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ENDOCRINOLOGY SECTION
THYROID SCAN
Description:
The thyroid scan may be performed in two ways. The first uses oral I-123 (0.3-0.4mCi). The patient swallows the capsules and returns at 2 & 24 hours for the scan and uptake.
The second method involves an intravenous injection of Tc-pertechnetate (5-10mCi). Approximately 20 minutes after receiving the radiopharamaceutical, an image is obtained.
Indications:
- Nodule
- Goiter
- Superior mediastinal mass (substernal goiter)
- Hyperthyroidism (Dx + Tx)
- Thyroid CA (Dx + Tx)
Preparation:
All preparations that interfere with the uptake of radiopharmaceuticals by the thyroid should be stopped: Cytomel (3 week); desiccated thyroid and synthroid (4-6 weeks); PTU, Tapezol (1 week); cough syrup (I), Li, Betadine, Vitamins (I)(1-2 weeks); Lugol's solution and Iodine preparations (2-3 weeks); x-ray contrast studies (4-6 weeks). Bronchoscopy and myelography (months and years). NPO 2 hours prior to exam.
THYROID UPTAKE
Description:
Before the patient receives the radiopharmaceutical a background count using the probe is obtained. The patient then receives the radiotracer orally. At 2 hours post-ingestion, a measurement of uptake is made over the neck and over the thigh of the patient. At 24 hours, the neck and thigh counts are repeated. This exam is frequently performed along with the thyroid scan.
Indications:
To assess the ability of the thyroid to preferentially extract iodine from the blood.
Preparation:
NECK AND CHEST SCAN FOR THYROID CARCINOMA
Description:
Scintigraphic images are obtained over the torso and neck to locate functioning thyroid metastases. The patient ingests 2-3mCi 123 orally followed by scintigraphic images in 2 to 3 hours and/or 24 hours of the neck and whole body. The patient ingests the radiotracer 131-Iodine (2-5mCi) orally. Scintigraphic images are obtained of the neck and torso at 48-hour post ingestion to locate functioning ectopic thyroid tissue.
Indications:
To locate functioning thyroid carcinoma metastases.
Preparation:
PARATHYROID SCAN
Description:
The patient first receives an oral dose of approximately 0.3mCi of I23. Two hours later, they return for a scan of the neck.
The patient is then injected with 20mCi 99 mTc Sestamibi I.V. Scintigraphic images of the neck and mediastinal regions are obtained at 10 minutes and 2 hours to localize a suspected parathyroid adenoma. Spect imaging may be performed at 30 minutes. Radiotracer should wash out of the normal thyroid gland and be retained in a parathyroid adenoma.
Indications:
Hyperparathyroidism.
ADRENAL SCANNING CORTEX
Description:
The patient is injected with 1-2mCi of the radiopharmaceutical (I-131 NP-59). Imaging commences two days after injection and continues as necessary every other day for approximately one week.
Indications:
- Cushing's syndrome.
- Primary aldosteronism.
- Post-surgical evaluation for adrenal remnants.
- Adrenal androgen excess.
Preparation:
- Signed consent form required.
- Lugol's solution. 16 drops daily PO starting 2 days before and continuing 5 days after the injection of the radiotracer.
- A mild laxative prior to imaging.
- Dexamethasone (Primary Aldosteronism), 2mg PO q6h daily for 2 days prior to study and continued for the duration of the study.
Complications:
Those associated with dexamethasone.
ADRENAL SCAN ADRENAL MEDULLA (PHEOCHROMOCYTOMA)
Description:
The patient is injected intravenously with 10mCi of I-123 MIBG(methyliodobenzylguanidine) or 1mCi I-131 MIBG which preferentially localizes in Pheochromocytomas, glomus tumors, and neuroblastomas. A whole body scan is performed at 24 hours post-injection (delayed scans obtained at 2+3 days as needed).
Indications:
- Pheochromocytoma
- Glomus gugularis
- Neuroblastoma
Preparation:
- Lugol's solution: (I-131 MIBG) 10 drops daily PO starting 2 days before and continuing for 5 days after the injection.
