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*New Workflow for Nuclear Medicine*
If you receive a Nuclear Medicine, call you can now transfer to our dedicated Nuclear Medicine Team
Transfer using Quick Connects to SCHD_Nuc_Queue
All PET/DAT and Specialty Nuclear Medicine still need to be transferred to the PET Team
Transfer using Quick Connects to SCHD_PET_Queue
The queue is open 5:00am - 6:00pm AZ, if you need to schedule a exam for a caller after queue hours please email the team the below details:
nuclear_scheduling@simonmed.com
Include Patient Name
MRN
Accession(s)
Nuclear Medicine exams to be transferred to Nuc Med Queue:
Bone Scans (Whole Body, 3 Phase, Spect or Spect/CT, and Limited)
Hepatobiliary Scan (Hida)
Thyroid Uptake Scan
Parathyroid/Sestamibi Scan
Meckel Scan
Gastric Studies
(Gastric Emptying 4 Hour, Dual Phase Gastric Emptying, Dual Phase Gastric Emptying 4 Hour)
Liver Spleen Scan
Hemangioma w/ Tagged RBC
Muga
Renal Scans (Renal GFR, Renal Morphology (Renal Cortical), Lasix Renal, Mag 3, Captopril Renal)
VQ Lung Scan
Pyrophosphate Cardiac Scan
Indium WBC Scan
Whole Body Indium 111
Dual Isotope WBC
Ceretec WBC
Gallium Scan
PET/DAT & Specialty Nuclear Medicine to be transferred to PET Queue:
PET Scans
DAT Scans
Sentinel Node Lymphoscintigraphy
I131 Thyroid Whole-Body Scan
MIBG (Metaiodobenzylguandine)
I131 Thyroid Ablation
Octreoscan
ORDERS ARE GOOD FOR 1 YEAR. IF EXPIRED, WE NEED TO CALL THE REFERRING DOCTOR TO GET AN UPDATED ONE
Auth Requirements:
Optum: MRI, NM, PET, CTA, MRA is 14 days minimum TAT
(In Nevada ONLY: Out of network for all PET, NM & US except ABI, Arterial, Venous mapping & Prostate. Out of network for ALL CT except CT lung, CTA PE, CTA runoff & patients over 400 lbs.)
Humana: All CT/A, MRI/A, NM Modalities are 5-7 days.
Humana FL (Only) All modalities - Schedule 9 days out. Add-Ons ONLY allowed if patient has referral/authorization number on hand.
**ONE CALL does not cover the dose for Indium WBC Scans (Whole Body or Dual Isotope)
Aetna Insurance: If patient has AETNA, they need to be self-pay for the below exams due to insurance does NOT cover the dosage for their procedure.
STAT GUIDELINES
Nuclear Medicine Add Ons need to be communicated and approved by sites or technologists so proper dose ordering can be executed.
Any double booking for Nuclear Medicine must also be approved by technologist
Any patients double booked should be notified they are being worked in and may have a wait, please notate this in your scheduling notes.
STATS we do try to accommodate same day next day, if it requires authorization, we schedule out 4 hours or next day AM to allow the authorization team to attempt to obtain.
We check the location most convenient to the patient but if we see no openings we can offer surrounding sites that may have openings, keeping in mind the dosage ordering still need to be communicated and approved
Same Day Appointments NON-STAT
Communicate with the site for dose ordering
Allow enough time for site/tech to prepare (Most sites need at least 2 hours to get a STAT dose from the pharmacy)
No same day appointments in Florida
Doses are delivered at 7am and 11 am
The only way same day appointments can be added is it must be BEFORE 9am EST and the timeslots are available. Approval from the technologist is mandated
FLORIDA ONLY: If a dose needs to be canceled for a next day appointment, please call Carmen at 407-819-4997
Nuclear Medicine Scheduling Guidelines
Nuclear Medicine Scheduling Guidelines
Nuclear Medicine Scheduling Guidelines and Procedures
If Patient is Pregnant, we can’t do the exam
Recommend patients who are breastfeeding pump and dump for 24hrs after any exam
Do not perform STRESS TEST at any SMI location
Do not Schedule more than 1 Nuclear Medicine exam per day per patient (48 hours minimum in between)
FLORIDA sites that can perform Nuclear Medicine & PET/DAT exams
Nuclear Medicine: Altamonte Springs, Ocoee 2, Kaley 2, Poinciana, Kissimmee
PET/DAT: Altamonte Springs, Ocoee 2, Kaley 2, Poinciana, Park Blvd, Park South - Bradenton
BONE SCANS
There are 4 types of bone scans to choose from:
Whole Body Bone (Diagnosis includes Prostate cancer, Breast cancer, Sclerotic lesion, etc.)
3-Phase Bone Scan (Diagnosis includes: Knee replacement, Hip replacement, Joint pain, Eval of loosening of components, etc.)
SPECT or SPECT/CT (SPECT can be of any body part, but must be added for spine indications)
a. SPECT/CT can only be done at Estrella, Central Phoenix, or Greenfield
Limited Bone Scan (Should one be added to a 3-Phase or SPECT & SPECT/CT scan. We do not perform limited scans by themselves).
Whole Body Bone Scan
DOSE:
Drop down : NM Bone Imaging Whole Body (1211)
15 minute duration (1 block)
This is patients first appointment
Patients will receive an I.V. injection
If the diagnosis is for the spine (cervical, thoracic, or lumbar) we need to ADD a Bone Imaging w/Spect (1213). Book right after NM Bone Imaging Whole Body (1211)
We need to call the referring to get the Spect added to the order.
