Nuclear Medicine Studies

Front Range Nuclear Services performs a variety of different diagnostic imaging studies. Whether you're a patient looking for more information about an upcoming procedure or you're just interested in learning more about the various studies, the list below provides a great deal of information about each type of study we conduct.

Click on the name of a study to read about the purpose, process involved and patient preparation necessary for that study.

Bone SPECT

Tomographic Bone Scan (SPECT)

Overview

Tomographic bone scanning is indicated in examining areas in which there is substantial overlap or superimposition of bone structures. This technique provides superior image contrast and anotomic detail, which has been proven to be a significant diagnostic value.

Indications

A vascular necrosis of the hips due to idopathic osteochondrosis or trauma, such as a subcaptial fracture of the femoral neck or steroid therapy.
Symptomatic patients with defects in the pars interarticularis.
Temporamandibular joint dysfunction.
Spondyloysis and/or spondylolithesis.
The extent of arthritis in patients with chronic knee pain.
Any chronic back pain.

Study Description

A radiopharmaceutical is injected intravenously and allowed to circulate for three hours. This time is required for the tracer to accumulate in the osseous tissue. Images are then obtained for the area of interest. Additional static images are acquired prior to SPECT imaging to help localize the problem area. Image acquisition requires approximately one hour. It is very important that the patient remain still during the acquisition.

Examination Time

Initially: 15 minutes for the injection.
3 hours later: 1 hour for image acquisition.

Patient Preparation

Well hydrated prior to exam
Ensure the patient is not pregnant or breastfeeding

Breast Scintigraphy

Breast Scintigraphy - Sestamibi

Overview

The Tumor Viability Nuclear Medicine Study demonstrates the presence and location of viable tumor tissue. Tc-99m-Sestamibi tends to localize in metabolically active tumor cells to a greater extent than in normal cells. The exact mechanism of Tc-99m Sestamibi uptake by tumor cells is uncertain. Primary factors include its lipophilicity, which permits passive transport through tumor cell membranes and its active uptake by mitochondria once intracellular. Cells with higher mitochondrial content show greater Tc-99m Sestamibi concentration.

Indications

Detection and localization of viable tumor of primary breast cancer and axillary metastases.
Differentiation of high and low grade tumors.
Selection of mammographic abnormalities for biopsy.
Evaluation of patients with breast implants which may obscure a lesion.
Detection of multi-drug resistance in tumors.

Study Description

The patient will be required to undress to the waist, put on a gown, and remove all jewelry. The patient will receive an injection and wait for 10 minutes. The patient will then lie on the table for images. The number of views required is determined by the location of the suspected abnormality so time required may vary from 40 to 60 minutes.

Examination Time

1 hour

Patient Preparation

Ensure the patient is not pregnant or breastfeeding

None

Additional Information

Breast Scintimamography Education Brochure

Cystogram

Overview

The radionuclide Cystogram allows the diagnosis and follow-up of vesicoureteral reflux. In general, the study is more sensitive than radiographic methods because of the high contrast between instilled radioactivity in the bladder and the lack of radioactivity outside of the bladder.

Indications

Evaluation of vesicouretal reflux.

Study Description

A Foley catheter should be placed with the patient lying on the nuclear medicine imaging table for patient comfort. Extension tubing (3-4 ft) is attached to the three-way stopcock and to a bag of sterile saline (250-1000 ml depending on patient’s age and size).

After introducing a small amount of sterile saline into the bladder to check for leakage, the radiopharmaceutical is introduced through the three-way stopcock and the bladder is continously filled with sterile saline. When filling the bladder, special attention is used in order to minimize patient discomfort.

Imaging is begun at the same time filling is begun and continued through complete filling. When the bladder has filled, the three-way stopcock is closed and an additional static image is taken. With the catheter in place the patient is instructed to void. Images are taken throughout the voiding and continued until the bladder appears to be emptied. Another additional static image of the bladder will be taken after it is emptied. At the end of the study the catheter will be removed.

