This blog is used the University of Arkansas College of Pharmacy Radiopharmacy course.
Tuesday, September 15, 2009
Nuclear Medicine Observations
Please reply to post about your experiences in observing the nuclear medicine procedures. Reflect on the experience and share what you saw and learned.
42 comments:
Christy Agee
said...
Amber and I observed a parathyroid image today with sestimibi. It was quite obvious and they were using it to pinpoint coordinates for physicians to use when surgically removing the tumor. We also discussed stress tests. The technician pointed out that people on beta blockers cannot do the exercise stress test which now seems obvious but I had not thought about it. I also saw what happens when the nuclear pharmacy is late. It was interesting to see the other side of the situation when things are not going right.
This morning I was able to observe a Parathyroid image. They used Sestimibi which was really interesting since we just talked about it in class. I was able to see how the liver "lights up"! The lady had a tumor which was various obvious by the imaging. They knew this before the test but were looking for the exact location. It was really interesting to see how it worked.
This morning Kristen and I went to the nuclear medicine department at UAMS. We were going to see a stress test performed, but there was a cancellation. We ended up discussing stress tests instead. However, we did observe a spect CT on the parathyroid. Stestimibi was used. Unfortunately we were only able to observe the basic anatomical image because the next results wouldn't come for 3 hours. But, the image we did see, was very interesting.
This morning I was able to review several different types of images. Wes showed us a MUGA scan in process, in which radiolabled red blood cells are scanned in order to determine the circulation dynamics of the marker. The patient was about to begin chemotherapy, and the team wanted to make sure that her ejection fraction was above 50 %, thus reducing the chance of cardiotoxic events. Wes also showed us a VQ scan, looking for the presence of a PE. If a scan shows good ventilation to an area but poor perfusion (in a characteristic triangle shape), a PE may be present. Finally, Doug showed us a knee scan using cobalt. It was very interesting to see the different types of scans, as well as the prep work that is involved for each.
This morning I visited the nuclear medicine department and saw a small part of a Myoview scan. Since I have had past experience observing this type of scan and there wasn’t much else going on; I got to look at various other scan results that were previously performed. This included a bone scan where it seemed as though a patient had a met. on the right illium and a previous spinal fracture. I also saw the results from a MUGA and a MAG3 scan both of which looked pretty normal. Overall it was a great experience. -Jason McElyea
Last Wednesday Morning I saw a couple of scans. The first was a lady about to undergo chemotherapy and was having an MUGA scan done to determine the ejection fraction of her heart. Her EF was 66% so she was good to start chemo. Another lady was having knee problems and they did a bone scan using MDP . Almost immediately after the MDP was injected in her vein, a "blood flow" image was seen on the camera. They told her to come back in 3 hours to have a "delayed view" of her leg.
On 10/27 I watched a resting imaging and a stress test. The imaging was done with Myoview. Everything appeared to be fine. They did have to image longer than usual since the patient was overweight. The stress test was on a different patient. The patient needs a kidney transplant. The stress test was to see if he was a viable candidate. At first they attempted a treadmill test, but he failed to reach 85% of his maximum heart rate. They ended up using Persantine and countered it with aminophylline.
I went to the nuclear medicine department and was able to see a couple different kinds of scans. I saw a MUGA study and a bone scan of a patient's knee. It was interesting seeing these scans. I was able to see a thyroid, stress tests, and others this summer, but I was not able to see these. The MUGA scan showed that the patient had a high enough EF (66%) to start chemo.
I went to the nuclear med department on the 27th and got to see a cardiac rest SPECT image being performed. I got to talk to one of the doctors about how the heart pumps oxygen and how they can use this mechanism to obtain heart function in nuclear medicine. I then got to see a cardiac stress test with a renal failure patient. The test began on the treadmill, but the patient couldn't obtain the necessary heart rate, so Persantine was given to stress the heart. This test was very interesting and I'm glad I got to see it. All of the staff was very helpful and very kind in helping me understand all of the tests and what was happening.
Jason and I shadowed a nuclear tech. He had just administered a cardiac rest dose prior to our arrival. He took us into the room where the gamma camera was imaging the patient and explained how the camera took pictures in different planes. As the images were taken, he explained how they were interpreted in terms of physiological function. Someone else then came in and told us we shouldnt be in there while the patient was being imaged, so we all left. The nuclear tech then took us around to the different rooms that had gamma cameras. He showed examples of different studies from patients on file, and explained some of the differences between the cameras and how some are better for some studies than for others. He then took us into the hot lab to show us how drugs are prepared prior to injection, and how they are disposed of and sent back to the nuclear pharmacy.
I saw the start of a stress test. Basically they were interviewing the patient getting a history, and then they injected the isotope. The patient was going to wait for about thirty minutes before actually doing the stress test so I went and watched a Muga scan. I thought it was interesting that on the muga they based the time on the counts instead of good heart beats. After the 4 million counts the nuclear tech would adjust the camera position. Then we went to the computer and he would draw a region of interest to get the LVEF. At one point he had one dot off the region and it through the EF off by 10%. It seemed like it would be hard to get an accurate EF.
I watched a rest study which turned out normal. Watched a nuc med tech try to convince another patient to opt for the treadmill for the stress portion.
I observed a thyroid scan and an uptake with I-123 for diagnosis of hyperthyroidism. The patient had lost 40# in 6weeks. They had done a background reading on his thigh, had performed counts on the capsule before giving it to the patient. It has been 4hrs since the patient had swallowed the I-123cap. The patient's absorption was 1.6% (normal is 5-15%). The patient was also on TPN, which might have and iodine that could have been showing the low I-123 uptake. The technician showed me the Cobalt markers placed on the neck during the scan. The scan was very poor due to the low uptake. The patient was going to be scheduled for another scan and uptake count 24hrs after administration time of the capsule.
