---
title: "Operational Protocol for Radionuclide Imaging in Pulmonary Thromboembolism"
id: "pubmed-42811564"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42811564"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42811564/"
doi: "10.3760/cma.j.cn112147-20260602-00327"
published_at: "2026-10-12T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Operational Protocol for Radionuclide Imaging in Pulmonary Thromboembolism
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42811564
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42811564/)
- **DOI:** [10.3760/cma.j.cn112147-20260602-00327](https://doi.org/10.3760%2Fcma.j.cn112147-20260602-00327)
- **Published At:** 2026-10-12T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Radionuclide pulmonary ventilation/perfusion (V/Q) imaging is vital for diagnosing **pulmonary thromboembolism** (PTE). - Differences exist in V/Q imaging techniques among Chinese hospitals. - A consensus was formed to standardize **V/Q imaging** procedures and clinical application in PTE diagnosis. - **Recommendations** include using 99mTc-Technegas for ventilation imaging and proper oxygen supplementation during perfusion imaging. - Specific guidelines for **radiopharmaceutical** usage and monitoring during imaging were established. - Suggested protocols for imaging include considerations for pregnant patients and patients with allergies. - Emphasis on clear reporting of results to avoid ambiguity in diagnosing PTE. - Recommendations aim to improve diagnostic accuracy and streamline clinical protocols.
## Clinical Analysis & Structured Key Points
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Zhonghua Jie He He Hu Xi Za Zhi. 2026. Show details Display options Display options Format Abstract PubMed PMID Zhonghua Jie He He Hu Xi Za Zhi Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Zhonghua+Jie+He+He+Hu+Xi+Za+Zhi%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Zhonghua+Jie+He+He+Hu+Xi+Za+Zhi%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42811564/) . 2026 Oct 12;49(10):1072-1081. doi: 10.3760/cma.j.cn112147-20260602-00327. ### Authors [Chinese Thoracic Society, Chinese Medical Association](https://pubmed.ncbi.nlm.nih.gov/?term=Chinese+Thoracic+Society%2C+Chinese+Medical+Association%5BCorporate+Author%5D); [Chinese Association of Chest Physicians](https://pubmed.ncbi.nlm.nih.gov/?term=Chinese+Association+of+Chest+Physicians%5BCorporate+Author%5D); [National Collaborative Group for Prevention and Treatment of Pulmonary Embolism and Pulmonary Vascular Diseases](https://pubmed.ncbi.nlm.nih.gov/?term=National+Collaborative+Group+for+Prevention+and+Treatment+of+Pulmonary+Embolism+and+Pulmonary+Vascular+Diseases%5BCorporate+Author%5D); [Expert Committee, National Project of Standardized Diagnosis and Treatment of Pulmonary Hypertension](https://pubmed.ncbi.nlm.nih.gov/?term=Expert+Committee%2C+National+Project+of+Standardized+Diagnosis+and+Treatment+of+Pulmonary+Hypertension%5BCorporate+Author%5D); [Expert Committee of Pulmonary Embolism and Pulmonary Vascular Diseases, National Center for Respiratory Medicine](https://pubmed.ncbi.nlm.nih.gov/?term=Expert+Committee+of+Pulmonary+Embolism+and+Pulmonary+Vascular+Diseases%2C+National+Center+for+Respiratory+Medicine%5BCorporate+Author%5D); [Cardiopulmonary Vascular Group, Nuclear Medicine Branch, Beijing Medical Association](https://pubmed.ncbi.nlm.nih.gov/?term=Cardiopulmonary+Vascular+Group%2C+Nuclear+Medicine+Branch%2C+Beijing+Medical+Association%5BCorporate+Author%5D); [Nuclear Medicine Physicians Branch, Chinese Medical Doctor Association](https://pubmed.ncbi.nlm.nih.gov/?term=Nuclear+Medicine+Physicians+Branch%2C+Chinese+Medical+Doctor+Association%5BCorporate+Author%5D) * PMID: **42811564** * DOI: [ 10.3760/cma.j.cn112147-20260602-00327 ](https://doi.org/10.3760/cma.j.cn112147-20260602-00327) Item in Clipboard Full text links Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42811564/#eng-abstract) [ Chinese ](https://pubmed.ncbi.nlm.nih.gov/42811564/#zho-abstract) Radionuclide pulmonary