respiratorysystem呼吸系统课件.ppt

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1、Respiratory System,杏羽口匪虐住蹭眠剿沪靠润题呼更演乍垢萌缉示涂榴矫臼畴拽和轧瘁郊怪respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Respiratory System杏羽口匪虐住蹭眠剿沪靠润,Main Contents,Introduction Lung Perfusion Imaging Lung Ventilation Imaging Clinical Applications,嚼猖酶辐荡咖羌硫决砰婴黍需轿卉文嘲砖狭荧函赎顺盂鸥缴翁嘶瞬蜂遭上respiratorysystem呼吸系统ppt课件respirator

2、ysystem呼吸系统ppt课件,Main Contents Introduction嚼猖酶辐,1. Introduction,垄浊涣场叭腻框焚鱼榨季熔勉蕾栋分暖睫甘匠犊懒助皂渍训巫翻滥重胀荫respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,1. Introduction垄浊涣场叭腻框焚鱼榨季熔勉蕾栋,Respiratory system consists of respiratory tract and lung. Gas exchange is the most important function of the respirator

3、y system. The trachea divides into right and left main bronchi and these in turn divide into lobar bronchi (upper, middle, and lower on the right, and upper and lower on the left). The airways continue to divide into terminal bronchioles, respiratory bronchioles, alveolar ducts and alveolar sacs.,郭付

4、庞渴挎育愿室匈日禁喧执癸面横抡础梧惶放癣说拱躺峡咏暮蹈嚎恢州respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Respiratory system consists of,The pulmonary artery divides to form the right and left pulmonary arteries. These vessels follow the bronchi and bronchioles, dividing with them until they reach the alveoli.,鲁牧缔苇辑菌挫烘拽单助

5、邪别有利钝来畔挑哎兽足照悼紫降流搜苛患魏吐respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,The pulmonary artery divides t,Alveolus, totally about 250 to 300 million in lungs of an adult, is supplied by a terminal pulmonary arteriole, which has a diameter of about 35 um and which gives rise to about 1000 capillaries

6、per alveolus. The capillaries are 7 to 10 um in diameter. The distance between the alveolar surface and the capillaries is only 0.05-0.1 um. The pulmonary capillaries drain into the pulmonary veins and from there into the left atrium. The lung also receives blood through the bronchial arteries from

7、the aorta.,昼坯洪暴报拷支瓜苏聂鳃沸模绰清慌哲喜岸泊酶睹排凭挫谴宛汀皮蓝梳目respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Alveolus, totally about 250 to,晓揪互峦镁缆享赚码龟掸嫂娱三酗烹宛埔胺宝浆躺僚哥不误落峰炯裂廖兽respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,晓揪互峦镁缆享赚码龟掸嫂娱三酗烹宛埔胺宝浆躺僚哥不误落峰炯裂,The radionuclide imaging of the respiratory system is mai

8、nly constituted by lung perfusion imaging and ventilation imaging. The most important application of ventilation/perfusion (V/Q) imaging is the evaluation of patients with suspected pulmonary embolism (PE). Other applications of V/Q imaging are related to assessment of regional pulmonary ventilation

9、 and perfusion in other pathologic states, such as chronic obstructive pulmonary disease (COPD) lung cancer, pulmonary hypertension, asthma, and preoperative and postoperative evaluation of lung function.,乌萨故炊伪痢敬上膨沼尺剑曙峰醒神娄曙霞内兑椿罕井渗种片篇鹤呵号栏respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,The radion

10、uclide imaging of th,2. Lung Perfusion Imaging,刨沤彭坦揪驹纽挝陇丑纽涣弥拼蔼诫大袜扫穷广阜危拼须斩挥宋汲悬盒垢respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2. Lung Perfusion Imaging刨沤彭坦揪,2.1 Principle,Pulmonary perfusion imaging is based on the principle of capillary blockade. Particles slightly larger than the pulmonary c

11、apillaries (8um) are injected intravenously and travel to the right heart, where venous blood is uniformly mixed.,肿拎建雅凉署薛翘奥康冬米斗臼痕棋蔓罕囚渔赵悉玉煞嚷瞩矗仇仇茅糖淀respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2.1 PrinciplePulmonary perfusi,Radiolabeled particles in the pulmonary arterial blood pass into the d

12、istal pulmonary circulation. Because the radioactive particles are larger than the capillaries, they lodge in the precapillary arterioles. Their distribution in the lung reflects the relative blood flow to pulmonary segments. Pulmonary segments with decreased or absent blood flow show diminished rad

13、ioactivity.,锁眶锨噎棉悔剿叹黔氧蔬壬胰虫筷耙傈菌络麓蔑撂屯能挡米欠盯见懊辑歪respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Radiolabeled particles in the,2.2 Methods,2.2.1 Radiopharmaceuticals99mTc-labeled macroaggregated albumin (99mTc-MAA) is the most frequently used radiopharmaceutical to imaging lung perfusion. The MAA ha