When I visited the Nuclear Medicine department I watched a nuclear stress test performed on a patient that had been in the hospital for a month. The man was in pretty bad shape and the doctors administering the pharmacologic stress asked me to help keep the patient awake while the test was going on. It was interesting to be involved in that part of the test. Then I watched the scan and got to check out all the different views and tools that it offers.
On Friday 30th I observed a triple phase study. The patient complained of pain and infection in his right arm. The triple phase study allows the physicians to difference between cellulites (infection of soft tissue) and osteomyelitis (infection in the bone). The technician injected technetium into the patient's foot and observered blood flow, pooling, and delayed. I learned that if you inject technetium in the arm you would not be able to observe the blood flow very well because of the technetium. You want to be able to observe blood flow in both arms in other to notice a difference. I also observed a gastric study in which Sulfur colloid was mixed in scrambled gigs and given to the patient to eat, and then an hour later a scan was done to observe gastric emptying time. If the content was not emptied in an hour, it means that the patient has some type of gastric problem.
I observed a thyroid scan using I-123.The radiation was given in the form of a capsule that was to be swallowed and monitored. His level of absorption was 1.6% which was much lower than the 5-15% range. This was also interesting because the patiet was actually being treated for a diagnosis of HYPERthyroidism. The patient was on an a TPN and a Multi-vitamin IV. The technicians believed that the multi-vitamin, along with the fact that the patient may not have NPO before could have interfered with the reading.Cobalt markers were placed on above and below the patient's thyroid to give an approximate region of where the thyroid gland was located. Because the scan results were inaccurate and in poor quality, another scan was scheduled for the next day.
October 30 2009, I had the opportunity to seen a triple phase study of a man who was having problems with pain after an infection in his right elbow. The study was used to determine between cellulites and osteomyelitis. Since the study was comparing both arms, the technetium was injected into his foot so both arms would get adequate perfusion of technetium. The Nuclear Tech looked at blood flow image for 90 seconds, blood pooling image for 3 minutes after that, delayed image 2 hours later. The result was that it was cellulites. I also saw and sulfur colloid gastric emptying scan where the patient ate scrambled eggs with sulfur colloid. This patient did not have complete emptying because he was scanned an hour later and there was still activity in his stomach. I enjoyed it thanks Calvin Langley
On October 26, 2009 I was able to look at the PET images of a patient who was undergoing chemotherapy treatment for nasal cancer. The attending nuclear medicine doctor showed me the patient's scan before treatment and pointed out the cancer. The attending then showed me a scan after the patient recieved treatment and pointed out the cancer again. Less FDG was seen in the area of the nasal cancer after treatment compared to that of before treatment. It was interesting to see PET images that showed a patient's therapy is working.
Bailey and I went to the nuclear medicine department and saw a spect-CT of the parathyroid using sestamibi. It was the patient's second scan. The first had been negative, but the blood results still showed something wrong. We were only able to observe the first scan, but we were shown another patient's positive scan and discussed how the procedure is used to help surgeons pinpoint the area to remove.
I got to watch a PET scan from start to finish here at UAMS. The scan took about 45 minutes. The images from the PET scans had a much higher resolution than I was expecting. The doctor working in the booth showed me several of the different views the scan is capable of imaging. The patient had previously had a hip replacement which you could clearly see in the scan and the doctor showed me how the metal in the replacement interfered with the imaging. I found it really interesting to finally see in a procedure that we've been learning about.
The scan that I observed was a cardiac rest test. The patient had already received the 10 mCi dose and was laying on the scanner. I watched the tech adjust the cameras and start the scan. I believe it took about 13 min and every few seconds the cameras would adjust and image. The images that come up on the screen of the counts look very different from what the final image looks like. The tech said that they use Myoview instead of Cardiolite because it is suppose to image better. After I left, the patient would do the stress part of the test where he would be given 30 mCi and I beleive he was also getting Persantine. Everyone was very nice and helpful!
Several weeks ago I spent a Wednesday morning shadowing a technologist, Laquita, in the nuclear medicine department. I followed beside her as she called patients' names in the waiting room and led them back into smaller, individual rooms where they waited for the cameras to be prepped and the doses administered. I observed her prepare a patient's dose in the hot lab. (She also discussed receiving much of their activity from Cardinal Health.) I watched her administer a 29.8 mCi dose to a patient who was sitting in a chair in a corner waiting room. I followed her into another room where she was finishing up a MUGA scan. I was able to see the 3 different views (LAO, LAT, ANT) of the heart on the computer and also noted the patient mentioning that she had damage to her heart, lungs and kidney due to her chemotherapy. Next, I observed Laquita give another patient with a history of thyroid cancer an I-131 capsule and she was scheduled to come back in 2 days to see if there was any reoccurrence. Laquita was very busy that morning and we were walking back and forth several times among all the different patients. She was very knowledgable and I enjoyed being her sidekick that morning. :)
This morning I observed a pharmacologic stress test in the Nuclear Medicine Department. The patient had already received 11 mCi Tc-99m Tetrofosmin and a rest image had been taken. I came when they were preparing her for the stress part. After advising her of the procedure and asking questions about her pain levels, she was given Persantine. Persantine is the trade name for dipyridamole, which increases adenosine by blocking reuptake. They explained to me that they were watching for hemodynamic effects. The dose was titrated into her I.V. for 4 minutes to minimize discomfort and the peak effect took place after about 7 minutes. After the patient squeezed a stress ball and moved her toes, her heart rate increased enough for them to inject the Tc-99m tetrofosmin. She was given a 38.8 mCi dose. She was then given aminophylline, as sister of caffeine, to reverse the effects of the Persantine. Since it would be a while for her imaging, I looked at images of cardiac stress tests for other patients. It was very interesting!