· RETURN SCAN:
Drop down : Bone Imaging Whole body Return (6459)
45 minute duration (3 blocks)
Schedule 3-5 hours after the first appointment
This is patients return
Patient will lay flat for approximately 45 minutes of imaging
When adding a SPECT, we also need to add SPECT Return (Bone Imaging Tomographic Spect Return) (6462) (1 hour duration) in addition to Bone Imaging Whole Body Return (6459) Book right after
EX: 8:00am injection, return scan between 11:00am - 1:00pm
Purpose: To evaluate the bony skeleton for areas of abnormal function, such as metastases, or fractures.
Prep:
Be well hydrated for exam. Drink 2 or more 8 ounce glasses of water.
Patient may continue taking all meds as needed.
You may double book the injection portion of this exam during the first hour of a HIDA scan and anytime during a gastric emptying study or a parathyroid scan.
Limited Bone Scan
· Dose:
o Drop down : Bone and Joint Imaging Limited Area(1209) (15 minute duration)
o If imaging an EXTREMITY need to add a Three Phase (1212) right below can’t overbook.
o If the diagnosis is for the spine (cervical, thoracic, or lumbar) we need to call to get the Spect (1213) added to the order.
o This is patients first appointment.
· Scan:
o Drop down: Bone and Joint Limited Area Return (2671) (45 minute duration)
When adding a SPECT, we also need to add SPECT Return (Bone Imaging Tomographic Spect Return) (6462) (1 hour duration) in addition to Bone and Joint Limited Area Return (2671) Book right after
o This patients return
Same as a whole body bone scan. Same rules apply. Allow 3-5 hours between dose and scan time. If it is for the wrist the scan time needs to be extended to 1 hour. If it’s for an extremity we need to add a Three Phase. Prep same as whole body.
3-Phase Bone Scan
*All 3-Phase Bone scans require a limited bone scan scheduled at the same time
DOSE:
Drop down : Bone Imaging Three phase (1212)
30 minute duration (2 blocks)
This is the patients first appointment
You cannot double-book this injection over any type of exam due to needing camera time at the time of injection. Please make sure to notate the area of interest.
Patients will receive an I.V. injection while being imaged.
Drop down: Bone and/or JT IMG, Limited Area (1209)
15 minute duration (1 block)
Book right after Bone Imaging Three Phase (1212)
*IF diagnosis is for spine (cervical, thoracic, lumbar), we need to replace the Limited with a SPECT. We need to call referring and get updated order.
Bone Imaging Tomographic (SPECT) (1213)
15 minute duration (1 block)
Book right after Bone Imaging Three Phase (1212)
RETURN SCAN:
Drop down : Bone Imaging Three Phase Return (6461)
30 minute duration (2 blocks)
Schedule 3-5 hours after first appointment
This is patients return
Patients will lay flat and be positioned for imaging
*IF done with SPECT, we need to add the SPECT return in addition to the Three Phase return to Spect Return
DROP DOWN: Bone Imaging Tomographic Spect Return (6462)
60 minute duration (4 blocks)
EX: 8:00am injection, return scan between 11:00am - 1:00pm
Prep:
Be well hydrated for the exam. Drink 2 or more 8 oz glasses of water.
Patients may continue taking all meds as needed.
Spect and Limited Bone Scan
· Dose:
o Drop down : Bone Imaging W/SPECT/CT (8500)
o (30 minute duration)
o If imaging an EXTREMITY need to add a Three Phase (1212) right below
o This is patients first appointment
· Scan :
o Drop down: Bone Imaging Tomographic Spect Return (6462)
o (60 minute duration)
o This is patients return
Injection time is only 15 minutes. Return needs to be scheduled for 1 hour. Again please notate area, it can only be a 14” radius. If it’s for an extremity we need to add a Three Phase. Prep same as whole body. Scan should be scheduled 3-5 hours after the start of the dose time.
Bone Spect/CT : Check site search for locations that can perform here.
*All SPECT/CT bone scans require a limited bone scan scheduled at the same time.
SPECT/CT only performed at the Greenfield, Central Phoenix and Estrella locations
FLORIDA DOES NOT PERFORM SPECT/CT AT ANY FACILITY
SPECT is the only option in Florida
If orders come in for any scan that has SPECT/CT, we need to obtain a corrected order for SPECT
We do not schedule for Bone SPECT ONLY at any Florida facility
If there is an area of concern, then we need a limited scan with Bone SPECT scan
If the patient has a history of cancer, we need a Whole Body Bone scan with a SPECT
DOSE:
Drop down : Bone Imaging W/SPECT/CT (8500)
15 minute duration (1 block)
This is the patients first appointment
If for a joint Replacement or Extremity (shoulders, hips, knees, ankles/feet) ADD a 3-Phase (Bone Imaging Three Phase) (1212) instead of Limited Bone.
15 minute duration (1 block)
Same time as injection
*We no longer need an additional order for the 3-Phase to be added if we have an order for the SPECT/CT
RETURN SCAN:
Drop down : Bone Imaging Tomographic Spect Return (6462)
60 minute duration (4 blocks)
Schedule 3-5 hours after first appointment
This is patients return
Patients will lay flat with arms above head for most of the imaging (except for cervical spine)
Scheduled the same as a SPECT Bone Scan. Just add in the notes SPECT/CT. Allow 3-5 hours between Dose and Return Scan
EX: 8:00am injection, return scan between 11:00am - 1:00pm
PREP:
Be well hydrated for the exam. Drink 2 or more 8 oz glasses of water.
Patients may continue taking all meds as needed.
