Nuclear Medicine Ordering Guide

Transcription

1 Nuclear Medicine Ordering Guide The Children s (updated 02/21/11) Radiological Institute MUSCULOSKELETAL STUDIES Examples of symptoms / diagnoses / indications for exam Recommended Examination CPT Codes Bone 3 phase: This exam includes blood flow and blood pool images in the area of interest, as well as planar whole body bone images. It is frequently performed in evaluation of infection / inflammation, to differentiate soft tissue and bony involvement. arthritis Elevated sed rate FUO (possibly with point tenderness) fevers with inability to weight bear sepsis decubitus ulcers Osteomyelitis pain, suspect RSD (reflex sympathetic dystrophy) Bone 3 Phase Bone 3 Phase Bone 3 Phase Bone 3 Phase Bone 3 Phase Bone 3 Phase Bone 3 Phase Bone 3 Phase Bone imaging: The basic bone scan will be performed and images checked before the patient leaves. If additional oblique or lateral images or SPECT images are needed they will be performed. Bone pain Confirm bone or joint origin of pain Detection of bone infarction Non-accidental trauma Pathologic fracture Pre-bone marrow transplant elevated alkaline phosphatase Screening for multifocal bone lesions in sydromes (for example: Langerhan Cell Histiocytosis, Ollier s disease, osteochondromatosis, Mafucci syndrome, Fibrous Dysplasia) Stress fracture Trauma Tumors: primary bone tumors or evaluation for metastases

2 MUSCULOSKELETAL STUDIES SPECT bone scan: In addition to planar whole body bone images, transverse, coronal, and sagittal images through the area of interest will be performed with 3D reconstruction. Back pain Scoliosis Spondylolisthesis Spondylolysis bone disease involving face, shoulder girdle, spine, pelvis (areas of complex anatomy) Spect Bone Scan Spect Bone Scan Spect Bone Scan Spect Bone Scan Spect Bone Scan Bone Marrow Imaging: To evaluate blood flow to the bone marrow; to distinguish between osteomyelitis and infarct Extramedullary hemopoieses Osteomyelitis vs infarct Osteopetrosis Sickle Cell disease Bone Marrow Imaging Bone Marrow Imaging Bone Marrow Imaging Bone Marrow Imaging

3 BRAIN STUDIES Brain Vascular Flow: Evaluate whether there is blood flow to the brain suspected brain death Brain Vascular Flow CNS Shunt Evaluation: injection of radiopharmaceutical into a shunt reservoir Evaluate shunt patency CNS Shunt Evaluation CSF Leakage Detection: Give radiopharmaceutical through lumbar puncture done by Interventional radiologist Evaluate for CSF leak post surgery Evaluate for CSF leak post trauma Recurrent meningitis CSF Leakage Detection CSF Leakage Detection CSF Leakage Detection PET/CT Brain: Evaluate the increased or decreased metabolic activity of different regions of the brain Brain Tumor Seizures PET/CT Brain PET/CT Brain Spect Brain Scan: Evaluate the increased or decreased blood flow to different regions of the brain Concussion Seizures: Inter-ictal Scan Seizures- ictal scan Spect Brain Scan Spect Brain Scan Spect Brain Scan

4 GASTROINTESTINAL STUDIES Esophageal Motility/ Aspiration, also known as Saliva Aspiration scan: radiopharmaceutical placed in mouth, images of swallowing as well as delayed image of lungs to look for aspiration Aspiration Asthma Chronic choking Chronic cough Recurrent pneumonia Trouble with secretions Esophageal Motility/ Aspiration Esophageal Motility/ Aspiration Esophageal Motility/ Aspiration Esophageal Motility/ Aspiration Esophageal Motility/ Aspiration Esophageal Motility/ Aspiration : To provide a gastric emptying percentage to help determine if emptying is in normal or abnormal range using either liquid or solid meals Abdominal distension Abdominal pain Dyspepsia Emesis Gastroparesis Nausea Poor weight gain Pre nissan Vomiting Weight loss

5 GASTROINTESTINAL STUDIES CHALASIA SCAN (GER/GASTRIC EMPTYING) : images to watch for GER, check gastric emptying percent. *Can also obtain image of lungs, if requested, to look for aspiration. Abdominal pain Anemia Apnea Aspiration Asthma CF Dyspepsia Emesis Esophageal stricture Esophagitis Evaluate for microaspiration failure to thrive Feeding intolerance Gagging with feeds Gastroesophageal reflux gastroparesis Pneumonia Pre-lung transplant workup Recurrent respiratory infection Vomiting Wheezing

