- Nuclear Medicine - Regular Hours: 7:30 am 4:30 pm Monday Friday See *1 Scheduling/Orders: Ph. (850) 278-3800 Fax (850) 278-3787 Results: Health Information Mgmt (Med Records) Ph. (850) 278-3020 Contact Name(s): Staff Technologists Nariman Nandlal cell (850) 699-0548 Lori Myers cell (850) 723-4270 Phone: Dept. (850) 278-3563 or (850)278-3560 Fax: Dept. (850) 278-3562 Location: Hospital 1 st Floor Radiology Area All outpatient Nuclear Medicine Scans (with the exceptions of Sentinel Lymph Node localizations of surgical breast cancer patients) can be scheduled through our scheduling department. Due to the necessity of advance ordering of the radioactive isotopes needed to perform all Nuclear Medicine exams, this department operates by appointment only. NO walk-ins. *1 Some Nuclear Medicine exams are emergent in nature, but they still require emergency scheduling prior to the patient arriving in Nuclear Medicine. Nuclear Medicine is primarily a diagnostic imaging tool. This technology utilizes safe diagnostic levels of radiation along with sophisticated radiation detection cameras to image body organs and organ systems. To accomplish these studies, a licensed technologist typically introduces the radiation into the patient s body via IV injection, oral consumption, or inhalation. Imaging sessions can range 30 minutes to 3 hours continuously. Imaging start times, and the length of time required for image completion is dependent on the type of scan the ordering physician has requested, and the patient s personal medical history. Nuclear Medicine looks at the functional process of body organs and most of these processes take a considerable amount of time for the body to complete. That is the reason for lengthy imaging sessions and the occasional necessity to return for imaging at a later time/date. The radiation introduced is of safe diagnostic levels that the patient will have NO adverse reaction to. However, knowing that developing embryos are ultra-sensitive to radiation: if the patient is pregnant or nursing, Nuclear Medicine exams should be scheduled at a later date after child delivery and nursing has been completed. If there is any possibility a patient might be pregnant, a pregnancy test should be performed and results that the patient is not pregnant should be verified prior to scheduling the exam. When a patient is coming to Nuclear Medicine for an exam they should wear warm, comfortable clothing, preferably without metal. Sometimes patients will be asked to hold medications they are currently taking due to the fact that those medications might alter the results of a specific Nuclear Medicine exam. Following are some helpful guidelines for ordering a number of Nuclear Medicine exams: **Most pediatric cases require sedation to be scheduled with the Radiology Nurse as well** Total Body Bone Scan: Commonly ordered on patients with diagnosed or suspected cancers, generalized bone pain, arthritic evaluations, post trauma, and more. No prep, other than it would be advised to bring copies of x-ray films from outside facilities that are pertinent to the condition warranting the ordering of the bone scan. The patient will be given an IV injection of a radioactive isotope (Sometimes in addition to the later pictures, we obtain images immediately after the IV injection) and then they will be given a time to return a minimum of 3 hours and a maximum of 24 hours after the injection for imaging that takes approximately 30 minutes. Return times are patient specific based on their medical history, but the most common return time given is 3 hours after the injection. Patients will be encouraged to drink liquids and to empty their urinary bladder frequently after the injection to facilitate higher quality images upon their return. Limited Bone Scan: Commonly ordered on patients when interested in a single body location of injury, specific area of bone pain, post surgery, cases of infection, and more. (In the infection cases, a 3-phase form of the limited bone scan is performed). When there are multiple sites of concern or any history of cancer is present, a Total Body Bone Scan should be ordered requesting special attention to those specific sites. The methods for a Limited Bone Scan are identical to the Total Body Bone Scan listed above, with the only difference being the most common return time for imaging in these cases is 3-4 hours after the injection. Due to the later return times post injection; these should not be scheduled for injection later than noon. SHHEC Section I - 1 09/09
