Case Author(s): J. Wallis, M.D. , . Rating: #D2, #Q3

Diagnosis: Improper energy window during acquisition

Brief history:

Evaluate for myocardial ischemia


Planar 35 degree LAO, Anterior, and 70 LAO images of the chest are shown, with the stress images at the top and the rest (reinjection) images below.

What is wrong with this study ?

View main image(mi) in a separate image viewer

Full history/Diagnosis is available below

Diagnosis: Improper energy window during acquisition


The initial (stress) images are blurred and uninterpretable.


The patient was studied using a two-injection same-day Tc-99m Sestamibi protocal. Prior to the stress data set, the previous patient had been imaged using Tl-201, and the camera energy window had not been reset. The resulting blurred images contain mainly scattered photons.

Major teaching point(s):

In clinical employing multiple tracers for cardiac imaging, extra care needs to be taken to ensure proper camera settings.

Inspection of the acquired stress data prior to reinjection would have allowed the stress images to be re-acquired, thereby salvaging the study.

ACR Codes and Keywords:

References and General Discussion of Myocardial Imaging (Anatomic field:Heart and Great Vessels, Category:Other(Artifact))

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Case number: mi003

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