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Procedures Flashcards

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1
Q

Bone Scan- Radiopharmaceutical (t1/2, E, Camera)

A

99mTc-MDP (Methylene-Diphosphonate)
99mTc- HDP (Hydroxymethylene Diphosphonate)

T1/2- 6hrs, E- 140keV, Camera- LFOV; LEHR or LEAP

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2
Q

Bone Scan- Dose & Administration

A

20-30mCi (740-1110MBq)

intravenous, Straight Stick

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3
Q

Bone Scan- Patient Prep

A

Hydrate (2x 8oz water) & Void Frequently

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4
Q

Bone Scan- Imaging Parameters

A

2hr Delay After Admin, Void Bladdder Immediately Prior, Patient Supine

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5
Q

Bone Scan- Views/Images

A 
Spot &/or Whole Body:
Phase 1- Vascular (60sec) Dynamic
Phase 2- Soft Tissue (Blood Pool) @ 5min
Phase 3- Delayed (Bone); 2-3hrs post
Phase 4- 24-72hr Delay
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6
Q

Bone Scan- Image/Views Counts

A

Dyanmic- 2-4sec for 60sec w/ immediate blood pool (500,000cts)
Static- Extremities = 200,000-300,000cts; Appendicular= 150,000-300,000cts; Axial= 500,000-800,000cts; Foot= 75,000cts; Whole Body = 10-14cm/min (body Contour), 2.5million cts.
SPECT: LEHR; Pt. supine, knees bent; Body Contour; 64x64 or 128x128; 120-128 views, 360deg.; High cts. = High Res.; 64 steps, 20-25sec/stop

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7
Q

Bone Scan- Indications

A

Evaluate and Detect: Metastatic Disease, Neoplasm/Lesions, Osteomyelitis & Prosthesis Loosening, Occult Fractures & Pain & Pagets, Viability for Bone Graph & Surgery, Response to Therapy, Abnormal Findings X-ray/Labs

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8
Q

Bone Scan- Contraindications

A

Barium Contrast; Tc based scan recently

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9
Q

Bone Scan- Results

A

Normal: Symmetric Uptake, Kidneys light and bladder bright, Epiphyseal Plates, 3-5days post injury = Fracture, Nasopharynx Uptake

Abnormal: Asymmetric Uptake, “SuperScan”, Metabolic Disease (Axial Skeleton), Cold Lesions= Cancer, Osteomyelitis = ‘Hot’ increase uptake, Cellulitis = ‘Hot’ increased uptake, Prosthesis= ‘Hot’ increased uptake, Arthritis - joints light

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10
Q

Lung Perfusion (Q)- Radiopharmaceutical, t1/2, E, Camera

A

99mTc- MAA (MacroAggregated Albumin)
99mTc- HAM (Human Albumin Mesospheres)

T1/2- 6hrs, E- 140keV, Camera- LFOV; LEHR or LEAP

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11
Q

Lung Perfusion (Q)- Dose & Administration

A

2-6mCi (74-222MBq)
Particles- 10-90micrometers, 75,000-700,000 (total)
*Infant: <50,000 (less for R-L Shunts)

Intravenous, Lift Arm to Circualte, No Re-Blush

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12
Q

Lung Perfusion (Q)- Patient Preparation

A

Chest X-Ray w/in 24hrs

If in conjunction w/ Ventilation (V), V FIRST

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13
Q

Lung Perfusion (Q)- Imaging Parameters

A

Patient Supine, Start Computer prior to injection

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14
Q

Lung Perfusion (Q)- Views/Images

A

Static: RAO, RLAT, RPO, LPO, LLAT, LAO, Ant

R-L Shunt: Ant, Post, RLAT, LLAT, Whole Body Sweep

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15
Q

Lung Perfusion (Q)- Counts

A

Dyamic Flow - Immediate, 1-3sec/frae, 60-120sec
Static- (post flow) 500,000-1million cts.
R-L Shunt- immediate, whole body sweep

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16
Q

Lung Perfusion (Q)- Indications

A

Evaluate & Detect: Pulmonary Embolism, Deep Vein Thrombosis, Chest Pain, Dyspnea (low SpO2), Right-to-Left Shunt, & Chronic Lung Disease
Evaluate Lungs for surgy &/or Transplant

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17
Q

Lung Perfusion (Q)- Contraindications

A

Pulmonary Hypertenson, Active Pneumonia, R-L shunt, Hypersentivity to human Serum Albumin

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18
Q

Lung Perfusion (Q)- Results

A

Normal: Homogenous Uptake of skeleton, breasts, heart, apical activty < base (patient upright)
Abnormal: Segmental/Wedge shaped decrease in activity, high Mismatch w/ Vent. = PE, Stripes = COPD, Matching Defects w/ Vent. = COPD, Large lungs = Emphysema, Lack of Activity in Base = Pleural Effusion, 1 Lung = Problem, Decrease V/Q = Pneumonia

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19
Q

Lung Ventilation (V)- Radiopharmaceutical GAS (t1/2, E, Camera)

A

133Xenon
t1/2: 5.3d
E: 81 keV
LFOV, LEHS

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20
Q

Lung Ventilation (V)- GAS Dose & Administration

A

10-20mCi Xenon133

Inhalation

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21
Q

Lung Ventilation (V)- GAS Patient Preparation

A

Chest X-ray w/in 24hours

If in conjunction with Perfusion (Q), Vent. first

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22
Q

Lung Ventilation (V)- GAS Imaging Parameters

A 
Seated Upright (camera Posterior)
Negative Pressure room, Inject/Pump gas as patient breathes in, Start Computer Simultaneously acquire Dynamics, Mask on for 60sec or 4 frames
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23
Q

Lung Ventilation (V)- GAS Views/Images

A

Dynamic flow 20-60sec/frame
Static: RAO, RLAT, RPO, Post, LPO, LLAT, LAO

Wash-In (hold); full deep breath & hold
Equilibrium; breath normal 3-5min
Wash-Out; breath normal 2-3min

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24
Q

Lung Ventilation (V)- GAS Indications

A

Evaluate & Detect: Pulmonary Embolism, Chronic Obstructive Pulmonary Disease, Dyspnea (obstructed//constricted airway), Chest Pain, Low SpO2, ARDS, Carcinoma

