NM bone scan

COMPARISON: []

RADIOPHARMACEUTICALS: []mCi of Tc-MDP was injected I.V.

TECHNIQUE: 3-4hrs after radiotracer injection, whole body bone scan was performed with selected spot view.

FINDINGS: No suspicious bone uptake. There is degenerative-type uptake within [site]. Physiologic uptake within kidneys and bladder. 

IMPRESSION: No bone scan evidence for osteoblastic metastasis.

NM bone scan 2phase WB

COMPARISON: []

RADIOPHARMACEUTICALS: []mCi of Tc-MDP was injected I.V.

TECHNIQUE: 2-phase whole body bone scan. Whole body blood pool imaging was performed followed by 3-4hrs delayed whole body imaging with selected spot views.

FINDINGS: No abnormal periarticular uptake on either blood pool or delayed whole body imaging. Physiologic uptake within kidneys and bladder. 

IMPRESSION: No bone scan evidence for synovitis or active inflammatory arthritis.

NM bone scan 3phase

COMPARISON: []

RADIOPHARMACEUTICALS:  []mCi of Tc-MDP was injected I.V.

TECHNIQUE: 3 phase bone scan was performed of [site]

FINDINGS:  There is [mild/moderate] abnormal [focal/non-focal/diffuse] peri-articular uptake on all 3 phases of bone scan within [left/right] [site] which is asymmetric compared to opposite side consistent with CRPS.

Patient has [left/right] [hip/knee[ arthropasty in place. There is pmild/moderate[ intensity [focal/non-focal/diffuse] periprosthetic uptake along site on [flow/blood pool/delayed] imaging. On delayed imaging there is degenerative vs post-traumatic uptake within site. 

IMPRESSION: No scintigraphic evidence for CRPS or prosthetic complication.

NM bone scan mets FU

COMPARISON: Bone scan []

RADIOPHARMACEUTICALS:  []mCi of Tc-MDP was injected I.V.

TECHNIQUE: 3-4hrs after radiotracer injection, whole body bone scan was performed with selected spot view.

FINDINGS: Patient has known widespread metastatic disease.  In comparison to the prior exam, there is interval…

no significant change in overall number and intensity of lesions within axial and proximal appendicular skeleton. 

development of [number] new lesion(s) within [location].

remainder of numerous axial skeletal lesions (including ribs, spine, and pelvis) appear to be stable/slightly improved/slightly worsened.  

IMPRESSION: Known widespread osseous metastasis with no significant interval change.

NM Gallium scan

COMPARISON:  [] 

RADIOPHARMACEUTICAL: []mCi Gallium-67 citrate I.V. on [date]

TECHNIQUE: Whole body infection/inflammation imaging with Gallium was performed [24/48]hrs after injection along with selected spot views.

FINDINGS: No focal abnormal uptake. There is physiologic uptake within liver, spleen, bowel, and bone/bone marrow.

IMPRESSION: No site of infection identified.

NM GE liquid

COMPARISON: No similar past studies are available for comparison.

RADIOPHARMACEUTICAL: []uCi of Tc-sulfur colloid P.O. in 300cc of water

TECHNIQUE: Liquid gastric emptying study. 60min of dynamic imaging over abdomen in anterior or LAO position.

FINDINGS: Time to half max (T1/2) gastric activity is approximately []min (normal less than 23min).

IMPRESSION: Normal liquid gastric emptying study.

NM GE oatmeal (semi-solid)

COMPARISON: [none]

RADIOPHARMACEUTICAL: []uCi of Tc-sulfur colloid P.O. in oatmeal (semi-solid meal). [Patient is unable/unwilling to consume standard egg meal or is allergic to eggs.]

TECHNIQUE: [60-90]min of dynamic imaging over abdomen in anterior or LAO position.

FINDINGS: Time to half max (T1/2) gastric activity is approximately []min (normal less than equal to 50min).

IMPRESSION: Normal semi-solid gastric emptying study.

NM GE solid

COMPARISON: [none]

RADIOPHARMACEUTICAL: []uCi of Tc-sulfur colloid P.O. in cooked eggs (standardized solid meal)

TECHNIQUE: 4hr solid gastric emptying study. After ingestion of radiolabeled standardized solid meal, anterior or LAO static imaging over the abdomen generally performed at 1hr, 2hr, and 4hr.

