Topic 4 Flashcards by Lee Vincent Neolar

The acquisition of a single image or snapshot of a particular structure. the simplest type of nuclear medicine image that looks like a single snapshot of a target anatomy.
•Records and demonstrates all radioactivity from the patient above and below the region of interest

Uses low radiopharmaceutical activity levels.
• Rationale: to minimize radiation exposure to the patients
• Disadvantage: images must be acquired for a preset time or minimum number of counts or radioactive emissions.
• 30 seconds and 5 minutes – time it takes to obtain a sufficient number of counts to produce a satisfactory image.

planar/Static imaging

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Examples of planar/static imaging

Lung scan, spot bone scan images, and thyroid images.

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This imaging uses a specially designed moving detector or system to produced an image of the entire body or a large body section.
•Gamma Camera collects data as it passes through the body

Whole body imaging

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Whole-body Imagine systems:

a.For whole-body bone scans
b.For whole-body tumor imaging.
c.For whole-body abscess imaging
d.For other clinical and research applications.

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A flow of a particular structure.
•This provides a series of images that demonstrates blood flow in the body within specific organs.
•This generally used to evaluate blood perfusion to the tissue.

Dynamic Images:
•These can be thought as it sequential or time-lapse image.
•These display the distribution of a particular radiopharmaceutical over the specific period

Dynamic imaging

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Common applications of dynamic imaging

1st-pass cardiac studies
Hepatobiliary studies
Gastric emptying studies

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Rationale: because all examinations is based on the distribution of radiopharmaceutical within the body.
●In vivo: within the living body

In vivo examinations

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Patient preparation:

●Most tests requiring no special preparations
●All metal objects must be removed – because they may mimic or attenuate pathologic conditions.
●Patient may resume all normal activities after completion of a routine procedure

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●A survey procedure to evaluate patients with malignancies, diffuse musculoskeletal symptoms, abnormal laboratory results and hereditary or metabolic disorders
●Radiopharmaceutical: Localize in bone and soft tissue structures.
●Skeletal Areas of increase Uptake: result of tumor, infection or fracture.

Bone scintigraphy

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Performed to look at the skeletal system and to detect abnormalities such as metastases, stress fracture or a loose prosthesis.
•Can detect a fracture 2 years after an injury

Bone scan

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Bone scan Major factors that Influence Uptake:

•Regional blood flow
•Osteoblastic activity
•Extraction efficiency

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Radiopharmaceutical used in bone scan
•Tc-99
•Tc-99m
•Tc-99m
Adult dose:

labelled diphosphates
hydroxemethylene diphosphate (HDP)
Methylene diphosphate (MDP)
20 mCi (740 MBq)

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Routine Scanning in bone scan

begins 2 – 3 hours after the injection and it takes 30-40 minutes.

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A noninvasive study

Purpose:
•Assess cardiac performance
•Evaluate myocardial perfusion
•Measure viability and metabolism

Nuclear cardiology

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Procedures in nuclear cardiology
•Exercise radionuclide angiography
•Thallium
•Technitium

201 myocardial perfusion study
99m sestamibi myocardial
perfusion study.

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•Performed with a patient using a treadmill or stationary bicycle.
•Used to alter the blood flow to the heart.

Stress test

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During stress test what is monitored during procedure?

Heart rate
Ecg
Blood pressure
Symptoms

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Alternative to stress test
•Used in place of the exercise test
•Used to alter the blood flow to the heart
•For patient who cannot exercise
•For patient with peripheral vascular disease, neurological problems or musculoskeletal problems

Pharmacological intervention

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▪ Used to measure left ventricular ejection fraction.
▪Used to evaluate left ventricular regional wall motion.
▪ requires that the blood be labelled with Tc-99m
▪Cardiac cycle: Divided into 16-20 frames during a gated acquisition.
▪Radiopharmaceutical: Tc-99m labelled red blood cells
▪Adult dose: 25-40 mCi (based on patient’s body surface – height and weight)

Gated exercise radionuclide angiography

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Gated exercise radionuclide angiography scanning

▪Begin immediately after the injection
▪Takes about 1 hour
▪ Anterior position
▪Left lateral position
▪Left anterior Oblique position

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●A SPECT study that is used to identify perfusion defects in the left ventricular wall.
●Useful for assessing myocardial viability in patients with known Coronary Artery Disease.
●Useful for evaluating patients with revascularization.

Spect myocardial perfusion study

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Stress thallium-201 myocardial perfusion study

Radiopharmaceutical:
●
●
●For obese patients
●Used so that higher dose can be administered
●Mode of Administration(MOA) –

●Th-201 thallous chloride
●Tc-99m Sestamibi
Intravenously while the patient is physically stressed on a threadmill

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Adult dose:

a. Stress study:
●Administered intravenously before rest study

b. Delayed Study:
●Administered intravenously before delayed

c. Rest Study –
●Administered intravenously before rest study

3 mCi of Th201 thallous chloride
1 mCi of Th201 thallous chloride
4 mCi of Th201 thallous chloride

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Scanning in stress thallium-201 myocardial perfusion study
● Anterior planar image of the chest and heart.

