tag:blogger.com,1999:blog-84683232948403721132024-03-05T12:38:02.619-05:00Nuclear Medicine Technology ProgramAnonymoushttp://www.blogger.com/profile/16382806271426075019noreply@blogger.comBlogger31125tag:blogger.com,1999:blog-8468323294840372113.post-37636997349711506562015-03-30T19:49:00.000-04:002015-03-30T19:49:28.942-04:00The elusive gallbladder<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdf6t2iP8dMy3iCPhdfnCS7cPmLDKQc0kjNhHxKdFRz1zt2RCCDLnIdEtkaD1gOYltYm3Tmz9Ky1a7mEJ4Tc35pxcNeVa_AziNgh7cBsvlo5BZuvRdZYRAvSs_KgVueEIaG-tkp4mBR3vF/s1600/gb20150325+30min.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdf6t2iP8dMy3iCPhdfnCS7cPmLDKQc0kjNhHxKdFRz1zt2RCCDLnIdEtkaD1gOYltYm3Tmz9Ky1a7mEJ4Tc35pxcNeVa_AziNgh7cBsvlo5BZuvRdZYRAvSs_KgVueEIaG-tkp4mBR3vF/s1600/gb20150325+30min.jpg" height="320" width="320" /></a></div>
30 minute of the hepatobiliary study, pre-CCK administration. The question was raised if this was the gallbladder or distended duct. An additional image was obtained in the LAO view to further determine if this was the gallbladder..<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_Hph99iaDs4IUQUH9YVt5kxwbI2P3p7k-szZLktD1Hduo5Gi-RxVq4QDJHaSa_pVHOI5yi_8eYVjdeu6vf1qwsSGu_0hJArs0skX2Em-A02rNb3MHZjHwFKTRoQfp47Oi_kmQVa07bIeZ/s1600/gb20150325+1hrlao.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_Hph99iaDs4IUQUH9YVt5kxwbI2P3p7k-szZLktD1Hduo5Gi-RxVq4QDJHaSa_pVHOI5yi_8eYVjdeu6vf1qwsSGu_0hJArs0skX2Em-A02rNb3MHZjHwFKTRoQfp47Oi_kmQVa07bIeZ/s1600/gb20150325+1hrlao.jpg" height="320" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
After review of the LAO view (5 minute acquisition time) it was decided that this looked like the gallbladder, so the CCK study could begin.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmWfHFBaqH_ol69X2eCg8kxGgW2ICwnVJDsPCSQv4gNvqSmaqn6YloEFOXfTq-9AKWZyIbHF2M8wI7eH_lDG6lud__KG3Q_ADGQP6ITjh6R7SKVGz4rqHwxpC2NGAyCqWCMNndbsLmeaar/s1600/gb20150325+cck.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmWfHFBaqH_ol69X2eCg8kxGgW2ICwnVJDsPCSQv4gNvqSmaqn6YloEFOXfTq-9AKWZyIbHF2M8wI7eH_lDG6lud__KG3Q_ADGQP6ITjh6R7SKVGz4rqHwxpC2NGAyCqWCMNndbsLmeaar/s1600/gb20150325+cck.jpg" height="320" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
Using the same position as the previous LAO image, the computer was set-up for CCK infusion and acquisition. As the study was started it was noted that the gallbladder appeared.</div>
<div class="separator" style="clear: both; text-align: center;">
In review the structure that was originally thought to be the gallbladder was most likely distended common bile duct.</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<span style="font-size: x-small;">Thanks to Larisa Levran</span></div>
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-39588555900239806462014-11-17T15:21:00.001-05:002014-11-17T15:21:17.738-05:00PET scan mis-alignment<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibv7-wjaDTBvF35sC4j7R1LWugiWgg-c81JjOfUG056Z0Kit3tPl157NcimKE7Zv4feV8uW3tuz0UPHnKZdOmRspku8ZjLFG-8SPcqBEFwiclqa5E1fvEFrLDhNykyon7e3E43s-aicDZG/s1600/pet+1+align.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEibv7-wjaDTBvF35sC4j7R1LWugiWgg-c81JjOfUG056Z0Kit3tPl157NcimKE7Zv4feV8uW3tuz0UPHnKZdOmRspku8ZjLFG-8SPcqBEFwiclqa5E1fvEFrLDhNykyon7e3E43s-aicDZG/s1600/pet+1+align.bmp" height="320" width="299" /></a></div>
This patient was scheduled for a PETCT with Diagnostic CT of the chest. The patient was positioned on the scanner, the tomogram was acquired followed by the whole body CT scan. Contrast was injected and the diagnostic CT of the chest was acquired. Even though the patient had used the rest room prior to the scan, she indicated she had <span style="text-align: center;">to go again.</span><br />
<br />
When the patient was repositioned on the scan table, a new topogram and whole body scan were entered into the original set-up (Siemens Biography 16, we copied and pasted the newer acquisition into the original acquisition page).<br />
<br />
A new topogram and CT whole body were re-acquired followed by the whole body PET scan. The computer preformed the attenuation corrected image, with the above results, showing lack of data in the right half of the brain.<br />
<br />
Review of the uncorrected data reveal that the data was good (below), which did not give any indication as to why right portion of the brain should be lacking in counts.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXeyz9lNx0KD3CLlSYj96syLcR8Ks3I-E4GR4rP8wtpyVRyrrXfWSr0h3nF8Xl1Xo0D6XtnHF2vljgo6zSfoPQBcPyJ4d1BfTOpbHZSzNtXuF7c8IqfnvJ8OLk2rI5AWU4WlIzmXLM5hA5/s1600/pet+uc+align.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXeyz9lNx0KD3CLlSYj96syLcR8Ks3I-E4GR4rP8wtpyVRyrrXfWSr0h3nF8Xl1Xo0D6XtnHF2vljgo6zSfoPQBcPyJ4d1BfTOpbHZSzNtXuF7c8IqfnvJ8OLk2rI5AWU4WlIzmXLM5hA5/s1600/pet+uc+align.bmp" height="320" width="299" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The study was re-processed manually using the second whole body CT data with the corrected results shown below. The image demonstrates complete uptake by the brain when compared with the first image.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYXLRMAgfj7fWpGeVCcZ4CMhbtBcOg2uNrshtS-cbpkwljtgoJIvP_Krbe0KiNkeTyMhyATzF9SJD70bQV11jzNmG2lsQr9dMJkfcKme7XzfhQLQzsN1vS6Ob08c1rFPJ5CYd8JgsFDxxm/s1600/pet+3+align.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYXLRMAgfj7fWpGeVCcZ4CMhbtBcOg2uNrshtS-cbpkwljtgoJIvP_Krbe0KiNkeTyMhyATzF9SJD70bQV11jzNmG2lsQr9dMJkfcKme7XzfhQLQzsN1vS6Ob08c1rFPJ5CYd8JgsFDxxm/s1600/pet+3+align.bmp" height="320" width="299" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
The automatic processing selected the data from the first whole body CT acquired and not the second scan acquired prior to the PET scan. The differences in patient position from the first CT scan to the second CT scan is evident in the first set of PET processed data..</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-13026556773016021842014-08-18T16:24:00.001-04:002014-08-18T16:25:27.940-04:00Iterative reconstruction v filtered backprojectionIterative reconstruction (IR) is the primary method of reconstruction of SPECT data. However there are some drawbacks to using this process.<br />
<br />
IR utilizes the collected data and breaks it down into pixels and then treat each pixel value as an unknown. Using an algorithm values can be assigned to each pixel, permitting the emission and detection data to be accurately modeled.<br />
<br />
Noise acquired during the SPECT acquisition, in the absence of attenuation correction, is constant across the reconstructed field. This eliminates streaking artifact in the image and provides a visually superior image to filtered back projection (FB) processing.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dyjzP7iqRnYcougTjuTcy6KEqNeDmWVgMJJqVBSq7qIVFSRILF0jSqpua8F9qUrJ6UpPCuIAi1iGByl6Zx7jw' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<br />
The above image of a bone whole body spect, processed with iterative reconstruction shows a large photopenic area where the femurs should be. Using IR the pixel values of a low count area may be treated as background or noise in comparison to the adjoining pixels...<br />
<br />
Filtered backprojection, takes the acquired data and fills in the spaces between the projections (azimuths) to create a completed 360-degree image. Although this completes the image it does create blurring, to which filters can be applied for an improved appearance. Unlike IR processing, FB does contain noise and background activity..<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dyDF40by3JxnZiWkJ3o90-ZMFWZwHFNO66tINQ1GH1qR2zYhVcxS_HyTG4bOg5nxk7Py3KMv0noscmbKbCEhA' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<br />
<br />
Recprocessing the acquired data with filtered back projection shows a complete if not more favorable image. Note the noise or "rays" of activity surrounding the scan, especially around the bladder activity...<br />
<br />
<span class="Apple-style-span" style="font-size: x-small;">References:</span><br />
<span class="Apple-style-span" style="font-size: x-small;">1. Image reconstruction - a tutorial, G.L. Zeng, Computerized Medical Imaging and Graphics 2001</span><br />
<span class="Apple-style-span" style="font-size: x-small;">2. An introduction to iterative reconstruction, B Hutton</span><br />
<span class="Apple-style-span" style="font-size: x-small;">3. Filtering in SPECT image reconstruction, M. Lyra and A. Ploussi, International Journal of Biomedical Imaging, April 2011</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-43234569351580699522014-07-01T08:00:00.000-04:002014-07-01T08:09:59.980-04:00Dilated Common Bile Duct<div class="separator" style="clear: both; text-align: center;">
</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5QH_Zs9gGanEB_hDRFMdWCzmF890Erp_ttiPKjmsF85dTVRhkPQhPpMBG2qjYf8XL7YZFiK_DDLKSkPTAmvehb4mmZsUepZkVOPtc7qDHmP8-wHZOlniAFTpbFPiFMg8slMwY_URSbVXG/s1600/140422+ct1a.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj5QH_Zs9gGanEB_hDRFMdWCzmF890Erp_ttiPKjmsF85dTVRhkPQhPpMBG2qjYf8XL7YZFiK_DDLKSkPTAmvehb4mmZsUepZkVOPtc7qDHmP8-wHZOlniAFTpbFPiFMg8slMwY_URSbVXG/s1600/140422+ct1a.jpg" height="213" width="320" /></a></div>
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.<br />
<br />
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCz2u6DuVL2NQy6a62N-bDdSJWqKRcuVuc70yl6Hyo4eGO0nyG2QiajUwJ6MQ-4uQDfzYqMV9D8W53DF8IE3TiR9Q3U0_6QXKDpHqXS_Fx4si0uPIG6w_-JiX1nrnPetemagVTAIiq_i6o/s1600/140505+duct+patency.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCz2u6DuVL2NQy6a62N-bDdSJWqKRcuVuc70yl6Hyo4eGO0nyG2QiajUwJ6MQ-4uQDfzYqMV9D8W53DF8IE3TiR9Q3U0_6QXKDpHqXS_Fx4si0uPIG6w_-JiX1nrnPetemagVTAIiq_i6o/s1600/140505+duct+patency.jpg" height="213" width="320" /></a></div>
<div class="" style="clear: both; text-align: center;">
