Energy window: 20% window centered at 140 kev. Technique of administration: Bolus in intravenous line. Prefer antecubital.

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1 1 NUCLEAR MEDICINE SERVICES SUBJECT: CEREBRAL BLOOD FLOW Indications This study is performed to evaluate cerebral perfusion in patients suspected of having no blood flow to the brain. These patients are often victims of motor vehicle accidents or other intracranial injuries. Examination Time 30 minutes. Patient Preparation None. Equipment & Energy Windows Gamma camera: Large field of view. Collimator: VXGP Energy window: 20% window centered at 140 kev. Radiopharmaceutical, Dose, & Technique of Administration Radiopharmaceutical: Tc99m DTPA. Adult Dose: 20mCi. Pediatric Dose: 5 mci minimum, 0.3 mci/kg Technique of administration: Bolus in intravenous line. Prefer antecubital. Patient Position & Imaging Field Patient position: Supine. Imaging field: Make sure the patient s head is as straight as possible. It may be necessary to secure head with tape, or use towels to keep the head straight.

2 2 Acquisition Protocol Flow study: 1. Chose the Cerebral Blood Flow protocol. Dynamic 1 sec/frame 120 images. Matrix 128 x 128 Zoom 1.46 STATICS: 1. ANTERIOR, POSTERIOR, RIGHT AND LEFT LATERALS. Static image: 300 sec. Matrix 256 x 256 Zoom 1.46 Data Processing Flow: 1. Compress 10 frames, 3X4 configuration 2. Annotate orientation, dose, tech initials. Statics: 1. Display all 4 statics 2. Annotate orientation, dose, tech initials. Optional Maneuvers None. Principle Radiation Emission Data - Tc-99m (7) Physical half-life = 6.01 hours. Radiation Mean % per disintegration Mean energy (kev) Gamma Dosimetry - Tc-99m-ECD (45) Organ rads/20 mci mgy/740 MBq Bladder wall 2 hour void hour void Gallbladder wall Large intestine Small intestine Kidneys Brain

3 3 Dosimetry - Tc-99m-HM-PAO (46) References Organ rads/20 mci mgy/740 MBq Lachrymal glands Gallbladder wall Kidneys Thyroid Large intestine Liver Small Intestine Bladder wall Brain Ovaries Total body Testes Payne JK, Trivedi MH, Devous MD: Comparison of technetium-99m-hmpao and xenon-133 measurements of regional cerebral blood flow by SPECT. J Nucl Med 37: , Devous MD, Thisted RA, Jagust WJ, et al: Meta analysis of SPECT brain imaging in dementia. J Nucl Med 36:107P, Bonte FJ, Weiner MF, Bigio EH, et al: Brain blood flow in the dementias: SPECT with histopathologic correlation in 54 patients. Radiology 202: , Devous MD, Thisted RA, Morgan GF, et al: SPECT brain imaging in epilepsy: A meta-analysis. J Nucl Med 39: , Spanake MV, Spencer SS, Corsi M, et al: Sensitivity and specificity of quantitative difference SPECT analysis in seizure localization. J Nucl Med 40: , Lewis DH, Eskridge JM, Newell DW, et al: Brain SPECT and the effect of cerebral angioplasty in delayed ischemia due to vasospasm. J Nucl Med 33: , Weir CJ, Bolster AA, Tytler S, et al: Prognostic value of single-photon emission tomography in acute ischaemic stroke. Eur J Nucl Med 24:21-26, Spieth ME, Ansari AN, Kawada TK, et al: Direct comparison of Tc-99m DTPA and Tc-99m HMPAO for evaluating brain death. Clin Nucl Med 19: , Wieler H, Marohl K, Kaiser KP, et al: Tc-99m HMPAO cerebral scintigraphy: A reliable, noninvasive method for determination of brain death. Clin Nucl Med 18: , Masdeu JC, Yudd A, Van Heertum RL, et al: Single-photon emission computed tomography in human immunodeficiency virus encephalopathy: A preliminary report. J Nucl Med 32: , Jeffery PJ, Monsein LH, Szabo Z, et al: Mapping the distribution of amobarbital sodium in the intracarotid Wada test by use of Tc-99m HMPAO with SPECT. Radiology 178: , Tanaka F, Nishizawa S, Yonekura Y, et al: Changes in cerebral blood flow induced by balloon test occlusion of the internal carotid artery under hypotension. Eur J Nucl Med 22: , Jacobs A, Put E, Ingels M, et al: One-year follow-up of technetium-99m-hmpao SPECT in mild head injury. J Nucl Med 37: , Woods SW, Hegeman IM, Zubal G, et al: Visual stimulation increases technetium-99m-hmpao distribution in human visual cortex. J Nucl Med 32: , Scao YL, Jezequel J, Robier A, et al: Reliability of low-frequency auditory stimulation studies associated with technetium-99m hexamethylpropylene amine oxime single-photon emission tomography. Eur J Nucl Med 20: , Holman BL, Zimmerman RE, Johnson KA, et al: Computer-assisted superimposition of magnetic resonance and high-resolution technetium-99m-hmpao and thallium-201 ASPECT images of the brain. J Nucl Med 32: , Juni JE, Waxman AD, Devous MD, et al: Procedure guideline for brain perfusion SPECT using technetium-99m radiopharmaceuticals. J Nucl Med 39: , Li J, Jaszczak RJ, Turkington TG, et al: An evaluation of lesion detectability with cone-beam, fanbeam and parallel-beam collimation in SPECT by continuous ROC study. J Nucl Med 35: , 1994.