Amandeep Kaur I watched a couple of scans on 10/14. The first scan I watched was a thyroid scan. I watched them inject the lady with the radiopharmaceutical then she was sent to the waiting room. While she was waiting the tech showed me the hot room where they keep all the radiopharmaceuticals. Once a room was ready the lady was taken in and made as comfortable as possible and was told about the scan. First a CT scan was performed then a nuclear scan was started but the machine broke and they were unable to finish the scan and the lady was sent back in to the waiting room and the scan was redone but I was not able to watch that scan. The second scan I watched was renal scan. The renal scan was interesting because usually the patient has to lay down for the scan but this patient could not lay down do to pain from other medical conditions so they did scan with the patient sitting up. They were not sure how this would effect the scan. First they inject the radiopharmaceutical and watched the kidney function for about 30 min. during this time we chatted with the patient. Then the patient was injected with lasix and the renal function observed. The patient also had catheters in place this is important because once the patient was placed back in the hospital bed we noticed that the catheters leaked. This had to be immediately cleaned up with a special solution and a geiger counter had to be used to check the room. The tech said if there was too much radiation in the room the room would have to be closed down luckily this was not the case. It was very interesting watching the scans that we have learned about in class.
I observed a couple of different scans today. The first was a MUGA scan and the second was a stress test. I arrived after the patients were injected so I watched the actual imaging and veiwed the results from the scans. The patient doing the stress test had been stressed pharmacologically with Persantine. The technician tagged the WBCs of the patient getting the MUGA scan and reinjected them before I arrived. It was sad to see the results from the MUGA scan. The patient had a low EF and was needing chemo for prostate cancer but the doctors weren't sure if he could handle it. But it was neat to get to see the things we talk about in class.
Today, I visited the nuclear medicine department at UAMS. First, I got to see the hot lab where all of the doses are held before they are administered to the patients. Next, I watched a MUGA scan of a patient who had prostate cancer and was supposed to start chemotherapy. However, his ejection fraction was only 29 percent so the patient may not get to start the chemo because his heart may not be able to handle it. Next, I watched the imaging of a patient who had undergone pharmacologic stress with Persantine. My visit to the nuclear medicine department was very interesting and educational. I was able to witness the huge impact that nuclear medicine has on the lives of these patients.
Daniel and I observed as Dr LeBlanc evaluated a viability study in a 84 y/o patient with 2 previous MI's. It was interesting to see that in the original scan there was an obvious area of ischemia, but after 24 hours that area was lighting up on the scan showing that there was still viable tissue. I found it interesting to see how the information on the scan determined the next step in therapy for this patient. Upon discovery that there was viable tissue, the patient was sent to cath lab for stent placement. The goal is to restore blood flow to the ischemic area and prevent further tissue death
Eric and I observed a gallbladder scan at Children's last Friday. They were concerned about the function of the gallbladder. For this they used a HIDA (Hepatobiliary Imino-Diacetic Acid) scan. The radioactive tracer they used was technetium-99m. During the scan, we observed the hepato-billiary tree. They also administered CCK (cholecystokinin) during the later part of the scan in order to induce the release of bile from the gallbladder. This allowed them to calculate the ejection fraction of the gallbladder.
Tiffany and I went to the nuclear med department at UAMS on Monday morning. We first watched a bone scan of an elderly patient complaining of "old age pains." The scan was done with HDP because of the shorter wait time before scanning. In addition to the expected lit up kidneys and bladder, her left knee and part of her skull was lit up. We were also shown pictures from a MUGA scan in which the patient's own blood cells were tagged with Tc and then injected back into him. We pictures from a gastric emptying scan they were still working on that day, for which they said the patient eats eggs with the radioactive drug on them and then they remain there for about 4 hours for scanning. We also saw the very beginning of a stress test with Myoview. The patient and camera was situated, but we weren't there long enough the see the scans. Overall, it was an interesting experience!
A couple of weeks ago, I went to the nuclear medicine department hoping to get an overview of what usually goes on in the procedures. I got to see a cardiac scan with Myoview, where a nuclear medicine student used the computer software to focus the center of the screen on the center of the heart, so that the images were easier to see and interpret. I also got to see I-123 being used for a thyroid uptake scan. On that particular scan, the CNMT tried to make sure that the patient was comfortable, since the cameras seemed to be very very close to the patient's body. For a lung ventilation scan I watched, I asked the CNMT if they were using Xe-133 gas since it seemed to be more commonly used, but he said that it was actually DTPA aerosol, because using Xe-133 means that they had one chance to get an image. During each scan, I noticed that the CNMTs talked to each patient to make sure they felt comfortable and gave them extra pillows if they asked for more. They also talked to the patients to inform them of each step, so that the patients would be more likely to cooperate in the scans, making the procedures easier.
Last week I observed a patient receiving a gallbladder scan, also know as a HIDA (hepatobiliary iminodiacetic acid) scan. The patient reported having a chronic upset stomach with n/v after eating fatty or greasy foods. The technician administered Choletec to the patient and the patient was scheduled to be under the gamma camera from about an hour and a half. During the scan, I was able to view the gallbladder, biliary ducts, liver and the small intestine light up on the computer. The tech. also administered CCK (cholecystokinin) to stimulate the gallbladder. She told the patient they may feel some abdominal pain due to the CCK. During the scan, the tech. mentioned the size and shape of the gallbladder were normal.
