Myocardial Perfusion Scintigraphy PDF

Preface

Over the past 15 years, the nuclear cardiology service in Leeds has moved from a small dedicated cardiac surgery hospital to a large tertiary referral teaching centre and has grown in size from a one-camera facility into one with three cameras working full time on cardiac imaging. There have been parallel changes in staffing and working practices, to the extent that the imaging process is now almost doctor-free, with radiographers and imaging technicians stressing the patients as well as scanning them, in addition to vetting the requests and determining the protocols to be used. Medical physicists play a vital role in processing the studies, and are also present during reporting sessions, and the reporting itself is carried out by radiologists and a cardiologist. During this protracted period of change, we have learned a lot of lessons, and we thought that a book outlining our approach might be useful. For reasons outlined in the introduction and subsequent chapters, there is reason to expect that more departments will be setting up nuclear cardiology services in the UK, and although we work in a large tertiary referral centre, our reliance on the extended role of radiographers and imaging technicians is likely to be just as relevant for smaller units, if not more so.

Chapters 2 to 5 cover the logistics of service provision and will be of particular interest to radiographers and imaging technicians, although it is important for all members of the team to have an understanding of the principles involved. Chapter 6, covering the essentials of image processing, is required reading for those reporting the images as well as for the person doing the processing, and while chapter 7 does not pretend to teach the reader how to report, it does highlight important points of principle, and potential pitfalls. We also say something about the philosophy involved in producing a useful report, a topic that is not always covered in textbooks or, dare we say it, in radiology and cardiology training schemes. Chapter 8 gives the perspective of a reporting cardiologist, and therefore offers useful advice for both referrers and reporters, emphasising the need to engage with clinicians when setting up a service and ensuring that it meets clinical needs.

It is a truism that the provision of medical care is a team game, and that is certainly the case for nuclear cardiology. It is possible to run an imaging service in a vacuum, where the only contact points between referrers and service providers are the written referral and report, but this is not a professionally rewarding way to work, and results in sub-optimal patient care. Attempting to set up a nuclear cardiology facility without clinical engagement makes the job that much more difficult for those involved, and runs the risk of producing a service which fails to realise the undoubted benefits in patient outcome and cost-effectiveness which result from the appropriate use of myocardial perfusion scintigraphy. We hope that this book will help enthusuasts to build a team and set up a useful service with the minimum of pain.