Comparison of estimates of left ventricular ejection fraction obtained from gated blood pool imaging different software packages and cameras

摘要

Serial measurement of LVEF using gated blood pool (GBP) imaging is an established technique for monitoring LVEF in patients undergoing chemotherapy with cardiotoxic medication and in patients after heart transplants.1, The nuclear medicine department at Groote Schuur Hospital performs up to a thousand GBP studies annually. The majority of these studies are for patients receiving cardiotoxic chemotherapy and have a significant impact on patient management.In our hospital, the radiation oncologists consider not starting cardiotoxic chemotherapy if the LVEF is below 50% and terminating chemotherapy if there is a 10% decrease. In patients who have had heart transplants, the cardiologists start patients on glucocorticosteroids if a patient’s LVEF decreases by10%. It is therefore imperative that serial studies on an individual patient are comparable.Two software systems are used in our nuclear medicine department. The Siemens system (Siemens Medical Solutions, Chicago, USA) was introduced in February 2006 and the Hermes system (Hermes Medical Solutions, Stockholm Sweden) in September 2007. After the introduction of the Hermes system, we found large differences between the LVEFs calculated by the two systems. This was confirmed by a pilot study and is consistent with the literature that different software programs for processing equilibrium gated radionuclide studies cannot be used interchangeably.-The department also uses two different cameras, a General Electric (GE) Starcam 400 AC single-head and a Siemens Signature Series e.cam dual-head camera to acquire the raw data. These are then transferred to the Siemens and Hermes processing systems.This study was done to determine how the software packages used for processing GBP studies should be integrated into our department and if the use of different cameras for acquisition influences results. The study had two components. The first examined the values and reproducibility of estimates of LVEF from two software packages using data acquired on the GE gamma camera and processed independently by three operators. The second component examined the values and reproducibility of estimates of LVEF calculated with the same software packages using matched pairs of raw data acquired on both gamma cameras (GE and Siemens) processed by one operator.