title: Evaluating the development of a SPECT protocol in a Canadian epilepsy unit.
abstract: BACKGROUND
  Functional neuroimaging can address some challenges of seizure localization, and sometimes preclude the need for EEG recording using intracranial electrodes. Ictal Single Photon Emission Computed Tomography (SPECT) has developed into an important tool in the presurgical evaluation of patients with medically-intractable localization-related epilepsy. The purpose of the study was to determine whether the development of a programme using trained nurses to perform ictal injections enabled a more efficient delivery of radiopharmaceuticals and therefore a greater sensitivity and specificity of outcome.
  
  
  METHODS
  In our epilepsy unit, nursing staff inject 99mTc-HMPAO at bedside, during or at seizure onset. Brain SPECT is performed later on a gamma camera.
  
  
  RESULTS
  Since the implementation of the new protocol (February 2005), 57 scans have been performed: 22 ictal and 35 interictal. Latency of ictal injection was found to be 5-40 seconds (mean 19.7 sec, standard deviation (SD) 10.4). Only 20% of reconstituted radiopharmaceutical vials were not used. Contamination rate was nil. Sixty three percent of SPECT studies were concordant with standard presurgical evaluation.
  
  
  CONCLUSIONS
  The latency of injections and the percentage of unused vials indicated an efficient and effective protocol compared to the literature. Our results show that ictal SPECT can be a safe, noninvasive procedure performed on a routine basis in the epilepsy unit when appropriately trained support staff are incorporated into a structured multidisciplinary programme.
authors.affiliation: Epilepsy Programme, University of Western Ontario, London, ON, Canada.
authors.forename: J G
authors.initials: JG
authors.lastname: Burneo
authors.forename: W
authors.initials: W
authors.lastname: Vezina
authors.forename: J
authors.initials: J
authors.lastname: Romsa
authors.forename: B J
authors.initials: BJ
authors.lastname: Smith
authors.forename: R S
authors.initials: RS
authors.lastname: McLachlan
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging*; D001931:Brain Mapping / Q000295:instrumentation / Q000379:methods*; D002170:Canada; D004827:Epilepsy / Q000000981:diagnostic imaging*; D006801:Humans; D009741:Nursing Staff, Hospital; D019275:Radiopharmaceuticals; D012640:Seizures / Q000000981:diagnostic imaging*; D013192:Staff Development; D019690:Technetium Tc 99m Exametazime; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods* / Q000451:nursing
chemical_list: D019275:Radiopharmaceuticals; D019690:Technetium Tc 99m Exametazime