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NM ORDERING GUIDE
Table of Contents
CARDIAC
Myocardial Perfusion Scan
MUGA Scan
IMG5491
IMG430
2
3
SKELETAL
Whole Body Bone Scan
Triple Phase Bone Scan
Limited Body Bone Scan
Multi-Body Bone Scan
SPECT Bone Scan
IMG401
IMG402
IMG399
IMG400
IMG8571
4
5
6
7
8
GASTROINTESTINAL
Gastric Emptying Scan
GI Bleed Scan
HIDA w/Ejection Fraction
Liver/Spleen Scan
Meckels Diverticulum Scan
IMG388
IMG394
IMG8575
IMG379
IMG396
9
10
11
12
13
PULMONARY
Lung VQ Scan
Lung Quantification Scan
IMG5257
IMG442
14
15
ENDOCRINE
Thyroid Uptake & Scan
Parathyroid Scan
Iodine 131 Whole Body Imaging
IMG344
IMG351
IMG349
16
17
18
GENITOURINARY
Renal Scan w/Lasix
Renal Scan w/Captopril
Renal Cortical Imaging
IMG1161
IMG2149
IMG8616
19
20
21
ABSCESS/INFECTION
Indium 111 Tagged WBC LTD
Indium 111 Tagged WBC WB
Triple Phase Bone Scan
Gallium 67 Abscess/Infection Scan
IMG1167
IMG1170
IMG402
IMG2410
22
23
24
25
TUMOR/ONCOLOGY
Sentinel Node Lymphatic Imaging
Octreotide Scan
Gallium 67 Tumor Imaging
IMG372
IMG8579
IMG8580
26
27
28
MYOCARDIAL PERFUSION SCAN
EXAM CODE:
BACK
IMG5491 - NM MYOCARDIAL PERFUSION MULT SPECT
INDICATIONS:
• Detection and evaluation of coronary artery disease, coronary
atherosclerosis, myocardial infarction, and history of heart
disease.
• Evaluation of precordial pain, abnormal EKG, and abnormal
cardiac laboratory findings.
RADIOPHARMACEUTICAL & DOSE:
• 10 millicuries Technetium 99m sestamibi
• 30 millicuries Technetium 99m sestamibi
PATIENT PREPARATION:
• NPO after midnight prior to scan.
• No caffeine 12 hours prior to scan.
• Check with Exam for medication hold list.
PROCEDURE:
• For most patients, both resting and stress scan are done on
the same day.
• Patient is intravenously injected with isotope followed by a
resting scan.
• A chemical or treadmill stress test will be performed during
which another intravenous injection of isotope will occur.
• The stress images will then be performed last.
TOTAL EXAM TIME:
• 3-4 hours for entire procedure
REMINDERS:
•
•
•
•
•
NPO after midnight.
No caffeine 12 hours prior to scan.
Discontinue indicated meds per physician.
Total exam time is 3-4 hours.
Two-day patient studies will return the following day for injection and
imaging (2 hours).
NM Ordering Guide | Updated: 7.22.13
2
MUGA SCAN
(Tagged RBC Imaging)
EXAM CODE:
BACK
IMG430 - NM CARDIAC BLOOD POOL GATED SPECT W EF
INDICATIONS:
• Assessment of left ventricle ejection fraction and cardiac wall
motion.
• Scan is typically performed prior to chemotherapy
administration.
RADIOPHARMACEUTICAL & DOSE:
• 30 millicuries Technetium 99m RBC (tagged red blood cells)
PATIENT PREPARATION:
• No caffeine 24 hours prior to exam.
• No PET scan within last 24 hours.
• 20g IV catheter or larger for RBC blood draw.
PROCEDURE:
• The patient will have a blood sample collected.
• Patient’s red blood cells will be tagged to an isotope and
intravenously injected 30 minutes post blood sample
collection.
• Gated planar imaging of the heart will be performed for 20
minutes.
• SPECT tomographic images will also be taken for additional 20
minutes.
TOTAL EXAM TIME:
• 2 hours for entire procedure.
REMINDERS:
• Total exam time is 2 hours.
• No PET scan within last 24 hours
REMINDERS:
• 20g IV catheter or larger for RBC blood draw.
