1. GIT AND RENAL SYSTEM
Nuclear medicine
PROCEDURES
Vipin kumar
PG Medical Imaging
Kmc manipal

2. BY
JOSEPH BERNARD

4. INDICATION

5. PATIENT PREPARATION
Identification and verification of request
-NPO 8 hours
-instructions

6. EQUIPMENT
Camera- large field
Collimator- low energy
Computer setup-
flow-sec/15sec for 1 mnt
Dynamic- 15sec/frame for 9 mnts

7. PROCEDURE
 Patient supine, camera anterior over the thorax
 Patient draws dose into the mouth,
 On command patient swallow once in a single bolus
 Patient dry swallow once in every 15 sec for 10 mnts

9. ARTIFACTS
 Aspiration of the dose
 Regurgitation with or without aspiration
 Attenuating articles or clotting

10. GASTRIC EMPYING
Radio nuclide 99Tc
Radiopharmaceutical 99Tc-SC ( sulfur colliod)
location Compartmental, moved along
with food through GIT
Adult dose 200µCi to 1mCi
Method of administration Radiotracer usually mixed with 1
or 2 egg white for solid study,
radiotracer mixed with 120 ml of
water or other and ingested
orally

11. INDICATION
 Determination of delayed gastric emptying
 Evaluation of mechanical obstruction
 Evaluation of anatomic obstruction
 Evaluation of altered function
 Evaluation of suspected tumor or surgery
 Evaluation of nausea
 Evaluation of weight loss
 Evaluation of gastric therapy
CONTRA INDICATION
 Allergic to egg,
if so use baby food, sweet potatoes etc

12. PATIENT PREPARATION
 identify the patient, verify the procedure and explain
 ensure diabetics receive orange juice 2 hrs prior to the
study
 NPO 4-12 hours
 discontinue sedatives 12 hours prior

13. EQUIPMENT
 Camera- large or small
 Collimator-low energy ,high resolution
 Computer set ups-
 Static-preset for 60-120 sec or 50000 counts
 Dynamic- 60sec / image

14. PROCEDURE
BASELINE SOLID STUDY
mix the radiotracer with the egg
-administer to the patient PO with 30-120 ml of water,
- Encourage patient to eat quickly

15. POSITION OF PATIENT
 PATIENT SUPINE
 Supine is good for checking esophageal reflex
 Camera – anterior or LAO
 instruct the patient to be motionless
 obtain static images every 5 mnts up to 30 mnts, then every 15
mnts there after.

16. POSITION
 PATIENT STANDING
 realism study
 obtain immediate images and then every 10 mnts
 ADITIONAL TESTING
 if emptying is slow metaclopramide is administered
 continue with the protocol for 60 mnts

19. ARTIFACTS
 Non uniform mixing of radiotracer and egg
 Too little or too much food
 Patient allergies
 Aspiration

20. GASTROESOPHAGEAL REFLUX
Radio nuclide 99Tc
Radiopharmaceutical 99Tc -SC
location Compartmental, esophagus to
gastrointestinal tract
Adult dose 300µCi- 2mCi
Method of administration PO in water, orange, milk, saline
PO with acidified orange juice to
delay the gastric emptying

21. INDICATION
 Detection of GE reflux
 diaphramatic hernia
 children with asthma, chronic lung disease, aspiration
pneumonia
NO CONTRA INDICATION

22. PROCEDURE
 At 15 mnts after injection position the patient in front of
 Now camera patient supine on the table
the place the
 Place the abdominal binder at the lower abdomen
 Acquire 30 second image
 Attach sphygmomanometer under the binderused as the
 From this image the ROI drawn will be
 Acquire 30 second image with pressure in the abdominal
background
binder at 0, 20, 40,60,80 & 100mm Hg
 Post processing is done to acquire the gastro esophageal reflex

