Nuclear Medicine Procedures

This information has been prepared to:

(a) outline the more commonly performed Nuclear Medicine investigations,
(b) assist referrers in requesting the most appropriate Nuclear Medicine procedure for a given patient

 

This information is designed as a reference source for referring medical practitioners. Your patients should ask the North Coast Radiology Nuclear (NCR) Medicine service for any specific additional information revelvant to their procedure or express any concerns they have.

 

Many procedures will be performed in conjunction with a low-dose CT scan for attenuation correction and anatomical localisation. The CT scan will take about 2 minutes.

Please notify NCR Nuclear Medicine if patient is breast feeding or suspected to be pregnant.

Myocardial perfusion stress tests or sometimes listed according to the radiopharmaceutical used (e.g. MIBI, Myoview or Thallium scans).

 

Times allowed and preparations are intended as a guide only to assist you and your patients when organising appointment times for scans. Please note that approximate time is the time from administration of radiopharmaceutical to the end of scanning. For many procedures there is a gap of an hour or more between administration of radiopharmaceutical and the actual scan when patients may be able to leave the clinic.

 

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Skeletal System

INDICATION

PREPARATION

APPROXIMATE TIME

Bone Scan

• Primary / secondary bone tumors 3
• Occult fracture
• Complex regional pain syndrome / RSD
• Bone infarct
• Bone graft viability
• Sacroiliitis
• Fibrous dysplasia and other benign bone lesions
• Arthritis
• Osteomyelitis
• Enthesopathies – plantar fasciitis, trochanteric bursitis
• Metabolic bone disease – Paget’s disease
Sport injuries – stress fracture & stress reaction
• Avascular necrosis
• Distribution of osteoblastic activity before radionuclide
therapy

Well hydrated before and after radiopharmaceutical injection.

 

If history of trauma; ensure this occurred more than 3 days prior to scan.

2 PART TEST

 

Scan sometimes required at time of injection depending in clinical indications. (Allow 15 minutes)

 

Scans performed at 2-3 hours after injection. (Allow 45-90 minutes)

Click here for Case study:

Benefits of performing a Nuclear Medicine SPECT/CT Bone Scan prior to CT guided Facet Joint Steroidal Injection

CNS

INDICATION

PREPARATION

APPROXIMATE TIME

Cerebral Perfusion / Brain SPECT

Dementia, stroke. Cerebral flow reserve, brain tumor & suspected recurrance.

90 minute total.

CSF Flow / Leak
  • Confirm normal pressure hydrocephalus
  • Assess and localize CSF leak

Nil

Allow 60 minutes for lumbar puncture in preparation for scan.

Scans performed at various intervals throughout day.

Allow 2 – 24 hours for scan completion.

CSF Shunt Patency
  • Assess VP & VA shunt patency & localize obstruction

Nil

Allow 30 minutes for scan preparation and injection.

The area around the reservoir may be shaved.

Scans performed at various intervals throughout day.

Allow 2 – 24 hours for scan completion.

Endocrine

INDICATION

PREPARATION

APPROXIMATE TIME

Thyroid
  • Hyperthyroidism – Graves’ disease, toxic nodules,
    thyroiditis (subacute, post-partum, Hashimoto’s)
  • Determine activity of I-131 therapy for Graves’
    disease, toxic nodule and toxic multinodular goitre
  • Functional status of solitary or multiple nodules
  • Thyroid carcinoma detection, staging, management and follow-up
  • Goitre
  • Upper mediastinal mass / retrosternal goitre
  • Neonatal hypothyroidism, mouth and neck masses
  • Post thyroidectomy neck masses

No CT or iodine based contrast 4-6 weeks prior to scan.

 

Some medications need to be ceased prior to scan, depending on clinical indications.

 

Patient preparation will be further discussed when making appointment.

45 minutes.

Parathyroid
  • Hyperfunctioning parathyroid adenoma

Nil

Allow 60 minutes for lumbar puncture in preparation for scan.

Scans performed at various intervals throughout day.

Allow 2 – 24 hours for scan completion.

Cardiac

INDICATION

PREPARATION

APPROXIMATE TIME

Myocardial Perfusion Study
  • Ischemia
  • Infarction
  • LVEF
  • CAD
  • Unexplained arrhythmia
  • Efficacy post revascularisation
  • Angina
  • Pre-operative risk assessment

Prep only necessary in relation to the stress test (part 2)

 

NO tea, coffee, chocolate, soft drink (including herbal & decaffinated drinks) for 24 hrs prior to stress test.