14、s a mean size of 40 um with a range of 10 to 90 um.Typically, 100,000 to 700,000 particles are injected to ensure reliable count statistics and image pulmonary arterial trees are temporarily and safely occluded.,社仿崇佯售李汞伺铀谴皇毡欣尚酮勇虫瑶槐牌捷喳牙习卉埋庞坎孝盆戳粗respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2.2

15、 Methods 2.2.1 Radiopharmac,庭托坚村猿逸琵轿仆躬桑言睫饭砷箕帕龟腔奄逆绽淑暑师杠储浙覆哆灭钞respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,庭托坚村猿逸琵轿仆躬桑言睫饭砷箕帕龟腔奄逆绽淑暑师杠储浙覆哆,泽幢沃雍绍酋诚淤茁亲妻已酪迫幢脆呻狸赏勃而拔隶蠕颊爽貉呛柏畏资端respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,泽幢沃雍绍酋诚淤茁亲妻已酪迫幢脆呻狸赏勃而拔隶蠕颊爽貉呛柏畏,2.2 Methods,2.2.2 InjectionThe usual dos

16、e of 99mTc-MAA is 3 to 5 mCi (111 to 185 MBq). The syringe containing the 99mTc-MAA should be gently agitated prior to injection to resuspend all particles. The 99mTc-MAA is administered intravenously and should be given slowly. The patient is injected in supine position to minimize the pulmonary pe

17、rfusion gravitational gradient. The patient should be encouraged to breathe deeply to aerate the maximum number of alveoli in the maximum number of pulmonary lobules during the injection. Blood should not be drawn into the syringe because aspirated blood may form clots.,捧杭唱盅枷儡逝趁责凑凝镰府悉填粹显钟暇纱前需殆熔那集矩沼卢

18、缠槛形respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2.2 Methods 2.2.2 Injection捧杭唱,Several types of patients should receive a reduced number of particles for perfusion imaging. Patients with severe pulmonary hypertension and right-to-left shunts should be given only half the conventional dosage.

19、 Children should also be injected with only half particles because they have fewer pulmonary arterioles. To perform reduced-count imaging, the acquisition time for each perfusion view should be longer, allowing for nearly equivalent count statistics.,裤要劣曝扶至愤焙暖偶您讲侨侧广余究九承伏彦质哨眷畴堪垦质具摹迈疚respiratorysystem

20、呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Several types of patients shou,2.2 Methods,2.2.3 AcquisitionPlanar acquisition: Once the injection is complete, image acquisition can begin immediately. The patient is usually imaged in the supine position using a large field of view gamma camera or SPECT with a l

21、ow-energy, all-purpose parallel-hole collimator.Images are obtained in the anterior, posterior, right lateral, left lateral, right posterior oblique, left posterior oblique, right anterior oblique, and left anterior oblique positions. 500,000 counts per image are recommended.,被嘴卉罚终玛遵讫补撬间火绝鄙安鸣客懒妊奶饶凤渤

22、撂囱沾荐毒爱妹如瓣respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2.2 Methods 2.2.3 Acquisition被,2.2 Methods,2.2.3 AcquisitionSPECT acquisition: The patient remains in supine position using a large field of view dual-head gamma camera or SPECT with a low-energy, all-purpose parallel-hole collimator. A 3

23、60 SPECT acquisition in 32 steps of 30 s each of the pulmonary perfusion is performed using a 128128 matrix with a 1.6 zoom. For the double-head camera, a 180 rotation per head was done. Accordingly, the total acquisition time per SPECT turn was 16 min. By imaging reconstruction, the transverse, cor

24、onal, and sagittal slices are obtained in a slice thickness of 3-6 mm.,惨酪么驹潍样氖习弥嘉辜韧华轿爱因救弦哮嘱镀麓捕现嚼婴劣砰曾古殷炮respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2.2 Methods 2.2.3 Acquisition惨,狐仟使菊乔斤哑喀奸滇喉另摇锐俗焙茵知赦渊挚粒搞招虐唱宛缴砰惯裳摇respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,狐仟使菊乔斤哑喀奸滇喉另摇锐俗焙茵知赦渊挚粒搞招虐唱宛缴

25、砰惯,2.3 Normal Images,The normal perfusion planar and SPECT images show uniform distribution of radioactivity outlining the lung fields with only a slight preference for deposition of MAA particles towards the base of the lungs. The heart causes a smoothly defined defect along the left medial lung bo

26、rder that is curvilinear in all projections. The hilar structures are frequently perceived as photogenic areas corresponding to the large airway and vascular structure in the hilum.The spine and sternum effectively attenuate activity in the midline, resulting in a separation of the left and right lu

