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Navigate through our intriguing clinical case studies and up to date scans in our growing Nuclear Medicine field. Learn what it means to be a Nuclear Medicine Technologist. Learn how the affiliated sites help students become well rounded technologists. Experience and explore the wonderful field that is Nuclear Medicine!!!

Tuesday, July 1, 2014

Dilated Common Bile Duct


When blockages can occur in the  bile ducts, they can become dilated. These blockages can be associated with gall stones or cholangiocarcinomas. Dilated ducts are also common in patients following cholecystecomy, which may increase in size over time. However this is usually of no significance by itself, unless there are other findings such as pancreatitis or elevated liver functions.

The non-contrast CT images above demonstrated an incidental finding of dilated common bile duct (yellow outline) in a female with a history of cholecystectomy. Hepatobiliary scan requested to determine duct patency.

4 mCi Tc Choletec was administered intravenously and imaging was completed in the anterior projection for 1 hour. The images demonstrate normal  passage of the Tc Choletec through the common bile duct and into the small intestine, demonstrating no blockage in the common bile duct.

Reference image - Gallbladder (green) liver (orange) kidneys (light blue) aorta (red) inferior vena cava (blue)

Reference: Are dilating bile ducts a cause for concern?  ML Wilkinson, Gut 1999;45:637-638

Wednesday, May 28, 2014

Empathy: The Human Connection to Patient Care


Saw this as part of a patient care presentation at work. A great video, from the Cleveland Clinic, to attempt understand everything that evolves around us each day at work and in life in general...

Sunday, March 9, 2014

Non-osseous abnormalities on bone imaging

I have always found non-osseous uptake of skeletal imaging agents to be of interest. In 2003 the Journal of Nuclear Medicine Technology published an excellent article on non-osseous abnormalities. During my years of teaching, students have brought in many examples which I wish to share...

In the area of altered biodistribution, whether due to faulty preparation or pharmaceutical interference:
Free technetium due to the presence of air in the container during preparation will lead to increased uptake of unbound technetium in the stomach, gastrointestinal tract, thyroid and salivary glands...

It was noted in the article that drug interaction with diphosphonates used in treatment of osteoporosis can lead to decreased skeletal uptake.
Male on hemodialysis, with a complaint of back pain. Findings include decreased skeletal uptake of the radiopharmaceutical. The patient medical history includes administration of PhosLo (calcium acetate tablets) 3-times a day with meals indicated for patients with hyperphosphatemia. The retention of phosphates in patients with renal insufficiency plays a role in causing secondary hyperparathyroidism. This scan was compared to another patient scanned with radiopharmaceutical from the same bath to verify this was not associated with poor radiopharmaceutical preparation. Due to the patient's condition his attending physician would not take him off the PhosLo for a repeat scan...

Uptake related to the urinary system, is the most common finding of non-osseous uptake. Findings include: dilated, obstructed ureters, hydronephrosis, renal cysts:
80-y female, history of melanoma, complains of back pain. Findings include a mild right side hydronephrosis, with a dilated ureter noted in the pelvis...
91-y female, fell 3 days prior to scan, complains of left hip pain. Findings include marked hydronephrosis of both kidneys with dilatation of both ureters. Possible obstructive uropathy near the urinary bladder...
25-y male, with history of right renal abscess. Skeletal imaging was ordered for a complaint of right side flank pain to rule out osteomyelitis. Findings include a photon deficient 4cm area in the upper pole of the right kidney consistent with a cysts, tumor or abscess...
38-y female with a history of right lung carcinoma. Findings include poorly defined uptake at the areas superior to both kidneys, suggestive of metastatic disease in the adrenal glands...