Gastric Emptying: Commonly ordered on patients with gastro paresis, nausea, vomiting, esophageal reflux, severe weight loss, abdominal pain, and more. This test will provide a gastric emptying half time. Prep for this study requires the patient to be NPO 4 to 6 hours prior to exam. Adult patients will be required to ingest two scrambled eggs or oatmeal with a radioactive isotope added during the eggs preparation. They will also drink 4 oz of water. They will be positioned on their back on an imaging table and imaged continuously without interruption for 90 minutes. On pediatric cases not capable of ingesting eggs, liquids will be utilized. The parent or guardian should bring the child s normal liquid (i.e. Formula with bottle) feeding to be supplied to the technologist for the child s testing. If the child has special connectors for g-tube feedings or something of that nature, all necessary feeding tools should be brought with them to accomplish feeding. Pediatrics will be imaged on their back for a total of 60 minutes without sedation (Sedation not possible due to feeding). Reglan will not be utilized in pediatrics. For all patients: If nausea/vomiting is so severe that they are unable to keep any feeding down, this testing is not possible. Gallium Scan Commonly ordered on patients with FUO, osteomyelitis, chronic infections, localization of specific tumors and more. Gallium scans require no prep. Patient will get a radioactive injection IV. They leave after the injection and will be given a time to return, 24, 48, 72, and/ or 96 hours later for imaging. Sometimes patients are given a bowel prep kit after their injection to use before later returning. Hepatobiliary Scan with GBEF (hida, gallbladder, disida), HIDA with CCK Ordered on patients with right upper quadrant pain, nausea, vomiting, cholecystitis, biliary leaks and more. Prep is NPO 4 6 hours and absolutely no pain meds for 6 hrs prior to testing. Patient will be given an I.V. injection of radioactive isotope. Patient will be imaged continuously for 60 min to 2 hrs. Biliary function of each patient will determine time. If the patients gallbladder is visualized during imaging, patient is given an injection (through an I.V. site), which simulates a fatty meal, then imaging is continued. A GBEF will not be obtained on an emergency basis or in situations where the patient cannot withhold pain meds. In this case, only acute cholecystitis and nothing more will be determined. Debray Hepatobiliary Scan Ordered on patients that have had a cholecystectomy, but abdominal pain similar to that pain prior to gallbladder removal persists. Prep is NPO 4 6 hours and absolutely no pain meds for 6 hrs prior to testing. Patient cannot be allergic to morphine. Patient must have a driver accompany them. Patient will be injected with radioactive isotope and scanned for 60 to 90 min. During the scan, patient will get a morphine injection by radiology nurse. This is done to induce the patient s symptomatic pain while we are imaging. Patient will then be released with the driver. Hemangioma Scan Ordered on patients with liver lesions seen on some other diagnostic tests with suggested diagnosis of hemangioma. No prep for this exam. Patient should plan on 3 hours for exam completion. Tech will draw 5 milliliters of blood. The blood will be tagged with the radioactive isotope. Tagging will take 30 min. The radioactive blood will then be reinjected into the patient s IV for further testing. Additional images will be taken 1 hr. later. Thyroid Scan only (tc99m) Ordering a scan only will provide functional imaging, but won t provide a % uptake of iodine by the thyroid gland. Ordered when thyroid nodules have been seen on other exams. Knowing the functionality of these nodules is needed. Utilized in infants to establish the presence of a thyroid, sublingual, or ectopic gland. Patient will be given an IV injection of a radioactive isotope, 10 min later, 4 images of the patients neck will be obtained, taking 30 minutes to complete. I-123 Thyroid Uptake Scan This uptake scan gives the most complete analysis of thyroid function offered by Nuclear Medicine. These will render a % value of iodine uptake (iuthyroid, hyperthyroid, or hypothyroid) by the patient s thyroid gland. Also provides functional images of the thyroid gland indicating size, uniform functionality vs. nodular activity (hot vs. cold nodules). Ordered in patients suspect for hyperthyroidism, hypothyroidism, thyroiditis, and more. Prep: patient should not take any thyroid meds for 3 to 4 weeks prior to appointment date. Patient also must not have had any contrast enhanced exams within the last 2 months. NPO preferred for 1 st day exam. The test requires 2 days. First day patient will be given 1-2 radioactive iodine capsules to ingest. Patient will then be given a time to return the same day 6 hours later. At this time the uptake will be performed. 4 images of the patient s neck will be taken, taking 30-45 minutes. Patient will be given a time to return the next day, usually close to the same time as the initial visit. One more 24-hour uptake will be obtained during the 2 nd visit. SHHEC Section I - 2 09/09
