Glomerular Filtration Rate (GFR)
Indications will include:
- Calculation of carboplatin dose in chemotherapy.
- Assessment of potential live donors for kidney transplantation.
- Monitoring of patients receiving drugs that can cause nephrotoxicity.
- Assessment of renal function in chronic kidney disease including the evaluation and follow up of renal function in chronic glomerulonephropathies (such as diabetes mellitus and haemolytic uremic syndrome).
- Detection of renal failure in patients in whom serum creatinine results might be misleading, for example due to abnormal diet or musculature.
- Detection of renal failure in patients in whom missing a decline in renal function might be disastrous, for example in those with a single kidney, renovascular disease or a renal transplant.
- The evaluation of single kidney function in conjunction with relative renal function measurements from static or dynamic radionuclide imaging, including patients about to undergo renal surgery.
- Complex urological problems or long-term urological conditions such as diversions.
- Assessment of kidney function as part of the work up for receiving a liver transplant.
Additional instructions
Please indicate if the patient has ascites, oedema or other expanded body space and the severity
Dosage
Effective dose = 0.05
Dose range = <1
Bile acid malabsorption (SeHCAT) study
Indications will include:
- Assessment of ileal function
- Investigation of inflammatory bowel disease and chronic diarrhoea
- Study of enterohepatic circulation.
Additional instructions
Ideally patients should avoid taking bile acid sequestrants the day before the first appointment and for the following 7 days as these may interfere with the test results.
Dosage
Effective dose = 0.3
Dose range = <1
Bone scan
Indications will include:
- Osteoid osteoma
- Primary: osteosarcoma, secondary: metastases
- Inflammatory arthropathies
- Osteomyelitis, discitis, septic arthritis
- Avascular necrosis, reflex sympathetic dystrophy
- Osteomalacia, Paget’s disease
- Fracture, insufficiency fracture, Charcot’s joint, shin splints, non-accidental injury (NAI)*
- Postoperative periprosthetic or fixation device complication
- Osteoarthritis
- Rhabdomyolysis, myositis ossificans
- An abnormality on a plain radiograph that requires investigation as to its cause.
- Bone Pain
- An unexpected abnormality in calcium metabolism e.g. raised calcium and alkaline phosphatase.
Additional instructions
*Bone scintigraphy may be unhelpful in the context of NAI as it can be difficult to date an injury with confidence for legal purposes.
The referral should identify sites of clinical tenderness / pain.
Dosage
Effective dose = 3.9 + CT dose if SPECT-CT
Dose range = 1-5
Cardiac perfusion scan
Indications will include:
- To assess presence and degree of coronary obstruction in patients with suspected coronary disease.
- To aid management of patients with known coronary disease:
- To determine the likelihood of future coronary events, i.e. post myocardial infarction or related to proposed non-cardiac surgery.
- To guide strategies of myocardial revascularisation by determining the haemodynamic significance of coronary lesions.
- To assess the adequacy of percutaneous and surgical revascularisation.
- To assess myocardial viability and hibernation, particularly with reference to plan myocardial revascularisation.
- To assess the haemodynamic significance of known or suspected anomalocoronary arteries and muscle bridging.
- To assess the haemodynamic significance of coronary aneurysms in Kawasaki’s disease.
Additional instructions
None.
Dosage
Effective dose = 5.5 – 13.5 + CT dose
Dose range = 5.1 to 10 / >10
DaTSCAN
Indications will include:
- To help differentiate essential tremor from Parkinsonian syndromes.
- To differentiate Parkinsonian syndromes from drug induced Parkinsons and vascular pseudoparkinsonism.
- To differentiate between Lewy Bodies Dementia and Alzheimer’s.
Additional instructions
Prior to the investigation patients should avoid taking any medications or drugs of abuse which could significantly influence the visual and quantitative analysis of DAT binding ligands - a list of medications needs to be provided.
Dosage
Effective dose = 4.6
Dose range = 1-5
Gastric emptying
Indications will include:
- Suspected gastroparesis in diabetic patients
- After gastric surgery
- When taking medication that affects gastric motility.
Additional instructions
Certain drugs stopped two days prior to scan:
- Opiates
- Prokinetic agents
- Atropine, Nifedipine, Progesterone, Octreotide, Theopyline, Benzodiazepine, Phentolamine.
Dosage
Effective dose = 0.9
Dose range = <1
Gastrointestinal bleed
Indications will include:
- Evaluation of upper and lower gastrointestinal bleeding.
Additional instructions
Contraindicated in patients receiving blood products.
Dosage
Effective dose = 3.6
Dose range = 1-5
Gallbladder scan (HIDA)
Indications will include:
- Cystic duct obstruction in acute or chronic cholecystitis.
- Post-op biliary leak.
- Congenital conditions - choledochal cyst.
- the assessment of biliary dyskinesia or sphincter of Oddi dysfunction.
- Differentiation of neonatal hepatitis from biliary atresia.
Additional instructions
None
Dosage
Effective dose = 2.4
Dose range = 1-5
Liver and spleen
Indications will include:
- Residual spleen function (e.g. after splenectomy).
- Location of ectopic tissue.
- Nature of abnormalities.
- To help distinguish hepatic adenoma from follicular nodular hyperplasia.