- Discontinue Reserpine, tricyclic antidepressants, Phenylpropanolamine.
PULMONARY
LUNG VENTILATION SCAN
Description:
The patient breaths radioactive gas Xe 133 (20mCi) through a mask into a closed system. The study requires patient cooperation and will usually take approximately 15 minutes.
Indications:
- Aid in the diagnosis of pulmonary embolus.
- Qualitative and quantitative assessment of lung ventilation.
PULMONARY PERFUSION SCAN
Description:
The patient is intravenously injected with the radiotracer Tc-99m MAA (3-4mCi) which is carried in the blood flow to the lungs. The absence of activity in a region of the lungs suggests obstruction either from clot or other causes. Approximately 30 minutes is necessary to complete the study.
Indications:
- The diagnosis of pulmonary embolism.
- Quantitative assessment of lung perfusion.
- Preoperative quantitation of lung perfusion.
- Right to left shunt evaluation.
Contraindications:
- Severe pulmonary hypertension (relative contraindication).
- History of hypersensitivity reactions to products containing human serum albumin.
Preparation:
Current chest radiograph (within 24 hours).
Complications:
- In a patient with severe pulmonary hypertension, death has been reported, however, with current methods using a reduced number of particles, this is very unlikely.
- Hypersensitivity (rare).
RADIONUCLIDE ANGIOGRAM OF THE CHEST
Description:
The patient is intravenously injected with a bolus of radiotracer Tc Pertechnetate or TcDTPA (15-20mCi) and sequential scintigraphic images are obtained to evaluate blood flow through the lungs, heart and mediastinum.
Indications:
- Suspected superior vena cava obstruction.
- Suspected aortic aneurysm,
- Suspected pulmonary arteriovenous malformation.
- Pericardial effusion.
Preparation:
None.
CARDIAC STUDIES
RADIONUCLIDE CARDIAC IR (Also called "First Pass")
Description:
The patient receives a bolus injection of the radiotracer Tc-pertechnetate or other technetium products (15-20mCi) while under the camera Sequential images are recorded on the computer for analysis and calculation while the flow of the bolus is monitored. This study is frequently done in conjunction with a gated blood pool study.
Indications:
- Quantification of intracardiac shunt.
- Assessment of right ventricular ejection fraction.
- Evaluation of cardiac function in patients with valvular disease.
MYOCARDIAL PERFUSION
Description:
There are two phases of this study. One requires the patient to be at rest, they are injected with 10-15mCi Tc99m Sestamibi. After the planar or SPECT images are obtained, the patient is stressed on a treadmill until maximum exercise. They are then injected with 20-30mCi.. The stress images can be performed before or after the resting study. This can also be performed as a two-day protocol. Both planar and SPECT imaging takes approximately 20-30 minutes.
Indications:
- Angina, to establish the diagnosis of coronary artery disease.
- Atypical chest pain.
- To evaluate the significance of a coronary artery lesion seen on coronary arteriography.
- Differentiation of scar from ischemia.
- Evaluate for myocardial infarction.
Preparation:
- Overnight fast.
- Exercise is scheduled with the cardiac stress laboratory (X7285).
Complications:
Complications of stress EKG test including arrhythmias and death.
PHARMACOLIGICAL STRESS (PERSANTINE-DOBUTAMINE)
Description:
The patient undergoes resting images after the injection 10-15mCi Tc . Persantine-Dobutamine is administered intravenously as a pharmacological challenge in patients who are unable to exercise adequately. Immediate planar and/or SPECT images are then acquired in the same manner used for the exercise stress study.
Indications:
To evaluate coronary perfusion.
MYOCARDIAL INFARCT IMAGING (HOT SPOT IMAGING, TECHNETIUM PYROPHOSPHATE IMAGING OF THE HEART)
Description:
Approximately 2 to 3 hours after the IV administration of Tc pyrophosphate (15-20mCi) images of the heart are obtained in multiple projections. The best results are obtained when imaging one to seven days post-onset of symptoms.
