SALIVARY GLAND IMAGING :SALIVARY GLAND IMAGING By: Carolina Narvaez NMT 1713


OBJECTIVES :OBJECTIVES Learn about the Radiopharmaceutical, localization, dosage, QC, dosage and method of administration of salivary gland imaging procedure. Learn about the indication and contraindications. Learn about what patient preparation and history to be taken.


RADIOPHARMACY :RADIOPHARMACY Radionuclide Tc99m T1/2= 6 hours Energy 140 keV Radiopharmaceutical Na 99mTcO4- (pertechnetate) Localization Parenchyma cells of the parotid gland QC Moly-Al breakthrough Adult Range Dose 8-12 mCi (10 mCi) Method of Administration IV Injection (good bolus for flow)


INDICATIONS & CONTRAINDICATIONS :INDICATIONS & CONTRAINDICATIONS Indications Tumors Salivary gland function Masses in parathyroid Salivary tissue Anatomic size & position of salivary glands Contraindications NONE


PATIENT HISTORY & PREPARATION :PATIENT HISTORY & PREPARATION Patient History Do you have history of family history of cancer, salivary dysfunction? Dry mouth? Pain or palpable lumps in or under jaw? Labial biopsy (minor salivary gland tissue)? Patient Preparation Withhold thyroid blocking meds (ex. iodine) for 48 hrs. Administer patient gum to stimulate salivary glands


PROCEDURE (60-90 minutes) :PROCEDURE (60-90 minutes) Patient in supine position Pillow under shoulders Neck extended & camera as close as possible Administer injection to patient; Start camera Obtain one of the following: Flow & dynamic; 30-60 min; Anterior marker, left & right laterals Flow with statics;15 min PI;3 min/view; Anterior marker, left & right laterals Statics only;15 min PI;3 min/view; some images at 2,5,10,15,20, &, 30 min; Anterior marker, left & right laterals


PROCEDURE….continued :PROCEDURE….continued Lemon Phase Place lemon extract or gauze soaked with lemon juice on both sides of mouth (some do this at 40 min dynamic or after dynamics & statics- use 2 ml of lemon juice through straw) Remove gauze after 5 min; allow patient to expectorate excess saliva & rinse with water Repeat anterior, left, & right laterals at 15-30 min after lemon administration


PROCEDURES …..continued :PROCEDURES …..continued Salivary function evaluation Draw ROI around thyroid, submandibular, parotid glands, & backgrounds-lateral/anterior views Record counts & repeat for all sequential timed images


RESULTS :RESULTS normal Symmetric uptake in the parotid & submandibular glands Uptake in sublingual, thyroid glands & nasal cavity Significant reduction of activity in salivary glands after lemon admin abnormal Asymmetrical uptake on one/both sides of face Activity remains local after lemon admin Increased activity in mass (Warthin’s tumor) Patchy decreases in activity (Sjogren’s syndrome-dry mouth) Inflammation of salivary glands


CONCLUSION :CONCLUSION With the lemon extract administration, the salivary glands are evaluated to rule out tumors, lesions, or infections.


QUESTIONS :QUESTIONS How much Na 99mTcO4- (pertechnetate) should be administered to the patient? What is the method of localization of the salivary glands? What views are acquired in the salivary gland imaging?


ANSWERS :ANSWERS 10 mCi Na 99mTcO4- Parenchyma cells of the parotid gland and salivary glands Anterior marker, left and right laterals