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25
Lung Ventilation (V)- GAS Contraindications
Active Pneumonia, Other Disease
26
Lung Ventilation (V)- GAS Results
Normal- Uniform Washes, Cardiac Notch Abnroml- Decreased activity, Mismatch V//Q, Patchy Equilibrium= COPD/ Emphysema, Decreased V & slight decreased Q = Bacterial Pneumonia, Liver = Alcoholism
27
Lung Ventilation (V)- AEROSOL Radiopharmaceutical (t1/2, E, Camera)
99mTc- DTPA (Diethylenetriamine Pentaacetate) 6hrs, 140keV LFOV, LEHR
28
Lung Ventilation (V)- AEROSOL Dose & Administration
25-40mCi | PO
29
Lung Ventilation (V)- AEROSOL Patient Preparation
Chest X-ray w/in 24hrs | If in conjunction w/ Perfusion (Q), Vent. First
30
Lung Ventilation (V)- AEROSOL Imaging Parameters
``` Seated Upright (camera Posterior) Inject in Nebulizer, clamp nose, ~10mL/min of air, 1mCi inhalaed, breathe normal for 5min ```
31
Lung Ventilation (V)- AEROSOL Views/Images
Dynamic Flow 20-60sec/frame | Static: RAO, RLAT, RPO, Post, LPO, LLAT, LAO; 150,000cts
32
Lung Ventilation (V)- AEROSOL Indications
Evaluate & Detect: Pulmonary Embolism, Chronic Obstructive Pulmonary Disease, Dyspnea (obstructed/constricted airway), Chest Pain, Low SpO2, ARDS, Carcinoma
33
Lung Ventilation (V)- AEROSOL Contraindications
Active Pneumonia, Other Disease
34
Lung Ventilation (V)- AEROSOL Results
Normal: Pharynx bright, Swallowed saliva = stomach, facial from mask, Trachea & Bronchi easily visualized Abnormal: Decreased Activity, Accelerated Clearance, Only1 Lung; Mismatch V/Q, Decreased V & Slight Decreased Q = Bacterial Pneumonia
35
Hepatobiliary (HIDA) Scan- Radiopharmaceutical (t1/2, E, Camera)
99mTc-IDA (Iminodiacetic Acids - Mebrofenin) 6hrs 140keV LFOV; LEHR
36
Hepatobiliary (HIDA) Scan- Dose & Administration
3-15mCi (~10mCi - based on Serum Bilirubin levels) | Intravenous
37
Hepatobiliary (HIDA) Scan- Patient Preparation
NPO 2-4hrs (no >24hrs), D/C Opiates 6-12hrs
38
Hepatobiliary (HIDA) Scan- Imaging Parameters
Patient Supine | Liver in Upper LEft Corner FOV
39
Heptobiliary (HIDA) Scan- Views/Images
Flow/Dynamic - immediate Sequential Statics every 5min for 45-60min Ant, RAO, RLAT, LAO
40
Hepatobiliary (HIDA) Scan- Views/Images Counts
Flow- 2sec/frame for 60sec & immediate post injection Dyn- 60sec/frame for 60-90min; Pausse @ 30-45minif GB & Bowel Static- Immediate, every 5min up to 30min, Every 110-15min; 90-180sec
41
Hepatobiliary (HIDA) Scan- No Gallbladder?
W/in 40-60min Morphine Sulfate (Astramorph/Duramorph) -Contracts Sphincter of Oddi -Dose: 0.04-1mg/kg Intravenous over 2-3min -Contraindication: neonate, decrease respi., allergy, pancreatitis -Adverse: decrease respir, sweating, constipation -Reversal: Naloxone
42
Hepatobiliary (HIDA) Scan- No Intestines?
Sincalide (Kinevac) - Cholecystokinin (CCK) -Contracts Pyloric Sphincter/ Relax Oddi -Dose: 0./01-0.02ug/kg Intravenous over 3-5min, before tracer (30-60min) *not given before Morphine*; Dilute in 10mL Saline & infuse 30-40min —Imaging 60min post CCK —-Contraindications: hypersensitivty, obstrution —-Adverse: nausea, pain, dizziness, flushing
43
Hepatobiliary (HIDA) Scan- Infant/Neonate- Pharmaceutical & Dose
Phenobarbital (Lumina) pre-treatment for assessment of Biliary Atresia 5mg/kg/day for 3-5days prior
44
Hepatobiliary (HIDA) Scan- Infant/Neonate- Indications
Differentation b/w biliary Atresia (block of ducts from Liver to GB) from other causes of jaundice
45
Hepatobiliary (HIDA) Scan- Infant/Neonate- Contraindications
Allergy to Barbituates and/or Decrese in Respiration
46
Hepatobiliary (HIDA) Scan- Infant/Neonate- Results
Normal: enhanced excretion of tracer w/ Patent Bile Ducts, excretion w/in 24hrs Abnormal: not excreted into Bowel = Biliary Atresia
47
Hepatobiliary (HIDA) Scan- Indications
Evaluate Right Upper Quadrant Pain, Cholecystitis, Biliarycoli, Biliary Diyskinesia, Gallbladder Function, GB Surgery/Perforation, Hepatic Function, Liver Anatomy
48
Hepatobiliary (HIDA) Scan- Contraindications
Recent food, No CCK//Morphine, Known Obstruction
49
Hepatobiliary (HIDA) Scan- Results
Normal Liver in 5-15sec, Ducts & GB in 5-10m, Cardiac Blood Pool in 5-10m, Intestines in 10-60m, Hepatic Artery, Liver Diminishes & GB fills, GBEF >35% GBEF (%) = {[(max GB cts - bkg)-(min GB cts- bkg)] / (maxGB cts- bkg)} x 100
50
Hepatobiliary (HIDA) Scan- Abnormal
No GB in 60min, No GB but bladder in 60m, No Bowel w/ good Hepati in 60m, No Liver, Cardiac Blood Pool longer than 5-10m, No Bowel w/in 24hr = Biliary Dyskinesia (Infant), GBEF <35% GBEF(%) = {[(max GB cts - bkg) - (min GB cts - bkg)] / (max GB cts - bkg)} x 100
51
Gastric Emptying- Radiopharmaceutical (t1/2, E, Camera)
99mTc- Sulfur Colloid (SC) 6hrs 140keV LFOV, LEHR
52
Gastric Emptying- Dose & Administration
0.5-1mCi (18.5-37MBq) | Injected & Mixed in ~118mL (4oz) Egg Whites (Scrambled), w/ 2 slices toasted White Bread, 120mL Water, 30g Jam/Jelly
53
Gastric Emptying- Patient Preparation
NPO 4-12hrs
54
Gastric Emptying- Imaging Parameters
Immediate (w/in 10min of finishing meal) | Patient Supine
55
Gastric Emptying- Views/Images
Statics & Dynamic: Ant, Post, LAO Dynamic- immediate, 60s/image for 60-90m (hourly intervals up to 4hrs) Static- immediate, 60-120s for 50,000cts; if no Dyn. Image every 15min
56
Gastric Emptying- Data Processing
ROI around entire stomach, Ant & Post, avoid activity from small bl. Iliac Crest Marker. Time-Activity curve from geometric mean of gastric cts
57
Gastric Emptying- Adjunct
Reglan (contract stomach)
58
Gastric Emptying- Indications
Determine delayed emtying quatity & rate | Evaluate: tumors/surgery, Nausea/Vomiting, Weight Loss, Gastric therapy, Gastroparesis, Abdmonial Distension/fullness
59
Gastric Emptying- Contraindications
Allergy to Eggs (use Oatmeal/Chicken Liver)
60
Gastric Emptying- Results
Normal- 50% w/in 32-120min (90min), 63% w/in 1hr, End study before 60min if >95%; Infants 50% 25-48m (formula) or 60-90m (milk) Abnormal- Little/No movement, Rapid Emptying ‘Dumping Syndrome’, or Delayed ‘Gastroparesis’
61
Meckel’s Diverticulum- Radiopharmaceutical (t1/2, E, Camera)
99mTc- Pertechnetate (Tc-O4) 6hrs 140keV LFOV, LEHR
62
Meckel’s Diverticulum- Dose & Administration
10-15mCi, Intravenous
63
Meckel’s Diverticulum- Patient Preparation
NPO 2-12hrs No Barium Contrast or Laxatives Adjunct Meds
64
Meckel’s Diverticulum- Patient Prep. W/ Adjunct Meds
Pentagastrin (Peptavlon), Sub-Cutaneous: NPO 8hrs, Admin 15-20m prior, 6ug/kg Cimetidine (Tagamet), Intravenous or PO: 2d prior, 300mg 4x/d; Children 20mg/kg/d & Neonate 10-20mg/kg/d Glucagon, 50ug/kg IV, 10m after TcO4
65
Meckel’s Diverticulum- Imaging Parameters
Patient Supine Enhance Visualization w/ Pentagastrin - Stims Gastric Secretion Enhance Visualization w/ cimetidine - Retains TcO4 Enhance Visualization w/ Glucagon - Relaxes/Slows Peristalsis = Increased Tc-O4 uptake
66
Meckel’s Diverticulum- Views/Images
Ant, Post, RLAT, LLAT, RAO, LAO Statics: immediate, every 30-60s for 30-60m Flow/Dynamic: 1image every 5m up to 30m
67
Meckel’s Diverticulum - Images/Frames/Counts
Flow- 1-5sec/frame for 1min Dynamic- 15s/frame for 239m or 1m/frame for 15m Statics- ~500,000-1million cts/image
68
Meckel’s Diverticulum- Indications
Localization of Meckel’s Detection of GI Bleed Evaluate positive Guaiac Test, Abdominal Pain, Bleed, Twisting Bowel *More prevalent in Males; 25% have rectal bleeds*
69
Meckel’s Diverticulum- “Rules of Two”
Occurs in 2% of population, w/in 2ft of ileocecal valve, ~2” long, symptomatic by age 2
70
Meckel’s Diverticulum- Results
Normal: Increased GI uptake & Renal in 10-20m decreasing as study progresses, Bladder increases w/ time Abnormal: Meckel’ w/ functioning Gastric Mucosa in 10-15m & stomach activity at sane time (in Right Lower Quadrant), remains in same position despite peristalsis
71
Gastrointestinal Bleeding- Active Bleed- Radiopharmaceutical (t1/2, E, Camera)
99mTc- Sulfur Colloid (SC), leaves blood pool rapidly (RUG blocked by increased Liver uptake) 6hrs 140keV LFOV, LEHR
72
Gastrointestinal Bleeding- Active Bleed- Dose & Administration
99mTc-SC 10-20mCi Intravenous (while under camera)
73
Gastrointestinal Bleeding- Active Bleed- Patient Preparation
None
74
Gastrointestinal Bleeding- Active Bleed- Imaging Parameters
Patient Supine
75
Gastrointestinal Bleeding- Active Bleed- Views/Images
Anterior from bottom of heart to lower Bowel, RAO & LAO Rapid sequental images as tracer admin. (Dynamic) Short Static images every 5min up to 60-90m
76
Gastrointestinal Bleeding- Active Bleed- Counts/Frame
Flow- 2-5sec/frame, 60-180sec Dynamic- post Flow, 60sec/frame, 1hr Statics- 500,000-1mill cts
77
Gastrointestinal Bleeding- Active Bleed- Indications
Detect and Locate Bleeding Sites (active or intermittent) | Detect and Locate Secondary Blood Loss (Blood Pool)
78
Gastrointestinal Bleeding- Intermittent Bleed- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Perchlorate RBCs (In-Vivo- Phosphate= lesser option) (In-Vitro- UltraTag) - remains in blood pool for delays 6hrs 140keV LFOV, LEHR
79
Gastrointestinal Bleeding- Intermittent Bleed- Dose & Administration
20-50mCi, Intravenous while under the Camera
80
Gastrointestinal Bleeding- Intermittent Bleed- Patient Preparation
None; Collect blood w/Heparin Syringe
81
Gastrointestinal Bleeding- Intermittent Bleed- Imaging Parameters
Patient Supine
82
Gastrointestinal Bleeding- Intermittent Bleed- Views/Images
Anterior from bottom of heat to Lower Bowel, RAO & LAO Rapid Sequental images as tracer admin (Dynamic) Short Static images every 5min up to 60-90m *Delayed 4 & 24hr if nothing seen*
83
Gastrointestinal Bleeding- Intermittent Bleed- Counts/Image
Flow- 2-5sec/frame, 60-180s Dynamic- post Flow, 60s/frame, 1hr Statics- 500,000-1million counts
84
Gastrointestinal Bleeding - Intermittent Bleed- Indications
Detect & Locate Bleeding Sites (active or intermittent) | Detect & Locate Secondary Blood Loss (Blood Pool)
85
Gastrointestinal Bleeding- Results
Liver/Spleen Uptake = Clears blood ~12-15m Normal: w/RBCs, Liver Spleen, Abdominal Vessels, kidneys, Bladder, Gential Organs & Stomach, high bkg activity, site localization impaired Abnormal: progressive tracer accumulation = bleed, increased focal uptake (blood pool), Focal uptake moves thru Bowel Loop; w/Tc-SC area with active bleeding increases within first 5m and increased intensity as bkg decreases
86
Liver/Spleen Scan- Radiopharmaceutical (t1/2, E, Camera)
99mTc- Sulfur Colloid (1um) 6hrs 140keV LFOV, LEHR
87
Liver/Spleen Scan- Dose & Administration
5-10mCi (185-370MBq) | Intravenous (under camera for Flow)
88
Liver/Spleen Scan - Patient Preparation
None; no Barium Contrast prior
89
Liver/Spleen Scan- Imaging Parameters
Patient Supine | 85% Liver, 10% Spleen, 5% Bone Marrow
90
Liver/Spleen Scan- View/Images:
Ant., Post., RLAT, LLAT, RAO, LAO, RPO, LPO Flow w/ injection if needed, allow sufficient time before begining Statics (10-15m) Reference Marker Right Coastal Margin Breath-holding View in Ant to assess motility of Liver SPECT = abnorms/artifacts visible
91
Liver/Spleen Scan- Images/Counts
Flow- 1-3sec/frame for 1min | Statics - 350k-700k counts
92
Liver/Spleen Scan - Indications
Determine size, configuration & position (Hepatomegaly/Splenomegaly) Detection of Tumors, Hematomas, Cysts, Abscesses, Trauma Evaluation of functional liver diseases (cirrhosis & hepatitis)
93
Liver/Spleen Scan- Contraindications
Colloidal Reaction, Pulmonary Hypertension
94
Liver/Spleen Scan- Results
Normal: ( Liver= above right costal margin, R. Lobe> L. Lobe; Spleen= retroperitoneally in LUQ (viewed Posterior) Flow- ~6sec delay from Aorta to Liver, Dual Blood Supply, Statics- Liver & Spleen equa heterogenous dstribution w/ no Bone Marrow; L 85%, S10%, BM5% *Heart, R. Kidney, Porta Hepatis & Gallbladder may distort. Do SPECT* Abnormal: Fast uptake = tumor, Increased Uptake = Hemangioma, Slow uptake = Heart Failure/Cirrhosis
95
Liver SPECT- Radiopharmaceutical (t1/2, E, Camera)
99mTc- RBCs OR 99mTc-SC 6hrs 140keV LFOV, LEHR
96
Liver SPECT- Dose & Administration
Tc-RBCs: 20-50mCi Intravenous Tc-SC: 3-5mCi
97
Liver SPECT- Preparation
InVitro- Ultra Tag ~2-2.5mL InVivo- Cold PYP 20min - inject tracer For Flow = Hemangioma or RBC Liver Study
98
Liver SPECT- Imaging Parameters
Invitro/Vivo inject under camera; for flow image 1-2hrs post