ventilation/perfusion (V/Q) imaging is an important non-invasive tool for diagnosing pulmonary thromboembolism (PTE) and is used for screening, follow-up, and assessment of treatment response of PTE and chronic thromboembolic pulmonary hypertension (CTEPH). Currently, hospitals in China differ in their use of planar and tomographic acquisition methods for V/Q imaging, and interpretation requires a high level of expertise among nuclear medicine physicians. After surveying the nuclear medicine departments of multiple hospitals and holding expert discussions, the working group developed the _Expert consensus on the operational protocol for radionuclide pulmonary ventilation/perfusion scintigraphy of pulmonary thromboembolism._ This consensus covers examination procedures, diagnostic approaches, and precautions, with the aim of standardizing the clinical application of V/Q imaging procedures and their clinical application in PTE diagnosis. The following recommendations were formulated.**Summary of Recommendations****Recommendation 1:** For ventilation imaging, 99mTc-Technegas is recommended as the preferred radiopharmaceutical. During the preparation of Technegas, the working group recommends wetting the crucible with anhydrous ethanol before the addition of the sodium pertechnetate solution to improve the efficiency and quality of Technegas generation. If Technegas is unavailable, 99mTc-Diethylenetriaminepentaacetic acid (99mTc-DTPA) aerosol may be used as an alternative (Consensus level: 100%).**Recommendation 2:** Routine supplemental oxygen is suggested before pulmonary perfusion imaging to prevent false-positive images caused by pulmonary vasospasm. The recommended oxygen flow rate is 2-4 L/min, with an inhalation duration of 5-10 minutes (Consensus level: 83.3%).**Recommendation 3:** For pulmonary perfusion imaging, 200 000-700 000 radiopharmaceutical particles (mean, approximately 400 000) should be administered, with the recommended activity of 120-240 MBq (3-6 mCi). For patients with severe pulmonary hypertension, conditions with right-to-left heart shunting, or a history of single-lung transplantation, the particle number should be reduced to 100 000-200 000 (Consensus level: 83.3%).**Recommendation 4:** Gently agitate and homogenize the suspension of 99mTc-macroaggregated human serum albumin (99mTc-MAA) prior to injection. With the patient supine and breathing at normal tidal volume, slowly inject the tracer over several respiratory cycles through a patent intravenous line, continuously monitoring for adverse reactions; discontinue immediately if discomfort occurs. Strictly avoid backflow of blood into the syringe, which may cause particulate aggregation and bolus formation, leading to artifactual hot spots (Consensus level: 100%).**Recommendation 5:** For patients with protein allergies, a routine skin test is recommended before pulmonary perfusion imaging. Inject 0.1 ml of 99mTc-MAA suspension into the appropriate part of the forearm and observe for 15-20 minutes. If there is no positive reaction, perfusion imaging can be proceeded, with close observation and emergency medications on standby. If the skin test is positive, pulmonary perfusion imaging is not recommended. Routine skin testing is not indicated in patients without a history of allergy (Consensus level: 83.3%).**Recommendation 6:** For the 2-day acquisition protocol, perform pulmonary perfusion imaging on the first day. If the result is abnormal, perform pulmonary ventilation imaging the following day to aid diagnosis; if the perfusion imaging result is normal, pulmonary ventilation imaging may be omitted (Consensus level: 83.3%).**Recommendation 7:** For pregnant women with suspected PTE, if V/Q imaging is considered necessary after clinical assessment, a 2-day protocol is recommended. Dose reduction is recommended for lung perfusion imaging, the recommended dose of 99mTc-MAA is 50 MBq (1.35 mCi) (Consensus level: 100%).