/
I Purpose The purpose of this guideline is to assist nuclear medicine practitioners in I Purpose The purpose of this guideline is to assist nuclear medicine practitioners in

I Purpose The purpose of this guideline is to assist nuclear medicine practitioners in - PDF document

pamella-moone
pamella-moone . @pamella-moone
Follow
528 views
Uploaded On 2014-12-28

I Purpose The purpose of this guideline is to assist nuclear medicine practitioners in - PPT Presentation

Purpose The purpose of this guideline is to assist nuclear medicine practitioners in recommending perform ing interpreting and reporting the results of bone scintigraphy II Background Information and Definitions ID: 30554

Purpose The purpose

Share:

Link:

Embed:

Download Presentation from below link

Download Pdf The PPT/PDF document "I Purpose The purpose of this guideline ..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.


Presentation Transcript

I.PurposeThe purpose of this guideline is to assist nuclearII.Background Information and Definitionsevaluate the distribution of active bone forma- 131 I, 67 Ga, or 111 Society of Nuclear Medicine Procedure Guideline for Bone Scintigraphy 5.Results of prior bone scintigraphyventional radiographs, computed tomogra-7.History of therapy that might affect the re-sults of bone scintigraphy (e.g., antibiotics,steroids, chemotherapy, radiation therapy,C.PrecautionsD.Radiopharmaceutical 99m phy. The usual administered activity for adultpatients is 740Ð1,110 MBq (20Ð30 mCi) injectedintravenously. For markedly obese adult pa-tients, the administered activity may be in-pediatric patients, the administered activity is9Ð11 MBq/kg (250Ð300 µCi/kg), with a mini-administered activity for pediatric patientsing air into the multidose vial. Quality controlshould be performed before administration ofofProcedure Guideline for Useof Radiopharmaceuticals).E.Image Acquisition1.Flow imagesIf flow images are acquired, the cameraest before tracer injection. The acquisitionapproximately 30 frames. When digital im-2.Blood pool (tissue phase) imagescompleted within 10 min of tracer injection,for approximately 3Ð5 min/image. After 10min, some activity may be apparent in theskeleton. Blood pool images are usually ob-counts/image (150,000Ð200,000 counts/im-3.Delayed (skeletal phase) imagescomplished with multiple overlapping im-ages (i.e., spot imaging) or with continuousacquiring bone images, the areas of bonyThe first spot view of the axial skeleton,usually the chest, is acquired for approxi- BONESCINTIGRAPHY Radiation Dosimetry in Adults 99m Tc-phosphates740Ð1110Bone0.0080and phosphonates(20Ð30)0.063(0.030)Intravenously(0.23)R a d i o p h a r m a c e u t i c a l sEffective DosemSv/MBq (rem/mCi)Organ Receiving theLargest Radiation Dose* mGy/MBq(rad/mCi)AdministeredActivityMBq(mCi) * International Commission on Radiological Protection. Radiation Dose to Patients from Radiopharmaceuticals. ICRP re-port 53. London, UK: ICRP; 1988:215. Values for normal bone uptake and normal renal function. See also MedicalInternal Radiation Dose Committee dose estimate report No. 13: radiation absorbed dose for 99m Tc-labeled boneimaging agents. J Nucl Med. 1989;30:1117Ð1122. matrix. Whole-body views are usually ob-larly so in pediatric populations because ofextreme ranges of normal uptake. Films ofscintigrams photographed with different in-When whole-body scanning is used, thecount rate (usually of the anterior chest)should be determined before image acquisi-injection) anterior or posterior whole-bodyimages contain �1.5 million counts. If thescanner electronically joins multiple passes,ease is small, a limited study is reasonable.When disseminated disease is more likely,4.SPECT imagingextent of disease. SPECT imaging should beperformed as recommended by the cameramanufacturer. Typical acquisition and pro-cessing parameters are 360¡ circular orbit,5.Other imagingAdditional delayed (6Ð24-h) images will re-sult in a higher target-to-background rationecessary. Approximately 75,000Ð100,000counts