BASIC STUDY PROTOCOLS FOR NMTEC 200-260

NMTEC 200-2 Myocardial perfusion imaging Gated cardiac scintigraphy

NMTEC
Indications200-3 Ventilation-Perfusion Scan
 Known CAD – evaluate severity,  Evaluation of EF and wall
Indications  progression
Hypoxia, shortness of breath motion
 Chest
Hemoptysis
pain, R/O
(coughing
CAD up blood)
 Abnormal
Known or suspected
ECG or exercise
deep venous
ECG thrombosis (DVT)
Radiopharmaceutical Tc-99m MAAcardiac
Equivocal for perfusion
cath results
Tc-99m DTPA aerosol
Pre-operative or Xe-133 for ventilation
evaluation
Delay to imaging
Radiopharmaceutical Immediate
Tl-201, Tc-99m MIBI, Tc-99m Tc-99m RBCs
Study type and  Static images at multiple angles for MAA and DTPA
tetrofosmin
views
Delay to imaging  Dynamic–study
Immediate 60 min
in posterior view for Xe-133Immediate
Study
Normaltype and MAASPECT– lungs
studies after rest and stress  Gated planar – LAO,
views
biodistribution DTPA aerosol
injections – lungs;
(gated mouth, esophagus, stomach,
for stress) GI (swallowed)
anterior, steep LAO or LLat
Normal Xe-133 – lungs,
Myocardium, transient
muscle, liver thyroid
kidneys, Circulatory system and heart,
biodistribution MIBI, Tetrofosmin – also liver, spleen spleen
NMTEC 200-4 Whole body bone scan Three-phase bone scan
Indications  History of cancer  Limited area pain
 Whole body pain  History of trauma (localized)
 Elevated alkaline phosphatase
 History of trauma
 Arthritis
Radiopharmaceutical Tc-99m MDP or HDP Tc-99m MDP or HDP
Delay to imaging 2-3 hrs Immediate and 3-5 hrs
Imaging parameters  Whole-body scan (head to  Flow study (dynamic)
toes), ANT and POST  Blood pool images
 Spot views as needed  Static images (high resolution
collimator) – views determined by
extremity and/or location of pain
Normal Bones, joints, kidneys, bladder Bones, joints, kidneys, bladder
biodistribution
NMTEC 200-5 Gastric emptying study GI bleed study
Indications and  Abdominal fullness  Blood in stool (melena,
contraindications  Nausea/vomiting hematochezia, bright red blood
 Diabetes/gastroparesis per rectum)
 Effect of medications
Radiopharmaceutical Tc-99m sulfur colloid in food Tc-99m RBCs
Delay to imaging Immediate Immediate
Study type and  Static images at 0, 1, 2, 4 hrs, ANT  Dynamic images 15-60
views and POST views sec/image or sequential static
images for 60 min (ANT view)
 High res collimator
Normal Stomach, GI tract Circulatory system, heart, spleen;
biodistribution may see some kidneys and bladder

NMTEC 200-6 Liver/spleen scan Hepatobiliary study Hemangioma study

Indications  Liver lesion  RUQ pain  Liver lesion
 Trauma  Neonatal jaundice
 Splenosis, accessory  Post-op evaluation
spleen
Radiopharmaceutical Tc-99m sulfur colloid Tc-99m iminodiacetic Tc-99m RBCs
acid
Delay to imaging 15 minutes Immediate 2-4 hours
Study type and  Static images at  NPO 2 hrs  SPECT
views multiple angles  ANT view, dynamic  Static views from
 costochondral and or sequential static multiple angles
size markers imaging for 1 hour  HiRes collimator
 SPECT probable  RLAT view after 1 hr
Normal Liver, spleen, bone Blood pool, liver, gall Circulatory system,
biodistribution marrow bladder, intestines heart, spleen; some liver
and kidneys

NMTEC 200-7 Renal flow and function Lasix renogram

Indications Renal failure Hydronephrosis
Renal transplant
Differential renal function
Radiopharmaceutical Tc-99m MAG3 Tc-99m MAG3
Delay to imaging Immediate Immediate
Study type and  Dynamic imaging in POST  Dynamic imaging in POST
views projection projection
 1 sec/frame for 60 sec  1 sec/frame for 60 sec
 10 sec/frame for 20 minutes  10 sec/frame for 30-40 minutes
 Pre- and post-void images may be  Lasix administration
done
Normal Kidneys, ureters, bladder; some Kidneys, ureters, bladder; some
biodistribution liver/gall bladder liver/gall bladder
NMTEC 200-8 Radioactive Native thyroid Whole-body Parathyroid
iodine uptake imaging iodine imaging imaging
Radiopharmaceutical I-131 sodium I-123 sodium I-131 sodium Tc-99m MIBI
iodide (10-30 iodide iodide (1-10
Ci) Tc-99m mCi)
pertechnetate
Indications  Low TSH  Thyroid  History of  Elevated
(hyper- nodule(s) thyroid cancer calcium level
thyroidism)  Evaluation of  Elevated
 Determina- thyroid parathyroid
tion of remnant hormone level
treatment (post-op)
dosage
 Follow-up for
thyroid
surgery
Delay to imaging 4, 6, and/or 24 3-4 hours (I- 24-48 hours 5 min, delayed
hours 123); 5-10 min images at 90-120
(Tc-99m pert.) min
Study type and  Thyroid probe  Static  High energy  Static images
views measure-ment images: ANT, collimator including survey
RAO, LAO  Static images image, anterior
 Survey image or whole-body and obliques
with scan (head to  Pinhole
anatomic pelvis), ANT collimator or
markers and POST zoom
 Pinhole projections  SPECT or
collimator or SPECT/CT
zoom possible
Normal Thyroid, Thyroid, Thyroid, Thyroid/parathy-
biodistribution salivary glands, salivary glands, stomach, roids; heart,
stomach, stomach, kidneys, bladder; stomach, muscles,
kidneys, bladder kidneys, liver seen very liver, gall bladder
bladder late
NMTEC 200-9 Cerebral Perfusion Brain death Cisternogram
Indications and  Memory loss,  Indicators of brain  Dementia
contraindications dementia death (EEG, etc.)  Enlarged ventricles
 Localization of  Closed head injury
epileptic focus  Hypoxic brain injury
 Cerebrovascular  Subarachnoid
disease hemorrhage
Radiopharmaceutical Tc-99m HMPAO Tc-99m HMPAO In-111 DTPA
Tc-99m ECD Tc-99m ECD Intrathecal injection
Delay to imaging 30-45 min Immediate 4, 24, 48 hrs
Dark, quiet room
Study type and  SPECT study  Dynamic images in  Static images, ANT
views ANT projection, static and both LAT’s
images (ANT and  Med energy
LAT) collimator
Normal Brain, kidneys, liver, Brain, kidneys, liver, gall CSF spaces, kidneys
biodistribution gall bladder, some bladder, some muscle;
muscle; lachrymal lachrymal glands
glands (HMPAO) (HMPAO)

NMTEC 200-10 Sentinel node localization Pentetreotide study

Indications  Breast cancer  Elevated 5-HIAA, flushing
 Melanoma  Neuroendocrine tumor
Radiopharmaceutical Tc-99m sulfur colloid, filtered In-111 pentetreotide
Delay to imaging 0-15 minutes 4, 24 hours
Study type and  Static images in ANT or POST and  Static images or whole-body scan
views oblique angles (head to thighs), ANT and POST
 Skin marking of SLN location  SPECT study
 Med energy collimator
Normal Injection site, lymphatics, sentinel Liver, spleen, kidneys
biodistribution lymph node and downstream nodes