NM Ordering Guide | Updated: 7.22.13
3
WHOLE BODY BONE SCAN
EXAM CODE:
BACK
IMG401 - NM BONE SCAN WHOLE BODY
INDICATIONS:
• Detection and evaluation of primary and metastatic disease of
the bones, Paget’s disease of the bone, neoplasm, or known
lesions.
• Evaluation of abnormal x-rays or abnormal laboratory results
such as; elevated alkaline phosphatase and elevated prostate
specific antigen (PSA).
RADIOPHARMACEUTICAL & DOSE:
• 25 millicuries Technetium 99m MDP (methylene
diphosphonate)
PATIENT PREPARATION:
• There is no prep for this procedure, however the patient will
be instructed to hydrate after the bone scan injection.
• Please provide current x-rays taken of any areas of interest for
radiological comparison.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• The patient will return 3 hours later for whole body imaging.
TOTAL EXAM TIME:
• 15 minutes for injection.
• 1 hour for delayed whole body bone imaging.
REMINDERS:
•
•
•
There is no patient preparation for this exam.
The patient will receive an injection and will return about 3 hours later for imaging.
Please provide any current and relative films for exam.
NM Ordering Guide | Updated: 7.22.13
4
TRIPLE PHASE BONE SCAN
EXAM CODE:
BACK
IMG402 - NM BONE SCAN 3 PHASE SCAN
INDICATIONS:
• Assessment of loosening or infected prosthesis, infection of
extremities, and detection of osteomylitis.
RADIOPHARMACEUTICAL & DOSE:
• 25 millicuries Technetium 99m MDP (methylene
diphosphonate)
PATIENT PREPARATION:
• There is no prep for this procedure, however the patient will
be instructed to hydrate after the bone scan injection.
• Please provide any current x-rays taken of the area of interest
for radiological comparison to the triple phase bone scan.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• During injection, blood flow images are taken of the area of
interest, followed by blood pool images of the same area.
• The patient will return 3 hours later for static bone imaging.
TOTAL EXAM TIME:
• 30 minutes for injection and blood flow imaging.
• 1 hour for delayed bone imaging.
REMINDERS:
•
•
•
•
There is no patient preparation for this exam.
The patient will receive an injection with immediate imaging, and will return about 3 hours
later for delayed imaging.
Please note the specific area of interest on physician order.
Please provide any current and relative films for indicated area.
NM Ordering Guide | Updated: 7.22.13
5
LIMITED BODY BONE SCAN
EXAM CODE:
BACK
IMG399 - NM BONE SCAN LIMITED
INDICATIONS:
• Evaluation limited to one specific area of interest for abnormal
x-rays, pain, trauma, occult fractures, neoplasm or known
lesions.
RADIOPHARMACEUTICAL & DOSE:
• 25 millicuries Technetium 99m MDP (methylene
diphosphonate)
PATIENT PREPARATION:
• There is no prep for this procedure, however the patient will
be instructed to hydrate after the bone scan injection.
• Please provide any current x-rays taken of the area of interest
for radiological comparison.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• The patient will return 3 hours later for limited static imaging
of area indicated for scan.
TOTAL EXAM TIME:
• 15 minutes for injection.
• 1 hour for delayed bone imaging.
REMINDERS:
•
•
•
•
There is no patient preparation for this exam.
The patient will receive an injection and will return about 3 hours later for imaging.
Please note the specific area of interest on physician order.
Please provide any current and relative films for indicated area.
NM Ordering Guide | Updated: 7.22.13
6
MULTI BODY BONE SCAN
EXAM CODE:
BACK
IMG400 - NM BONE SCAN MULTIPLE
INDICATIONS:
• Evaluation two or more specific areas of interest for abnormal
x-rays, pain, trauma, occult fractures, neoplasm or known
lesions.
RADIOPHARMACEUTICAL & DOSE:
• 25 millicuries Technetium 99m MDP (methylene
diphosphonate)
PATIENT PREPARATION:
• There is no prep for this procedure; however the patient will
be instructed to hydrate after the bone scan injection.
• Please provide any current x-rays taken of the areas of interest
for radiological comparison.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• The patient will return 3 hours later for multiple static imaging
of areas indicated for scan.
TOTAL EXAM TIME:
• 15 minutes for injection.
• 1 hour for delayed bone imaging.
REMINDERS:
•
•
•
•
There is no patient preparation for this exam.
