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Functional cardiac imaging using the first-pass technique is sometimes referred to as radionuclide angiography, whereby the initial passage of the radiopharmaceutical through the cardiac chambers is recorded.An advantage to the technique is that the tracer activity is limited to one chamber at a time, so it is easier to define regions of interest during processing, and background interference is thus minimized.The camera system chosen for the first-pass study must provide adequate temporal and spatial resolutions with acceptable counting statistics.The multicrystal camera is preferred over single crystal gamma cameras because they permit much higher count rates without significant dead-time losses (as high as 450,000 counts/sec).The procedure requires about 25-60 seconds for data acquisition.

The short acquisition time and relative lack of dependence on patient cooperation make it an ideal assessment of cardiac performance in: Resting exams may be performed with the patient in the supine or upright position.The ratio of tracer in the lung to tracer gaining access to the systemic circulation provides a measure of the severity of shunting.Right-to-left shunts are generally given as a relative contraindication to the use of macroaggregated albumin, owing to the theoretical risk of embolizing the capillary bed of the brain.RADIOPHARMACEUTICAL SELECTION The recommended dose for first-pass imaging using 99m Tc based radiopharmaceuticals is 10 to 30 m Ci per injection.Any Tc99m based radiopharmaceutical EXCEPT 99m Tc MAA may be used for a first-pass study, since all these agents remain in the intravascular space long enough to complete the acquisition.PATIENT PREPARATION Since the radiopharmaceutical will be administered using the bolus technique, it is recommended that an 18-20 gauge angiocath placed into an appropriate vein in the forearm.