Importance of Methodology on 99mTechnetium Dimercapto-Succinic Acid Scintigraphic Image Quality

Imaging Pilot Study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) Multicenter Investigation

Harvey Ziessman, Massoud Majd

Research output: Contribution to journalArticle

Abstract

Purpose: We reviewed our experience with 99mtechnetium dimercapto-succinic acid scintigraphy obtained during an imaging pilot study for a multicenter investigation (Randomized Intervention for Children With Vesicoureteral Reflux) of the effectiveness of daily antimicrobial prophylaxis for preventing recurrent urinary tract infection and renal scarring. We analyzed imaging methodology and its relation to diagnostic image quality. Materials and Methods: 99mTechnetium dimercapto-succinic acid imaging guidelines were provided to participating sites. High-resolution planar imaging with parallel hole or pinhole collimation was required. Two core reviewers evaluated all submitted images. Analysis included appropriate views, presence or lack of patient motion, adequate magnification, sufficient counts and diagnostic image quality. Inter-reader agreement was evaluated. Results: We evaluated 70, 99mtechnetium dimercapto-succinic acid studies from 14 institutions. Variability was noted in methodology and image quality. Correlation (r value) between dose administered and patient age was 0.780. For parallel hole collimator imaging good correlation was noted between activity administered and counts (r = 0.800). For pinhole imaging the correlation was poor (r = 0.110). A total of 10 studies (17%) were rejected for quality issues of motion, kidney overlap, inadequate magnification, inadequate counts and poor quality images. The submitting institution was informed and provided with recommendations for improving quality, and resubmission of another study was required. Only 4 studies (6%) were judged differently by the 2 reviewers, and the differences were minor. Conclusions: Methodology and image quality for 99mtechnetium dimercapto-succinic acid scintigraphy varied more than expected between institutions. The most common reason for poor image quality was inadequate count acquisition with insufficient attention to the tradeoff between administered dose, length of image acquisition, start time of imaging and resulting image quality. Inter-observer core reader agreement was high. The pilot study ensured good diagnostic quality standardized images for the Randomized Intervention for Children With Vesicoureteral Reflux investigation.

Original languageEnglish (US)
Pages (from-to)272-279
Number of pages8
JournalJournal of Urology
Volume182
Issue number1
DOIs
StatePublished - Jul 2009

Fingerprint

Vesico-Ureteral Reflux
Succinic Acid
Radionuclide Imaging
Kidney
Urinary Tract Infections
Cicatrix
Guidelines

Keywords

  • antibiotic prophylaxis
  • technetium Tc dimercaptosuccinic acid
  • urinary tract infection
  • vesico-ureteral reflux

ASJC Scopus subject areas

  • Urology

Cite this

@article{579c295fdb5b497eb6dbcb2cac329192,
title = "Importance of Methodology on 99mTechnetium Dimercapto-Succinic Acid Scintigraphic Image Quality: Imaging Pilot Study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) Multicenter Investigation",
abstract = "Purpose: We reviewed our experience with 99mtechnetium dimercapto-succinic acid scintigraphy obtained during an imaging pilot study for a multicenter investigation (Randomized Intervention for Children With Vesicoureteral Reflux) of the effectiveness of daily antimicrobial prophylaxis for preventing recurrent urinary tract infection and renal scarring. We analyzed imaging methodology and its relation to diagnostic image quality. Materials and Methods: 99mTechnetium dimercapto-succinic acid imaging guidelines were provided to participating sites. High-resolution planar imaging with parallel hole or pinhole collimation was required. Two core reviewers evaluated all submitted images. Analysis included appropriate views, presence or lack of patient motion, adequate magnification, sufficient counts and diagnostic image quality. Inter-reader agreement was evaluated. Results: We evaluated 70, 99mtechnetium dimercapto-succinic acid studies from 14 institutions. Variability was noted in methodology and image quality. Correlation (r value) between dose administered and patient age was 0.780. For parallel hole collimator imaging good correlation was noted between activity administered and counts (r = 0.800). For pinhole imaging the correlation was poor (r = 0.110). A total of 10 studies (17{\%}) were rejected for quality issues of motion, kidney overlap, inadequate magnification, inadequate counts and poor quality images. The submitting institution was informed and provided with recommendations for improving quality, and resubmission of another study was required. Only 4 studies (6{\%}) were judged differently by the 2 reviewers, and the differences were minor. Conclusions: Methodology and image quality for 99mtechnetium dimercapto-succinic acid scintigraphy varied more than expected between institutions. The most common reason for poor image quality was inadequate count acquisition with insufficient attention to the tradeoff between administered dose, length of image acquisition, start time of imaging and resulting image quality. Inter-observer core reader agreement was high. The pilot study ensured good diagnostic quality standardized images for the Randomized Intervention for Children With Vesicoureteral Reflux investigation.",
keywords = "antibiotic prophylaxis, technetium Tc dimercaptosuccinic acid, urinary tract infection, vesico-ureteral reflux",
author = "Harvey Ziessman and Massoud Majd",
year = "2009",
month = "7",
doi = "10.1016/j.juro.2009.02.144",
language = "English (US)",
volume = "182",
pages = "272--279",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "1",