The patient will receive an injection and will return about 3 hours later for imaging.
Please note the specific areas of interest on physician order.
Please provide any current and relative films for indicated areas.
NM Ordering Guide | Updated: 7.22.13
7
SPECT BONE SCAN
EXAM CODE:
BACK
IMG8571 - NM BONE SCAN MULTIPLE W SPECT
INDICATIONS:
• Evaluation of back pain specific to the spine.
RADIOPHARMACEUTICAL & DOSE:
• 25 millicuries Technetium 99m MDP (methylene
diphosphonate)
PATIENT PREPARATION:
• There is no prep for this procedure, however the patient will
be instructed to hydrate after the bone scan injection.
• Please provide current x-rays taken of area of interest for
radiological comparison.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• The patient will return 3 hours later for tomographic imaging
of the spine.
TOTAL EXAM TIME:
• 15 minutes for injection.
• 1 hour for delayed whole body bone imaging.
REMINDERS:
•
•
•
•
There is no patient preparation for this exam.
The patient will receive an injection and will return about 3 hours later for imaging.
Please note the specific area of interest on physician order.
Please provide any current and relative films for exam.
NM Ordering Guide | Updated: 7.22.13
8
GASTRIC EMPTYING SCAN
EXAM CODE:
BACK
IMG388 - NM GASTRIC EMPTYING
INDICATIONS:
• Evaluation of gastric emptying, pain, bloating, gastric
regurgitation, diabetic gastroparesis, nausea and vomiting.
RADIOPHARMACEUTICAL & DOSE:
• 1 millicurie Technetium 99m SC (sulfur colloid)
PATIENT PREPARATION:
• NPO after midnight prior to scan.
• Discontinue sedatives 12 hours prior to scan.
PROCEDURE:
• Patient eats a small isotope labeled meal consisting of 1
scrambled egg and 2 pieces of toast.
• After meal is consumed images will be taken every hour for up
to 4 hours.
• Data will be processed and a percent of gastric emptying will
be graphed on a time activity curve.
TOTAL EXAM TIME:
• 2-4 Hours for entire procedure.
REMINDERS:
•
•
•
Patient NPO after midnight prior to scan.
Discontinue sedatives 12 hours prior to scan.
Total exam time is 2 hours.
NM Ordering Guide | Updated: 7.22.13
9
GASTROINTESTINAL BLEED SCAN
(Tagged RBC Scan)
EXAM CODE:
BACK
IMG394 - NM GI BLOOD LOSS
INDICATIONS:
• Detection and localization of acute gastrointestinal bleeding.
RADIOPHARMACEUTICAL & DOSE:
• 30 millicuries Technetium 99m RBC (tagged red blood cells)
PATIENT PREPARATION:
• No patient prep, scan is typically ordered on an acute basis
either from the ER, ICU, or unit floor.
• 20g IV catheter or larger for RBC blood draw.
PROCEDURE:
• The patient will have a blood sample collected.
• Patient’s red blood cells will be tagged to an isotope and
intravenously injected 30 minutes post blood sample
collection.
• Imaging will start immediately after isotope injection.
• Dynamic images of the abdominal cavity will be taken for
approximately 1 hour.
TOTAL EXAM TIME:
• 2 hours for entire procedure.
REMINDERS:
•
•
•
No patient preparation for exam.
20g IV catheter or larger for RBC blood draw.
Total exam time is 2 hours.
NM Ordering Guide | Updated: 7.22.13
10
HIDA SCAN W/ EJECTION FRACTION
(Hepatobiliary or Gallbladder Imaging)
EXAM CODE:
BACK
IMG8575 – NM HEPATOBILIARY W CCK W VASCULAR FLOW
INDICATIONS:
• Evaluation of biliary system for acute cholecystitis,
cholelithiasis, biliary tree function and biliary leak after
surgery.
• Evaluation of abdominal pain and/or right upper quadrant
(RUQ) pain.
RADIOPHARMACEUTICAL & DOSE:
• 4 millicuries Technetium 99m Choletec (mebrofenin)
PATIENT PREPARATION:
• NPO 4-12 hours prior to scan.
• Discontinue opiate-based medications 4 hours prior to scan.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• Dynamic imaging will be performed for 60 minutes.