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.</div>
<div class="" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_xDTUV2ldbJpbkSXsOvZJP2-EaPGTQsJ2tpzp_RtDmpA6tFRcGmrkfqTqVqu3gkALtGkm48d1DaGtXgf1u2qfqTumo0H-Q2qfQyE5H846kz4zrmp6rP0flCPcy7RFb9CIbCJ79yRqB8vP/s1600/hep+ref.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_xDTUV2ldbJpbkSXsOvZJP2-EaPGTQsJ2tpzp_RtDmpA6tFRcGmrkfqTqVqu3gkALtGkm48d1DaGtXgf1u2qfqTumo0H-Q2qfQyE5H846kz4zrmp6rP0flCPcy7RFb9CIbCJ79yRqB8vP/s1600/hep+ref.jpg" height="213" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
Reference image - Gallbladder (green) liver (orange) kidneys (light blue) aorta (red) inferior vena cava (blue)</div>
<div class="" style="clear: both; text-align: center;">
<br /></div>
<div class="" style="clear: both; text-align: left;">
Reference: Are dilating bile ducts a cause for concern? ML Wilkinson, Gut 1999;45:637-638</div>
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-72163046488719975332014-05-28T19:36:00.001-04:002014-05-28T19:38:17.442-04:00Empathy: The Human Connection to Patient Care<div class="separator" style="clear: both; text-align: center;">
<object class="BLOGGER-youtube-video" classid="clsid:D27CDB6E-AE6D-11cf-96B8-444553540000" codebase="http://download.macromedia.com/pub/shockwave/cabs/flash/swflash.cab#version=6,0,40,0" data-thumbnail-src="https://ytimg.googleusercontent.com/vi/cDDWvj_q-o8/0.jpg" height="266" width="320"><param name="movie" value="https://youtube.googleapis.com/v/cDDWvj_q-o8&source=uds" /><param name="bgcolor" value="#FFFFFF" /><param name="allowFullScreen" value="true" /><embed width="320" height="266" src="https://youtube.googleapis.com/v/cDDWvj_q-o8&source=uds" type="application/x-shockwave-flash" allowfullscreen="true"></embed></object></div>
<br />
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...Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-39529214585502576762014-03-09T16:07:00.002-04:002014-03-09T16:09:17.976-04:00Non-osseous abnormalities on bone imagingI 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<a href="http://tech.snmjournals.org/content/31/3/149.full" target="_blank"> non-osseous abnormalities</a>. During my years of teaching, students have brought in many examples which I wish to share...<br />
<br />
In the area of altered biodistribution, whether due to faulty preparation or pharmaceutical interference:<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwT3BBYljlvXo1FOtxpJQ-Sxt1LN-I_Ps4HCy8hKMSVUdfG-KHOqZOF4dRKqtypazEaDD8VaB4KjwAIQT4mcV7YV67EEbpJy02jB1o9DPbYvRA2tGIrZQnrSxcFvdoRDofIPHhgS8kooWz/s1600/Bone+2001-0222.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwT3BBYljlvXo1FOtxpJQ-Sxt1LN-I_Ps4HCy8hKMSVUdfG-KHOqZOF4dRKqtypazEaDD8VaB4KjwAIQT4mcV7YV67EEbpJy02jB1o9DPbYvRA2tGIrZQnrSxcFvdoRDofIPHhgS8kooWz/s1600/Bone+2001-0222.jpg" height="320" width="212" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<br />
It was noted in the article that drug interaction with diphosphonates used in treatment of osteoporosis can lead to decreased skeletal uptake.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaNyIXYWQ7ZOHWZZU-4nwqISWIpq6F6sOYv4Ag5LGM21qXYWykIJ2MG5onKpkTbPsZK-ACQq1YlFP48nbiSZ1nNTihfeClUakAnlhgRQGzbcV0TlgqSduK4Q9EwK5PIMViaNXEMxPotKP0/s1600/Bone+2000-0103.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjaNyIXYWQ7ZOHWZZU-4nwqISWIpq6F6sOYv4Ag5LGM21qXYWykIJ2MG5onKpkTbPsZK-ACQq1YlFP48nbiSZ1nNTihfeClUakAnlhgRQGzbcV0TlgqSduK4Q9EwK5PIMViaNXEMxPotKP0/s1600/Bone+2000-0103.jpg" height="320" width="117" /></a></div>
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...<br />
<br />
Uptake related to the urinary system, is the most common finding of non-osseous uptake. Findings include: dilated, obstructed ureters, hydronephrosis, renal cysts:<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg49wdzWqEy-rWrJDlof1CzR6yEa8A2I-CiU4f41w2TPXjymFXtV5UXOkpCQZg3ubhSlrBw5bVirRQCvUfQO_5bUHzj8waWkPEvROqUZdA_MlpXq2cfTH-_iR4EkQYQA50NqkifV7Sp0Nvo/s1600/2001-1024.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg49wdzWqEy-rWrJDlof1CzR6yEa8A2I-CiU4f41w2TPXjymFXtV5UXOkpCQZg3ubhSlrBw5bVirRQCvUfQO_5bUHzj8waWkPEvROqUZdA_MlpXq2cfTH-_iR4EkQYQA50NqkifV7Sp0Nvo/s1600/2001-1024.jpg" height="320" width="90" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIY-WjRFhiM1dxrz4L4-bbz9Am2fCOVt0EtFdXVtktz-CAfTVxP06WPcte2K-N1tiSv5574X2QI5rIFREeHVwXnHm27cMZHdXYFp_Tp3cANqsc_cEqffSVKnXG6BKAxZqcZ0ylXVv6BUjc/s1600/Bone+2003-0508.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIY-WjRFhiM1dxrz4L4-bbz9Am2fCOVt0EtFdXVtktz-CAfTVxP06WPcte2K-N1tiSv5574X2QI5rIFREeHVwXnHm27cMZHdXYFp_Tp3cANqsc_cEqffSVKnXG6BKAxZqcZ0ylXVv6BUjc/s1600/Bone+2003-0508.jpg" height="320" width="176" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOBoX-jzcA6uPiubR48hbzRXO8BHhdrIuORxRsf6GHWAzs5qkL4rHpS0izIMMQsVfqRIcRJlxmpLnnNOIamUcbNEv0a6ufsiEvO2T4oADkI-0vr6ve_y7RE1qGn0UKzx2GGKqosqG5Fei1/s1600/Bone+1986-0117.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOBoX-jzcA6uPiubR48hbzRXO8BHhdrIuORxRsf6GHWAzs5qkL4rHpS0izIMMQsVfqRIcRJlxmpLnnNOIamUcbNEv0a6ufsiEvO2T4oADkI-0vr6ve_y7RE1qGn0UKzx2GGKqosqG5Fei1/s1600/Bone+1986-0117.jpg" height="200" width="156" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOr1SgPEZVV4FoowRTsamVkMPbdeLAi2F9kYtUfOutYYoB_yW8R67_w43DNBS1TUhXmPxoCnEJKRRsIuCWi_niuN0dUqbsfS2HDcIkkikOtsAN-ROY5D3vfNl9eKW80OwVE4O9JpHMtyYR/s1600/skeletal+adrenal-p.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhOr1SgPEZVV4FoowRTsamVkMPbdeLAi2F9kYtUfOutYYoB_yW8R67_w43DNBS1TUhXmPxoCnEJKRRsIuCWi_niuN0dUqbsfS2HDcIkkikOtsAN-ROY5D3vfNl9eKW80OwVE4O9JpHMtyYR/s1600/skeletal+adrenal-p.jpg" height="200" width="200" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Soft tissue uptake may be found in various areas due to soft tissue calcification, which may point to specific pathology:</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9PMfz0NyDawEH0jNp6p-QGhpzRIajpafeKc-u1ZVaxgqYus3qI993Sw6b0runBJ1S-R5A3C5-0BtCw6s_iyzUzWIz_Sr3prgtDaAs7aoe4XzdhQocP83jDL4Yqjc_ABJmaX8y4actm2Ol/s1600/bone+2002-0320.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi9PMfz0NyDawEH0jNp6p-QGhpzRIajpafeKc-u1ZVaxgqYus3qI993Sw6b0runBJ1S-R5A3C5-0BtCw6s_iyzUzWIz_Sr3prgtDaAs7aoe4XzdhQocP83jDL4Yqjc_ABJmaX8y4actm2Ol/s1600/bone+2002-0320.jpg" height="320" width="98" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDY8hp1c3V3lclH2yQWWpfWmlbUOSjRN7GfWzTSw5pzUpGnJAuJBaz7qcXG-xSkfPs18uGUfwgwFLjPLxIX9dJfqjY-QTq1ZXoBcV3mQiYw217sbJ8HqfTRPgHl3Ok9uwEBVVUZXLNweXn/s1600/Bone+2002-1018.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDY8hp1c3V3lclH2yQWWpfWmlbUOSjRN7GfWzTSw5pzUpGnJAuJBaz7qcXG-xSkfPs18uGUfwgwFLjPLxIX9dJfqjY-QTq1ZXoBcV3mQiYw217sbJ8HqfTRPgHl3Ok9uwEBVVUZXLNweXn/s1600/Bone+2002-1018.jpg" height="320" width="120" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy546-xo3XkScSOoYwGqNv1YrEKaNi0GjIp1aIXq01kSJHqjsxdqPpXcXLTde4e-S_5NQ3VbppSK9Ox4IKEj8bcDUIahVl1dDVAj-2FUI5OB8uz6HNMutnGKD2lUyYuveolrB7LtPkBi2h/s1600/Bone+2002-1030.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjy546-xo3XkScSOoYwGqNv1YrEKaNi0GjIp1aIXq01kSJHqjsxdqPpXcXLTde4e-S_5NQ3VbppSK9Ox4IKEj8bcDUIahVl1dDVAj-2FUI5OB8uz6HNMutnGKD2lUyYuveolrB7LtPkBi2h/s1600/Bone+2002-1030.jpg" height="320" width="121" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOrr7VV167tnAMgT1gkf6jiNH3D4dyInAoe8PXMfGJEScPzOb0_MclZx7S0WLOrsIgjGPOWrF0lnx8Xvov6YGSiaA7AKN2mchoYlccWZb6JCNSOAaTz99x3gaWNid3Cg7uC_nXbtdIIAS-/s1600/Bone+2001-0208.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiOrr7VV167tnAMgT1gkf6jiNH3D4dyInAoe8PXMfGJEScPzOb0_MclZx7S0WLOrsIgjGPOWrF0lnx8Xvov6YGSiaA7AKN2mchoYlccWZb6JCNSOAaTz99x3gaWNid3Cg7uC_nXbtdIIAS-/s1600/Bone+2001-0208.jpg" height="320" width="102" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTECkOu4J3xfImITFG4it8tXxcc14NKg95kyhFtG28Z8ZaZ0Xvh8jWjFEl0-KvzLDfmDxqbbCpozxys6eM3eWyDCW0oV0olHIc1RcQ9PTqXMrMbeJfZ-EWmtwMDsrjFqFKi8t8dkL77YF9/s1600/Bone+2005-0331a.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTECkOu4J3xfImITFG4it8tXxcc14NKg95kyhFtG28Z8ZaZ0Xvh8jWjFEl0-KvzLDfmDxqbbCpozxys6eM3eWyDCW0oV0olHIc1RcQ9PTqXMrMbeJfZ-EWmtwMDsrjFqFKi8t8dkL77YF9/s1600/Bone+2005-0331a.jpg" height="320" width="98" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
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...</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<i>Thanks to Heny Shah, Dolores Ambrosy, Corrine Zenkel,</i> </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<br />
<br />
<br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-67464674873123787532013-12-21T18:20:00.002-05:002013-12-21T18:20:47.236-05:00WB Skeletal Imaging - motion artifact<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgn8Mx_uysGW0tXGtA5WObOHIJ0WV13Oxime4pEDUYATjs8xe4ViBZMwpb6XYrQXQgES_WXGXDCa_asUMzeWiDYmQIa4PZBLEKEaUtLVYcVEp_EAuVrwcF30oHP6wui6c2cjrsPTrffHPa_/s1600/1984+skeletal+motion.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgn8Mx_uysGW0tXGtA5WObOHIJ0WV13Oxime4pEDUYATjs8xe4ViBZMwpb6XYrQXQgES_WXGXDCa_asUMzeWiDYmQIa4PZBLEKEaUtLVYcVEp_EAuVrwcF30oHP6wui6c2cjrsPTrffHPa_/s320/1984+skeletal+motion.jpg" width="106" /></a></div>
<br />
<br />
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;">Whole
body bone scan obtained 2 hours following the intravenous injection
of Tc99m MDP.</span></div>
<div style="margin-bottom: 0in;">
<br /></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;">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.</span></div>
<div style="margin-bottom: 0in;">
<br /></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;">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.</span></div>
<div style="margin-bottom: 0in;">
<br /></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;">On
this particular image the patient noticeably moved their head from
right to left resulting in the alien feature of a twin lobed cranium.