FINDINGS: The gastric retention measures []% at 1hr (normal between 30-90%), []% at 2hr (normal 60% or less), and []% at 4hr (normal <10%).

IMPRESSION:  Normal solid gastric emptying study.

NM GI bleed

COMPARISON: []

RADIOPHARMACEUTICAL:  []mCi Tc-RBC (in-vitro labeling) I.V.

TECHNIQUE: [90]min anterior dynamic imaging was performed over the abdomen/pelvis after radiotracer injection.   

FINDINGS: No abnormal focus of radiotracer activity was noted during the entire length of study.  There is physiologic uptake within blood pool, spleen, kidneys and bladder.

There is focal abnormal activity that appears in expected region of [], intensifies over time, and transits intraluminally in antegrade/retrograde fashion.

IMPRESSION: No scintigraphic evidence for active GI bleed.

Active X GI bleed within [SMA/IMA] distribution.

NM hemangioma

COMPARISON: [] 

RADIOPHARMACEUTICAL:  []mCi Tc-RBC I.V.

TECHNIQUE: Flow, blood pool, and [2-3]hr delayed planar imaging of the abdomen was performed followed by delayed SPECT imaging.

FINDINGS: Hepatic lesion of interest is relatively photopenic on flow and blood pool imaging with diffuse increased uptake (greater than hepatic background and equal to blood pool acitivity) on delayed imaging best evaluated on SPECT imaging consistent with hemangioma.

IMPRESSION: Scintigraphic findings confirm [location] hepatic hemangioma.

NM HIDA
COMPARISON: []

RADIOPHARMACEUTICALS:  []mCi Tc-choletec IV

TECHNIQUE:  [60]min anterior dynamic imaging over the abdomen was performed after radiotracer injection. [Additional 4hr delayed static imaging was obtained.] [Patient was pretreated with CCK 30 minutes before injection.]

FINDINGS: Normal hepatic uptake and excretion with appropriate clearance of background blood pool activity. Normal visualization of biliary, gallbladder and bowel activity.

Normal hepatic uptake with decreased excretion and poor clearance of background blood pool activity suggestive of hepatocellular dysfunction.

Normal visualization of biliary and bowel activity. However, no gallbladder activity on initial or 4hr delayed imaging. 

Delayed biliary-to-bowel transit is non-specific but can be seen with chronic cholecystitis.

Incidental note of enterogastric reflux.

Distended common bile duct with poor clearance of biliary activity suggestive of partial/high-grade biliary obstruction.

IMPRESSION: No scintigraphic evidence for acute cholecystitis. Cannot exclude chronic cholecystitis.

HIDA with GBEF

COMPARISON: []

RADIOPHARMACEUTICALS: []mCi Tc-cholectec IV

ANCILLARY PHARMACEUTICAL:  []ug CCK IV

TECHNIQUE: 60min anterior dynamic imaging followed by GB ejection fraction determination using CCK infusion over [30]min

FINDINGS: Normal hepatic uptake and excretion with appropriate clearance of background blood pool activity.  Normal visualization of biliary, gallbladder, and small bowel activity.

After CCK infusion, gallbladder ejection fraction is calculated to be  []% (normal greater than 35%). [Patient was asymptomatic] during CCK infusion.

60min after oral Ensure/Boost (in lieu of CCK) administration, gallbladder ejection fraction is calculated to be []% (normal greater than or equal to 33%). 

IMPRESSION: Depressed gallbladder ejection fraction consistent with chronic cholecystitis or gallbladder dyskinesia.

NM I131 cancer therapy inpatient

COMPARISON: []

ADDITIONAL HISTORY: [cancer pathology]. [social situation].

RADIOPHARMACEUTICALS:  []mCi I-131 P.O. inpatient therapy for thyroid cancer ablation. 

TECHNIQUE: Dose was prescribed by an Authorized user in conjunction with treatment request by endocrinologist/ENT physician. The risks, benefits, and potential complications of radioactive I-131 therapy were discussed in detail with the patient. Verbal and written informed consent was obtained. [Urine B-hCG was confirmed negative prior to therapy.] Dose was verified in dose calibrator and patient was given oral I-131 pill under my direct supervision. Patient will be kept in hospital for next few days under supervised isolation for radiation safety precautions and subsequently, discharged to home per release criteria.  Take-home written instructions sheet will be given at discharge for radiation safety precautions to be observed as an outpatient. Patient has been specifically advised to avoid close contact with children, pregnant women, and other members for public at time of discharge. [Also, patient has been advised to use appropriate contraceptive method to avoid pregnancy for 6 to 12 months following therapy.]

