• Donohoe KJ, Frey KA, Gerbaudo VH, Mariani G, Nagel JS, Shulkin B. Procedure guideline for brain death scintigraphy, 1.0. Reston (VA): Society of Nuclear Medicine; 2003 Feb 25. 5 p. [10 references]

This is the current release of the guideline.

Brain death

Diagnosis

Nuclear Medicine
Radiology

Allied Health Personnel
Physicians

To assist nuclear medicine practitioners in recommending, performing, interpreting, and reporting the results of brain perfusion imaging to assist in confirming the diagnosis of brain death

Patients suspected of brain death

Cerebral perfusion scintigraphy

Not stated

Hand-searches of Published Literature (Primary Sources)
Hand-searches of Published Literature (Secondary Sources)
Searches of Electronic Databases

Literature searches were performed. In addition, references known to experts and references from the nuclear medicine community were considered.

Not stated

Not stated

Not applicable

Review

Not stated

Expert Consensus

Drafts of the guideline were submitted to members of the Guideline Development subcommittee (methodologists) and the Task Force (subject experts). These reviewers indicated on a line-by-line basis any suggestions or recommendations for the revision of the guideline. The percentage of agreement for all reviewers was calculated for each revision and compiled by the Society of Nuclear Medicine (SNM) central office. It is expected that the percentage of agreement will increase with each revision.

Not applicable

A formal cost analysis was not performed and published cost analyses were not reviewed.

Internal Peer Review

When the Task Force and Guideline Development Subcommittee completed their edits, draft procedure guidelines were distributed to the Society of Nuclear Medicine (SNM) Sample Review Group for comment. (The SNM Sample Review Group is a cross-section of approximately 100 nuclear medicine practitioners representing every field of specialization).

The guideline was approved February 25, 2003 by the SNM Commission on Health Care Policy, the Board of Directors, and the House of Delegates.

Background Information and Definitions

The diagnosis of brain death is a clinical diagnosis that is sometimes made with the help of cerebral perfusion scintigraphy. It is important that all physicians be knowledgeable in the clinical requirements for the diagnosis of brain death, especially the need to establish irreversible cessation of all function of the cerebrum and brain stem. Institutions performing scintigraphy for the evaluation of possible brain death should develop clinical guidelines and procedures for the clinical diagnosis that incorporate both clinical evaluations and the integration of ancillary tests such as perfusion scintigraphy.

Common Indications

1. Assess brain blood flow in patients suspected of brain death.

Procedure

The detailed procedure recommendations in the guideline address the following areas: patient preparation; information pertinent to performing the procedure (i.e., important data that the physician should have about the patient at the time the exam is performed and interpreted); precautions; information regarding the radiopharmaceutical (i.e., ranges of administered activity, organ receiving the largest radiation dose, effective dose); image acquisition; interventions; processing; interpretation/reporting; quality control; and sources of error.

None provided

The type of evidence supporting the recommendations is not specifically stated.

Appropriate use of cerebral perfusion scintigraphy to diagnose brain death

• If using brain-specific agents, quality control of labeling and stability of the compound is essential to prevent false-positive results. Poor radiopharmaceutical labeling or stability would result in minimal concentration of tracer in the brain. This could be falsely interpreted as lack of cerebral perfusion.
• Drainage of blood from the scalp into the superior sagittal sinus may cause a false-negative flow study.
• Hyperemic scalp structures may result in false-negative flow studies if non-specific brain agents are used.
• Infiltration of tracer at injection site may cause a false-positive study if the entire dose is infiltrated and not available to the vascular space. Absence of activity in the carotid vessels on flow images suggests complete infiltration of the dose.

• The Society of Nuclear Medicine has written and approved guidelines to promote the cost-effective use of high quality nuclear medicine procedures. These generic recommendations cannot be applied to all patients in all practice settings. The guidelines should not be deemed inclusive of all proper procedures or exclusive of other procedures reasonably directed to obtaining the same results. The spectrum of patients seen in a specialized practice setting may be quite different than the spectrum of patients seen in a more general practice setting. The appropriateness of a procedure will depend in part on the prevalence of disease in the patient population. In addition, the resources available to care for patients may vary greatly from one medical facility to another. For these reasons, guidelines cannot be rigidly applied.
• Advances in medicine occur at a rapid rate. The date of a guideline should always be considered in determining its current applicability.

An implementation strategy was not provided.

End of Life Care

Effectiveness

• Donohoe KJ, Frey KA, Gerbaudo VH, Mariani G, Nagel JS, Shulkin B. Procedure guideline for brain death scintigraphy, 1.0. Reston (VA): Society of Nuclear Medicine; 2003 Feb 25. 5 p. [10 references]

Not applicable: The guideline was not adapted from another source.

2003 Feb 25

Society of Nuclear Medicine, Inc - Medical Specialty Society

Society of Nuclear Medicine (SNM)

Task Force

Authors: Kevin J. Donohoe, MD (Beth Israel Deaconess Medical Center, Boston, MA); Kirk A. Frey, MD, PhD (University of Michigan Medical Center, Ann Arbor, MI); Victor H. Gerbaudo, PhD (Brigham and Women's Hospital, Boston, MA); Giuliano Mariani, MD (University of Pisa Medical School, Pisa, Italy); James S. Nagel, MD (Veterans Affairs Boston Healthcare System, West Roxbury, MA); and Barry Shulkin, MD (University of Michigan Medical Center, Ann Arbor, MI)

Not stated

This is the current release of the guideline.

None available

This NGC summary was completed by ECRI on April 15, 2005.

This NGC summary is based on the original guideline, which is subject to the guideline developer's copyright restrictions.