</span>
</div>
<div style="margin-bottom: 0in;">
<br /></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;">The
practice of this institution was to perform a whole body posterior
image with spot shots of the anterior skull chest, abdomen, and
pelvis. </span><br />
<span style="font-family: Arial, sans-serif;"><br /></span>
<span style="font-family: Arial, sans-serif;">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..</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-79901309816019763312013-12-21T18:18:00.000-05:002013-12-21T18:18:48.399-05:00Quality Control Troublshooting<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinfFDIt35Q2dG8w-YLLzvtV0hoIIEJNspMNnot45T82FVB5z71KkYy2cp9-mXzoDPGRWe4_H1MIk6CYxEKUWUCioBtB44RxlJGoG_w6pTVK3Qxg84ZTMV4bB5EOrlVESEqekEhQCWa8a4T/s1600/20131216+flood.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEinfFDIt35Q2dG8w-YLLzvtV0hoIIEJNspMNnot45T82FVB5z71KkYy2cp9-mXzoDPGRWe4_H1MIk6CYxEKUWUCioBtB44RxlJGoG_w6pTVK3Qxg84ZTMV4bB5EOrlVESEqekEhQCWa8a4T/s320/20131216+flood.JPG" width="320" /></a></div>
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.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZgMaj2JI_u6ZdiCEzZM7LSEjnDfgetLpDnErPlz9jl-8QTRQlahBND2TMd7EZhDzbrWRFuE_t71QkNhIw1klUeazHtrpz-5Gtl0gbhtzEmSo-uZ60auJj_8XK6tfqXlc1EbMoaKU9cBdZ/s1600/20131216+flood+A.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="256" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgZgMaj2JI_u6ZdiCEzZM7LSEjnDfgetLpDnErPlz9jl-8QTRQlahBND2TMd7EZhDzbrWRFuE_t71QkNhIw1klUeazHtrpz-5Gtl0gbhtzEmSo-uZ60auJj_8XK6tfqXlc1EbMoaKU9cBdZ/s320/20131216+flood+A.JPG" width="320" /></a></div>
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.<br />
<br />
I then checked my discarded gloves, which I Usually place on top of the collimator cart after placing the source and removing them...<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTvAqM9WY91C61PewCOBWAQ7Z3i3AiHb5-y8hk3CgNAIbRsm82-nUH4WcZPhpHL00gmbyOi_FMzkgm5zx0Dl1rvZxoIle62FojKrJg9jyNpktknc_V_xxg6diPHiTzDyriFo8x1B_hoWrU/s1600/uniformity.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTvAqM9WY91C61PewCOBWAQ7Z3i3AiHb5-y8hk3CgNAIbRsm82-nUH4WcZPhpHL00gmbyOi_FMzkgm5zx0Dl1rvZxoIle62FojKrJg9jyNpktknc_V_xxg6diPHiTzDyriFo8x1B_hoWrU/s320/uniformity.jpg" width="320" /></a></div>
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...Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-61145231633684132752013-06-22T12:50:00.002-04:002013-06-22T12:52:06.374-04:00WB Skeletal Imaging - Contamination<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUJa_pkfGeUF7VlZLoyuVC0V4OuVU7Hw6zWScWM4n4z9vmUli5Tcei_1P04xr44D6LwyFtB3gyrMakPnmFxq-mNPbVwkAGmGoxCFp5SQwpcjrsrwOAQSDJ8PrHM0rHyZciJiAEXzO0ZdMI/s1600/19971208+skeletal.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUJa_pkfGeUF7VlZLoyuVC0V4OuVU7Hw6zWScWM4n4z9vmUli5Tcei_1P04xr44D6LwyFtB3gyrMakPnmFxq-mNPbVwkAGmGoxCFp5SQwpcjrsrwOAQSDJ8PrHM0rHyZciJiAEXzO0ZdMI/s320/19971208+skeletal.jpg" width="278" /></a></div>
<br />
<br />
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;"><i>Clinical
History</i>: 73 year old female with low back pain. </span>
</div>
<div style="margin-bottom: 0in;">
<br /></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;"><i>Technique</i>:
3phase and whole body bone scan performed following injection of 23
mCi MDP.</span></div>
<div style="margin-bottom: 0in;">
<br /></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;"><i>Findings</i>:
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.</span></div>
<div style="margin-bottom: 0in;">
<br /></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;">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.</span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif;"><br /></span></div>
<div style="margin-bottom: 0in;">
<span style="font-family: Arial, sans-serif; font-size: x-small;">Thanks to Y.H. Park, MD, Meredith Smela, Debbie Reed</span></div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-43447422280439366262013-03-16T07:12:00.001-04:002013-03-16T07:12:57.242-04:00GNYCSNM Atlantic City 2013!!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4ewJdOFlXv_WKFmkgeQIrC8yZsm1FlCfKVd25jHIh0fFWlSXdYudBbKPwUYNihZjKUd6osR4y3KsfTNC8L9jSQzilqTO93LdKyPQ1nZ5GQFs9VrIDg_MowQukgTNen8J0NOHnC1kueqI/s1600/IMG_2385.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4ewJdOFlXv_WKFmkgeQIrC8yZsm1FlCfKVd25jHIh0fFWlSXdYudBbKPwUYNihZjKUd6osR4y3KsfTNC8L9jSQzilqTO93LdKyPQ1nZ5GQFs9VrIDg_MowQukgTNen8J0NOHnC1kueqI/s320/IMG_2385.jpg" width="320" /></a></div>
<br />Anonymoushttp://www.blogger.com/profile/16382806271426075019noreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-37388078789964910922013-02-02T06:49:00.000-05:002013-02-02T06:49:00.441-05:00Bone Scan - Post Reclast Therapy<div class="separator" style="clear: both; text-align: left;">
Reclast is marketed by Novartis, was was approved by the FDA for treatment of Paget's Disease in 2007. Administered by infusion, the main ingredient, zoledronioc acid, is also marketed by Novartis as Zometa for use in the treatment of skeletal fractures in patients with cancers such as multiple myeloma and prostate. It has also been used to treat osteoporosis. For the treatment of Paget's patients recieve a single dose, annually. Results of studies for Reclast were published in the Sep 1, 2005 issue of the New England Journal of Medicine.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The cause of Paget's Disease is unknown. The disease causes an abnormal breakdown of bone tissue, followed by abnormal bone formation. The new bone is enlarged but weaker. The disease often effects the bones of the arms, collarbones, legs, pelvis, spine and skull.</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLgKYcsnXTH9yuJ80H15RW7RIwZQ_6lDOxv4H-kRXSUfyAwa80wcyXsQoOSFsmTLVgBr46sSP-3SNtLqDiU1c-jbmx1eS1irmL-KyXpUy0kqhUzbJBDjWq_3lHOVgwj70zeHNYWuxV0Sqc/s1600/paget11b.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLgKYcsnXTH9yuJ80H15RW7RIwZQ_6lDOxv4H-kRXSUfyAwa80wcyXsQoOSFsmTLVgBr46sSP-3SNtLqDiU1c-jbmx1eS1irmL-KyXpUy0kqhUzbJBDjWq_3lHOVgwj70zeHNYWuxV0Sqc/s320/paget11b.jpg" width="320" /></a></div>
<div style="text-align: center;">
2011</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh85DNmkEebNd7xuhqIzNNfSiXKgZDjM8SqybsTQZNXKtNKyCV90N_NaXMZhkAXhUbIJUPVuR-o-q0rCjZNHduJWMYrHjG20E0ur4LaeDg1aIHetIy3ENl4KGMmLM_JdQeGxhaU3ooLIsh/s1600/paget13b.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh85DNmkEebNd7xuhqIzNNfSiXKgZDjM8SqybsTQZNXKtNKyCV90N_NaXMZhkAXhUbIJUPVuR-o-q0rCjZNHduJWMYrHjG20E0ur4LaeDg1aIHetIy3ENl4KGMmLM_JdQeGxhaU3ooLIsh/s320/paget13b.jpg" width="320" /></a></div>
<div style="text-align: center;">
2013</div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
The above patient studies were obtained at 3 hours following the injection of 25 mCi Tc MDP. Whole body bone scans with post void images of the pelvis were obtained. The study from 2013 demonstrates marked decreased activity in the right hemipelvis, following Reclast therapy, as compared to the study from 2011. </div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-74041059258432367222013-01-31T19:52:00.000-05:002013-01-31T19:52:00.111-05:00Sentinel Node ImagingSentinel Node imaging was introduced it served as a means to reduce the number of lymph nodes excised during surgery, thereby reducing the morbidity rate in women undergoing the procedure. The concept is to establish the path that cancerous cells may take along the lymphatic channels, allowing for metastic cells to travel to other organs.<br />
<br />
Debate has often been raised as to whether there is a need for imaging or not. Surgeons have requested patients receive the injection and go right to surgery...<br />
<br />
The proceeding example demonstrates a reason to image the patient, which is first and foremost to ensure the injection is good and the materials is traveling through the lymphatic channels. But secondary to determine where the radiopharmaceutical is traveling.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_6NIMnvfirUCBG7_phRD6r35JcAqT2qJHQgGjTFcDJhLR8bt9JxlOnJh6c00xeYQtEapuwKVMitJMojUj1_mOaj3K3rv6Qle-pNxx7-ZTNZ6QEINZTK_MvC-xuy1JV7RJ-RRjjnMcdqma/s1600/SN1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="235" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_6NIMnvfirUCBG7_phRD6r35JcAqT2qJHQgGjTFcDJhLR8bt9JxlOnJh6c00xeYQtEapuwKVMitJMojUj1_mOaj3K3rv6Qle-pNxx7-ZTNZ6QEINZTK_MvC-xuy1JV7RJ-RRjjnMcdqma/s320/SN1.jpg" width="320" /></a></div>
This patient presents with right breast cancer, pre-lumpectomy and lymph node dissection. The patient was positioned in a right oblique position and injected with 500 uCi Tc99m sulfa colloid with Lidocaine by subcutaneous injection to the right of the nipple. When the patient was placed under the camera it was noted that there were lymphatic tracks above and below the injection site.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBO2dTBUBmFbABcKPmKk7axqdNJwn0DGh91pNDd9W9qQfB1HuPBNmaeAcFUDq-u_2Kssp8wr_K8rJBZg2Slq164V2jHEgMlUHgczmQGrIAvX8BUqzZNMNqIIkWR0MwZ2E8cTM3NxlMZpzS/s1600/SN2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="228" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhBO2dTBUBmFbABcKPmKk7axqdNJwn0DGh91pNDd9W9qQfB1HuPBNmaeAcFUDq-u_2Kssp8wr_K8rJBZg2Slq164V2jHEgMlUHgczmQGrIAvX8BUqzZNMNqIIkWR0MwZ2E8cTM3NxlMZpzS/s320/SN2.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
