Objective: Procedure guidelines suggest that optimal (99m)Tc-dimercaptosuccinic acid (DMSA) planar scintigraphy of the kidney should include right and left posterior oblique views in addition to the posterior projection. However, in a small number of restless children, it is sometimes difficult to get 3 good-quality images. The aim of this study was to evaluate the prevalence of cases in which posterior oblique views were useful for interpreting (99m)Tc-DMSA renal scintigraphy.
Methods: Three nuclear medicine specialists were asked to interpret 40 (99m)Tc-DMSA renal scans twice, first on the basis of the posterior projection only and then by using the posterior and the right and left posterior oblique views.
Results: The oblique posterior views were considered useful by observers 1 and 2 for 4 kidneys and by observer 3 for 5 kidneys and were considered somewhat useful for up to 7 kidneys. The addition of oblique posterior views changed the interpretation on 5 occasions for observer 1, on 9 occasions for the observer 3, and on no occasion for observer 2. On average, therefore, changes in interpretation occurred for fewer than 6% of the kidneys. Moreover, no relationship was observed between the opinion of the clinicians that oblique views were useful and changes in the scintigraphic interpretations.
Conclusion: Oblique views were found useful in only a few cases and, even in these cases, did not significantly modify the interpretations. Therefore, when restless children are being imaged, the focus should be on obtaining a good posterior projection, even at the price of not having oblique posterior views.