6 GASTROINTESTINAL STUDIES Colonic Transit: images obtained at 24 and 48 hours to evaluate motility / constipation Abdominal pain, Vomiting, Nausea and concern for constipation Chronic soiling / encopresis Constipation Defecation disorder Colonic Transit Colonic Transit Colonic Transit Colonic Transit GI bleding scan: evaluate GI tract blood loss - acute or chronic GI bleed Hemoptysis Rectal bleeding GI Bleed GI Bleed GI Bleed Meckel s scan: evaluates for ectopic gastric mucosa in a Meckel s diverticulum Abdominal Pain with Anemia; Decrease in Hemoglobin, episodic anemia GI Bleeding: blood in stools (melena, guaiac + stools, hematochezia Recurrent intussusception Meckels Localization Meckels Localization Meckels Localization

7 HEPATOBILIARY STUDIES scan (also called HIDA Scan): Evaluation of cystic duct or common duct patency, differentiate biliary atresia from neonatal jaundice, evaluation of biliary tree integrity (leak or biloma). Can evaluate gallbladder response to CCK Abnormal gallbladder US Bile Leak s/p trauma or cholecystectomy Biliary Atresia Biliary Colic Biliary dyskinesia Billious vomiting Cholecystitis Cholestasis Clay colored stools Dilated Bile Duct Dyspepsia Early satiety Elevated billirubin, Hyperbilirubinemia Evaluate for gallbladder presence or absence Feeding intolerance Jaundice Nausea RUQ pain Liver / Spleen scan: Evaluation organ size, function and position. Detect and localize focal or diffuse lesions Abdominal heterotaxia Abnormal or absence of Spleen on US Evaluation for splenic function Liver lesions evaluation Low platelet count Malrotation Sickle cell disease Situs inversus or situs ambiguous Spect Liver /Spleen scan Spect Liver /Spleen scan Spect Liver /Spleen scan Spect Liver /Spleen scan Spect Liver /Spleen scan Spect Liver /Spleen scan Spect Liver /Spleen scan Spect Liver /Spleen scan

8 LUNG STUDIES LUNG SCAN PERFUSION ONLY : Evaluate R L lung Differential perfusion, look for right to left shunt Congenital heart disease for evaluation of pulmonary blood flow, pulmonary stenosis quantify right to left shunts Lung hypoplasia Patent ductus ateriosus S/P heart transplantation or paliative shunts Lung Perfusion Lung Perfusion Lung Perfusion Lung Perfusion Lung Perfusion Lung Ventilation-perfusion (VQ) imaging: looks for ventilation and perfusion abnormalities and subsequently areas of VQ mismatch PE (pulmonary embolus) CF (cystic fibrosis), pre or post lung transplant Congenital heart disease / pulmonary artery stenosis Respiratory Distress bronchiolitis obliterans Lung VQ Imaging Lung VQ Imaging Lung VQ Imaging Lung VQ Imaging Lung VQ Imaging

9 CARDIAC STUDIES MUGA study: Evaluation of the ejection fraction of the left ventricle Cardiotoxic chemotherapy Decreased ejection fraction Pre BMT Pre chemotherapy S/P BMT Dynamic Cardiac Imaging Dynamic Cardiac Imaging Dynamic Cardiac Imaging Dynamic Cardiac Imaging Dynamic Cardiac Imaging

10 THYROID STUDIES Thyroid uptake and scan with I123: Evaluate functional status of thyroid. Evaluate thyroid position, size, and anatomy Abnormal thyroid Lab work Fatigue Graves Disease Hashimoto s Disease Hyperthyroidism Hypothryoidism Suppressed TSH Thyroid Mass / nodule Iodine Uptake/ Scan Iodine Uptake/ Scan Iodine Uptake/ Scan Iodine Uptake/ Scan Iodine Uptake/ Scan Iodine Uptake/ Scan Iodine Uptake/ Scan Iodine Uptake/ Scan Thyroid imaging study with Tc99m. Evaluate for presence and location of thyroid gland only Congenital hypothyroidism Evaluate for functioning thyroid gland Evaluate for lingual thyroid gland Thyroglossal duct sinus Tongue mass Thyroid Imaging Thyroid Imaging Thyroid Imaging Thyroid Imaging Thyroid Imaging Iodine Therapy: Ablation of overactive Thyroid Gland Graves Disease Hashimoto s Disease Hyperthyroidism Radiopharm Therapy Oral Radiopharm Therapy Oral Radiopharm Therapy Oral