Examination Time

Approximately 1 hour

Patient Preparation

Ensure patient is not pregnant or breast-feeding
Need to know if there is an allergy to latex
Obtain written informed consent. If the patient is a minor, obtain written consent from the parent or guardian.
Cover the examination table with absorbent paper to avoid contamination with the radiopharmaceutical.
Cleanse the urethral meatus and surrounding tissues with an aseptic solution. Anesthetic jelly (lidocaine) may be used for males.
Insert age-appropriate Foley catheter and inflate the balloon.
Connect the catheter to a 500 ml bottle of normal saline that is positioned not more than 100 cm above the table. Keep tubing clamped.
Ensure the patient is not pregnant or breastfeeding.

Additional Information

Breast Scintimamography Education Brochure

Gastric Emptying

Overview

The Gastric Emptying Study demonstrates the movement of an ingested bolus of solid and/or liquid from the stomach into the small intestine.

Indications

Diagnosis of functional gastric dysmotility.

Study Description

After an overnight fasting period the patient is taken to the imaging area and fed a radioactive meal consisting of 2 scrambled eggs labeled with Tc-99m Sulfur Colloid, two slices of white bread (generally toasted) with 30g jelly (Strawberry or grape-usually 2 small packets of Smucker’s jelly (Net wt ½ oz (14g)), and 4-6 ounces of water. (If the patient is unable to ingest eggs, oatmeal can be substituted.) Images are taken immediately for 1 ½ hours after ingestion (optional 4 hour protocol).

Examination Time

Approximately 2-4 hours (optional 4 hour protocol)
Initially 30 minutes for meal preparation and ingestion of test meal
90 minute protocol: 90 minutes of continuous imaging
4 hour protocol: Imaging immediately followed by 1 minute images at 1,2,3, and 4 hours

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
NPO (nothing by mouth) for a minimum of 6 hours prior to exam
No BARIUM studies for 48 hours prior to exam
The study should be done in the morning. Start no later than 10 a.m. because the gastric emptying time varies with the time of day.

Gastrointestinal Bleeding

Overview

The Gastrointestinal Bleeding Study detects the extravasation of radio labeled red blood cells from the vascular space into the gastrointestinal lumen. The subsequent movement of the extravasated red blood cells within the gastrointestinal lumen secondard to peristalsis allows localization of the site of bleed along the gastrointestinal tract.

Indications

Localization of gastrointestinal bleeding sites.
Localization of non-gastrointestinal bleeding sites.

Study Description

Examination Time

Approximately 2 hours (Images acquired for approximately 1 to 1 ½ hours) (Variable depending on whether and when the site of bleeding is identified.)
The study may be terminated as soon as the bleeding site is identified and confirmed by a radiologist.
Imaging can be performed for up to 36 hours with a single injection of radiopharmaceutical. Usually the patient will not tolerate lying under the camera for more than three hours at a time. However, imaging may be stopped and restarted.

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
No BARIUM studies for 48 hours prior to exam (unless exam is an emergency)

Hepatobiliary/HIDA

Hepatobiliary/HIDA - Gallbladder

Overview

The Hepatobiliary Nuclear Medicine Study successively demonstrates hepatic perfusion, hepatocyte clearance, hepatic parenchymal transit and biliary excretion as the radiopharmaceutical moves from the injection site to the intestine.

Indications

Diagnosis of acute cholecystitis
Evaluation of extrahepatic biliary tract obstruction
Evaluation of the post-surgical biliary tract
Detection of bile leaks(No CCK used if gallbladder removed)
Diagnosis of biliary atresia and other congenitial anomalies of the biliary tract
Evaluation of liver transplants

Study Description

The patient receives a radiopharmaceutical intravenously. Serial images will be acquired at 5-15 minute intervals for approximately 1 hour. In some cases of a non-visualizing gallbladder, morphine may be administered to facilitate the contraction of the sphincter of Odi of the cystic bile duct allowing the gallbladder to fill and visualize. If the facility protocol, does not call for a morphine injection, then the images will still continue every 5-15 minutes for an additional 30 minutes. When the hepatobiliary scan approaches 60 minutes post injection and displays the appropriate normal pattern of the gallbladder “filling”, then kinevac (if applicable) will be given (0.02 ug/kg). During the injection of kinevac a 30 minute dynamic picture will be taken.

NOTE: If the kinevac injection is not requested for the procedure and the ordering doctor indicates “Hida without CCK” images will only be taken for the first 60 minutes (up to 90 minutes for gallbladder non-visualization) after the radiopharmaceutical is injected.

