Nuclear Medicine Studies

If there is ANY chance at all that you may be pregnant or you are currently breastfeeding, please inform the Nuclear Medicine Physician before the test commences.

Bone Scans
Why are bone scans needed?

• Suspected fracture, arthritis, infection, tumour, Paget's Disease, staging of cancer or looking for the cause of bony pain
• The bone scan may looks at the blood supply to your bones, and unlike an X-ray, examines the metabolism of your bones which may indicate disease.

Preparation:

• Nil, however you should bring any previous x-rays and bone scans along with you.

About the bone scan:

• You will be given an injection into a vein in your arm of a radioactive tracer (^99mTechnetium MDP) which goes to your bones. Some images may be taken straight after the injection, particularly if your doctor is querying an infection, inflammation or fracture.
• You will then be given a time to return to the department 2-3 hours later. This wait enables the tracer to be adequately taken up by the bones. You may leave the department in this time and there are no restrictions on what you can do (eg. Eat, drink), however you will be encouraged to drink plenty of fluids and void before the scan.
• When you return, images will be taken using a gamma camera and these images plus a written report will be sent to your doctor.
• The images take between 30 - 60 minutes and you will be required to lay still on a bed while a camera moves above, below and around you.
• You may remain fully clothed throughout the scan and will only need to remove items such as belts, necklaces and metal objects (eg. Keys, coins) from your pockets.

Are there any side effects ?

• There are no common side effects to this test. You will not feel dizzy, sleepy or hot and sweaty. Rarely, sensitive people may develop an itchy rash after injection.

What is a Gallium Scan?

Why are Gallium scans needed?

• Suspected infection, tumour, Hodgkin's or Non-Hodgkin's Lymphoma.

Preparation:

• Nil
• If your doctor suspects that you have an infection you may need to have a bone scan first.

About the Gallium Scan:

• On the first day you will be given an injection into a vein in your arm of a radioactive tracer (⁶⁷Gallium citrate). This takes a minimum of 24 hours to accuulate in areas of infection and a minimum of 48 hours to accumulate in tumours. You will be given times to return for the images at 24 or 48 hours after the injection.
• When you return, images will be taken using a gamma camera and these images plus a written report will be sent to your doctor.
• The images take between 30 - 90 minutes and you will be required to lay still on a bed while a camera moves above, below and around you.
• You may need to return to the department at 24 hours after the initial scan if the Nuclear Medicine Physician requests this and times will be given to you.
• You may remain fully clothed throughout the scan and will only need to remove items such as belts, necklaces and metal objects (eg. Keys, coins) from your pockets.

Are there any side effects ?

• There are no known side effects to this test. You will not feel dizzy, sleepy or hot and sweaty.

Cardiac Scans

Cardiac studies in Nuclear Medicine can assess the heart in different ways :

• Testing blood flow to the heart - assessing Coronary Artery Disease
• Testing heart function - the Gated Blood Pool scan
• Testing for damaged tissue after a heart attack

What is Coronary Artery Disease?

The arteries supplying blood to the heart muscle, are collectively known as coronary arteries.

In CORONARY ARTERY DISEASE some of the vessels become narrowed, restricting the blood flow to parts of the heart muscle. If the vessel blocks and heart muscle supplied by it dies, a myocardial infarction results. This is also known as a heart attack or coronary.

A narrowing of a coronary artery may produce chest pain if blood flow is too restricted, known as ANGINA.

The narrowing is due to a build up of fats and other substances in the lining of the vessel, a process called ATHEROSCLEROSIS.

Types of Cardiac scans:

• Exercise Thallium Scan
• Dipyridamole Thallium Scan
• Exercise Tetrofosmin Scan
• Dipyridamole Tetrofosmin Scan
• Gated Blood Pool Study

Why perform an Exercise/Dipyridamole Thallium/Tetrofosmin Scan ?

• Suspected coronary artery disease, suffering chest pain, and assessing the viability of the heart muscle.

Preparation:

• No caffeine containing beverages after midnight.
• Fast from 7:00 am - before this you may have a light breakfast eg. Lightly buttered toast and orange juice.
• Wear suitable clothing and footwear if having an exercise test
• Know that the test may take the whole day, however you may have a break of 2-3 hours in the middle of the day.