On the next image a lead blocker was placed over the injection site and imaging was continued at 2 minute intervals.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMYW3j37IgcuiqkdS9SZMDM4dfR-rVpST10qv7SNX9WWJdAoxf4ABtVC6yhf0KQRGXzo9navXPiMx29qoNnGxxp2S49YfENKXqVcDeDJMwm4gftTY7t1MOEPuuGBNXXIA6tIDdLmS2xWwO/s1600/SNRL.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="227" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiMYW3j37IgcuiqkdS9SZMDM4dfR-rVpST10qv7SNX9WWJdAoxf4ABtVC6yhf0KQRGXzo9navXPiMx29qoNnGxxp2S49YfENKXqVcDeDJMwm4gftTY7t1MOEPuuGBNXXIA6tIDdLmS2xWwO/s320/SNRL.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
Although the physician was confident in the location of the sentinel node in the right axilla, he wanted confirmation that the lower track was not going to a lymph node but as altered due to the patient's previous surgery in the lower portion of the right breast. The patient was placed in the right lateral position and the right axillary node is easily identified and the lower track appears to remain in the breast tissue. No lead placed over injection site.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMYmWH_150KCHwJaoXe5JsyR9oZQrz6-jK5QYngAw4vxqFscUAL5_CSdknMmi-BP2GHXbPdsWs2d3LP_9VJ2do7_TjM-6xXjld6FKOH_IRUX_HW0PRsUPfybqpy6f4m8kzKh1Jz5JmRyXM/s1600/SN+rpo.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="232" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjMYmWH_150KCHwJaoXe5JsyR9oZQrz6-jK5QYngAw4vxqFscUAL5_CSdknMmi-BP2GHXbPdsWs2d3LP_9VJ2do7_TjM-6xXjld6FKOH_IRUX_HW0PRsUPfybqpy6f4m8kzKh1Jz5JmRyXM/s320/SN+rpo.jpg" width="320" /></a></div>
To further define the activity in the right breast, the patient was placed in an oblique position with a wedge under the left shoulder and imaged from the right posterior oblique position. This view allows the breast to move away from the patient's torso to further show the activity below the injection site (blue dot at site of lead blocker) is confirmed to be in the breast tissue.<br />
<br />
As the radiologist put it, this became an exercise in obliques to best find the view that would confirm the activity was indeed in the breast and not traveling to a lymph node.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-89190064464479722582013-01-30T19:01:00.001-05:002013-01-30T19:02:19.452-05:00Whole Body Bone SPECT<br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
Recently we starting looking at whole body bone spect imaging for metastatic evaluation. Metastatic disease in the vertebral bodies can be difficult to detect on planar whole body imaging, and an abnormal finding does not always mean metastatic disease. It is also difficult to detect small abnormalities in the thoracic vertebrae.<span class="Apple-style-span" style="font-size: xx-small;">1 </span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<span class="Apple-style-span" style="font-size: xx-small;"><br /></span>In order to acquire a whole body bone spect in an acceptable time frame, the time per bed has to be reduced. Studies were performed and determined that a bone spect can be acquired in as little as 5 minutes and still be acceptable as compared to planar imaging.<span class="Apple-style-span" style="font-size: xx-small;">2</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<br /></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
Filtered back projection - the most commonly used method of image reconstruction. the back projection assigns values in the projection to all points along the line of acquisition through the image plane from which it is acquired. This can create an star artifact consisting of radial lines at the edge of the object, to which a filter is then applied to reduce this artifact.<span class="Apple-style-span" style="font-size: xx-small;">3</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<br /></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
Iterative reconstruction - is a more computer intensive program, which uses the original projections and models of the acquisition to predict areconstruction. The predicted projections are used to modify the recontstruction. In the OSEM method the projection data are ordered into subsets. The advantage of this is an increase in computer processing speed.<span class="Apple-style-span" style="font-size: xx-small;">3</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<br /></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
Iterative reconstruction has proven to be superior to count poor data, which would create excessive noise from the radial lines when filtered back projection is applied. Our data was acquired at 6 secs per view, 64 views for a 12 minute acquisition time, compared to our standard SPECT acquisition time of 40 minutes.</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<br /></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
When the initial study was reviewed it was noted that some problems existed. The first bed (patient head) looked good but the rest of the body offered excessive background noise, especially around the bladder. It was discovered that the iterative reconstruction was applied to the first bed, while filtered back projection had been applied to the remainder of the study.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjX95xzJyIQlHbQd6-h15FD-nBpFKzAzIw7Tao2qMaPLpDOq0orqeanDpFgNIZDOnOYm66uR9GZ2t_FSbW_Yc3r4s34FCp9UiRtknSb0_y6qFxgGyV8S0pBvppOIwUky-YFbDJP_rnW9IyO/s1600/WB+BONE+SPECT+fbp.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjX95xzJyIQlHbQd6-h15FD-nBpFKzAzIw7Tao2qMaPLpDOq0orqeanDpFgNIZDOnOYm66uR9GZ2t_FSbW_Yc3r4s34FCp9UiRtknSb0_y6qFxgGyV8S0pBvppOIwUky-YFbDJP_rnW9IyO/s320/WB+BONE+SPECT+fbp.jpg" width="320" /></a></div>
<br />
<div style="text-align: center;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<i>Whole body coronal slices processed with filtered back projection</i></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<br /></div>
<div style="text-align: left;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
After re-processing the data with iterative reconstruction applied to all of the beds we noted another problem. The right half of the skeleton has a brighter, crisper look. It was then discovered that the data selector for processing was for 180 degrees. </div>
</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR63b8WHkUqAf7JFk7JhfppDLZmuVp42ogRK2EDhXVhGIsWjVzxWfrGX17RbhJhqRSRY7QiQOV6xAKydf98SxDWftKc-oUO4rmPuKhvUZzR5JO04x6aBJ77e6p6GQLkHxQPMH535zvOceo/s1600/WB+BONE+SPECT+180.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR63b8WHkUqAf7JFk7JhfppDLZmuVp42ogRK2EDhXVhGIsWjVzxWfrGX17RbhJhqRSRY7QiQOV6xAKydf98SxDWftKc-oUO4rmPuKhvUZzR5JO04x6aBJ77e6p6GQLkHxQPMH535zvOceo/s320/WB+BONE+SPECT+180.jpg" width="320" /></a></div>
<br /></div>
<div class="separator" style="clear: both; margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: center;">
</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<i>Reprocessed coronal slices with iterative reconstruction, but 180 degree processing</i></div>
</div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
<br /></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
We adjusted the processing protocol to used the 360 degree method and re-processed the data again. This time the study came out with excellent results. (I never knew the system could process half a study?!)<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxRH6Ko1YHcSCfWYRzenHFq5fkYnMhEW7RjuZQSc3BFpxifjD6PnQhim8u8Q1aXpXWmqpO_oDku1h2EHqiYgAe7qIiFDJyNTWk9JxO_byIAtmMOJtzajar0UHlnZGPNfOwahA-N89yuToB/s1600/WB+BONE+SPECT.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxRH6Ko1YHcSCfWYRzenHFq5fkYnMhEW7RjuZQSc3BFpxifjD6PnQhim8u8Q1aXpXWmqpO_oDku1h2EHqiYgAe7qIiFDJyNTWk9JxO_byIAtmMOJtzajar0UHlnZGPNfOwahA-N89yuToB/s320/WB+BONE+SPECT.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIHA3VbSpLA7QxZ4MUJ7_usOj5jAF9tH9YLHKCLRszEZoXK1liRrabd6dlW6Q2KzHVV36gvwK0Iv-dzKCrr8dCQiWcf_R-arFaVDJ4SpFc0-xv0xgmxwcCDVGgyW4QKyvrn5JKgaluzKFC/s1600/wb+bone+process.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIHA3VbSpLA7QxZ4MUJ7_usOj5jAF9tH9YLHKCLRszEZoXK1liRrabd6dlW6Q2KzHVV36gvwK0Iv-dzKCrr8dCQiWcf_R-arFaVDJ4SpFc0-xv0xgmxwcCDVGgyW4QKyvrn5JKgaluzKFC/s320/wb+bone+process.jpg" width="280" /></a></div>
<div class="" style="clear: both; text-align: center;">
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
Processing page, applying 5 separate acquisitions into one study</div>
<div>
<br />
<div style="text-align: left;">
<br /></div>
<br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<span class="Apple-style-span" style="font-size: x-small;">References:</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<span class="Apple-style-span" style="font-size: x-small;">1 - Do short-time SPECT images of bone scintigraphy improve the diagnostic value in the evaluation of solitary lesions in the thoracic spine in patients with extra-skeletal malignancies? </span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<span class="Apple-style-span" style="font-size: x-small;">Kobayashi, et al. Annals of Nuclear Medcine vol 19 No 7, p557-566, 2005.</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="font-size: x-small;"><br /></span></div>