Examination Time

With CCK (Kinevac): 1 ½ hours (delayed images may be needed)
Without CCK (Kinevac): 1 hour

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
NPO (nothing by mouth) for a minimum of 4 hours to a maximum of 12 hours prior to exam
Patient off of narcotic drugs for 24 hours prior to exam
No BARIUM studies for 48 hours prior to exam
No CT CONTRAST (ORAL) for 4 hours prior to exam

Liver Hemangioma

Overview

The Hepatic Hemangioma Nuclear Medicine Study depicts the amount of perfusion (early images) and vascular space (delayed images) within hepatic lesions. Hemangiomas are distinguished by their relatively decreased perfusion and increased vascular volume compared to hepatic parenchyma and most other hepatic lesions.

Indications

Diagnosis of hepatic hemangiomas.

Study Description

The patient will have some blood drawn that will be used in the Red Cell tagging process. It takes about 45 minutes to tag the patient’s red cells with the radiopharmaceutical. The tagged cells will then be reinjected intravenously and the patient will wait for approximately 1 hour for the radiopharmaceutical to circulate and accumulate. The patient will then be brought into the imaging room for images that will be acquired for 45 minutes.

Examination Time

Approximately 2 ½ hours (Images acquired for approximately 1 hour).

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
None

Liver/Spleen

Overview

The Liver/Spleen Nuclear Medicine Study demonstrates the distribution of the intravascular mononuclear phagocyte system. The intravascular members of this system are cells that line the sinusoids of the liver (Kupffer cells), spleen and bone marrow.

Indications

Assessment of chronic liver disease.
Assessment of liver or spleen size and configuration.
Diagnosis of focal nodular hyperplasia.
Detection of accessory splenic tissue.

Study Description

The patient is brought into the department and a dose of a radiopharmaceutical is administered intravenously. After allowing 10 minutes for tracer circulation and absorption, images are obtained from several projections. Image acquisition will require approximately 30-45 minutes.

Examination Time

45 Minutes

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
None

Lung Aerosol

Overview

The Lung Aerosol Study, using DTPA, demonstrates the distribution of ventilation within the lungs in multiple projections. Tc-99-DTPA is effective, easy to use and gives a lower radiation dose to the mucosa of the lungs than other ventilation agents (Xenon).

The aerosol is breathed for a period of approximately 5 minutes to insure sufficient lung deposition is acquired. The length of the time the aerosol stays in the airspace depends on the permeability of the pulmonary epithelium. It then enters the vascular space where it is filtered by the renal system. The aerosol does not stay in the lungs as long in smokers because of the increased epithelium permeability seen in these patients. Oxygen should not be used during imaging unless it is necessary because of the patient’s condition.

The quality of the study can be degraded if some of the aerosol deposits on the bronchi and does not reach the alveoli.

Indications

Diagnosis of pulmonary embolism.
Evaluation of ventilation.

Study Description

Prior to the acquisition of a Lung Perfusion Scan, the patient will be instructed on the breathing protocol necessary for the ventilation. The patient will have a mouthpiece placed in their mouth making sure to keep a tight seal and a clip placed on their nose in order to prevent leakage of the radiopharmaceutical. The patient will be allowed to “practice breathing” to become accustomed to the mouthpiece and closed breathing system prior to the start of the radiotracer ventilation.

There is a constant supply of oxygen and the patient should not have difficulty breathing, however some patients become apprehensive and feel "trapped" by the system. If this should happen and the patient feels they cannot tolerate the study, the procedure can be interrupted at any point by hand signaling the technologist. It is very important that the patient does NOT try to remove the mask.

When adequate lung filling has occurred, approximately 4-5 minutes, the technologist will remove the mask and breathing system and a series of images will be acquired.

Examination Time

30-45 Minutes
1 ½ hours if in conjunction with “Lung Perfusion” (normal protocol majority of the time)

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.

A chest x-ray must be taken within 24 hours of the lung scan for comparison.
Rehearse the breathing procedure to assure optimal patient cooperation; instruct the patient to breathe normal through their mouth.
Contraindication: Patient with severe pulmonary hypertension, right to left shunt, pneumonectomy, and poor respiratory function.

