National Imaging Associates, Inc.
Clinical guidelines
MUGA (Multiple Gated Acquisition) Scan
Original Date: September 1997
Page 1 of 3
CPT Codes: 78472, 78473, 78494, +78496 Last Review Date: September 2015
Guideline Number: NIA_CG_027 Last Revised Date: July 2012
Responsible Department:
Clinical Operations
Implementation Date: January 2016
INTRODUCTION:
Multiple-gated acquisition (MUGA) scanning is a radionuclide ventriculography technique to evaluate the pumping function of the ventricles of the heart. During this noninvasive nuclear test, radioactive tracer is injected into a vein and a gamma camera detects the radiation released by the tracer, providing moving images of the heart. From these images, the health of the heart’s pumping chamber, the left ventricle, can be assessed. It is used to evaluate the left ventricular ejection fraction (LVEF), a measure of overall cardiac function.
It may also detect areas of poor contractility following an ischemic episode and it is used to evaluate left ventricular hypertrophy.
INDICATIONS FOR MULTIPLE-GATED ACQUISITION (MUGA) SCAN:
 To evaluate left ventricular (LV) function at baseline before chemotherapy or cardiotoxic therapy; may be repeated prior to subsequent chemotherapy cycles until a total cardiotoxic dose has been reached.
 To evaluate ejection fraction in a patient with congestive heart failure (CHF).
 To evaluate patient, who is obese or who has chronic obstructive pulmonary disease
(COPD), for coronary artery disease (CAD).
COMBINATION OF STUDIES WITH MUGA:
Abdomen CT/Pelvis CT/Chest CT/Neck MRI/Neck CT with MUGA – known tumor/cancer for initial staging or evaluation before starting chemotherapy or radiation treatment.
ADDITIONAL INFORMATION RELATED TO MUGA:
Request for a follow-up study - A follow-up study may be needed to help evaluate a patient’s progress after treatment, procedure, intervention or surgery. Documentation requires a medical reason that clearly indicates why additional imaging is needed for the type and area(s) requested.
MUGA Scan Monitoring during Chemotherapy – Chemotherapeutic drugs that are used in cancer treatment may be toxic to the heart muscle. To minimize the risk of damaging the heart muscle with these drugs, the patient’s cardiac function may be monitored with the
MUGA scan before and during administration of the drug. Before the first dose of the drug, a MUGA scan may be performed to establish a baseline left ventricle ejection fraction
(LVEF). It may then be repeated after cumulative doses. If the LVEF begins to decrease, cardio toxicity risk must be considered if continuing the treatment.
1— MUGA 2016 Proprietary

REFERENCES
ACC/AHA/AATS/PCNA/SCAI/STS 2014 Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart DiseaseA Report of the
American College of Cardiology/American Heart Association Task Force on Practice
Guidelines, and the American Association for Thoracic Surgery, Preventive
Cardiovascular Nurses Association, Society for Cardiovascular Angiography and
Interventions, and Society of Thoracic Surgeons.
2014, 7, doi:10.1016/j.jacc.2014.07.017. Retrieved from http://content.onlinejacc.org/article.aspx?articleid=1891717 .
ACCF/AHA/ASE/ASNC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2013 Multimodality
Appropriate Use Criteria for the Detection and Risk Assessment of Stable Ischemic
Heart DiseaseA Report of the American College of Cardiology Foundation Appropriate
Use Criteria Task Force, American Heart Association, American Society of
Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of
America, Heart Rhythm Society, Society for Cardiovascular Angiography and
Interventions, Society of Cardiovascular Computed Tomography, Society for
Cardiovascular Magnetic Resonance, and Society of Thoracic Surgeons.
2014, 63(4), 380-406. doi:10.1016/j.jacc.2013.11.009.
Retrieved from http://content.onlinejacc.org/article.aspx?articleid=1789799
Anagnostopoulos, C., Harbinson, M., Kelion, A., Kundley, K., Loong, C.Y., Notghi, A., . . .
