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GIT and RENAL SYSTEM NUCLEAR MEDICINE PROCEDURES
This document discusses several nuclear medicine procedures related to evaluating the renal system and gastrointestinal tract. It provides information on radiopharmaceuticals, dosages, indications, contraindications, preparation, equipment, procedures, artifacts, and normal/abnormal results for renal cortical imaging, glomerular filtration rate measurement, gastrointestinal bleeding detection, and gastric emptying studies. Key details are given for accurately performing and interpreting these nuclear medicine scans.
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GIT and RENAL SYSTEM NUCLEAR MEDICINE PROCEDURES
- 1. GIT AND RENALSYSTEM Nuclear medicine PROCEDURES Vipin kumar PG Medical Imaging Kmc manipal
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- 5. PATIENT PREPARATION Identification andverification of request -NPO 8 hours -instructions
- 6. EQUIPMENT Camera- large field Collimator- low energy Computer setup- flow-sec/15sec for 1 mnt Dynamic- 15sec/frame for 9 mnts
- 7. 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
- 9. ARTIFACTS Aspiration ofthe dose Regurgitation with or without aspiration Attenuating articles or clotting
- 10. GASTRIC EMPYING Radio nuclide 99Tc Radiopharmaceutical 99Tc-SC ( sulfur colliod) location Compartmental, moved along with food through GIT Adult dose 200µCi to 1mCi Method 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
- 11. 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
- 12. PATIENT PREPARATION identifythe 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
- 13. EQUIPMENT Camera- largeor small Collimator-low energy ,high resolution Computer set ups- Static-preset for 60-120 sec or 50000 counts Dynamic- 60sec / image
- 14. 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
- 15. 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.
- 16. 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
- 19. ARTIFACTS Non uniformmixing of radiotracer and egg Too little or too much food Patient allergies Aspiration
- 20. GASTROESOPHAGEAL REFLUX Radio nuclide 99Tc Radiopharmaceutical 99Tc -SC location Compartmental, esophagus to gastrointestinal tract Adult dose 300µCi- 2mCi Method of administration PO in water, orange, milk, saline PO with acidified orange juice to delay the gastric emptying
- 21. INDICATION Detection ofGE reflux diaphramatic hernia children with asthma, chronic lung disease, aspiration pneumonia NO CONTRA INDICATION
- 22. PROCEDURE At 15mnts 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
- 23. GASTRO INTESTINAL BLEED Radionuclide 99Tc Radiopharmaceutical Tagged red blood cells by pyrophosphate or stannous chloride to 99m TcO4 by in vivo, in vitro location Compartmental, tagged to and circulating with blood Adult dose 20-30mCi Method of administration Iv injection, or drawing, tagging and reinjection the tagged red blood cells
- 24. INDICATION Detection andlocalization 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
- 25. PATIENT PREPARATION Obtainsigned 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
- 26. ABNORMAL RESULT Focal areaof increased activity Focal area peristalsing with time
- 27. URINARY SYSTEM CORTICAL IMAGING GLOMERULAR FILTRATION RATE TUBULAR FUNCTION
- 28. RENAL: CORTICAL IMAGING Radionuclide 99Tc Radiopharmaceutical 99Tc DMSA(90% binds to plasma proteins, preventing any glomerular filtration, hence show clearance from renal cortex) location Compartmental, blood stream Adult dose 1-6 mci Method of administration Direct Iv injection or Iv catheter with saline flush
- 29. INDICATIONS Evaluation ofrenal 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
- 30. PATIENT PREPARATION Identifythe 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
- 31. 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
- 32. NORMAL RESULT:- Bothkidneys visualized at the same size and intensities Collecting system may not be visualized because of the slow clearance
- 33. GLOMERULAR FILTRATION RATE Radionuclide 99Tc Radiopharmaceutical 99Tc DTPA location Compartmental, blood( 10% bound to blood , filtered by glomerulus Adult dose 3- 15 mCi Method of administration Bolus IV
- 34. INDICATION Evaluation ofrenal 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)
- 35. PREPARATION Well hydrated ,void before the test begins Discontinue any ACE inhibiters EQUIPMENT Camera-large FOV Collimator- low energy, high resolution
- 36. PROCEDURE DTPA isused 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
- 37. POST PROCESSING Generate timeactivity curve and differential function Generate % uptake of each kidney Generate pictures of dynamic or static images
- 38. NORMAL RESULT Bothkidneys at the same size and intensities. Both the graph peaking with parallel up slope and dropping off about the same rate. GFR-125ml/minute
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