}

TY - JOUR

T1 - Importance of Methodology on 99mTechnetium Dimercapto-Succinic Acid Scintigraphic Image Quality

T2 - Imaging Pilot Study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) Multicenter Investigation

AU - Ziessman, Harvey

AU - Majd, Massoud

PY - 2009/7

Y1 - 2009/7

N2 - Purpose: We reviewed our experience with 99mtechnetium dimercapto-succinic acid scintigraphy obtained during an imaging pilot study for a multicenter investigation (Randomized Intervention for Children With Vesicoureteral Reflux) of the effectiveness of daily antimicrobial prophylaxis for preventing recurrent urinary tract infection and renal scarring. We analyzed imaging methodology and its relation to diagnostic image quality. Materials and Methods: 99mTechnetium dimercapto-succinic acid imaging guidelines were provided to participating sites. High-resolution planar imaging with parallel hole or pinhole collimation was required. Two core reviewers evaluated all submitted images. Analysis included appropriate views, presence or lack of patient motion, adequate magnification, sufficient counts and diagnostic image quality. Inter-reader agreement was evaluated. Results: We evaluated 70, 99mtechnetium dimercapto-succinic acid studies from 14 institutions. Variability was noted in methodology and image quality. Correlation (r value) between dose administered and patient age was 0.780. For parallel hole collimator imaging good correlation was noted between activity administered and counts (r = 0.800). For pinhole imaging the correlation was poor (r = 0.110). A total of 10 studies (17%) were rejected for quality issues of motion, kidney overlap, inadequate magnification, inadequate counts and poor quality images. The submitting institution was informed and provided with recommendations for improving quality, and resubmission of another study was required. Only 4 studies (6%) were judged differently by the 2 reviewers, and the differences were minor. Conclusions: Methodology and image quality for 99mtechnetium dimercapto-succinic acid scintigraphy varied more than expected between institutions. The most common reason for poor image quality was inadequate count acquisition with insufficient attention to the tradeoff between administered dose, length of image acquisition, start time of imaging and resulting image quality. Inter-observer core reader agreement was high. The pilot study ensured good diagnostic quality standardized images for the Randomized Intervention for Children With Vesicoureteral Reflux investigation.

AB - Purpose: We reviewed our experience with 99mtechnetium dimercapto-succinic acid scintigraphy obtained during an imaging pilot study for a multicenter investigation (Randomized Intervention for Children With Vesicoureteral Reflux) of the effectiveness of daily antimicrobial prophylaxis for preventing recurrent urinary tract infection and renal scarring. We analyzed imaging methodology and its relation to diagnostic image quality. Materials and Methods: 99mTechnetium dimercapto-succinic acid imaging guidelines were provided to participating sites. High-resolution planar imaging with parallel hole or pinhole collimation was required. Two core reviewers evaluated all submitted images. Analysis included appropriate views, presence or lack of patient motion, adequate magnification, sufficient counts and diagnostic image quality. Inter-reader agreement was evaluated. Results: We evaluated 70, 99mtechnetium dimercapto-succinic acid studies from 14 institutions. Variability was noted in methodology and image quality. Correlation (r value) between dose administered and patient age was 0.780. For parallel hole collimator imaging good correlation was noted between activity administered and counts (r = 0.800). For pinhole imaging the correlation was poor (r = 0.110). A total of 10 studies (17%) were rejected for quality issues of motion, kidney overlap, inadequate magnification, inadequate counts and poor quality images. The submitting institution was informed and provided with recommendations for improving quality, and resubmission of another study was required. Only 4 studies (6%) were judged differently by the 2 reviewers, and the differences were minor. Conclusions: Methodology and image quality for 99mtechnetium dimercapto-succinic acid scintigraphy varied more than expected between institutions. The most common reason for poor image quality was inadequate count acquisition with insufficient attention to the tradeoff between administered dose, length of image acquisition, start time of imaging and resulting image quality. Inter-observer core reader agreement was high. The pilot study ensured good diagnostic quality standardized images for the Randomized Intervention for Children With Vesicoureteral Reflux investigation.

KW - antibiotic prophylaxis

KW - technetium Tc dimercaptosuccinic acid

KW - urinary tract infection

KW - vesico-ureteral reflux

UR - http://www.scopus.com/inward/record.url?scp=67349102699&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=67349102699&partnerID=8YFLogxK

U2 - 10.1016/j.juro.2009.02.144

DO - 10.1016/j.juro.2009.02.144

M3 - Article

VL - 182

SP - 272

EP - 279

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 1

ER -