I observed a full body bone scan earlier this week where they used HDP on a lady who was having joint pains. There was a prominent spot showing up on her left knee. There was also some activity on her skull so the doctor ordered a head scan to get a better view. The technician also showed us some pictures of a gastric emptying that was done earlier using sulfur colloid on some eggs that they had the patient eat. They take pictures over the 4 hours after the patient eats the eggs. He also showed us some images from a MUGA scan performed on a patient to determine his heart function since he was about to start chemotherapy. On the way out we stopped to watch a the beginning of a Myoview scan (not sure if it was stress or rest). I can see how hard it would be for the patient to remain still...the cameras were really slow!
Lee and I observed a cardiac viablity scan where an 84 y/o female with two previous MI's was injected with Tl-201, the image was 1 hour after infusion(for perfusion imaging) and another taken 24hours post injecttion(viability imaging) It was thought that this patient did not have viable tissue left. The 24 hour post image revealed that there actually was metabolic acitivty in the myocardium. The patient was then sent immediately to the CATH lab where a stent was placed to restore blood flow to the previously ischemic areas. Dr. Le Blanc was very helpful in describing the entire thought process behind the scan/imaging then to the next step in this patients treatment.
I observed a MUGA scan on a patient undergoing chemotherapy. The test was UltraTag where RBC's were taken and tagged with Tc99m, then re-injected into the patient who then had 3 different imaging angles taken of the heart. The end result showed the ejection fraction of the patient and demonstrated that the current chemotherapy was not having a deleterious effect on the heart. The rad. technician was very helpful and quite knowledgeable about all aspects of nuclear medicine. Overall, it was a very good experience to see the end result of the pharmacy work we are doing.
Questin and I observed a gallbladder scan done at Children's Hospital. The patient had been experiencing stomach problems for the past year(nausea, vomiting, etc.). They were concerned that it was due to the gallbladder so they performed a scan using HIDA (Hepatobiliary Imino-Diacetic Acid) and the tracer used was Tc-99m. After about an hour they were able to see the gallbladder and the injected CCK to make the gallbladder empty. This allowed them to measure the ejection fraction of the gallbladder. They also showed us images from previous scans such as bone, abuse cases, and thyroid.
On 10/28/10, I observed the rest phase and a small part of the stress portion of a nuclear cardiac stress test. The nuclear agent that was used was Tc-99m Tetrofosmin (10mCi). While the patient lie still on her back, the camera rotated in a quarter-wise fashion around the patient. After several images were taken, the rest portion was completed and they began to prepare for the stress portion. Artificially stress, by way of dipyridamole was used for the stress portion of the test. Once the patients heart rate reached the target rate, a 30 mCi dose was administered. Aminophylline was later given to reverse the stress effects of dipyridamole. It was very interesting to see how the nuclear agents were administered in order to diagnosis potential diseases and disorders. I wish I could have observed the physicians interpret the images, however time did not permit.
On the afternoon of 10/26 I visited the nuclear medicine department at UAMS. I was able to watch parts of several different scans. The first was a bone scan for a 60yo AAM that was in remission from prostate cancer. His doctor has a scan done biannually to watch for recurrence and metasticies. He was obese and you could tell that there was still some tissue uptake and some attenuation but the bones were all visible. He had kidney and bladder uptake which were expected but he was also showing uptake in the sinus cavities that was unusual. I didn't get to hear the discussion on that before I moved over to watch the resting image of a cardiac stress test. It was neat to see the 3D image before they compiled it into the sections for comparison. I followed this patient and watched the stress test. They did a pt history and found that he was post chemo and was there for a follow up to make sure there had been no cardiac damage since he had no previous cardiac trouble (not even hypertension). They used dipyridamole to induce cardiac stress and it took about ten minutes. Then they injected the myoview and waited another five before injecting the rescue drug which was aminophylline (a methyl xanthene). He was then moved to a waiting area until an imaging room was ready and he was offered snacks and drinks since he had been NPO since the previous night. I hadn't realized that stress test patients needed to be NPO, but since N&V are side effects of the stress drugs it makes sense in hindsight.
I went on Friday and saw several interesting scans. The most interesting was an MAA scan. The patient was injected and within minutes he was getting pictures taken. They positioned the cameras and within a few minutes the scan was finished. It was eye opening knowing that they were looking for the amount of functioning lung was available so they could remove part of it and the patient sitting right there in front of me.
I went on 10/28 to the nuclear department and watched a MUGA scan. The patient was elderly and they were determing the ejection fraction to make sure chemotherapy was not effecting the patient's heart. I've had a MUGA scan so it was neat to see it from a different perspective.
Clare Mathis On Friday at the Uams Nuclear medicine department I observed a gallbladder scan, bone imaging of a patient's knees ( very interesting, one of the technicians pointed out where the patient had a knee replacement) and a scan on a cardiac patient who was believed to have a gi bleed. It was really neat to see what we are learning in class applied to a patient experience.
On Friday, October 29th 2010, I went to the Nuclear Dept at UAMS and saw several different scans. The first was a scan for a GI bleed, the next scan was a bone scan on a patient that had 2 knee replacement surgeries and the third was a lung perfusion study with MAA. They were all very interesting, but I thought the lung scan was especially fascinating. It was interesting to see how the different scans were performed and the various obstacles that had to be overcome with each patient. For instance, in the lung perfusion study the gentleman had a hard time keeping his arms above his head which made it difficult to get the camera close enough to get a good image. It was interesting to see how what we have studied in class applies to real patients. Also, I didn't really think about the challenges the technicians face with trying to get a good scan and just various "real world" obstacles that have to be overcome.
