Tracer Notes
Table Of Contents
q��� Cardiovascular
Imaging. 3
q��� Pulmonary
System.. 3
q��� Skeletal
System.. 3
q��� Gallium
67 Citrate. 3
q��� Indium
-111 Labeled Leukocytes. 4
q��� Technetium -99m HMPAO - Labeled Leukocytes. 4
q��� Liver
Spleen study. 4
q��� I-123
metaiodobenzylguanidine (MIBG) 4
q��� Octreotide. 4
q��� Hepatobilary
System.. 4
q��� Gastointestinal
System.. 5
q��� GU.. 5
q��� Thyroid
imaging. 6
q��� Parathyroid. 6
q��� CNS. 6
q��� LYMPHOSCINTIGRAPHY.. 6
q��� Dose
5 mCi 8
q��� Dose
10 mCi 8
q��� Dose
20+ mCi 8
q��� Other 8
o
Thallium 201- chloride
�
2-3.5 mCi
�
Window 69-83 KeV, can use 2nd
window of 167 KeV to increase counts.
�
Critical organ =
Kidneys
o
Technetium-99m sestamibi
�
Same day rest and stress:
initially done with 10mCi, 2nd is done 3-4 hrs later using 20-30
mCi (account for residual activity)
�
Critical Organ = GB,
if no GB then Colon
o
Tc-99m macroaggregated albumin (Tc-99m MAA) - typical 5 mCi dose 500,000
particles
�
Critical organ =
Lungs
o
Tc-99m DTPA give 20-30 Mci Aerosol -� 1 MCi (reaches
lungs)
o
Xenon
o
Single
Breath
�
Deep inspiration, patient hold breath while
100,000 count image is acquired
o
Equilibrium
�
Patient breaths air and Xenon and image acquired
every 60 sec for 3 min
o
Washout
�
Patient breaths room air and serial images are
obtained
�
Good for air trapping in COPD, will show
inreased tracer on delayed images
o Techneium 99m MDP
� � - 6 hrs
� Kev =140
� Dosage 15-25 mCi
� Critical organ = bladder
o
� life 78 hours
o
circulates bound to transferrin
o
Uptake highest in liver but also spleen ,salivary
glands, bone marrow and Lacrimal gland, kidneys only faintly seen at
48-72 hrs
o
Photo peaks are 93, 185 and 300
o
Infection 5 mCi �
o
Tumors 10 �mCi
o Critical organ = Colon
o
Typically image at 48
(BEST) and 72 hrs
o
� life = 67 hrs
o
Typically
image at 24 hr
o
Photopeak = 173 and 247 Kev
o Critical organ = Lungs
o
Dose = 500 uCi in adults
o Dose - 10 mCi
o Critical organ = Colon
o
Image at 1-2 hrs for IBD 4-6 for other (osteo, etc..)
o
Better for peds due to lower radiation dose and
extremities
o
T99m-sulfur or albumin
o
Dose = 4-6mCi; inj-to-imaging 20min
o
pheochromocytoma
and neuorblastoma
o
precursor
of norepinephrine
o
Normal
MIBG activity should be confined to the heart, salivary glands, liver,
spleen, and bladder, with some excretion into the GI tract.
o
Image at
24, 48 and 72 hours
o
Dose - 10 mCi
o
Imaging is useful for detecting a variety of
neuro-endocrine tumors which contain somatostatin receptors, including VIPomas,
insulinomas, gastrinomas and pheochromocytomas
o
Pentetreotide is a somatostatin analog (In-111
Pentetreotide (Octreotide)
o
Dose = 6 mCi
o
Accumulates in the thyroid and salivary
glands, spleen, liver, and kidneys, with excretion
into urinary bladder and bowel (mainly on 24 hour
images)
o
Tc-99m mebrofenin (Choletec)
o
Dose � 5 mCi
o Critical organ = Colon
o
Sincalide (Kinevac) is synthetic CCK dose is - .02 �g/kg
o
Morphine - .04mg/kg about 2 mg
o
Diabetic Gastroparesis
�
Most common cause (vagal nerve damage?)