IMPRESSION: Inpatient []mCi I-131 P.O. therapy for thyroid cancer ablation.

UPDATE: Patient was kept in hospital for [3]days in supervised isolation for radiation safety precautions. Inpatient stay was uneventful. Patient was discharged on [date/time] in stable condition to home per release criteria (exposure rate of  []mR/hr at 1m) and was given a take-home written instructions sheet for radiation safety precautions to be observed for another [2]days as an outpatient. Patient has been instructed to return in 7-10 days for post-ablation whole body scan.

NM I131 cancer therapy outpatient

COMPARISON: I-131 post-ablation scan or Metascan []   

ADDITIONAL HISTORY:  [social history]. []TSH (on hormone withdrawl) on [date].

RADIOPHARMACEUTICALS:  []mCi I-131 P.O. outpatient therapy for thyroid cancer. 

TECHNIQUE: Dose was prescribed by an Authorized user in conjunction with treatment request by endocrinologist/ENT physician.  Suitability for outpatient therapy was determined during in-office consultation on [date] and patient release calculations were performed using patient-specific factors to ensure potential dose to public of less than 0.5rem.  The risks, benefits, and potential complications of radioactive I-131 therapy were discussed in detail with the patient. Verbal and written informed consent was obtained and take-home written instructions were given for radiation safety precautions to be observed for [5]days as an outpatient. Patient was specifically advised to avoid close contact with children, pregnant women, and other members of public. [Also, patient has been advised to use appropriate contraceptive method to avoid pregnancy for 6 to 12 months following therapy. Urine B-hCG was confirmed negative prior to therapy.] Dose was verified in dose calibrator and patient was given oral I-131 pill under my direct supervision. No immediate complications.

IMPRESSION:

1. Outpatient []mCi I-131 P.O. therapy for thyroid cancer.

2. Patient will return in 7-10days for post-ablation scan.

NM Pre-I131 consultation

Relevant medical history:  []year-old [F/M] with [type] thyroid cancer [pathology], status post total thyroidectomy on [date]. [No] prior I-131 therapy or metascan. Patient denies urinary incontinence or renal disease. Patient is currently on low iodine diet and is currently off thyroid replacement therapy.

Social history: Patient lives with []. Patient will be able to sleep alone and have a bathroom for own exclusive use.  No pregnant female or children 18years or younger at home.

Pertinent Imaging: []

Pertinent Labs:  [] TGag/TGab with [] TSH on [date]. [] Cr/GFR on [date].          

Pregnancy/Breastfeeding: Patient denies pregnancy or breastfeeding. Pregnancy test will be obtained prior to therapy.

Discussion: Pre-therapy consultation with patient was done to determine suitability of I-131 cancer therapy in an outpatient setting. Patient's social situation was discussed in detail to determine whether patient would be able to follow strict radiation safety precautions at home following therapy without need for hospital stay. The radiation safety precautions were reviewed in detail and written documentation was provided for reference.  Risks, benefits and potential complications of I-131 ablation were also explained and patient had an opportunity to ask questions and have them answered. 30min was spent in consultation.

PLAN: Perform high-dose I-131 therapy as an outpatient. Patient understands and agrees to necessary radiation safety precautions related to outpatient therapy. Patient's social situation is conducive to outpatient therapy.

NM I131 dosimetric evaluation

RADIOPHARMACEUTICAL:  []mCi I-123 P.O. on [date]

TECHNIQUE: Patient-specific dosimetric evaluation was performed to determine max tolerated dose ensuring lung/WB retention of less than 80/120mCi at 48hrs. Whole body imaging was performed at 2hrs (pre-voiding) and 24hrs (post-voiding) after radiotracer administration. Geometric mean of total anterior and posterior counts derived from ROI over whole body at 2hrs and over lungs/WB at 24hrs were utilized for determination of WB retention at 48hrs.  