99
Liver SPECT- Views
``` Determined by Physician post MRI/CT/US Flow- immdiate, 1frame/sec fr 60sec Dynamic- immediate blood pool Delayed- 45-180m Statics- 500k-1million counts ```
100
Liver SPECT- Results
``` Hemangioma = Decreased/Normal Perfusion on flow ut Increased Uptake on delayed Tumor = RBCs early but is not retained ```
101
Gastroesophageal Reflux- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Sulfur Colloid 6hrs 140keV LFOV, LEHR
102
Gastroesophageal Reflux- Dose & Administration
300uCi-2mCi (<1um) PO, 150mL Orange Juice &150mL Dilute Hydrochoric Acid *Infants: PO, tracer mixed w// formula (NJ or Bottle)*
103
Gastroesophageal Reflux- Patient Preparation
NPO 6hrs
104
Gastroesophageal Reflux- Imaging Parameters
Patient Supine, Seated Upright Can use abdominal binder Outline ROis to calc GEReflux% Stomach in Lower FOV, Focus on Esophagus & Lungs
105
Gastroesophageal Reflux- Views/Images
Ant., Serial Images -Statics - 30sec after admin, 30s/imae, 300k-500k cts —30s, 60s, 15m - outline ROIs - w/ Binder 30s image as increse pressure -Delayed - 24hrs check lungs
106
Gastroesophageal Reflux- Indications
Detect & Quantify Reflux, Diaphragmatic Hernia, Heartburn, Vomiting, children w/ Asthma, COPD, Aspiration, Pnemonia
107
Gastroesophageal Reflux- Results
Normal: <3% refluxed, bright stomach w/ no esophagus & stays in stomach, clear lungs Abnormal: >4-5% refluxed, visible refluxing toward mouth, Lungs = esophagus reflux 0-25%, activity in lungs
108
Salivagram- Radiopharmaceutical
99mTc-O4
109
Salivagram- Dose & Administration
<1uL; 250-300uCi | PO, rinse mouth w/ lemon
110
Salivagram- Patient Preparation
None
111
Salivagram- Imaging Parameters
Patient Seated, FOV Mouth the Stomach, Rapid Sequence
112
Salivagram- Views
Ant., RLAT., LLAT. | -Dynamic- 1-2s for 15-20s
113
Salivagram- Indications
More sensitive for Aspiration than Reflux
114
Salivagram-Results
Normal: Oral Activity, thr Esoophagus to Stomach Abnormal: Oral cavity into Tracheal-Broncheal Tree
115
Esophageal Motility- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Sulfur Colloid 6hrs 140keV
116
Esophageal Motility- Dose & Administration
150-300uCi | PO in 15mL water; 1 bolus swallow or 1.35mCi in 50mL Apple Sauce
117
Esophageal Motility- Patient Preparation
NPO >8hrs, Cooperate w/ swallowing
118
Esophageal Motility- Imaging Parameters
Supine, sip thru straw, hold bolus in mouth, start Camera, patient dry swallow
119
Esophageal Motility- Views
Ant. Flow- 0.25s/15s for 1 min (4x) or 1-2s/frame for 1min Post Flow- 15s/frame for 9
120
Esophageal Motility- Indications
Evaluate Sphincter Dyfunction, Dysphagia, Dysmotility or Ranaud’s Phenomenon
121
Esophageal Motility- Results
Normal: Low ct. rates or None Detectable (5-10s after 1st swallow), Transit rates >90% after 1-8swallows, <4% of max activity in Esophagus by 10m Abnormal: Tansit rates 5-40% after 8swallows, Diffuse Esophagus spasm as signiffcantly reduced transit rate for 1st half of study, then no rm after 20swallows
122
Thyroid Scan- Radiopharmaceutical (t1/2, E, Camera)
123Iodine 13.2hrs 159keV LFOV, Pinhole
123
Thyroid Scan- Dose & Administration
0.2-0.6mCi | PO, Capsule (rince mouth w/ water/lemon)
124
Thyroid Scan- Patient Preparation
Discontinue Meds, low iodine Diet 3-10days prior
125
Thyroid Scans- Imaging Parameters
Supine, pillow under shoulders, chin up (Water’s) Camera /w/in 10cm of Neck Marker on Suprasternal Notch
126
Thyroid Scans- Views/Images
``` Ant., RAO, LAO, ‘Pull-Back’ Ant. Mediastinum to view Ectopic Thyroid -Statics- 2 parts: 3-4 or 16-24hr post admin 6-24hr post admin -50k-100k counts or 8-10min per image *In conjunction with Thyroid Uptake* ```
127
Thyroid Scan- Tc- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Pertechnetate (Tc-O4) 6hrs 140keV LFOV, Pinhole
128
Thyroid Scans- Tc- Dose & Administration
``` 2-10mCi Intravenous Injection (water/lemon clear salivary) ```
129
Thyroid Scans- Tc- Patient Preparation
None
130
Thyroid Scans- Tc- Imaging Parameters
Supine, Pillow under shoulders, Chin Up (Water’s); Camera w/in 10cm, Marker on Suprasternal Notch
131
Thyroid Scans- Tc- Views
Ant., RAO, LAO, ‘Pull-Back’, Whole Body | -Statics- 2parts: 15-30m post Admin., 300sec or 50,000-100k counts
132
Thyroid Scan- Tc- Indications
Evaluate Thyroid, posiiton/goieter, Detect & Evaluate Hyper/Hypo., Metastases, Functioning Nodule, Heterogenity of Function, Ectopic Tissue
133
Thyroid Scan- Tc- Contraindications
Allergy to Iodine, Meds, Contrast
134
Thyroid Scan- Tc- Results
Normal: Euthyroid, L. Lobe smaller than R, Straight/Convex Margins, Equal uptake of Salivary Glands & Stomach, Colon, Bladder, Nasopharynx, & soft tissue, Brain (TcO4), Butterfly Shape Abnormal: Plummer’s Disease, Non-Visualization, Grave’s Disease, Hashimotos, Carcinoma, Cold Nodule (Non-Functioning-Benign cyst, Adenoma, Inflammatory), Increased Blood Pool; Hot=benign *In conjuction w/ Uptake*
135
Thyroid Uptake- Radiopharmaceutical (t1/2, E, Camera)
123 Iodine 13.1hrs 159keV LFOV/Thyroid Probe; Flat field w// PHA or LEHR
136
Thyroid Uptake- Dose & Administration
0.1-0.2mCi, PO Capsules
137
Thyroid Uptake- Patient Preparation
Discontinue Meds, low Iodine Diet (3-10d prior)
138
Thyroid Uptake- Imaging Parameters
Patient Seated, Probe 25-30cm away or Camera ~10cm
139
Thyroid Uptake- Views/Images
``` Ant. Thyroid Centered: 1 min count x2 Patient Bkg/Thigh: 1min count x2 Neck Phantom: 1min count x2 -Static- 4-6hrs post & 24hr Delay ```
140
Thyroid Uptake- Calculations
Uptake w/ Probe: [(pt thyroid cpm - thigh cpm)/{(std. ct or capsule cpm x DF)-Bkg room}] x 100 Uptake w/ Camera: [2 60sec pt count x2 / 2 60sec std. cts added up] x100
141
Thyroid Uptake- Indications
``` Evaluate Uptake (trapping/organification?), Hyper/Hypo, Function of Nodules Evaluate Abnormal findings W/ Camera- Detect & Localize Cancer, Benign vs. Malignant, Hertero or Hypo function, Detect & Localize Ectopic Tissue ```
142
Thyroid Uptake- Results
Normal: 4-6hrs = 5-20%, 24hrs = 7-35%, TcO4= 20min= ~4% Abnormal: @ 24hrs <7% indicates Hypothyroid; >35%indicates Hyperthyroidism, Early Hashimotos; TSH (factors that increase uptake); Hypothyrois, Iodine Overload, Autoimmune Thyroiditis, Ectopic Secretion, Renal failure
143
131Iodine Scan/Uptake/Therapy- t1/2, E, Camera
8.1days; E= 364keV Gamma & 606keV Beta | LFOV/Thyroid Probe; High E Parallel Hole, Flat Field
144
131Iodine Scan/Uptake/Therapy- Dose & Administration
Uptake - 0.004-0.01mCi (5-30uCi) Imaging - 0.05-0.2mCi (WB 2-5mCi) “Stuns” Thyroid follicular (Therapy) - 1-10mCi PO, Capsule
145
131Iodine Scan/Uptake/Therapy- Patient Preparation
Discontinue Meds, Low Iodine Diet (3-10d prior), NPO 4-6hrs
146
131Iodine Scan/Uptake/Therapy- Imaging Parameters
Patient Supine, Pillow under shoulders, Chin up (water’s) | Probe 25-30cm, Camera 10cm Away from neck
147
131Iodine Scan/Uptake/Therapy- Views/Images
Ant., RAO, LAO, ‘pull-back’ - Statics - 24, 48, 72hrs; >100,000cts. Thyroid & Whole Body * 4-6hrs if w Uptake +Scan*
148
131Iodine Scan/Uptake/Therapy- Indications
Same as 123I, Locate Residual & Recurrent cancers
149
131Iodine Scan/Uptake/Therapy- Results
Normal: Euthyroid, L. Lobe smaller than R., Butterfly shaped, Equal uptake, Equal Uptake of salivary glands, stomach, colon, bladder, nasophayrnx Abnormal: Non-Visulization, Increased Blood Pool, Nonfunctioning Nodules ‘Cold’ = benign Adenoma, Cystm Hematoma & Inflammatory, “Hot” nodules = benign
150
Parathyroid Dual Isotope- Radiopharmaceuticals (t1/2, E, Camera)
99mTc-Perchlorate (Tc-O4); 201 Thallium Chloride 6hrs, 140keV ; 73hrs, 167keV LFOV, Pinhole or LEHR; LFOV, Pinhole or LEHR
151
Parathyroid Dual Isotope- Dose & Administration
Intravenous Tc-Perchlorate: 5-12mCi 201Tl: 2-3mCi
152
Parathyroid Dual Isotope- Patient Preparation
None
153
Parathyroid Dual Isotope- Imaging Parameters
``` Patient Supine w// Neck Hyperextended Neck & Mediastinumin FOV Static & SPECT 99mTcO4- Normal Thyroid 201Tl-Ch- Normal Thyroid & Abnormal Para ```
154
Parathyroid Dual Isotope- Views/Images
Ant. Planar- 128x128 or 64x64, 1mill cts. Or 300-900s/image SPECT- Circ. Or Non-Circ. , 128x128, 64 stops, 20-25sec/stop
155
Parathyroid Dual Isotope- Procedure
Inject Tl201, w/in 2-3min, obtain 300sec image (Pinhole looking for focal uptake b/w Heart & Thyroid). Follow image w/ 900sec centered on Thyroid. Follow image w/ injection of TcO4, wait 5min, ensure no movement. Obtain 900sec. Run subtraction if needed to separate Tl201 accumulation from 99mTc trapping
156
Parathyroid Dual Isotope- Indications
Detect & Locate Primary & Secondary Parathyroid Cancer, ID of single Adenomas/Glandular hyperplasia in newly diagnosed hypercalcemia & elevated PTH Localize cancer for pre-op, parathyroid after surgery for hyper-parathyroidism (increased Calcium + increased PTH)
157
Parathyroid Dual Isotope- Contraindications
Patient on Ca meds/thyroid meds, Patient agitate or prone to move/claustraphobia
158
Parathyroid Dual Isotope- Results
Normal: No increased Tl201 activity w/in or outside normal thyroid tissue, Normal parathyroid tissue does not accumulate Tl201 Abnormal: Areas of increased Tl201 w/in and outside normal thyroid tissue
159
Parathyroid Dual Phases- Radiopharmaceutical (t1/2, E, Camera)
99mTc- Sestamibi 6hrs, 140keV LFOV; Pinhole or LEHR
160
Parathyroid Dual Phase- Dose & Administration
16-30mCi, Intravenous
161
Parathyroid Dual Phase- Patient Preparation
None
162
Parathyroid Dual Phase- Imaging Parameters
Seated or Supine in Water’s Neck & Mediastinum in FOV Static or SPECT Transports via Blood Flow, Removes in Adenomatous & Hyperplastic
163
Parathyroid Dual Phase- Views/Images
Ant., LAO - Planar- 128x128 or 64x64, 1mill cts. Or 300-900sec/image - SPECT- Circ. Or Non-Circ., 128x128, 64steps, 20-25sec/stop
164
Parathyroid Dual Phase- Procedure
Inject, wait 15min, Water’s position, Camera Anterior over extended Neck & Mediastinum, use LEAP/LEHR, 300-600sec (> or equal to 1million cts.), repeat after 15min, use lemon if needed to clear salivary
165
Parathyroid Dual Phase- Indications
Detect & Locate Primary & Secondary Parathyroid CA, ID single Adenomas/Glandular hyperplasia in newly diagnosed hypercalcemia & elevated PTH Localize Cancer for pre-op, post-op for hyper-para
166
Parthyroid Dual Phase- Contraindications
Patient on Ca meds/thyroid meds, Patient agitated or prone to move/claustraphobic
167
Parathyroid Dual Phase- Results
Normal: Initial- Hetero uptake by thyroid, Salivary, Heart & gut; Delays- Hetero washout, no focal points of lingering uptake Abnormal: Washt of Thyroid w/ focal increases on delay images from salivary to mediastinum; obliques hlp define position of abnormal uptake
168
Renal Perfusion- Radiopharmaceuticals (t1/2, E, Camera)
99mTc-Mertiatide (Tc-MAG3) 99mTc-Succimer (Tc-DMSA) 99mTc-Pentetate (Tc-DTPA) 6hrs, 140keV, LFOV; LEAP/LEHR
169
Renal Perfusion- Dose & Administration
10-15mCi, Intravenous Bolus
170
Renal Perfusion- Patient Preparation
Hydrate & Void | Check Blood Pressure for Renovascular Hypertension
171
Renal Perfusion- Imaging Parameters
``` Patient Supine (Camera Posterior) Kidneys centered (Iliac crest in lower 1/3 FOV) ```
172
Renal Perfusion- Views/Images
Posterior (Anterior if needed) - Sequential images- every 2sec for 30-60sec - Blood Pool- immediately post Flow
173
Renal Perfusion- Indications
Localization & Detection of Tumors, Malformations, Cysts
174
Renal Perfusion- Results
Renal Tubular Binding, 2-3hr total; Everythign else~30min total* Normal: soon after arrival in the aorta, bolus perfuses each kidney in a vascular blush. Activity in renal area at same time & equal intensity. (Concentration levels depend on agent used). Gradual increase of concentration of Pentetate as a result of Glomerlar Filtration. Activity will then be seen in renal collecting system, ureters & bladder. Mertiatide is taken up promptly in kidneys, followed by excretion into the collecting system & bladder. With Succimer, activity accumulates gradually, outlining tubular cells. A minute amount of agent is excreted in the urine, so the collecting system will no concentrate the radiopharma. Abnormal: Vascular tumors & Arteriovenous Malformations (AVMs)= areas of increased activity during the flow sequence. Cysts or Avascular tumors = areas of Decreased activity during the flow sequence
