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GIT AND RENAL SYSTEMNuclear medicine
PROCEDURES
Vipin kumar PG Medical Imaging
Kmc manipal
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BY
JOSEPH BERNARD
BY
JOSEPH BERNARD
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INDICATION
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PATIENT PREPARATION
Identification and verification of request-NPO 8 hours-instructions
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Camera- large fieldCollimator- low energy
Computer setup-flow-sec/15sec for 1 mnt
Dynamic- 15sec/frame for 9 mnts
EQUIPMENT
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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
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ARTIFACTS
Aspiration of the dose Regurgitation with or without aspiration Attenuating articles or clotting
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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
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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
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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
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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
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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
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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.
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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
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ARTIFACTS
Non uniform mixing of radiotracer and egg Too little or too much food Patient allergies Aspiration
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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
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INDICATION
Detection of GE reflux diaphramatic hernia children with asthma, chronic lung disease, aspiration
pneumonia
NO CONTRA INDICATION
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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
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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
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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
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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
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ABNORMAL RESULT
Focal area of increased activity Focal area peristalsing with time
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CORTICAL IMAGING
GLOMERULAR FILTRATION RATE
TUBULAR FUNCTION
URINARY SYSTEM
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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
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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
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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
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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
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NORMAL RESULT:-
Both kidneys visualized at the same size and intensities Collecting system may not be visualized because of the
slow clearance
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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
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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
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PREPARATIONWell hydrated , void before the test beginsDiscontinue any ACE inhibiters
EQUIPMENTCamera-large FOVCollimator- low energy, high resolution
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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
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POST PROCESSING
Generate time activity curve and differential functionGenerate % uptake of each kidneyGenerate pictures of dynamic or static images
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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
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PERFUSION - DTPA
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