Underwood, S.R. (2004). Procedure guidelines for radionuclide myocardial perfusion imaging.
90, 1i010. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1876307/pdf/v090p000i1.pdf
Berman, D.S., Kang, X, Hayes, S.W., Friedman, J.D., Cohen, I., Abidov, A., . . .
Hachamovitch, R. (2003). Adenosine myocardial perfusion single-photon emission computed tomography in women compared with men: Impact of diabetes mellitus on incremental prognostic value and effect on patient management.
, 41, 1125-1133. Retrieved from http://content.onlinejacc.org/cgi/reprint/41/7/1125.pdf
Fatima, N., Zaman, M.U., Hashmi, A., Kamal, S., & Hameed, A. (2011).
Assessing adriamycin-induced early cardiotoxicity by estimating left ventricular ejection fraction using technetium-99m multiple-gated acquisition scan and echocardiography.
(5), 381-385. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/21346663
Hachamovitch, R., Hayes, S.W., Friedman, J.D., Cohen, I., & Berman, D.S. (2004). Stress myocardial perfusion single-photon emission computed tomography is clinically effective and cost effective in risk stratification of patients with a high likelihood of coronary artery disease (CAD) but no known CAD.
43, 200-208. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/14736438
Hacker, M., Jakobs, T., Matthiesen, F., Vollmer, C., Nikolaou, K., Becker, C., & Tiling, R.
(2005). Comparison of spiral multidetector CT angiography and myocardial perfusion imaging in the noninvasive detection of functionally relevant coronary artery lesions:
2— MUGA 2016 Proprietary

First clinical experiences Journal of
46, 1294-1300. Retrieved from http://jnm.snmjournals.org/content/46/8/1294.full.pdf+html
Hakeem, A., Bhatti, S., Dillie, K.S., Cook, J.R., Samad, Z., Roth-Cline, M.D., & Chang, S.M.
(2008) Predictive value of myocardial perfusion single-photon emission computed tomography and the impact of renal function on cardiac death.
118, 2540-
2549. Retrieved from http://circ.ahajournals.org/content/118/24/2540.abstract
Karkos, C.D., Thomson, G.J., Hughes, R., Hollis, S., Hill, J.C., & Mukhopadhyay , U.S.
(2002). Prediction of cardiac risk before abdominal aortic reconstruction: Comparison of a revised Goldman Cardiac Risk Index and radioisotope ejection fraction.
35(5), 943-949.Retrieved from http://www.jvascsurg.org/article/S0741-5214(02)23579-X/abstract
Krahn, A.D., Hoch, J.S., Rockx, M.A., Leong-Sit, P., Gula, L.J., Yee, R., . . . Klein, G.C.
(2008). Cost of preimplantation cardiac imaging in patients referred for a primaryprevention implantable cardioverter-defibrillator. echocardiography: A meta-analysis. during anthracycline therapy.
102(5), 588-592. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/18721517
Marcassa, C., Bax, J.J., Bengel, F., Hesse, B., Petersen, C.L., Reyes, E., & Underwood, R.
(2008) Clinical value, cost-effectiveness, and safety of myocardial perfusion scintigraphy: a position statement.
, 29, 557-63. Retrieved from http://eurheartj.oxfordjournals.org/content/29/4/557.full.pdf+html
Metz, L.D., Beattie, M., Hom, R., Redberg, R., Grady, D., & Fleischmann, K.E. (2007).The prognostic value of normal exercise myocardial perfusion imaging and exercise
227-237. Retrieved from http://content.onlinejacc.org/cgi/reprint/49/2/227.pdf
Shureiqi, I., Cantor, S.B., Lippman, S.M., Brenner, D.E., Chernew, M.E., & Fendrick, A.M.
(2002). Clinical and economic impact of multiple gated acquisition scan monitoring
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2375190/pdf/86-6600037a.pdf
,
49,
86, 226-232. Retrieved from
3— MUGA 2016 Proprietary