Indications:
- Acute myocardial infarction. Patients who benefit most from this study are patients who have had a recent acute MI.
- Suspected reinfarction.
- Evaluation of perioperative chest pain, especially in status post-CABG patients.
- Pre-op in patients having cardiac surgery.
- In assessing patients with a vague history of myocardial infarction during the previous week.
- Sizing of acute myocardial infarcts.
Preparation:
Appropriate monitoring should be arranged for unstable patients.
GATED WALL MOTION STUDY
Description:
The patient's own red blood cells are labeled in vivo with Tc pertechnetate (15-20mCi). Then multiple gated cardiac cycle images are obtained with a gamma camera.
Preparation:
The patient is intravenously injected with stannous pyrophosphate approximately 30 minutes prior to the injection of the radiotracer.
Indications:
- Suspected or known coronary artery disease (this is done with exercise).
- Evaluation of wall motion in a patient with a known or suspected myocardial aneurysm.
- Evaluation of ejection fraction, particularly for patients receiving chemotherapy.
- To evaluate cardiac disease in patients with chronic obstructive lung disease.
- Localization of previous myocardial infarction.
- To evaluate the effect of a specific drug on cardiac function.
GASTROENTEROLOGY
HEPATOBILIARY SCAN
Description:
The patient is kept supine under a gamma camera following the IV administration of 5-8mCi of TC labeled IDA compound. Multiple images are obtained of the anterior abdomen over the region of the liver during the first hour. If the study is clearly negative (the gallbladder is visualized) within this time, no additional views are necessary. If the small bowel and gallbladder are not visualized during the first hour, then additional views may be taken. If the gallbladder is not visualized and the small bowel is visualized then Morphine Sulfate may be injected and additional images for the next 30 minutes are obtained (re-injection with 2-3mci of IDA is required). If the gallbladder is not visualized during 30 minutes then obstruction of the cystic duct is diagnosed. No further delayed images are necessary. If there are contraindications to Morphine Sulfate additional views may be taken at 2, 4, and up to 24 hours post-injection.
Indications:
- Diagnose acute cholecystitis.
- Evaluation of hepatobiliary function.
- Evaluation of common bile duct obstruction.
- Evaluation of biliary reflux.
- Evaluation of post-surgical changes in biliary excretion.
- Evaluation for bile leak.
Preparation:
- Fasting from midnight unless an emergency study when a minimum fast of 2 hours is suggested, but the study can be performed with no fasting.
- If the patient has had adverse reactions or is allergic to morphine analogs, then morphine sulfate will not be administered.
Complications:
Of CCK (cholecystokinin) or morphine.
LIVER/SPLEEN SCAN
Description:
The patient is intravenously injected with radiotracer Tc-sulfur colloid (5mCi). After approximately a 15-minute delay, scintigraphic images are obtained in various projections usually with the patient supine, however erect images may be necessary. SPECT images may also be obtained in transaxial, sagittal and coronal projections.
Indications:
- Evaluate for liver metastases in patients with known malignancies.
- Evaluate hepatosplenomegaly.
- Evaluate unexplained abdominal masses.
- Assess liver status in diffuse liver disease.
- Evaluate the liver in patients with unexplained peripheral edema and/or ascites.
- Assessment of patients with jaundice.
- Evaluation of trauma.
- Assessment of functional asplenia.
- Assessment of polysplenia.
- Evaluation for hepatic abscesses.
- Localization of lesions for biopsy.
Contraindications:
History of hypersensitivity reactions to products containing human serum albumin.
Complications:
Hypersensitivity (very rare).
HEPATIC BLOOD FLOW AND BLOOD POOL HEMANGIOMA STUDY
Description:
A bolus of the radiotracer is injected to label the RBC's in-vitro(20-25mCi) using the kit and sequential scintigraphic images are obtained. This study is usually completed within 2 hours. SPECT images are necessary if a hemangioma is suspected.
Indications:
- To evaluate the blood flow to the hepatic region.
- Evaluate the vascularity of regions within the liver (hemangiomas).