Purpose: SPECT-CT is where two different types of scans are done and the images from each are fused together, or merged, to provide more precise information about how different parts of the body function and more clearly identify problems.
Sentinel Node Lymphoscintigraphy
**These need to be Scheduled, Rescheduled and/or Canceled by PET ONLY Transfer to PET Queue**
Drop Down: NM Sentinel Node Lymphoscintigraphy (9092)
Duration: 45 minutes
Locations that perform: Greenfield, Phoenix, Estrella
Notes:
For surgery scheduled the next day these exams will need to be booked the day prior in the last time slot. Maximum of 21 hours is allowed between injection (exam start time) and surgery time.
For surgery the same day in the afternoon/early morning we will do the exams same day early. Patient should be booked in the earliest time slot possible.
Hepatobiliary Scan/HIDA Scan w/o (Bile Leak) - Patient has no Gallbladder
DOSE AND SCAN:
Drop down: NM HIDA W/O CCK (6863)
75 minute duration (5 blocks)
Patient will received an I.V. injection
Patients will lay flat while being imaged
Please note that the patient does not have gallbladder in your notes
PREP:
Patient may eat and drink before bile leak scan
NO Narcotic pain medication 4 hours prior to exam
Do NOT take any meds 4 hours prior to exam
Purpose: To evaluate for post surgical changes (bile leak); evaluate abdominal pain post Cholecystecomy surgery
HIDA w/ CCK (Hepatobiliary Scan/HIDA Scan) - Patient still has Gallbladder **MOST COMMON**
DOSE AND SCAN:
Drop down: NM HIDA W/CCK (1214)
90 minute duration (6 blocks)
Patient will received an I.V. injection
Patients will lay flat while being imaged
Please note that the patient has gallbladder in your notes
PREP:
NPO 4 hours prior (Nothing to eat or drink, NOT EVEN SIPS OF WATER)
NO Narcotic pain medication 4 hours prior to exam
Do NOT take any meds 4 hours prior to exam
Purpose: To evaluate the function on the gallbladder, assess gallbladder ejection fraction, the patency of the cystic duct and/or the common bile duct and bile leak.
Thyroid Scan with Uptake CANNOT BE SCHEDULED ON THE WEEKENDS. M-TH ONLY. **THIS IS A 2 DAY EXAM**
EXAM REQUIRES 48 HOURS TO ORDER THE DOSE FOR THIS EXAM. PLEASE DO NOT SCHEDULE SAME WEEK UNLESS YOU SPEAK TO A TECH
In FLORIDA ONLY, we can do a 24 hour return on a thyroid uptake and scan on Friday.
DOSE:
Drop down : Thyroid Imaging w/Uptake Multiple Determinations (1206)
15 minute duration (1 block)
This is the patients first appointment
Patient will receive the dose in pill form with a cup of water to drink
RETURN SCAN:
Drop down : Thyroid Imaging w/Uptake 4 Hour Return (6452)
15 minute duration (1 block)
This is the patients second appointment
Patient will have imaging done at this appointment
Drop down : Thyroid Imaging w/Uptake 24 Hour Return (6463)
45 minute duration (3 blocks)
This is the patients 24hr return (24 hours after the dose administration)
Patient will have imaging done at this appointment
Patient will lay flat while being imaged for approximately 30-40 minutes
This is a 2 day exam. Schedule a 15 minute dose, 15 minute 4 hour return, and 45 minute 24 hour return
EX: 8:00am dose, 12:00pm return, 8:00am return the following day
PREP:
NPO (Nothing to eat or drink, NOT EVEN SIPS OF WATER) for 4 hours prior
Patients must not be pregnant
Patients must stop all thyroid medications: PATIENT NEEDS TO CONSULT WITH THEIR DOCTOR BEFORE DISCONTINUING ANY THYROID MEDICATIONS. PLEASE DIRECT THE PATIENT TO CONTACT THEIR DOCTOR TO SEE IF IT IS OKAY FOR THEM TO BE OFF THEIR MEDICATION. PATIENT ONLY NEEDS TO BE OFF THYROID MEDS (NOT ALL MEDS).
One Week
Methimazole (Tapazole), Carbimazole, Multivitamins that contain iodine
Two Weeks
Triiodthronine (Cytomel), Prolthiouracil (PTU)
Three Weeks
Expectorants, kelp, agar, carrageen, Lugol's Solution, Potassium Iodide (SSKI), Topical Iodine (surgical skin prep)
Four Weeks
Synthroid, Armor Thyroid, Thyroxine, Electroxin, Levoxine, Iodinated contrast agents (CT contrast)
Three MONTHS
Amiodarone
*Patients should not eat foods containing iodine such as cabbage, turnips, collard greens, seafood, kelp, or large amounts of table salt for 5 days before the exam. They also need to discontinue the use of any multivitamins that contain iodine 5 days prior to the exam.
Need thyroid labs with order, if available
Purpose: To assess the function and anatomy of the thyroid gland.
Parathyroid Scan/ Sestamibi Scan
Dose and Scan:
Drop down : Parathyroid Scan w/Spect (6472) OR Parathyroid Scan W/Spect/CT (1217)
*** If the order says SPECT/CT we have to use drop down Parathyroid Scan W/Spect/CT (1217)***
***SPECT/CT only done at Estrella, Central Phoenix and Greenfield***
45 minute duration (3 blocks)
This is patients first appointment
Patient will receive an I.V. injection and the first set of imaging is done
Return Scan:
Drop down : Parathyroid Return (6464)
45 minute duration
Schedule 2 hours after injection (+/- 15 minutes)
This is patients second appointment
Patient will lay flat while being imaged for approximately 45 minutes
Schedule a 45 minute injection and scan, then a 45 minute return, 2 hours later
PREP:
No prep
Purpose: The localization of parathyroid adenomas, hyperplasia, or carcinoma in patients with hypercalcemia and elevated PTH levels.
