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  1. 1. GIT AND RENAL SYSTEM Nuclear medicine PROCEDURES Vipin kumar PG Medical Imaging Kmc manipal
  4. 4. PATIENT PREPARATIONIdentification and verification of request -NPO 8 hours -instructions
  5. 5. EQUIPMENT Camera- large field Collimator- low energy Computer setup- flow-sec/15sec for 1 mntDynamic- 15sec/frame for 9 mnts
  6. 6. PROCEDURE  Patient supine, camera anterior over the thorax  Patient draws dose into the mouth, On command patient swallow once in a single bolus Patient dry swallow once in every 15 sec for 10 mnts
  7. 7. ARTIFACTS Aspiration of the dose Regurgitation with or without aspiration Attenuating articles or clotting
  8. 8. GASTRIC EMPYINGRadio nuclide 99TcRadiopharmaceutical 99Tc-SC ( sulfur colliod)location Compartmental, moved along with food through GITAdult dose 200µCi to 1mCiMethod of administration Radiotracer usually mixed with 1 or 2 egg white for solid study, radiotracer mixed with 120 ml of water or other and ingested orally
  9. 9. INDICATION  Determination of delayed gastric emptying  Evaluation of mechanical obstruction  Evaluation of anatomic obstruction  Evaluation of altered function  Evaluation of suspected tumor or surgery  Evaluation of nausea  Evaluation of weight loss  Evaluation of gastric therapy CONTRA INDICATION Allergic to egg,if so use baby food, sweet potatoes etc
  10. 10. PATIENT PREPARATION identify the patient, verify the procedure and explain ensure diabetics receive orange juice 2 hrs prior to the study NPO 4-12 hours discontinue sedatives 12 hours prior
  11. 11. EQUIPMENT Camera- large or small Collimator-low energy ,high resolution Computer set ups- Static-preset for 60-120 sec or 50000 counts Dynamic- 60sec / image
  12. 12. PROCEDURE BASELINE SOLID STUDY mix the radiotracer with the egg-administer to the patient PO with 30-120 ml of water, - Encourage patient to eat quickly
  13. 13. POSITION OF PATIENT PATIENT SUPINE Supine is good for checking esophageal reflex Camera – anterior or LAO instruct the patient to be motionless obtain static images every 5 mnts up to 30 mnts, then every 15 mnts there after.
  14. 14. POSITION PATIENT STANDING realism study obtain immediate images and then every 10 mnts  ADITIONAL TESTING  if emptying is slow metaclopramide is administered  continue with the protocol for 60 mnts
  15. 15. ARTIFACTS Non uniform mixing of radiotracer and egg Too little or too much food Patient allergies Aspiration
  16. 16. GASTROESOPHAGEAL REFLUXRadio nuclide 99TcRadiopharmaceutical 99Tc -SClocation Compartmental, esophagus to gastrointestinal tractAdult dose 300µCi- 2mCiMethod of administration PO in water, orange, milk, saline PO with acidified orange juice to delay the gastric emptying
  17. 17. INDICATION Detection of GE reflux diaphramatic hernia children with asthma, chronic lung disease, aspiration pneumonia NO CONTRA INDICATION
  18. 18. PROCEDURE At 15 mnts after injection position the patient in front of Now camera patient supine on the table the place the Place the abdominal binder at the lower abdomen Acquire 30 second image Attach sphygmomanometer under the binderused as the From this image the ROI drawn will be Acquire 30 second image with pressure in the abdominal background binder at 0, 20, 40,60,80 & 100mm Hg Post processing is done to acquire the gastro esophageal reflex
  19. 19. GASTRO INTESTINAL BLEEDRadio nuclide 99TcRadiopharmaceutical Tagged red blood cells by pyrophosphate or stannous chloride to 99m TcO4 by in vivo, in vitrolocation Compartmental, tagged to and circulating with bloodAdult dose 20-30mCiMethod of administration Iv injection, or drawing, tagging and reinjection the tagged red blood cells
  20. 20. INDICATION Detection and localization of the bleeding site in patient with active or intermittent bleeding. This could be caused by ulcers, perforation, cancer, inflammation, diverticula. CONTRAINDICATION patient with contrast studies under way
  21. 21. PATIENT PREPARATION Obtain signed consent for blood work Look for active signs of bleeding PROCEDURE In in vitro method extract 2.5 ml of blood from the patient into a heparinized syringe and tag with Radio pharmacy. In in vivo method inject cold pyrophosphate, then 20 minutes later inject radiotracer under camera for flow
  22. 22. ABNORMAL RESULTFocal area of increased activityFocal area peristalsing with time
  24. 24. RENAL: CORTICAL IMAGINGRadio nuclide 99TcRadiopharmaceutical 99Tc DMSA(90% binds to plasma proteins, preventing any glomerular filtration, hence show clearance from renal cortex)location Compartmental, blood streamAdult dose 1-6 mciMethod of administration Direct Iv injection or Iv catheter with saline flush
  25. 25. INDICATIONS Evaluation of renal cortex Evaluation and quantization of regional relative function. Evaluation of differential function Localization of the renal mass Detection and differentiation of acute and chronic pyelonephritis Evaluation of renal blood supply Evaluation of renal transplant CONTRAINDICATION None
  26. 26. PATIENT PREPARATION Identify the patient and verify Explain the procedure Should be well hydrated and should void before the test begins Discontinue angiotensin converting enzymes inhibiters EQUIPMENT Camera-large field of view Collimator-large energy high resolution
  27. 27. PROCEDURE DMSA is usually used for anatomic studies, Maintain patient hydration Patient position supine Obtain images- inject and take immediate static (500000- 800000 counts) then delays at 1 hour
  28. 28. NORMAL RESULT:- Both kidneys visualized at the same size and intensities Collecting system may not be visualized because of the slow clearance
  29. 29. GLOMERULAR FILTRATION RATERadio nuclide 99TcRadiopharmaceutical 99Tc DTPAlocation Compartmental, blood( 10% bound to blood , filtered by glomerulusAdult dose 3- 15 mCiMethod of administration Bolus IV
  30. 30. INDICATION Evaluation of renal tubular function Evaluation of renal vascular flow Evaluation of renal hypertension Detection of acute tubular necrosis Renal tubular trauma Renal transplant CONTRAINDICATION Patient still on adrenal cortical extract (ACE)
  31. 31. PREPARATIONWell hydrated , void before the test beginsDiscontinue any ACE inhibiters EQUIPMENT Camera-large FOV Collimator- low energy, high resolution
  32. 32. PROCEDURE DTPA is used for inexpensive and easy baselines checking for normal renal function If GFR is included count the syringe before and after the injection for 1 mnt at 30cm from camera face  Place the patient in supine, camera posterior except for renal transplant  Position camera in FOV, kidney and bladder must be in FOV  If study calls for frusimide IV setup with butterfly is needed  Inject bolus and start camera  Images are obtained
  33. 33. POST PROCESSINGGenerate time activity curve and differential functionGenerate % uptake of each kidneyGenerate pictures of dynamic or static images
  34. 34. NORMAL RESULT Both kidneys at the same size and intensities. Both the graph peaking with parallel up slope and dropping off about the same rate. GFR-125ml/minute
  35. 35. PERFUSION - DTPA