• For ejection fraction the patient will be given Kinevac
(sincalide) to stimulate gallbladder contraction.
• Dynamic ejection fraction images will be taken for another 30
minutes and will determine percent excretion of gallbladder.
TOTAL EXAM TIME:
• 2 hours for entire procedure.
REMINDERS:
•
•
•
NPO 4-12 hours prior to scan
Hold opiate based meds 4 hours prior to scan.
Total exam time is 2 hours.
NM Ordering Guide | Updated: 7.22.13
11
LIVER/SPLEEN SCAN
EXAM CODE:
BACK
IMG379 - NM LIVER SPLEEN SCAN W VASCULAR FLOW
INDICATIONS:
• Detection and localization of hepatic tumors, abscesses, cysts,
and hematomas.
• Evaluation of thrombocytopenia and hepatic diseases such as
cirrhosis and fatty infiltration.
• Evaluation of anatomy, size, and position of the liver and
spleen.
RADIOPHARMACEUTICAL & DOSE:
• 10 millicuries Technetium 99m SC (sulfur colloid)
PATIENT PREPARATION:
• NPO 4 hours.
PROCEDURE:
• Patient is intravenously injected with isotope.
• Imaging starts 15 minutes post injection.
• Static images are taken in various projections for approx. 45
minutes.
TOTAL EXAM TIME:
• 1 hour for entire procedure.
REMINDERS:
•
•
Patient must be NPO for at least 4 hours.
Total exam time is 1 hour.
NM Ordering Guide | Updated: 7.22.13
12
MECKELS DIVERTICULUM SCAN
EXAM CODE:
BACK
IMG396 – NM MECKELS DIVERTICULUM
INDICATIONS:
• Detection and evaluation of meckels diverticulum.
• Localization of functional gastric mucosa not found in the
stomach.
RADIOPHARMACEUTICAL & DOSE:
• 10 millicuries Technetium TC04 (sodium pertechnetate)
PATIENT PREPARATION:
• There is no prep for this procedure.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• Imaging will start immediately after isotope injection.
• Dynamic images will be taken for approximately 1 hour.
TOTAL EXAM TIME:
• 90 minutes for entire procedure.
REMINDERS:
•
•
There is no patient preparation for this exam.
Total exam time is 90 minutes.
NM Ordering Guide | Updated: 7.22.13
13
LUNG VENTILATION & PERFUSION SCAN
(Lung VQ Scan)
EXAM CODE:
BACK
IMG5257 - NM LUNG PERFUSION VENTILATION
INDICATIONS:
• Detection and evaluation of pulmonary embolism (PE).
RADIOPHARMACEUTICAL & DOSE:
• 15 millicuries Xenon 133 gas
• 5 millicuries Technetium 99m MAA (macro-aggregated
albumin)
PATIENT PREPARATION:
• Obtain a recent chest x-ray within 24 hours to correlate with
lung scan.
PROCEDURE:
• Ventilation images are acquired first followed by the perfusion
imaging.
• Dynamic ventilation images are taken for 5 minutes while
patient breathes in isotope.
• Patient is then intravenously injected with isotope for
perfusion imaging.
• Static perfusion imaging is performed in various projections
for approx. 20 minutes.
TOTAL EXAM TIME:
• 1 Hour for entire procedure.
REMINDERS:
•
•
Patient needs a chest x-ray within 24 hours to correlate with lung scan.
Patient must be able to remain off administered oxygen for 6 minutes to complete
ventilation study.
NM Ordering Guide | Updated: 7.22.13
14
LUNG QUANTITATION SCAN
EXAM CODE:
BACK
IMG442 - NM LUNG DIFFERENTIAL PERF VENT
INDICATIONS:
• A pre-operative evaluation to access regional lung functions.
RADIOPHARMACEUTICAL & DOSE:
• 15 millicuries Xenon 133 gas
• 5 millicuries Technetium 99m MAA (macro-aggregated
albumin)
PATIENT PREPARATION:
• Obtain a recent chest x-ray within 24 hours to correlate with
lung scan.
PROCEDURE:
• Ventilation images are acquired first followed by the perfusion
imaging.
• Dynamic ventilation images are taken for 5 minutes while
patient breathes in isotope.
• Patient is intravenously injected with isotope for perfusion
imaging.