About the Exercise Thallium/Tetrofosmin Scan:

• You will be asked to go straight to the Cardio-vascular Investigation Unit (Level 6, Theatre Block, Royal Adelaide Hospital) in the morning.
• You will be connected to a heart monitor (ECG) and a drip line put into a vein in your arm.
• You will be asked to walk on a treadmill that will slowly increase in speed.
• Your heart rate and blood pressure will be monitored the whole time, however if you experience any shortness of breath or chest pain or similar symptoms, tell the staff immediately.
• You need to exercise for as long as possible to improve the effectiveness of the test.
• One minute prior to you stopping, the radiotracer (²⁰¹Thallium chloride or ^99mTechnetium Tetrofosmin) will be injected through the drip line.
• After the exercising is complete you will be taken to the department of Nuclear Medicine.
• The images are taken while you are lying on your back with your hands above your head.
• The images take approximately 30 minutes.
• You may be asked to return to the department in the afternoon for another set of images that will show your heart when it has been rested. You will be given instructions to tell you what time you need to return and if there are any restrictions on what you can do in that time.
• All of these images plus a written report will be sent to your doctor.

About the Dipyridamole Thallium/Tetrofosmin Scan:

• Dipyridamole is used if the doctor thinks that you will be unable to exercise adequately on a treadmill.
• The medication can affect people with lung disease or asthma, so you should tell the doctor peforming the procedure and bring your medication with you.
• You will be asked to go straight to the Cardio-vascular Investigation Unit (Level 6, Theatre Block, Royal Adelaide Hospital) in the morning.
• You will be connected to a heart monitor (ECG) and a drip line put into a vein in your arm.
• An infusion of Dipyridamole will be given through the drip line to dilate the coronary arteries to test coronary blood flow reserve.
• Your heart rate and blood pressure will be monitored the whole time, however if you experience any shortness of breath or chest pain or similar symptoms, tell the staff immediately.
• One minute prior to stopping the infusion, the radiotracer (²⁰¹Thallium chloride or ^99mTechnetium Tetrofosmin) will be injected through the drip line.
• After the infusion is complete you will be taken to the department of Nuclear Medicine.
• The images are taken while you are lying on your back with your hands above your head.
• The images take approximately 30 minutes.
• You may be asked to return to the department in the afternoon for another set of images that will show your heart when it has been rested. You will be given instructions to tell you what time you need to return and if there are any restrictions on what you can do in that time.
• All of these images plus a written report will be sent to your doctor.

What does a Gated Blood Pool Scan show?

• Assessing heart function (eg. before & after chemotherapy/or other heart disease), or checking the size and motion of the left ventricle.

Preparation:

• Nil

About the Gated Blood Pool Scan:

• You will first be given a small injection of a substance called Stannous pyrophosphate. This enables the blood to be labelled with a radioactive tracer.
• 10-15 minutes after this injection some blood will be taken to which the radioactive tracer will be added.
• 10-15 minutes later you will be taken into a room and asked to lie on a bed. You will be connected to an ECG machine for the scan and then you will be reinjected with your own blood.
• Images will be taken by a gamma camera for approximately 10 minutes each.
• You may need 1-3 images depending on the reasons for the test and you may also need to exercise during the images.

Lung Scans

What is a lung scan ?
A lung scan looks at the air and blood flow into your lungs and gives different information from a chest x-ray.

 

When is a lung scan performed?

• Shortness of breath, chest pain, suspected pulmonary embolism  (blood clots) or chronic obstructive airways disease.

Preparation:

• You will need to bring any chest x-rays that you have had done previously.

About the Lung Scan:

• The test is done with you lying on a bed with the gamma camera moving around you or with you sitting up and turning around for each image.
• The first part involves breathing in a radioactive gas through a tube to demonstrate the air supply to the lungs. This takes about 5 minutes and a technologist will be with you the whole time and will give you a break if you need one.
• Images will then be taken at different angles around your chest.
• The second part involves a small injection into a vein in your arm to demonstrate the blood supply to your lungs.
• The images will be repeated.
• The nuclear medicine physician will then compare the 'ventilation' and 'perfusion' images and the films and a written report will be sent to your doctor.

Are there any side effects ?

• There are no common side effects to this test. You will not feel dizzy, sleepy or hot and sweaty if you are very short of breath, the test may be modified to make you more comfortable.