HEPATIC ARTERY PUMP STUDY
Description:
After consent is obtained from the patient, 5mCi of Technetium 99m MAA is injected into the tubing and sideboard of the infusion pump. Images are then obtained in multiple projections. If other correlative studies are not available, then a liver scan is performed 24 hours later.
Indications:
The procedure is performed to check the position of the hepatic artery catheter and to insure that the appropriate portions of the liver are being perfused by the chemotherapeutic drugs. The stomach and lungs are imaged to evaluate for shunting of activity past the liver,
Preparation:
Written consent. A non-boring needle, one and a half to two inches in length, which can be obtained from the clinical oncology service.
LEVEEN-PERITONEAL-JUGULAR (SHUNT PATENCY) STUDY
Description:
The radiotracer (Tc-MAA or 99mTc Sulfur Colloid) is injected peritoneally. Scintigraphic images are obtained along the path of the shunt. If patent, the lungs or liver/spleen will be visualized within 20 minutes to 1 hour. Delayed images may be necessary in partial obstruction. Deep respirations are used to assure maximal shunt function.
Indications:
Assess the patency of the LeVeen (peritoneal-jugular shunt).
Contraindications:
- Inflammation of the abdominal wall.
2.
- Infection involving the patient's ascites.
Preparation:
Coordination with patient’s Physician for the paracentesis.
Complications:
Infection and ascitic fluid leak.
GASTROINTESTINAL BLEEDING SCAN (TC SULFUR COLLOID)
Description:
The patient is intravenously injected with the radiotracer Sulphur Colloid (10-12mCi) and sequential images of the abdomen are obtained for 30 minutes. If the patient is acutely bleeding, a focus of activity will locate the site of acute GI bleeding. Bleeding in the hepatic flexure and UGI tract is difficult to assess. This test is most sensitive in the lower GI tract.
Indications:
Evidence of acute lower gastrointestinal bleeding.
GASTROINTESTINAL BLEEDING SCAN LABELED RBC
Description:
The patient is intravenously injected with Technetium 99M in-vitro labeled RBC (15-20mci). Sequential images of the abdomen are obtained for approximately 1-2 hours. If the patient is acutely bleeding a focus of activity will locate the site of acute GI bleeding
Indications:
Evidence of acute lower gastrointestinal bleeding.
MECKEL'S DIVERTICULUM SCANNING
Description:
The patient is injected intravenously with Technetium Pertechnetate (5-10mCi). Patient is imaged supine under a gamma camera for the next 60 minutes. At the end of the first hour, a right lateral and posterior view are also obtained.
Indications:
To locate ectopic gastric mucosa (Meckel's diverticulum).
Preparation:
- Overnight fast.
- Cimetadine 200mg PO/IV Q6 hours for 1-4 doses prior to the study.
- After the study, patient should receive 250-500mg of potassium perchlorate for thyroid blockage.
RADIONUCLIDE ESOPHAGEAL TRANSIT STUDY (RET)
Description:
The patient is instructed to swallow a bolus of 25ml of water labeled with Technetium 99m Sulfur Colloid (300-500 uCi) while dynamic images of the esophagus are being acquired.
Indications:
To evaluate esophageal motility.
Preparation:
Overnight fast.
GASTRO-ESOPHAGEAL REFLUX SCAN
Description:
The patient is given a mixture of 150ml of orange juice and 150ml 0.1 N Hydrochloric acid labeled with 0.3mCi of technetium Sulfur Colloid to drink. An abdominal binder is placed on the patient. Multiple images are obtained with the patient in the upright position while the abdominal binder is progressively inflated up to 100mm Hg. The procedure is then repeated with the patient in the supine position.
Indications:
To detect and quantitate symptomatic gastro-esophageal reflux.
Preparation:
Overnight fast.
GASTRIC EMPTYING SCAN (SOLID and LIQUID)
Description:
Images of the anterior and posterior upper abdomen are obtained for 2 hours after the ingestion of.3mCi of Technetium Sulfur Colloid labeled EGG WHITE to determine the emptying of the solid meal. Liquid meal emptying is performed following oral ingestion of mixed orange juice and saline (150ml each). These images are recorded on a computer for 1 hour.