Soft tissue uptake may be found in various areas due to soft tissue calcification, which may point to specific pathology:
51-y female with a history of breast cancer. Findings include mild diffuse uptake in the liver, of uncertain clinical significance. The likelihood of interference of additional imaging procedures was reviewed. The patient did not have a prior liver scan, which would have been performed by calculation on Sunday when the department was closed for routine imaging. Gallium-67 for soft tissue imaging would present with considerable background activity. The pattern of uptake is not suggestive of hepatic metastatic disease, but may suggest necrosis or microcalcification...
Elderly female fell out of bed onto her left side, complains of left hip pain. Findings include increased cardiac uptake as well as uptake in several left ribs suggestive of cardiac contusion and rib fractures related to trauma...
76-y male with a history of right nephrectomy, on hemodialysis, complains of low back pain. Findings include cardiac uptake related to calcification of the pericardium, which was seen on a recent CT of the chest. This may be an indication of metastatic calcification, which can be seen in secondary parathyroid hyperplasia...
46-y male with a recent finding of multiple myeloma. Findings include intense uptake in the region of the myocardium, most likely secondary to calcified pericarditis, however diffuse myocardial infarction may also have this appearance...
Female with documented history of hypercalcemia. Findings include diffuse uptake of the the radiopharmaceutical in both lungs. This pattern of uptake has been implicated with hypercalcemia and related to metastatic calcification...

Thanks to Heny Shah, Dolores Ambrosy, Corrine Zenkel, 






Saturday, December 21, 2013

WB Skeletal Imaging - motion artifact



Whole body bone scan obtained 2 hours following the intravenous injection of Tc99m MDP.

Older cameras used to perform whole body images by scanning at the right side of the body head-to-toe, moving the table and scanning the left side of the body toe-to-head. This often produced a zipper line done the middle of the body where the images were joined. If the patient moved or the camera and table were not properly aligned the images could result in separation of the images or mis-registration.

Newer systems have the ability for single-pass imaging, which eliminates the zipper and mis-registration problems. The single-pass technique although does not always allow for inclusion of the patients arms in the field of view.

On this particular image the patient noticeably moved their head from right to left resulting in the alien feature of a twin lobed cranium.

The practice of this institution was to perform a whole body posterior image with spot shots of the anterior skull chest, abdomen, and pelvis. 

Although this is older technology, newer camera do not require a double pass for the whole body image, I have always enjoyed the "alien" presence in this image..

Quality Control Troublshooting

We have three cameras in my department. I completed the first intrinsic flood (2million counts) when I noticed the uniformity on detector 2 was not good. I decided to move on to the next camera and come back to determine the problem, since the pattern was not typical of most non-uniformity problems.

The second camera demonstrated a similar, but more intense non-uniformity issue with detector 2. Coincidence... Now I had to determine the problem. I removed the source from the area and started a uniformity flood without a source to see if there was contamination in the area. A previous episode had a hot needle in a nearby sharps container. This time nothing was initially found.

I then checked my discarded gloves, which I Usually place on top of the collimator cart after placing the source and removing them...
In the first room my gloves were placed at the back of the collimator cart, so the activity on the glove was attenuated by the cart. In the second room, to which I carried my gloves (I dispose of them in the hot lab after completion of acquiring all morning uniformities) and had placed them at the front of the cart. Without the attenuation from the cart, the "extra" source is predominant in the acquired image...

Saturday, June 22, 2013

WB Skeletal Imaging - Contamination



Clinical History: 73 year old female with low back pain.

Technique: 3phase and whole body bone scan performed following injection of 23 mCi MDP.

Findings: The dynamic blood flow study and immediate post injection scan of the lower back demonstrate no evidence of a focally increased blood flow of increased vascularity. Bone imagings from the head to toes demonstrate a slightly increased tracer uptake involving the lower lumbar spine at the level of L4 and L5, probably due to degenerative bone and joint disease. Slightly increased tracer uptake involving both shoulder joints, probably non-specific arthritis. No abnormal tracer uptake is noted in the sacrum and coccyx.

Slightly increased tracer uptake involving patient's boots. The patient was on lasix, and urinated through her pantyhose. She went home and changed her hose prior to imaging. She did not change her boots, therefore only the boots show contamination and not her hosiery.

Thanks to Y.H. Park, MD, Meredith Smela, Debbie Reed