• Indications:
  • Metastasis / Neoplasm: whole body imaging, possible SPECT
  • Possible fracture / Stress fracture: three-phase or limited area imaging, possible SPECT
  • Osteomyelitis: three-phase imaging, possible SPECT
  • others: Paget's disease evaluation, joint prosthetic evaluation, unexplained bone or back pain, heterotopic ossification, avascular necrosis
• Patient Preparation:
  • No special preparation is required. Good hydration is helpful.
  • The patient should be aware that there is a 3 hour (or more) delay between injection and imaging. The imaging procedure itself can be about 30 minutes, depending on the length of the body or number of images needed, or longer if SPECT (tomographic) images are needed.
• Procedure: The patient will be injected with a Tc-99m diphosphonate. For patients undergoing a three-phase study, they will be placed under a gamma camera during injection for evaluation of the initial flow (arterial) phase and blood pool (venous) images. All patients will then be scanned at a minimum of 3 hours after injection for the delayed images. Whole body or limited images in multiple projections will be acquired, depending on the region of interest and indication. SPECT (tomographic) imaging may be required when a particular region is in question, commonly the lumbar spine, and will take additional time

Posterior view of a whole body bone scan showing widespread osteoblastic metastatic prostate cancer.

Anterior delayed image (3rd phase) of a three phase bone scan of the distal lower exremities, showing a left mid tibial stress fracture (red arrow).

• Indications:
  • Cholecystitis: Evaluation of the gallbladder or bile duct system, particularly to evaluate for cholecystitis and/or obstruction of the cystic duct or common bile duct.
  • Bile Leak: Evaluation for possible bile leak in post-cholecystectomy patients.
• Patient Preparation:
  • Important: No food or drink (except water) for 4-6 hours prior to the test, and remain fasting until completion of the test (which may take up to 4 hours after injection). Foods that stimulate gallbladder contraction will interfere with the results of the test.
  • Avoid narcotic analgesics for about 12 hours prior to the test. If this is not possible, please inform us of the patient's medications. Certain analgesics including morphine will constrict the sphincter of Oddi, preventing adequate evaluation of obstruction or patency of the common duct.
  • Patients with hepatocellular dysfunction and decreased hepatic clearance may have suboptimal tests.
• Procedure: The patient will be injected with a Tc-99m-labelled iminodiacetic (IDA) analog, and placed under a gamma camera for sequential imaging of the upper anterior abdomen for up to one hour. If patency of the ducts is established with normal filling of the gallbladder, the patient will be given Sincalide (a cholecystikinin analog) intravenously to dynamically evaluate for gallbladder contractility and ejection fraction. If no adequate gallbladder is initially evident, the patient will be rescanned in 4 hours to assess for possible acute cholecystits. In certain situations, the patient may be rescanned up to 24 hours after initial injection to verify common duct patency.

• Indications
  • Radionuclide ventriculography is considered the gold standard for calculation of the cardiac left ventricular ejection fraction (LVEF). MUGA scans are often used for baseline and post therapy monitoring of cardiac function, usually with chemotherapy agents that may be cardiotoxic.
• Patient Preparation:
  • No special preparation is required.
  • The patient should be aware that his or her own red blood cells will be radiolabelled (or "tagged") for imaging. This laboratory procedure occurs onsite, and will require a small amount of blood to be drawn from the patient, which will then be re-administered intravenously after labelling is complete. The patient must be able to lie still for a series of images of the heart, up to 30 minutes.
  • Images will be synchronized with the patient's EKG. Gating may be inadequate in patients with significant arrhythmia.
• Procedure: A small amount of blood will be drawn from the patient from an intravenous line for in-vitro radiolabelling of the red blood cells. This process occurs in the laboratory onsite for a duration of about half an hour. The patient's radiolabelled red blood cells are then re-administered intravenously. EKG leads will be placed on the patient, and the patient will be positioned under the gamma camera for a series of images of the left chest in multiple projections. Processing of the images is done after all images are acquired.