Indications:
- Evaluation of the ability of the stomach to clear food (liquid and/or solid).
- Evaluation of gastric motility in patients with systemic disease (diabetes mellitus, scleroderma. etc).
- To quantitate changes in gastric function following therapy (e.g., metaclopramide).
Contraindications:
Vomiting.
Preparation:
Overnight fast.
PERITONEAL FLUID LEAK DETECTION
Description:
Technetium 99m Sulphur Colloid (1-2mCi) is injected into the patient's dialysate bag, which is connected to the intraperitoneal catheter. The dialysate fluid is instilled into the peritoneal cavity to insure homogenous distribution of activity throughout the abdomen. Sequential images of the abdomen and pelvis are obtained for one hour. Delayed imaging may be obtained 2 to 3 hours post-injection.
Indications:
To detect peritoneal fluid leaks, usually in patients with ascites, pleural effusions, abdominal wall hernias, or scrotal edema.
Preparation:
An indwelling intraperitoneal catheter.
SALIVARY GLAND SCANNING
Description:
The patient is intravenously injected with the radiotracer Tc pertechnetate. Sequential images of the salivary glands are obtained for approximately 30 minutes. Washout images may be obtained to assess salivary secretion after stimulation with lemon drops.
Indications:
- To assess the function and anatomy of the salivary glands.
- To assess function in Sjorgren's syndrome.
- To assess a parotid mass for a suspected Warthin's tumor.
- To separate cysts, abscess, and metastatic lesions.
Preparation:
The patient drinks 16 oz. water prior to the exam.
Complications:
None.
GENITOURINARY
RENAL FUNCTION SCAN
Description:
The patient is intravenously injected with a bolus of the radiotracer TC DTPA, or TC-MAG 3 (15-20mCi). Sequential images are obtained to assess perfusion and glomerular (DTPA) tubular (MAG 3) function. Urine flow from the kidneys to the bladder is monitored.
Indications:
- To assess the glomerular and tubular function of the kidney (DTPA and MAG-3 respectively).
- Evaluation of the kidneys in patients allergic to iodine contrast agents.
- Evaluation of the kidneys in patients with elevated BUN and creatinine.
- Abdominal masses of undetermined etiology.
- Evaluation of obstructive uropathy (lower tract obstruction).
- Evaluation of possible renal infarct.
- Evaluation of patients whose kidneys were not visualized on an IV Urogram.
- Evaluation of patients with abdominal (suspected renal) trauma.
- Differentiate renal pseudotumors from pathological renal masses.
- Non-invasive diagnosis of renovascular hypertension due to renal artery stenosis. (Captopril Study).
- Estimation of glomerular filtration rate.
Contraindications:
None.
Preparation:
Hydration before study (if possible).
DIURETIC RENOGRAM
Description:
At the completion of the standard renal scan; if there is persistent activity in the collecting system of one or both kidneys, the patient will be given Furosemide (20-25mg) intravenously. Thereafter, sequential imaging in the posterior projection will be performed for 20 minutes.
Indications:
To differentiate between an obstructed and dilated collecting system.
Contraindications:
Any contraindication for administering Furesemide.
Preparation:
Patient should be well-hydrated.
CAPTOPRIL RENOGRAM
Description:
The patient empties his bladder and is given a dose of Captopril (25 50mg) orally. Blood pressure is monitored. One hour later, the patient receives an intravenous injection of the radiotracer Tc-DTPA or Tc MAG3 (20mCi). Sequential images are obtained for approximately a half-hour. If the study appears suggestive of renal artery stenosis, a baseline study is subsequently obtained without Captopril.
Indications:
To diagnose renovascular HTN due to renal artery stenosis.
Preparation:
Discontinuation of anti-hypertensive medication at least 12 hours and preferably 2 days before the study. Fast 4 hours before study. Patient must be well-hydrated prior to study.