4 19. Moretti JK, Caglar M, Weinmann P: Cerebral perfusion imaging tracers for SPECT: Which one to choose? J Nucl Med 36: , Asenbaum S, Brucke T, Pirker W, et al: Imaging of cerebral blood flow with technetium-99m-hmpao and technetium-99m-ecd: A comparison. J Nucl Med 39: , van Dyck CH, Lin CH, Smith EO, et al: Comparison of technetium-99m-hmpao and technetium-99m-ecd cerebral SPECT images in Alzheimer's disease. J Nucl Med 37: , Rieck H, Adfelwohrer C, Lungenschmid K, et al: Discordance of technetium-99m-hmpao and technetium-99m-ecd SPECT in Herpes simplex encephalitis. J Nucl Med 39: , Mayberg HS, Lewis PJ, Regenold W, et al: Paralimbic hypoperfusion in depression. J Nucl Med 35: , Kotzki PO, Mariano-Goulart D, Quiquere M, et al: Optimum tomographic reconstruction parameters for HMPAO brain SPET imaging: A practical approach based on subjective and objective indexes. Eur J Nucl Med 22: , Licho R, Glick SJ, Xia W, et al: Attenuation compensation in Tc-99m-SPECT brain imaging: A comparison of the use of attenuation maps derived from transmission versus emission data in normal scans. J Nucl Med 40: , Hashikawa K, Matsumoto M, Moriwake H, et al: Three-dimensional display of surface cortical perfusion by SPECT: Application in assessing Alzheimer's disease. J Nucl Med 36: , Oshima M, Tadokoro M, Sakuma S: Comparison of Tc-99m HMPAO fast SPECT with Tc-99m HMPAO conventional SPECT in patients with acute stroke. Clin Nucl Med 17:18-22, Pavics L, Grunwald F, Reichmann, et al: Regional cerebral blood flow single-photon emission tomography with Tc-99m-HMPAO and the acetazolamide test in the evaluation of vascular and Alzheimer"s dementia. Eur J Nucl Med 26: , Burt RW, Witt RM, Cikrit D, et al: Carotid artery disease: Evaluation with acetazolamide-enhanced Tc-99m HMPAO SPECT. Radiology 182: , Carter JC, Burt RW: Acetazolamide intervention for technetium-99m HMPAO brain imaging. J Nucl Med Technol 20: , Soricelli A, Cuocolo A, Romano M, et al: Comparison between adenosine and acetazolamide for neuroactivation with single photon emission tomography. Eur J Nucl Med 34:830, Hwang TL, Sainz A, Farrell JJ, et al: Brain SPECT with dipyridamole stress to evaluate cerebral blood flow reserve in carotid artery disease. J Nucl Med 37: , Activation protocols in normal subjects using SPET: A window into normal brain function. In Neuroactivation and neuroimaging with SPET, MS George, HA Ring, DC Costa, et al, eds, Springer-Verlag, London, 1991, pp Ebmeier KP, Murray CL, Dougall NJ, et al: Unilateral voluntary hand movement and regional cerebral uptake of technetium-99m-exametazime in human control subjects. Eur J Nucl Med 33: , Tikofsky RS, Hellman RS: Brain single photon emission computed tomography: Newer activation and intervention studies. Sem Nucl Med 21:40-57, Bartenstein P, Minoshima S, Hirsch C, et al: Quantitative assessment of cerebral blood flow in patients with Alzheimer's disease by SPECT. J Nucl Med 38: , Matsuda H, Tsuji S, Noriyuki S, et al: Noninvasive measurements of regional cerebral blood flow using technetium-99m hexamethylpropylene amine oxime. Eur J Nucl Med 20: , Houston AS, Kemp PM, Macleod MA: A method for assessing the significance of abnormalities in HMPAO brain SPECT images. J Nucl Med 35: , Claus JJ, van Harskamp F, Breteler MMB, et al: Assessment of cerebral perfusion with single-photon emission tomography in normal subjects and in patients with Alzheimer's disease: Effects of region of interest selection. Eur J Nucl Med 21: , Brinkman BH, O'Brien TJ, Aharon S, et al: Quantitative and clinical analysis of SPECT image registration for epilepsy studies. J Nucl Med 40: , Stokking R, van Isselt JW, van Rijk PP, et al: Integrated visualization of functional and anatomic brain data: A validation study. J Nucl Med 40: , Pietrzyk U, Herholz K, Fink G, et al: An interactive technique for three-dimensional image registration: Validation for PET, SPECT, MRI and CT brain studies. J Nucl Med 35: , Devous MD, Payne JK, Lowe JL: Dual-isotope brain SPECT imaging with technetium-99m and iodine-123: Clinical validation using xenon-133 SPECT. J Nucl Med 33: , Tc-99m: In MIRD: Radionuclide Data and Decay Schemes, DA Weber, KF Eckerman, AT Dillman, JC Ryman, eds, Society of Nuclear Medicine, New York, 1989, pp Holman BL, Hellman RS, Goldsmith SJ, et al: Biodistribution, dosimetry, and clinical evaluation of technetium-99m ethyl cysteinate dimer in normal subjects and in patients with chronic cerebral infarction. J Nucl Med 30: , Soundy RG, Tyrrell DA, Pickett RD, et al: The radiation dosimetry of Tc-99m-exametazime. Nucl Med Commun 11: ,

