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Nuclear Medicine

Nuclear Med Exams Available at Madison Memorial Hospital

  • BONE MARROW STUDY (No specific preparation)

INDICATION:  Evaluation of functional capacity of bone marrow (especially in cases of Anemia)

Evaluation of bone marrow for metastasis, abnormalities, thrombocytopenia (too few platelets), thrombocytosis (too many platelets).

PROCEDURE:  Patient is injected with a radioactive isotope, and waits anywhere from 15min to 1hour.

Patient will lie flat on back while scanning of whole body or a specific area of interest will take place. Images will then be reviewed by a Radiologist for evaluation and a report will be given to the patient’s physician.

  • BONE SCANS (No specific preparation)

  • Three Phase Bone Scan:

INDICATION:  Differentiation between osteomyelitis (inflammation of bone and bone marrow), and cellulitis (inflammation of cellular or connective tissues).

PROCEDURE:  Patient will lie on scan table and injected with a radioactive isotope and immediate imaging will occur ( first phase-blood flow) that will take approximately 1 min.  Then another image will take place immediately following the blood flow (second phase) taking approximately 5 min.  Then the patient will be able to leave facility and return 3 hours later for the delay imaging (third phase).

  • Limited Bone Scan:

INDICATION:  Evaluation of a specific area of bone in the body for fractures that are difficult to find.  Evaluation of bone pain.

PROCEDURE:  Patient is injected with a radioactive isotope and can leave the facility to return 3    hours later for imaging of the specific area of interest.

  • Whole Body Bone Scan:

INDICATION:  Evaluation of the whole skeletal system for abnormal lab results (elevated PSA, elevated alkaline phosphatase), metastatic disease, abnormal findings on other diagnostic images, response to chemotherapy, nonspecific bone pain.

PROCEDURE:  Same as the limited bone scan except when patient returns for imaging the whole body will be scanned and additional spot images will be taken as well. Images will then be reviewed by a Radiologist for evaluation and reporting.

  • BRAIN SCAN (No specific preparation)

INDICATION:  Evaluation of brain death, this is the most common usage of brain scans in Nuclear Medicine.  Other indications can be for evaluation of blood flow, detection of vascular malformations, inflammatory or infectious diseases, cerebrovascular accidents (CVA’s), and transient ischemic attacks (TIA’s).

PROCEDURE:  Patient is placed on scan table and injected with radioactive isotope and immediate images are obtained. Images will then be evaluated by a Radiologist

  • BREATH TEST FOR H. PYLORI (PY TEST) (UREA BREATH TEST)

PREPARATION:  Patient to be fasting, nothing to eat or drink for 6 hours prior, off antibiotics for 30 days, no bismuth (pepto bismol) for 30 days, no proton pump inhibitors and sucralfate for 2 weeks, off Prilosec for 7 days.

INDICATION:  Detection of gastric urease as an aid in the diagnosis of H. pylori infection in stomach and/or duodenum.

PROCEDURE:  A radioactive capsule is swallowed with 20ml water, and another 20ml water after 3 min.  After another 7min (10min total) patient will be instructed to take in a deep breath and hold it for 10 seconds and then while letting out breath blowing up a small mylar balloon through a straw.  The balloon is then analyzed at a lab.  The results are then faxed directly to the ordering physician’s office.

  • CARDIAC TESTS

  • MUGA:

PREPARATION:  Patient to be fasting NPO 4-8 hours.

INDICATION:  Evaluation of left and sometimes right (for congestive heart failure) wall motion. Calculation of ejection fraction, ventricular volume, cardiac output, and diastolic function. Assessment of CHF, CAD (Coronary Artery Disease), evaluation of cause of dyspnea, physical. Indicators, elevated labs.

PROCEDURE:  An IV catheter will be inserted into patients arm and 3ml of blood will be drawn. Out and tagged with a radioactive tracer and a specific kit.  After 20 minutes of tagging the blood mixture will be re-injected into IV. The patient will be hooked up to a 3 lead EKG and imaged for 5-10 minutes.

  • REST/STRESS:

PREPARATION:  Patient to be fasting NPO 4-12 hours.

INDICATION:  Detection and evaluation of coronary artery disease.  Abnormal EKG evaluation.