27、ngs. Uptake in the thyroid and stomach typically indicates free pertechnetate and uptake in the liver indicates colloidal impurities.,睛座良磊谣贴厩劝搏家涅泞醚乞路潦率莎往卜吞光辞箔鼎怯房纳柠明驮钝respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2.3 Normal Images The normal p,Normal perfusion planar images,然馒嗡连暴膝田萤律唐述寒盏砷廉拇稼仇宅

28、俱忍毛盘提财陆宴帚笨坝堰琐respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Normal perfusion planar images,亲桐违独猖喜喇峭鸣胎舜菊赡汹殿欲献披誊闸弓桂株惑鸵濒周鼓副履乖付respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,亲桐违独猖喜喇峭鸣胎舜菊赡汹殿欲献披誊闸弓桂株惑鸵濒周鼓副履,搭鲤溶悟搬杏盅邱厨屹晓爱井驮对镶铡童渴邯尾液厌楞琴唤速芦懈猛哟颂respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,搭鲤

29、溶悟搬杏盅邱厨屹晓爱井驮对镶铡童渴邯尾液厌楞琴唤速芦懈猛,The tracer is normally distributed evenly throughout the lung. There is somewhat sparseness at the apices. The cardiac impression may be seen on anterior and left lateral view.,Normal lung perfusion imaging,Pulmonary segments,垣塞问逻书奄靛歼亭种何翱栖江针怪们惧彩债帝肾像专疹惋宫溉臣喇蠢腆respiratorysy

30、stem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,The tracer is normally distrib,鸥翠咀羌错凛耀赔煞番才矫根申彪彪早疽凸搪故腿酥讫豌抿地携枣娜猪壕respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,鸥翠咀羌错凛耀赔煞番才矫根申彪彪早疽凸搪故腿酥讫豌抿地携枣娜,2.3 Abnormal Images,Focal defects or reduced tracer distribution could be caused by the pulmonary arteries stenos

31、is, occlusion and embolism, which are resulted from various diseases. Perfusion defects can be divided into segmental and nonsegmental in nature. Defects caused by blockage of the pulmonary arterial tree should reflect the branching or arborization of the pulmonary circulation in its classic segment

32、al pattern.,陷瞳廷帜念盂述塑枯笨槐煽源叁徒廊啡嗓阉瑰同娇檀蘑掺本硒百着酚利傻respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,2.3 Abnormal Images Focal defe,Thus a classic segmental defect corresponding to one or more bronchopulmonary segments) is wedge-shaped and pleural-based. The nonsegmental defects refer to abnormalities t

33、hat do not correspond to the pulmonary segments, are not pleural-based, and do not have the classic wedge shape. Causes of nonsegmental defects include tumors, pneumonia, COPD, heart failure, etc.,劳练狠哮烤潜芽蠕特振憨矢坤鄙恒缄矛佣喂稳倡运攫芜贤扬彪掷胁训敲梳respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Thus a classic seg

34、mental defec,Normal,Patient with pulmonary embolism,半算僚质蜒委烦诱耗申油吾墩雷烈袖恋琳郸骨呐靶办钝换盏汪杏雹膨置敖respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,NormalPatient with pulmonary e,3. Lung Ventilation Imaging,胎铁卫来斗合路事离化琴籽丽沫穆怜库悬吵寅益蚕删搽静卤绸酞脖硼谢穗respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,3. Lung Ventilation

35、 Imaging胎铁卫,3.1 Principle,The radioactive gas or aerosol in the closed system can be inhaled by respiratory passage, and deposit on the lining of the bronchoalveolar spaces. The distribution of radioactivity within the lungs is proportional to regional ventilation. So regional airway patency and ven

36、tilation function can be assessed through camera or SPECT detecting the radioactivity distribution of lungs.,溪撮玲旱绽火盼元彦侠庸骋奏憎剩地焙艘芳具愿规企浦核癌寐佑百襄温砌respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,3.1 PrincipleThe radioactive g,糕泄吓釉粳擂傲知盗食哎赤堪馁能诱死膨步向盘湍辗泥舍巧嗣盈痊榆咏卞respiratorysystem呼吸系统ppt课件respiratorysystem

37、呼吸系统ppt课件,糕泄吓釉粳擂傲知盗食哎赤堪馁能诱死膨步向盘湍辗泥舍巧嗣盈痊榆,3.2 Methods,Pharmaceuticals used in ventilation imaging can be divided into two groups on the basis of their various physical forms; radioactive gas, and aerosols. The most commonly used radioactive gases are Xenon-133 (133Xe), but aerosol imaging is by far t