Lung Perfusion

Overview

The macro-aggregated albumin perfusion nuclear medicine exam is very useful as an adjunct for evaluating regional pulmonary blood flow. The particles that are greater than 10 micrometers in size are trapped in the pulmonary alveolar capillary bed by a purely mechanical process. Areas of reduced perfusion are revealed by decreased photon density. The aggregated albumin particles are sufficiently fragile for erosion and fragmentation to reduce the particle size, thus allowing passage through the pulmonary alveolar capillary bed.

The fragments are then taken up by the reticuloendothelial system. Elimination from the lung occurs with a half-life of about five hours. This test is used in conjunction with the inhalation exam to rule out pulmonary emboli. If a defect is noted on the perfusion exam and is not seen on the same view in the aerosol study then an emboli is a high probability diagnosis. The aerosol will also show defects in the studies such as pneumonia, tumor, bronchiectasis and sometimes asthma.

Other conditions that might cause a defect in both studies are vasculitis, enlarged lymph nodes, COPD and neoplasm. All of these may cause a false positive perfusion exam, if it is interpreted without accompanying aerosol study and a chest x-ray. A chest x-ray must be obtained within 24 hours of the lung perfusion/aerosol study.

Indications

Diagnosis of pulmonary embolism.
Evaluation of regional pulmonary perfusion prior to lung reduction surgery.

Study Description

The patient will be injected intravenously with a radiopharmaceutical and asked to take deep breaths during infusion. Images will be taken shortly after. Injection should be done with the patient supine. Images will be taken from a variety of projections as the patient condition permits and will require 30-45 minutes. This test is used in conjunction with the aerosol inhalation exam.

Examination Time

30-45 Minutes
1 ½ hours if in conjunction with “Lung Aerosol/Ventilation” (normal protocol majority of the time)

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
A chest x-ray must be taken within 24 hours of the lung scan for comparison.
Contraindication: Patient with severe pulmonary hypertension, right to left shunt, pneumonectomy, and poor respiratory function.

Meckel's Diverticulum

Overview

The Meckel's Diverticulum Nuclear Medicine Study depicts the uptake of pertechnetate within the abdomen. As a small molecule with a single negative charge, pertechnetate is secreted into the stomach as well as any ectopic gastric mucosa.

Indications

Detection and localization of a Meckel's diverticulum containing functioning gastric mucosa.
Detection and localization of other pathologic structures containing gastric mucosa.

Study Description

The patient is brought into the imaging area and the radiopharmaceutical is administered intravenously. A series of images of the abdomen will begin approximately five minutes later and will continue intermittently for 45 minutes post injection. On occasion, imaging may be extended to 60 minutes.

Examination Time

1 hour 15 minutes

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
NPO (nothing by mouth) for at least four hours and better if NPO for 8 hours.
No intestinal irritants for three days prior to the exam. These include: barium, laxatives and aspirin.

MUGA - Gated Blood Pool - Rest

Overview

The resting electrocardiographic Gated Blood Pool Nuclear Medicine Study evaluates right and left regional ventricular wall motion and ejection fraction at rest. A radiotracer that is confined to the vascular space, such as Tc-99m red blood cells, is used to acquire images of the heart at multiple intervals throughout the cardiac cycle. These images are displayed dynamically to evaluate wall motion visually or are analyzed with region of interest to quantitate ventricular ejection fraction.

Indications

Evaluate ventricular regional wall motion.
Quantitate ventricular ejection fractions.
Monitor cardiotoxicity of doxorubicin.
Differentiate pulmonary and cardiac causes of dyspnea.

Study Description

The patient will have some blood drawn that will be used in the Red Cell tagging process. It takes about 45 minutes to tag the patient’s red cells with the radiopharmaceutical. The tagged cells will then be reinjected intravenously and serial images will be acquired 5-minutes after injection that will last 15 minutes.

Examination Time

1 Hour

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
Place three EKG leads on the patient.
Ensure good electrical contact. This can be done by preparing the skin with methyl alcohol and/or extra-fine sandpaper.
The right arm lead is placed in the region of the right axilla, the left arm lead in the region of the left axilla, and the left leg lead in the upper quadrant of the abdomen.

Myocardial Perfusion

Overview

The Myocardial Perfusion Nuclear Medicine Study demonstrates the distribution of blood flow and perfusion to the mycocardium at stress and rest.