42 comments:
Amber and I observed a parathyroid image today with sestimibi. It was quite obvious and they were using it to pinpoint coordinates for physicians to use when surgically removing the tumor. We also discussed stress tests. The technician pointed out that people on beta blockers cannot do the exercise stress test which now seems obvious but I had not thought about it. I also saw what happens when the nuclear pharmacy is late. It was interesting to see the other side of the situation when things are not going right.
This morning I was able to observe a Parathyroid image. They used Sestimibi which was really interesting since we just talked about it in class. I was able to see how the liver "lights up"! The lady had a tumor which was various obvious by the imaging. They knew this before the test but were looking for the exact location. It was really interesting to see how it worked.
This morning Kristen and I went to the nuclear medicine department at UAMS. We were going to see a stress test performed, but there was a cancellation. We ended up discussing stress tests instead. However, we did observe a spect CT on the parathyroid. Stestimibi was used. Unfortunately we were only able to observe the basic anatomical image because the next results wouldn't come for 3 hours. But, the image we did see, was very interesting.
Nick Eudaly-
This morning I was able to review several different types of images. Wes showed us a MUGA scan in process, in which radiolabled red blood cells are scanned in order to determine the circulation dynamics of the marker. The patient was about to begin chemotherapy, and the team wanted to make sure that her ejection fraction was above 50 %, thus reducing the chance of cardiotoxic events. Wes also showed us a VQ scan, looking for the presence of a PE. If a scan shows good ventilation to an area but poor perfusion (in a characteristic triangle shape), a PE may be present. Finally, Doug showed us a knee scan using cobalt. It was very interesting to see the different types of scans, as well as the prep work that is involved for each.
This morning I visited the nuclear medicine department and saw a small part of a Myoview scan. Since I have had past experience observing this type of scan and there wasn’t much else going on; I got to look at various other scan results that were previously performed. This included a bone scan where it seemed as though a patient had a met. on the right illium and a previous spinal fracture. I also saw the results from a MUGA and a MAG3 scan both of which looked pretty normal. Overall it was a great experience.
-Jason McElyea
Last Wednesday Morning I saw a couple of scans. The first was a lady about to undergo chemotherapy and was having an MUGA scan done to determine the ejection fraction of her heart. Her EF was 66% so she was good to start chemo. Another lady was having knee problems and they did a bone scan using MDP . Almost immediately after the MDP was injected in her vein, a "blood flow" image was seen on the camera. They told her to come back in 3 hours to have a "delayed view" of her leg.
On 10/27 I watched a resting imaging and a stress test. The imaging was done with Myoview. Everything appeared to be fine. They did have to image longer than usual since the patient was overweight. The stress test was on a different patient. The patient needs a kidney transplant. The stress test was to see if he was a viable candidate. At first they attempted a treadmill test, but he failed to reach 85% of his maximum heart rate. They ended up using Persantine and countered it with aminophylline.
I went to the nuclear medicine department and was able to see a couple different kinds of scans. I saw a MUGA study and a bone scan of a patient's knee. It was interesting seeing these scans. I was able to see a thyroid, stress tests, and others this summer, but I was not able to see these. The MUGA scan showed that the patient had a high enough EF (66%) to start chemo.
I went to the nuclear med department on the 27th and got to see a cardiac rest SPECT image being performed. I got to talk to one of the doctors about how the heart pumps oxygen and how they can use this mechanism to obtain heart function in nuclear medicine. I then got to see a cardiac stress test with a renal failure patient. The test began on the treadmill, but the patient couldn't obtain the necessary heart rate, so Persantine was given to stress the heart. This test was very interesting and I'm glad I got to see it. All of the staff was very helpful and very kind in helping me understand all of the tests and what was happening.
Jason and I shadowed a nuclear tech. He had just administered a cardiac rest dose prior to our arrival. He took us into the room where the gamma camera was imaging the patient and explained how the camera took pictures in different planes. As the images were taken, he explained how they were interpreted in terms of physiological function. Someone else then came in and told us we shouldnt be in there while the patient was being imaged, so we all left. The nuclear tech then took us around to the different rooms that had gamma cameras. He showed examples of different studies from patients on file, and explained some of the differences between the cameras and how some are better for some studies than for others. He then took us into the hot lab to show us how drugs are prepared prior to injection, and how they are disposed of and sent back to the nuclear pharmacy.
I saw the start of a stress test. Basically they were interviewing the patient getting a history, and then they injected the isotope. The patient was going to wait for about thirty minutes before actually doing the stress test so I went and watched a Muga scan. I thought it was interesting that on the muga they based the time on the counts instead of good heart beats. After the 4 million counts the nuclear tech would adjust the camera position. Then we went to the computer and he would draw a region of interest to get the LVEF. At one point he had one dot off the region and it through the EF off by 10%. It seemed like it would be hard to get an accurate EF.
I watched a rest study which turned out normal. Watched a nuc med tech try to convince another patient to opt for the treadmill for the stress portion.
I observed a thyroid scan and an uptake with I-123 for diagnosis of hyperthyroidism. The patient had lost 40# in 6weeks. They had done a background reading on his thigh, had performed counts on the capsule before giving it to the patient. It has been 4hrs since the patient had swallowed the I-123cap. The patient's absorption was 1.6% (normal is 5-15%). The patient was also on TPN, which might have and iodine that could have been showing the low I-123 uptake. The technician showed me the Cobalt markers placed on the neck during the scan. The scan was very poor due to the low uptake. The patient was going to be scheduled for another scan and uptake count 24hrs after administration time of the capsule.
