**Northern Lincolnshire and Goole NHS Foundation Trust - Nuclear Medicine** 

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^  Authorised By  ^  Authorising Role  ^  Authorisation Signature \\  (only on master paper copy)  ^  Date Authorised  |
|   Dr M Balerdi          | ARSAC Licence Holder     |                                                           |  2024-11-26        |

====== REF010 - Myocardial Perfusion Imaging Referral Criteria ======

See [[referral_criteria:ref000-how_to_refer_to_nlagnm|REF000 - Referring to Nuclear Medicine (NLAG)]]

===== Description =====
Myocardial perfusion scintigraphy is a non-invasive technique to evaluate myocardial perfusion and ventricular function. It is used to detect functional abnormalities of the coronary arteries, myocardial scar, and ventricular function; and to stratify cardiac risk. A radioactive tracer is administered intravenously, usually during exercise which can be dynamic (treadmill) or pharmacological. The distribution of the tracer within the myocardium is imaged using a gamma camera, the degree of uptake of tracer representing a combination of myocardial viability and perfusion. Further images after a resting injection of tracer are usually obtained to distinguish between defects caused by scan and inducible perfusion defects.  



[[sqlite:unused:unused:unused:/home/heynmorg/public_html/wikifarm/nlag/data/meta/arsac/database2019.db|SELECT fullname AS "ARSAC Licence Holders", chemicalform AS "Radiopharmaceutical" FROM practitionerlicences INNER JOIN practitioners,procedurecodes,praclicproc,nuclides,chemicalforms ON practitionerlicences.practitioner=practitioners.id AND praclicproc.plicid=practitionerlicences.id AND praclicproc.procid=procedurecodes.id AND procedurecodes.nuclide_id=nuclides.id AND procedurecodes.chemicalform_id=chemicalforms.id AND practitionerlicences.certificateactive='Y' WHERE procedure_code='99mTc-156-83' OR procedure_code='201Tl-157-83'  AND date('now')<=expirydate  ORDER BY expirydate|0]]


^                              ^ Radiopharmaceutical  |
^Typical Radiation Dose (mSv)  |   3-17   |  

===== Staff Entitled to Refer =====
  * Consultant cardiologists and renal physicians for those patients as part of renal transplant assessment. 
  * Vascular surgeons for MPI prior to AAA or major bypass surgery.
  * Other secondary care clinicians may refer if the test has been recommended by one of the above.

Referrals for patients with congenital abnormalities of the cardiovascular system or patients who are 40 years old or under must be authorised by an ARSAC Licence Holder only. Referrers are encouraged to discuss such cases directly with the ARSAC licence holder before submitting a referral.


===== Supplementary Drugs =====
Sodium chloride for parenteral use (0.9% w/v).

Regadenoson, Adenosine, Dobutamine, GTN.  

In addition we may administer any pharmaceutical considered necessary to mitigate the effects of the agents listed above 

===== Contraindications =====
Pregnancy


===== Clinical Indications =====

|Detecting the presence, location, and extent of ischaemic coronary artery disease[([[https://www.acr.org/-/media/ACR/Files/Practice-Parameters/CardiacScint.pdf|ACR–NASCI–SNMMI–SPR–STR Practice Parameter For The Performance of Cardiac Scintigraphy (Amended 2023)]])]  |
|As part of the investigational strategy in the management of established coronary artery disease in people who remain symptomatic following myocardial infarction or reperfusion interventions [([[https://www.nice.org.uk/guidance/ta73|Myocardial perfusion scintigraphy for the diagnosis and management of angina and myocardial infarction. Technology appraisal guidance Reference number:TA73]])]  |
|Evaluating the functional significance or sequelae of coronary artery stenosis[(#1)]  |
|To determine the likelihood of future events for patients with known coronary artery disease  |
|To guide myocardial revascularisation by determining the haemodynamic significance of coronary lesions  |
|Monitoring the effects of treatment of coronary artery disease, including revascularisation and medical therapy[(#1)]  |
|Detecting myocardial infarction [(#1)]  |
|Evaluating the viability of dysfunctional myocardium (hibernating myocardium)[(#1)]  |
|Stratifying the risk assessment of acute coronary syndromes, including preoperative risk[(#1)]  |
|Stratifying the risk after myocardial infarction[(#1)]  |
|Assessment of the haemodynamic significance of known or suspected anomalous arteries and muscle bridging   |
|Assessment of the haemodynamic significance of coronary artery disease in Kawasaki’s syndrome/other anatomical and functional abnormalities   |
|Assessment of the presence, extent and severity of endothelial dysfunction   |