Indications

Detection of coronary artery disease.
Documentation of myocardial perfusion abnormalities before and after interventional therapy.
Evaluating the success of Coronary Angioplasty (PTCA) or Coronary Bypass Surgery (CAB).

Study Description

When the patient arrives they are first taken to get a double port IV started (someone at the hospital usually does this). After the IV is started, the nuclear medicine technologist will meet the with the patient, explain the procedures and give them an injection of Tc-99m-Cardiolite (Sestimibi).

The patient will then wait approximately 30 minutes before they are taken for their first set of pictures, which lasts approximately 12-30 minutes. After taking the first set of pictures, the patient is taken to another part of the hospital to await the stress portion of their test.

Respiratory will get the patient when they are ready. The patient will be hooked up to an EKG, oxygen saturation monitor (if desired), and blood pressure equipment.

The doctor will come into the room and the stress test will begin.

Treadmill Stress Testing

A target heart rate needs to be calculated before the stress test begins.
The treadmill protocol (used by other facilities) is at the start of each three minute stage. The treadmill should increase in speed and grade (Bruce Protocol).
The goal and recommended time to inject the second dose of Tc-99m- Cardiolite (Sestimibi) is not less than 85% of the target heart rate (220 - patient's age * 85%).
After the second injection, the patient has to continue to exercise for at least one minute.
When the treadmill is finished, the patient is monitored and EKG's are taken.
After the monitoring is complete and the patient has recovered from the stress testing, the patient is returned to the waiting room where they will wait for a minimum of 30 minutes before taking the second set of pictures. The second set of pictures will also last approximately 30 minutes.

Adenosine/Lexiscan Stress Testing

Aminophylline or Theophylline needs to be on hand.
The patient lies on a bed (the head can be slightly raised).
The adenosine/lexiscan is injected and a second dose of Tc-99m-Cardiolite (Sestimibi) will be injected with the stress agent.
When the injection is finished, the patient is monitored and EKG's are taken. After the monitoring is complete and the patient has recovered from the stress testing, the patient is returned to the waiting foom where they will wait approximately 30 minutes before taking the second set of pictures. The second set of pictures will also last approximately 12-30 minutes.

The patient is now free to go home, eat, drink and continue daily routines.

Examination Time

Rest - Initially, 5-10 minutes for injections. Then patient must wait approximately 30 minutes before the first set of images can be taken. Imaging takes approximately 12-30 minutes.
Stress - Intially, 20-30 minutes to complete stress testing and receive second injection. Then the patient must wait approximately 30 minutes before the second set of images can be taken. Imaging takes approximately 12-30 minutes.

Patient Preparation

Ensure patient is not pregnant or breast-feeding
NPO (nothing by mouth) for 4 hours prior to exam (patient is allowed water)
No caffeine or caffein containing medications 24 hours prior to exam (No coffee, decaf coffee, tea, herbal tea, soft drinks, chocolate) (Note: Caffeine-free and decaffeinated beverages also contain small amounts of caffeine.)
No Theophylline for 48 hours prior to exam
No Aggrenox or Persantine for 72 hours prior to exam
No beta blockers for 24 hours
Wear comfortable clothes and shoes with no metal on the shirt
If the patient uses inhalers, they should bring them to the stress test.

Parathyroid

Overview

The Parathyroid Study depicts hypertrophied parathyroid tissue, due to uptake of Tc-99m-sestamibi in the mitochondria of hyperactive cells. The main function of the parathyroid is to make, store, and secrete PTH. PTH regulates the level of calcium and phosphorus in the blood. The parathyroid and thyroid tissue takes up Tc99m-Sestamibi. The clearance rate of the tracer is faster in normal thyroid or parathyroid than in abnormal parathyroid.

Indications

Detect and localize parathyroid adenomas.

Study Description

A radiopharmaceutical is injected intravenously and allowed to circulate for 10 minutes. The patient is brought into the imaging room and positioned supine on the imaging table with a pillow under the mid back to hyperextend the neck. A 10-minute image is taken and the patient is allowed to leave. (If SPECT, allow 45 minutes for early exam time.) The patient will then return 3-hours post injection for a repeat image that will last 10 minutes.

