Validity of medium-energy collimator for sentinel lymphoscintigraphy imaging

For lymphoscintigraphy to detect sentinel lymph node (SLN) in the breast cancer, the lead shielding of the injection site is often used to avoid artifacts, but the method tends to cover the neighborhood SLN. To exclude this defect, authors developed ME (medium-energy) method where ME collimator and energy setting shifted to its higher region were employed. This paper described the development and validity evaluation of the ME method. Performed were examinations with 3 acrylic phantoms of the injection site (IS), LN and combination of IS+LN (CB): IS was a cylinder, containing 40 MBq of 99mTc-pertechnetate and LN, a plate with 30 sealed holes having 0.78-400 kBq. CB phantom consisted from LN-simulating holes (each, 40 kBq) placed linearly around the center of IS in H and S directions. Imaging was conducted with 2 kinds of 2-detector gamma camera, FORTE (ADAGA) and DSX rectangular (Sopha Medical Corp.). CB phantom was found optimally visualized by ME collimator at 146, rather than 141, keV. In clinic, 99mTc-Sn-colloid 40 MBq was given near the tumor of a patient and imaging was done with or without the lead shield with FORTE equipped with low energy high-resolution or ME collimator for their comparison. The present ME method described above set at 146 keV was found to give the image with excellent contrast and without false positive when compared with the lead shield method hitherto. (R.T.)