5 Normal Findings > Activation protocols in normal subjects using SPET: A window into normal brain function. In Neuroactivation and neuroimaging with SPET, MS George, HA Ring, DC Costa, et al, eds, Springer-Verlag, London, 1991, pp > Davis PC, Mirra SS, Alazraki N: The brain in older persons with and without dementia: Findings on MR, PET, and SPECT images. AJR 162: , > Catafau AM, Lomena FJ, Pavia J, et al: Regional cerebral blood flow pattern in normal young and aged volunteers: A Tc-99m-HMPAO SPET study. Eur J Nucl Med 23: , > Deutsch G, Mountz JM, Katholi CR, et al: Regional stability of cerebral blood flow measured by repeated technetium-99m-hmpao SPECT: Implications for the study of state-dependent change. J Nucl Med 38:6-13, > Patterson JC, early TS, Martin A, et al: SPECT image analysis using statistical parametric mapping: Comparison of technetium-99m-hmpao and technetium-99m-ecd. J Nucl Med 38: , > Koyama M, Kawashima R, Ito H, et al: SPECT imaging of normal subjects with technetium-99m-hmpao and technetium-99m-ecd. J Nucl Med 38: , > Mozley PD, Sadek AM, Alave A, et al: Effects of aging on the cerebral distribution of technetium-99m hexamethylpropylene amine oxime in healthy humans. Eur J Nucl Med 24: ,1997. > Schiepers C, Verbruggen a, Casaer P,et al: Normal brain perfusion pattern of technetium-99m-ethylcysteinate dimer in children. J Nucl Med 38: , > Kuji I, Sumiya H, Niida Y, et al: Age-related changes in the cerebral distribution of Tc-99m-ECD from infancy to adulthood. J Nucl Med 40: , > Avery RA, Spencer SS, Spanaki MV, et al: Effect of injection time on postictal SPET perfusion changes in medically refractory epilepsy. Eur J Nucl Med 26: ,

Detection of abscesses and infection in soft tissues, particularly in patients without localizing findings.

Detection of abscesses and infection in soft tissues, particularly in patients without localizing findings. NUCLEAR MEDICINE SERVICES SUBJECT: WHITE BLOOD CELL STUDY Overview Indications The White Blood Cell Study demonstrates the distribution of labeled autologous white blood cells within the body at various