Examination Time

Initially, 30-45 Minutes (with SPECT-45 minutes)
Delayed imaging at three hours: 15 minutes

Patient Preparation

Ensure the patient is not pregnant or breastfeeding
None

Renal - Captopril

Renal Study: Captopril

Overview

Significant renal artery stenosis (60-75%) decreases afferent arteriolar blood pressure, which stimulates renin secretion by the juxtaglomerular apparatus. Renin effects the production of angiotensin I, which is acted on by ACE to yield angiotensin II. Angiotensin II induces vasoconstriction of the efferent arterioles, which restores glomerular filtration pressure and rate. ACE inhibitors, such as captopril and enalapril, prevent the production of angiotensin II, so that in patients with renal artery stenosis and compensated renal function, preglomerular filtration pressures are no longer maintained.

Indications

Diagnosis of renovascular hypertension.
Diagnosis of renal artery stenosis.

Study Description

After an IV is started, the partient is positioned on the imaging table with the camera detector adjusted to image from the posterior projection. The radiopharmaceutical will be administered and a dynamic study (a rapid series of short duration images) will immediately be acquired to assess the blood flow to the kidney. Following this, a series of dynamic (continous) images will be taken immediately for 30 minutes.

After the picture is obtained, the patient will be set in a designated waiting area and a baseline blood pressure will be taken. (If the baseline blood pressure is less than 140/70, consult the physician or radiologist about continuing the exam).

After the baseline blood pressure is taken, the patient will receive an oral Captopril. Sitting blood pressures should be taken at 15 minute intervals for one hour. The patient is then taken for another image just like the one that was previously acquired for 30 minutes.

Examination Time

Approximately 3 1/4Hours

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
No solid food 4 hours prior to exam
Well hydrated prior to exam
Off ACE inhibitors and Angiotensin II receptor blockers (ARB’s) for 3 to 7 days prior to study (longer half-life drugs discontinued for 7 days)
Examples:
- Off Captopril 3 days
- Off of Lisinopril, Benzapril, Enalapril, Irbesartan, Candesartan, Losartan, or Valsartan for 5 days
Off diuretics for 3 to 5 days prior to study
Off other Antihypertensive drugs (beta blockers & calcium channel blockers) the night before the exam
The patient should void before beginning the study

Renal - Glomerular Filtration

Renal Study: Glomerular Filtration

Overview

The Renal Glomerular Filtration Study images Tc-99m-DTPA as it passes through the vascular system, renal glomeruli, renal tubules and collecting system. This series of images allows the sequential evaluation of renal perfusion, renal clearance by glomerular filtration, renal parenchymal transit time and passage of urine through the renal collecting system. In addition, the study provides high contrast images for evaluation of renal anatomy.

Indications

Evaluation of internal perfusion and function.
Evaluation of renal trauma.
Evaluation of renal transplants.

Study Description

The patient is positioned on the imaging table with the camera detector adjusted to image from the posterior projection. The radiopharmaceutical will be administered and a dynamic study (a rapid series of short duration images) will immediately be acquired to assess the blood flow to the kidney. Following this a series of dynamic (continuous) images will be taken immediately for 30 minutes.

Examination Time

45 Minutes

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
Well hydrated prior to exam
The patient should void before beginning the study

Renal - Lasix

Renal Study: Lasix

Overview

Diuretic renography provides a noninvasive method to distinguish collecting system dilation due to a true obstruction from the secondary to an atonic, but patent collecting system.

Indications

Distinguish between obstructive hydronephrosis and nonobstructive dilation due to vesicoureteral reflux.
Evaluate obstruction of the ureteropelvic junction.
Urinary tract infections.
Congenital malformations.
Evaluation if there has been a previous renal collecting system obstruction.
Evaluation of noncompliant bladder.

Study Description

The patient is positioned on the imaging table with the camera detector adjusted to image from the posterior projection. An IV will be started and the radiopharmaceutical will be administered. A dynamic study (a rapid series of short duration images) will immediately be acquired to assess the blood flow to the kidney(s). Following this a series of dynamic (continuous) images will be taken immediately for 40 minutes. Half way into the images an injection of Lasix (Furosemide) will be administered intravenously and imaging will continue.

Examination Time

1 hour

Patient Preparation

Ensure the patient is not pregnant or breastfeeding
The patient should be well hydrated prior to the exam
The patient should be off diuretics the night before the exam
The patient should void before beginning the study

Renal - Tubular Function

Renal Study: Tubular Function

Overview

Tc-99m-DMSA is cleared from the blood into the renal tubular cells, but is not secreted into the tubular lumen. Thus, the Tubular Function Study depicts tubular function without interference from radioactivity in the collecting system.