175
Renal Function: Renogram- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Pentetate (DTPA) 99mTc-Mertiatide (Tc-MAG3) 6hrs, 140keV LFOV; LEHR, LEAP
176
Renal Function: Renogram- Dose & Administration
10-15mCi, Intravenous
177
Renal Function: Renogram- Patietn Preparation
Hydrate & Void
178
Renal Function: Renogram- Imaging Parameters
Patient prone or Supine (camera posterior) - Dynamic Flow Study- Sequential images every 2sec for 30-60sec for 20-30m - Time-Activity Curve (Renogram)
179
Renal Function: Renogram- Adjunct
Administer Furosemide (Lsix) if needed to rule out uretral obstruction if tracer activity does not clear from renal pelvis or ureteropelvic junction after the initial acquisition is completed
180
Renal Function: Renogram- Indications
Evaluate for Renal Artery Stenosis/Obstruction, Renal Tubular Function, Evaluat Renal Fow, Evaluate for Nephropathy or Hydronephrosis, Detect Necrosis, Evaluate Kidney translant
181
Renal Function: Renogram- Contraindications
Iodine IV same day, patient dehydrated (dehydration = may exhibit delayed transit time)
182
Renal Function: Renogram- Results
Normal: show prompt tracer uptake in kidneys w/ peak uptake at 3-5min. Kidney activity then gradually decreases as the tracer is excreted. Renal pelvis & Bladder activity usually seen by 3-6min. Time-Activity Curve: 3 Phases- Vascular, Secretory & Excretory -Vascular: arrival of the bolus of activity in renal area -Secretory: tracer is concentrated in kidneys -Peak:3-5min after injection, timw @ which tracer reaches its maximum concentration in the kidneys -Excretory: rapid drop in Activity Curve as tracer is excreted from kidney into the bladder Abnormal: reflected in Second & Third Phase of Curve. Adequate UpSlope but No subsequent Fall in activity = obstruction & renal tubules take up the material but cannot excrete the activity. A below-normal level of activity throughout the Renogram = poor renal function. Serial images corresponding to curve = additional visual demonstration of the abnormalities
183
Diuresis Renography- Indication
If tracer retained in Renal Pelvis or Calyces, admin diuretic to rule out urinarytract obstruction
184
Diuresis Renography- Patient Preparation
Hydrate & Void (cath if needed)
185
Diuresis Renography- Pharmaceutical
Furosemide (Lasix)
186
Diuresis Renography- Dose & Administration
Intravenous, slow over 1-2min Adult: 20-40mg Child: 0.5-1mg/kg
187
Diuresis Renography- Imaging
Flow -Images begin during injection —should see effect w//in 30-60sec -Imaging continued for 20min
188
Renal Imaging w/ ACE Inhibitor- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Pentetate (DTPA) 6hrs, 140keV LFOV; LEHR/LEAP
189
Renal Imaging w/ ACE Inhibitor- Dose & Administration
5-15mCi, Intravenous
190
Renal Imaging w/ ACE Inhibitor- Patient Preparation
Hydrate & Void Discontinue ACE Inhibitor Terapy 3-7d prior Baseline Sitting & Standing BP & HR
191
Renal Imaging w/ ACE Inhibitor- Imaging Parameters
Captopril (Capoten), PO 25-50mg (can be crushed in water), Admin. 60min prior to RP, NPO 4hrs,monitor BP every 15m OR Enalaprilat, Intravenous slow push 40ug/kg in 10mL Saline over 3-5min, RP 15min post, monitor BP (drops in first 10-15min)
192
Renal Imaging w/ ACE Inhibitor- Views/Images
Posterior (Anterior if needed) - Flow- 1-5sec/frame for 1min - Dynamic- 20-30sec/frame for 19min - Baseline- count syringe before & after, wait for activity blush in abdomen before starting camera
193
Renal Imaging w/ ACE Inhibitor- Proedure
Captopril: 1 or 2 day study; - 1. Initial 45min MAG3 - - 1hr Cap - - 1.5hrs - 3hrs total (Renin Levels Pre & Post); - 2. Baseline - - 1hr - - next day Cap. 2hrs
194
Renal Imaging w/ ACE Inhibitor- Indications
Decrease in kidney’s perfusion pressure, results in adecrease in the afferent arterioles pressure. Declined Filtration pressure & Decreased GFR, Renal ArteryStenosis (RAS)
195
Renal Imaging w/ ACE Inhibitor- Adverse Effects
Captopril: Orthostatic hypotension, Dizziness, Tachycardia, Chest Pain, Rash & Loss of Taste Enalaprilat: Orthostatic hypotension, Dizziness, Chest Pain, Headache, Dry Cough, electrolyte Disturbances, Fatigue, Abdominal Pai, Vomiting & Diarrhea
196
Static Renal Imaging- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Succimer (DMSA) 6hrs, 140keV LFOV; LEHR/LEAP
197
Static Renal Imaging- Dose & Administration
1-6mCi, Intravenous
198
Static Renal Imaging- Patient Preparation
Hydrate & Void | D/C ACE &/or ARBs
199
Static Renal Imaging- Imaging Parameters
Patient supine
200
Static Renal Imaging- Views/Images
Left & Right Posterior Obliques (Ant. If needed) - Statics- 2-3hrs post Flow - Delay- Severe Renal Failure: 24hr & Ant.
201
Static Renal Imaging- Results
Normal: smooth renal contour, Equal & Uniform Tracer Distribution Abnormal: Congential Abnormalities- Horseshoe kidneys, ectopic kidney, & absence of a kidney; Congenital Malformations- fetal lobulations & horseshoe kidneys = areas of activity outside the normal renal outline. Areas of increased or decreased activity = cysts, neoplasms, infants or renal tumors
202
Renal Cystography (VCUG)- InDirect- Radiopharmaceuticals (t1/2, E, Camera)
99mTc-Pentetate (DTPA) 99mTc- Mertiatide (MAG3) 6hrs, 140keV LFOV; LEHR//LEAP
203
Renal Cystography (VCUG)- InDirect- Dose & Administration
3-10mCi, Intravenous
204
Renal Cystography (VCUG)- InDirect- Patient Preparation
Hydrate, NO VOID 2hrs prior
205
Renal Cystography (VCUG)- InDirect- Imaging Parameters
Patient Supine, No Catheter
206
Renal Cystography (VCUG)- InDirect- Views/Images
``` Posterior (Anterior if needed) -Dynamic- Renal Functional —Inject & No Void 2hrs -Dynamic- 2sec/frame for 120frames as VOIDING -Static- 120sec Post: SKIP if not needed ```
207
Renal Cystography (VCUG)- Direct- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Pertechnetate (TcO4) 6hrs, 140keV LFOV; LEHR/LEAP
208
Renal Cystography (VCUG)- Direct- Dose & Administration
1mCi, Intravenous w/ 50-150mL Saline mixed
209
Renal Cystography (VCUG)- Direct- Patient Preparation
Catheterize Patient
210
Renal Cystography (VCUG)- Direct- Imaging Parameters
Patient Supine, Upper Portion bladder in lower FOV; Connect Cath to Bottle w/ saline-RP
211
Renal Cystography (VCUG)- Direct- View/Images
Posterior (Anterior) -Dynamic Flow - Sequential iages as bladder fills, 60sec/frame for 30min —D/c Saline when bladder reached —-Posterior Pre-Void Images -Emptying Phase- Voiding images - Patient in seated position camera against bacl; 120frames, 2sec/frame -Remove Cath & encourage patient to void in a bad pan -Obtain Post Void image
212
Renal Cystography (VCUG)- Direct- Results
Normal: increasing activity in the bladder w/out reflux into ureters. Abnormal: reflux increases as study progresses, altough transient reflux may occur *Prep area w/ absorbent paper; ensure bladder can fill w/o leak; if quantitative, note any loss of urine = inaccurate calc.
213
Blood-Brain Barrier- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Pentetate (DTPA) 6hrs, 140keV LFOV; LEHR
214
Blood-Brain Barrier- Dose & Administration
15-30mCi, Intravenous bolus
215
Blood-Brain Barrier- Patient Preparation
Verify Patient ID
216
Blood-Brain Barrier- Imagign Parameters
``` Patient Supine (or Upright), Tape to Secure head, FOV Top of head to Anterior Neck ```
217
Blood-Brain Barrier- Views/Images
Anterior, Posterior, R & L LAT (& Vertex psitions) - Image as tracer injected—Flow: 1-3sec intervals 30-60sec - Blood Pool: 60sec w/in 5-10min; post Flow Study - Anterior Projection- 500,000-1million counts
218
Blood-Brain Barrier- Procedure notes
For Vertex: a lead cape draped over shlders For Lateral: a lead shield - reduce counts from facial activity Immediate & Delayed Static in same projections if any suspicion of a lesion/abnormality on initial iages
219
Blood-Brain Barrier- Indications
Primary (Glioma, Meningioma) or Metastatic Disease, Intracranial inflammatory disease (abscess, encephalitis), Cerebrvascular Disease (cerebral hemorrhage, vascualr occlusion, hemangiomas, arteriovenous malformation), Complications of Head Trauma (subdural hematoma, brain death)
220
Blood-Brain Barrier- Results
Normal: ~6sec = symmetric distribution in Right & Left coratid arteries & visualization of anterior cerebral artery. Visualiation of superior sagital sinus after 16sec indicates that arterial blood has begun to flow into venous system. Normal delayed static shows symmetric ativity around entire skull border. Increased activity observed around face and base of skull in Sagittal, Transverse & Sigmoid sinuses as a result of blood pool activity Abnormal: Increased Localization in area of dsruption of the BBB from a lesion. In case of Brain Death, the flow study will demonstrate tracer distribution in the carotids & a cmoplete absence of perfusion in the middle anterior cerebral arteries due to increased intra-cranial pressure **in case of Brain Death- Planar**
221
Brain Perfusion- Radiopharmaceuticals (t1/2, E, Camera)
99mTc-Exametazime (HMPAO) - Ceretec 99mTc- Bicisate (ECD) - Neurolite 6hrs, 140keV LFOV; Ultra High Res.
222
Brain Perfusion- Dose & Administration
10-20mCi | butterfly Intravenous, Floow w/ Saline Flush
223
Brain Perfusion- Patient Preparation
Patient Supine in Quiet, Dim Room prior | Insert Butterfly 5-10min prior
224
Brain Perfusion- Imaging Parameters
Admin. Tracer & saline flush, remove Butterfly, patient remain quiet and unstimulted for 10-15min (ECD = 15-20m, 45 is best) & (HMPAO = no earlier than 1hr) - there is very white redistribution so Delays are okay
225
Brain Perfusion- Views/Images
SPECT; Detector perpendicular to floor @ side of head, cam. Rotate under head first = 180degree = in case panic/agitation - total: 20-40min (transaxial, sagittal, Coronal slices) - 64 view 40sec per view, 360degree rotation
226
Brain Perfusion- Indications
Cerebrovascular Disease (Acute stroke, transient ischemic attacks), Dementia (Alzheimer’s, Multi-Infarcted Dementia), Psychiatric Disorders (affectve disorders = depression/schizophrenia), Seizure Disorders (ID & Locate sites of focal epilepsy), Head Trauma (cerebral brain death)
227
Brain Perfusion- Results
Normal: symmetric in both cerebral hemispheres, b/c blood flow to Gray matter structures is much greater than to white matter (Basal Ganglia & Thalamus = greater intensity of increased uptake), white matter = areas of decreased or no uptake Abnormal: Site of Acute Cerbral Infarct = Phoopenic Defect = cerebral artery affected by stroke. Alzehimer’s = decreased perfusion in parietal, temporal &frontal lobes of both hemispheres. This contrasts w/ Multi-Infarct Dementia = random areas of decreased or absent uptake b/c of multiple areas of infarction. Schizophrenia = decreased perfsion in frontl lobes. Increased activity in area of basal ganglia and temporal lobes. Depressed patients = decreased uptake over entire cerebral cortex and, Manic = increased activity perfusion overall. during active seizure activity, area of intense focal uptake
228
Cerebral Brain Death- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Exametazime (HMPAO) - Ceretec 6hrs, 140keV LFOV; Ultra High Res.; Converging (Peds.)
229
Cerebral Brain Death- Dose & Administration
10-20mCi, Intravenous
230
Cerebral Brain Death- Patient Preparation
Signed Consent from Surrogate
231
Cerebral Brain Death- Imaging Parameters
Static Planar, ~30min total | Often repeated 1-2days later
232
Cerebral Brain Death- Views/Image
Anterior & Laterals - 50,000-1million cts. Each view - Imaging begins 1-3hrs post injection
233
Cerebral Brain Death- Results
Normal: intense symmetric uptake throuhgout both Cerebral Hemispheres & Cerebellum ( not very detailed, if needed = SPECT) Abnormal: total absence of tracer uptake in brain = Brain Dead; any uptake = ‘negative’ for brain death. Maysee perfusion defects = cerebral blood flow is compromised in specifc areas, more severe the defects the greater probability of eventual brain death
234
PET Brain Imaging- Radiopharmaceutical (t1/2, E, Camera)
18Fluorine-Fluorodeoxyglucose (FDG) 110min, 511keV Transmission scan (CT) prior
235
PET Brain Imaging- Dose & Adminsitration
10-20mCi, Intravenous/ (in a Quiet & Dim room, rest at least 40 min)
236
PET Brain Imaging- Patient Preparation