<span class="Apple-style-span" style="font-size: x-small;">2 - What is the optimal minimum whole body bone SPECT scan duration that can replace planar scintigraphy? </span><br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<span class="Apple-style-span" style="font-size: x-small;">Mawlawi, et al, The Journal of Nuclear Medicine vol 48 supplement 2, p120, 2007.</span></div>
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px;">
</div>
<div style="text-align: left;">
<span class="Apple-style-span" style="font-size: x-small;"><br /></span></div>
<span class="Apple-style-span" style="font-size: x-small;">3 - Nuclear Medicine and PET/CT, technology and Techniques.</span><br />
<div style="margin-bottom: 0px; margin-left: 0px; margin-right: 0px; margin-top: 0px; text-align: left;">
<span class="Apple-style-span" style="font-size: x-small;">Christian and Watersum-Rich, Mosby Elevier</span></div>
</div>
</div>
</div>
</div>
Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-89138825736049047462012-12-02T19:26:00.001-05:002012-12-02T19:26:54.472-05:00Stress Fracture - Shin SplintsA stress fracture is an overuse injury, one of the most common injuries in sports, especially the weight bearing bones of the lower extremities.<br />
<br />
MRI has surpassed skeletal scintigraphy showing equal sensitivity, but a higher specificity, while providing improved anatomical detail. However, there is still reason for obtaining a three phase bone scan for lower extremity trauma when MRI may be inconclusive or for patients who can not handle the MRI scan.<br />
<br />
Often a physician will request a 3 phase bone scan for lower leg pain to determine if the pain in a patient's lower extremity is either a stress fracture or trauma, or shin splints (medial tibial stress syndrome).<br />
<br />
A stress fracture often occurs as the result of an increasing amount or intensity of pressure during an activity more rapidly than the bone structure can manage. They may also be caused by impact (rapid change in surface hardness), improper equipment (poor foot support in a shoe) and increased physical stress.<span class="Apple-style-span" style="font-size: xx-small;"><a href="http://Monarchy of Roses Factory of Faith Brendan's Death Song Ethiopia Annie Wants a Baby Look Around The Adventures of Rain Dance Maggie Did I Let You Know Goodbye Hooray Happiness Loves Company Police Station Even You Brutus? Meet Me At the Corner Dance, Dance, Dance Even You Brutus" target="_blank">1</a></span><br />
<br />
The stress fracture is a small crack in the bone without displacement. The associated symptom is pain, which subsides with rest.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpJGN91jBQ-vMPPUui1TSr6pr4OQnsO_qNmBUo-0ai-idQfvJpBdvjCQ3miR9z_rowm41LlKmVEk_aotCfoF7h5BXZXJBpOlhiG-JQ-N9Sv2qzb-uSYRJcDLcIkYSUGUhzo5bgtbo0IjeO/s1600/Bone+2003-0219A.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpJGN91jBQ-vMPPUui1TSr6pr4OQnsO_qNmBUo-0ai-idQfvJpBdvjCQ3miR9z_rowm41LlKmVEk_aotCfoF7h5BXZXJBpOlhiG-JQ-N9Sv2qzb-uSYRJcDLcIkYSUGUhzo5bgtbo0IjeO/s320/Bone+2003-0219A.jpg" width="310" /></a></div>
<i>Delayed skeletal images of a young jogger complaining of lower extremity pain while running. Top images show lateral and medial images, white the lower images show anterior and posterior images of the lower extremities. all views demonstrate a focal area of uptake in the left tibia, consistent with a stress fracture. The area correlated with the patient's focus of pain.</i><br />
<br />
On a 3 phase bone scan the dynamic flow with have increased uptake at the site of injury. The second phase (blood pool, soft tissue) will also have increased uptake associated with edema around the injured site.<br />
<br />
The 3rd phase (skeletal image) will again demonstrate increased focal uptake at the site associated with the patient's pain.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ8YlFwWstn985r_yoMAX2OUbDv6lzPHCnttslqWg-qgTP9R5KB7ysRCamGkB9K5qrCNvKtlqyaqfEQ8dvBF2IoR-MbHSDwm9L8lxEo9mmkot6BFPlpi8Txqf9F-lzP8CPEARh5aHcXmi2/s1600/20120731+sk1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjQ8YlFwWstn985r_yoMAX2OUbDv6lzPHCnttslqWg-qgTP9R5KB7ysRCamGkB9K5qrCNvKtlqyaqfEQ8dvBF2IoR-MbHSDwm9L8lxEo9mmkot6BFPlpi8Txqf9F-lzP8CPEARh5aHcXmi2/s320/20120731+sk1.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<i>The dynamic images and soft tissue phase (not shown) demonstrated no abnormal uptake or early osseous localization.</i></div>
<div class="separator" style="clear: both; text-align: center;">
<i>Anterior delayed image - young female athlete complaining of lower extremity pain for 6 months. MRI was inconclusive for stress fracture, but positive for a stress injury.</i></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEpG4lTZl872klZFVMlqm5566wAu8vuDKUGhPUJqDpt4vsLvMFGIqICVRWL6gr9ZFb3DMyP-MjqqugyAvmKaLx-SIgnpSvMP_3TREkqNX7CtL7ObJCN6wui6WGVnGWc1EHx41UkBFAIlS6/s1600/20120731+lt.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjEpG4lTZl872klZFVMlqm5566wAu8vuDKUGhPUJqDpt4vsLvMFGIqICVRWL6gr9ZFb3DMyP-MjqqugyAvmKaLx-SIgnpSvMP_3TREkqNX7CtL7ObJCN6wui6WGVnGWc1EHx41UkBFAIlS6/s320/20120731+lt.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<i>Right lateral and left medial image demonstrates linear uptake along the tibial shaft consistent with </i></div>
<div class="separator" style="clear: both; text-align: center;">
<i>shin splints. No evidence of fracture.</i></div>
<div class="separator" style="clear: both; text-align: center;">
<i><br /></i></div>
The shin splint is an inflammation of the muscle, tendons and bone tissue around the tibia, usually along the inner border of the tibia where the muscle attaches to the bone. Shin splints may be the result of improper footwear, increase in workload on the lower extremities, changes in surface conditions. All the same causes as a possible stress fracture.<br />
<br />
The patient complaint is pain, which may be associated with mild swelling, which subsides with rest.<br />
<br />
On a 3 phase bone scan their may be some activity associated with edema on the flow or soft tissue phases. However the delayed skeletal image will not have a focal point of activity, but increased uptake seen along the tibia.<br />
<br />
An advantage of utilizing the bone scan over MRI is the ability to image the whole body following injection. Keep in mind that patients complaining of lower extremity pain may have associated hip pain.<br />
<br />
<br />
<br />
<br />
<br />
<br />Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-11624085937858089362012-10-10T18:08:00.001-04:002012-10-10T18:08:45.530-04:00Abnormal I-131 case studyExamination: Whole Body Iodine Scan<br />
<br />
Clinical Information: 79 year old female with prior history of thyroid cancer<br />
<br />
Following thyrogen stimulation performed according to standard protocol. 4.10 mCi I-131 was administered to the patient orally. At 48 hours after radiopharmaceutical administration, anterior and posterior whole body images were acquired along with with anterior and posterior images of the head, neck, thorax, abdomen, and pelvis.<br />
<br />
The study demonstrates increased activity in the mediastinum and the two foci of increased activity in the right abdomen. Mediastinal activity appears abnormal and is most concerning for recurrent disease. Activity in the abdomen may be physiologic. For these regions, a chest, abdomen and pelvic CT is advised for fursther investigation.<br />
<br />
The calculated uptake at the level of the thyroid bed is 0.4%. No focal site of abnormal increased activity is seen at this level on the acquired images.<br />
<br />
IMPRESSION:<br />
<br />
Abnormal whole body iodine scan with increased activity in the mediastinum that is most concerning for recurrent disease. Additional sites of uptake are noted in the right abdomen but this may be physiologic. CT scan of the chest, abdomen, and pelvis is advised for further investigation.<br />
<br />
END IMPRESSION<br />
<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpB1cWoSj3UGGnLdjzuEV6_tI91IctsWWP2aM_t5Lx7vJbWJ2Tkv1nQrncXPMTLzWbFT5ofgy5rlNE607eQ24LPWTiVtiURPuIQq074X09GH0D9V340ekFF9OxC6OVCuQjE7gbeFMc2-E/s1600/Abnormal+I-131+WB.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpB1cWoSj3UGGnLdjzuEV6_tI91IctsWWP2aM_t5Lx7vJbWJ2Tkv1nQrncXPMTLzWbFT5ofgy5rlNE607eQ24LPWTiVtiURPuIQq074X09GH0D9V340ekFF9OxC6OVCuQjE7gbeFMc2-E/s320/Abnormal+I-131+WB.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtMscQydM1fvXVOo7y4WlA2yCRrS6bQMlzSsWGye6dhFt8Ju7_x8tvruaPGf_Gd6TUYzflJOtxswDQYBZenSa8NGKKhZ-9ccRxTbmqGWd6dbrRvGlL2k-W0MUhQKKGTjVJ_0N9o4uNCcs/s1600/I-131+Statics.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtMscQydM1fvXVOo7y4WlA2yCRrS6bQMlzSsWGye6dhFt8Ju7_x8tvruaPGf_Gd6TUYzflJOtxswDQYBZenSa8NGKKhZ-9ccRxTbmqGWd6dbrRvGlL2k-W0MUhQKKGTjVJ_0N9o4uNCcs/s320/I-131+Statics.jpg" width="320" /></a></div>