I-131 Total Body Scan: Ordered on patients that have had thyroidectomies after being diagnosed with thyroid cancer. Prep: patient should not take any thyroid meds for 3 to 4 weeks prior to appointment date. Patient also must not have had any contrast enhanced exams within the last 2 months. NPO preferred for 1 st day exam. Patient will be given radioactive isotope iodine capsule to ingest by mouth. Patient will be given time to return 2-3 days later for imaging. On the return day, images will be taken of the patient s entire body. Images will take 1 hr to complete. Parathyroid Scan Ordered on patients suspected of hyperthyroidism, elevated blood calcium levels, or elevated parathyroid hormone levels. Ordered postoperatively on the day of surgery for external skin markings to be made for neoprobe localization by surgeon. No prep. Lab results indicating the elevated calcium and PTH levels should accompany the doctor s orders for this exam. Patient will be injected IV with a radioactive isotope. First set of images will begin 10 minutes after the injection. The patient will then leave and return in 3 hours for a second set of delayed images. Liver/ Spleen Scan Ordered for patients diagnosed with hepatitis, cirrhosis, abnormal liver enzymes, and more. No prep. Barium studies should not have been done in the prior 3 days.. Patient will be injected IV with a radioactive isotope. Imaging will begin 10 minutes after injection. Test takes 30-45 minutes to complete. Lung V/Q Scan (Aerosol ventilation with perfusion) Ordered on patients to rule out pulmonary embolism only when CT scan is not possible. Prep requires patient to have a 2- view chest xray, within 24 hours of lung scan. Scan consists of 2 parts, 1 st the patient will breath on a hose with a mouthpiece with their nose pinched. The hose will have oxygen passing through it for 10 minutes. These 10 minutes of breathing will deposit the radioactive aerosol in the patient s lungs without side effect. * Images will be obtained. 2 nd, patient will receive an I.V. injection of a radioactive isotope that will demonstrate the blood flow to the lungs. Another set of images will be taken. Scan time will take 30 minutes to an hour. Split Lung Quantitative scan This test is ordered on lung cancer patients and known pulmonary anomalies. This exam gives a % of right to left lung function helpful in surgery planning. No prep. Patient will be given IV injection of a radioactive isotope. Exam will take 30 minutes. Mag3 Renal Scan with Lasix Ordered on patients with hydronephrosis, renal failure, right or left flank pain. No prep. Patient will be given radioactive isotope by IV injection. Continuous images will be taken for 40 minutes. At the 10-minute time, IV lasix will be given. For pediatrics, this exam will need a radiology nurse for sedation. Vasotec Mag3 Renal Scan Ordered on patients to r/o renal artery stenosis. Prep includes no blood pressure meds for however long their physician feels necessary to get it out of their system. Some patients cannot come off their meds. Patient will have an IV placed in their arm. 2.5 mg of blood pressure meds called vasotec will be given. Patient will be given several cups of water to drink and their blood pressure will be monitored for 15 minutes. Patient will receive a radioactive isotope, images will be taken for 30 minutes. DMSA SPECT Renal Scan Ordered on patients with pyelonephritis or renal cortical scarring (most common on pediatric patients). Most pediatric patients will require a radiology nurse for sedation. Pediatric patients needing sedation will need to be NPO after midnight before exam. Regular patients have no prep. Patient will receive radioactive isotope injection through I.V. site. Patient will leave and return 2-3 hours after injection. Images will take 30 45 minutes to complete. Cystogram Pediatrics Only Done after patient had a positive urinary reflux study. Sedation may be required. Small Foley catheter will be placed in patient s urethra. A radioactive isotope liquid will be infused into the bladder. While filling takes place, camera will be underneath patient s body taking images. When bladder is full, patient will then urinate on the table while images are taken to see any residual urine in bladder, test will then be complete. This test may be difficult for potty-trained children. Resting Muga scan Used on cancer patients prior to chemotherapy, during chemo and as a follow up. Test provides a left ventricular ejection fraction at rest, no prep. Patient will be given an IV and blood will be drawn. Blood will then be tagged to a radioactive material. Patient will wait for 30 minutes, then the blood mixture will be reinjected into patient. We will place EKG patches on their skin and obtain 3 images. Test will take 60 90 minutes. SHHEC Section I - 3 09/09