Blood Glucose ~120mg/dL (void prior) | NPO 4hrs
237
PET Brain Imaging- Imaging Parameters
Patient Supine, head stablized | Laying in Quiet & Dim room inject and remain resting 40min
238
PET Brain Imaging- Views/Images
3D - Emission scan for 30min - Transmission scan for Attenuation Correction
239
PET Brain Imaging- Indications
Evaluation of Primary Brain Tumors, Epilepsy, Dementa & Alzheimer’s & Parkinson’s Disease
240
PET Brain Imaging- Normal Results
Normal: uptake in gray matter normally; Active brain tissue will demonstrate intense uptake, (inactive tissue = lesser degrees of uptake)
241
PET Brain Imaging- Abnormal Results
Primary Brain Tumors = positive correlation b/w FDG uptake on PET & tumor or grade of malignancy. High-grade tumor = intense FDG uptake; Necrosis = no uptake Epilepsy = seizures that cannot be controlled; effective in locating the seizure focus. FDG injected during Inter-Ictal /Phase = significant reduction of uptake in area of seizure focus. Injected during Ictal Phase = focal ‘hot’ areas at focus Dementia = FDG demonstrates unique pattern for Alzheimers, typicall show decreased uptake in parietal, temporal & frontal cortex but the sensorimotor & visual regions = normal. Non-Alzheimers Dementia = Pick’s Disease (frontotemporal dementia) = decreased uptake in frontal lobes; Creutzfeldt-Jakob Disease (Bovine Spongiform Encephaly ‘mad cow’) = generalized poor uptake thru-out brain
242
Cisternography- Radiopharmaceutical (t1/2, E, Camera)
111Indium-Pentetate 2.8days 173keV & 247keV LFOV; Medium Energy
243
Cisternography- Dose & Administration
0.5-1.5mCi | Intrathecal b/w 3rd & 4th vertebrae
244
Cisternography- Patient Preparation
Pledgets placed in Nose & Ears in case of a leak
245
Cisternography- Imaging Parameters
Patient Supine during injection & several hours post Count pledgets every 2hrs (in Well Counter) Entire Skull & Spinal Tract in FOV
246
Cisternography- Views/Images
Anterior, Posterior & Laterals - Imaging begins 4-6hrs post admin., 300sec/view - Additional Images @ 24, 48 & 72hrs if needed
247
Cisternography- Indications
Diagnosis of normal pressure hydrocephalus, Detection of CSF leaks & Evaluation of Ventricular Shunt Patency
248
Cisternography- Normal Results
@4-6hrs tracer completed its ascent, 1-4hr =Basal Cisterns (2hrs @ abdomen= ~200,000cts), @24hrs = uptake in subarachnoid spaces surrounding cerebral hemispheres as well as in interhemispheric cisterns & visualized in superior sagittal region (where reabsorpation of CSF occurs). Tracer clearance from Basal Cisterns @24hrs
249
Cisternography- Abnormal Results
Normal Pressure Hydrocephalus: older adults, develops slowly over time = chronic disease. Drainage CSF is blocked gradually & excess fluis builds uo slowly over time. Slow enlargement of ventricles = fluid pressure. Enlarged ventricles press on brain = Persistant visualization of lateral ventricles & w/ abnormal delay of tracer in reaching the superior sagittal region CSF: Pledgets measure abnormal activity in nose/ears = leak, imaging the site of suspected leak while radiopharmaceutical is passing thru the suspected area (1-3hrs post injection);leaks may be intermittent Evaluation of Ventricular Shunts: usedto treat Hydrocephalus. Injection of 111In or 99mTc-O4 directly into shunt resevoir will cleary demonstrate shunt patency. Persistent radiopharmaceutical uptae in the shunt can indicated partial or complete obstruction of shunt
250
Dopamine Transporter Imaging (DaT)- Radiopharmaceutical (t1/2, E, Camera)
123Iodine-Ioflupane 13.22hrs 159keV LFOV; High Res. SPECT
251
Dopamine Transporter Imaging (DaT)- Dose & Administration
3-5mCi, Intravenous (Slow, ~20sec push)
252
Dopamine Transporter Imaging (DaT)- Patient Preparation
Check Med List, D/C Cocaine, Amphetamines, Fentanyl | Pre-Treat w/ 400mg f Potassium Perchlorate OR Lugol’s
253
Dopamine Transporter Imaging (DaT)- Imaging Parameteres
SPECT Void Prior Patient Supine w/ Head Restraint FOV w/ Entire Brain & as close as possible to detector heads
254
Dopamine Transporter Imaging (DaT)- Views/Images
``` 360degree Anterior, Posterior, & Laterals -Imaiging begins 3-6hrs post admin, minimum 1000k cts. -3-head detector- 120-20sec slices -2-head detector- 120-30sec slices -1-head detector- 120-20sec slices ```
255
Dopamine Transporter Imaging (DaT)- Indications
Detecting Degenerative Dopaminergic Nigrostriatal pathway; Tremor vs. Post-Synaptic Parkinson’s. differentiate Parkinsonism; Normal = w/out presynaptic dopaminergic loss. Dementia w/ lewy bodies vs. Alzheimer’s (A = normal)
256
Dopamine Transporter Imaging (DaT)- Results
Normal: Classic Comma Sign, showing head of the caudate nucleus & putamen in the transverse slice Abnormal: Incomplete Comma Sign appearance of the caudate nucleus & putamen in the transerse slice
257
Gallium Imaging (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)
67Gallium-Citrate 78hrs 93, 184, 296, 388keV LFOV; Medium or High Energy Parallel-Hole
258
Gallium Imaging (Infection/Inflammation)- Dose & Administration
4-6mCi (148-222MBq) | Intravenous
259
Gallium Imaging (Infection/Inflammation)- Patient Preparation
None
260
Gallium Imaging (Infection/Inflammation)- Imaging Parameters
Patient supine Planar or SPECT Imaging can begin 6hrs-1wk post
261
Gallium Imaging (Infection/Inflammation)- Views/Images
Ant/Post, Whole-Body - Planar/Tomographic/SPECT - WB Images (A&P) begins 6hrs-1wk post injection for 1-2million cts. - 64x64 or 128x128, 360degree w// 3-6degree sampling for 40-50sec - Statics- 800,000-1million cts.
262
Gallium Imaging (Infection/Inflammation)- Indications
Localization of sources of fever of uknown origin (FUO), Suspected Osteomyelitis, Pulmonary & Mediastinal Inflammation/Infection, Evaluation & Monitoring of Inflmmatory Processors (Sarcoidosis), Acute or Chronic Inflammation or Infection
263
Gallium Imaging (Infection/Inflammation)- Contraindications
Recent laxatives/enema (these cause inflammation = increased uptake = mistaken for disease)/Bowel Prep for patients who are acutely ill/unable to eat soli food, Recent Barium Contrast (barium scan after 67Ga is ok)
264
Gallium Imaging (Infection/Inflammation)- Normal Results
Tracer uptake in Nasopharynx, Lacrimal glands, Salivary glands, Bony thorax (ribs, sternum, clavicle, scapule), Extnal genitalia, Liver, Kidney (up to 48hrs after), Colon contents, & Pelvis (lumbar spine, sacrum, ileum, ischium) & Epiphyses; Liver is INTENSE. Excreted 20-30% from kidneys during first 24hrs = Renal activity up to 48hrs 1) Skeleton & Liver are Well-Vsualized, faint activity in Colon 2) Skeleton & Hepatic Uptake is less intense, while intense activity is present in proximal colon 3) Skeleton is well defined, Hepatic Activity intense & Colonic activity confined to proximal ascending colon is faint 4) Nasopharyngeal activity is prominent & pancolonic activty is intense ***GALLIUM = GUT ACTIVITY***
265
Indium-Labeled Leukocytes (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)
111Indium-Oxine ( labeled white cells) 67.4hrs 247kev (94%) & 171keV (90%) LFOV; Medium or High Energy Parallel-Hole
266
Indium-Labeled Leukocytes (Infection/Inflammation)- Dose & Administration
500-600uCi | Lare Bore, Intravenous (Slow Push)
267
Indium-Labeled Leukocytes (Infection/Inflammation)- Patient Preparation
Void Bladder | Withdraw ~50mL Blood (check WBC count)
268
Indium-Labeled Leukocyte (Infection/Inflammation)- Imaging Parameters
``` Patient Supine -Whole Body SPECT (& or static) —imaging begins 1-4hrs or 16-30hrs after labeling —no delays past 24hrs —lower counting statistics than 67Ga ```
269
Indium-Labeled Leukocytes (Infection/Inflammation)- Labeling Procedure
White cells ae isolated, 1111In diffusses into cells & binds (total~2hrs). ~70-90% efficient, important WBC & RBCs separated (& Platelets), requires Centrifuge @ correct speed. If platelets are tagged = False-Positives
270
Indium-Labeled Leukocytes (Infection/Inflammation)-Views/Images
Ant, Post of Head, Abdomen, Pelvis, Chest & Extremities
271
Indium-Labeled Leukocytes (Infection/Inflammation)- Indications
Detection of sources of fever of Unknown Origin (FUO), Detection of sites of Inlammatory Bowel Disease, Detection of Osteomyelitis
272
Indium-Labeled Leukoctes (Infection/Inflammation)- Results
Normal: Spleen, Liver, Bone Marrow, (most Intense. SPLEEN < in Liver & < in BM) Abnormal: Damaged luekocytes, Extravasation of labeled cells compromises image quality = False-Negative (also if insufficient leukocytes adminsitered)
273
Indium-Labeled Leukocytes (Infection/Inflammation)- Radiation Dosimetry
WB: 0.50-0.53rad/mCi Liver: 1-5rad/mCi Spleen: 18-20.4rad/mCi
274
Technetium-Labeled Leukocytes (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera)
99mTc-Exametazime (HMPAO-Ceretec) 6hrs, 140keV LFOV; LEHR/LEAP Parallel or Pinhole
275
Technetium-Labeled Leukocytes (Infection/Inflammation)- Dose & Administration
7-25mCi, | Large Bore, Intravenous (Slow push)
276
Technetium-Labeled Leukocytes (Infection/Inflammation)- Patient Preparation
Void Bladder | Withdraw 40-50mL Blood for labeling (check WBC ct)
277
Technetium-Labeled Leukocytes (Infection/Inflammation)- Imaging Parameters
Patient Supine
278
Technetium-Labeled Leukocytes (Infection/Inflammation)- Exametazime Radiopharmaceutical Kit
Re-constituted w/ 99mtc-O4, added to white cells suspended in plasma (stabilizer, Methylene blue NOT added)
279
Technetium-Labeled Leukocyte (Infection/Inflammation)- Views/Images
Ant, Post Head,*Pelvis & Abdomen Critical*, Chest & Extremities - 4 & 24hr Delay, 30min = Max Sensitvity - 15-30min & Delays = FUO
280
Technetium-Labeled Leukocyte (Infection/Inflammation)- Indications
Fever of Unown Orign (FUO), Abdominal Pain, Detection of Inflammation or Ischemia in Small Bowel & Detection of Acute OM
281
Technetium-Labeled Leukocytes (Infection/Inflammation)- Results
Normal: Slow Blood Clearance = Activity in Heart, Lungs & Great Vessels (on Delayed image), Bowel activity increases over time, Spleen/Liver/Bone Marrow/Kidneys/Bowel/Bladder & Major Blood Vessels Abnormal: can be seenin bowel very early (15-30min after injection) & increases over time. lung persisting longer than 4hrs
282
Bone Marrow Imaging (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera) Tc-SC
99mTechnetium-Sulfur Colloid 6hrs, 140keV LFOV, LEHR/LEAP
283
Bone Marrow Imaging (Infection/Inflammation)- Dose & Administration Tc-SC
10mCi, Large-Bore Intravenous, Slow push
284
Bone Marrow Imaging (Infection/Inflammation)- Patient Preparation
Void Bladder | Withdraw 40-50mL Blood (check WBC counts)
285
Bone Marrow Imaging (Infection/Inflammation)- Imaging Parameters
Patient Supine
286
Bone Marrow Imaging (Infection/Inflammation)- Procedure Tc-SC
1st inject fresh Tc-SC (>2hrs old = blood pool & bladder), image 30min post injection (maximizes clearance from circ.) -10min images of ROI w// LFOV, 128x128
287
Bone Marrow Imaging (Infection/Inflammation)- Views/Images | Tc-SC
Ant, Post, WB *Om vs. Bone Marrow Tc-SC: image 30min post injection
288
Bone Marrow Imaging (Infection/Inflammation)- Radiopharmaceutical (t1/2, E, Camera) 111In
111Indium-Oxine (WBC) 67.4hrs 247kev & 171keV
289
Bone Marrow Imaging (Infection/Inflammation)- Dose & Administration 111In
0.3-1mCi | Large Bore Intravenous, slow push
290
Bone Marrow Imaging (Infection/Inflammation)- Procedure | 111In
2-Day, 111In procedure, cells labeled & re-injected on 1st day & image 24hrs later 9image Marrow prior to injection) - After injection, 10% window, 10min/view, 128x128
291
Bone Marrow Imaging (Infection/Inflammation)- Views/Images
Ant, Post WB | 111In-WBC: image 24hrs post injection
292
Prostate Cancer- Radiopharmaceutical (t1/2, E, Camera)
111Indium-Capromab Pendetide (Prostascint) 67.4hrs; 247keV & 171kev LFOV; Medium-Energy ProstaScint is a Monoclonal Antibody, directed at PSMA (an antigen secreted by Malignant Prostate Cells)
293
Prostate Cancer- Dose & Administration
5mCi | Intravenous, infuse over 3-5min
294
Prostate Cancer- Patient Preparation
Hydrate, Laxatives, Void Frequently Catheter if needed Check PSA #d & HAMA Titer
295
Prostate Cancer- Imaging Parameters
Patient Supine | SPECt
296
Prostate Cancer- Views//Images
Abdomen & Pelvis, Ant. Post Spont View/WB - early Blood Pool @ 30min-4hrs - 4-5day delay - 96-120hr post injection = optimal target &