• Static perfusion imaging is performed in various projections
for approx. 20 minutes.
• Image processing will determine regional lung quantification.
TOTAL EXAM TIME:
• 1 Hour for entire procedure.
REMINDERS:
•
•
Patient needs a chest x-ray within 24 hours to correlate with lung scan.
Patient must be able to remain off administered oxygen for 6 minutes to complete ventilation
study.
NM Ordering Guide | Updated: 7.22.13
15
THYROID UPTAKE AND SCAN
EXAM CODE:
BACK
IMG344 - NM THYROID UPTAKE AND SCAN MULTIPLE
INDICATIONS:
• Detection and evaluation of hypothyroidism, hyperthyroidism,
toxic and non-toxic nodules, goiter, and differentiation of
benign from malignant nodules.
RADIOPHARMACEUTICAL & DOSE:
• 500 microcuries Iodine 123 sodium iodine capsule
PATIENT PREPARATION:
• Discontinue thyroid medications 4 weeks prior to scan.
• No intravenous iodinated contrast 4 weeks prior to scan.
• NPO after midnight.
• Avoid large amounts of salt prior to scan.
• Current thyroid labs available to NM department.
• Related study information available to NM department.
PROCEDURE:
• Isotope is administered orally in pill form.
• Patient returns 4 hours later for imaging and uptake to
determine percent localization of isotope in thyroid.
• The patient also returns the following morning for a 24 hour
uptake.
TOTAL EXAM TIME:
• Patient assessment and isotope administration 30 minutes.
• 4 Hour uptake and scan will take approx. 1 hour.
• 24 Hour uptake only requires 15 minutes.
REMINDERS:
•
•
•
•
•
Discontinue thyroid meds 4 weeks prior to exam.
NPO after midnight.
Current thyroid labs available to NM department.
Related study information (ultrasound) available to NM department.
Patient will return to NM department at 4 hrs and 24 hrs for imaging & uptake.
NM Ordering Guide | Updated: 7.22.13
16
PARATHYROID SCAN
EXAM CODE:
BACK
IMG351 - NM PARATHYROID SCAN
INDICATIONS:
• Evaluation of hyperparathyroidism to detect parathyroid
adenomas.
RADIOPHARMACEUTICAL & DOSE:
• 20 millicuries Technetium 99m sestamibi
PATIENT PREPARATION:
• Patient needs to discontinue thyroid medications and calcium
medications for 1 week.
• No previous iodinated contrast studies for 2 weeks prior to
scan.
PROCEDURE:
• Patient is intravenously injected with isotope.
• Immediate static imaging of parathyroid and thyroid glands
from multiple projections.
• Delayed static images are then acquired 90 minutes post
isotope injection.
TOTAL EXAM TIME:
• 3 hours for entire procedure.
REMINDERS:
•
•
•
•
Patient needs to discontinue thyroid and calcium meds for 1 week prior to exam.
No previous iodinated contrast studies for 2 weeks prior to exam.
Current thyroid/parathyroid labs available to NM department.
Total exam time is 3 hours.
NM Ordering Guide | Updated: 7.22.13
17
IODINE 131 WHOLE BODY IMAGING
EXAM CODE:
BACK
IMG349 - NM THYROID CANCER METASTATIC SCAN WHOLE BODY
INDICATIONS:
• Detection and localization of residual thyroid tissue post
thyroidectomy.
• Evaluation of recurrent thyroid carcinoma.
RADIOPHARMACEUTICAL & DOSE:
• 1-5 millicuries Iodine 131 sodium iodine capsule.
PATIENT PREPARATION:
• Patient is required to have 2 forms of identification.
• Discontinue thyroid medications 4 weeks prior to scan.
• No intravenous iodinated contrast within 4 weeks prior to
scan.
• NPO after midnight.
• Avoid large amounts of salt and seafood prior to scan.
PROCEDURE:
• Isotope is administered orally in pill form.
• Whole body imaging is then performed at 24 & 48 hours after
isotope administration.
TOTAL EXAM TIME:
• 30 minutes for isotope administration.
• 1 hour for whole body imaging each day.
REMINDERS:
•
•
•
•
•
Patient is required to have 2 forms of identification.
Discontinue thyroid medications x 4 weeks.
No IV contrast x 4 weeks.
NPO after midnight.