 

Cease following medications for 5 days prior to stress test component of test: Persantin / Dipyridamole / Asasantin, Cialis, Theophylline

 

Fast morning of the test.

 

Diabetics can have juice or small meal to prevent hypoglycaemia.

3 PART TEST

  1. Rest Scan
  2. Stress Test
  3. Stress Scan

Allow 5 hours (on & off)

Myocardial Perfusion Study Myocardial Viability Using Thallium-201
  • Infarction
  • Hibernating myocardium

Nil

1st scan performed immediately after injection. Allow 45 minutes for this scan.

 

2nd scan performed 4 hours after injection. Allow 60 minutes for this scan.

 

3rd scan (if required) performed 24 hours after injection. Allow 60 minutes for this scan.

Gated Heart Blood Pool (MUGA)
  • Left ventricular ejection fraction
  • Baseline and post chemotherapy
  • Cardiomyopathy

Nil

Allow 30 minutes for scan preparation and injection and 30 minutes for scan.

Total 60 minutes.

Cardiac Shunt Qp:Qs First Pass
  • Ventricular / atrial septal defects
  • Patent ductus arteriosus

Nil

20 to 60 minutes.

Respiratory

INDICATION

PREPARATION

APPROXIMATE TIME

VQ Lung Scan
  • Pulmonary embolism
  • Quantitative lung perfusion to assess function prior to lung reduction surgery
  • Ventilation lung clearance to assess activity of inflammatory lung disease

Nil

40 to 60 minutes.

Hepatobiliary

INDICATION

PREPARATION

APPROXIMATE TIME

HIDA +/- CCK
  • Acute / chronic cholecystitis
  • CBD obstruction
  • GB EF%
  • RUQ pain
  • Sphincter of Oddi dysfunction
  • Post-cholecystectomy pain
  • Bile leak

6 hr fast (nil food or drink)

 

Avoid opoids for 4 hrs prior

 

Avoid fasting > 24hrs

 

Fatty meal before test

Allow 2 hours for scan.

Liver – Spleen (Colloid)
  • Liver: size, shape, function
  • FNH, tumour, cyst, trauma
  • Chronic liver disease
  • Portal hypertension

No Barium 48hrs prior to scan.

1 to 1.5 hours.

Liver (RBC Hemangioma)
  • Hemangioma

Nil

Allow 60 minutes for scan preparation, injection & 1st scan.

 

Allow 30-60 minutes for 2nd scan performed 1-3 hours after injection.

Gastrointestinal

INDICATION

PREPARATION

APPROXIMATE TIME

Gastric Emptying
  • Gastroparesis
  • Rapid gastric emptying & dumping
  • Epigastric discomfort & bloating
  • Post gastric surgery assessment

6 hr fast

Allow 15-30 minutes to prepare & eat meal in preparation for scan.

 

Allow 2 hours for scan.

Colonic Transit Study
  • Constipation

Cease all laxatives 3 days prior to scan & continue until completion of test.

5 DAY TEST

Monday morning (15 minutes)

Monday afternoon (15 minutes)

Tuesday – Friday morning (15 minutes)

GI Bleed Localisation

Call NCR Nuclear Medicine

90 minutes to 6 hours.

Meckel’s Diverticulum

Detect Meckel’s diverticulum.

6 hour fast prior to scan.

Allow 30-60 minutes for preparation and scan.

Infection / Inflammation

INDICATION

PREPARATION

APPROXIMATE TIME

Gallium - localised
  • Bone / soft tissue / joint infection

Prefer to scan prior to antibiotic treatment.

Scan is performed 48 hours after injection.

Allow 15 minutes for injection appointment.

Allow 90 minutes for scan appointment.

WBC – Infection
  • Occult infection
  • PUO

Prefer to scan prior to antibiotic treatment.

Allow 5-8 hours (on & off all day for preparation, injection & scans).

 

Repeat imaging may be required the following day.

WBC – Inflammatory Bowel Disease
  • Ulcerative colitis
  • Crohn’s disease

Nil

Allow 5-8 hours (on & off all day for preparation, injection & scans).

Oncology

INDICATION

PREPARATION

APPROXIMATE TIME

Gallium
  • Lymphoma – staging, monitoring pre- & post- therapy
  • Sarcoidosis

Nil

Allow 15 mins for injection appointment.

Scan is performed 48 hours after injection.

Allow 120 minutes for scan appointment.

Allow 60 minutes for scan 72 hours after injection (if required).

