NM ORDERING GUIDE/media/images...Myocardial Perfusion Scan IMG5491 2 MUGA Scan IMG430 3 . SKELETAL . Whole Body Bone Scan IMG401 4 Triple Phase Bone Scan IMG402 5 . Limited Body Bone

NM ORDERING GUIDE Table of Contents

CARDIAC Myocardial Perfusion Scan IMG5491 2 MUGA Scan IMG430 3 SKELETAL Whole Body Bone Scan IMG401 4 Triple Phase Bone Scan IMG402 5 Limited Body Bone Scan IMG399 6 Multi-Body Bone Scan IMG400 7 SPECT Bone Scan IMG8571 8 GASTROINTESTINAL Gastric Emptying Scan IMG388 9 GI Bleed Scan IMG394 10 HIDA w/Ejection Fraction IMG8575 11 Liver/Spleen Scan IMG379 12 Meckels Diverticulum Scan IMG396 13 PULMONARY Lung VQ Scan IMG5257 14 Lung Quantification Scan IMG442 15 ENDOCRINE Thyroid Uptake & Scan IMG344 16 Parathyroid Scan IMG351 17 Iodine 131 Whole Body Imaging IMG349 18 GENITOURINARY Renal Scan w/Lasix IMG1161 19 Renal Scan w/Captopril IMG2149 20 Renal Cortical Imaging IMG8616 21 ABSCESS/INFECTION Indium 111 Tagged WBC LTD IMG1167 22 Indium 111 Tagged WBC WB IMG1170 23 Triple Phase Bone Scan IMG402 24 Gallium 67 Abscess/Infection Scan IMG2410 25 TUMOR/ONCOLOGY Sentinel Node Lymphatic Imaging IMG372 26 Octreotide Scan IMG8579 27 Gallium 67 Tumor Imaging IMG8580 28

NM Ordering Guide | Updated: 7.22.13 2

MYOCARDIAL PERFUSION SCAN EXAM CODE: BACK

IMG5491 - NM MYOCARDIAL PERFUSION MULT SPECT REMINDERS:

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

• 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).


MUGA SCAN (Tagged RBC Imaging)

EXAM CODE: BACK

IMG430 - NM CARDIAC BLOOD POOL GATED SPECT W EF REMINDERS: REMINDERS:

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.

• Total exam time is 2 hours. • No PET scan within last 24 hours • 20g IV catheter or larger for RBC blood draw.


WHOLE BODY BONE SCAN EXAM CODE: BACK

IMG401 - NM BONE SCAN WHOLE BODY REMINDERS:

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.

• 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.


TRIPLE PHASE BONE SCAN EXAM CODE: BACK

IMG402 - NM BONE SCAN 3 PHASE SCAN REMINDERS:

INDICATIONS: • Assessment of loosening or infected prosthesis, infection of

extremities, and detection of osteomylitis. RADIOPHARMACEUTICAL & DOSE: • 25 millicuries Technetium 99m MDP (methylene


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.

• 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.


LIMITED BODY BONE SCAN EXAM CODE: BACK

IMG399 - NM BONE SCAN LIMITED REMINDERS:

INDICATIONS: • Evaluation limited to one specific area of interest for abnormal

x-rays, pain, trauma, occult fractures, neoplasm or known lesions.




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.

• 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.


MULTI BODY BONE SCAN EXAM CODE: BACK

IMG400 - NM BONE SCAN MULTIPLE REMINDERS:

INDICATIONS: • Evaluation two or more specific areas of interest for abnormal

x-rays, pain, trauma, occult fractures, neoplasm or known lesions.


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.

• 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.


SPECT BONE SCAN EXAM CODE: BACK

IMG8571 - NM BONE SCAN MULTIPLE W SPECT REMINDERS:

INDICATIONS: • Evaluation of back pain specific to the spine. RADIOPHARMACEUTICAL & DOSE: • 25 millicuries Technetium 99m MDP (methylene


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.

• 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.


GASTRIC EMPTYING SCAN EXAM CODE: BACK

IMG388 - NM GASTRIC EMPTYING REMINDERS:

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.

• Patient NPO after midnight prior to scan. • Discontinue sedatives 12 hours prior to scan. • Total exam time is 2 hours.


GASTROINTESTINAL BLEED SCAN (Tagged RBC Scan)

EXAM CODE: BACK

IMG394 - NM GI BLOOD LOSS REMINDERS:

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.

• No patient preparation for exam. • 20g IV catheter or larger for RBC blood draw. • Total exam time is 2 hours.