Imaging is performed at 24 and 48 hours post dose administration.
NM Ordering Guide | Updated: 7.22.13
18
RENAL SCAN W/LASIX WASHOUT
(Flow & Function w/Lasix Washout)
EXAM CODE:
BACK
IMG1161 - NM KIDNEY W FLOW AND FUNCTION W DIURETIC
INDICATIONS:
• Evaluation of renal function, vascular flow, drainage,
obstruction, and differential renal function
RADIOPHARMACEUTICAL & DOSE:
• 10 millicuries Technetium MAG3 (mercaptoacetyltriglycine)
PATIENT PREPARATION:
• Patient is to be well hydrated and should void before test
begins.
• Patient should discontinue angiotensin converting enzyme
(ACE) inhibitors.
PROCEDURE:
• Patient is intravenously injected with an isotope; flow and
function images are immediately acquired.
• Once renal pelvises are full, Lasix is administered at 0.5 mg/kg
up to 40 mg to obtain a Lasix washout.
• Pre and Post void images are also acquired.
TOTAL EXAM TIME:
• 1.5 hours for entire procedure.
REMINDERS:
•
•
Patient needs to be well hydrated prior to exam.
ACE inhibitors should be discontinued for exam.
NM Ordering Guide | Updated: 7.22.13
19
RENAL SCAN W/CAPTOPRIL
(Flow & Function w/Captopril)
EXAM CODE:
BACK
IMG2149 - NM KIDNEY W FLOW & FUNCTION W WO CAPTOPRIL
INDICATIONS:
• Detection and Evaluation of renovascular hypertension.
RADIOPHARMACEUTICAL & DOSE:
• 10 millicuries Technetium MAG3 (mercaptoacetyltriglycine)
PATIENT PREPARATION:
• Patient should be well hydrated prior to exam.
• Patient should discontinue captopril meds 48 hours prior to
exam.
• Patient should discontinue enalapril and lisinopril medications
for 1 week prior to exam.
PROCEDURE:
• The Captopril exam is performed first.
• On day of Captopril exam patient will be given 50mg Captopril
and have blood pressure monitored for 1 hour prior to
imaging.
• Flow and functional images are then performed.
• On day of Baseline exam flow & functional images are
performed without using Captopril stimulation.
• The Captopril and Baseline exams should be performed no
sooner than 48 hours between each other, then compared to
evaluate for renovascular hypertension.
TOTAL EXAM TIME:
• 2 hours for Captopril exam.
• 1 hour for Baseline exam.
REMINDERS:
•
•
•
Patient needs to be well hydrated prior to exam.
Patient should discontinue Captopril meds for 48 hrs prior to exam.
Captopril and baseline scans are performed no sooner than 48 hrs between each other.
NM Ordering Guide | Updated: 7.22.13
20
RENAL CORTICAL IMAGING
EXAM CODE:
BACK
IMG8616 - NM KIDNEY MORPHOLOGY
INDICATIONS:
• Assessment of the renal cortex for scarring, infarct, or renal
mass, and evaluation of renal transplant.
RADIOPHARMACEUTICAL & DOSE:
• 6 millicuries Technetium 99m DMSA (dimercaptosuccinic acid)
PATIENT PREPARATION:
• Patient is to be well hydrated and should void before test
begins.
• Patient should discontinue angiotensin converting enzyme
(ACE) inhibitors.
PROCEDURE:
• Patient will receive intravenous injection of isotope and return
3 hours later for imaging.
• Patient should continue hydrating between injection and
acquisition of images.
• Static imaging of kidneys will be performed in multiple
projections.
TOTAL EXAM TIME:
• 15 minutes for injection.
• 1 hour for delayed renal imaging.
REMINDERS:
•
•
•
Patient needs to be well hydrated prior to exam.
ACE inhibitors should be discontinued for exam.
Patient will return 3 hours after injection for imaging.
NM Ordering Guide | Updated: 7.22.13
21
INDIUM 111 WBC LIMITED BODY IMAGING
(Indium 111 Tagged WBC)
EXAM CODE:
BACK
IMG1167 - NM INFLAMMATORY WBC W INDIUM111 LIMITED
INDICATIONS:
• Detection and evaluation of osteomylitis, infected joint
prosthesis, abscess, or infection.