Evaluation of physical indicators – Myocardial infarction, chest pain, shortness of breath, history of heart disease.

PROCEDURE:  Patient will change into a gown with everything off from the waist up.  An IV will be started and an injection of a radioactive isotope will be given. Patient will then be hooked up to a 12 lead EKG machine and will wait for 30 minutes.  While waiting the patient will be instructed to drink approximately half a can of sprite.  After the 30 min. the patient will be placed on the scan table and images of heart will be conducted.  These first images are the RESTING images of the heart.  Once images are taken, the patient will then stress the heart by either walking on a treadmill to increase the heart rate or will be given an injection of a pharmacological agent that will increase the heart rate.  As soon as the heart rate is elevated to a specific rate another injection of a radioactive isotope will be injected.  The patient will then wait another 45 min. until the STRESS set of images are obtained.  While waiting the patient will drink the other half can of sprite and will also eat peanut butter and a few crackers, this will help flush the isotope out of the stomach and liver and gallbladder in order for a better image of the heart. Images will then be evaluated by the Cardiologist and a report will be given to the ordering MD.

  • CISTERNOGRAM

INDICATION:  Evaluation of cerebrospinal fluid (CSF) flow in the spinal column and brain.

Detection of CSF leak, evaluation for normal-pressure hydrocephalus, detection of obstructive

Hydrocephalus.

PROCEDURE:  the patient will undergo a spinal tap by the radiologist and a radioactive isotope will be injected into the spinal canal.  The patient will then be imaged at 4 hours post injection

24 hours post injection, 48 hours post injection and 72 hours post injection.  The imaging will take approximately 15 min each time.

  • CYSTOGRAM

INDICATION:  Evaluation and detection of ureteral reflux, surgical intervention or other to prevent subsequent impairment of renal function.

PROCEDURE:  Patient will empty bladder prior to start of procedure.   A nurse will insert a catheter into patient.  Patient will lie on scan table, a 500ml bag of saline mixed with a radioactive isotope will be connected to the catheter.  The bag of fluid will be introduced into the bladder and images will be taken.  Once the bladder is full the patient will then void into the saline bag through the catheter and images will be taken.

  • GALLIUM SCAN

INDICATION:  Evaluation of fever of unknown origin, chronic inflammations, pulmonary disorders, localization of osteomyelitis, detection and localization of tumors.

PROCEDURE:  Patient is injected via IV a radioactive isotope and imaged at 6 hour, 24 hour and 48 hour post injection for whole body imaging.

  • GASTRIC EMPTYING SCAN

PREPARATION:  Patient to be NPO for 12 hours.

INDICATION:  Determination of delayed gastric emptying, evaluation of obstruction, weight loss, nausea and vomiting.

PROCEDURE:  Patient will consume a meal that consists of 2 scrambled eggs that are tagged with a radioactive isotope, 2 slices of bread and a glass of water.  As soon as the meal is consumed an image of the patient’s stomach will be taken, and subsequent images at 1, 2, and 4 hours after consumption.  The patient will be instructed to not eat or drink anything until after the 4 hour image is taken.

  • GASTROINTESTINAL (G.I.) BLEED

INDICATION:  Detection and localization of bleeding sites in patients with active or intermittent gastrointestinal bleeding.  This usually presents as low red blood cell counts in labs and/or blood in stool.  Dark red blood may be small bowel or old bleed, bright red blood may be large bowel or anal.  It could be cause by aspirin, ulcers, perforation, cancers, inflammation, diverticula, and hemorrhoids.

PROCEDURE:  3ml of patients’ blood is drawn out of an IV catheter and tagged with a radioactive isotope.  The tagging process takes approximately 30 minutes.  The tagged blood is then re-injected into patient and placed on scan table for approximately 90 minutes or until bleed is identified whichever comes first.

  • HIDA SCAN (GALLBLADDER SCAN WITH EJECTION FRACTION)

PREPARATION:  Patient is to be NPO for 4-6 hours

INDICATION:  Evaluation of abdominal pain, cholecystitis; acute inflammation of gallbladder, cystic or common bile ducts.  Obstruction, spasms of gallbladder, function from abnormal lab testing.  A normal ultra sound but still having right upper quadrant pain.