Indications

Diagnosis of acute and chronic pyelonephritis.
Differentiation of renal masses from normal variants.
Quantification of regional renal function.
Evaluation space-occupying lesions.
Functioning pseudotumors such as columns of Bertin.

Study Description

The patient is positioned on the imaging table with the camera detector adjusted to image from the posterior projection. The radiopharmaceutical will be administered and a dynamic study (a rapid series of short duration images) will immediately be acquired to assess the blood flow to the kidney. The patient will then leave and return in 3 hours. Images will be taken for 15 minutes when they return.

Examination Time

Initially, 15 minutes for injection of the radiopharmaceutical.
Delayed images at 3 hours. 15 minutes for image acquisition.

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
None

Renal - Tubular Secretion

Renal Study: Tubular Secretion

Overview

The Renal Tubular Secretion Study images Tc-99m-MAG3 as it passes through the vascular system, renal tubular cells, tubular lumens and collecting system. This series of images allows the sequential evaluation of renal perfusion, renal clearance by tubular secretion, renal parenchymal transit time and passage of urine through the renal collecting system. In addition, the study provides high contrast images for evaluation of renal anatomy.

Indications

Evaluation of renal perfusion and function.
Evaluation of renal trauma.
Evaluation of renal transplants.

Study Description

Examination Time

45 Minutes

Patient Preparation

Ensure the patient is not pregnant or breastfeeding
The patient should be well hydrated
The patient should void before beginning the study.

Testicular/Scrotal

Overview

Scrotal imaging may be a useful adjunctive test to differentiate the causes of a swollen or painful testicle. Essentially, this entails differentiating acute testicular torsion, a surgical emergency, from acute epididymo-orchitis, which may be treated conservatively with antibiotic therapy.

Indications

Differentiating acute testicular torsion and acute epididymo-orchitis.
Evaluation of hydrocele spermatocele tumor abscess.
Evaluation of chronic epididymitis.

Study Description

The patient is positioned supine on the imaging table. A towel is placed under the testes to support and separate them. The penis is taped upward on the lower abdomen. The radiopharmaceutical is injected intravenously and a dynamic study (a rapid series of short duration images) is acquired to evaluate the patency of blood flow to the testes. Following the dynamic flow study, static images are acquired immediately and then again 15 minute post-injection. The procedure will take 45 minutes to complete.

Examination Time

Approximately 45 Minutes

Patient Preparation

None

Three Phase Bone

Overview

This procedure differs from a total body bone scan in that images are taken of a particular area of interest in both an arterial phase, a cellular (blush/blood pool) stage, and a normal static stage.

Indications

Determination of abscesses such as osteomyelitis vs cellulitis of the soft tissue.
Determining post-surgical necrosis of the bone.
Determining aseptic necrotic areas in children.
Diagnosis of early skeletal inflammatory disease.
Evaluation of musculoskeletal trauma.
Evaluation of painful joint prosthesis.
Diagnosis of Reflux Sympathy Disease (RSD).

Study Description

The patient is transported to the imaging area and positioned under the camera with the suspected area and the corresponding contralateral area both in the camera field of view.

The radiopharmaceutical is then injected and dynamic images (a series of rapid, short duration images) are obtained to monitor and compare the blood flow to the suspected and normal area. Then a series of static images (individual pictures) are taken of the cellular or blush/blood pool phase of tracer distribution. These portions of the study will take approximately 15-30 minutes.

The patient may then leave and return 3 hours later for the delayed images that will take approximately 30 minutes.

Examination Time

Initially 30 minutes for the perfusion and blood pool components.
3 hours later, 30 minutes for image acquisition.

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
Well hydrated prior to exam.

Thyroid (I-123) with Uptake

Thyroid: Iodine-123

Overview

The Thyroid Imaging Study with radioiodine demonstrates the distribution of functioning thyroid tissue, including ectopic tissue, since thyroid tissue is the only tissue that concentrates large amounts of iodine. The Thyroid Uptake Measurement measures the metabolic activity of the thyroid gland as reflected in its extraction of iodine from the blood.