FINDINGS: Total Lung/WB retention at 48hrs was calculated to be []mCi.

IMPRESSION: Given total lung/WB retention at 48hrs of []mCi, recommend therapy with []mCi I-131 PO.

NM I131 Hyperthyroid therapy

COMPARISON: I-123 uptake/scan []   

ADDITIONAL HISTORY: []

RADIOPHARMACEUTICALS:  []mCi I-131 P.O. outpatient therapy for hyperthyroidism. 

TECHNIQUE: Dose was prescribed by an Authorized user in conjunction with treatment request by endocrinologist/ENT physician.  The risks, benefits, and potential complications of radioactive I-131 therapy were discussed in detail with the patient. Verbal and written informed consent was obtained and take-home written instructions were given for radiation safety precautions to be observed for [3]days as an outpatient. Patient was specifically advised to avoid close contact with children, pregnant women, and other members for public [and also to use appropriate contraceptive method to avoid pregnancy for 6 months following therapy]. [Urine B-hCG was confirmed to be negative prior to therapy]. Dose was verified in dose calibrator and patient was given oral I-131 pill under my direct supervision. No immediate complications.

IMPRESSION: Outpatient []mCi I-131 P.O. therapy for hyperthyroidism. Patient to follow-up with [ENT/endocrinologist] to determine adequacy to treatment.

NM I131 Metascan

ADDITIONAL HISTORY: []

RADIOPHARMACEUTICAL: []mCi I-131 P.O. on [date]   

TECHNIQUE: Radioactive iodine was administered under supervision of an Authorized User. After 48hrs, whole body I-131 Metascan was performed with spot views of the neck with and without markers.

FINDINGS: There is physiologic uptake within salivary glands, nasopharynx, stomach, colon and bladder. No suspicious uptake within neck/chest.

IMPRESSION: No evidence for iodine-avid thyroid cancer recurrence.  Please correlate with serum thyroglobulin levels.

NM I131 post-ablation scan

COMPARISON: []  

RADIOPHARMACEUTICAL:  []mCi I-131 P.O. radio-iodine ablation therapy as [outpatient] on [date]    

TECHNIQUE: [7-10]days post-ablation I-131 whole body scan with spot views of neck.

FINDINGS: Post-ablation scan shows expected uptake within the thyroid bed likely representing remnant thyroid tissue. No other areas of abnormal uptake. Normal/physiologic uptake within salivary glands, nasopharynx, stomach, colon and bladder.

IMPRESSION:

1. Expected uptake within thyroid bed most likely represents remnant thyroid tissue.

2. No regional lymph node uptake or distant metastatic disease.

NM Indium dual-isotope hardware

COMPARISON: 3phase bone scan []       

RADIOPHARMACEUTICAL: [0.5]mCi Tc-WBC I.V. on [date] and [10]mCi Tc-SC I.V. on [date]  

TECHNIQUE: Simultaneous dual-isotope imaging of [site] with Indium labeled WBC (infection imaging) and Tc- Sulfur Colloid (marrow imaging). Post-processing normalization and subtraction was performed.

FINDINGS:

There is no focal abnormal uptake on indium scan. 

There is concordant [minimal/mild/moderate] [focal/non-focal/diffuse] periprosthetic uptake on Indium and Sulfur Colloid scans suggestive of non-infectious etiology like redistributed or reactivated marrow. 

There is [minimal/mild/moderate] [focal/non-focal/diffuse] periprosthetic uptake along [site] on Indium scan [corresponding to region of concern on 3phase bone scan] which is discordant with sulfur colloid scan.

IMPRESSION:  No dual-isotope imaging findings to suggest hardware infection. 

Given abnormal 3 phase bone scan hardware loosening cannot be entirely excluded (correlate clinically). 

NM Indium scan

COMPARISON: [] 

RADIOPHARMACEUTICAL:  []mCi Indium labeled WBC I.V. on [date]

TECHNIQUE: Whole body infection imaging with Indium-WBC was performed [24]hrs after injection along with selected spot views.

FINDINGS:  No focal abnormal uptake. There is physiologic uptake within spleen, liver, and bone marrow.

IMPRESSION: No site of infection identified.