297
Prostate Cancer- Indications
Diagnose & Assess Prostate Cancer, at risk or Lymphnode metastases
298
Prostate Cancer- Contraindications
HAMA response/ Allergy
299
Prostate Cancer- Results
Normal: activity in blood pool & blood-filled structures (Liver, Spleen, Penis), Bone Marrow & Large Bowel
300
Neuroendocrine Cancer- Radiopharmaceutical (t1/2, E, Camera)
111Indium-Pentetreotide (OctreoScan) 67.4hrs 247keV & 171keV LFOV; Medium Energy
301
Neuroendocrine Cancer- Dose & Administration
Adult: 6mCi Child: 0.14mCi/kg Intravenous
302
Neuroendocrine Cancer- Patient Preparation
Hydrte Prior & 24hrs Post Mild Laxative evening prior & post Insulinoma - IV solution w/ Glucose prior to avoid hypoglycemia
303
Neuroendocrine Cancer- Imaging Parameters
Patient Supine, Void Prior | SPECT/ WB/ Planar
304
Neuroendocrine Cancer- Views/Images
WB, Ant & Post, Pelvis -Aqcuire images at 4, 24, 48hrs -WB/ 800,000-1million, A&P Planar @ 4hrs -SPECT- 24 &48hrs images (differentiate bowel activity & disease) —-128x128, 360degree, 3degree sampling, 30-45sec time/stop
305
Neuroendocrine Cancer- Indications
Localize Primary & Metastatic Tumors Originating from neuroendocrine cell, cells that contain Somatotatin Receptor Sites(Pituitary & Endocrine tumors, Paranglioma, Medullary Thyroid Carcinoma, Carcinoids & Small-cell lung cancer
306
Neuroendocrine Cancer- Results & Adverse Effect %
Normal: Pituitary, Thyroid, Liver, Spleen, Kidneys, Bowel, Gallbladder, Ureters, Bladder & Stimulated Adrenal Glands;s ~4hrs = GI, Intestinal activity = 24hr Adverse Effects %: <1%
307
Neuroendocrine Cancer- Octreotide Analog & Function
Octreotide is an analod of the hormone Somatostatin. binds to somatostatin receptors on surface of cells, concentrating in Tumors w/ high density of receptor sites. Somatostatin is concentrated in hypothalamus, cerebral cortex, brains tem, GI tract & pancreas Fuctions: Neurotransmission & inhibition of the release of growth hormone, insulin, glucagon, & gastrin & hormone production by certain tumors
308
Neuroendocrine Cancer- Receptor sites for Octreotide (Somatostatin)
Receptor sites for somatostatin are located in the Anterior Pituitary Gand, Pancreatic Islet, Lymphocytes & certain type of tumors (Brain, Breast, lung Cancer & Lymphoma)
309
Adrenal Tumors- Radiopharmaceuticals (t1/2, E, Camera)
``` 131Iodine-Meta-Iodobenzylguanine (MIBG) -8.02days; 606keV (364keV/peak) -High Energy 123Iodine-Iobenguane (MIBG) Sulfate (AdreView) -13.2hours; 159keV -LEHR/LEAP ```
310
Adrenal Tumors- Dose & Administration
Intravenous Adult: 131I-MIBG: 0.5-1mCi 123I-MIBG: 10mCi Child: 131I-MIBG: 0.135mCi 123I-MIBG:avg. weight- 13.7-162uSv/MBq
311
Adrenal Tumors- Patient Preparation
Lugol’s (Potassium Iodide) 1day prior & 6-7days post
312
Adrenal Tumors- Imaging Parameters
Patient Supine | Void Prior
313
Adrenal Tumors- Views/ Images
Ant & Post, Top of Skull to Pelvis FOV -Ant/Post Planar of EHad, Chest, Abdomen & Pelvis —Acquired on days 1 & 3 for 131I —Acquired at 6 &24hrs for 123I (24hr= SPECT) -SPECT- 64x64, 360degree, 3-6degree sampling, 3-45sec/stop
314
Adrenal Tumors- Indications
Detection, Localization, Staging & follow-up of Neuroendocine Tumores & their Metastases: Neuroblastomas, Pheochromcytomas, Ganglioneuroblastomas, Carcinoid Tumors, Ganglioneuromas, Parangliomas, Medullary Thyroid Carcinomas & Meckel Cell Tumors
315
Adrenal Tumors- Results
Normal: Uptake in Liver, Spleen & Heart, Salivary Glands, Nasopharynx & Urinary Bladder Abnormal: persist over time, Pheochromocytomas may occur in Adrenal Bed or other places in Thorax & abdomen, Metastases may be visualized in Liver,Bone, Lymph Nodes, Heart, Lungs
316
Adrenal Tumors- Pheochromocytomas
Catecholamine-Secreting Tumors from Adrenal Medulla. Hypertension is primary symptom
317
Adrenal Tumors- Neuroblastoma
Malignant Tumors of symptomatic Nervous syste & most often in children (<10yr olds). Most originate in Adrenal Glands or Sympathetic Nervous System Ganglia of the abdomen (1/3 found in chest, neck, pelvis or spinal cord)
318
Adrenal Tumors- Catecholamines & Adrenal Gland location
Epinephrine & Norepinephrine | *Adrenal glans located at superior poles of kidneys
319
Scintimamography- Radionpharmaceutical (t1/2, E, Camera)
99mTechnetium-Sestamibi 6hrs, 140kev Specialized tube; LEHR//LEAP
320
Scitimammography- Dose & Administration
20-30mCi, Intravenous (contralateral arm)
321
Scintimammography- Patient Preparation
No needle aspiration 2wks piror | No biopsy w/in 4-6wks prior
322
Scintimammography- Imaging Parameters
Patient Upright/Supine/Prone If bilateral - inject in Foot vein SPECT
323
Scintimammography- Views//Images
Planar Ant. Chest & axillae, Lat. each breast (arms extended above head), Prone /Lateral Axillae -Planar Ant & Lat 10min images Imaging begins 5-10min post injection —place markers near palpated abnormalities —Ant- Upright or Supine —Lats - Prone, Breast suspended
324
Scintimammography- Indications
Indeterminate x-ray mammogram, Dense breast tissue, Suspected recurrence of breast CA after surgery/radiation
325
Scintimammography- Results
Normal: Uptake in the Salivary & Thyroid Glands, Myocardium, Liver, Gallbladder, Intestines, Skeletal Muscles, Kidneys & Bladder
326
Lymphoscintigraphy- Radiopharmaceutical (t1/2, E, Camera)
99mTechnetium- Sulfur Colloid 6hrs, 140keV LFOV; LEHR **Filter Colloid thru 0.2um filter; <0.10um**
327
Lymphoscintigraphy- Doe & Administration
~200uCi (in 4-5syringes) (~1mCi total) | Subcutaneous (4-6syringes) Intradermal
328
Lymphoscintigraphy- Patient Preparation
Wipe/Betadine Area (shave if needed) | Lymphedema - stockings removed 3-4hrs prior
329
Lymphoscintigraphy- Imaging Parameters
One Day: 0.1mCi in 0.05mL, intradermal injection, iamge @ 30min, surgery @ 2-4hrs Two Day: 0.5mCi in 0.05mL, intradermal injection, image @ 0min & 2hrs, surgery next morning OR Mapping: longer delay b/w injection & surgery the better
330
Lymphoscintigraphy- Views/Images
Post injection, Dynamic/statics, Whole body/ Ant/ Post/ Lats/ Obl., SPECT (best to visualize draining) -immediate, 45min-1hr& 30-45min
331
Lymphoscintigraphy- Injection Sites
Surface Lesions: 2-6injections around area of Cancerous tissue or ROI (shield injection site) Retroperitoneal Lymph Nodes: Injection into medial 2 interdigital webs of feet. Image @ 4hrs w/ part of Liver in FOV w/ lumbar nodes Axillary & Apical Lymph Nodes: Injection into Medial 2 interdigital webs of the hands. Image @ 2-4hrs Cervical Ndoes: Inject into the dorsum of mastoid process Internal Mammary change: inject into the posterior rectus sheet below the rib cage Iliopelvic Lymph Nodes: Injection into perianal justlatera to anal margin @ 3’ & 9’o’clock positions
332
Lymphoscintigraphy- Methods: Melanoma
2-6 subcutaneous &/or intradermal producing a wheal, places around the cancer site, surgery, or ROI (w/in 5mm). Other routes, Intradermal into we of hand/foot, <0.25mL/injection site. FILTERED Sulfur Colloid
333
Lymphoscintigraphy- Methods: Breast Cancer
4injections in tissue surrounding the lestion (2-3mm), 4mL/syringe @ 3, 6, 9, 12 positions around site, lidocaine to reduce pain UN-FILTERED Sulfur Colloid
334
Lymphoscintigraphy- Methods: Lymphodema
IV injection, 2 sites/limb, placed into web of fingers or toes depending on ROI
335
Lymphoscintigraphy- Methods: Non-Palpable Tumors
Wire localization done via US prior to sending patient to OR, radionuclide injected after wire has been placed (injection around periphery of tumor/biopsy cavity w/ 800-1000mCi) FILTERED Sulfur Colloid, divided into 4doses & injected @ 12, 3, 6, 9 o’clock positions w/in 1cm of cavity edge
336
Lymphoscintigraphy w/ Lymphoseek- Radiopharmaceutical (t1/2, E, Camera)
99mTc- Tilmanocept 6hrs, 140keV LFOV; LEHR or LEAP
337
Lymphoscintigraphy w/ Lymphoseek- Dose & Administration
0.5mCi, Subcutaneous (Intradermal)
338
Lymphoscintigraphy / Lymphoseek- Patient Preparation
None
339
Lymphoscintigraphy w/ Lymphoseek- Kit Preparation
Sterile Syringe, draw ~92.5MBq (2.5mCi) 99mTc Sodium injection solution in either 0.35mL volume (for 0.5mL reconsituted vial volume) or 0.7mL volume (for 2.5mL or 5mL reconstituted vial volume), Assay syringe for 99mTc in Dose Calibrator. Record amount, date, time, etc. Add 99mTc injection solution to the Tilmanocept Powder Vial. Remove needle, gently shake to mix, let stand @ rm. temp for 15min
340
Lymphoscintigraphy w/ Lymphoseek- Imaging Parameters
Site of Lesion = PAtient position, SPECT (CT) if extremity or unknown -Admin 15min before intitating intraoperative lymphatic mapping sentinel node biopsy (complete w/in 15min)
341
Lymphoscintigraphy w/ Lymphoseek- Views/Images
3 Ant, 1 Lat, w & w/o 57Co, WB sweep - planar (90-120sec)/ Dynamic (Immediate, 30sec/frame for 20-30min) - or sequential static (Immediate, 30-60min, every 5min for 60min) *VISIBLE in 10-15min & up to 15-30hrs*
342
Lymphoscintigraphy w/ Lymphoseek- Methods
4 intradermal injections @ 12, 3, 6, 9 o’clock positions (0.25mL/syringe) 1-8 intradermal peritumoral inejctions around cavity, 100uCi in a volume of 0.1mL
343
Lymphoscintigraphy w/ Lymphoseek- Notes/How it works
A 1st class Mannose Receptor (CD206) binding radiopharmaceutical agent developed for use in external lymphnode imaging, intraoperative lymphatic mapping & Sentinel Node Biopsy - Allows rapid transit from injection site, accumulates in tumor - Transits thru lymphatic vessels & accumulates in lymph nodes draining from primary tumor *VISIBLE in 10-15min & up to 15-30hrs*
344
Parathyroid Cancer- Radiopharmaceutical (t1/2, E, Camera)
201 Thallous-Chloride 73.1hrs, 69-81keV (~71keV) LFOV; LEHR/LEAP
345
Parathyroid Cancer- Dose & Administration
3-4mCi 201Tl, Intravenous
346
Parathyroid Cancer- Patient Preparation
None
347
Parathyroid Cancer- Imaging Parameters
Dual-Phase/Dual-Isotope
348
Parathyroid Cancer- Views/ Images
Ant, Neck/Mediastinum (SPECT) | -Image 20-60m post injection, immediate @20m (CNS neoplasm) Delay 3hrs
349
Parathyroid Cancer- 201Tl Note
Accumulation is < in connective tissue w/ inflammatory cells - Localizes in ATPas System Tl does not cross intact BBB; Karposi’s Tl+ &Ga-; Lymphoma + w/ both; Infection = Ga avid but Tl-; Lung CA seen w// Tl if >2cm, delays also helpful (inflammation is washed out)
350
Parathyroid Cancer- Method w/ 201Tl
201Tl inject - - - 20min - - - image (1hr)
351
Parathyroid Cancer w/ MIBI- Radiopharmaceutical (t1/2, E, Camera)
99mTechnetium-Sestamibi 6hrs, 140keV LFOV; LEHR/ Pinhole/ Parallel-hole
352
Parathyroid Cancer w/ MIBI - Dose & Administration
20mCi, Intravenous
353
Parathyroid Cancer w/ MIBI- Patient Preparation
None
354
Parathyroid Cancer w/ MIBI- Imaging Parameters
Dual-Phase / Dual Isotope
355
Parathyroid Cancer w/ MIBI - Views/Images
Ant, Neck-Mediastinum (SPECT) - Flow- immediate, 1st phase begins 15-20min post injection, (Thy), 2nd phase begins 2hrs post injection (parathy) * Not w/ PArathyroid= decreases in Thyroid faster & longer*
356
Parathyroid Cancer w/ MIBI- Method
99mTc-MIBI - - - Inject, initial pic - - -2hr delay - - - 1.5hr/image
357
Lung Cancer- Radiopharmaceutical (t1/2, E, Camera)
99mTechnetium-Depreotide (NeoTect) 6hrs, 140keV LFOV; LEHR/LEAP
358
Lung Cancer- Dose & Administration
15-20mCi, Intravenous (must be a new line)
359
Lung Cancer- Patient Preparation
Hydrate & Void
360
Lung Cancer- Imaging Parameters
SPECT w/ entire Lung fields
361
Lung Cancer- Views/Images
Arms above head, Anteroposterior - Imaging begins 2-4hrs post injection - 128x128, 360degree, 3degree sampling & 30-40min acquistion time per stop - optional: 800,000-1million planar images
362
Lung Cancer- Results
Normal: Kidneys, Liver, Spleen & Bone Marrow
363
Lung Cancer- Depreotide Function
A 10-amino acid synthetc peptide tht contains a somatostatin receptor (SSTR) binding domain that demonstrates a high affinity for SSTR-expressing tumor. Increased SSTR = most neuroendocrine tumors including small cell lung carcinoma
364
Non-Hodgkin’s Lymphoma- Radiopharmaceutical (t1/2, E, Camera)
90Yttrium-Ibritumomab Tiuxetan (Zevalin) 64. 1hrs 2. 28MeV Betas (penetrates ~5mm)
365
Non-Hogdkin’s Lymphoma- Dose & Rad. Dose & Critical Organ
0.3mCi/kg for 100,000-149,000 platelet count 0.4mCi/kg for >150,000 platelet count ~Radiation Dose, 23-79cGy (60cGy) *Critical Organ: Liver, 532cGy