PROCEDURE:  Patient will have an IV catheter placed and an injection of a radioactive isotope will be injected.  60 minutes of imaging will then be performed. At the end of the first imaging the gallbladder should be seen and another injection of a pharmacological agent will be injected to empty the gallbladder, this will take place during another 30 min. of scanning.  If the gallbladder doesn’t show up at the end of the first 60 min scan the patient will be given a small amount of morphine and scanned for 20 minutes to force the gallbladder to appear.  If the morphine is given then the pharmacological agent will not be given.

  • LIVER/SPLEEN SCAN

INDICATION:  Assessment of anatomy, size and relative position of liver and spleen.

Assessment of chronic liver or spleen disease including primary liver tumors and metastasis, jaundice, cirrhosis, hepatocellular disease, hepatitis, hepatic abscess, reticuloendothelial system function, or elevated blood work results.

PROCEDURE:  Patient will be injected with a radioactive isotope and imaged for 30 minutes.

  • LUNG VENTILATION/PERFUSION SCAN

INDICATION:  Evaluation of pulmonary embolism (PE) the main cause being deep vein thrombosis.  Evaluation of pulmonary perfusion, chest pain, shortness of breath, low blood oxygen saturation.

PROCEDURE:  Patient will be sitting and will have a mouthpiece in mouth, a nose clamp on the nose, and will be instructed to breathe through the mouthpiece being careful of not letting any air escape.  This process will take at least 10 minutes and up to 15minutes. Then the patient will be supine on the imaging table and imaged for approximately 15 minutes.  A radioactive isotope will then be injected through an IV catheter and imaged for an additional 15 minutes.

  • LYMPHOSCINTIGRAM

INDICATION:  Evaluation of staging of cancers into the lymph system.  Detection of metastatic invasion of the lymph nodes.  Evaluation of node resection as an alternative to removing an entire bed of lymph nodes, which may case edema of that area and other related complications.  It is designed to find the few sentinel nodes to which the cancer may drain.

PROCEDURE:  For melanoma, the patient is injected around the ROI with two to six doses of a radioactive isotope subcutaneously and intradermal by a radiologist.  For breast cancer the patient is injected with four to six injections of the radioactive isotope around the lesion. If so indicated imaging will be performed until the isotope moves to the sentinel node.

  • MECKEL’S DIVERTICULUM

PREPARATION:  NPO for 4-12 hours.

INDICATION:   localization of a Meckel’s diverticulum with functioning gastric mucosa. Detection of gastrointestinal bleeding.  Evaluation of abdominal pain, especially in children.

PROCEDURE:  Radioactive isotope is injected IV and images are taken immediately following.

  • OCTREOSCAN

PREPARATION:  Patient should be well hydrated, drink 2 eight ounce glasses of water before and after radioactive isotope injection.  Suspend medications 72hrs before injection.  Patient will have a light laxative night before injection and for 2 days after injection.

INDICATION:  Detection and localization of primary and metastatic neuroendocrine tumors.

PROCEDURE:  Patient will be injected with a radioactive isotope in the morning of the first set of images, a whole body scan will be done at the 4, 24, 48, and 72 hour mark after the injection. The patient will be instructed to take a laxative the night before each scan.  The patient will stay on a strict diet of light meals and clear liquids until the last scan is complete.

  • PARATHYROID SCAN

PREPARATION:  No specific prep.

INDICATION:  Detection and localization of primary and secondary parathyroid cancer.  Identification of single adenomas, multiple adenomas, or glandular hyperplasia in patient with newly diagnosed hypercalcemia and elevated parathyroid hormone (PTH) levels.  Localization of cancer for surgery candidates.  Localization of parathyroid tissue after surgery.

PROCEDURE:  The patient will be injected with a radioactive isotope IV, and then wait for 15 minutes before the first set of images are taken.  Another set of imaging will then be taken approximately 4 hours post injection.

  • RENAL SCANS

  • FLOW AND FUNCTION WITH LASIX:

PREPARATION:  Patient should be NPO for at least 4 hours on morning of exam. Patient should be well hydrated and discontinue any diuretic medication.

INDICATION:  Evaluation of renal function and perfusion.  Evaluation of renal obstruction of the renal ureters.