●A 180 degree SPECT study. (45 degree RAO to 45 degrees LPO)

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Stress Thallium-201 Myocardial Perfusion Study Images: 2 sets A. B. NOTE: During Th-201 myocardial perfusion study,

a.After the stress test b.Several hours after the patient is rested. the symptoms may be apparent at rest.

●Used to assess myocardial salvage resulting from the therapeutic intervention in acute infarction. ●Used to determine the myocardial blood flow during periods of spontaneous chest pain.

Technetium-99m Sestamibi Myocardial Perfusion Study

First Pass Flow study Technetium-99m sestamibi myocardial perfusion study ● Used to evaluate ● ●

●Performed with a rest or stress Tc99m sestamibi myocardial perfusion scan ●Heart function ●Ejection fraction

Radiopharmaceutical: Technetium-99m Sestamibi Adult dose: a.Stress study: ● administered intravenously at peak b. Rest study: ● administered intravenously before rest study Note: __- provides optimum image quality __- more convenients in px, technologist and physician

10-30 mCi of Tc-99m sestamibi 10-30 mCi of Tc-99m sestamibi 2 day protocol 1 day protocol

Technetium-99m Sestamibi Myocardial Perfusion Study Scanning: ▪ ▪ ▪

▪ SPECT imaging done 30-60 minutes after injection. ▪ for both stress and rest study ▪ delayed images done 4-6 hours after injection

Brain perfusion imaging spect study ▪ Useful in the evaluation of patient with: A. B. C. D. E. ▪imaging agent:

a.Stroke b.Transient Ischemia c.Alzheimer’s disease d.Epilepsy e.Parkinson’s disease Capable of penetrating the intact blood brain barrier (BBB)

BRAIN PERFUSION IMAGING SPECT STUDY Radiopharmaceutical: * * ▪Dose: 20 mCi

▪ Tc-99m ethylcysteinate diamer (ECD) ▪ Hexamethylpropyleneamine oxime (HMPAO)

Brain perfusion imaging spect study Scanning: Begins __ after Tc-99m ECD Begines __ after Tc-99m HMPAO Note: “the patient is placed in a quiet, darkened area before injection and instructed to close the eyes – helpful in reducing uptake of the tracer in the visual cortex.”

30 minutes 1 hour

Useful in diagnosis of CSF leakage after the trauma or surgery. Useful in the diagnosis of normal pressure hydrocephalos

Radionuclide cisternography

Performed to evaluate the size, shape, nodularity and functional studies of the thyroid gland. Used to screen for thyroid CA. Used to differentiate hyperthyroidism, nodular goiter, solitary thyroid nodule and thyroiditis. Used to determine the relative function of nodules in different regions within the thyroid.

Thyroid scan

Thyroid scan Radiopharmaceutical: __ __ – Advantages: Low patient dose, No particulate radiation and well-resolved images. Adult Dose: __ of Tc-99m pertechnetate __ mCi in I-123

Tc-99m pertechnetate I-123 5 mCi 0.5-1.5

Factors that affect thyroid uptake

Thyroid medication Foods Drugs Iodine-containing contrast agents.

Thyroid Scanning: - - Used to obtained anterior, left oblique and right anterior oblique thyroid images Used to obtained a 6 inches (15 cm) anterior neck image. Pinhole Collimator: A thick, conical collimator that allows for magnification of the thyroid.

Begin 20 minutes after the injection Used in gamma camera with a pinhole collimator

Useful in distinguishing between thyroiditis and Grave’s disease (toxic nodular goiter or Plummer’s disease) Used to evaluate the function of the thyroid gland. “Uptake” – expressed as the percentage of the dose in the thyroid gland at a given time after administration.

I-131 thyroid uptake measurement

High tyroid uptake * * * * Low thyroid uptake * * * *

Thyroid with increased activity Overactive thyroid gland Hyperthyroidism May indicate grave's or plummer's disease or toxic nodular goiter Thyroid with decreased activity or less functional Thyroid cannot visualized during imaging More common in women than men May indicate thyroiditis

Radiopharmaceutical I-131 Sodium iodide Mode of administration: __ Adult Dose: Standard Uptake Test: __ of I-131 Uptake readings: acquired at __ and/or at __ NOTE: “thyroid therapy with I-131 can be given to reduce the function of the thyroid.”

Orally 3-5 microcurie 4-6 hours /24 hours.

Recommended for the locating residual thyroid tissue in patients with thyroid carcinoma. Recommended for the recurrent thyroid CA cells in patients with thyroid carcinoma. NOTE: __ – performed 1-3 months after thyroidectomy. (To check for residual normal thyroid tissue) __ – performed after the residual thyroid tissue has been ablated or destroyed. (To check for the metastatic spread of the CA.)

Neck/total body I-131 scan Neck I-131 Scan Total Body I-131 Scan

Neck/total body scan Radiopharmaceutical: __ Mode of Administration: __ Adult dose: __ Total Body Scan – __ Neck Scan – __ __ – injected on each two days before the dose administration to allow the patient to remain on thyroid medications.