Meckles Scan Ordered on patients having diverticulum sometimes signaled by blood in stool. Prep NPO 4 6 hours. 2 hours NPO is acceptable for infants. Most pediatric patients require sedation. Patient will get an I.V. injection of a radioactive isotope. Images will be taken of the patient s abdomen for 60 minutes. Myocardial Perfusion Scan Stress and Rest Also referred to as cardiolite scan, myoview scan, sestamibi scan, tetrofosmin scan, and mibi scan. This is a two-part test evaluating blood flow to the heart at rest and stressed. It can be accomplished in one day for thinner more fit patients. Patients weighing over 200 pounds this test will take 2 days. When the patient is capable of reaching an adequate heart rate by physically performing the stress, they will be using a treadmill. If the patient has physical limitations and cannot use the treadmill, they should be scheduled for stress chemically with lexiscan, adenosine or dobutamine. All methods are commonly ordered on patients with chest pain, sob during exertion, ischemia, myocardial infarcts. Prep for all methods includes NPO for 6 hours before test. No caffeine for 12 hours prior. Diabetics should hold insulin until study is complete. Most blood pressure patients are asked to hold medication. This decision will be determined by physician. When this test is scheduled for a single day protocol, patient should plan on test taking 3 5 hours. When this test is done in 2 days, the test will take 1 3 hours both days. Patient will receive an I.V. radioactive injection at rest and the same during exercise, when their heart is at peak stress. The chemical stress agents used on patients that can t use the treadmill have some effects. After injection, patient will wait a minimum of 30 min and then be imaged while laying on their back with their hands above their head for 20 min. Resting Thallium Viability Scan Ordered on patients with known heart disease usually deciding whether to revascularize or not. Immediate imaging and 4-hour or 24- hour redistribution images are done. Prep NPO 4 6 hours prior. No caffeine 12 hours prior. Patient will receive IV radioactive injection. Images will occur 15 min after injection and take 30 minutes. Patient will return 4 or 24 hours later based on the doctor s request. A booster I.V. injection of the same isotope will be given and same pictures will be repeated. Lymphoscintigraphy also called (Sentinel Node biopsy) Ordered on patients who have been diagnosed with breast cancer. Procedure is performed usually the day prior to Breast surgery. Patient will receive 4 injections of the radioisotope subcutaneously on the affected breast. Injections will be given by a radiologist. The isotope is given to map the flow of the lymphatic system, and imaging can last up to two hours after injection. Total procedure time is 2-4 hours. If any other test is ordered that is not mentioned in this print out, please contact your nuclear medicine tech for any questions. SHHEC Section I - 4 09/09
COMMON CPT CODES Procedure CPT Code(s) Bone And/Orjoint Scan-3 Phase 78315 Bone Scan Total 78306 Bone Scan-Limited Area 78300 Bowel Imaging-Meckels 78290 Brain Scan W/Cerebral Bloodflow 78601 Spect Brain Scan(Iofetamine Hcl) 78607 / 78891 Cardiac Fdg 78491 Cerebral Bloodflow 78601 Cardiolite Gxt 93017 / 78465 / 78480 / 78478 / 78891 Cardiolite Dobutamine 93017 / 78465 / 78480 / 78478 / 78891 Cardiolite Adenosine 93017 / 78465 / 78480 / 78478 / 78891 Cisternogram 78630 Cystogram 78740 Gallbladder Scan 78223 / 78890 Gallium Scan 78806 Gastric Emptying 8264 / 78890 Gi Bleed Scan 78999 Gi Reflux Scan 78262 / 78890 Liver/Spleen Scan 78215 Spect Liver With Hemangioma 78216 / 78891 Lumbar Puncture For Cisternogram 62270 / 62272 Lung Perfusion 78580 Lung Perfusion W/ Ventilation Aerosol 78588 Lung Vent Scan, Aerosol, Mutl 78587 Lymphoscintigraphy 78195 Myoview/Cardiolite Persantine 93017 / 78465 / 78480 / 78478 / 78891 Myocardial Infarct Scan 78469 Oncoscint Scan 78802 / 78803 / 78891 Parathyroid (Sestimibi) 78070 / 78890 Renal Function Study-Captopril 78707 Or 78708 / 78890 Renogran With Renal Plasma Flo 78704 / 78890 Renal Scan 78710 / 78891 Renal Scan W/Blood Flow-Dtpa 78704 / 78890 Renal Scan W/Flow Function 78707 Or 78708 Or 78704 / 78890 Renal Transplant Evaluation 78707 / 78891 Resting Gated Heart 78472 / 78890 Salivary Gland (Parotid) 78230 Testicular Scan W/ Flow 78761 Thallium Scan With Injection 78465 / 78891 Therapy-Hyperthyroidism 79000 Thyroid Uptake Scan Return 24hrs 78000 / 78010 Thyroid Metastases - Whole Body 78018 Thyroid Multideterminia I123 78010 Thyroid I123 Scan 78010 Thyroid Uptake - Single Determinan 78000 Wbc Scan (Technetium/Ceretec) 78806 SHHEC Section I - 5 09/09