PROCEDURE:  Patient will have an IV catheter inserted and injection of a radioactive isotope will be introduced.  The patient will be imaged for 60 minutes at which point they will be given Lasix (diuretic) and continue imaging for an additional 30 minutes, once complete the patient will use the rest room and empty their bladder and imaged another minute post void.

  • FLOW AND FUNCTION WITH CAPTOPRIL:

PREPARATION: Same as with the Lasix study along with discontinuing ACE inhibitors ( high blood pressure medication) for 48 hours prior to exam if able to.

INDICATION:  Evaluation for renal artery stenosis, obstruction and/or trauma.  Evaluation for renal hypertension that might be causing high blood pressure.

PROCEDURE:  Patient will be injected with a radioactive isotope and imaged for thirty minutes.  This gives a baseline scan of kidneys without an ACE inhibiter.  After thirty minutes the patient will be given Captopril and blood pressures will be taken every 15 minutes for 1 hour. Then another dose of radioactive isotope will be given and another 30 minutes of imaging will be done.

  • TESTICULAR SCAN:

PREPARATION: None

INDICATION:  Evaluation of groin pain, patency of blood supply to testes, differentiation between acute testicular torsion (twisting and lack of blood supply to one or both testes), and acute epididymitis (infection or trauma to epididymis or scrotum) and infection of testes. Evaluation of scrotal mass.

PROCEDURE:  Patient is injected with a radioactive isotope through IV catheter, and images over pelvic region done for 30 minutes.

  • THYROID UPTAKE AND SCAN: 

PREPARATION:  Patient to discontinue taking any thyroid medications, refrain from eating foods containing iodine such as cabbage, turnips, greens, seafood, kelp, or large amounts of table salt.

INDICATION:  Evaluation of the thyroid gland, detection and evaluation of hyperthyroidism and hypothyroidism.  Localization of thyroid mass, nodules, and evaluation of thyroid from abnormal findings on other diagnostic images such as ultra sound, CT scan, or MRI.

PROCEDURE:  Patient will arrive at facility having been instructed to avoid the certain foods as stated above, given a pill to swallow and instructed to return 3-4 hours later for a count of the thyroid uptake of the radioactive isotope pill.  Patient will then return 24 hours after taking the pill and another count of the thyroid will be done along with images taken.

  • THYROID THERAPY

  • HYPERTHYROIDISM/THYROID CANCER:

PREPARATION:  The patient will be instructed to be off all thyroid medication and a blood test will have been performed at the ordering doctor’s office.  Once the test results of the TSH is above 35% the patient can then be treated for the thyroid diseases.

INDICATION:  Treatment of hyperthyroidism, Graves disease, toxic nodular goiter. Total ablation of residual functioning thyroid carcinoma, thyroid tissue after total or partial thyroidectomy.

PROCEDURE:  the patient will be instructed on the hows and whys of the treatments, what to expect and what to do following treatment.  There will be specific instructions to follow after an ablation and the radiologist will discuss these things with the patient.  The patient will have a total understanding and have no questions before the dosing occurs.  It will be understood that the patient will be able to follow the strict guidelines outlined by the radiologist. Then the patient will be given a radioactive iodide tablet to swallow, the tablets strength will depend on the type of therapy needed (hyperthyroidism or cancer).

  • THERAPY FOR BONE PAIN AND OTHER METASTATIC DISEASE:

Depending on the type of therapy needed there will be certain criteria that the patient will need before any certain therapy is given.  The patient’s doctor will have these criteria taken care of prior to arrival in the nuclear medicine department for the treatment.  The patient will be injected IV with a certain radioactive isotope specific for the type of therapy needed.

  • WHITE BLOOD CELL SCAN:

INDICATION:  Detection and localization of acute and chronic osteomyelitis (especially acute) and other musculoskeletal infections.  Detection and localization of acute abscesses, infections, inflammatory diseases, prosthesis rejections.

PROCEDURE:  The technologist will draw approximately 50cc of blood from patient.  The patient will be instructed to return approximately 2 hours later.  During this time the patient’s blood will be prepared to the point that only the white blood cells will be tagged with a radioactive isotope.  The patient will then be injected with their own radioactive white blood cells and then images will be done at 24, 48, and possibly 72 hours post injection.