Renal Studies

What does a renal scan test for?

A renal scan is a diagnostic test used to assess the anatomy, function, and blood supply of your kidneys.

Where are my kidneys ?

Your kidneys are located just below the middle of your back and on either side of your spine. The right kidney is just lower than your left kidney. Each of your kidneys are connected to your bladder which is located behind your pubic bone, by a tubular structure called the URETER. The bladder is emptied via another tubular structure called the URETHRA, which leads to the exterior of the body.

What is involved ?

Preparation:

• You need to be well hydrated ie. Drink 1-2 litres of water beforehand.

About the Renal scan:

• You need to empty your bladder just prior to beginning the scan.
• You will be asked to remove all metal objects or belts from around your waist.
• You will need to lie on a bed for most of the test.
• After you are in the correct position a nuclear medicine physician will give you a small injection into a vein in your arm.
• The images are started immediately as you have this injection and you will need to lie very still for approximately 30 minutes.
• After the first set of images you will be asked to go to the toilet and empty your bladder before returning for several shorter images.
• The nuclear medicine physician will then decide if :
  1. You need an injection of a diuretic (if there appears to be a blockage as the kidneys drain), this requires another 20 minutes of images
  2. You need to have blood samples taken at 1 hour and 3 hours after the injection of the tracer, you will be allowed to leave the department in between these samples and there are no restrictions on what you can do in that time. (this test accurately measures kidney function)
  3. You do not need any further images or blood samples.
• After the test you can leave and a copy of the films and a written report will be sent to your doctor

Are there any side effects ?

• There are no common side effects to this test. You will not feel dizzy, sleepy or hot and sweaty. The injected material will be completely cleared from your body within 24 hours. By drinking extra fluids and going to the toilet more frequently, will clear the radiopharmaceutical from your body much quicker- so drink up!!!

Gastrointestinal studies

The gastrointestinal tract (GIT) is composed of multiple organs, and is characterised by relatively long transit times through each. Although radiology can assess the structure of some parts of the GIT, its function needs to be assessed over longer periods of time.

Nuclear Medicine allows us to assess GIT function by giving patients a radioactively labelled meal. The movement of this meal can be monitored over time with the gamma camera, and the rate of movement compared to established normal ranges.

What is involved?

The studies presently available are :

• Oesophageal transit
  This study assesses the transit time from the mouth to the stomach of solid food.
  There can be holdups in moving food due to physical or physiological problems, and this study aids in diagnosing these problems.
  You are required to sit in front of a gamma camera, and then given a small piece of a radioactively labelled cooked meat patty to chew.
  You will be required to swallow this, then have dry swallows every 15 seconds until the food has entered your stomach.
  This is repeated 3 times.
  The appointment generally takes no more than 30 minutes.
• Gastric emptying (often performed with an oesophageal transit first)
  This study assesses the movement of solid and liquid food from the stomach to the intestine.
  You are required to sit in front of a gamma camera, and given a cooked meat patty to eat, along with a cup of glucose drink.
  The study generally takes 2 to 3 hours, with data continously collected for 30 minute periods. You will be allowed a short spell between each period.
• Small bowel transit
  This test allows us to assess the transit of liquids through the small bowel.
  You will be given a radioactively labelled glucose drink and required to lie flat on a bed for 5-6 hours whilst we take pictures.
  There are short breaks every hour to allow a stretch.
• Colonic transit
  This test examines the transit time through your colon (large bowel) of a test meal.
  It uses a glucose drink which we  can observe over a period of up to one week as it passes through your body.
  On day 1, you will be required to attend for 10 minutes to have the radioactive dose, and then a 30 minute scan in the afternoon.
  On subsequent days, you are required to attend for 30 minutes on each day.
  Each scan requires you to lie flat on a bed.

Patient Preparation

• Gastrointestinal tests require you to fast overnight, and may require you to return for further imaging.
• Each test has its own preparation :

• Oesophogeal and gastric emptying
  • All medications related to management of gastro-intestinal symptoms to cease 48 hours prior to test.
    This includes Cisapride(Prepulsid), Maxalon, Donperidone(Motilium)
  • No smoking from 9pm on the day before the test
  • Fast from midnight on day of study
  • Water allowed up to 8am
  • Diabetics should bring their insulin with them
  • Gastric emptying patients should bring some reading material with them
• Colonic transit
  • All medications related to colonic transit (mainly laxatives) to cease 3 days prior to test
  • No smoking from 9pm on the day before the test
  • Fast from midnight on day of study
  • Water allowed up to 8 am
• Small bowel transit
  • No special preparation required

Are there any common side effects ?