Lady Torreshttp://www.blogger.com/profile/01626462564015571540noreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-69128173278854116512012-10-10T17:50:00.001-04:002012-10-10T17:50:27.282-04:00Abnormal Parathyroid Scan<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEid1r_MSNYZLYjhziFMK1EznMzCDQLnzPkD7KYhgo8VGaT3C_sUNP5p1x3emF9ahRm7kC2ZilZlTd6thdcm11PvWYagzj5zeIqd5BiJ8ZkEwemlL6KBT0z_Osx5w_53dMEyrnXfIvodHug/s1600/Abnormal+Parathyroid+Statics+Case+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEid1r_MSNYZLYjhziFMK1EznMzCDQLnzPkD7KYhgo8VGaT3C_sUNP5p1x3emF9ahRm7kC2ZilZlTd6thdcm11PvWYagzj5zeIqd5BiJ8ZkEwemlL6KBT0z_Osx5w_53dMEyrnXfIvodHug/s320/Abnormal+Parathyroid+Statics+Case+1.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBmQ_LoWLNAkRiBTIFw6ZnUY0isKKK2C3ui-1L80sAMRWJnoNfZRc20zo2EADpm9zTopGR1JZzDUks9mNuKPDeygHx3l7wbIymkBVdtHg2YYDsCc4GvHOmkGtg-t7k0ipSKf5peDIiNVQ/s1600/Abnormal+Parathyroid+transverse+Case+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBmQ_LoWLNAkRiBTIFw6ZnUY0isKKK2C3ui-1L80sAMRWJnoNfZRc20zo2EADpm9zTopGR1JZzDUks9mNuKPDeygHx3l7wbIymkBVdtHg2YYDsCc4GvHOmkGtg-t7k0ipSKf5peDIiNVQ/s320/Abnormal+Parathyroid+transverse+Case+1.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUf9rRYkoO9b64a3FiLV4bjd5C0ZLwhTMs7nuIRBzk97s2U4hFytsOf2S447rp_T9ePHXq77o83S2_11-8z0mv3Cu8SiRxdGzwbA-yoLGVaVxvNe0njdx-brw7YH8-M854YwKQDgqTdB4/s1600/Abnormal+Parathyroid+Sagittal+SPECT+Case+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiUf9rRYkoO9b64a3FiLV4bjd5C0ZLwhTMs7nuIRBzk97s2U4hFytsOf2S447rp_T9ePHXq77o83S2_11-8z0mv3Cu8SiRxdGzwbA-yoLGVaVxvNe0njdx-brw7YH8-M854YwKQDgqTdB4/s320/Abnormal+Parathyroid+Sagittal+SPECT+Case+1.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiafTiLf41TfPVtTj3H9Z2Tj2lptD3uwJpEqquN8K0oIEmmXQEqaHqInB_UrYH8GDp_pVMahm30x71jQRT6QR-UU6PfqLYveQIOdGvU7WG7EHSoNwJ_04xVxaRQZVdYNVdPQMfYZMNGGPI/s1600/Abnormal+Parathyroid+Coronal+SPECT+Case+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiafTiLf41TfPVtTj3H9Z2Tj2lptD3uwJpEqquN8K0oIEmmXQEqaHqInB_UrYH8GDp_pVMahm30x71jQRT6QR-UU6PfqLYveQIOdGvU7WG7EHSoNwJ_04xVxaRQZVdYNVdPQMfYZMNGGPI/s320/Abnormal+Parathyroid+Coronal+SPECT+Case+1.jpg" width="320" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSh5-BQmfJdHPJ-V9b_ln2Vnxr2VH0uI_LJY1kY3xNKSvp2QF-QJ_g9rYLkmDgyu7vGfoSd9vA2ecojKTwB3RH5gw8ql5xVrtsShRTduQTBMzap37RctxSf2wZBsfvZrThQR0DYzgaIWE/s1600/Abnormal+Parathyroid+Composite+Case+1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSh5-BQmfJdHPJ-V9b_ln2Vnxr2VH0uI_LJY1kY3xNKSvp2QF-QJ_g9rYLkmDgyu7vGfoSd9vA2ecojKTwB3RH5gw8ql5xVrtsShRTduQTBMzap37RctxSf2wZBsfvZrThQR0DYzgaIWE/s320/Abnormal+Parathyroid+Composite+Case+1.jpg" width="320" /></a></div>
<br />
<br /><br />
<blockquote id="yui_3_2_0_5_1349905788662449" type="cite">
<div id="yui_3_2_0_5_1349905788662448">
<div id="yui_3_2_0_5_1349905788662447" style="background-color: white; color: black; font-family: times new roman, new york, times, serif; font-size: 12pt;">
<div id="yui_3_2_0_5_1349905788662557">
FINAL REPORT:</div>
<div id="yui_3_2_0_5_1349905788662559">
</div>
<div>
Examination: Nuclear Medicine parathyroid study</div>
<div>
</div>
<div>
Clinical Indication: 79 year old female with hyperparathyroidism</div>
<div>
</div>
<div id="yui_3_2_0_5_1349905788662446">
Technique: After the intravenous administration of 24.2 mCi of Technetium 99m labeled sestamibi. Anterior planar imaging over the neck and upper chest was performed at 15 minutes and at three hous. <span class="yshortcuts cs4-visible" id="lw_1349905796_2">SPECT imaging</span> was also performed.</div>
<div>
</div>
<div id="yui_3_2_0_5_1349905788662454">
Findings: Physiologic distribution of radiotracer is seen. There is a focus of activity within the mid pole of the right thyroid consistent with <span class="yshortcuts cs4-visible" id="lw_1349905796_3">parathyroid adenoma</span>.</div>
<div id="yui_3_2_0_5_1349905788662541">
</div>
<div id="yui_3_2_0_5_1349905788662543">
Impression:</div>
<div id="yui_3_2_0_5_1349905788662545">
</div>
<div id="yui_3_2_0_5_1349905788662547">
Parathyroid adenoma at the mid pole of the right thyroid</div>
<div id="yui_3_2_0_5_1349905788662549">
</div>
<div id="yui_3_2_0_5_1349905788662551">
END IMPRESSION</div>
</div>
</div>
</blockquote>
Lady Torreshttp://www.blogger.com/profile/01626462564015571540noreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-91972924102292714082012-09-06T18:50:00.000-04:002012-09-06T18:50:52.500-04:00Patient orientationWe strive to provide the best quality images possible. However, patients do not always co-operate due to severe pain, which can make lying still on an imaging table very difficult. As technologist it is our job to get the best possible images while accommodating the patient. this may mean making adjustments to the department protocol. If a whole body sweep is part of the protocol, this may mean imaging spot shots instead, or reducing time per image where acceptable.<br />
<br />
One alternative to whole body imaging for a patient who can not lie on their back may be to have the patient lie on their stomach or on their side. Patients who are claustrophobic may be able to manage a whole body scan on their stomach better then if they are on their backs. If the patient position must be adjusted for patient comfort make sure the camera orientation is changed accordingly.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgogPmeN-HT2bxpS3kp6x-N2uu9diFFIxtFDx4WrdbVg5tnlTTmTZMlapn4S3U0k-4uRSOMFu0kzBvtonYQlQuRIt-VrxQnBGyZL2yO5nw4P_8iKPXsTKrUIQQdlD8M2JUQ5a-QLdFLJT1g/s1600/pet+orientation.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="247" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgogPmeN-HT2bxpS3kp6x-N2uu9diFFIxtFDx4WrdbVg5tnlTTmTZMlapn4S3U0k-4uRSOMFu0kzBvtonYQlQuRIt-VrxQnBGyZL2yO5nw4P_8iKPXsTKrUIQQdlD8M2JUQ5a-QLdFLJT1g/s320/pet+orientation.jpg" width="320" /></a></div>
The above template is from a Siemens PETCT scanner. The acquisition page provides four boxes to the right of the upright figure, with small images for patient positioning (supine, prone, right side and left side). The last image of the left side position is depressed, therefore the correlating image on the bottom half of the page demonstrates the patient position. Before acquiring the image ensure the patient is in the same orientation.<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFifL0Rs1T2_MqN4NanlUy56hYTnzCX7k_QHxeWbFPyO1K7mJvCA9Br67oBzDq4uVKLAPBi8QeEqqG42CRVlaE3e1gZ2P8TxI1Ikh6Eux3NIwf6p2TItlM3Aoxud4kVmCRDLtBpAvLgStx/s1600/PETdec.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFifL0Rs1T2_MqN4NanlUy56hYTnzCX7k_QHxeWbFPyO1K7mJvCA9Br67oBzDq4uVKLAPBi8QeEqqG42CRVlaE3e1gZ2P8TxI1Ikh6Eux3NIwf6p2TItlM3Aoxud4kVmCRDLtBpAvLgStx/s320/PETdec.jpg" width="174" /></a></div>
Above is an example of the topogram from a PET scan patient with a history of lung cancer that had difficulty breathing while lying on her back. By having the patient lie on her side (her choice for comfort) she was able to manage the procedure without difficulty.<br />
<br />
Quality imaging does mean patient comfort.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-65316032794424109132012-08-20T22:19:00.002-04:002012-08-20T22:19:09.588-04:00DAT SCAN<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
DAT Scan is used to assess the pre-synaptic striatal uptake in the putamen and caudate of the brain. The different uptake patterns can differentiate between:</div>
<ul>
<li><div class="separator" style="clear: both; text-align: left;">
Parkinsonian syndrom and an essential tremor</div>
</li>
</ul>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
DaTSCAN has a dopamine transporter radioligand which allows it to be taken up by the dopamine receptors in the basal ganglia (putamen & caudate) of the brain.</div>
<span class="separator" style="clear: both; display: block; padding: 4px 0px 3px; text-align: left;"></span><span class="separator" style="clear: both; display: block; padding: 4px 0px 3px; text-align: left;"></span><div class="MsoNormal" style="margin: 0in 0in 10pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt; line-height: 115%;"><strong>Positioning the Patient:<o:p></o:p></strong></span></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Both
detectors should be in lateral positions. Detector 1 should be in left lateral
and detector 2 should be in right lateral. <o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<v:shapetype coordsize="21600,21600" filled="f" id="_x0000_t75" o:preferrelative="t" o:spt="75" path="m@4@5l@4@11@9@11@9@5xe" stroked="f"><span style="font-family: Calibri;">
<v:stroke joinstyle="miter">
<v:formulas>
<v:f eqn="if lineDrawn pixelLineWidth 0">
<v:f eqn="sum @0 1 0">
</v:f></v:f></v:formulas></v:stroke></span></v:shapetype><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Patient
should be laying supine with the head between both detectors. Patient should be
on head rest. You should have 2 straps for chin and forehead. Check if the
patient is straight by using their chin as a guide now the nose.<o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Attempt
to align the ear of patient with middle of detector. Use a point source on ear
to position the caudate and putamen in FOV. The caudate and putamen are always
above the ears meaning you do not have to image the whole head. This is good
for patients with short necks.<o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p> </o:p></span><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Now you find the
radius by mapping around the patient avoiding any collision between camera and
detectors. Once you go around patient 180 degrees. Put detector 1 anterior and
