Evaluating the Swirler nebulizer: a user's perspective.
The change from multi-use to single-use nebulizer systems could potentially result in greatly increased expense for aerosol ventilation imaging and a larger waste disposal problem. We have therefore investigated a new compact single-use nebulizer system, the Swirler (Amici), for ventilation lung imaging using 99Tcm-DTPA aerosol. Seventy-five patients requiring lung ventilation/perfusion imaging were studied. The ventilation imaging was assessed using three different fills: Group 1, 1000 MBq in 2 ml; Group 2, 1000 MBq in 4 ml; and Group 3, 2000 MBq in 4 ml. The nebulization times to give 1200 counts s-1 on the posterior ventilation image were similar for Groups 1 and 3 (mean 4 min) but slower for Group 2 (mean 6 min). Room contamination was very low when performed in a room with an extractor device. The mean room air contamination was 117.0 Bq l-1 min-1 for Group 1 amd 27.6 Bq l-1 min-1 for Group 2, comparable to previous nebulizers we have used. Dose rates measured at the surface of the lead shielded nebulizer were 6.8 microSv h-1 for 1000 MBq in 2 ml and 10.9 microSv h-1 for 2000 MBq in 4 ml. The mass median diameter (span) without the extension tubing was 1.39 microns (1.85) and with a small extension tube reduced to 1.11 microns (1.70). Qualitative and quantitative assessment of image quality showed good peripheral airways penetration of particles with no uninterpretable scans, comparable with other systems we have used. In practical terms, the device is much more compact than other systems and therefore generates a much smaller volume of waste. It is an easy device to use. However, when ventilating patients supine or erect, we found that it was necessary to use the small extension tube.