366
Non-Hodgkin’s Lymphoma- Administration & Pre-Admins
250mg/m^2 Rituximab (Rituxan infusino ~2-6hrs) Zevalin Dose (in 4-8mL) over 10min Flush w/ 0.9% NaCl
367
Non-Hodgkin’s Lymphoma- Patient Preparation
Recent Bone Marrow Biopsy, Lymphoma in BM <25%; Recent Blood Count, platelet >100,000uL; WB scan / 111In 2-24hrs & 48072hrs to confirm treatment; Intravenous Line Established
368
Non-Hodgkin’s Lymphoma- Patient Discharge & Radiation Safety
For 3DAYS: Wash Hands Carefully, Avoid Transfer of Bodily Fluids, Clean Up Spilled Urine/Blood Contamination For 1WEEK: Use condom For 1YEAR: Use effective contraception
369
Non-Hodgkin’s Lymphoma- Zevalin Function
A Murine IgG, monoclonal antibody that targets CD20 Antigen; a targeted dose @ tumor (binds to tumor), rad. Dose is minimal to surrounding tissue
370
Liver Cancer- Radiopharmaceutical (t1/2, E) | “Selective Internal Radiation Therapy (SIRT)”
99Yttrium-Glass Microspheres (Therasphere) 64. 2hrs 936. 7keV
371
Liver Cancer- Dose & Administration | “Selective Internal Radiation Therapy (SIRT)”
Y90 Activity: 80-150Gy (max 18.4mCi) Diameter: 20-30um (22,000-73,000microspheres/mg) Catheter via Groin; Dose adminstered in multiple small increment infusions during Therapeutic Hepatic Angiogram. Vascular status is mapped w/ contrast b/w each infusion. Full dose is administered or until stasis is reached
372
Liver Cancer- Patient Preparation “Selective Internal Radiation Therapy (SIRT)”
Transfemoral 99mTc-MAA (2-4mCi) injection to assess Liver arterial perfusion, lung & intra-abdominal shunting (Ant & Post Planar Head to Thighs & SPECT//CT Abdomen; ROI around Liver & each Lung)
373
Liver Cancer- Y90 Facts
Blood flow plays large effect on Norm. Liver rad & tumor
374
Liver Cancer- Exposure “Selective Internal Radiation Therapy (SIRT)”
Bremsstrahlung 15uSv per GBq @ 15cm
375
Liver Cancer- Y90 Therapsheres vs/. Y90 SIR Spheres
Y90 Theraspheres: Glass/Resin Beads & Fewer Beads Y90 SIR Spheres: Plastic, Larger # Beads, Colorectal Carcinoma
376
MidGut Neuroendocrine Cancer - Radiopharmaceutical (t1/2, E)
177Lutetium-Dotatate (Lutathera) 6. 647days 0. 498MeV
377
MidGut Neuroendocrine Cancer- Dose & Administration
200mCi (every 8WEEKS, 4 DOSES TOTAL) Intravenous (20gauge) 500mL NaCl 5-10min 4x w/ 2MONTH BREAK
378
MidGut Neuroendocrine Cancer- Patient Preparation
No Somatostatin Analog Drugs (SSA) Kidney function measured 1st & end (6mos from 1st dose) Kidney protecting AminoAci Infusion (long lasting Octreotide) 30min PRIOR
379
MidGut Neuroendocrine Cancer- Side Effects
``` Hormonal Crisis (Hypotensino, Bronchoconstriction, Flusing, Arrhythmia) Low Blood Counts ```
380
MidGut Neuroendocrine Cancer- Radiation Safety
Avoid close contact, 3feet from others for 2-3DAYS | Can be detected in Urine for 30DAYS
381
MidGut Neuroendocrine Cancer- Location & Lutathera Localization
MidGut, Jejunum - Ascending Colon; Carcinoid Tumors; Peptide Receptor Radionuclide Therapy (binds to CA)
382
Hyperthyroidism/Thyroid Carcinoma- Radiopharmaceutical (t1/2, E)
131Iodine-Sodium Iodide 8days 606keV (gamma 364keV)
383
Hyperthyroidism/Thyroid Carcinoma- Dose & Administration
1uCi or 5uCi, >30mCi PO, Pill Inpatient, until <30mCi or <5mrem/hr @1m
384
Hyperthyroidism/Thyroid Carcinoma- Preparation
Private Room & Bath, Labeled, Patietn Secretion Absorbed (w/ paper, own phone, bedrails, floor, mattress, remote. Spray Cold Iodine on Porcelain. All Disposable
385
Hyperthyroidism/Thyroid Carcinoma- Monitoring/ Area Surveys
Surveyed @ bedside, 3feet, Door, Next Door Room, Outside Room below 2mrem, <100mrem/y, 2mrem/hr
386
Hyperthyroidism/Thyroid Carcinoma- Discharge
<33mCi or <7mrem @ 1m | 200mCi —-> 33mCi = 72hrs, Force Fluids
387
Hyperthyroidism/Thyroid Carcinoma- Post D/C
RSO checks everything, store till BKG (~80-120days)
388
Hyperthyroidism/Thyroid Carcinoma- Side Effects
Sialoadenitis (Salivary Gland Swelling) 10-33% | Hypothyroid
389
Hyperthyroidism/Thyroid Carcinoma- Notes on images & dpm
METS post Thyroid removed = Liver Shadow = BAD | If Thyroid dpm reaches 2.22x10^6 = evaaute for why, if 1.11x10^7dpm = investigate
390
Bone Pain Therapy- Radiopharmaceutical (t1/2, E)
89Strontium-Chloide (Metastron) 50.5days, 1463keV, 583.keV Betas penetrate 8mm
391
Bone Pain Therapy- Dose & Administration
4mCi (40-60uCi/kg) | Intravenous w/ Saline 100mL
392
Bone Pain Therapy- Preparation & Retention
Pb (lead) syringe shield; IV running w/ saline = clears rapidly from blood, 50-70% retained in Skeleton (14days) in bone METs (>50days) Rentention in METS longer than Bone
393
Bone Pain Therapy- Results
30-50% decrease in WBC & Platelets Excretion is Renal/Urinary (2/3) greatest up to 2 days Normal: Decrease in pain for 10-16weks, Increases quality of life
394
Bone Pain Therapy- Crtical Organ & Behavior/Function of 89Sr
Bone Surface & Red Bone Marrow Behaves like Calcium Analog; areas of active osteogenesis (incorporated into Hydroxyapatite molecule)
395
Bone Pain Therapy w/ Quadramet- Radiopharmaceutical (t1/2,E)
153Samarium-Lexidronam (Quadramet) 46. 7hrs 0. 81MeV (103keV photopeak)
396
Bone Pain Therapy w/ Quadramet- Dose & Administration
~4mCi (1mCi/kg), Intravenous | 153Sm-Lexidronam
397
Bone Pain Therapy w/ Quadramet- Uptake & Excretion
Rapid uptake by skeleton in osteoblastic Bone METS - 45-90% localizes to skeleton thru chemisorption on surface of hydroxyapatite molecule 2-13% to Liver Rapid Renal Excretion w/in 6hrs Complexed w// EDTMP Rapidly cleared from blood w/in 1hr, b/c shorter t1/2 a higher dose can be administered vs. 89Sr
398
Bone Pain Therapy- 89Sr vs. 153Sm
Sm greater dose (faster acting) Lower t1/2 (Sm) Hematopoietic response immediate & resolves faster than Sr
399
PET Tumor Imaging: Metabolic Cancers- Radiopharmaceutical (t1/2, E)
18Fluorine-Flurodeoxyglucose (FDG) | 110min; 2x 511keV
400
PET Tumor Imaging: Metabolic Cancers- Dose & Administration
5-20mCi(~10mCi), Intravenous
401
PET Tumor Imaging: Metabolic Cancers- Patient Preparation
NPO 4hrs (heart = laxative prior)
402
PET Tumor Imaging: Metabolic Cancers- Imaging Parameters
Blood Glucose Level <200mg/dL | Post injection, Relax in Dim Rm before imaging
403
PET Tumor Imaging: Metabolic Cancers- Views/Images
Whole-Body | -Imaging begins 30-60min prior
404
PET Tumor Imaging: Metabolic Cancers- Quality Control
Visual Inspection (clear//colorless), ID Testing w/ Dose Calibrator, pH (4.5-7.5), Radiochemical & Chemical Purity (99.5%), Residual Solvent analysis, Sterility Testing & Bacterial Endotoxin Test (<175u/mL)
405
PET Tumor Imaging: Metabolic Cancers- Normal Distribution
Brain, Myocardium, Liver, Spleen, Stomach, Intestines, Kidneys & Bladder (Organs w/ increased glucose metabolism, Bone Marrow, Skeletal Msucle, GI tract, Accumulates in Liver)
406
PET Tumor Imaging: Metabolic Cancers- Excretion
In Renal System (unlike Glucose)
407
PET Tumor Imaging: Metabolic Cancers- Head/Neck/Brain
Cortex intense uptake (6%), WB @ 1-2hrs post = Brain. Can be interpreted as synaptic Activity. Cancer cells metabolize glucose @ high rate; phosphorlization process ends instead trapped in cells, high sensitivity to disease. FDG cannot be broken down or re-cross the cell membrane once transformed into FDG-6-P, accumulation w/in cellular crystal
408
PET Tumor Imaging: Metabolic Cancers- Skeletal Uptake
Neck & Paaspinal Musculature; Cause = tension, talking, movement; Scalene or Supraclavicular
409
PET Tumor Imaging: Metabolic Cancers- Retroperitoneal
Excreted thru kidneys, accumulation in colon, not filtered by Glomerulus & not re-absorbed, frequent hydrate & void
410
PET Tumor Imaging: Metabolic Cancers- Renal Uptake
Poorly reabsorbed by kidneys allowing filtered FDG to be excreted in urine, results can sow intense concentrated activity in renal collecting symptoms, can be influenced by level of renal function, hydration, patient position, activity extendeds Craino-Caudal
411
PET Tumor Imaging: Metabolic Cancers- Liver Uptake
Faint, Heterogeous activity
412
PET Tumor Imaging: Metabolic Cancers- Gastrointestinal Tract
Large bowel activity can be focal/segmental or diffuse, Focal in colon = further inspection to rule out neoplasm, Segmental Colong = inflamamtion vs. diffuse, Cecum & Right Colon = Increased b//c abundant lymphoid tissue, Stomach = normal LowLevel Activity
413
PET Tumor Imaging: Metabolic Cancers- Thymus
“V” shaped (bi-lobed)
414
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Radiopharmaceutical (t1/2, E, Camera)
99mTechnetium-Pertechnetate labeled Red Blood Cells 6hrs, 140keV LEAP or LEHR, Parallel-Hole
415
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Dose & Administration
15-30mCi (555-1110MBq) 99mTc -RBCs | Intravenous
416
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - In-Vitro Kit Prep
Withdraw 2 10mL blood, centrifuge & wash cells, combine with a reducing agent (Stannous Phosphate) & Anticoagulent./ Add 99mTc-O4 & incubate @ room temp. For 20-30min. Re-inject, image 4hrs later; ULTRATAG (no centrifuge) 95%
417
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - In-Vivo
IV inject 2-3mg of stannous pyrophosphate, allow to circulate 15-20min, IV inject 99mTc-O4; 60-90%
418
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Patient Preparation
None
419
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Imaging Parameters
Patient Supine 3 Electrode standard lead II ECG Patient lay on R. Side for LAO
420
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Views/Images
LAO, ANT, LLAT - each view 3-7million counts - R. Ventricular function —> Gated 1st Pass in list mode while RBCs injected & 10-15degree RAO position
421
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Frames
Divide Cardiac Cycle into 16, 24, or 32 frames. The time that an individual frame wil accumulate counts during a single cardiac cycl depends on the average length pf R-R. 20-30% acceptance window placed around average R-R. Counts begin to be depositied in 1st frame @ first R-R etc. End Diastolic & End Systlic frames can be seen
422
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Indications
Detect/Assess CAD, MI, Congestive Heart Failure Assess Cardiac function in chemo patients LVEF, SV, CO, Peak Filling Rate
423
Multigated Blood Pool Acquisition (MUGA) / Radionuclide Ventriculography (RVG) / Equilibrium Radionuclide Angiography (ERNA) - Results
Normal: 5% increase in LVEF in Stress, Homogenous Uptake, Normal Wall Motion, acceptable R-R wave Abnormal: Akinesis (absence of motion), Hypokinesis (decreased motion) & Dyskinesis (segment of ventricle bulges out), Paradoxical Motion, Abnormal R-R
424
First-Pass- Radiopharmaceutical (t1/2, E, Camera)
Any Technetium: 99mTc-DTPA or 99mTc-O4 6rs, 140keV LFOV; High-Sensitivity Collimator
425
First-Pass- Dose & Administration
15-30mCi in <1mL Rapid Antecubital Intravenous Bolus Large Bore (>18guage) Rapid 10mL Saline Flush
426
First-Pass- Patient Preparation
Baseline ECG
427
First-Pass- Imaging Parameters
Patient Supine or Upright Camera Anterior or 10-15degree RAO 1mCi source, mark sternal notch & xiphoid Camera on & Positioned Prior
428
First-Pass- Views/Images
ANT, RAO -ROI drawn over RV, Lungs & LV or Non-Pulmonary BKG —Applied to Dynamic -200,000counts/sec; acquisition started before injection,then the bolus & acquisition temrinated once tracer travels thru the right side of the heart, lungs & left side of heart
429
First-Pass- Indications
Evaluate R.Ventricular dysfunction, Interventricular shunts, Myocardial Ischemia/Infarction
430
First-Pass- Results
Normal: Tracer in the venous blood being shunted into left ventricle & systemic circulation; Paks representing the bolus of activity are observed by graphing each region over time. LV EF calc. After LV ROI, 2-3peaks = contraction, Apices=Diastole & Low Points = Systole Abnormal: Poor perfusion = mix of oxygen-rich & oxygen-poor blood is ejected into systemic circulation as a result of blood shunting from RV into LV
431
Right-to-Left Shunt Quantification- Radiopharmaceutical
99mTc-Macroaggregated Albumin (Tc-MAA) 6hrs, 140keV LFOV; LEHR
432
Right-to-Left Shunt Quantification- Dose & Administration
(Less than Lung Perfusion) <2-5mmCi, <200,000-700,000particles (20-40um) Intravenous
433
Right-to-Left Shunt Quantification- Patient Preparation