When I visited the Nuclear Medicine department I watched a nuclear stress test performed on a patient that had been in the hospital for a month. The man was in pretty bad shape and the doctors administering the pharmacologic stress asked me to help keep the patient awake while the test was going on. It was interesting to be involved in that part of the test. Then I watched the scan and got to check out all the different views and tools that it offers.
On Friday 30th I observed a triple phase study. The patient complained of pain and infection in his right arm. The triple phase study allows the physicians to difference between cellulites (infection of soft tissue) and osteomyelitis (infection in the bone). The technician injected technetium into the patient's foot and observered blood flow, pooling, and delayed. I learned that if you inject technetium in the arm you would not be able to observe the blood flow very well because of the technetium. You want to be able to observe blood flow in both arms in other to notice a difference. I also observed a gastric study in which Sulfur colloid was mixed in scrambled gigs and given to the patient to eat, and then an hour later a scan was done to observe gastric emptying time. If the content was not emptied in an hour, it means that the patient has some type of gastric problem.
I observed a thyroid scan using I-123.The radiation was given in the form of a capsule that was to be swallowed and monitored. His level of absorption was 1.6% which was much lower than the 5-15% range. This was also interesting because the patiet was actually being treated for a diagnosis of HYPERthyroidism. The patient was on an a TPN and a Multi-vitamin IV. The technicians believed that the multi-vitamin, along with the fact that the patient may not have NPO before could have interfered with the reading.Cobalt markers were placed on above and below the patient's thyroid to give an approximate region of where the thyroid gland was located. Because the scan results were inaccurate and in poor quality, another scan was scheduled for the next day.
October 30 2009, I had the opportunity to seen a triple phase study of a man who was having problems with pain after an infection in his right elbow. The study was used to determine between cellulites and osteomyelitis. Since the study was comparing both arms, the technetium was injected into his foot so both arms would get adequate perfusion of technetium. The Nuclear Tech looked at blood flow image for 90 seconds, blood pooling image for 3 minutes after that, delayed image 2 hours later. The result was that it was cellulites. I also saw and sulfur colloid gastric emptying scan where the patient ate scrambled eggs with sulfur colloid. This patient did not have complete emptying because he was scanned an hour later and there was still activity in his stomach. I enjoyed it thanks Calvin Langley
On October 26, 2009 I was able to look at the PET images of a patient who was undergoing chemotherapy treatment for nasal cancer. The attending nuclear medicine doctor showed me the patient's scan before treatment and pointed out the cancer. The attending then showed me a scan after the patient recieved treatment and pointed out the cancer again. Less FDG was seen in the area of the nasal cancer after treatment compared to that of before treatment. It was interesting to see PET images that showed a patient's therapy is working.
Bailey and I went to the nuclear medicine department and saw a spect-CT of the parathyroid using sestamibi. It was the patient's second scan. The first had been negative, but the blood results still showed something wrong. We were only able to observe the first scan, but we were shown another patient's positive scan and discussed how the procedure is used to help surgeons pinpoint the area to remove.
I got to watch a PET scan from start to finish here at UAMS. The scan took about 45 minutes. The images from the PET scans had a much higher resolution than I was expecting. The doctor working in the booth showed me several of the different views the scan is capable of imaging. The patient had previously had a hip replacement which you could clearly see in the scan and the doctor showed me how the metal in the replacement interfered with the imaging. I found it really interesting to finally see in a procedure that we've been learning about.
The scan that I observed was a cardiac rest test. The patient had already received the 10 mCi dose and was laying on the scanner. I watched the tech adjust the cameras and start the scan. I believe it took about 13 min and every few seconds the cameras would adjust and image. The images that come up on the screen of the counts look very different from what the final image looks like. The tech said that they use Myoview instead of Cardiolite because it is suppose to image better. After I left, the patient would do the stress part of the test where he would be given 30 mCi and I beleive he was also getting Persantine. Everyone was very nice and helpful!
Several weeks ago I spent a Wednesday morning shadowing a technologist, Laquita, in the nuclear medicine department. I followed beside her as she called patients' names in the waiting room and led them back into smaller, individual rooms where they waited for the cameras to be prepped and the doses administered. I observed her prepare a patient's dose in the hot lab. (She also discussed receiving much of their activity from Cardinal Health.) I watched her administer a 29.8 mCi dose to a patient who was sitting in a chair in a corner waiting room. I followed her into another room where she was finishing up a MUGA scan. I was able to see the 3 different views (LAO, LAT, ANT) of the heart on the computer and also noted the patient mentioning that she had damage to her heart, lungs and kidney due to her chemotherapy. Next, I observed Laquita give another patient with a history of thyroid cancer an I-131 capsule and she was scheduled to come back in 2 days to see if there was any reoccurrence. Laquita was very busy that morning and we were walking back and forth several times among all the different patients. She was very knowledgable and I enjoyed being her sidekick that morning. :)
This morning I observed a pharmacologic stress test in the Nuclear Medicine Department. The patient had already received 11 mCi Tc-99m Tetrofosmin and a rest image had been taken. I came when they were preparing her for the stress part. After advising her of the procedure and asking questions about her pain levels, she was given Persantine. Persantine is the trade name for dipyridamole, which increases adenosine by blocking reuptake. They explained to me that they were watching for hemodynamic effects. The dose was titrated into her I.V. for 4 minutes to minimize discomfort and the peak effect took place after about 7 minutes. After the patient squeezed a stress ball and moved her toes, her heart rate increased enough for them to inject the Tc-99m tetrofosmin. She was given a 38.8 mCi dose. She was then given aminophylline, as sister of caffeine, to reverse the effects of the Persantine. Since it would be a while for her imaging, I looked at images of cardiac stress tests for other patients. It was very interesting!