Thallium
  • MSK tumors
  • Grading of cartilaginous tumors

Nil

Allow 60-120 minutes.

MIBI
  • Multiple Myeloma
  • MSK tumors

Nil

Allow 60-120 minutes for myeloma imaging.

Allow 60 minutes for MSK imaging

Allow 60 minutes for breast imaging

Octreotide

Detect tumors & their metastases with somatostatin receptors:

  • Carcinoid tumor
  • Pancreatic islet cell tumor
  • Adrenal medullary tumors
  • Gastroenteropancreatic tumors
  • Merkel cell tumor
  • Pituitary adenoma
  • Small cell lung carcinoma

Contact NCR Nuclear Medicine

3-4 PART TEST

Scans performed 4-6 hrs and 24hrs after injection & occasionally at 48hrs.

  1. Allow 30 minutes for injection
  2. Allow 60 minutes for scan at 4-6hrs
  3. Allow 60-120 mins for scan at 24hrs

 

Allow 60 mins for scan at 48 hours (if required).

Lymphatic

INDICATION

PREPARATION

APPROXIMATE TIME

Sentinel Node Localisation
  • Sentinel node localization / mapping / drainage
  • Facilitate radio guided localization
  • Breast / Penile / Gyne / Colorectal Ca / Melanoma

Nil

 

Bring previous ultrasounds & mammograms.

 

Notify theatre times & bookings.

Allow 1.5 – 2 hours.

Lymphoscintigraphy – lymphatic drainage
  • Lymphoedema

Nil

Variable. 30 minutes – 4 hours.

Therapy

INDICATION

PREPARATION

APPROXIMATE TIME

I-131 thyrotoxicosis

Call NCR Nuclear Medicine

Strontium-89

Call NCR Nuclear Medicine

Renal

INDICATION

PREPARATION

APPROXIMATE TIME

DSMA
  • Cortical scarring
  • Active infection such as pyelonephritis
  • Differential renal function

Nil

Allow 1.5 – 2 hours.

MAG3 / DTPA baseline differential
  • Differential renal function
  • Assess function of renal transplant grafts
  • ATN

Eat normally.

Drink 4 glasses of water in hour prior to appointment.

Empty bladder as needed.

30 minutes.

MAG3 / DTPA + diuretic (frusemide)
  • Assess urinary drainage
  • PUJ & VUJ obstruction
  • Post operative surveillance

Eat normally.

Drink 4 glasses of water in hour prior to appointment.

Empty bladder as needed.

60 minutes.

MAG3 / DTPA + ACE inhibitor (captopril)
  • Renovascular hypertension
  • Renal artery Stenosis

Eat normally.

Drink 4 glasses of water in hour prior to appointment.

Empty bladder as needed.

ACE inhibitors to be ceased 5 days prior to scan.

ACE inhibitor challenge scan. Patient given oral ACE inhibitor (usually captopril) & scanned 60 minutes later. Allow 30 minutes for this scan.

Indirect Micturating Cystogram
  • Urinary reflux

Eat normally.

Drink 4 glasses of water in hour prior to appointment.

Empty bladder as needed.

No IDC required.

ACE inhibitor challenge scan. Patient given oral ACE inhibitor (usually captopril) & scanned 60 minutes later. Allow 30 minutes for this scan.

GFR Assessment
  • evaluation and monitoring of renal function in cases of chronic kidney disease
  • quantification of renal perfusion and function
  • evaluation of urinary drainage from the kidneys and collecting systems
  • evaluation of renal function in potential live donors
  • evaluation and monitoring of single-kidney renal function and pre- and postoperative follow-up
  • evaluation of renal function in patients to predict or assess the need for dialysis

Eat normally.

Drink 4 glasses of water in hour prior to appointment.

Empty bladder as needed.

45 minute appointment followed by 3 X 15 minute every hour for 3 hours.

 

Process involves a 30 minute scan assessing the kidneys followed by 3 samples of the patient’s blood being taken every hour for 3 hours post injection.

 

For example, initial appointment at 9am followed by 10am, 11am and 12pm.

 

Please note: The patient is not required to stay in the department for the whole time.

Miscellaneous

INDICATION

PREPARATION

APPROXIMATE TIME

Lacrimal Duct / Dacroscintigraphy
  • Blockage in lacrimal drainage system (excessive tearing)

Nil

30 to 60 minutes.

Salivary Gland Study
  • Salivary gland dysfunction

Nil

30 to 60 minutes.