detector 2 posterior.</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><span style="font-family: "Times New Roman","serif"; font-size: 12pt;">You can now begin acquisition.<o:p></o:p></span></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><strong>Acquisition parameters:</strong></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Matrix size : 128 x 128</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">High resolution collimator</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Dual head camera</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"> </span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">60 projections per head</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">30 seconds per view</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">Imaging time : 45 min</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="http://www.cedars-sinai.edu/Patients/Programs-and-Services/Imaging-Center/Imaging-Procedures/Nuclear-Medicine/DaTscansmall.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="220" src="http://www.cedars-sinai.edu/Patients/Programs-and-Services/Imaging-Center/Imaging-Procedures/Nuclear-Medicine/DaTscansmall.jpg" width="320" /></a></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><strong>Case Studies:</strong></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">The following case studies were acquired at Holy Name Medical Center:</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;">CASE #1</span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4pPKCs0v-ID3mFv9DZW2cy_dJ3UXTHa757zwnuTSC-tuwZyiyt6U34-m2v1zSmQIdgQVyMUbLsGI97ix41Lbd38nt395I05kpa4VM5eQ1MWmsBLQtAnhbGSRS3iJk0phCGcitzTchP_0/s1600/DAT+scan+1+transverse.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh4pPKCs0v-ID3mFv9DZW2cy_dJ3UXTHa757zwnuTSC-tuwZyiyt6U34-m2v1zSmQIdgQVyMUbLsGI97ix41Lbd38nt395I05kpa4VM5eQ1MWmsBLQtAnhbGSRS3iJk0phCGcitzTchP_0/s320/DAT+scan+1+transverse.jpg" width="320" /></a></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p> Report Results:</o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p>Abnormal scan consistent with Parkinson's syndrome</o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
CASE #2</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirmvbh2y842Tccp00m0vjq-emxcbEDIYh-L3hd-g-2rRQ26B4G1Ca8qqVuu-EcCtYLMr3uPbFc10iok3rqSeRkUulhoX1frhnzS5TOcqKedxq6BBbk_jPOmIpjqkN9eAyHO4w_7It3LY4/s1600/DAT+scan+5+transverse.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="243" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirmvbh2y842Tccp00m0vjq-emxcbEDIYh-L3hd-g-2rRQ26B4G1Ca8qqVuu-EcCtYLMr3uPbFc10iok3rqSeRkUulhoX1frhnzS5TOcqKedxq6BBbk_jPOmIpjqkN9eAyHO4w_7It3LY4/s320/DAT+scan+5+transverse.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p> Report Results:</o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p>Scan is negative for Parkinson's disease</o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p>If you want additional information; go to the the following link:</o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<span style="font-family: "Times New Roman","serif"; font-size: 12pt;"><o:p><a href="http://us.datscan.com/" target="_blank">DaTSCAN</a></o:p></span></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin: 0in 0in 0pt;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
</div>
Lady Torreshttp://www.blogger.com/profile/01626462564015571540noreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-90753336756781030852012-07-27T09:05:00.001-04:002012-07-27T09:10:09.747-04:00IV<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dwmWvR9IFmMvDerePftZUnBCe7aPdPCwM6GjstWru68k2pfLHfmQab0n4JDegjRD_uBFfvE_imG9exDLoWBjA' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<br />Anonymoushttp://www.blogger.com/profile/16382806271426075019noreply@blogger.com2tag:blogger.com,1999:blog-8468323294840372113.post-24984635197224353352012-07-23T17:00:00.000-04:002012-07-23T17:00:02.696-04:00PET (F18FDG) - Atherosclerosis<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJO44Q8YbYjfEeqQ2AzUtMBHR_9fHuQyXF9EZGqPd504MbSHk0fptcyEIvBmJ5CTgjhDIrD9Kk1lIWi0THiyDd71dhNj2lOqlu1zwhoVjnCj3gto_1kTlpt_uWn4FzW5X583rmAexugAzr/s1600/athrosis.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjJO44Q8YbYjfEeqQ2AzUtMBHR_9fHuQyXF9EZGqPd504MbSHk0fptcyEIvBmJ5CTgjhDIrD9Kk1lIWi0THiyDd71dhNj2lOqlu1zwhoVjnCj3gto_1kTlpt_uWn4FzW5X583rmAexugAzr/s320/athrosis.jpg" width="180" /></a></div>
<div class="separator" style="clear: both; text-align: left;">
Clinical history: multiple myeloma and temporal arteritis (inflammation and dammage to the blood vessels that supply the head, particularly the large or medium arteries that branch from the neck and supply the temporal area), weight loss.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
PET scan for temporal arteritis can produce detailed images of the blood vessels and highlight areas of inflammation. PET imaging for atherosclerosis of carotid and peripheral arteries have been documented in several studies see below.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
The patient was injected with 15 mCi F18 FDG and imaged from brow to mid-thigh at 1.5 hours post injection, with CT for attenuation correction. blood glucose at the time of injection was 90 mg/dl. </div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Findings - The images demonstrate diffuse metabolic activity in the carotid arteries suggesting active atherosclerosis or inflammation. Diffuse activity is present in the aorta, large vessels of the thorax, pelvis, upper and lower extremities...</div>
<div class="separator" style="clear: both; text-align: left;">
There was no evidence of metabolically active neoplasm.</div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Further reading</div>
<div class="separator" style="clear: both; text-align: left;">
<a href="http://jnm.snmjournals.org/content/49/6/871.full" target="_blank"><span class="Apple-style-span" style="background-color: black; color: #ea9999;">JNM June 2008: Atherosclerosis Inflammation imaging</span></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-2011558249937915432012-07-20T09:28:00.004-04:002012-07-20T09:40:05.338-04:00July 20, 2012 UMDNJ Newark<div style="text-align: center;">
<span class="Apple-style-span" style="font-size: x-large;"><br /></span><br />
<span class="Apple-style-span" style="font-size: x-large;">Welcome to the Advisory Committee Meeting!!</span></div>
<span class="Apple-style-span" style="font-size: x-large;"><br /></span><br />
<div style="text-align: center;">
<u><b><span class="Apple-style-span" style="font-size: large;">Agenda</span></b></u></div>
<div style="text-align: center;">
<u><b><span class="Apple-style-span" style="font-size: large;"><br /></span></b></u></div>
<div style="text-align: center;">
Update on Current Students</div>
<div style="text-align: center;">
Review of Applicant Pool for 2013 Program</div>
<div style="text-align: center;">
Update on Competencies and Required Program Content as per Accrediting Bodies</div>
<div style="text-align: center;">
Documentation of Student Performance at Clinical Sites - New Evaluation Form</div>
<div style="text-align: center;">
Program Status and Accreditation</div>
<div style="text-align: center;">
Updates from Affiliates</div>
<div style="text-align: center;">
Open Discussion </div>Anonymoushttp://www.blogger.com/profile/16382806271426075019noreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-67993121625885147952012-07-19T17:00:00.000-04:002012-07-19T17:00:06.959-04:00Cutaneous MetastasesBreast cancer is known to metastasize
to anywhere in the body, either by hematogenous or lymphatogenous
routes. Cancers that have the highest tendency to metastasize to the
skin include melanoma, breast, nasal sinuses, larynx and oral cavity.<br />
<br />
<div style="margin-bottom: 0in;">
Excluding melanoma, cutaneous
metastases occur more often in breast cancer than in other diseases
in women and is the most often encountered in clinical practice. In
a recent study, that included 12146 patients with internal
malignancies, the rate of CM associated with breast carcinoma was
2.42 percent.</div>
<div style="margin-bottom: 0in;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6BOGlA3hoEl3xiZfZltavnee1QsqU4PnY3uN48hh9qq6YLNCDzibUtLXN41zdncEh5mZblGuPHLSKfYuneW4VJ1nywfVwMlWms1Px2dQF3CmcNd89yqn2JGhmgAgXDu_S6-LBrXOlEjEj/s1600/SubQ1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="215" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg6BOGlA3hoEl3xiZfZltavnee1QsqU4PnY3uN48hh9qq6YLNCDzibUtLXN41zdncEh5mZblGuPHLSKfYuneW4VJ1nywfVwMlWms1Px2dQF3CmcNd89yqn2JGhmgAgXDu_S6-LBrXOlEjEj/s400/SubQ1.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
PETCT - subcutaneous metastases - transverse image shows extent of disease located in the soft tissue at the upper lobe of the liver.</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div style="text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dwnntws3AlPi481k7BL2h3rxKrGBNFsk7ix7UEVSxPcbS84WxVEy4mteHBSCu0--IZz-pYaAKG98mO07vdzzg' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<div style="text-align: center;">
projection image</div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsdFsQkwV74YfCNLEI-FYNGVfJ9bT3wXm6FelYDDgFupqrDNsiHr6E-zYDptkkOfl4YuCdXklvk97PYh5YMR2M7LDI7-7Z2R9RFT5da6M6HXcXsY59wf5H5IVzmI0rGfLZDlhZJq0mHSP0/s1600/subq+mets.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="312" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhsdFsQkwV74YfCNLEI-FYNGVfJ9bT3wXm6FelYDDgFupqrDNsiHr6E-zYDptkkOfl4YuCdXklvk97PYh5YMR2M7LDI7-7Z2R9RFT5da6M6HXcXsY59wf5H5IVzmI0rGfLZDlhZJq0mHSP0/s320/subq+mets.jpg" width="320" /></a></div>