Meckel Scan:
DOSE AND SCAN:
Drop Down: NM Meckel Scan (1304)
90 minute duration (6 blocks)
Patients will receive an I.V. injection while being imaged
Patients will lay flat for entire scan
PREP:
NPO 4 hours prior (Nothing to eat or drink, NOT EVEN SIPS OF WATER)
No medications or procedures for the GI tract for 2-3 days
No Potassium Perchlorate the day of the exam
**GASTRIC STUDIES CANNOT BE SEEN IN FLORIDA ON FRIDAYS DUE TO PHARMACY SHORTAGE**
Gastric Emptying Study - 4 hour *** MOST COMMON EXAM****
DOSE AND SCAN:
Drop down: NM GASTRIC EMPTYING STUDY 4 HOUR (6580)
15 minute duration (1 block)
This is the patients first appointment
Patients will eat the sandwich they brought at this appointment
RETURN SCAN:
Drop Down: NM Gastric Emptying 30 Minute Return (7020) (FLORIDA ONLY)
15 minute duration (1 block)
Drop Down: NM Gastric Emptying 1 Hour Return (6577)
15 minute duration (1 block)
Schedule 1 hour after first appointment
Drop Down: Gastric Emptying 2 Hour Return (6578)
15 minute duration (1 block)
Schedule 2 hours after first appointment
Drop Down: Gastric Emptying 4 Hour Return (6579)
15 minute duration (1 block)
Schedule 4 hours after first appointment
EX: 8:00am dose, 9:00am 1 hour return, 10:00am 2 hour return, 12:00pm 4 hour return
PREP:
NPO 8 hours prior to exam (Nothing to eat or drink, NOT EVEN SIPS OF WATER)
Diabetics should have the exam in the morning after 2/3 of their insulin dose
Discontinue Reglan 24 hours prior to exam
Patients are to bring in their own Egg White sandwich consisting of 2 cooked egg whites and 2 pieces of bread
Patients may use any kind of bread,
Most important is that they do NOT add any fat (Ex: No Butter, oil, mayonnaise, etc.)
The 4 Meal Options:
1. Egg White Sandwich (GOLD STANDARD and always 1st option - 2 hard boil eggs or 4oz of liquid)
2. Turkey or Ham Sandwich (4oz of meat)
3. Tofu Sandwich (4oz of firm tofu)
4. Oatmeal (4oz-8oz and LAST option)
Purpose: To evaluate the function of the stomach and diagnose abnormal emptying of food from the stomach. The study usually is done when a patient has continued nausea and vomiting, signs that the stomach is not emptying normally.
Procedure: We acquire 4 images as follows:
Immediately after the patient eats their sandwich, we acquire a 1 minute image of the abdomen.
FLORIDA ONLY: 30 minutes after the initial images was acquired, we acquire another 1 minute image of the abdomen.
1 hour after the initial images was acquired, we acquire another 1 minute image of the abdomen.
2 hours after the initial image was acquired, we acquire another 1 minute image of the abdomen.
4 hours after the initial image was acquired, we acquire another 1 minute image of the abdomen.
Dual Phase Gastric Emptying Study: 90 minute Protocol *ORDER MUST STATE, "DUAL PHASE AND OATMEAL"
**WE DO NOT USE EGGS. WE USE OATMEAL.** This is not commonly ordered.
DOSE AND SCAN:
Drop down: NM Gastric Emptying Study Dual Phase (Solid/Liquid) Gallium (10036) OR
NM Gastric Emptying Study Dual Phase (Solid/Liquid) Indium (10035)
90 minute duration (6 blocks)
Choose which isotope by what is listed on the order. If you have questions, please contact a technologist
Patient will eat the oatmeal and be imaged continuously for 90 minutes
PREP:
NPO 8 hours prior (Nothing to eat or drink, NOT EVEN SIPS OF WATER)
Patients are to bring in their own OATMEAL (NO sugar, NO flavors).
They will be asked to eat this at their appointment.
Dual Phase Gastric Emptying Scan (solid/liquid) - 4 hours ** ORDER MUST STATE, "DUAL PHASE"
DOSE AND SCAN:
Drop Down: NM GASTRIC EMPTYING STUDY DUAL PHASE 4 HOUR (SOLID/LIQUID) GALLIUM (10036) OR
NM GASTRIC EMPTYING STUDY DUAL PHASE 4 HOUR (SOLID/LIQUID) INDIUM (10035)
90 minutes duration (6 blocks)
This is the patients first appointment
Patient will eat the egg white sandwich they brought and drink water with the medication in it
RETURN SCAN:
Drop Down: NM Gastric Emptying 2 hour return (6578)
15 minutes duration (1 block)
Schedule 2 hours after first appointment
Drop Down: Gastric Emptying 4 hour return (6579)
15 minutes duration (1 block)
Schedule 4 hours after first appointment
EX: 8:00am dose and scan, 10:00am 2 hour return, 12:00pm 4 hour return
PREP:
NPO 8 hours prior to exam (Nothing to eat or drink, NOT EVEN SIPS OF WATER)
Diabetics should have the exam in the morning after 2/3 of their insulin dose
Discontinue Reglan 24 hours prior to exam
Patients are to bring in their own Egg White sandwich consisting of 2 cooked egg whites and 2 pieces of bread
Patients may use any kind of bread,
Most important is that they do NOT add any fat (Ex: No Butter, oil, mayonnaise, etc.)