Complications:
Hypotension
RENAL MASS DETECTION STUDY
Description:
The patient is intravenously injected with a bolus of the radiotracer Tc-Glucoheptonate (20mCi or Tc DMSA). A renal flow study is obtained in the routine manner. Delayed images are obtained at approximately 2-4 hours post-injection. The size, shape, position, and presence or absence of space occupying lesions is assessed. SPECT imaging with 3-D reconstruction may be performed for further evaluation if indicated.
Indications:
To assess the presence or absence of a renal mass.
RENAL TRANSPLANT STUDY
Indications:
To evaluate the perfusion and function to the transplanted kidney. Except for imaging a different anatomic site, the rest is identical to what is described above. (See renal function study).
VOIDING CYSTOURETHROGRAM (VCUG)
Description:
Saline mixed with the radiotracer (Tc-pertechnetate) is instilled into the bladder until it is maximally filled. The catheter is removed and voiding proceeds with the patient in the vertical position. Data are stored on a computer for interpretation. Residual bladder capacity can be determined from this study also.
Indications:
- Detection of vesicoureteral reflux.
- Follow-up examinations to determine effect of therapy on reflux.
Contraindications:
Complications of catheterization.
Preparation:
Bladder catheterization through the urethra.
Complications:
Only secondary to catheterization.
TESTICULAR SCAN
Description:
The patient is placed under a gamma camera the scrotum is elevated. Patient receives an intravenous bolus injection of the radiopharmaceutical Tc-pertechnetate (10mCi) while sequential scintigraphic images of the perfusion to the scrotum are recorded. Tissue phase images are obtained immediately following the flow study. In testicular torsion, there is an absence of perfusion to the testicle. The study usually can be completed in 10-15 minutes.
Indications:
Differentiate testicular torsion from epididymitis.
Preparation:
Potassium perchlorate is administered prior to the study.
BONE SECTION
BONE SCAN
Description:
After injection of the radiopharmaceutical Tc-MDP, there is a 3 hour delay until the imaging commences. Imaging is either whole body or limited to specific bone(s). The patient is encouraged to drink liquids and void to lower his or her radiation burden.
Indications:
- Locate and assess osseous neoplasm’s or metastases.
- Characterize or locate source of pain.
- Extent of known processes (Paget's Disease, arthritis, fibrous dysplasia, etc.).
- Diagnose osteomyelitis.
- Evaluate bone viability including avascular necrosis.
- Separate nonunion with pseudoarthrosis from nonunion without pseudoarthrosis.
- Evaluate for traumatic and stress fractures.
- Evaluate prostheses.
- Locate sites for biopsy.
- Suspected child abuse.
- Any other active osseous process.
Contraindications:
May not be performed on the same day as any other Technetium-based imaging study.
BONE SCAN (3 PHASE)
Description:
After an IV injection of Tc-MDP, sequential 2 second images are obtained of the region of suspected osteomyelitis (1st phase). Sequential 1 minute images are obtained of the region of interest (2nd image). Later, the routine (3rd phase) images are obtained 2-4 hours post injection.
Indications:
- Suspected osteomyelitis.
- To differentiate cellulitis from osteomyelitis.
BONE MARROW SCAN
Description:
The patient is injected with the radiopharmaceutical Tc Sulfur Colloid. Approximately 20 minutes later, imaging commences over the axial and appendicular skeleton. The bone marrow near the liver and spleen is difficult to assess due to scatter from these reticuloendothelial rich organs.
Indications:
- Evaluate bone marrow spaces for location and function.
- Aid in the separation of bone infarction from osteomyelitis.
- Identify sites for biopsy.
Complications:
Hypersensitivity (very rare).
CNS IMAGING
BRAIN SCAN FOR BRAIN DEATH
Description:
Patient receives an IV injection of 99mTc Neurolite, HMPAO (coretec) or DTPA. Images are obtained during injection and 5-10 minutes post injection to see whether there is tracer uptake within the brain.
Indications:
To prove brain death in comatose patients.
Preparation:
None.