should be obtained for pinhole colli-mator views. Zoom magnification or a con-verging collimator also may be used to im-prove resolution, particularly when smallaged. The physician interpreting the imageOther views (e.g., lateral, oblique, or tan-of the hips or sitting-on-detector [caudal]views of the pelvis) may be obtained whenF.Interventionsthere is overlying bladder activity. In patientsing additional views may better evaluate the SOCIETYOFNUCLEARMEDICINEPROCEDUREGUIDELINESMANUALAUGUST 2003·207 Radiation Dosimetry in Children(5 Years Old) 99m Tc-phosphates9Ð11Bone 0.025and phosphonates(0.20Ð0.30)0.22(0.093)Intravenously(0.81)Min: 0.50 mCiMax: 30 mCiR a d i o p h a r m a c e u t i c a l sEffective Dose mSv/MBq(rem/mCi)Organ Receiving theLargest Radiation Dose* mGy/MBq(rad/mCi)AdministeredActivityMBq/kg(mCi/kg)*International Commission on Radiological Protection. Radiation Dose to Patients from Radiopharmaceuticals.ICRP report 53. London, UK: ICRP; 1988:215. Values for normal bone uptake and normal renal function. Seealso Medical Internal Radiation Dose Committee dose estimate report No. 13: radiation absorbed dose for 99m Tc-labeled bone imaging agents. J Nucl Med. 1989;30:1117Ð1122. 1.Repeat images immediately after voiding2.Sitting-on-detector (caudal) or oblique views3.Lateral views4.24-hrÐdelayed images5.SPECT acquisition. Single or multiple rapid(5Ð10 min/acquisition) SPECT acquisition(s)are preferred to avoid artifacts caused bySPECT acquisition begins and ends. Begin-ning SPECT acquisition with the cameradual-head camera) or posterior position (for6.Image immediately after catheterization ofthe bladder. (Note: Bladder catheterizationG.Processinging is required. For general SPECT image pro-cessing guidelines, refer to the SNM H.Interpretation Criteria1.Increased (decreased) tracer activity in thea.Focalb.Diffusec.Indicates increased (decreased) osteoblas-d.Differential diagnosis is long, but can beii.Location and number of abnormalitiesii.Often caused by benign conditions:i.Often indicates improvementi.Progression of diseaseii.Flare response to therapy3.Soft tissuesa.Normal structures should be noted:i.Kidneysii.Bladderiii.Generalized interstitial uptake com-(a)Increased(1)Renal failure(2)Dehydration(3)Shortened interval between in-(b)Decreased(1)Superscan(2)Prolonged interval between in-b.Focal tracer uptakec.Diffuse tracer uptake a.History b.Physical exam c.Other test results d.Comparison with previous studies I.Reporting1.Description of techniquea.Flow imagesb.Blood pool imagesc.Delayed imagesd.Injection sitee.SPECT (if applicable)2.Description of abnormal tracer uptakea.Increasedb.Decreasedc.Pattern of abnormal uptaked.Bone findingse.Soft tissue findings3.Correlation with other studies4.Comparison with previous studies5.Interpretationa.Narrow differential as much as possibleb.Recommend further, more definitiveJ.Quality ControlSee the SNM Procedure Guideline for GeneralK.Sources of Error1.Urine contamination or a urinary diversion2.Injection artifacts3.Prosthetic implants, radiographic contrastmaterials, or other attenuating artifacts that5.Patient motion BONESCINTIGRAPHY 6.Greater than necessary collimator-to-patientdiopharmaceutical has been optimally9.Prior administration of a higher energy ra- 131 I, 67 Ga, 111 In) or of a 99m gan that could obscure or confound the10.Radioactivity extraneous to the patientest that may be missed if a limited study is12.Radiopharmaceutical degradation13.Changing bladder activity during SPECT of14.Purely lytic lesions16.Renal failureV.Issues Requiring Further ClarificationVI.Concise Bibliography part 1. Oncology and infection. J Nucl Medpects of bone scintigraphy. Radiol Clin North Am.part 2. Orthopedic bone scanning. J Nucl MedVII.Disclaimerhigh-quality nuclear medicine procedures. Thesesetting. The appropriateness of a procedure will de-to another. For these reasons, guidelines cannot beof a guideline should always be considered in deter- SOCIETYOFNUCLEARMEDICINEPROCEDUREGUIDELINESMANUALAUGUST 2003·209