title: Importance of methodology on (99m)technetium dimercapto-succinic acid scintigraphic image quality: imaging pilot study for RIVUR (Randomized Intervention for Children With Vesicoureteral Reflux) multicenter investigation.
abstract: OBJECTIVE
  We reviewed our experience with (99m)technetium 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.
  
  
  METHODS
  (99m)Technetium 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, (99m)technetium 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 (99m)technetium 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.
authors.affiliation: Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Sciences, The Johns Hopkins University, Baltimore, Maryland 21287, USA. hziessm1@jhmi.edu
authors.forename: Harvey A
authors.initials: HA
authors.lastname: Ziessman
authors.forename: Massoud
authors.initials: M
authors.lastname: Majd
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007223:Infant; D007231:Infant, Newborn; D010865:Pilot Projects; D011786:Quality Control; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D012016:Reference Values; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D019783:Technetium Tc 99m Dimercaptosuccinic Acid; D018608:Ultrasonography, Doppler; D014552:Urinary Tract Infections / Q000000981:diagnostic imaging* / Q000209:etiology; D014718:Vesico-Ureteral Reflux / Q000150:complications / Q000000981:diagnostic imaging*; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D019783:Technetium Tc 99m Dimercaptosuccinic Acid