This nuclear medicine procedure evaluates whether a patient has enough viable lung tissue remaining after removal of cancerous tissue. It involves regional perfusion and ventilation tests using radioactive gases to measure function in each lung. Pulmonary function tests are also performed to determine if the patient can tolerate significant lung removal based on criteria like FEV1 and FVC values. A split lung scan using Tc-99m albumin aggregates may be ordered if criteria are not met to assess resection. DLCO measures gas exchange ability and is used to assess restrictive and obstructive lung diseases.
This nuclear medicine procedure evaluates whether a patient has enough viable lung tissue remaining after removal of cancerous tissue. It involves regional perfusion and ventilation tests using radioactive gases to measure function in each lung. Pulmonary function tests are also performed to determine if the patient can tolerate significant lung removal based on criteria like FEV1 and FVC values. A split lung scan using Tc-99m albumin aggregates may be ordered if criteria are not met to assess resection. DLCO measures gas exchange ability and is used to assess restrictive and obstructive lung diseases.
This nuclear medicine procedure evaluates whether a patient has enough viable lung tissue remaining after removal of cancerous tissue. It involves regional perfusion and ventilation tests using radioactive gases to measure function in each lung. Pulmonary function tests are also performed to determine if the patient can tolerate significant lung removal based on criteria like FEV1 and FVC values. A split lung scan using Tc-99m albumin aggregates may be ordered if criteria are not met to assess resection. DLCO measures gas exchange ability and is used to assess restrictive and obstructive lung diseases.
This nuclear medicine procedure evaluates whether a patient has enough viable lung tissue remaining after removal of cancerous tissue. It involves regional perfusion and ventilation tests using radioactive gases to measure function in each lung. Pulmonary function tests are also performed to determine if the patient can tolerate significant lung removal based on criteria like FEV1 and FVC values. A split lung scan using Tc-99m albumin aggregates may be ordered if criteria are not met to assess resection. DLCO measures gas exchange ability and is used to assess restrictive and obstructive lung diseases.
evaluate resectability of lung tissue on patients with lung carcinoma or lung transplant – The concern relates to whether or not there is enough viable lung tissue following the removal of cancerous lung tissue – The rationale to perform the thoracotomy is based on: • Resecting the tumor • Patient's ability to tolerate the surgical results • Regional Perfusion Test - Intravenous injection of insoluble radioactive xenon (133Xe). The peak radioactivity of each lung is proportional to the degree of perfusion of each lung. • Regional Ventilation Test - Using an inhaled, insoluble radioactive gas (Xenon, 99m-technetium), the peak radioactivity over each lung is proportional to the degree of ventilation. • Combining radiospirometry with whole-lung testing (FEV1, FVC, maximal breathing capacity) has resulted in a fair degree of correlation between predicted volumes and pulmonary function tests measured after pneumonectomy. • It should also be noted that a split lung procedure is very non-specific in finding lung cancer and it is unable to identify metastatic involvement • The study is combined with pulmonary lung function test – Forced expiratory volume in time (1 - 3 seconds) - FEV1 – Forced vital capacity (FVC) - volume of air forced out of lung – Study should be done when the patient is not on a bronchodilator • The patient can tolerate significant amount of lung removal if the pulmonary lung function test meets the following values: – FEV1 is greater than 50% of the FVC and the FVC is greater than 2 L – Maximum voluntary ventilation is greater than 50% of the predicted value – Ratio of residual volume to total lung capacity is less than 50% • Surgery is usually not performed if the FEV1is below 0.8 L • When the above criteria is/are not met, a split lung procedure using 99mTcMAA is usually ordered • The procedure is as follows: – Inject the patient with 4 mCi IV using 99mTcMAA – Camera setup • 256 x 256 • LEHR collimator • 500 to 750k counts per image • Take anterior and posterior images • Once the images are collected, ROIs are drawn over the R and L lungs DLCO • Diffusing capacity (also referred to as transfer factor) is usually measured using small concentrations of carbon monoxide (CO) and is referred to as DLCO or DCO. • DLCO is used to assess the gas-exchange ability of the lungs, specifically oxygenation of mixed venous blood. • The most commonly used method is the single- breath, or breath-hold technique. The single-breath method is also the most widely standardized. • DLCO measures the transfer of a diffusion- limited gas (CO) across the alveolocapillary membranes. • DLCO is reported in milliliters of CO/minute/millimeter of mercury at 0°C, 760 mm Hg • In the presence of normal amounts of Hb and normal ventilatory function, the primary limiting factor to diffusion of CO is the status of the alveolocapillary membranes. • This process of conductance across the membranes can be divided into two components: – Membrane conductance (Dm) Dm reflects the process of diffusion across the alveolocapillary membrane. – The chemical reaction between CO and Hb Uptake of CO by Hb depends on the reaction rate (θ) and the pulmonary capillary blood volume (Vc). • DLCO will be affected by – Changes in membrane component – Alterations in Hb – Capillary blood volume Decreases with • Restrictive Lung diseases • Asbestosis • Silicosis • Idiopathic pulmonary fibrosis • Sarcoidosis • Systemic lupus erythematosus • Inhalation of toxic gases (alveolitis) • Loss of lung tissue • Space occupying lesions (tumors) • Pulmonary edema • Lung resection • Radiation therapy (fibrotic changes) • Chemotherapy • DLco sometimes used to differentiate between emphysema and chronic bronchitis • In patients with COPD, DLco less than 50% of predicted indicate O2 desaturation during exercise • Low resting DLco (<50% - 60% of predicted) may indicate the need for assessment of oxygenation during exercise INDICATIONS OF DLCO