I-131 Sodium Iodide Orally 3-5mCi 1 mCi Thyrogen

Scanning: A. __ starts 24 hours after the administration of the dose Anterior Planar neck B. __ Starts 48 hours after the administration of the dose Anterior and Posterior whole body.

Neck Imaging Total Body Scan

Used to assess the functional status of different internal and accessory organs of the alimentary canal Most commonly performed examinations are - - Other examinations are: * * * *

Gastrointestinal nuclear medicine studies Gastric emptying study Hepatobiliary scans Gastroesophageal reflux scan Spleen scan Cystogram Gastrointestinal bleed scan

__ – performed to evaluate the motility of the solids and liquids through the GI tract __ – performed to evaluate gallbladder function, performed to identify the bile leak following the removal of the patient’s gallbladder. __ – performed to identify the location of the bleeding in the stomach, small intestine or large intestine.

Gastric Emptying Study Hepatobiliary Scan Gastrointestinal Bleed Scan

Used to evaluate the liver for functional disease: Cirrhosis, Hepatitis, Metastatic disease Used to look for residual splenic tissue following splenectomy. Used to assess the functional status of liver and spleen. Used to determine whether certain lesions found with other methods may be benign (Advantage: obviating the need for biopsy.)

Liver/spleen scan

Liver/spleen scan Uptake: Normal Patients: __ uptake in the liver __ uptake in the spleen The rest in the bone marrow Radiopharmaceutical __ __

80-90% 5-10% Tc-99m Sulfur Colloid Tc-99m Albumin Colloid

Mode of administration: Scanning: Images taken are: Anterior Posterior R and L anterior Oblique R and L lateral R Posterior Oblique Note: “Gastric emptying and Hepatobiliary scans are the most commonly performed GI.”

Intravenously

A reliable, noninvasive procedures Used for evaluating the anatomy and function of the systems in nephrology, urology and kidney transplantation. Note: “the radiopharmaceutical that is administered is cleared by normally functioning kidneys in about 20 minutes.”

Genitourinary nuclear medicine studies

Used to assess renal perfusion and function in patients with renal failure, renovascular hypertension and renal transplant. Radiopharmaceutical:__ Secreted primarily by the proximal renal tubules Not retained in the parenchyma of normal kidneys.

Dynamic renal scan Tc-99m Mertiatide (MAG3)

Mode of administration: __ Adult Dose: __ Patient Preparation: Patient must be well __ before all renal studies. Scanning: Initiated immediately after the injection It should be delayed for 24 hours after contrast studies

Intravenously 10 mCi hydrated

Images taken: Over the __ Centered at the level of 12th rib __ – for transplanted kidneys.

posterior lower back Anterior pelvis

Hematologic Nuclear Medicine Studies Two Types: __ __ Non-imaging Studies: __ – for quantitating biologically important substances in the serum or other body fluids __- for evaluation of physiological function.

In vitro studies In vivo studies In vitro radioimmunoassay (RAI) In vivo radioimmunoassay (RAI)

2 types of measurements: __ is made after administration of radiopharmaceutical __ Vit B12 absorption (Schilling test)

Quantitative measurement Physiologic Event Measurements:

Used to locate inflammation infection and abscess in any organ or tissue within the body __: useful for diagnosis and localization of infection and inflammation.

Infection nuclear medicine Gallium-67 and Indium-labelled white cell scans

Useful for demonstration of pulmonary perfusion using limited transient capillary blockade Useful in the assessment of the ventilation using an inhaled radioactive gas or aerosol. Most commonly performed to evaluate: * * * *

Resporatory nuclear medicine studies Pulmonary emboli COPD Chronic bronchitis Emphysema Lung Ca.

In respiratory nuclear medicine studies Note: __ is usally performed 1st followed by the __

Ventilation, perfusion scan

Used in combination with lung perfusion scans __: used for a ventilation study. Characteristic: Must be absorbed significantly by the lungs. Must be diffuse easily Radiopharmaceutical: __ Mode of administration: __

Xe-133 lung ventilation scan Gas Xe-133 gas inhalation

Adult Dose: __ Scanning: Starts immediately after __ The ventilation study must precede the __ Images are taken: __– for the first breath equilibrium and washout __– for the first breath equilibrium

15-30 mCi inhalation Tc-99m perfusion scan Posterior and Anterior LPO & RPO

Xe-133 lung ventilation scan Note: the body usually absorbs less than __ of the gas

15%

Radiopharmaceutical: Adult dose: Scanning: Starts __ after the injection Images are taken: Anterior/posterior R and L lateral R and L Anterior Oblique R and L Posterior Oblique

Tc-99m Macroaggreated Albumin: Lung perfusion Scan Tc-99m MAA 4 mCi 5 minutes

__: taken within 24 hours of the lung scan for accurate interpretation of the lung scan to determine the probability for pulmonary embolism.

Chest radiograph

Lung ventilation scan- Lung perfusion scan

Xe-133 gas (inhalation) Tc-99m MAA (injection)

Topic 4 Flashcards

(63 cards)