• There are no known side effects to any of these tests. You will not feel dizzy, sleepy or hot and sweaty. If you have special dietary requirements (eg vegetarian) we would appreciate being informed before you attend, as an appropriate test meal may be prepared for you.

Central Nervous System studies

Shunt function study
This tests if the shunt inserted into the skull to drain excess fluid from the brain is functioning.

Patient Preparation

• Nil - but the site around the shunt will have to be shaved before the injection

What is involved ?

• A small injection will be given into the shunt chamber and images taken for the next 30 - 60 minutes

Are there any common side effects ?

• No

CSF leak
This test determines if there is leakage of the cerebro-spinal fluid from the brain into the nasal passages.

Patient Preparation

• Nil

What is involved ?

• You will have pledgets (cotton wadding) inserted into your nasal passages by and Ear Nose & Throat specialist.
• The Nuclear Medicine physician will inject a small amount of radioactive tracer at the base of your lumbar spine, and images will then be taken of your head every hour for up to 5 hours.
• The pledgets will then be removed, but if the procedure is inconclusive, more may need to be inserted again the next day.
• The lumbar puncture procedure has some side effects, such as headache, which your doctor will discuss with you.

Ceretec Brain scan
This test examine the function of the brain to determine signs of dementia , poor circulation of blood in the brain, or epilepsy.

Patient Preparation

• Nil

What is involved ?

• You will have a catheter inserted into a vein in your arm to allow us to inject the radiopharmaceutical
• You will be rested in a darkened room for approximately 20 minutes
• After this time, you will be given a small injection into the catheter in your arm, and then rest for a further 10 minutes
• You need to then lie on a bed for a further 30 minutes whilst a camera takes images around your head for about 30 minutes

Are there any common side effects ?

• No

Endocrine studies

Thyroid scan
This test examines the function of the thyroid gland which may be over or under active, or enlarged.

Patient Preparation

• If you are taking medications which affect the thyroid, or thyroid hormones, you must discuss this your doctor or the nuclear medicine specialist as some treatments need to be stopped or modified.

What is involved ?

• You will have a blood sample taken prior to the test for testing of thyroid hormone.
• The Nuclear Medicine physician may examine you for signs of goitre
• You will then be given a small injection of a radioactive pharmaceutical into your arm
• After 30 minutes images will be taken over your neck

Are there any common side effects ?

• Generally nil, although ceasing medication may have some effect.

Parathyroid scan
This test examines the parathyroid glands. You may have an overactive parathyroid gland that affects calcium metabolism in your body. This may require surgery, and to help the surgeon, the status of the parathyroid can be determined.

Patient Preparation

• Nil

What is involved ?

• You will receive an injection of a radioactive pharmaceutical into the arm
• Images of the neck and chest region will be taken for up to 45 mins
• You will be required to return a few hours later in the day for delayed images

Are there any common side effects ?

• No

Therapy procedures

What is Radioiodine therapy?

Iodine is a naturally occurring element (contained in some foods - such as seafood), which is concentrated by the thyroid gland to produce thyroid hormones. These hormones control the speed of your metabolism. In some cases the thyroid gland may become overactive and produce an excess of these thyroid hormones.

Your doctor has referred you to us for the treatment of your overactive thyroid gland with radioactive iodine. This treatment has been recommended in your case as being preferable to other options such as long term medications or surgery. The radioactive iodine will be given to you as a capsule to swallow after which the radioiodine is absorbed into the bloodstream and travels to the thyroid gland. Once in the thyroid gland, the radioiodine is concentrated and the radiation it produces inhibits the ability of the thyroid gland to produce thyroid hormones. Any of the radioiodine that is not taken up by the thyroid gland is cleared from the body in the urine.

How much radiation is received?

• The dosage of radioactive iodine that you will receive is a calculated estimate which has been based on a knowledge of the severity of your thyroid condition and information gained from other tests that you may have had.