• Indications
  • Diagnosis, localization, and/or evaluation of possible metastasis of suspected neuroendocrine tumors, including carcinoids, gastrinomas, insulinomas, pancreatic islet cell neoplasm, medullary carcinoma of the thyroid, neuroblastomas, paragangliomas, and small cell lung cancers, i.e. tumors which express somatostatin receptors.
• Patient Preparation:
  • For patients currently undergoing octreotide treatments - unlabelled octreotide can potentially reduce the sensitivity of an Octreoscan by occupying the somatostatin receptors in a tumor. The recommendation is to discontinue octreotide for at least 3 days prior to scanning. If a longer-acting form of octreotide is used, the Octreoscan may have to be delayed even further.
  • A well-hydrated patient for the duration of the test is ideal.
  • The patient should be aware that delayed imaging is needed about 4 hours, 24 hours, and possibly 48 hours post injection of radiopharmaceutical. The patient is allowed to leave the center between scans.
• Procedure: The patient will be injected intravenously with Indium-111 pentetreotide. He or she will be placed under a gamma camera usually at 4 and 24 hours post injection for images of the neck, chest, abdomen, and pelvis, with addtional SPECT (tomographic) images usually of the upper abdomen. Further 48-hour delayed images may be needed. Each imaging session is about half an hour in duration.

• Indications
  • Diagnosis, localization, and/or evaluation of possible metastasis of suspected neuroendocrine tumors, particularly pheochromocytomas. MIBG is a norepinephrine analog which is accumulated in catecholamine storage granules, particularly in tumor cells with the type-1 amine uptake mechanism.
• Patient Preparation:
  • Important: To reduce the uptake of radioactive iodine (especially if I-131 is used) in the thyroid, the patient should be administered oral potassium iodide starting a few days prior to administration of radiopharmaceutical in order to block uptake by the thyroid. The recommendations is Lugol's solution (5 drops orally, twice a day) or SSKI (2 drops orally, twice a day), ideally starting 3 days prior to injection.
  • Certain drugs may interfere with MIBG uptake:
    • Tricyclic antidepressants - ideally discontinue 6 weeks prior to MIBG scan
    • Long-acting beta blockers - ideally discontinue 3 weeks prior to MIBG scan
    • Other drugs which may interfere with MIBG uptake: cocaine, pseudoephedrine/phenylephrine, amphetamines and sympathomimetics, reserpine, phenothiazine and thiothixine antipsychotics, calcium channel blockers.
  • The patient should be aware that he or she will have to return to the center for delayed imaging 72 hours after injection (or sooner, depending on the type of radioiodine available).
• Procedure: The patient will be injected intravenously with Iodine-131 Metaiodobenzylguanidine (MIBG). He or she will be placed under a gamma camera 72 hours later for anterior and posterior images, including the chest, abdomen, and pelvis. The duration of imaging should be less than half an hour. In certain situations, Iodine-123 MIBG will be used - imaging will be 24 hours post injection, and additional SPECT images will increase the duration of imaging.

• Indications
  • Infection / Inflammation: fever of unknown origin, pulmonary and abdominal infections, osteomyelitis, chemotherapy-induced pneumonitis. Often used as an alternative to a WBC scan in patients with low WBC count or in the AIDS patient..
  • Oncology: evaluation, staging, and monitoring of lymphoma, sometimes melanoma, other tumors, as an alternative to FDG PET-CT
• Patient Preparation:
  • No special dietary preparation is required. However, gallium scanning should be delayed for at least 24 hours after a blood transfusion or a gadolinium-enhanced MRI scan, which may interfere with gallium distribution.
  • The patient should be aware that he or she will be instructed to return to the center likely 48 hours and 72 hours after the initial injection.
• Procedure: The patient will be injected intravenously with Gallium-67 citrate. Imaging with a gamma camera is started no earlier than 48 hours after injection, with additional images at 72 hours. SPECT (tomographic) images may be needed, and can take over half an hour to complete. In certain cases, the patient may be asked to take a mild laxative in order to assist in clearance of the bowel.

• FDG PET-CT scans for cancer diagnosis, staging, and restaging are discussed in greater detail on our PET-CT page. Please click here for more information.

• FDG PET-CT scans for neurologic indications, including seizures and dementia evaluation, are discussed in greater detail on our PET-CT page. Please click here for more information.

• FDG PET-CT scans for evaluation of myocardial viability by assessment of metabolic function are discussed in greater detail on our PET-CT page. Please click here for more information