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What is Nuclear Medicine?
Nuclear Medicine, which includes molecular imaging, is the medical specialty that utilizes sealed and unsealed radioactive materials in the diagnosis and therapy of various diseases. Nuclear Medicine refers to medicine (a pharmaceutical) that is attached to a small quantity of radioactive material (a radioisotope). The combination is called a radiopharmaceutical. The pharmaceutical part of the radiopharmaceutical is designed to go to a specific place in the body where there could be disease or an abnormality. The radioactive part of the radiopharmaceutical that emits radiation, known as gamma rays, is then detected using a special camera called a gamma camera. Nuclear Medicine also includes the utilization of pharmaceuticals (as adjunctive medications) to enhance the evaluation of the physiologic process at the molecular level. Nuclear Medicine provides doctors with information about structure and function of organs. Radiopharmaceuticals are introduced into the patient's body by injection, swallowing (oral) or inhalation.
The Nuclear Medicine Department at Penrose Hospital is ACR Accredited in Planar, SPECT and Cardiac Imaging. Our dedicated staff is registered through the Nuclear Medicine Technology Certification Board or the American Registry of Radiologic Technologists.
Common Nuclear Medicine procedures that may be ordered by your provider include the following along with preparations and approximate exam times:
This exam involves imaging the skeletal structure. The exam may be considered a whole body exam in which the entire skeleton is imaged anteriorly and posteriorly along with standard oblique images of the trunk area of the body. The bone scan may be a limited exam in which one area is imaged (such as knees or lower back). The bone scan can be ordered for numerous reasons including: Abnormal blood tests or x-rays, fever, or unexplained pain. It may be ordered to evaluate bones for fracture, infection or arthritis. It also may be ordered to evaluate painful prosthetic joints, and a work up for possible metastatic disease.
How to prepare for a bone scan:
No restrictions prior, Butterfly IV injection, Drink water after injection
-Imaging requires that the patient lie flat on a scan table face up for approximately an hour in which a gamma camera is positioned over and under the patient's body.
-Injection times begin at 8 a.m., every hour until 1 p.m.
-There is a 2 - 3hr delay between injection and scan time
-The bone scan takes approximately 60-75 minutes to complete depending on images acquired
LUNG SCAN (V/Q)
This exam is normally ordered for the evaluation of respiratory or blood flow problems such as blood clots in the lungs or pulmonary emboli. The test is ordered for patients with unexplained chest pain or shortness of breath. The exam may be ordered for abnormal lab results ( d-dimer) and may be ordered as an alternative to CT imaging of the pulmonary arteries when a patient has an iodine allergy and or has elevated renal function tests that do not allow CT imaging. On occasion the exam is ordered for the evaluation of split lung function when a patient may be undergoing surgery for removal of a lobe of the lung or an entire lung.
How to prepare for a lung scan:
Chest X-ray prior to exam within 6 hours, Butterfly IV injection
-This a 2-part exam with exam taking approximately 45 min. in which the patient lies flat on imaging table with two gamma cameras positioned at various angles around the chest.
-Imaging times begin at 9 AM, with most times open until 4 PM
-The first imaging component involves breathing a radioactive aerosol - the airway images
-The second imaging component involves the butterfly IV - the perfusion images
HIDA SCAN (BILIARY SCAN
This exam is a functional assessment of the hepatobiliary system. The exam is ordered for the suspicion of cholecystitis or suspected common bile duct obstruction. Other reasons to order the exam are for right upper quadrant pain with or without nausea or vomiting, evaluation of the hepatobiliary system with or without cholelithasis. The hida scan also evaluates the contraction of the gallbladder after pharmaceutical intervention, called the ejection fraction. (using sincalide/cholecystokinin) Occasionally the exam is ordered post cholecystectomy to evaluate the biliary system for bile leak or obstruction of the biliary tree.
How to prepare for a HIDA Scan:
No food, liquids or narcotics 4 hours prior to the exam, IV injection
-Imaging requires the patient to lie flat on an imaging table or cart for approximately 2 hours with gamma camera above the abdomen.
-Imaging times 8 AM, 10:30 AM, 12:30 PM and then 2 PM
-No restrictions on patients being evaluated for bile leak or obstruction.