NM injection only

The patient was injected with []mCi [radiotracer] for [] nuclear medicine study. Due to [patient’s condition] no imaging could be obtained therefore study was cancelled. The exam code was changed to [injection only].

NM liver spleen scan

COMPARISON: [] 

RADIOPHARMACEUTICAL:  []mCi Tc-Sulfur Colloid I.V.

TECHNIQUE: Planar imaging of liver/spleen was performed in multiple projections [including SPECT imaging of abdomen]

FINDINGS: [No] hepatosplenomegaly.  [No] abnormal increased splenic uptake or evidence for colloid shift.  [Faint physiologic] bone marrow uptake is noted.

IMPRESSION: No evidence for colloid shift or sequela of portal hypertension.

NM Lymphoscintigraphy Breast

RADIOPHARMACEUTICAL: []mCi [Tc-SC (filtered)/Tc-Lymphoseek] in [4] equal doses

PROCEDURE: [Four] peri-areolar intra-dermal injections were performed for pre-op [left/right] breast sentinel lymph node localization. Time-out was done prior to procedure. No imaging was requested. 

IMPRESSION: [Left/Right] breast injected for sentinel lymph node localization.

NM Lymphoscintigraphy Melanoma

RADIOPHARMACEUTICAL: []mCi [Tc-SC (filtered)/Tc-Lymphoseek] in [2] equal doses

TECHNIQUE: Pre-operative sentinel node mapping for Melanoma. [3] peritumoral intradermal injections were performed at the [site] followed by dynamic imaging for [2]hrs. Time-out was done prior to procedure.

FINDINGS/IMPRESSION: [Single] [location] sentinel lymph node(s) was identified and overlying skin was marked to assist with intraoperative localization.

NM lymphosintigraphy LE

RADIOPHARMACEUTICAL: []mCi [Tc-SC (filtered)/Tilmanocept (Lymphoseek)] intradermal injections bilateral feet. 

TECHNIQUE: Intradermal injection of radiotracer was performed at first and second web spaces of bilateral feet. Dynamic and static imaging of bilateral lower extremities was performed from feet to upper abdomen. 

FINDINGS: There is [high grade obstruction of right lower extremity deep lymphatic channel] located [at the level of knee with resultant significant dermal backflow (superficial lymphatic channels) and poor transit distally]. At [2]hrs no significant radiotracer transit was seen above the knee. [Normal left lower extremity lymphatic imaging with visualization of inguinal nodes and subsequent physiologic liver uptake.]

IMPRESSION:
1. High grade obstruction of [right lower extremity deep lymphatics] located [at the level of the knee]. This correlates with history of lymphedema.
2. Normal left lower extremity lymphatics.

NM MPS 1day mibi/mibi

COMPARISON:  []

RADIOPHARMACEUTICALS: []mCi Tc-Sestamibi IV at rest and []mCi Tc-Sestamibi IV at stress

PROCEDURE: 1-day Myocardial Perfusion Scan with Tc-Sestamibi. SPECT imaging was performed at rest followed by same day gated SPECT imaging after pharmacological stress with 0.4mg Lexiscan IV. 

FINDINGS:  [No significant perfusion defect]. [No] transient ischemic dilation (TID) at stress. Left ventricular ejection fraction is []% (normal 50% or above). Normal wall motion.

IMPRESSION: 

1. No ischemia or infarct.

2. Ejection fraction of []% with normal wall motion.

NM MPS 2day mibi/mibi

COMPARISON:  []

RADIOPHARMACEUTICALS:  []mCi Tc-Sestamibi IV at stress on [date] and []mCi Tc-Sestamibi IV at rest on [date]   

PROCEDURE: 2-day Myocardial Perfusion Scan with Tc-Sestamibi. Gated stress SPECT imaging was performed after pharmacological stress with 0.4mg Lexiscan IV. Rest SPECT imaging was performed on a separate date.

FINDINGS:  [No significant perfusion defect]. [No] transient ischemic dilation (TID) at stress. Left ventricular ejection fraction is []% (normal 50% or above). Normal wall motion.

IMPRESSION: 

1. No ischemia or infarct.

2. Ejection fraction of []% with normal wall motion.

NM MPS with thallium

COMPARISON: []

RADIOPHARMACEUTICALS: [3]mCi Thallium-201 IV

PROCEDURE: Myocardial Perfusion Scan with Thallium-201. Gated stress SPECT imaging was performed after pharmacological stress with 0.4mg Lexiscan IV followed [3-4]hr later by rest SPECT imaging.