Amandeep Kaur
I watched a couple of scans on 10/14. The first scan I watched was a thyroid scan. I watched them inject the lady with the radiopharmaceutical then she was sent to the waiting room. While she was waiting the tech showed me the hot room where they keep all the radiopharmaceuticals. Once a room was ready the lady was taken in and made as comfortable as possible and was told about the scan. First a CT scan was performed then a nuclear scan was started but the machine broke and they were unable to finish the scan and the lady was sent back in to the waiting room and the scan was redone but I was not able to watch that scan. The second scan I watched was renal scan. The renal scan was interesting because usually the patient has to lay down for the scan but this patient could not lay down do to pain from other medical conditions so they did scan with the patient sitting up. They were not sure how this would effect the scan. First they inject the radiopharmaceutical and watched the kidney function for about 30 min. during this time we chatted with the patient. Then the patient was injected with lasix and the renal function observed. The patient also had catheters in place this is important because once the patient was placed back in the hospital bed we noticed that the catheters leaked. This had to be immediately cleaned up with a special solution and a geiger counter had to be used to check the room. The tech said if there was too much radiation in the room the room would have to be closed down luckily this was not the case. It was very interesting watching the scans that we have learned about in class.
I observed a couple of different scans today. The first was a MUGA scan and the second was a stress test. I arrived after the patients were injected so I watched the actual imaging and veiwed the results from the scans.
The patient doing the stress test had been stressed pharmacologically with Persantine. The technician tagged the WBCs of the patient getting the MUGA scan and reinjected them before I arrived. It was sad to see the results from the MUGA scan. The patient had a low EF and was needing chemo for prostate cancer but the doctors weren't sure if he could handle it.
But it was neat to get to see the things we talk about in class.
Today, I visited the nuclear medicine department at UAMS. First, I got to see the hot lab where all of the doses are held before they are administered to the patients. Next, I watched a MUGA scan of a patient who had prostate cancer and was supposed to start chemotherapy. However, his ejection fraction was only 29 percent so the patient may not get to start the chemo because his heart may not be able to handle it. Next, I watched the imaging of a patient who had undergone pharmacologic stress with Persantine. My visit to the nuclear medicine department was very interesting and educational. I was able to witness the huge impact that nuclear medicine has on the lives of these patients.
Daniel and I observed as Dr LeBlanc evaluated a viability study in a 84 y/o patient with 2 previous MI's. It was interesting to see that in the original scan there was an obvious area of ischemia, but after 24 hours that area was lighting up on the scan showing that there was still viable tissue. I found it interesting to see how the information on the scan determined the next step in therapy for this patient. Upon discovery that there was viable tissue, the patient was sent to cath lab for stent placement. The goal is to restore blood flow to the ischemic area and prevent further tissue death
Eric and I observed a gallbladder scan at Children's last Friday. They were concerned about the function of the gallbladder. For this they used a HIDA (Hepatobiliary Imino-Diacetic Acid) scan. The radioactive tracer they used was technetium-99m. During the scan, we observed the hepato-billiary tree. They also administered CCK (cholecystokinin) during the later part of the scan in order to induce the release of bile from the gallbladder. This allowed them to calculate the ejection fraction of the gallbladder.
Tiffany and I went to the nuclear med department at UAMS on Monday morning. We first watched a bone scan of an elderly patient complaining of "old age pains." The scan was done with HDP because of the shorter wait time before scanning. In addition to the expected lit up kidneys and bladder, her left knee and part of her skull was lit up. We were also shown pictures from a MUGA scan in which the patient's own blood cells were tagged with Tc and then injected back into him. We pictures from a gastric emptying scan they were still working on that day, for which they said the patient eats eggs with the radioactive drug on them and then they remain there for about 4 hours for scanning. We also saw the very beginning of a stress test with Myoview. The patient and camera was situated, but we weren't there long enough the see the scans. Overall, it was an interesting experience!
A couple of weeks ago, I went to the nuclear medicine department hoping to get an overview of what usually goes on in the procedures. I got to see a cardiac scan with Myoview, where a nuclear medicine student used the computer software to focus the center of the screen on the center of the heart, so that the images were easier to see and interpret.
I also got to see I-123 being used for a thyroid uptake scan. On that particular scan, the CNMT tried to make sure that the patient was comfortable, since the cameras seemed to be very very close to the patient's body.
For a lung ventilation scan I watched, I asked the CNMT if they were using Xe-133 gas since it seemed to be more commonly used, but he said that it was actually DTPA aerosol, because using Xe-133 means that they had one chance to get an image.
During each scan, I noticed that the CNMTs talked to each patient to make sure they felt comfortable and gave them extra pillows if they asked for more. They also talked to the patients to inform them of each step, so that the patients would be more likely to cooperate in the scans, making the procedures easier.
Last week I observed a patient receiving a gallbladder scan, also know as a HIDA (hepatobiliary iminodiacetic acid) scan. The patient reported having a chronic upset stomach with n/v after eating fatty or greasy foods. The technician administered Choletec to the patient and the patient was scheduled to be under the gamma camera from about an hour and a half. During the scan, I was able to view the gallbladder, biliary ducts, liver and the small intestine light up on the computer. The tech. also administered CCK (cholecystokinin) to stimulate the gallbladder. She told the patient they may feel some abdominal pain due to the CCK. During the scan, the tech. mentioned the size and shape of the gallbladder were normal.