RADIONUCLIDE CISTERNOGRAPHY
Description:
The radiotracer In 111 DTPA (700uCi) is injected into the lumbar CSF space. Sequential images are taken approximately 2-4 hours post-injection or until the tracer has flowed over the brain convexities (usually 24 to 48 hours). If CSF leak is suspected, pledgets are placed in the nose or other locations. Multiple early images are obtained when a CSF leak is suspected.
Indications:
- Evaluation of CSF flow dynamics.
- Evaluate and locate suspected CSF leaks in patients with rhinorrhea and otorrhea.
- Diagnose normal pressure hydrocephalus.
- Diagnose porencephalic and subarachnoid cysts.
Preparation:
- To inject into the CSF space, the patient must have a lumbar puncture. This is usually performed by the requesting physician or his designate.
- If CSF leak suspected, pledgets are placed in the nostrils. This is done by ENT.
Complications:
Related to lumbar puncture and placement of the pledgets.
CNS SHUNT PATENCY STUDY
Description:
Once the shunt reservoir has been located, a needle with a three-way stopcock is placed in it. The patient is then placed in front of the gamma camera and the radiopharmaceutical (l11 InDTPA) is injected. Sequential scintigraphic images of the shunt reservoir and the brain are obtained. This is followed by images over the abdomen, and along the path of the shunt.
Indications:
To demonstrate patency of CNS shunt.
Contraindications:
Inflammation or infection at the site of the shunt.
Preparation:
This study is coordinated with neurosurgery. Aseptic techniques are used for the injection.
Complications:
Infection.
FUNCTIONAL BRAIN IMAGING WITH SPECT
Description:
30 minutes after the intravenous administration of 99mTc Neurolite (25mCi), SPECT images of the brain are obtained. The entire study is 60 minutes.
Indications:
- Stroke.
- Assessment of regional cerebral perfusion and function in various neuropschiatric disorders. (Alzheimer's disease, depression, head trauma, etc.)
- Localization of seizure foci.
Preparation:
None
INFECTION /INFLAMMATION
GALLIUM SCAN (SOFT TISSUE SCAN) FOR INFECTION AND ONCOLOGY
Description:
The patient is injected with the radiopharmaceutical Ga-citrate (3-5mCi, 10mCi for Hodgkin’s) and imaged at 48 hours using planar and SPECT techniques. Follow-up images may be obtained at 72 hours and beyond if necessary.
Indications:
- Inflammatory disease (including abscess formation).
- Staging of Hodgkin’s lymphoma.
Preparation:
Bowel cleansing between 24-48 hours post-injection (before 48 hour imaging commences).
ABSCESS LOCALIZATION WITH LABELLED/LEUKOCYTES
Description:
Approximately 50cc of blood are removed from the patient. The WBC's are separated and labeled with In-111-oxine (preparation time-2 hours) and then 500 uCi labeled WBC's are re-injected into the patient. Images are obtained at 24 hours post injection.
Indications:
Localization of inflammation, particularly intra-abdominal abscess, osteomyelitis.
LYMPHOSCINTIGRAPHY (LYMPH NODE SCANNING)
Description:
The patient is injected with Tc- HSA or sulphur colloid (1-2mCi) between toes or other locations as requested subcutaneously. Sequential images are acquired over the next hour. If necessary 24 hour images are obtained.
Indications:
Assessment of lymphatic system. Location of metastatic sentinel nodes in cancer patients. Evaluation of edema.
THYROID THERAPY
TREATMENT FOR HYPERTHYROIDISM
Description:
The patient receives the radiopharmaceutical 131-I (10-25mCi) orally. The patient is instructed in radiation precautions with regard to urine and other body fluids. The major alternative forms of therapy are surgery or continued medication.
Indications:
Hyperparathyroidism due any cause, Graves Disease, toxic multi-nodular Goiter, etc.
Contraindications:
Pregnancy.
Preparation:
- Pregnancy test.
- Consent form for therapy.
- Thyroid uptake and scan.
- All preparations that interfere with the uptake of radiopharmaceuticals by the thyroid should be stopped: (See Thyroid Scan)
Complications:
- Hypothyroidism.
- Return of hyperthyroidism.