�
1 mCi of
technetium-99m sulfur colloid microwaved with 30 grams of liver pate.
o
Sulfer Colloid (GI bleed)
�
Dose - 10 mCi
�
Critical organ =
Liver
o
Meckel scan
�
Tc99m-pertechnetate� Dose - 10mCi for child 20
for adult�
�
Critical organ =
Stomach
o
GI Bleeding Study
� Tc-99m Tagged Red Blood cells
�
Critical organ =
Heart
� Dose = 20 mCi
� Use in vitro Ultratag KIT
o
Denver
shuntogram
�
Peritoneal-venous shunting (Denver shunt) is used in
cases of intractable ascites
�
5.5 mCi Tc-99m maa intraperitoneally
o
ESOPHAGEAL TRANSIT (done for reflux)
�
Tc99m-sulfur or albumin colloid
�
Oral, 0.15-0.30mCi;
�
Igestion-to-imaging:immediate
�
NPO=4-6hrs
�
Normal, 90% activity should have transferred
esophagus in 15sec.
o
GERD (kids)
�
Tc99m sulfur or albumin colloid; 140keV,
T1/2=6hrs.
�
Oral in 150cc of orange juice mixed with 150cc
of 0.1N HCl; 0.3mCi, Imm
�
More than 4% of gastric activity back in
esophagus is abnormal.
o
Tc-99m DTPA � Dose - 20 mCi
�
Critical organ =
bladder
o
Tc-99m MAG3
(mercaptylacetyltriglycine) Dose - 8 mCi
�
Critical organ =
bladder
o
Tc-99m DMSA (dimercaptosuccinic acid)
Tubular agent
�
Critical organ = kidney
o
Lasix (routine is 40mg IV)
o
enalaprilat (40 ug/kg, maximum of 2.5 mg)
o
RADIONUCLIDE CYSTOGRAM
�
Tc99m pertechnetate(prefer)
�
Tc99m-sulfur colloid/DTPA
�
Can also be used.
�
Sterile urethral catheterization.0.5-1.0mCi
mixed with 250-300cc of saline
�
Used in pediatric as VCUG, less radiation.
o
TESTICULAR SCAN
�
Tc99m pertechnitate/DTPA
�
IV, 30mCi; Inj-to-imaging: immediate
�
Delay in 15min.
o
Iodine-123
�
decays by electron capture,
�
Gamma energy of 159 keV.
�
Dose -200-400 uCi
�
Critical organ =
thyroid
o
�Iodine -131 .
�
Critical organ =
thyroid
�
Dose�
o
Diagnostic: 2-5 mCi po for whole
body for following a patient with thyroid carcinoma.
Therapeutic: 80-150 uCi per gram of thyroid tissue for Graves'
disease
o
100-200 mCi for thyroid carcinoma
ablation in thyroid neoplasm
o
Technetium-99m Pertechnetate
�
Dose - 3 mCi intravenously
o % Uptake = (normal = 10 - 30 %).
�
Dose 20 mCi
�
Image at 15 min and 2 hrs
q CNS
o
Tc99m-HMPAO (Hexamethylpropylenamine
oxime): Ceretec
�
Dose � 20 mCi - Flow study
o
CISTERNOGRAM
�
In111-DTPA - Spinal injection, 0.5mCi
�
Filtered Tc99m sulfur colloid
�
Intradermal or peritumoral 4-8 injections within
1cm of biopsy/tum.
�
0.1mCi, immediate
o
Technetium-99m Pertechnetate� (thyroid) - 3 mCi
o
Iodine -131 - 2-5mCi
o
Choletec � 5 mCi
o
MAA
� 5 mCi for VQ and Denver
shunt
o
Gallium 67 � 5 mCi for infection
o
Octreotide � 6 mCi
o
Tc-99m MAG3
(mercaptylacetyltriglycine) - 8 mCi
o
Sulfer Colloid (GI bleed) - 10 mCi
o Technetium -99m HMPAO - Labeled Leukocytes - 10 mCi
o
MIBG - 10 mCi
o
Gallium 67 � 10 mCi for Tumor
o Techneium 99m MDP - 15-25 mCi
o
Tc99m Sestamibi - 20 mCi
o
Tc99m-HMPAO CNS
- 20 mCi
o
Tc-99m DTPA GU � ��20m
o
Tc-99m Tagged Red Blood cells - 20
mCi
o
Tc-99m DTPA - 20-30 mCi Aerosol -� 1 MCi (reaches
lungs)
o
Tc99m pertechnitate/DTPA (Testicle) -� 30mCi
o
Iodine-123� - 200-400 uCi
o
Indium -111 Labeled Leukocytes - 500
uCi in adults
o
In111-DTPA - Spinal injection, 0.5mCi