FINDINGS:  [No significant perfusion defect]. [No] transient ischemic dilation (TID) at stress. Normal lung-to-heart ratio. Left ventricular ejection fraction is []% (normal 50% or above). Normal wall motion.

IMPRESSION: 

1. No ischemia or infarct.

2. Ejection fraction of []% with normal wall motion.

NM MPS and viability

COMPARISON: []

RADIOPHARMACEUTICALS: [3]mCi Thallium-201 IV at stress and [1]mCi re-injection at rest for 24hr viability

PROCEDURE: Myocardial Perfusion and Viability Scan with Thallium-201. Gated-SPECT imaging was performed after pharmacological stress with 0.4mg Lexiscan IV followed by 4hr resting SPECT imaging and 24hr delayed re-distribution (viability) imaging.

FINDINGS: Myocardial Perfusion and Viability Scan with Thallium-201.  There is [] wall defect which is demonstrates [no significant viability].  LV ejection fraction is []% (normal 50% or above) with normal wall motion.

IMPRESSION:

1.  [] wall [partial/complete] viability.

2.  [] wall infarct without significant viability.

3.  Depressed LV ejection fraction of []% with [abnormal] wall motion.

NM MPS viability only

COMPARISON:  Myocardial perfusion scan []   

RADIOPHARMACEUTICALS: total [4]mCi Thallium-201 IV [(including 1mCi reinjection after 4hr imaging)]

PROCEDURE: Myocardial Viability Scan with Thallium-201. Resting gated SPECT imaging was performed [10]min after radiotracer injection followed by [4hr and 24hr] re-distribution SPECT imaging.

FINDINGS: There is [] wall defect which demonstrates [no significant viability]. LV ejection fraction is []% (normal 50% or above) with normal wall motion.

IMPRESSION: [] wall infarct without significant viability.

NM MPS planar

COMPARISON: []

RADIOPHARMACEUTICALS: []mCi Tc-Sestamibi IV at stress on [date] and []mCi IV at rest on [date]      

PROCEDURE: 2-DAY PLANAR MYOCARDIAL PERFUSION SCAN. Due to patient's body habitus (beyond camera table weight-limit), very limited Planar-only (non-SPECT, non-gated) Myocardial Perfusion Scan was performed at rest and stress in anterior, LAO, and left lateral projections. Stress imaging was obtained after pharmacological stress using 0.4mg Lexiscan IV.

FINDINGS/IMPRESSION:  Very limited planar Myocardial Perfusion Scan.

1. [No significant ischemia/infarct].

2. No ventricular function data available.

NM MUGA

COMPARISON: recent MUGA [] and baseline MUGA [].

RADIOPHARMACEUTICALS:  []mCi Tc-RBC (in-vitro labeling) I.V.

TECHNIQUE: Gated dynamic imaging was performed in LAO and additional projections.  Using end-systolic and end-diastolic ROIs on LAO projection, left ventricular ejection fraction was calculated. 

FINDINGS/IMPRESSION: Left ventricular ejection fraction is estimated to be []% (normal 50% or more), previously []% on [date]. Normal phase/amplitude and LV wall motion.

NM Octreoscan

COMPARISON: [] 

RADIOPHARMACEUTICAL:  []mCi In-111-Pentreotide (OctreoScan) I.V.

TECHNIQUE: Whole body planar imaging was performed in anterior/posterior projection at [4hr, 24hr, and 48hr] after radiotracer injection including SPECT imaging of [abdomen/pelvis] at [24hr and 48hr].

FINDINGS:  There is no focal abnormal uptake. Physiologic uptake is seen within the liver, spleen, kidneys/bladder, bowel, and thyroid gland.

IMPRESSION: No scintigraphic evidence for metastasis.

NM Parathyroid

COMPARISON: [None]

RADIOPHARMACEUTICAL: []mCi Tc-sestamibi IV.

TECHNIQUE: Dual-phase 20min early and 2hr delayed Parathyroid scan with Tc-sestamibi. [Delayed SPECT was also obtained].