RADIOPHARMACEUTICAL & DOSE:
• 500 microcuries Indium 111 WBC (tagged white blood cells)
PATIENT PREPARATION:
• There is no prep for this procedure, however the patient will
be instructed to hydrate after injection.
PROCEDURE:
• The patient will arrive the morning of procedure to have a
blood sample collected.
• Patient will return 4 hours later for white cell labeled
intravenous isotope injection.
• The patient will be instructed to return the following day for
delayed 24 hour imaging.
TOTAL EXAM TIME:
• 30 minutes for blood sample collection.
• 15 minutes for labeled white cell injection.
• 45 minutes for the delayed images done at 24 hours post
isotope injection.
REMINDERS:
•
•
•
•
•
There is no patient preparation for this exam.
Patient will need to hydrate after injection
Patient will return at 4 hours for isotope injection and at 24 hours for imaging.
Please note the specific area of interest on physician order.
Please provide any current and relative films for indicated area.
NM Ordering Guide | Updated: 7.22.13
22
INDIUM 111 WBC WHOLE BODY IMAGING
(Indium 111 Tagged WBC)
EXAM CODE:
BACK
IMG1170 - NM INFLAMMATORY WBC WHOLE BODY W INDIUM111
INDICATIONS:
• Evaluation of fever of unknown origin.
• Detection and evaluation of osteomylitis, infected joint
prosthesis, abscess, or infection.
RADIOPHARMACEUTICAL & DOSE:
• 500 microcuries Indium 111 WBC (tagged white blood cells)
PATIENT PREPARATION:
• There is no prep for this procedure, however the patient will
be instructed to hydrate after injection.
PROCEDURE:
• The patient will arrive the morning of procedure to have a
blood sample collected.
• Patient will return 4 hours later for white cell labeled
intravenous isotope injection.
• The patient will be instructed to return the following day for
delayed 24 hour imaging.
TOTAL EXAM TIME:
• 30 minutes for blood sample collection.
• 15 minutes for labeled white cell injection.
• 45 minutes for the delayed images done at 24 hours post
isotope injection.
REMINDERS:
•
•
•
There is no patient preparation for this exam.
Patient will need to hydrate after injection.
Patient will return at 4 hours for isotope injection and at 24 hours for imaging.
NM Ordering Guide | Updated: 7.22.13
23
TRIPLE PHASE BONE SCAN
EXAM CODE:
BACK
IMG402 - NM BONE SCAN 3 PHASE SCAN
INDICATIONS:
• Assessment of loosening or infected prosthesis, infection of
extremities, and detection of osteomylitis.
RADIOPHARMACEUTICAL & DOSE:
• 25 millicuries Technetium 99m MDP (methylene
diphosphonate)
PATIENT PREPARATION:
• There is no prep for this procedure, however the patient will
be instructed to hydrate after the bone scan injection.
• Please provide any current x-rays taken of the area of interest
for radiological comparison to the triple phase bone scan.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• During injection, blood flow images are taken of the area of
interest, followed by blood pool images of the same area.
• The patient will return 3 hours later for static bone imaging.
TOTAL EXAM TIME:
• 30 minutes for injection and blood flow imaging.
• 1 hour for delayed bone imaging.
REMINDERS:
•
•
•
•
There is no patient preparation for this exam.
The patient will receive an injection with immediate imaging, and will return about 3 hours
later for delayed imaging.
Please note the specific area of interest on physician order.
Please provide any current and relative films for indicated area.
NM Ordering Guide | Updated: 7.22.13
24
GALLIUM 67 ABSCESS/INFECTION SCAN
EXAM CODE:
BACK
IMG2410 - NM ABSCESS LOCALIZATION WHOLE BODY W GALLIUM
INDICATIONS:
• Detection and evaluation of inflammatory processes, fever of
unknown origin, osteomylitis and disc space infection.
RADIOPHARMACEUTICAL & DOSE:
• 5 millicuries Gallium 67 citrate
PATIENT PREPARATION:
• Patient should remain well hydrated throughout the course of
the examination.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• The patient will return 6 hours later for whole body imaging.
• The patient will also have whole body imaging performed at
24 and 48 hours post isotope injection.
• Optional SPECT tomographic imaging may also be performed
in conjunction with whole body imaging.
TOTAL EXAM TIME:
• 15 minutes for injection.
