Trabajo Practico: Ingles

PHYSICAL SPACE

• Imaging Rooms

Imaging rooms should be spacious enough to accommodate gamma camera systems.

• Stress Rooms—Stress rooms must be close to the imaging rooms. In this place the patien will walk on a treadmill or cycle.

• Injection Room—The injection room is useful for the administration of radiopharmaceuticals when the patient is at rest.

• Patient Preparation Area—This area is an option, but will facilitate the flow of patients.

• Reception/Waiting Rooms and Toilet Facilities—In these palces the patient will wait.

• Radiopharmacy—This area is a necessity whether one plans for a fully operational “hot lab,” or merely for the storage of “unit doses.”

• Reading/Interpretation Area—A separate and quiet area for interpretation of studies is optimal.

Storage Area—To store supplies, patient files, and digital image data.

• Staff Area—Areas for storage of personal items and for lunch breaks.

• Office Space—Offices for medical and technical directors.

Stress Procedures

One of the simplest methods to assess the heart’s ability to supply blood to the myocardium is the cardiac stress test. This test frequently referred to as the “treadmill test,” as walking on treadmill is a common way to stimulate the heart. In situations where the patient’s heart is suspected to be weakened or damaged, performing physical exercise may be too stressful, possibly leading to death. In these cases the patient will have their heart "exercised" by the injection of chemicals that will make the heart beat faster without requiring physical exercise.

The blood vessels supplying the heart may get obstructed due to the accumulation of plaque or blocked when a clot or vulnerable plaque breaks free and lodges itself in the vessel. One can assess the presence and/or severity of such blood flow restrictions by observing a patient's vital signs as the heart is made to work more heavily. This will require more blood to flow to the myocardium. Under normal conditions, the heart will beat faster and stronger to meet the body's needs. However, if the heart muscle is not receiving enough oxygenated blood due to an obstruction or blockage, vital signs will not go up as expected and the patient may feel some discomfort or chest pain.

The cardiac stress test provides an understanding of the heart’s overall condition. Nuclear imaging enables doctors to determine the specific parts of the heart which are damaged.

In the Nuclear Stress Test, the patient’s heart is exercised similarly to how it is during the treadmill test. The radiation is injected at the peak of the stress period when blood is flowing the most rapidly through all the heart (except for in the parts that are blocked). Several minutes after the injection the regions which are not receiving blood will have observably less radiation than the healthy regions making it possible to locate arterial obstructions from images of the radiation (1) (23).

PHARMACOLOGICAL VASODILATION STRESS

Exercise stress is always the preferred stress modality for evaluating patients with known or suspected coronary artery disease. Pharmacological stress is indicated in patients who are unable to perform adequate physical stress due to:

• Musculoskeletal and neurologic conditions

• Peripheral vascular disease

• Pulmonary disease

• Left bundle branch block or paced rhythm

• Treatment with medications that blunt heart rate response (beta blockers, calcium channel blockers)

• Recent acute myocardial infarction

DIPYRIDAMOLE

Patients with chronic obstructive pulmonary disease without bronchospasm usually tolerate infusion of dypiridamole well. If active wheezing is present, the test should be switched to dobutamine infusion. One should be prepared for the development of high-degree AV-block. Patients with baseline first degree AV-block are at higher risk. In the latter patients one may consider switching to adenosine or dobutamine.

PHARMACOLOGIC ADRENERGIC STRESS

Pharmacological adrenergic stress is indicated in patients who cannot undergo physical exercise stress and have contraindications to pharmacological vasodilator stress.

Dobutamine

In general, the patient population that requires dobutamine stress is a more selected and sicker population. It is important that the patient is warned about possible side effects of dobutamine infusion. The increase in heart rate and palpitations are often experienced as unpleasant.

Traduccion:

Espacio Físico

-Salas de imágenes

Las salas de imágenes debe ser lo suficientemente amplio para acomodar a los sistemas de cámara gamma.

-Salas de estrés

Las salas de estrés deben estar cerca de las salas de imágenes. En este lugar el paciente va a caminar en una cinta o en bicicleta.

-Sala de inyección

La sala de inyección es útil para la administración de radiofármacos cuando el paciente está en reposo.

-Área de preparación del paciente

Esta área es una opción, pero facilitará el flujo de los pacientes.

- Recepción/ Sala de espera y baños

En estos lugares el paciente va a esperar.

- Radiofarmacia

Esta área es una necesidad, un plan para un pleno funcionamiento “laboratorio caliente” o simplemente para el almacenamiento de “dosis unitarias”.

- Área de Interpretación/ Lectura

Un área separada y tranquila es óptima para la interpretación de los estudios.

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