HIDA SCAN W/ EJECTION FRACTION (Hepatobiliary or Gallbladder Imaging)

EXAM CODE: BACK

IMG8575 – NM HEPATOBILIARY W CCK W VASCULAR FLOW REMINDERS:

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.

• NPO 4-12 hours prior to scan • Hold opiate based meds 4 hours prior to scan. • Total exam time is 2 hours.


LIVER/SPLEEN SCAN EXAM CODE: BACK

IMG379 - NM LIVER SPLEEN SCAN W VASCULAR FLOW REMINDERS:

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.

• Patient must be NPO for at least 4 hours. • Total exam time is 1 hour.


MECKELS DIVERTICULUM SCAN EXAM CODE: BACK

IMG396 – NM MECKELS DIVERTICULUM REMINDERS:

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.

• There is no patient preparation for this exam. • Total exam time is 90 minutes.


LUNG VENTILATION & PERFUSION SCAN (Lung VQ Scan)

EXAM CODE: BACK

IMG5257 - NM LUNG PERFUSION VENTILATION REMINDERS:

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.

• 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.


LUNG QUANTITATION SCAN EXAM CODE: BACK

IMG442 - NM LUNG DIFFERENTIAL PERF VENT REMINDERS:

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.

• 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.


THYROID UPTAKE AND SCAN EXAM CODE: BACK

IMG344 - NM THYROID UPTAKE AND SCAN MULTIPLE REMINDERS:

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.

• 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.


PARATHYROID SCAN EXAM CODE: BACK

IMG351 - NM PARATHYROID SCAN REMINDERS:

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.

• 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.


IODINE 131 WHOLE BODY IMAGING EXAM CODE: BACK

IMG349 - NM THYROID CANCER METASTATIC SCAN WHOLE BODY REMINDERS:

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.

• 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.


RENAL SCAN W/LASIX WASHOUT (Flow & Function w/Lasix Washout)

EXAM CODE: BACK

IMG1161 - NM KIDNEY W FLOW AND FUNCTION W DIURETIC REMINDERS:

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.

• Patient needs to be well hydrated prior to exam. • ACE inhibitors should be discontinued for exam.


RENAL SCAN W/CAPTOPRIL (Flow & Function w/Captopril)

EXAM CODE: BACK

IMG2149 - NM KIDNEY W FLOW & FUNCTION W WO CAPTOPRIL REMINDERS:

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.

• 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.


RENAL CORTICAL IMAGING EXAM CODE: BACK

IMG8616 - NM KIDNEY MORPHOLOGY REMINDERS:

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.

• 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.


INDIUM 111 WBC LIMITED BODY IMAGING (Indium 111 Tagged WBC)

EXAM CODE: BACK

IMG1167 - NM INFLAMMATORY WBC W INDIUM111 LIMITED REMINDERS:

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.

• 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.


INDIUM 111 WBC WHOLE BODY IMAGING (Indium 111 Tagged WBC)

EXAM CODE: BACK

IMG1170 - NM INFLAMMATORY WBC WHOLE BODY W INDIUM111 REMINDERS:

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.

• 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.


TRIPLE PHASE BONE SCAN EXAM CODE: BACK

IMG402 - NM BONE SCAN 3 PHASE SCAN REMINDERS:

INDICATIONS: • Assessment of loosening or infected prosthesis, infection of

extremities, and detection of osteomylitis. RADIOPHARMACEUTICAL & DOSE: • 25 millicuries Technetium 99m MDP (methylene



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.

• 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.


GALLIUM 67 ABSCESS/INFECTION SCAN EXAM CODE: BACK

IMG2410 - NM ABSCESS LOCALIZATION WHOLE BODY W GALLIUM

REMINDERS:

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.

• 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.


SENTINEL NODE LOCALIZATION (Lymphatic Imaging)

EXAM CODE: BACK

IMG372 - NM LYMPHATICS LYMPH NODE REMINDERS:

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.

• There is no prep for this procedure. • Breast cancer patients need current mammography and ultrasound films available for radiologist

evaluation prior to injection.


OCTREOTIDE SCAN (Somatostatin Receptor Imaging)

EXAM CODE: BACK

IMG8579 - NM TUMOR OCTREOSCAN WHOLE BODY > 2 DAY REMINDERS:

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




• 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.


GALLIUM 67 TUMOR IMAGING EXAM CODE: BACK

IMG8580 - NM TUMOR GALLIUM WHOLE BODY > 2 DAY W SPECT REMINDERS:

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




• 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/media/images...Myocardial Perfusion Scan IMG5491 2 MUGA Scan IMG430 3 . SKELETAL . Whole Body Bone Scan IMG401 4 Triple Phase Bone Scan IMG402 5 . Limited Body Bone

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