• Delayed imaging done at 6, 24, and 48 hours will take
approximately 1 hour each day.
REMINDERS:
•
•
•
Patient should remain well hydrated throughout exam.
Patient will return at 6, 24, and 48 hours for imaging.
Imaging times are about 1 hour each day.
NM Ordering Guide | Updated: 7.22.13
25
SENTINEL NODE LOCALIZATION
(Lymphatic Imaging)
EXAM CODE:
BACK
IMG372 - NM LYMPHATICS LYMPH NODE
INDICATIONS:
• Localization and evaluation of sentinel node in patients with
breast cancer or melanoma.
RADIOPHARMACEUTICAL & DOSE:
• Four 500 microcurie doses of Technetium 99m SC (sulfur
colloid)
PATIENT PREPARATION:
• There is no prep for this procedure, however breast cancer
patients need current mammography & Ultrasound films
available for radiologist evaluation prior to injection.
PROCEDURE:
• The patient receives 4 small intradermal injections of isotope
around the lesion.
• Dynamic flow images are acquired immediately following the
injection.
• Static imaging will then be performed of the area of interest.
TOTAL EXAM TIME:
• For patients with breast cancer the total exam time is 30-60
minutes.
• Total exam time for patients with melanoma is 60-90 minutes.
REMINDERS:
•
•
There is no prep for this procedure.
Breast cancer patients need current mammography and ultrasound films available for radiologist
evaluation prior to injection.
NM Ordering Guide | Updated: 7.22.13
26
OCTREOTIDE SCAN
(Somatostatin Receptor Imaging)
EXAM CODE:
BACK
IMG8579 - NM TUMOR OCTREOSCAN WHOLE BODY > 2 DAY
INDICATIONS:
• Detection and localization of neuroendocrine tumors bearing
somatostatin receptors such as; carcinoids, neuroblastomas,
small cell lung cancer, gastrinoma, islet cell tumor of the
pancreas, meningiomas, pheochromocytomas,
paragangliomas, pituitary adenomas, and medullary thyroid
cancer.
RADIOPHARMACEUTICAL & DOSE:
• 6 millicuries Indium 111 Pentetreotide (Octreotide labeled
peptides)
PATIENT PREPARATION:
• Patient is to be well hydrated before and after injection.
• A mild laxative will be used the evening before imaging and
continued with light meals recommended and clear liquids
until all images are completed.
PROCEDURE:
• Patient will receive intravenous injection of isotope and return
4 hours later for whole body imaging.
• The patient will also have whole body imaging performed at
24 and 48 hours post isotope injection.
• Optional SPECT tomographic imaging may also be performed
in conjunction with whole body imaging.
TOTAL EXAM TIME:
• 15 minutes for injection.
• Delayed imaging done at 4, 24, and 48 hours will take
approximately 1 hour each day.
REMINDERS:
•
•
•
Patient should remain well hydrated before and after isotope injection.
Patient will return at 4, 24, and 48 hours for imaging.
Imaging times are about 1 hour each day.
NM Ordering Guide | Updated: 7.22.13
27
GALLIUM 67 TUMOR IMAGING
EXAM CODE:
BACK
IMG8580 - NM TUMOR GALLIUM WHOLE BODY > 2 DAY W SPECT
INDICATIONS:
• Detection and evaluation of Hodgkin’s disease, Non-Hodgkin’s
and Burkitt’s lymphoma.
RADIOPHARMACEUTICAL & DOSE:
• 5 millicuries Gallium 67 citrate
PATIENT PREPARATION:
• Patient should remain well hydrated throughout the course of
the examination.
PROCEDURE:
• Patient will receive intravenous injection of isotope.
• The patient will return 6 hours later for whole body imaging.
• The patient will also have whole body imaging performed at
24 and 48 hours post isotope injection.
• Optional SPECT tomographic imaging may also be performed
in conjunction with whole body imaging.
TOTAL EXAM TIME:
• 15 minutes for injection.
• Delayed imaging done at 6, 24, and 48 hours will take
approximately 1 hour each day.
REMINDERS:
•
•
•
Patient should remain well hydrated throughout exam.
Patient will return at 6, 24, and 48 hours for imaging.
Imaging times are about 1 hour each day.
NM Ordering Guide | Updated: 7.22.13
28