The 4 Meal Options:
1. Egg White Sandwich (GOLD STANDARD and always 1st option - 2 hard boil eggs or 4oz of liquid)
2. Turkey or Ham Sandwich (4oz of meat)
3. Tofu Sandwich (4oz of firm tofu)
4. Oatmeal (4oz-8oz and LAST option)
Procedure: We acquire images in the following sequence:
Immediately after the patient eats their sandwich and drinks the water, we acquire images at 15 minutes, 30 minutes, 60 minutes, and 90 minutes of the abdomen
2 hours after the initial image was acquired, we acquire another 1 minute image of the abdomen.
4 hours after the initial image was acquired, we acquire another 1 minute image of the abdomen.
**WE NO LONGER OFFER THE 90 MINUTE GASTRIC EMPTYING STUDY 90 MIN PROTOCOL BELOW AT ANY FACILITY THAT PERFORMS NUCMED. ONLY UNDER EXTREME CIRCUMSTANCES WILL WE DO EXAM WHEN PATIENT CANNOT EAT SOLID FOODS. ANY QUESTIONS PLEASE REACH OUT TO A TECH.**
Gastric Emptying Study: 90 minute Protocol *ORDER MUST STATE, "OATMEAL"
**WE DO NOT USE EGGS. WE USE OATMEAL.** This is not commonly ordered.
DOSE AND SCAN:
Drop down: NM Gastric Emptying Study "90 minute Protocol" (1300)
90 minute duration (6 blocks)
Patient will eat the oatmeal and be imaged continuously for 90 minutes
PREP:
NPO 8 hours prior (Nothing to eat or drink, NOT EVEN SIPS OF WATER)
Patients are to bring in their own plain OATMEAL (NO sugar, NO flavors).
They will be asked to eat this at their appointment.
Liver Spleen Scan:
DOSE AND SCAN:
Drop Down: NM Liver Spleen Scan (Static Only) (2470)
60 minute duration (4 blocks)
Drop Down: NM Liver Imaging SPECT (1277)
60 minute duration (4 blocks)
Needs to overbook with Liver Spleen Static
Patients will be given an I.V. injection and lay flat to image
PREP:
No prep
Patients need to check in 1 hour and 15 minutes prior to scan to drink Ensure
Purpose: To evaluate hepatic or splenic trauma, assessment of anatomy, size, and relative position of the liver and spleen, evaluation of chronic liver or spleen disease including primary liver tumors and metastasis, jaundice, cirrhosis, hepatocellular disease, hepatitis, hepatic abscess or elevated blood work results.
Hemangioma W/Tagged RBC
Dose and Scan:
Drop down: NM Liver Hemangioma Vascular Flow and Spect (6125)
45 minute duration (3 blocks)
This is the patients first appointment
Patient will receive an I.V. injection and lay flat for imaging at this appointment
Please note RBC in your notes
Return Scan:
Drop down: Liver Hemangioma Vascular Flow and Spect Return (6974)
60 minute duration (4 blocks)
This is the patients second appointment
The patient will lay flat, and imaging will be done at this appointment
EX: 8:00am injection, 10:00am Return
Purpose: This exam is done for liver hemangiomas.
Procedure: Patient has small amount of blood drawn and tagged with the isotope. The blood is then re-injected while imaging. A set of images are acquired. The patient then returns 2 hours after injection for additional imaging.
MUGA Scan:
DOSE AND SCAN:
Drop down: MUGA Scan/Cardiac Blood Pool - Multiple Determinations (1232)
60 minute duration (4 blocks)
Patients will have an I.V. started. A small amount of blood will be drawn and tagged with the isotope. The blood will then be re-injected, and imaging will begin.
PREP:
No prep
Purpose: To assess the left and right ventricular ejection fraction, wall motion and chamber size.
Renal Scans (These Exams Cannot be done after 5pm)
There are several different ways to do a renal scan depending on the doctor’s orders and patients diagnosis. If you have any questions do not hesitate to ask the tech.
**Schedule all Renal Scans as RENAL W/WO LASIX unless order specifies DMSA, GFR, Captopril, or NO LASIX. MAG3 is scheduled as RENAL W/WO LASIX**
Renal GFR Scan (These Exams Cannot be done after 5pm) **Order must state GFR or DTPA**
DOSE:
Drop down: NM Renal GFR with Vascular Flow Multi Study (1318)
60 minute duration (4 blocks)
Patients will receive an I.V. injection and imaging at this appointment
Patients will lay flat for approximately 40 minutes
PREP:
Patient to be well hydrated. Drink (2) 8oz glasses of water 1 Hour prior to appointment
Patient to discontinue diuretic medications (water pills, Lasix, furosemide, Demadex, ect.) for 24 hours prior to the exam
Purpose: To evaluate renal tubular function and perfusion for blood flow, parenchyma, and excretion; to evaluate differential Glomerular Filtration Rates.
