PT - JOURNAL ARTICLE AU - Le Pennec, Romain AU - Schaefer, Wolfgang AU - Mark, Tulchinsky AU - LAMOUREUX, François AU - Roach, Paul AU - Rischpler, Christoph AU - Zukotynski, Katherine AU - Christopher O'Brien, Christopher AU - Murphy, Declan AU - PASCAL, Pierre AU - Le Gal, Gregoire AU - Salaün, Pierre-Yves AU - Le Roux, Pierre-Yves TI - <strong>Performance and interpretation of lung scintigraphy: an evaluation of current practices in Australia, Canada, France, Germany and USA.</strong> DP - 2024 Jun 01 TA - Journal of Nuclear Medicine PG - 241416--241416 VI - 65 IP - supplement 2 4099 - http://jnm.snmjournals.org/content/65/supplement_2/241416.short 4100 - http://jnm.snmjournals.org/content/65/supplement_2/241416.full SO - J Nucl Med2024 Jun 01; 65 AB - 241416 Introduction: Although lung ventilation/perfusion scintigraphy is a widely used imaging test, different options are possible for the performance and interpretation of the scan. Various radiopharmaceuticals can be used for ventilation, including radioactive inert gases (81mKrypton or 133Xenon) or 99mTechnetium-labeled aerosols (carbon nanoparticles or DTPA). These tracers have different physical and physiological properties and are not approved in all countries. Different protocols are also possible for image acquisition, including planar, SPECT or SPECT/CT. Furthermore, the reporting criteria used for interpretation of both planar and SPECT scans are variable and data are lacking regarding which criteria are commonly used in daily practice.The aim of this study was to assess current practices regarding the use and interpretation of lung scintigraphy in various clinical indications.Methods: An online survey comprising 25 questions was created using an internet-based tool. The questionnaire covered a range of topics, including general information (radiopharmaceuticals, organization), acquisition protocols and image interpretation in various clinical indications, including the diagnosis of acute pulmonary embolism (PE), the follow-up of PE and the screening for chronic thrombo-embolic pulmonary hypertension (CTEPH), the management for specific population such as pregnant women or Covid-19 patients, or pre-treatment regional lung function assessment (surgery, endobronchial valve, radiation treatment planning). In collaboration with the Australasian Association of Nuclear Medicine Specialists (AANMS), the Canadian Association of Nuclear Medicine (CANM), the French Society of Nuclear Medicine (SFMN), the German Society of Nuclear Medicine (GSNM), and American College of Nuclear Medicine (ACNM), the survey was distributed to their memberships through emails between 2022 and 2023. A single response per department was consolidated.Results: 419 responses were collected, including 32 (7.6%) from Australia, 58 (13.8%) from Canada, 149 (35.6%) from France, 92 (22.0%) from Germany and 88 (21.0%) from the USA, respectively. For the diagnosis of acute PE, 82.8% of centres reported using SPECT acquisitions (occasionally or routinely): 93.3% in Australia, 91.8% in Canada, 99.2% in France, 96.2% in Germany and 32.1% in the USA. Among them, SPECT images were combined with a CT scan in 70.5% of centres. 10.6% of centers reported not using ventilation for acute PE diagnosis. SPECT acquisition was used in 97.8% of centres using Tc-99m carbon particles, 97.1% Kr-81m gas, 58.7% Tc-99m DTPA, and 19.4% Xe-133 gas, respectively. For V/Q SPECT interpretation, a binary interpretation based on the EANM criteria (1 segmental or 2 subsegmental mismatched perfusion defects) was used in 65.0 % of departments. For V/Q planar interpretation, a binary interpretation based on the EANM criteria was used in 39.9% of centres and a probabilistic approach based on the PIOPED criteria in 36.6%, respectively. A very wide variety of practices was observed in pregnant women and in COVID-19 patients. SPECT acquisition was widely used in the follow up of PE and for the screening of CTEPH (&gt;90% of centres), with inconsistency regarding the interpretation of matched perfusion defects in this setting. Conclusions: This survey showed the strong adoption of SPECT acquisition in the various clinical indications of lung scintigraphy, except in the USA where planar imaging is still mostly used. There is a wide difference in the proportion of centres using SPECT according to the radiopharmaceutical used for ventilation. When SPECT images are performed, they are combined to a CT scan in a majority of cases. The survey also shows variability in interpretation criteria both for PE diagnosis and screening for CTEPH, highlighting the need for further standardizations of practices.