**Recommendation 8:** When the 1-day acquisition protocol is used, perfusion imaging may be performed immediately after completion of ventilation imaging. To ensure the clarity and accuracy of pulmonary perfusion imaging, the perfusion count rate should be 3-4 times the ventilation count rate (Consensus level: 100%).**Recommendation 9:** Avoid ambiguous phrasing such as "possible pulmonary embolism" in image reports. Interpretations should provide a definitive conclusion, such as "pulmonary embolism present", "pulmonary embolism absent", or another specific conclusion, after excluding other causes of impaired pulmonary perfusion (e.g., Takayasu arteritis, mediastinitis or pulmonary arterial sarcoma). When the diagnosis remains uncertain, the report should state, "pulmonary embolism cannot be excluded; correlation with clinical findings and other imaging examinations is recommended" to support subsequent clinical assessment and therapeutic decision-making (Consensus level: 100%).**Recommendation 10:** For patients with CTEPH, visual semi-quantitative analysis (Begic/Meyer score) may serve as an adjunctive tool for efficacy assessment after percutaneous pulmonary balloon angioplasty (BPA) or pulmonary endarterectomy (PEA). Where institutional resources permit, structured reporting is encouraged to improve the clarity and reproducibility of segmental impairment documentation (Consensus level: 100%). 放射性核素肺通气/灌注（V/Q）显像是无创诊断肺血栓栓塞症（PTE）的重要手段，用于 PTE 和慢性血栓栓塞性肺动脉高压（CTEPH）的筛查、随访及疗效评估。目前国内医院在V/Q 显像的平面和断层采集方式上存在差异，且该显像对核医学医生诊断水平要求较高。为此，工作组在多所医院核医学科进行调研并经专家研讨后，制订了《肺血栓栓塞症核素肺通气/灌注显像检查操作规程专家共识》，涵盖检查、诊断方法和注意事项等内容，以规范 V/Q 显像操作及其在 PTE的临床应用。. [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement 所有作者声明无利益冲突 ## Similar articles * [ [Standard technical specifications for methacholine chloride (Methacholine) bronchial challenge test (2023)]. ](https://pubmed.ncbi.nlm.nih.gov/38309959/) Pulmonary Function and Clinical Respiratory Physiology Committee of Chinese Association of Chest Physicians; Chinese Thoracic Society; Pulmonary Function Group of Respiratory Branch of Chinese Geriatric Society.Pulmonary Function and Clinical Respiratory Physiology Committee of Chinese Association of Chest Physicians, et al.Zhonghua Jie He He Hu Xi Za Zhi. 2024 Feb 12;47(2):101-119. doi: 10.3760/cma.j.cn112147-20231019-00247.Zhonghua Jie He He Hu Xi Za Zhi. 2024.PMID: 38309959Chinese. * [ Vesicoureteral Reflux. ](https://pubmed.ncbi.nlm.nih.gov/33085409/) Leslie SW, Aeddula NR.Leslie SW, et al.2024 Apr 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.2024 Apr 30. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.PMID: 33085409Free Books & Documents. * [ [Expert consensus on optimizing the multidisciplinary clinical pathways and management models for pulmonary function testing]. ](https://pubmed.ncbi.nlm.nih.gov/41912385/) Task Forces on Pulmonary Function Testing from Chinese Association of Chest Physicians (CACP); Chinese Thoracic Society (CTS); Chinese Geriatrics Society (CGS).Task Forces on Pulmonary Function Testing from Chinese Association of Chest Physicians (CACP), et al.Zhonghua Jie He He Hu Xi Za Zhi. 2026 Apr 12;49(4):385-395. doi: 10.3760/cma.j.cn112147-20251114-00713.Zhonghua Jie He He Hu Xi Za Zhi. 2026.PMID: 41912385Chinese. * [ [Guidelines for the diagnosis and treatment of obstructive sleep apnea in adults (2025)]. ](https://pubmed.ncbi.nlm.nih.gov/41820035/) Chinese Thoracic Society.Chinese Thoracic Society.Zhonghua Jie He He Hu Xi Za Zhi. 2026 Mar 12;49(3):264-296. doi: 10.3760/cma.j.cn112147-20251108-00694.Zhonghua Jie He He Hu Xi Za Zhi. 2026.PMID: 41820035Chinese. * [ Folic acid supplementation and malaria susceptibility and severity among people taking antifolate antimalarial drugs in endemic areas. ](https://pubmed.ncbi.nlm.nih.gov/36321557/) Crider K, Williams J, Qi YP, Gutman J, Yeung L, Mai C, Finkelstain J, Mehta S, Pons-Duran C, Menéndez C, Moraleda C, Rogers L, Daniels K, Green P.Crider K, et al.Cochrane Database Syst Rev. 2022 Feb 1;2(2022):CD014217. doi: 10.1002/14651858.CD014217.Cochrane Database Syst Rev. 2022.Update in: [Cochrane Database Sy
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