Renal Morphology/Renal Cortical Imaging (DSMA)
DOSE:
Drop down: NM Renal Imaging Morphology (DSMA) (1233)
15 minute duration (1 block)
This is the patients first appointment
They will receive an I.V. injection and then return 3 hours later for scan
Return Scan:
Drop down: NM Renal Imaging Morphology (DSMA) 3 Hour Return (1234)
60 minute duration (4 blocks)
This is the patients return
Schedule 3 hours after first appointment
Patients will lay flat for imaging
EX: 8:00am injection, 11:00am return
PREP:
Patients are to be well hydrated
Patients to discontinue ACE inhibitors for 24 hours prior to the exam (Patients physician should instruct them to do so)
Purpose: To evaluate renal parenchyma disorders, detect and differentiate acute and chronic pyelonephritis, and evaluation of renal transplant
Lasix Renal (These Exams Cannot be done after 5pm) * MOST COMMON*
DOSE AND SCAN:
Drop down: NM Renal Scan W/WO Lasix (6730)
1 hour duration (4 blocks)
Patients will receive an I.V. injection
Patients will lay flat for 40 minutes for imaging
PREP:
Patients need to be well hydrated. Drink (2) 8oz glasses of water 1 hour prior to appointment.
Patients to discontinue diuretic medications (water pills, Lasix, furosemide, Demadex, ect.) for 24 hours prior to the exam.
Purpose: To differentiate between a true organic or structural obstruction, non-obstructed dilated collecting system due to various reasons; Evaluation of renal vascular flow; Evaluation of differential renal function; Evaluation of trauma; Evaluation of drainage pre and post uretal stents.
Mag 3: is a protocol schedule as a Lasix Renal W/WO Lasix
(These Exams Cannot be done after 5pm)
· Need to put in the notes Mag 3
Captopril Renal Scan (These Exams Cannot be done after 5pm) *THIS IS A 2 DAY EXAM*
Dose and Scan: (DAY 1)
Drop Down: NM Captopril Renal Scan (1309)
90 minutes duration (6 blocks)
This is patient’s first appointment
Nothing to eat for 4 hours prior to appointment (Water is OK)
Patients will check in 1 hour prior to take Captopril and have blood pressure monitored
Patients will receive an I.V. injection
Patients will receive Lasix during this scan
Dose and Scan: (DAY 2)
Drop Down: Renal Scan W/O Pharm (6732)
60 minutes duration (4 blocks)
This is patient 24hr return
Schedule 24 hours after first appointment
Patients will receive an I.V. injection
Schedule a 90 minute appointment, then 60 minute return at 24 hours
EX: 8:00am dose. Following day 8:00am return
PREP:
The patient’s doctor will prescribe 50 mg of Captopril
Patients need to fast for 4 hours prior to appointment. (Water is OK)
Patients need to check in 1 hour prior to appointment to take Captopril and for us to monitor their blood pressure
Discontinue diuretic medications (water pills, Lasix, furosemide, Demadex, etc.) for 24 hours prior to the exam.
Purpose: Evaluate Renal Artery Stenosis and Renovascular Hypertension
PET & DAT Scans **These need to be scheduled, rescheduled and/or canceled by PET PLEASE TRANSFER TO PET QUEUE***
I-131 Thyroid Whole Body Scan:
**These need to be Scheduled, Rescheduled and/or Canceled by PET ONLY Transfer to PET Queue**
· Dose:
o Drop down : Thyroid Carcinoma Imaging, Whole Body
o This is patients first appointment
· Scan:
o Drop down : Thyroid Carcinoma Imaging, Whole Body Return
o This is patients return
Purpose: Pre-therapy this is when they use thyrogen or post therapy.* Dr. Office has to do thyrogen*. Thyroid carcinoma.
Prep: NPO 2 hours prior, only liquids. 5 days no salt or seafood.
Appt time: Scan should be 48 hours after dosing. Scan time schedule for 1 hour. Follow the protocol below.
· Please note normal dose for this exam is 2-3 millicuries. We will not dose the patient any more than 3 unless the Dr specifies more and has been discussed with Dr Sakellis.
Ø They need to either have the patient discontinue their thyroid medications for 4-6 weeks per the referring physician or the Dr must give the patient thyrogen injections for two consecutive days prior to dosing. WE CANNOT GIVE THE PATIENT THYROGEN INJECTIONS. PLEASE MAKE SURE THAT MAKE THE DR OFFICE AWARE OF THIS.
Ø If you have scheduling a female patient for this exam please make the Dr Office aware that we need pregnancy test results within a week prior to dosing.
Example:
Monday patient gets injected with thyrogen at Dr Office.
Tuesday patient gets injected with thyrogen at Dr Office.
Wednesday patient comes here to get I131 dose. (Drop Down: Thyroid Carcinoma Imaging, Whole Body) Please schedule at any Nuclear Med Site.
Friday patient returns for 48 hour return (No wiggle Room) at a Nuclear Med site Mesa Greenfield, Thunderbird, Mesa Desert Campus or Fashion Square Allow 1 hour. (Drop down: Thyroid Carcinoma Imaging, Whole Body Return)
MIBG SCAN (METAIODOBENZYLGUANIDINE SCAN) **THIS EXAM IS NOW TO BE SCHEDULED, RESCHEDULED AND/OR CANCELED BY THE PET DEPT Transfer to PET Queue**
DROPDOWN (DAY 1): MIBG PRETREAT (7421) (1st Appt. to be scheduled on Monday or Tuesday)
DURATION: 15 MINUTES
DROPDOWN (DAY 2): MIBG PRETREAT (7421) (2nd Appt. to be scheduled 24 hrs. from 1st appt.)
DURATION: 15 MINUTES
DROPDOWN (DOSE): MIBG (6529) (3rd Appt. to be scheduled 1 hour from 2nd Appt.)
DURATION: 15 MINUTES
DROPDOWN (SCAN): MIBG 24 HOUR RETURN (6971) (4th Appt. to be scheduled 24 Hrs. from Dose)
DURATION: 105 MINUTES
DROPDOWN (SCAN): MIBG 48 HOUR RETURN (6972) (5th Appt. to be scheduled 48 Hrs. from Dose)
DURATION: 105 MINUTES
NOTES
· MIBG SCAN IS PERFORMED FOR DETECTION, LOCALIZATION, STAGING, AND FOLLOW UP OF NEUROENDOCRINE TUMORS AND THEIR METASTASES.