GASTRIC EMPTYING EXAM
This exam evaluates the rate in which the stomach empties. The exam is ordered by providers with a diagnosis of nausea or vomiting. Other reasons to evaluate the gastric emptying time is for abdominal pain, diabetes, bloating. Other reasons to evaluate the stomach are for gastroparesis, gastric outlet syndrome and possibly rapid gastric emptying or "dumping" For a gastric emptying study the patient eats a meal in which a solid component (egg) are mixed with a radiopharmaceutical. The patient will also be given bread and water for the exam to ingest. The meal must be eaten within 5 minutes.
How to prepare for a Gastric emptying exam:
No food or liquids 12 hours prior to the exam, no stomache meds or narcotics 4 hours prior to the exam. Patient can not be allergic to eggs.
-The patient will lie flat on a scan table or slightly upright on a cart for approximately 120 minutes in which a gamma camera is placed along the left side of the patient's abdomen.
-Imaging times 8 AM and 12 PM, call for other times.
-If a patient is allergic to eggs a substitute meal of beef stew is allowed.
-On rare occasion a liquid/solid gastric emptying is required, please call nuclear medicine for special instructions.
THYROID UPTAKE AND SCAN
This exam is ordered for the possible diagnosis of hyperthyroidism (Graves's disease, Multinodular Goiter, or toxic adenoma). It is also useful in the diagnosis of active or inactive nodules. Other reasons to order the exam are for abnormal thyroid blood tests, abnormal ultrasound or CT of neck. The uptake portion is a calculation that determines whether the thyroid in functioning in a normal range. The scan allows us to image the thyroid to determine shape, size and functionality of possible nodules.
How to prepare for a thyroid uptake and scan:
No IV contrast 6 weeks prior to the exam, off synthroid for 6 weeks prior to the exam, off Tapazole or PTU 5 days prior to the esam. Female patinets of child bearing age require serum pregnancy prior to the exam.
-The patient will initially sit in a chair for the uptake calculation in which a thyroid probe is placed near the patient's thigh and neck for each a 1 minute calculation. Then the patient is asked to lie flat on an imaging table in which a special cone shaped detector is placed anteriorly between the neck and the chest for three images of the thyroid.
-Patient is asked to take oral capsules in morning starting at 9 AM, 10 AM, 11 AM and Noon
-Patient is asked to not eat 1 hour after capsules are ingested.
-Imaging begins 4 hours after capsule is taken and imaging takes approximately 1 hour
This exam is ordered to analyze the split function of the kidneys. It is also useful in detecting urinary tract obstruction and helpful in evaluating hypertension related to the kidney or renal arteries. Other reasons to order the exam are for flank or back pain, abnormal blood or urine tests.
How to prepare for a renal scan:
Hydrate with 16-24 ounces of liquid prior to the exam, IV injection, provide information on medicaions that are taken and that you are allergic to.
-The patient will lie flat on a scan table for approximately 40 minutes while the gamma camera is underneath the table positioned mid back area.
-Imaging begins at 10 AM and can be scheduled anytime until 2 PM
-Imaging takes approximately 60-90min after radioactive injection
CARDIAC IMAGING (COORDINATED WITH CARDIOLOGY and a CARDIOLOGIST OR INTERNIST ABLE TO PERFORM CARDIAC EXAMS)
This exam is useful in detmining blood flow and function to the myocardium (myocardial perfusion scan). It helpful in detecting coronary artery disease and the extent of blockage or stenosis. It is useful in assessing damage to the heart following a heart attack and for evaluating treatment options such as coronary bypass or angioplasty.
How to prepare for a cardiac imaging scan:
No caffeine 24 hours prior to the exam, no food or liquids 4 hours prior to stress time, IV injection. The exam takes about 4 hours.
*For questions about medications to be withheld prior to the exam, consult with your cardiologist or referring physician.
-The patient well lie flat on a scan table with both of their arms above their head for approximately 20 minutes for a set of resting images and stress images. This is a three part exam in which the patient will be injected with the radiopharmaceutical specific for the heart then take rest images, go to cardiology for the actual stress test (by treadmill or pharmaceutical intervention) and then return to nuclear medicine for a set of stress images. There are waiting times between all of these steps.
-Imaging times vary due to cardiology and physician availabitly, please call department to schedule.
Please call Imaging and Radiology Services at 719-776-5242 for exam preparations for the following:
To schedule a Nuclear Medicine test at Penrose Hospital, call Scheduling Services at 719-776-8010.
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