NPO
434
Right-to-Left Shunt Quantification- Results
Normal: Cerebral Cortex, bolus in Left Heart, bolus in Lungs, >10%, ROI on Lungs & Total Body (4-6% in Lungs = Normal) *Kidneys = Bad Tage/ Free Tc-O4**
435
Myocardial Infarct Amyloid Imaging- Radiopharmaceutical
99mTechnetium- Pyrophophate (Tc-PYP) 6hrs, 140keV LFOV; LEHR
436
Myocardial Infarct Amyloid Imaging- Dose & Administration
20mCi, Intravenous
437
Myocardial Infarct Amyloid Imaging- Patient Preparation
None, Void Frequently
438
Myocardial Infarct Amyloid Imaging- Imaging Parameters
Patient Supine, L. Arm Raised | Image 1hr post Injection (SPECT/PLANAR)
439
Myocardial Infarct Amyloid Imaging- Views/Images
Ant, L. Lat., LAO - 750,000counts, 90degree - 180degee, Non-Gated, 40views///detector, 20sec/stop
440
Myocardial Infarct Amyloid Imaging- Results
Normal: 1-2hrs post injection. ~40-50% of dose is taken up by skeleton; localization in heart muscle is 0.01%-0.02% per gram of Acutely Infarcted Myocardium
441
Myocardial Infarct Amyloid Imaging- Critical Organs
Bone Surface & Bladder
442
Myocardial Imaging w/ MIBG- Radiopharmaceutical
123Iodine-Metaiodobenzylguanine (AdreView Iobenguane I-123) 13.1hrs, 159keV LFOV; LEHR
443
Myocardial Imaging w/ MIBG- Dose & Administration
10mCi, Intravenous
444
Myocardial Imaging w/ MIBG- Patient Preparation
~500mg Potassium Perchlorate (PO) or Lugol’s
445
Myocardial Imaging w/ MIBG- Imaging Parameters
Planar & SPECT | Heart to Mediastinum Ratio
446
Myocardial Imaging w/ MIBG- Views/Images
Ant, L.Lat, LAO - imaging begins at 15-20m & Again at 4hrs - ROIs over LV myocardium & Non-Cardiac portion of medistinum & Heart-to-Mediastinum Ratio is calc.
447
Myocardial Imaging w//MIBG- Results
Normal: washout at 4hrs - 35% Abnormal: increased washout & decreasing HMRatio = Heart Failure; Decreased uptake w/ increased washout that corresponds to sympathetic denervation = MI (post) & higher risk of vent. Arrhythmias Increased uptake = dense sympathetic innervation (good)
448
Myocardial Imaging w/ MIBG- Indication
Asessing Neuronal Status of heart
449
Myocardial Imaging w/ MIBG- MIBG Function
Guanethidine Derivative- a potent Neuron-Blocking acts on sympathetic nerve endings Molecular structure similar to Noradrenaline
450
Myocardial Perfusion: 2-Day Technetium Protocol- Radiopharmaceuticals (t/1/2, E, Camera)
``` 99mTechnetium-Sestamibi (CardioLite) OR 99mTechnetium-Tetrofosmin (MyoView) 6hrs, 140kkeV LFOV;LEHR ```
451
Myocardial Perfusion: 2-Day Technetium Protocol- Dose & Administration
24-36mCi, Intravenous | 99mTc-Sestamibi OR 99mTc-Tetrofosmin
452
Myocardial Perfusion: 2-Day Technetium Protocol- Patient Preparation
NPO 2-4hrs, D/C Caffiene 12hrs | Comfortable Clothes & Med. List
453
Myocardial Perfusion: 2-Day Technetium Protocol- Imaging Parameters (Stress):
``` Bruce Protocol (increase Speed & elevation every 3min), monitor Hr/BP @ 85% MAX HR Inject & wit 15-60min to begin imaging. Patient Supine, SPECT, L. Arm Raised; Rest - - wait 1hr Repeat ```
454
Myocardial Perfusion: 2-Day Technetium Protocol- Views/Images
Usually 180degrees, Ant, LAO, LLAT - 64 projections, 64x64, 20sec/stop - Gating, 8 or 16 frames
455
Myocardial Perfusion: 2-Day Technetium Protocol- Indications
Detection of CAD, Risk Stratification | Evaluate efficacy of theraputic interventions Drugs//Surgery
456
Myocardial Perfusion: 2-Day Technetium Protocol- Contraindications
Nitroglycerin w//in 4-6hrs, Cannot Exercise, Pulmonary Hypertension
457
Myocardial Perfusion: 2-Day Technetium Protocol- Results (Stunned Myocardium)
*If Stress is Normal, Testing is Done* Stunned Myocardium- Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischemia, length of time stunned = severity) (no myocardial necrosis), rest EF >5% higher than stress EF
458
Myocardial Perfusion: 2-Day Technetium Protocol- Results (Hibernating Myocardium)
Prolonged Ischemia, adaptive response in which viable but dysfunctionnal myocardium arises from prolonged myocardial hypoperfusion at rest in the absence of clincially evident ischemia
459
Myocardial Perfusion: 2-Day Technetium Protocol- When to Stop
ST Depression = STOP test & Inject If Stress Normal = Test Done
460
Myocardial Perfusion: 2-Day Technetium Protocol- Adjunct
Nitroglycerin
461
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Radiopharmaceuticals
99mTechnetium- Sestamibi (CardioLite) OR 99mTechnetium- Tetrofosmin (MyoView) 6hrs, 140keV LFOV; LEHR
462
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Dose & Administration
Rest: 8-12mCi (99mTc-MIBI or 99mTc-Tetrofosmin) Stress: 24-36mCi Intravenous
463
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Patient Preparation
NPO 2-4hrs, D/C Caffiene 12hrs (4-6hrs Nitro), Comfortable Clothes, Meds List
464
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Imaging Parameters
Rest 1st, inject dose & wait 30m-1hr, Image (15-3m/i). Wait 2-3hrs, Stress w/ Bruce protocol (increase Speed & Elevaion every 3m) monitor HR//BP until 85% MAX HR reached, Inject (w/in 5-10min)Dose & wait 30m-1hr, Image (15-30m/Imge) Image w/ Gating Patient Supine w/ L. Arm Raised
465
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Views/Images
180degree;Ant, LAO, LLAT - 64 projections, 64x64, 20sec/stop (low dose 25sec/stop) - Gating, 8 or 16 frames
466
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Adjunct
Nitrogen
467
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Indications
Detection of CAD, Risk Stratifications, | Evaluate efficacy of therapeutic interventions Drugs/Surgery
468
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Containdications
Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension
469
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Results (Stunned Myocardium)
Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischema, length of time stunned = severity) (no myocardial necross), Rest EF >5% higher than stress EF
470
Myocardial Perfusion: 1-Day Rest/Stress Protocol- Results (Hibernating Myocardium)
Prolonged Ischemia, adaptive response, in which viable but dysfuncitonal myocardium arise from prolonged myocardial hypoperfusion at rest in the absence of clinically evident ischemia
471
Myocardial Perfusion: 1-Day Rest/Stress Protocol- When to Stop
ST Depression = Stop Test & Inject
472
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Radiopharmaceuticals
99mTechnetium-Sestamibi (CardioLite) OR 99mTechnetium-Tetrofosmin (MyoView) 6hrs, 140keV LFOV; LEHR
473
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Dose & Administration
Stress: 8-12mCi; 99mTc-MIBI or 99mTc-Tetrofosmin Rest: 24-36mCi Intravenous
474
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Patient Preparation
NPO 2-4hrs, D/C Caffiene 12hrs (4-6hr Nitro) | Comfortable Clothes, Med. List
475
Myocardial Perfusion: 1-Day Stress/Rest Perfusion- Procedure
Stress w// Bruce Protocol (increase Speed & Elevation every 3min), Inject Dose w/in 5-10min & wait 30min-1hr, Image (15-30min/image), Delay 2-4hr/ ‘Rest’, Inject Dose & Wate 30min-1hr, Image (15-30min/I) If Stress is Normal —Done!
476
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Imaging Parameters
Image w/ Gating | Patient Supine, w/ L. Arm Raised
477
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Views/Images
180degree; Ant, LAO, LLAT - 64 projection, 64x64, 20sec//stop - Gating, 8 or 16 frames
478
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Indications
Detection of CAD, Risk Stratifications, | Evaluate efficacy of theraputic interventions Drugs/Surgery
479
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Contraindications
Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension
480
Myocardial Perfusion: 1-Days Stress/Rest Protocol- Results (Stunned Myocardium)
Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischemia, length of time stunned = severity) (no myocardial necrosis), Rest EF >5% higher than stress EF
481
Myocardial Perfusion: 1-Day Stress/Rest Protocol- Results (Hibernating Myocardium)
Prolonged Ischemia, adaptice response, in which viable but dysfuncitnoal mycardium arises from prolonged myocardial hypoperfusion at rest in the absence of clinically evident ischemia
482
Myocardial Perfusion: Dual Isotope Protocol- Radiopharmaceuticals
201Thallous-Chloride -73.1hrs; 69-81keV 99mTechnetium- Sestamibi (CardioLite) OR Tetrofosmin (MyoView) -6hrs; 140keV
483
Myocardial Perfusion: Dual Isotope Protocol- Dose & Administration
Rest: 201Tl- 2.5-4mCi Stress: Tc- 24-36mCi Intravenous
484
Myocardial Perfusion: Dual Isotope Protocol- Patient Preparation
NPO 2-4hrs, Caffiene 12hrs (4-6hr Nitro) | Comfortable Clothes, Med. List
485
Myocardial Perfusion: Dual Isotope Protocol- Protocol
Rest, Image within 20min (Inject 201Tl), Image (15-30min//image), NO Delay, Stress / Bruce Protocol (increase Speed & Elevation every 3min) monitor BP/HR until 85% MAX HR achieved, Inject 99mTc @ PEAK, Image w/in 5-10min, Image (15-30min/image)My
486
Myocardial Perfusion: Dual Isotope Protocol- Imaging Parameters
Image w/ Gating | Patient Supine w/ L. Arm raised
487
Myocardial Perfusion: Dual Isotope Protocol- Views/Images
180degree; Ant, LAO, LLAT - 32 projection, 40sec/stop (201Tl) - 64 projection, 20sec/stop (high dose) (Tc)
488
Myocardial Perfusion: Dual Isotope Protocol- Adjunct
Nitroglycerin
489
Myocardial Perfusion: Dual Isotope Protocol-Indications
Detection of CAD, Risk Stratifications Evaluate efficacy of therapeutic interventions Drugs/Surgery Need a Rapid Test, Despite High Radiation Dose
490
Myocardial Perfusion: Dual-Isotope Protocol- Contraindications
Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension
491
Myocardial Perfusion: Dual-Isotope Protocol- Results (Stunned Myocardium)
Delayed Recovery of regional LV dysfunction after a transient period of ischmia, followed by re-perfusion (severe ischemia, legth of time stunned = severity) (no myocardial necrosis), Rest EF >5% higher than Stress EF
492
Myocardial Perfusion: Dual-Isotope Protocol- Result (Hibernating Myocardium)
Prolonged Ischemia, adaptive response, in which viable but dysfunctional myocardium arises from prolonged myocardial hypoperfusion at rest in the absence of clinically evident ischemia
493
Myocardial Perfusion: 201Thallous-Chloride Protocol- Radiopharmaceutical
201Thallous-Chloride 73.1hrs, 69-81keV LFOV; LEAP
494
Myocardial Perfusion: 201Thallous-Chloride Protocol- Dose & Administration
Stess: 2.5-4mCi (201Tl) Re-inject@ Rest: 1-2mCi (if needed) Intravenous
495
Myocardial Perfusion: 201Thallous-Chloride Protocol- Patient Preparation
NPO 2-4hrs, D/C Caffiene 12hrs (4-6hrs Nitro) | Comfortable Clothes, Med. List
496
Myocardial Perfusion: 201Thallous-Chloride Protocol- Procedure
Stress w/ Bruce Protocol (increase Speed & Elevation) monitor HR/BP until 85% MAX HR reached, Inject Dose w/in 5-10min & wait 10-15min, Image (15-30min/image). *”Bumper Dose” re-inject*. Image Delayes 3-4hrs later. Rest, Inject Dose & wait 10-15min, Image (15-30min/image). Delays at 4 & 24hrs
497
Myocardial Perfusion: 201Thallous-Chloride Protocol- Imaging Parameters
Image w/ Gating | Patient Supine w/ L.Arm raised
498
Myocardial Perfusion: 201Thallous-Chloride Protocol- Views/Images
180degrees; Ant, LAO, LLAT | -32 projections, 40sec//stop
499
Myocardial Perfusion: 201Thallous-Chloride Protocol- Adjunct
Nitroglycerin
500
Myocardial Perfusion: 201Thallous-Chloride Protocol- Indications
Detection of CAD, Risk Stratification Evaluate efficacy of therapeutic interventions Drugs/Surgery (Higher extraction rate = good perfusion image)
501
Myocardial Perfusion: 201Thallous-Chloride Protocol- Contraindications
Nitroglycerin w/in 4-6hrs, Cannot Exercise, Pulmonary Hypertension
502
Myocardial Perfusion: 201Thallous-Chloride Protocol- Results (Stunned Myocardium)
Delayed Recovery of regional LV dysfunction after a transient period of ischemia, followed by re-perfusion (severe ischemia, length of time stunned = severity)(no myocardial necrosis), Rest >5% higher than Stress EF
503
Myocardial Perfusion: 201Thallous-Chloride Protocol- Results (Hibernating Myocardium)
Prolonged Ischemia, adaptive response, in which viable but dysfunctional myocardum arises from prolonged myocardial hypoperfusion at rest in the absence of clincially evident ischemia

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