Another example of a female with a clinical history of breast cancer who presents with "nodular" cutaneous metastases. image includes PET WB coronal slice and comparative transverse PET and CT slices. Localized nodules are the most common presentation, occurring in 10% of patients.<br />
<br />
Reading:<br />
<a href="http://www.casesjournal.com/content/2/1/71" target="_blank">Cutaneous metastases of breast carcinoma: a case report.</a><br />
<br />
<a href="http://www.annals.edu.sg/pdf/35VolNo8Aug2006/V35N8p585.pdf" target="_blank">Cutaneous and subcutaneous metastases of adenocarcicoma of the colon and rectum</a><br />
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div style="margin-bottom: 0in;">
<br /></div>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-4229642854695646602012-07-18T16:30:00.000-04:002012-07-18T16:34:48.773-04:00Lung Scan - renal uptake<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmKhgjjbwGoi1z46uYcF6Qw4-rK_bmSyZkRP8rYdRXxfVmwLXW1HA9NKDqiq2VaDYRIQuxslDhqfmkkcQOSDs1iako-wOWLpSq16HbuEJ1UffN2TJn5yfIl2YcQBILxMPq3WzRoiCzxCeo/s1600/VQ+2004-0304.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="265" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgmKhgjjbwGoi1z46uYcF6Qw4-rK_bmSyZkRP8rYdRXxfVmwLXW1HA9NKDqiq2VaDYRIQuxslDhqfmkkcQOSDs1iako-wOWLpSq16HbuEJ1UffN2TJn5yfIl2YcQBILxMPq3WzRoiCzxCeo/s400/VQ+2004-0304.jpg" width="400" /></a></div>
Clinical history: 85 y-male arrived in nuclear department for a lung scan to rule out pulmonary embolism.<br />
<br />
Technique: Patient received 20 mCi Xe133 ventilation, followed by 30 mCi<span class="Apple-style-span" style="color: #cccccc;"> <a href="http://www.nuclearonline.org/PI/Nycomed%20MAA.pdf" target="_blank">Tc99m MAA</a></span> for lung perfusion imaging.<br />
<br />
There was renal uptake noted on the perfusion images which was an unexpected finding. Following investigation it was found that the patient had come into the medical center the previous night through the emergency room and a lung scan had been started. Due to equipment malfunction the perfusion portion of the scan was not completed, and was to be repeated the following morning. The uptake by the kidneys was determined to be most likely due to biological breakdown of the Tc99 MAA from the previous night, which was being removed from the body through the kidneys.<br />
<span class="Apple-style-span" style="font-size: x-small;">Thanks to Cheryl Casale, 2004.</span>Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-82515553382583736572012-07-16T19:00:00.000-04:002012-07-16T19:11:40.515-04:00Perfusion Lung Scan - Artifact<div class="separator" style="clear: both; text-align: left;">
Perfusion lung scan - <a href="http://www.nuclearonline.org/PI/Nycomed%20MAA.pdf" target="_blank">Tc99m MAA</a></div>
<div class="separator" style="clear: both; text-align: left;">
<br /></div>
<div class="separator" style="clear: both; text-align: left;">
Images obtained on two consecutive patients demonstrated mild uptake in the salivary glands, thyroid and stomach. This represents free technetium due to either poor kit preparation or kit breakdown. According to the package insert no less than 90% of the pertechnetate added to a reaction vial is bound to aggregate at preparation time and remains bound throughout the 6-8 hour lifetime of the preparation (depending on the manufacturer).</div>
<div class="separator" style="clear: both; text-align: left;">
Use of Tc MAA after 8 hours of kit preparation has been shown to have an increase in agglomeration. It is recommended for preparation and use of Tc 99m MAA, that a fresh dose should be used for imaging.</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcx7LlIE4LpRotDPc-FPNEgzTOt89v3TcVmB2e5RkmffH2a6Kt6KPHrcHOZZKbLf0RSPXqDP7lYyjCEX__Wno-tE2ekihjJpzYiPop72xJw4b79QwgUZnZhRMRII60y40FOjR7iiN3kziP/s1600/Lung1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcx7LlIE4LpRotDPc-FPNEgzTOt89v3TcVmB2e5RkmffH2a6Kt6KPHrcHOZZKbLf0RSPXqDP7lYyjCEX__Wno-tE2ekihjJpzYiPop72xJw4b79QwgUZnZhRMRII60y40FOjR7iiN3kziP/s320/Lung1.jpg" width="310" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvsy5fRsYqlBNPUVeeqYNPMO8LOhSGfO2BMJIc8D1XKua3752OMUfe9KRpchOLeyRqlG1AX_CPx4MTF5oDDJLaxhqpOZGAbduo7eZoKNLSeH-_GqP8dFUG-u6_8_n26sXnqR5z3taovacs/s1600/Lung2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjvsy5fRsYqlBNPUVeeqYNPMO8LOhSGfO2BMJIc8D1XKua3752OMUfe9KRpchOLeyRqlG1AX_CPx4MTF5oDDJLaxhqpOZGAbduo7eZoKNLSeH-_GqP8dFUG-u6_8_n26sXnqR5z3taovacs/s320/Lung2.jpg" width="310" /></a></div>
The lower image demonstrates mild uptake int he stomach. If the ventilation portion of the scan had used Tc99m DTPA aerosol the stomach uptake could be accounted for by swallowed radiopharmacuetical. However at this facility the ventilation portion of the study was acquired utilizing Xe133.Unknownnoreply@blogger.com0tag:blogger.com,1999:blog-8468323294840372113.post-77630854305251972292012-07-13T20:00:00.003-04:002012-07-14T08:53:11.297-04:00ExtravasationExtravasation is the accidental administration of intravenously infused medications into the extravascular space around the infusion site, either by leakage due to brittle veins, previous venipuncture or mispositioned needles or IV catheters.<br />
<br />
Infiltration, the result of an extravasation, is the diffusion or accumulation of substance not normal to it in amounts in excess of the norm.<br />
<br />
IV infusion should be free flowing. The arm with the infusion should not begin to swell, get red (erythemia), get hot and the patient should not notice any pain or burning. It is best to assure good access with saline prior to injecting radioactive materials. Should you notice any problems with the injection stop immediately. Keep in mind that often the volume of radiopharmacuetical dose are small and a dose may be infiltrated before you can react.<br />
<br />
With scans such as a bone scan, the extravasation of a dose may not be critical to the scan. However the extravasation of labeled white blood cells, PET doses, any study requiring dynamic acquisition such as renal scans may result in the patient having to return for a repeat study. Take care when injecting.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwHj_efo_3QmyYjHeppaFP9ShpdhOzCN-7OYypwAws_N0nthCvNe5EmrGyXsIqwzRc09HgDZhKewuFA8AaVnYOKSFYdAD8HBMBCY1Rf7prh36N5vi3ncnLkp_-i0ZuJ59d0rxizUqyjIky/s1600/b1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiwHj_efo_3QmyYjHeppaFP9ShpdhOzCN-7OYypwAws_N0nthCvNe5EmrGyXsIqwzRc09HgDZhKewuFA8AaVnYOKSFYdAD8HBMBCY1Rf7prh36N5vi3ncnLkp_-i0ZuJ59d0rxizUqyjIky/s320/b1.jpg" width="101" /></a></div>
Note the increased uptake of radiopharmaceutical (TC MDP) in the left hand, site of injection.<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR8YaLzk5GhDfG9oNXA2zR4wRHWQDxcT-RU7fah3bYRLLgYYH3DBPvmPfzZT2zRXMlnqRWxeTJRMmPf11Vz2V_z3-APig_SWje1aOu97zawD7pGOl-1ZXQItYs7UBQfz1pZpx0le-1XTvz/s1600/b2.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="166" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR8YaLzk5GhDfG9oNXA2zR4wRHWQDxcT-RU7fah3bYRLLgYYH3DBPvmPfzZT2zRXMlnqRWxeTJRMmPf11Vz2V_z3-APig_SWje1aOu97zawD7pGOl-1ZXQItYs7UBQfz1pZpx0le-1XTvz/s400/b2.jpg" width="400" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
Additional views of the hand in the palmar and lateral views demonstrates increased uptake in the tissue of the left hand.</div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjPfeJE62bau2gl3DcZId8fVcHJxaXbP-ER-81pQaJmpaHejTiVkKagZ5rRofR9epg7mPOh_ItRjAw7yCYFJE578E0itophPJkzKldFDcrRC-HLBUJwEEZ8guHnPsBSXTqjBpvIC0Xnmoh/s1600/inj.bmp" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhjPfeJE62bau2gl3DcZId8fVcHJxaXbP-ER-81pQaJmpaHejTiVkKagZ5rRofR9epg7mPOh_ItRjAw7yCYFJE578E0itophPJkzKldFDcrRC-HLBUJwEEZ8guHnPsBSXTqjBpvIC0Xnmoh/s320/inj.bmp" width="299" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
PET scan with extravasation of F18FDG in the right upper arm. In the case of PET imaging the infiltration of the dose results in invalid standard uptake value (SUV) which is determined by the exact patient dose (Pre-calibration - post-calibration) and the patient weight. If the patient dose is made inaccurate by the infiltrated dose the SUV becomes invlaid. The scan however may still be diagnostic if enough of the radiopharmaceutical has been properly delivered. The small dot of activity in the right shoulder may represent a lymph node due to the infiltration.</div>
<div class="separator" style="clear: both; text-align: center;">
This patient was re-scanned with the area of extravasation out of the field of view and determined to be of diagnostic value.</div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3ahB_9Lgjo-M6mc0RaBLz4_o-DFVo8Ii0WfSRt3RMRLvb8PPfS9Q_nLASqPU5pe7mxW99J5Rebs2CabgkR6UoMvadPBiQYnPAwm6cBPTFTxkPtqgh3ahzRUfD-sDBw7ShWZfZO9C6a03H/s1600/infilt.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi3ahB_9Lgjo-M6mc0RaBLz4_o-DFVo8Ii0WfSRt3RMRLvb8PPfS9Q_nLASqPU5pe7mxW99J5Rebs2CabgkR6UoMvadPBiQYnPAwm6cBPTFTxkPtqgh3ahzRUfD-sDBw7ShWZfZO9C6a03H/s320/infilt.jpg" width="320" /></a></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
Infiltrated dose of TcMDP on this bone scan shows the radiopharmaceutical tracking up the left arm with a visible lymph node in the left axilla. Not all injections are going to be perfect. If the dose is infiltrated it can be covered with lead to attenuate the accumulated dose or the arm can be moved from the image. This will provide better count statistics from the image.Unknownnoreply@blogger.com0