Slide 1:Myocardial Infarction Scan Tc99m Stannous pyrophosphate 15- 30 mCi Invivo Method Inject Patient with 2-3 mg PYP 2-10 mL Blood drawn and tagged with Tc O4 by UltraTag 15-20 min wait, followed by Tc O4 administration Inject Patient with tag RBC, no longer than 2 hours Blood equilibrate for at least 15 min Before data acquisition Flow Study 1 sec/ frame for 30 seconds Blood Pool Static: 500k- 1000k counts 16 frames/ cardiac cycle ANT, LAO, LLAT & RAO Invitro Method SPECT (if protocol) 360˚, 64 stops at 25 sec/ stop


Slide 2:Cardiac Perfusion Rest Test Tc99m Sestamibi 8- 30 mCi Static Image ANT first 300 seconds SPECT 180˚, 32 stops at 20 sec/ stop 8 frames/cardiac cycle Followed by Stress Test Tc99m Tetrofosmin 8- 30 mCi Tl201 Chloride 2- 5 mCi 45- 60 min wait Before data acquisition 5- 20 min wait Before data acquisition 5- 30 min wait Before data acquisition


Cardiac: Gated First Pass :Cardiac: Gated First Pass


Cardiac: MUGA :Cardiac: MUGA


CARDIAC STRESS :CARDIAC STRESS ROBERT ROSENFELD


Slide 6:CARDIAC STRESS TEST TREADMILL 180° 32 OR 64 PROJECTION @ 20-40 SEC/FRAME INJECT 1 min before pt gives out for 60-90 sec STATIC TIMED FOR 300 SEC HEART RATE@ 85% COLLIMATOR LEAP 12 LEAD EKG 201 TICI 3-5 mCi TC99 SESTAMIBI 20-30 mCi 8FPS IF GATED MATRIX AT 64X64 FOR 25 MIN ROBERT ROSENFELD


Slide 7:Cisternography Spinal needle - Intrathecal injection In-111 DTPA: 0.5 – 1.5 mCi Tc99m DTPA: 0.4 – 12 mCi Obtain images for study 1 -2 hours after injection. Repeat delayed images 4, 24, 48, and 72 hours according to protocol. Statics: 50,000 to 200,000 counts each.


Slide 8:Gastric Emptying Solid Liquid 200uCi – 1mCi Tc99m SC Mixed with 1 or 2 whole eggs. 500uCi Tc99m DTPA Mixed into 120ml water Ingested orally. Acquisition started ASAP After ingestion of food. Statics: Preset for 60 – 120 seconds or 50,000 counts Dynamic: Preset for 60 sec/image 60-90 minutes Images same as solid study 1.5 hours NPO 4-12 hours before exam


Esophageal Transit Time andGallium Scan Flow Charts :Esophageal Transit Time andGallium Scan Flow Charts By: Katherin Martiniere


Slide 10:Esophageal Transit Time 150-300 uCi of Tc99m TC SC PO in 15 ml of H2O, one bolus Swallow. Alternative: PO using 1.35 mCi of Tc99m TC SC in 50 ml of apple sauce. Camera: large field of view Collimator: Low energy, all purpose or low energy, high sensitivity. Flow .25 sec/15 sec for 1 minute Or 1-2 sec/frame for 1 minute. Dynamic 15 sec/frame for 9 minutes


Slide 11:Gallium Scan Gallium Citrate 3-6 mCi for inflammation 10 mCi for tumors IV straight stick, heplock, or reseal w/ saline flush , or because of the amount a butterfly and three way stopcock with flush. Return for imaging at 6, 24,occasionally 48 hrs. Return for imaging at 24, 48, and 72 hours. Camera: large field of view Collimator: medium to high energy, parallel hole Statics: peak 25%, 1000k cts/image WB: 10 cm.min SPECT: circular or noncircular 360˚, 64 stops, 20-25 sec/stop; ROI centered


Slide 12:Lung Transmission (usually performed with Lung ventilation and Quantitation) patient in supine position, camera anterior, thorax Roll container, large drum, holding Na99mTc04-, directly under patient being exposed with the radiopharmaceutical lungs centered in camera’s field of view One static image for 3 million counts


Slide 13:Lymphoscintigraphy For Melanoma For breast lesions 200 µCi to 2 mCi, 450 µCi to 1 mCi 2-6 injections Inject Pt around the ROI 2-6 doses Subcutaneously and/or intradermally 4-6 injections around lesions Flow study Dynamic flow 30-60 sec/frame 10-15 minutes For Lymphedema Injected in webs of feet or hands as indicated 2 sites per limb Immediate Statics for 5 mins every 5 mins for up to 30 mins Delay Whole body 1-4 hrs same views as before