23. GASTRO INTESTINAL BLEED
Radio nuclide 99Tc
Radiopharmaceutical Tagged red blood cells by pyrophosphate
or stannous chloride to 99m TcO4 by in
vivo, in vitro
location Compartmental, tagged to and circulating
with blood
Adult dose 20-30mCi
Method of administration Iv injection, or drawing, tagging and
reinjection the tagged red blood cells

24. INDICATION
 Detection and localization of the bleeding site in patient
with active or intermittent bleeding.
 This could be caused by ulcers, perforation, cancer,
inflammation, diverticula.
CONTRAINDICATION
patient with contrast studies under way

25. PATIENT PREPARATION
 Obtain signed consent for blood work
 Look for active signs of bleeding
PROCEDURE
 In in vitro method extract 2.5 ml of blood from the patient
into a heparinized syringe and tag with Radio pharmacy.
 In in vivo method inject cold pyrophosphate, then 20
minutes later inject radiotracer under camera for flow

26. ABNORMAL RESULT
Focal area of increased activity
Focal area peristalsing with time

27. URINARY SYSTEM
CORTICAL IMAGING
GLOMERULAR FILTRATION RATE
TUBULAR FUNCTION

28. RENAL: CORTICAL IMAGING
Radio nuclide 99Tc
Radiopharmaceutical 99Tc DMSA(90% binds to plasma proteins,
preventing any glomerular filtration, hence
show clearance from renal cortex)
location Compartmental, blood stream
Adult dose 1-6 mci
Method of administration Direct Iv injection or Iv catheter with saline
flush

29. INDICATIONS
 Evaluation of renal cortex
 Evaluation and quantization of regional relative
function.
 Evaluation of differential function
 Localization of the renal mass
 Detection and differentiation of acute and chronic
pyelonephritis
 Evaluation of renal blood supply
 Evaluation of renal transplant
CONTRAINDICATION
None

30. PATIENT PREPARATION
 Identify the patient and verify
 Explain the procedure
 Should be well hydrated and should void before the test begins
 Discontinue angiotensin converting enzymes inhibiters
EQUIPMENT
Camera-large field of view
Collimator-large energy high resolution

31. PROCEDURE
 DMSA is usually used for anatomic studies,
 Maintain patient hydration
 Patient position supine
 Obtain images- inject and take immediate static (500000-
800000 counts) then delays at 1 hour

32. NORMAL RESULT:-
 Both kidneys visualized at the same size and intensities
 Collecting system may not be visualized because of the
slow clearance

33. GLOMERULAR FILTRATION RATE
Radio nuclide 99Tc
Radiopharmaceutical 99Tc DTPA
location Compartmental, blood( 10% bound to blood
, filtered by glomerulus
Adult dose 3- 15 mCi
Method of administration Bolus IV

34. INDICATION
 Evaluation of renal tubular function
 Evaluation of renal vascular flow
 Evaluation of renal hypertension
 Detection of acute tubular necrosis
Renal tubular trauma
 Renal transplant
CONTRAINDICATION
Patient still on adrenal cortical extract (ACE)

35. PREPARATION
Well hydrated , void before the test begins
Discontinue any ACE inhibiters
EQUIPMENT
Camera-large FOV
Collimator- low energy, high resolution

36. PROCEDURE
 DTPA is used for inexpensive and easy baselines checking for normal renal
function
 If GFR is included count the syringe before and after the injection for 1 mnt
at 30cm from camera face
 Place the patient in supine, camera posterior except for renal transplant
 Position camera in FOV, kidney and bladder must be in FOV
 If study calls for frusimide IV setup with butterfly is needed
 Inject bolus and start camera
 Images are obtained

37. POST PROCESSING
Generate time activity curve and differential function
Generate % uptake of each kidney
Generate pictures of dynamic or static images

38. NORMAL RESULT
 Both kidneys at the same size and intensities.
 Both the graph peaking with parallel up slope and
dropping off about the same rate.
 GFR-125ml/minute

40. PERFUSION - DTPA