· PATIENTS SHOULD BE WELL HYDRATED FOR THE EXAM.
· NOTATE ANY CURRENT MEDICATIONS FOR PATIENT IN CLINICAL INFO. (SEE MEDLIST FOR WITHHOLDING OF MEDICATIONS)
·
· Example:
· Monday 8:00AM- NM MIBG Pretreat (7421) (15 Min)
· Tuesday- 8:00AM- NM MIBG Pretreat (7421) (15 Min)
· Tuesday- 9:00AM- NM MIBG (6529) (15 Min)
· Wednesday- 9:00AM- NM MIBG 24 Hr. Return (6971) (105 Min)
· Thursday- 9:00AM- NM MIBG 48 Hr. Return (6972) (105 Min)
· DAY 1 MUST BE SCHEDULED ON MONDAY OR TUESDAY.
VQ LUNG SCAN: *SCHEDULE NO EARLIER THAN 8:00AM AND NO LATER THAN 3:30PM **THIS EXAM IS ALWAYS STAT**
**PATIENT MUST HAVE A CHEST X-RAY 1 HOUR BEFORE THE VQ SCAN**
DOSE AND SCAN:
Drop down: NM VQ SCAN (6245)
60 minute duration (4 blocks)
Patient will receive an I.V. injection
Patient will breathe through a nebulizer
You need to schedule a Chest X-ray 1 hour before the VQ Scan
If the order does not have a chest x-ray, you need to call the referring to get an order for one
ADDITIONAL QUESTIONS:
Ask patient if they have ever been diagnosed with Pulmonary Hypertension (this is not regular or essential hypertension), or Right to Left Shunt, and put it in your notes. (A special dose must be ordered for these patients)
Has the patient had a portion of their lung(s) removed? (If the answer is yes, we need to know what was done and how extensive)
*IF scheduling same day, make sure you contact the tech at the site to see if they can get a dose delivered in time (Typically 2-3 hours depending on location)
Schedule appointment for 1 hour. Make sure there is an order for a chest x-ray. This exam is ALWAYS STAT.
PREP:
No prep
Purpose: To detect a pulmonary embolism (blood clot) that prevents normal blood flow to part of the lung.
I-131 Thyroid Ablation
**These need to be Scheduled, Rescheduled and/or Canceled by PET Dept Transfer to PET Queue****
This is a 10 minute consultation that needs to be put in as a Nuc Med and can be overbooked in the PET room. We need to have patients Previous Thyroid Uptake Scan Images and Report. Need recent labs. For Female patients we will need to have a blood pregnancy test within 24hrs of the actual ablation procedure.
· Consultation
o Drop Down : Modality needs to be changed to Nuclear Medicine. Procedure: Thyroid Ablation Consult
· Ablation
o Drop Down : Modality needs to be changed to Nuclear Medicine
o Procedure: Thyroid Ablation
o Needs to be done 48hrs of Consultation
PYROPHOSPHATE CARDIAC SCAN (PYP) THIS EXAM IS NOT AVAILABLE IN FLORIDA
ONLY LOCATIONS THAT PERFORM: ESTRELLA, CENTRAL PHOENIX AND GREENFIELD
Drop Down: NM TC – PYROPHOSPHATE SPECT CARDIAC (7793)
90 minute duration (6 blocks)
Patients must check in 75 minutes early for injection
Patients will receive an I.V. injection 1 hour before appointment time
Patients will lay flat for imaging
PREP:
No prep
Purpose: : To detect Transthyretin Cardiac Amyloidosis and diagnose diastolic dysfunction in patients with preserved left ventricle ejection fraction
Procedure: The patient will check in one hour and fifteen minutes before the appointment time to receive dose. They will be injected and then wait one hour before imaging.
***INDIUM WBC Scans **NO AETNA PATIENTS **(These Can’t be done after 2:30pm)**
There are 2 Types of Indium WBC Scans:
Whole Body Indium (In-111)
Dual Isotope WBC *MOST COMMON*
Whole Body Indium - 111 (These Can’t be done after 2:30pm)
INITIAL APPOINTMENT:
Drop Down : Indium WBC Localization of Inflammatory Process (Whole Body) (10167)
15 minute duration (1 block)
This is the patient's first appointment
Patient will have an I.V. placed and blood drawn to be sent to the Nuclear Pharmacy for tagging
RETURN:
Drop Down : NM Indium Scan Blood Re-Injection (6522)
15 minute duration (1 block)
Schedule 4 hours after initial appointment
This is the patient’s second appointment
Patients blood will be returned from the Nuclear Pharmacy for re-injection
SCAN:
Drop Down : NM Indium Scan 24 Hour Return (6523)
60 minute duration (4 blocks)
Schedule 24 hours after blood re-injection
This is the patients 24 hour return (can be plus or minus 2 hours)
Patient will lay flat for imaging
EX: 8:00am initial appointment, 12:00pm blood re-injection, following day 12:00pm (24 hours after re-injection)
NOTE: IF order states, "WBC Scan", and the patient has hardware (fusion, screws, hip replacement, knee replacement, ect.), it needs to be a Dual Isotope. Please call the referring office to get an updated order. The order should state any of the following: "DUAL ISOTOPE WBC", "Indium WBC Scan with Bone Marrow Mapping", "Indium WBC Scan with Sulfur Colloid", or "In-111 WBC w/Tc99m overlay".