Additional instructions
None
Dosage
Effective dose = 0.7 – 1.8
Dose range = <1 / 1-5
Lung V/Q scan (ventilation/ perfusion)
Indications will include:
- Diagnosis of pulmonary embolism
- Assessment of regional ventilation and perfusion.
Additional instructions
The patient should have a clear chest X-Ray within 48 hours, or 24 hours for pregnant patients, and this must be made available.
Dosage
Effective dose = 2.2 – 2.8 + CT dose if SPECT-CT
Dose range = 1-5
Lung perfusion scan
Indications will include:
- Pre-operative estimation of relative pulmonary function in patients requiring pneumonectomy.
Additional instructions
None.
Dosage
Effective dose = 1.1 - 2.2
Dose range = 1.5
Lymphatic scan
Indications will include:
- Assessing lymphatic drainage in the investigation of lymphoedema.
Additional instructions
None.
Dosage
Effective dose = 0.09 – 0.18
Dose range = <1
Kidney scan (MAG3/DTPA) ± indirect micturating cystogram
Indications will include:
- Pelvi-ureteric or other obstruction.
- Post-surgical assessment / follow up.
- Assessment of renal perfusion and function (any age).
- Assessment of renal perfusion and function in patients aged <10 years when vesicoureteric reflux is suspected.
- Followed by indirect micturating cystogram to follow up the progress of vesico-renal reflux.
Additional instructions
- Please indicate if diuresis required.
- For reflux studies, patient should be toilet trained.
Dosage
Effective dose = 0.7
Dose range = <1
Kidney scan (DMSA)
Indications will include:
- Renal scarring post UTI age >3 months.
- Location of ectopic kidneys.
- Query absence of kidney.
- Relative kidney function pre-nephrectomy.
- Relative kidney function pre-renal biopsy.
- Assessment of functional renal tissue post-surgical intervention.
- Structural information as alternative to IVU or CT (contrast sensitivity or nephropathy).
Additional instructions
None.
Dosage
Effective dose = 0.7
Dose range = <1
Meckels
Indications will include:
- Meckel’s diverticulum.
- Rectal bleeding.
Additional instructions
- Please indicate if infants require sedation and nursing support.
- A recent barium examination within 24 hours may obscure a small bleeding site so delay meckels scans until after this.
Dosage
Effective dose = 5.2
Dose range = 5.1 to 10
MIBG scan
Indications will include:
- Neuroectodermal tumour.
- Adrenal medullary tumours.
Additional instructions
Withdraw (under medical agreement) from:
- opioids, cocaine, tramadol 7-14 days,
- Tricyclic antidepressants 7-21 days,
- sympathicomimetics (brochodilators, decongestants and diet aids) 7-14 days,
- antihypertensive/cardiovascular agents 14-21 days,
- ACE inhibitors 14 days,
- antipsychotics, phenothiazines (antiemetic/antiallergenic agents) 21-28 days.
Dosage
Effective dose = 5.2
Dose range = 5.1 to 10
Octreotide scan
Indications will include:
- Gastroenteropancreatic neuroendocrine tumours (carcinoid, insulinoma, gastrinoma, non-functioning islet cell carcinoma).
Additional instructions
Stop Octreotide therapy (Sandostatin) under medical advice:
- 6-8 weeks if intramuscular injection
- 3 days if subcutaneous injection.
Dosage
Effective dose = 5.9 - 11.9
Dose range = 5.1 to 10 / >10
Parathyroid
Indications will include:
- To aid in localisation of abnormal parathyroid glands in patients diagnosed biochemically with primary hyperparathyroidism.
Additional instructions
Patients must have had multinodular goitre ruled out by ultrasound before they may have an isotope parathyroid scan.
Dosage
Effective dose = 8.1 + CT dose if SPECT-CT
Dose range = 5.9 - 11.9
Sentinel lymph node (breast)
Indications will include:
- Identification of sentinel lymph node for biopsy 20 minutes - 24 hrs preop.
- T1 and T2 stage invasive breast carcinoma. With high risk and microinvasive ductal carcinomas in situ. With good prognostic group tumours (tubular, medullary, mucinous, papillary). Following primary chemotherapy.
Additional instructions
- Surgical team must discuss directly with department.
Dosage
Effective dose = 0.1
Dose range = <1
Sentinel lymph node (melanoma)
Indications will include:
- Identification of sentinel lymph node for biopsy 20 minutes - 24 hrs preop.
Additional instructions
- Surgical team must discuss directly with department.
Dosage
Effective dose = 0.2
Dose range = <1
Thyroid scan (Tc99m)
Indications will include:
- To differentiate between Graves disease, toxic nodular goitre and subacute thyroiditis.
- Hot or cold nodule.
- Ectopic thyroid tissue.
Additional instructions
None
Dosage
Effective dose = 1.0
Dose range = 1-5
Thyroid scan (I-131 or I-123)
Indications will include:
- Thyroid cancer remnants, post-ablation.
- Thyroid cancer metastases, post-ablation.
Additional instructions
- Oncologist should arrange thyrogen injections or withdrawal of thyroid medication.
- Oncologist should arrange blood test on day / day before scan appointment to check TSH levels.
Dosage
Effective dose = 6.1 –14.3
Dose range = 5.1 to 10 / >10.
It is the responsibility of the referrer to make the patient aware that there is a risk associated with exposure to ionising radiation and to explain how they believe the benefit of information gained by having the examination, outweighs this risk.