Indications

Evaluation of palpable nodules.
Evaluation of an abnormal gland with palpation, but without definite nodules.
Evaluation of patients who had irradiation of the head and neck in childhood with or without palpable nodules.
Evaluation for ectopic thyroid tissue, e.g. struma ovarii (image over pelvis) and lingual thyroid (image upper neck and jaw).
Diagnosis of Graves's disease
Evaluation of subacute and chronic thyroidistis
Evaluation of patients who had radiation of the head and neck in childhood with or without palpable nodules
Evaluation of primary congenital hypothyroidism

Study Description

The patient is given the radiopharmaceutical (I-123) orally. Images with uptake results are taken at 6 and/or 24 hours after ingestion of the capsule(s). (Dependent on the location, time will vary of when uptakes and/or imaging will be completed. Please see specific hospital Schedule Guidebook.) During uptake measurement portion the camera/uptake probe will take counts over the patient thigh and neck for 2-3 minutes each. During the imaging portion the camera is positioned over the patients neck while they lay on the table, each image can take 5-10 minutes.

Examination Time

Initially, 15 minutes for radiopharmaceutical administration.
Imaging with uptake at 6 and/or 24 hours for 30 minutes each.
Uptake only at 24 hours (if applicable-only done when imaging/uptake is done at 6 hours)

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
Off anti-thyroid medications for 4-7 days
Off Thyroxine (T4 therapy) for 4-6 weeks
Off Triiodothyronine (T3 therapy) for 2 weeks
No contrast studies (IVP's, CT's, etc.) 4 weeks prior to exam
Off Amiodarone (anti-arrhythmic drug) for 3-6 months
Off Iodine containing multivitamin for 2 weeks
Off kelp and iodine solution (Lugols) for 2 weeks
Off Expectorants (cough/cold medicine) for 2 weeks
No Topical iodine (surgical skin prep) for 2 weeks
NPO (nothing by mouth) 6 hours before and for 1 hour after the ingestion of the radiopharmaceutical
Bring list of medications and a copy of thyroid lab results (if applicable)

Thyroid (Tc-99m)

Thyroid: Tc-99m-Pertechnetate

Overview

The Thyroid Nuclear Medicine Study with Tc-99m-Pertechnetate demonstrates the distribution of tissues that take up anions. Such tissues include the thyroid, salivary glands and stomach.

Indications

Useful in evaluation of the thyroid position, size and internal anatomy.
Evaluation of palpable nodules to determine if they are intra or extra thyroidal.
Evaluation of abnormal gland with palpation, but without definite nodules.

Study Description

A radiopharmaceutical is injected intravenously and allowed to circulate for 15 minutes. The patient is brought into the imaging room and positioned supine on the imaging table with a pillow under the mid back to hyperextend the neck. Images are taken from several projections and require 30-45 minutes. Because the position is somewhat uncomfortable, the patient is permitted to move between images.

Examination Time

1 Hour

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
No contrast studies (IVP's, CT's, etc.) 4 weeks prior to exam

Total Body Bone

Overview

The accumulation of radionuclides in bone is related to the rate of bone metabolism. The localization of the various bone imaging agents is due to exchange with ions in the bone called Heterionic exchange. The bone agents can localize in soft tissue areas demonstrating calcification in infarction (seen most in the heart area), inflamation, trauma and tumors.

Indications

Detection of bone metastases.
Skeletal pain of questionable etiology.
Evaluation of elevated alkaline phosphates or other bone enzymes.
Evaluation of primary benign and malignant bone lesions.
Bone viability.
Evaluation of the response of Paget's disease to treatment.

Study Description

A radiopharmaceutical is injected intravenously and allowed to circulate 3 hours before imaging is started. This time is required for the tracer to accumulate in the osseous tissue. Images are then obtained of the entire skeleton from anterior and posterior projections. Additional oblique views may be acquired if indicated by patient history or complaints. Image acquisition requires approximately 1 hour. The patient will need to remain still during acquisition of each image but will be allowed movement between images as needed for comfort.

Examination Time

Initially, 15 minutes for injection of the radiopharmaceutical.
3 hours later, 1 hour for image acquisition.

Patient Preparation

Ensure the patient is not pregnant or breastfeeding.
Well hydrated prior to exam.