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Standing prone positioning in establishing causality between matched ventilation-perfusion defects and pleural
Joseph S Fotos1, Mark Tulchinsky
1From the Section of Nuclear Medicine, Department of Radiology, Milton S. Hershey Medical Center, Penn State University, Hershey, PA.
Clinical Nuclear Medicine
|September 24, 2014
Summary
Ventilation-perfusion scintigraphy can be challenging with pleural effusions. A modified standing prone position imaging technique improves visualization of posterior lung fields in patients with pulmonary thromboembolism.
Area of Science:
- Radiology
- Nuclear Medicine
- Pulmonary Medicine
Background:
- Ventilation-perfusion (V/Q) scintigraphy is standard for diagnosing pulmonary thromboembolism.
- Pleural effusions frequently complicate V/Q scans, causing matched defects, particularly in posterior views of supine patients.
- Conventional prone positioning can redistribute pleural fluid but is not feasible for all patients.
Purpose of the Study:
- To describe a modified imaging technique for V/Q scintigraphy in patients with pleural effusions.
- To evaluate the efficacy of a standing prone position for overcoming limitations of supine imaging.
Main Methods:
- A modified prone positioning technique was developed for V/Q scintigraphy.
- Patients were imaged in a standing prone position to alter pleural fluid distribution.
- Image quality and diagnostic utility were assessed.
Main Results:
- The modified standing prone technique successfully redistributed pleural fluid anteriorly.
- This redistribution improved visualization of posterior lung fields.
- Excellent imaging results were achieved, facilitating diagnosis.
Conclusions:
- A standing prone position is an effective modification for V/Q scintigraphy in patients with pleural effusions.
- This technique offers a viable alternative when conventional prone positioning is contraindicated.
- Improved imaging enhances diagnostic accuracy for pulmonary thromboembolism in challenging cases.
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