emptying, VP/VA shunt 99mTc-MDP Bone scan 99mTc-Sulfur Colloid Gastric emptying, Bone marrow mapping, Splenule / splenosis localization, Sentinel node localization, lymphoscintigraphy 99mTc-Pertecnetate Thyroid scan, Meckel’s diverticulum 99mTc-MAA Lung perfusion, Right-to-Left shunt assessment, Liver shunt assessment 99mTc-labelled RBC GI bleeding, MUGA, Hemangioma 99mTc-HIDA Cholecystitis, Bile leak, Functional gallbladder disorder 99mTc-Sestamibi Cardiac stress test, parathyroid localization, Molecular Breast Imaging (MBI) 99mTc- HMPAO Brain Death scan 111In-WBC Infection, inflammatory bowel disease 111In-Octreoscan Neuroendocrine tumor imaging 111In-DTPA Cisternography, CSF leak 133Xe Lung ventilation 67Ga Spine infection 201TI* Cardiac perfusion scan stress/rest 133Xe Ventilation Positron Emitters 18F-FDG Tumor imaging 68Ga-DOTATATE Neuroendocrine tumor imaging *Not commonly used at present time. B. Patient History Patients usually can supply adequate information to help assess the possibility of pregnancy [4]. All patients of childbearing age (typically at least ages 12 years to 50 years) [18] should be questioned about pregnancy status using a standardized form and/or through direct questioning by the technologist. The guidance is based on a minimum practical and balanced approach that considers patient and facility convenience, fertility (extremely rare without medical intervention beyond age 50 despite menstruation status), safety, and efficiency. A standardized form has the advantage of ensuring uniformity and can serve as documentation of pregnancy status for the medical record (see Appendix B). PRACTICE PARAMETER 6 Pregnant or Potentially Pregnant Patients C. Pregnancy Tests If the results of a pregnancy test are positive, the information must be brought to the attention of a radiologist or nuclear medicine physician prior to proceeding with an examination, except in the case of a life-saving emergency procedure. A negative pregnancy test should not be used by technologists as a reason to forgo standard screening procedures for pregnancy. If, following questioning of the patient, there is uncertainty in regard to her pregnancy status, the radiologist or nuclear medicine physician should be notified prior to performing the study, and the date and results of the negative pregnancy test should be included in the notification. Procedures that require a pregnancy test in normal circumstances should be documented in the facility’s policies. D. Patients Who Are Minors In most states, a minor is a child under the age of 18. However, the definition and age of a minor may vary depending on state law. Generally, a minor is considered emancipated if married, on active duty in the armed forces, or otherwise living apart from her parents and managing her own finances. Although a parent or guardian is usually responsible for consenting to a minor’s health care, in addition to the exceptions mentioned above, all states have specific laws for minors receiving medical treatment. Most states have laws that allow minors to have a pregnancy test without obtaining parental consent or notification. It is unclear, however, if those provisions apply only to situations where the minor is receiving prenatal care. It is important to be familiar with applicable state requirements. In 1996, the US Congress passed the Health Insurance Portability and Accountability Act (HIPAA). The resulting regulations contain numerous provisions that affect the patient’s health care privacy rights, including those of minors. The regulations recognize that, in specific circumstances, parents are not necessarily the personal representatives of their minor children (a) when under state law the minor is legally able to consent to her care; (b) when the minor may legally receive the care without the consent of a parent, and the minor or someone else has consented to the care; or (c) when a parent or guardian assents to a confidential relationship between a health care provider and the minor. In these situations, the radiologic or nuclear medicine technologist may ask a minor about her pregnancy status prior to an imaging procedure involving ionizing radiation. The minor may exercise most of the same rights as an adult under the regulations, including limiting access of the parent or guardian to the minor’s health care information. However, the regulations should be deferred to state laws, which might negate this aspect for specific states. The minor is also particularly vulnerable to social and parental pressures that can potentially result in the patient providing misinformation about her reproductive status. One approach to rectify this situation is for the technologist to ask the parent or guardian for permission to prepare the patient in the examination room privately prior to the examination. In the private setting, the technologist can either ask the patient the standard questions or ask the patient to fill out the standard form about menstrual history and the potential for pregnancy. If a private preparation is refused, then a backup screening policy may be put in place. If the responses indicate that the patient is or could be pregnant, verbal consent for a pregnancy test should be obtained from the patient and, when appropriate or when required by law, also from the minor’s parent or guardian. The order for the pregnancy test can be initiated either by the technologist working under written protocol from the radiologist or by the radiologist. If this consent is declined, the radiologist should be informed of the circumstance before any examination is conducted. It should be documented in the patient’s medical record that the patient and/or the guardian declined the pregnancy test. Alternatively the institutional policy might indicate that: All minors (eg, from age 12 years, regardless of menstrual status) that are not known to be pregnant are to undergo a pregnancy test prior to the following procedures: • Pelvic CT • Angiography and other interventions of the pelvis (eg, contrast enema) under fluoroscopy • All nuclear medicine and PET/CT PRACTICE PARAMETER 7 Pregnant or Potentially Pregnant Patients Such a policy has the advantage