GIT AND RENAL SYSTEMNuclear medicine

PROCEDURES

Vipin kumar PG Medical Imaging

Kmc manipal

BY

JOSEPH BERNARD

BY

JOSEPH BERNARD

INDICATION

PATIENT PREPARATION

Identification and verification of request-NPO 8 hours-instructions

Camera- large fieldCollimator- low energy

Computer setup-flow-sec/15sec for 1 mnt

Dynamic- 15sec/frame for 9 mnts

EQUIPMENT

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

ARTIFACTS

Aspiration of the dose Regurgitation with or without aspiration Attenuating articles or clotting

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

GASTRIC EMPYING

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

INDICATION

CONTRA INDICATION Allergic to egg, if so use baby food, sweet potatoes etc

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

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

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

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.

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

ARTIFACTS

Non uniform mixing of radiotracer and egg Too little or too much food Patient allergies Aspiration

Radio nuclide 99Tc

Radiopharmaceutical 99Tc -SC

location Compartmental, esophagus to gastrointestinal tract

Adult dose 300µCi- 2mCi

Method of administration

PO in water, orange, milk, salinePO with acidified orange juice to delay the gastric emptying

GASTROESOPHAGEAL REFLUX

INDICATION

Detection of GE reflux diaphramatic hernia children with asthma, chronic lung disease, aspiration

pneumonia

NO CONTRA INDICATION

PROCEDURE

At 15 mnts after injection position the patient in front of the camera

Acquire 30 second image From this image the ROI drawn will be used as the

background

Now place the patient supine on the table Place the abdominal binder at the lower abdomen Attach sphygmomanometer under the binder Acquire 30 second image with pressure in the abdominal

binder at 0, 20, 40,60,80 & 100mm Hg Post processing is done to acquire the gastro esophageal

reflex

Radio nuclide 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

GASTRO INTESTINAL BLEED

Detection and localization of the bleeding site in patient with active or intermittent bleeding.

This could be caused by ulcers, perforation, cancer, inflammation, diverticula.

CONTRAINDICATIONpatient with contrast studies under way

INDICATION

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

ABNORMAL RESULT

Focal area of increased activity Focal area peristalsing with time

CORTICAL IMAGING

GLOMERULAR FILTRATION RATE

TUBULAR FUNCTION

URINARY SYSTEM

Radio nuclide 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

RENAL: CORTICAL IMAGING

CONTRAINDICATIONNone

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

EQUIPMENTCamera-large field of view

Collimator-large energy high resolution

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

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

PROCEDURE

NORMAL RESULT:-

Both kidneys visualized at the same size and intensities Collecting system may not be visualized because of the

slow clearance

Radio nuclide 99Tc

Radiopharmaceutical 99Tc DTPA

location Compartmental, blood( 10% bound to blood , filtered by glomerulus

Adult dose 3- 15 mCi

Method of administration Bolus IV

GLOMERULAR FILTRATION RATE

CONTRAINDICATIONPatient still on adrenal cortical extract (ACE)

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

PREPARATIONWell hydrated , void before the test beginsDiscontinue any ACE inhibiters

EQUIPMENTCamera-large FOVCollimator- low energy, high resolution

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

POST PROCESSING

Generate time activity curve and differential functionGenerate % uptake of each kidneyGenerate pictures of dynamic or static images

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

NORMAL RESULT

PERFUSION - DTPA