Local General Nuclear Medicine Guidelines by broverya72


									                Local General Nuclear Medicine Guidelines

Investigation               Referral Criteria
Head and neck
Dacroscintigram (lacrimal   Epiphora. To assess lacrimal drainage.
CSF leak localisation       CSF leak. Repeated meningeal infection.
Salivary glands             Xerostomia.
(sialogram)                 To confirm salivary gland dysfunction
Thyroid-technetium          Thyrotoxicosis – graves or hot nodule
                            ? cold nodule
                            ? ectopic thyroid tissue in the neck
Thyroid-123-iodine          ? metastatic thyroid carcinoma
                            ? retrosternal goitre
Perchlorate discharge       Pendred’s syndrome.
DaTSCAN                     Differential diagnosis: Parkinson’s Spectrum Disorders
Parathyroid localisation    Primary, secondary or tertiary hyperparathyroidism, confirmed
(MIBI)                      biochemically, prior to surgical resection.
Lung Ventilation &          ? Pulmonary Embolism when CT pulmonary angiography is
Perfusion (VQ) scan         impossible due to patient condition / allergy etc.

Lung Differential           To assess right and left lung perfusion usually prior to lung resection
Perfusion scan              in cases of tumour, bronchiectasis, bullectomy etc
Pulmonary Aspiration        Usually infants: to confirm aspiration of milk, causing lung infections
Myocardial Perfusion        To confirm myocardial ischaemia . Optionally, gating may be
(Stress/rest)               requested, if wall motion and ejection fraction are required.
Myocardial thallium         Assess for hibernating myocardium.

Planar Multi-gated          Accurate assessment of ejection fraction, either for monitoring
acquisition (MUGA)          disease course e.g. cardiomyopathy, CAD or monitoring effect of
                            cardiotoxic drugs
Oesophagus GI Liver
and Spleen
Swallow with sucralfate     Identify inflamed mucosa cause by gastro-oesophageal reflux
Meckel’s diverticulum       Identification of ectopic gastric mucosa e.g. Meckel’s diverticulum

Hepatobiliary studies       Confirm: biliary atresia, bile duct obstruction, post surgical bile leak.
Cholecystokinin             ? biliary dyskinesia
Spleen                      Localisation of accessory splenic tissue
(denatured red cells)
GI Bleed (red cells)        Localisation of GI bleed
GI bleed (colloid)          Localisation of GI bleed
Hepatic Haemangioma            Confirm: cavernous hepatic haemangioma (when diagnosis from CT
                               / US is uncertain)
Liver dynamic                  Confirm post-prandial mesenteric hypertension
Platelet Sequestration         Thrombocytopaenia, where there is a need for localisation of platelet
                               destruction site with calculation of mean platelet life span.
Gastric emptying               ? gastric outlet obstruction
Renogram                       ? renal perfusion e.g. acute trauma
(with differential function)   ? ATN
MAG 3                          ? dilated obstructed or non-obstructed collecting system (study +/-
                               frusemide or F15 renogram)
                               Assessment of divided function e.g. pre-operatively for unilateral
                               nephrectomy for tumour.
                               Assessment of divided and residual function in kidney damaged by
                               e.g. ischaemia, infection, obstruction, reflux
                               ? post surgical ureteric leak
                               Renal transplant assessment

Captopril Renogram             Detection of functionally significant renal artery stenosis
DMSA                           ? cortical scarring
                               ? focal mass or dromedary hump on IVU/US
                               Divided renal function/ residual function as for MAG3
Indirect micturating           As part of a renogram -? vesico-ureteric reflux
GFR                            As part of a renogram (DTPA) or separate study (Tc-DTPA, by
                               specific request: Cr-EDTA)
Bone Scan                      Assessment of primary and metastatic bone tumour
+/- SPECT                      Evaluation of unexplained bone and joint pain
                               Diagnosis of stress fractures or other musculoskeletal injury involving
                               bones, joints, tendons and soft tissue
                               Evaluation of patients with possible osteomyelitis and septic arthritis,
                               particularly at early stages with negative x-rays
                               Evaluation of possible ischaemic necrosis
                               Evaluation of abnormality on x-ray, is it relevant / metabolically
                               Early detection and determination of the extent of Paget’s disease of
                               the bone
                               Differentiation between active versus chronic inactive arthritic
                               Monitoring of response to therapeutic procedures
                               Selection of site for bone biopsy
                               Planning of radiation therapy ports
3 phase bone scan              In cases of suspected fracture or infection
Leukocyte - technetium         Pyrexia of unknown origin
labelled HMPAO                 Inflammatory bowel disease
Leukocyte - indium             ? Infected orthopaedic metalwork or fracture site
labelled                       ? reactivation of chronic osteomyelitis (acute on chronic)
Gallium                        ? PCP in immuno-compromised patient with negative CXR
                               Widespread pulmonary changes on CXR e.g. sarcoid or fibrotic lung
                               disease, ? active or inactive disease present
Lymphoscintigraphy             Assessment of swollen limbs
In-111 Octreotide     Assessment of tumours with somatostatin receptors e.g. carcinoid,
Iodine-123 MIBG       Neural crest tumours e.g. phaeochromocytoma, neuroblastoma
Iodine 123            Thyroid carcinoma metastases
Sentinel Lymph Node   Breast Cancer: Pre-surgical imaging and intra-operative identification
Biopsy –              of the sentinel node(s)

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