THYROID CARCINOMA TREATMENT
Description:
Relatively large doses of I-131 (60-200mCi) are used for the treatment of thyroid cancer. The patient receives an oral dose of the radioactive iodine Patients may be treated as inpatients or outpatients, but must follow radiation safety precautions. If hospitalized, specially prepared, private room is required. They are usually discharged in 2-4days after the administration of the radiotracer.
Indications:
- Thyroid carcinoma (this may follow a sub-total thyroidectomy).
- Metastases from thyroid carcinoma.
Contraindications:
Preparation:
- Pregnancy test.
- Consent form for therapy.
- Thyroid uptake and scan are mandatory at the time of treatment.
- All preparations that interfere with the uptake of radiopharmaceuticals by the thyroid should be stopped: (See Thyroid Scan).
Complications:
- Hypothyroidism.
- Sialadenitis
TREATMENT FOR POLYCYTHEMIA VERA
Description:
The patient is intravenously injected with the radiopharmaceutical 32-phosphorous (4-5mCi).
Indications:
The presence of increased red cell mass (primary) or excessive platelet count.
Contraindications:
Pregnancy.
Preparation:
- Consent for therapy form.
- Negative pregnancy test.
Complications:
INTRACAVITARY THERAPY
Description:
The radiopharmaceutical 32-phosphorous (10-12mCi) is introduced through the paracentesis or thoracentesis tube. The patient is then positioned for full distribution of the radiopharmaceutical. The patient is then dismissed from the laboratory. If ascites or pleural fluid is again obtained from the patient, the fluid should be considered radioactive for 14 weeks and handled in an appropriate manner for radiation precautions.
Indications:
- Ovarian CA with positive cytology.
- Endometrial CA with positive cytology.
- Other malignant ascites.
Contraindications:
- Pregnancy.
- Impending death.
Preparation:
- Consent form for therapy.
- Negative pregnancy test.
- Paracentesis or thoracentesis tube in place. Usually placed by the surgeon or his designate.
- Signed consent form required.
NON-IMAGING INVIVO STUDIES SCHILLING TEST
Description:
A dose of radiocobalt cyanocobalamin (vitamin B12)(.5uCi) is administered orally in two stages. The first as free vitamin B12, the second, if necessary, is bound to intrinsic factor. A "flushing dose" of 1000 micrograms of vitamin B12 is administered intramuscularly one hour after the administered dose. A 24-48 hour urine collection is obtained.
Indications:
To define the etiology of a low serum vitamin B12 concentration as well as categorizing specific causes of malabsorption, i.e. pancreatic, intrinsic factor deficiency, bacterial overgrowth, etc.
Preparation:
Patient should be fasting from evening before test. Clear liquids until normal lunch. Intramuscular injection of 1000 micrograms vitamin B12 one hour following oral dose. A 24-48 hour collection of urine.
GLOMERULAR FILTRATION RATE
Description:
Radiolabeled Technetium 99m DTPA (1-2mCi) is administered intravenously. Serum samples are procured at 60 and 180 minutes following dose administration. Protein-free filtrates are radioassayed.
Indications:
Define renal function in a variety of bilateral renal diseases, the course of the disease and evaluation of therapy.
Preparation:
Availability of patient at specific time intervals. Presence of edema causes inaccurate estimate of filtration rate.
TOTAL BLOOD VOLUME (RBC AND PLASMA VOLUME)
Description:
The total blood volume may be derived by one of several methods using a simple dilution method. The most accurate procedure is independently estimating the red blood cell volume with radiolabeled CR 51 (50uCi) autologous erythrocytes and plasma volume by radiolabeled albumin (10uCi). The second most accurate is using the red blood cell volume and extrapolating the total blood volume using the peripheral hematocrit and its mean relationship to the total body hematocrit.
Indications:
Differentiate types of polycythemia and post-operative fluid replacement.
Preparation:
Intravenous fluid administration with the concomitant performance of a radiolabeled albumin method for estimating plasma volume is contraindicated.
The University of Pennsylvania Health System, Philadelphia, PA © 2006,
The Trustees of the University of Pennsylvania