11 PARATHYROID STUDIES Parathyroid scan: Localize hyper functioning parathyroid tissue (adenoma or hyperplasia) Hypercalcemia Hyperparathryoidism Parathyroid Scan Parathyroid Scan

12 GENITOURINARY STUDIES Cystogram: radiopharmaceutical and saline placed in bladder through a catheter, with imaging as bladder fills then as patient voids UTI, evaluation for vesicoureteral reflux or bladder dysfunction VUR (Vesicoureteral reflux) evaluation or follow-up follow-up of reflux surgery or deflux procedure evaluation of urinary tract anomaly Cystogram Cystogram Cystogram Cystogram GFR Renal Scan: Evaluate the Glomerular Filtration Rate, with imaging and blood draws Decreased urine output Increased Creatinine Pre / post BMT Pre / post chemo for tumors Sickle cell disease GFR Renal Scan GFR Renal Scan GFR Renal Scan GFR Renal Scan GFR Renal Scan : Evaluation of renal size, location, anatomy, infection, scarring. [Children under 5 done with pinhole images (renal cortical scan); Children over 5 done with Spect (Spect Renal scan)] Children Under 5 with the following symptoms Duplex kidney Evaluate for renal scarring Enuresis Febrile UTI Hypertension / elevated blood pressure Pyelonephritis Reflux nephropathy Renal dysplasia Solitary kidney Renal trauma Transplant kidney UTI Vesicoureteral reflux

13 GENITOURINARY STUDIES Children 5 Years or older with the following symptoms Duplex kidney Evaluate for renal scarring Enuresis Febrile UTI Hypertension/ elevated blood pressure Pyelonephritis Reflux nephropathy Renal dysplasia Solitary kidney Renal trauma Transplant kidney Uninhibited bladder UTI Vesicoureteral reflux Renal imaging DTPA or MAG-3 (patients under 2 years): Includes localization of functioning renal tissues. Measurement of relative function of each kidney, excretion over time. Differentiate stasis from mechanical obstruction using lasix, upright images Congenital anomalies including: hydronephrosis, duplex kidneys, dilated renal pelvis, horseshoe kidney, MCDK, pelvic kidney, solitary kidney, ureterocele Decreased urine output Dysuria Ectopic ureter Evaluate renal functions s/p nephrostomy Flank pain Hydronephrosis Megaureter Multicystic dyplastic kidney Neurogenic bladder Prenatal hydronephrosis S/P pyeloplasty / UPJ repair Transplant kidney UPJ obstruction

14 INFECTION / INFLAMMATION STUDIES WBC IMAGING: radiolabelled WBCs prepared and reinjected to evaluate for areas of active inflammation Note: PET /CT imaging can also be used for infection / inflammation evaluation Abdominal pain, Right lower quadrant pain Chronic pancreatitis Evaluate for infection, inflammation, fevers, FUO Increased WBC count Inflammatory bowel disease (IBD) Joint pain / swelling WBC Imaging WBC Imaging WBC Imaging WBC Imaging WBC Imaging WBC Imaging

15 LYMPHATIC STUDIES Lymphatic Imaging: Evaluate the flow of the lymphatic systemic Extremity swelling / Lymphedema Sentinel node evaluation prior to surgery Lymphatic Imaging Lymphatic Imaging

16 NEUROENDOCRINE STUDIES Neuroendocrine imaging: injection of MIBG or octreotide to evaluate for neuroendocrine masses Abdominal Mass Abnormal Labs: catecholamines / VMA Adrenal Mass Chest Mass Diarrhea tumor Follow up, evaluation for metastases Elevated histamine level Elevated VIP: evaluate for VIPoma Evaluation for a carcinoid tumor Fatigue, irritability Horners syndrome Myoclonus with positive paraneoplastic antibody Neuromuscular weakness Paraganglioma Reccurrent Neuroblastoma

17 PET / CT imaging PET/CT: Staging of malignant disease, Differentiation of benign from malignant lesion, Monitoring the response of therapy, evaluation of Fever of unknown origin Evaluate of Tumors and lymphadenopathy (Tumors including: Burkitts Lymphoma, Ewings Sarcoma, Ganglioneuroblastoma, Germ Cell Tumor, Hepatocellular Carcinoma, Leukemia, Lymphoma, Melanoma, Osteosarcoma, Rhabdomyosarcoma, Neuroblastoma) FUO, infection Hemangiomatosis Langerhans Cell Histiocytosis Mass Evaluation Neurofibromatosis PET/CT Full Body PET/CT Full Body PET/CT Full Body PET/CT Full Body PET/CT Full Body PET/CT Full Body