Purpose: Detection and localization of acute and chronic osteomyelitis, localization of infection, and detection of acute inflammatory disease
Dual Isotope WB WBC **NO AETNA PATIENTS (These Can’t be done after 2:30pm)
INITIAL APPOINTMENT:
Drop Down : Dual Indium WBC w/Sulfur Colloid (Bone Marrow Mapping) (10166)
15 minute duration (1 block)
This is the patient's first appointment
They will have blood drawn that will then be sent to the Nuclear Pharmacy to be separated, tagged with the isotope, and then sent back for re-injection
RETURN:
Drop Down: NM Indium Scan Blood Re-Injection (6522)
15 minute duration (1 block)
Schedule 4 hours after initial appointment
This is the patient’s second appointment
The patients white blood cells will be returned from the Nuclear Pharmacy and re-injected into the patient
RETURN SCAN:
Drop Down: NM Indium Scan 24 Hour Return (6523)
60 minute duration (4 blocks)
This is the patients 24 hour return (can be plus or minus 2 hours)
EX: 8:00am initial appointment, 12:00pm blood re-injection, following day 12:00pm (24 hours after re-injection)
NOTE: IF order states, "WBC Scan", and the patient has hardware (fusion, screws, hip replacement, knee replacement, ect.), it needs to be a Dual Isotope. Please call the referring office to get an updated order. The order should state any of the following: "DUAL ISOTOPE WBC", "Indium WBC Scan with Bone Marrow Mapping", "Indium WBC Scan with Sulfur Colloid", or "In-111 WBC w/Tc99m overlay".
Purpose: Detection and localization of acute and chronic osteomyelitis, localization of infection, and detection of acute inflammatory disease
Ceretec WBC Scan
*** They are to be performed on Hands and Feet only without hardware (plates, screws etc.). If there is hardware present, a WB Indium WBC with Sulfur Colloid is needed.***
These scans will be ordered as: Tc99m WBC Scan or Ceretec WBC Scan
The patient must have had a recent 3 phase bone scan of the area of interest prior to performing. The radiologist will not read cases without a prior 3 phase bone scan.
Prep: No prep.
They are to be performed on Hands and Feet only without hardware (plates, screws etc.). If there is hardware present, a Whole Body Indium WBC with Sulfur Colloid is needed.
· Dose:
o Drop Down :
o Ceretec WBC Scan (duration 15 minutes) (1236)
o This is patient's first appointment - During this phase, the technologist draws the patient's blood and sends it to the pharmacy for radioactive tagging. The patient is to return in 3 hours for their blood reinjection.
· Return:
o Drop Down : Tc99m WBC Blood Re-Injection (6934) (duration 15 minutes)
o This is patient’s second appointment.
· Scan:
o Drop Down : Tc99m WBC Scan Return (6935) (duration 60 minutes)
o This is patient’s third appointment 3 hours post blood re-injection.
Appt time: 15 minute dose. 15 minute 3 hour return. 30 minute 6 hour return scan. (Ex. 8:00AM dose. 11:00AM return. 2:00PM return scan.
Gallium Scans**NO AETNA PATIENTS
DOSE:
Drop Down : NM Gallium Infection Scan Whole Body (6468)
15 minute duration (1 block)
This is the patients first appointment
Patient will receive an I.V. injection at this appointment
Drop Down: NM Gallium Infection SPECT (6469)
Double book with GALLIUM INFECTION SCAN WHOLE BODY (6468)
RETURN SCAN:
Drop Down : NM Gallium Infection Scan Whole Body 6 hour return (10173)
90 minute in duration (6 blocks)
This is patient’s second appointment
Patient will lay flat for Whole Body and SPECT imaging
Drop Down : NM Gallium Infection Scan Whole Body 24 hour return (6520)
60 minute in duration (6 blocks)
Patient will lay flat for Whole Body and SPECT imaging
Drop Down : NM Gallium Infection SPECT 24 hour return (6521)
30 minute in duration (6 blocks)
Patient will lay flat for Whole Body and SPECT imaging
Purpose: Detect and localization of acute and chronic osteomyelitis, detect and localization of disc space infections, and detect and localization of pulmonary and mediastinal inflammation/infection, especially in the immunocompromised patient
Prep: Patient must be well hydrated the day before, the day of and the day after the exam. Routine Bowel preparation with oral laxatives will decrease activity in the bowel and radiation dose. Routine bowel prep is recommended unless the patient is too ill or unable to eat solid foods.
Octreoscan **NO AETNA PATIENTS** CANNOT BE SCHEDULED ON THE WEEKENDS. Mon.-Fri. ONLY. **THIS EXAM IS NOW TO BE SCHEDULED, RESCHEDULED AND/OR CANCELED BY THE PET DEPT Transfer to PET Queue**
Purpose: It is a type of scintigraphy used to find carcinoid, pancreatic neuroendocrine tumors and to localize sarcoidosis.
Prep: No Prep
· Dose:
o Drop Down : Octreotide Scan (6513)
o (duration 30 minutes) This is patient's first appointment
· Scan:
Drop Down : Octreotide Scan 4hr Return (6514)
o (duration 60 minutes) This is patient's second appointment
· Scan:
o Drop Down : Octreotide Scan 24hr Return (6515)
o (duration 90 minutes) This is patient's 24 hour Return
Appt time: 30 minute dose. 60 minute scan 4hr return. 90 minute scan 24hr return. (Ex. 8:00AM dose. 12:00PM return. Following day 24hr 8:00AM return.)
**Patients are to check in 30 minutes prior for NucMed exams**
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