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					Overview of Nuclear Medicine procedures

Group           Procedure             Typical indications:           How common?        Patient preparation        Duration         Dose*   Guidelines
                                      suspected …                                                                                   (mSv)
                                                                     1 year   5 years
Oncology        bone scan             bone metastases, Paget’s       2102               ensure continent           5 hrs            3-5
                                      disease, active arthritis,                        well hydrated
                                      shin splints, loose joint
                lymphoscintigram      lymphoedema, sentinel           219                                          2 hrs            0.05
                                      node (breast cancer,
                Octreotide            neuroendocrine tumours          49                somatadine and             2 hr scan at 4   12-17
                                                                                        octreotide treatment       and 24 hrs
                                                                                        discontinued 72 hrs        post injection
                                                                                        prior to test
                MIBG                  neuroendocrine tumours          32                potassium iodide day       2 hr scan at     5-6
                                                                                        before, day of and         20 hrs post
                                                                                        day after injection.       injection
                                                                                        Cert ain medication
                                                                                        interferes with the test
                                                                                        (we will check).
                FDG PE T/CT           lung canc er, oesophageal       472               fasted for 6 hours         2 hrs            10
                                      cancer, lymphoma,                                 (wat er allowed)
                                      colorectal cancer
                                      metastases, melanoma
                                      metastases (see full list of
                                      indications in UK PE T/CT
                                      Board guidelines)
Lung            VQ scan               pulmonary embolism              586               normal chest X-ray         2 hrs            1.4
                                                                                        (otherwis e CTPA)
                right to left shunt   right to left shunt                       2                                  20 minut es      1
Endocrinology   thyroid scan          Referrals for assessment        147               TFTs, medic ation          2 hrs            1
                                      of any thyroid pathology
                                      are accepted, but the
                                      choice of imaging can
                                      usually only be made after
                                      a consultation in clinic.
                Iodine scan           thyroid cancer                   4        21      stop thyroxine for 4       30 minut es      4-24
                                      metastases,                                       weeks
             MIBI scan               iodine-negative                      6                                5 hrs            11-18
             Thallium scan           recurrent/metastatic
                                     thyroid cancer
             parathyroid scan        parathyroid adenoma            156         Cert ain medication        up to 3 hrs      8-18
             (MIB I, Thallium)       (localisation)                             interferes with the test
                                                                                (we will check).
GI, liver,   HIDA scan               biliary atresia, jaundice,     38          phenobarbitone for 3       2.5 hrs          2
spleen                               non-functioning gall                       days, fast for 12 hrs
                                     bladder, cholecystitis, bile
                                     leak, focal nodular
             spleen scan             splenunculus                          1                               1 hr             2
             Meckel’s scan           Meckel’s diverticulum                38                               1 hr             2
             GI bleed scan           GI bleed                              1                               all day          4
             oesophageal transit     SLE, achalasia, reflux                2    Patient must not eat,      90 minut es      0.9
                                                                                drink or smoke for 4
                                                                                hrs before the test.
             gastric emptying        dumping, gastroparesis         16          Patient must not eat,      5 hrs            0.3
                                                                                drink or smoke for 4
                                                                                hrs before the test.
             gastrooesophageal       gastrooesophageal reflux             18    At time of normal feed     30 minut es to   0.9
             reflux study                                                                                  4 hours if
             H. pylori breath test   active H. pylori infection           198   No antibiotics or          30 minut es      0.02
                                                                                cytoprotectives for 30
                                                                                days. Certain
                                                                                medication interferes
                                                                                with the test (we will
                                                                                check). Fast
             glycocholic acid        intestinal bacterial                 13    No antibiotics or          8 hrs            0.02
             breath test             overgrowth                                 cytoprotectives for 30
                                                                                days. Certain
                                                                                medication interferes
                                                                                with the test (we will
                                                                                check). Fast
             Schilling test          Vitamin B12 deficiency               32    fast from midnight         24 hour urine    0.1
             SeHCA T                 bile salt malabsorption        40    125   Fast overnight. Check      3 hours          0.3
Inflammation   white cell scan        active IB D, PUO, infected      59         scan ideally before        7 hrs          2-9
                                      joint replacement                          antibiotics started        (sometimes
                                                                                                            imaging on
Haematology    red cell mass/blood    polycythaemia                   26                                    6 hrs          0.06
               red blood cell scan    GI bleeding (localisation),           1                               2 hrs          1
                                      liver haemangioma, site of
                                      red cell destruction
               platelet survival      thrombocytopaenia when                22   Anti-D within 1 month      daily for 10   10
                                      splenectomy is considered                  before test. FBC.          days
Renal          dynamic renogram       obstruction, reflux,           218         good hydration, not        1 hr           0.7
               (MAG3)  indirect      transplant donors, renal                   within 48 hours of X-
               micturating            artery stenosis                            ray IV contrast
               static renogram        aberrant kidney, renal          56                                    3 hrs          0.7
               (DMSA)                 scars post UTI, unilaterally
                                      decreased function
               GFR                    measurement of renal           310                                    4 hrs          0.006
                                      function (mostly pre-
               dynamic renogram       transplant perfusion                  1                               30 minut es    5
Cardiology     myocardial perfusion   IHD (diagnosis,                1658        no caffeine for 24 hrs,    up to 4 hrs    16
               scan (Tc )             prognosis), known                          fast for 4 hrs, bring
                                      stenosis (functional                       fatty meal. Certain
                                      impact)                                    medication interferes
                                                                                 with the test (we will
               thallium               hibernating myocardium                32                              4.5 hours      18
               MuGA                   LVEF measurement                42                                    1 hr           10
               first pass             left to right shunt                   7                               30 minut es    4
Neurology,     DaTScan                Parkinson’s, dementia with      25         potassium iodide day       4 hrs          5
Psychiatry                            Lewy bodies                                before, day of and
                                                                                 day after injection.
                                                                                 Cert ain medication
                                                                                 interferes with the test
                                                                                 (we will check).
                                                                                       Patient must be able
                                                                                       to lie flat.
                cerebral perfusion     cognitive decline              61               must be able to lie flat   1 hr             5
                Thallium brain scan    viability of known tumour                14     must be able to lie flat   1 hr             37
                shuntogram             patency of                               14                                1 hr             2-3
                                       ventriculoperitoneal shunt
Other           salivary gland scan    sicca syndrome                                                             30 minut es      0.5
                Gallium scan           connective tissue disease,               9      empty bowel morning        scan at 48       15
                                       PUO, unknown alignancy                          of both scans              and 72 hrs
                lacrimal gland scan    blockage                                 1                                 1 hr             0.04
Therapies       radioiodine            hyperthy roidism, thyroid     103                                          30 minut es
                                       cancer                                                                     (benign)
                                                                                                                  3 day
                                                                                                                  inpatient stay
                MIBG                   neuroendocrine tumours                   26     potassium iodide on        5 day
                                                                                       day of therapy and         inpatient stay
                                                                                       next 10 days. Full
                                                                                       blood count, liver
                                                                                       function tests.
                radiophosphorus          polycythaemia                           68                            30 minut es
                Strontium                metastatic bone pain                                                  30 minut es
                radiosynovectomy         inflammatory arthritis                  25                            2 hours
                Zevalin                  B cell lymphoma                          1
* The annual background radiation dos e from natural and man -made sources is 2.7 mSv (UK average) for comparison.