  
  Since it is only an estimate there is a possibility that the dose of radioiodine you receive may be greater (or less) than necessary, therefore an assessment will be made on the results of this therapy and further treatment may be warranted.

How long before the effects become apparent?

• The radioiodine treatment you will receive is not immediately effective, and may take up to six months for early effects of the treatment to be noticeable. It is also possible that your thyroid gland may become underactive in many years to come as a result of this treatment. For this reason, it is essential that any future medical consultants that you may attend are made aware of this treatment.

Are there any special preparations or precautions that should be taken?

• Following your dose of radioiodine, you will be mildly radioactive for several days . During this time, we suggest that you should avoid prolonged close contact with small children, as developing children are more susceptible to the effects of radiation. Social contact with other adults is not dangerous, although you may wish to sleep apart from your partner for the first couple of nights.  You will be provided with written radiation safety guidelines.
• It is desirable for you to maximise your urine output for the next 48 hours. This is because any of the radioiodine which is not taken up by your thyroid gland is cleared from your body by your kidneys and urine. By increasing your fluid intake and by passing water as often as possible any excess radiation will be removed from your body more rapidly.

Are there any side effects ?

• Radioactive iodine has been used as a therapy for over 50 years and despite extensive research no link has been established between the therapy and increased rates of thyroid cancer, leukaemia or other cancers. The radioiodine therapy that you will receive is a permanent treatment therefore we will ask you to sign a consent form before you receive the treatment to ensure that you are aware of the associated implications. As it is generally regardedas desirable to reduce radiation doses to people other than those being treated, we have put in place the recommendations for reducing doses to those in contact with you.

If there is ANY chance that you may be pregnant or if you are currently breastfeeding, it is essential that you inform the doctor as you should not receive the radioiodine dose in these circumstances.

Non-imaging tests

¹³C Triolein breath test
This test looks for malabsorption of fat in the diet

Patient Preparation

• You must fast from midnight

What is involved ?

• The test takes 6-7 hours
• You will drink a small quantity of  a ¹³C labelled fatty drink
• We will then take sample of your breath every hour for 6-7 hours
• Results will be sent to your doctor within 1 week

Are there any common side effects ?

• No

Faecal Blood Loss
This study looks for causes of anaemia or low level bleeding in the gastrointestinal tract, and is usually performed in conjunction with a red cell survival test.

Patient Preparation

• Nil

What is involved ?

• The test takes up to 3 weeks
• A small sample of blood will be taken from you and labelled with a radioactive pharmaceutical.
• This blood is then reinjected 1 hour later, and 2 further blood samples taken.
• You will be required to return to the department for further blood samples (the technologist will advise you on when)
• You will be required to collect your faeces for 2-3 weeks (we will supply you with containers for the purpose)

Are there any common side effects ?

• No

Red Cell Mass/Blood Volume
This study looks for causes of anaemia or other condition where your red blood cell count is unusually high or low.

Patient Preparation

• Nil

What is involved ?

• The test takes up to 3 hours
• A small sample of blood will be taken from you and labelled with a radioactive pharmaceutical.
• This blood then reinjected 1 hour later, and 2 further blood samples taken.

Are there any common side effects ?

• No

Red Cell Survival test
This test checks for causes of anaemia - specifically if your red blood cells are short lived.

Patient Preparation

• Nil

What is involved ?

• This is often performed with a Faecal Blood Loss study, and takes 4 weeks to perform
• You will be required to attend for:
  • 3 hours on day 1
  • 10 minutes every day for 1 week
  • 10 minutes every 2^nd day for the remaining time
• A small sample of blood will be taken from you and labelled with a radioactive pharmaceutical.
• This blood then reinjected 1 hour later, and 2 further blood samples taken.
• You will be required to return to the department for further blood samples (the technologist will advise you on when)

Are there any common side effects ?

• No

Schillings test
This test checks for pernicious anaemia, malabsorption and levels of vitamin B₁₂

Patient Preparation

• You will be required to fast from midnight and remain fasting for 2 hours after the study

What is involved ?

• The study takes about 10 minutes in the department.
• You will be given 2 small capsules to swallow of a radiopharmaceutical, and then given an injection of vitamin B₁₂ into your arm
• We will provide you with plastic bottles to collect all of your urine for the next 24 hours
• You will then have to return the bottles to the department for completion of the test

Are there any common side effects ?

• No.