient will be positioned on a scanning table.
2. Radiotracer Injection: Inject a small amount of radioactive material into the bloodstream.
3. Imaging at Rest: Initial images are taken while the patient is at rest.
4. Stress Induction: If needed, the patient will either exercise on a treadmill or be given a medication to simulate stress on the heart.
5. Imaging During Stress: Additional images are captured during this stress phase.
6. CT Scan: Concurrently, a CT scan is performed to provide detailed anatomical information.
7. Data Analysis: The scans are reviewed to evaluate blood flow, ventricular wall motion, and ejection fraction.

Duration

The entire procedure typically takes about 2 to 3 hours.

Setting

This procedure is performed in a hospital or specialized outpatient imaging center with PET/CT capabilities.

Personnel

• Nuclear medicine physician or cardiologist.
• Radiologic technologist.
• Nurse or medical assistant to supervise stress testing and manage IV access.

Risks and Complications

• Exposure to a small amount of radiation from the radiotracer.
• Allergic reaction to the contrast material used in the CT scan.
• Potential side effects from stress-inducing medication (e.g., nausea, headache).
• Rarely, complications related to the IV line (e.g., infection, bruising).

Benefits

• Detailed and accurate images of heart perfusion and function.
• Non-invasive with minimal discomfort.
• Provides critical information for diagnosing heart conditions and planning treatment.

Recovery

• Patients can usually return to normal activities immediately after the procedure.
• Drink plenty of fluids to help flush the radiotracer from the body.
• Follow-up appointments to discuss results and potential further treatment.

Alternatives

• Stress echocardiography: Uses ultrasound instead of radiation.
• Single-photon emission computed tomography (SPECT) scan: Another type of nuclear imaging test.
• MRI or CT angiography: Used for detailed images of heart and blood vessels.
• Pros and Cons: Each alternative has different levels of accuracy, risk, and availability.

Patient Experience

Patients may feel mild discomfort from the IV insertion. During stress induction, there may be shortness of breath or fatigue, similar to exercising. After the procedure, most people feel normal and can resume their usual activities. Pain management is typically unnecessary, as the procedure is generally well-tolerated.