I observed a full body bone scan earlier this week where they used HDP on a lady who was having joint pains. There was a prominent spot showing up on her left knee. There was also some activity on her skull so the doctor ordered a head scan to get a better view. The technician also showed us some pictures of a gastric emptying that was done earlier using sulfur colloid on some eggs that they had the patient eat. They take pictures over the 4 hours after the patient eats the eggs. He also showed us some images from a MUGA scan performed on a patient to determine his heart function since he was about to start chemotherapy. On the way out we stopped to watch a the beginning of a Myoview scan (not sure if it was stress or rest). I can see how hard it would be for the patient to remain still...the cameras were really slow!
Lee and I observed a cardiac viablity scan where an 84 y/o female with two previous MI's was injected with Tl-201, the image was 1 hour after infusion(for perfusion imaging) and another taken 24hours post injecttion(viability imaging) It was thought that this patient did not have viable tissue left. The 24 hour post image revealed that there actually was metabolic acitivty in the myocardium. The patient was then sent immediately to the CATH lab where a stent was placed to restore blood flow to the previously ischemic areas. Dr. Le Blanc was very helpful in describing the entire thought process behind the scan/imaging then to the next step in this patients treatment.
I observed a MUGA scan on a patient undergoing chemotherapy. The test was UltraTag where RBC's were taken and tagged with Tc99m, then re-injected into the patient who then had 3 different imaging angles taken of the heart. The end result showed the ejection fraction of the patient and demonstrated that the current chemotherapy was not having a deleterious effect on the heart. The rad. technician was very helpful and quite knowledgeable about all aspects of nuclear medicine. Overall, it was a very good experience to see the end result of the pharmacy work we are doing.
Questin and I observed a gallbladder scan done at Children's Hospital. The patient had been experiencing stomach problems for the past year(nausea, vomiting, etc.). They were concerned that it was due to the gallbladder so they performed a scan using HIDA (Hepatobiliary Imino-Diacetic Acid) and the tracer used was Tc-99m. After about an hour they were able to see the gallbladder and the injected CCK to make the gallbladder empty. This allowed them to measure the ejection fraction of the gallbladder. They also showed us images from previous scans such as bone, abuse cases, and thyroid.
On 10/28/10, I observed the rest phase and a small part of the stress portion of a nuclear cardiac stress test. The nuclear agent that was used was Tc-99m Tetrofosmin (10mCi). While the patient lie still on her back, the camera rotated in a quarter-wise fashion around the patient. After several images were taken, the rest portion was completed and they began to prepare for the stress portion. Artificially stress, by way of dipyridamole was used for the stress portion of the test. Once the patients heart rate reached the target rate, a 30 mCi dose was administered. Aminophylline was later given to reverse the stress effects of dipyridamole. It was very interesting to see how the nuclear agents were administered in order to diagnosis potential diseases and disorders. I wish I could have observed the physicians interpret the images, however time did not permit.
On the afternoon of 10/26 I visited the nuclear medicine department at UAMS. I was able to watch parts of several different scans. The first was a bone scan for a 60yo AAM that was in remission from prostate cancer. His doctor has a scan done biannually to watch for recurrence and metasticies. He was obese and you could tell that there was still some tissue uptake and some attenuation but the bones were all visible. He had kidney and bladder uptake which were expected but he was also showing uptake in the sinus cavities that was unusual. I didn't get to hear the discussion on that before I moved over to watch the resting image of a cardiac stress test. It was neat to see the 3D image before they compiled it into the sections for comparison. I followed this patient and watched the stress test. They did a pt history and found that he was post chemo and was there for a follow up to make sure there had been no cardiac damage since he had no previous cardiac trouble (not even hypertension). They used dipyridamole to induce cardiac stress and it took about ten minutes. Then they injected the myoview and waited another five before injecting the rescue drug which was aminophylline (a methyl xanthene). He was then moved to a waiting area until an imaging room was ready and he was offered snacks and drinks since he had been NPO since the previous night. I hadn't realized that stress test patients needed to be NPO, but since N&V are side effects of the stress drugs it makes sense in hindsight.
I went on Friday and saw several interesting scans. The most interesting was an MAA scan. The patient was injected and within minutes he was getting pictures taken. They positioned the cameras and within a few minutes the scan was finished. It was eye opening knowing that they were looking for the amount of functioning lung was available so they could remove part of it and the patient sitting right there in front of me.
I went on 10/28 to the nuclear department and watched a MUGA scan. The patient was elderly and they were determing the ejection fraction to make sure chemotherapy was not effecting the patient's heart. I've had a MUGA scan so it was neat to see it from a different perspective.
Clare Mathis
On Friday at the Uams Nuclear medicine department I observed a gallbladder scan, bone imaging of a patient's knees ( very interesting, one of the technicians pointed out where the patient had a knee replacement) and a scan on a cardiac patient who was believed to have a gi bleed. It was really neat to see what we are learning in class applied to a patient experience.
On Friday, October 29th 2010, I went to the Nuclear Dept at UAMS and saw several different scans. The first was a scan for a GI bleed, the next scan was a bone scan on a patient that had 2 knee replacement surgeries and the third was a lung perfusion study with MAA. They were all very interesting, but I thought the lung scan was especially fascinating. It was interesting to see how the different scans were performed and the various obstacles that had to be overcome with each patient. For instance, in the lung perfusion study the gentleman had a hard time keeping his arms above his head which made it difficult to get the camera close enough to get a good image. It was interesting to see how what we have studied in class applies to real patients. Also, I didn't really think about the challenges the technicians face with trying to get a good scan and just various "real world" obstacles that have to be overcome.
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