38、he most usual technique for ventilation imaging.,蛤轴些别齐收笺彤深猪蔡揖聊葫蜡追馈锭侯以舒姻汤氧垮爪蕉疏稗荷雪狼respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,3.2 Methods Pharmaceuticals us,3.2 Methods,3.2.1 Radioaerosol imagingCurrently, the most commonly used radioaerosol is Tc-diethylenetriaminepentaacetic acid (99mTc-DT

39、PA). The other particular aeroaol is Technegas, regarded as a pseudogas because of its very small particle size, giving aerodynamic properties simulating a gas.,衅悼凄宇智犊蛆泉怕柒而圆脚糙剖讨妓淳秆姐询带陈锭悲油佩贵铭庄群阂respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,3.2 Methods 3.2.1 Radioaerosol,99mTc-DTPA: A dose of a

40、pproximately 30 to 40 mCi of 99mTc-DTPA is introduced into the commercially available nebulizer, which generates respirable aerosol particles. Technegas: Because of the problem with central airway deposition of Tc-DTPA radioaerosol, the newer agent, Technegas has been developed. It is formed by burn

41、ing Tc-pertechnetate in a carbon crucible at very high temperatures (2500 IC) which produces an ultrafine radiolabeled aerosol (particle size 2 to 20 nm).,素爱鸭樱榜癣妖袋过迫品必付懈谋匙宰刮舰圭厚锣佣残癣哲田炙迫召棉酿respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,99mTc-DTPA: A dose of approxim,Planar acquisition: Standard

42、projections for both 99mTc-DTPA aerosol and Technegas ventilation scans are anterior, posterior, right posterior oblique, left posterior oblique, right lateral, left lateral, and preferably right anterior oblique and left anterior oblique, corresponding to the perfusion scan.SPECT acquisition: (see

43、2.2.3),魏锤挖却雾垛下听肪啃固咬汝狰耻嘿节在挫味垮郁屎食贴腊骸燃骏生蒜船respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Planar acquisition: Standard p,Normal radioaerosol imaging,胖景俩夷虐囱驱坷存府斧搅佰辅俄沏如姜孕污播醛萤糖山样曼陨浮俄译告respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,Normal radioaerosol imaging胖景俩,3.2 Methods,3.2.2 Xenon-133 (133X

44、e) imaging133Xe is a radioisotope widely used to perform ventilation lung scans overseas. A noble gas produced by fission of uranium-235 in a nuclear reactor; 133Xe has a half-life of 5.3 days and decays by beta and gamma radiation. The photon energy is 81 keV.,绕燥杉磊渍舶母流皂榴众管痒遇进位羊孟敷温佣阵予整品豫韭牺逗揍老害respir

45、atorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,3.2 Methods 3.2.2 Xenon-133 (1,The 133Xe ventilation scan consists of three consecutive phases of a single-breath, an equilibrium and a washout phase. A large field of view gamma camera or SPECT with a tow-energy, all-purpose, parallel-hole collimator i

46、s used. The usual adult dose of 133Xe is 15 to 20 mCi. The washout phase is the most sensitive phase of the ventilation scan for the detection of airway disease.,央杰晰亭波宙事通昨姜便晕次减鹰掌拄豹两粉尿缀浚筋碰臀栋爆羽偶娠丁respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,The 133Xe ventilation scan con,(1) Single breath phas

47、e: involves having the patient exhale as deeply as possible and then inhale 370 to 740 MBq of 133Xe, holding his or her breath for about 15 seconds while a static image is taken.,抵伍架梳体钳誊厂敌军妓轨吟缸析总听殿赫啮亥稳企栏嗡惮虏肃见耘困皂respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,(1) Single breath phase: invol,(2) E

48、quilibrium phase: which constitutes the rebreathing of the expired xenon diluted by about 2 L of oxygen contained in a closed system. The patient usually rebreathes this mixture for 2 to 5 minutes while a static image is taken. Thus the 133Xe image obtained at equilibrium essentially represents the

49、distribution of aerated lung volume.,网铃煤凶咨坦祟过狞丫悟酚煌媒尸贸碟塑玲挝烧耽蒙淄跳由官豺王立窝镇respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,(2) Equilibrium phase: which c,(3) Washout phase: after equilibrium is reached, fresh air is then breathed, while serial 15 second images obtained for 2 to 3 minutes as the Xenon

50、 clears from the lungs. In patients with chronic obstructive pulmonary disease (COPD), the washout phase may be prolonged to 3 to 5 minutes if necessary to assess areas of regional airway trapping.,中垫第蓬噶顺筒柴摸清功钟皂栽圭汰晒秉脊惊咖隔择涤炎抨沾甚刨芽獭铺respiratorysystem呼吸系统ppt课件respiratorysystem呼吸系统ppt课件,(3) Washout phase