FINDINGS:  Homogenous thyroid uptake on early and appropriate thyroid washout on delayed scan. No focal abnormal activity on either early or delayed parathyroid scan to suggest parathyroid adenoma.

IMPRESSION: No focal parathyroid adenoma identified.

NM Parathyroid dual-isotope

COMPARISON: [None]

RADIOPHARMACEUTICAL: [5]mCi Tc-pertechnetate IV and [20]mCi Tc-sestamibi IV.

TECHNIQUE: Dual-isotope imaging with post-processing subtraction.  Thyroid scan was performed with Tc-pertechnetate followed by early and delayed Parathyroid scan with Tc-sestamibi.

FINDINGS:    

No focal abnormal activity on thyroid-parathyroid subtraction imaging or delayed parathyroid scan.

On thyroid-parathyroid subtraction imaging, there is focal residual uptake along [inferior aspect of left thyroid lobe] suggestive of [left inferior] parathyroid adenoma. This is also confirmed on delayed parathyroid scan.

IMPRESSION: No focal parathyroid adenoma identified.

NM Peritoneal scintigraphy

RADIOPHARMACEUTICAL: [5]mCi Tc-MAA intraperitoneal via percutaneous catheter

TECHNIQUE: Approximately [2000]ml of radiolabeled dialysate was instilled into peritoneal cavity via existing percutaneous catheter in sterile fashion by [Nephrology nurse]. Anterior/posterior static imaging was performed at [1hr and 2hr]. Subsequently dialysate fluid was removed.

FINDINGS/IMPRESSION: Normal peritoneal scintigraphy. There is homogeneous distribution of dialysate within the 4 quadrants of abdominal cavity without focal fluid collection or evidence for extension into abdominal/inguinal hernia or within pleural cavity. No significant retention.   

NM PET scan

COMPARISON: []  

RADIOPHARMACEUTICAL:  []mCi of F18-FDG I.V.

PROCEDURE: Serum glucose of []mg/dl. PET/CT was performed [60]min following radiotracer injection from [skull base to mid thighs/head to toe (whole body)/top of head (including brain) to mid thighs]. CT images were acquired without breathhold and [with/without] [IV/oral contrast].

CT DOSE: CTDIvol of []mGy and total DLP of []mGy-cm (using Body 32cm phantom).

FINDINGS:

BRAIN: []  

NECK:  [] 

CHEST/MEDIASTINUM:  [] 

BREAST/AXILLA:  []

ABD/PELVIS:  [] 

MSK/MISC:  [] 

IMPRESSION:  No PET/CT evidence for active disease or recurrence.

NM PET brain

COMPARISON: []  

RADIOPHARMACEUTICAL:  []mCi of F18-FDG I.V.

PROCEDURE: Serum glucose of []mg/dl. Brain PET/CT was performed [30]min following radiotracer injection from vertex through skull base. Low dose CT images were acquired without IV for attenuation correction and anatomic correlation.

CT DOSE: CTDIvol of []mGy and DLP of []mGy-cm.

FINDINGS:

[Bilateral/unilateral] [symmetric/asymmetric] decreased FDG uptake within [parietal/temporal/frontal cortices to include posterior cingulate gyri with sparing of sensorimotor and occipital cortices and deep gray matter].

There is normal and symmetric FDG uptake within bilateral cerebral cortices, deep gray nuclei, thalami, cerebellum and brainstem.

[No focal anatomic abnormality or atrophy] on noncontrast CT.

IMPRESSION: No specific PET/CT abnormality to suggest etiology of MCI/dementia.

NM PET sarcoidosis

COMPARISON: Myocardial perfusion scan []  

RADIOPHARMACEUTICAL:  []mCi of F18-FDG I.V.

PROCEDURE: Serum glucose of []mg/dl. Myocardial PET/CT (including chest) was performed 90min radiotracer injection. Patient prep included high-fat, low-carbohydrate diet followed by extended fasting for [12]hrs before scan. Low dose CT images were acquired without IV and oral contrast, and were used for attenuation correction and for anatomic correlation.

CT DOSE: CTDIvol of  []mGy and total DLP of []mGy-cm.

FINDINGS:

MYOCARDIUM: []

CHEST/MEDIASTINUM: []  

MISC: []  

IMPRESSION: No PET/CT evidence for myocardial sarcoidosis.

NM Renal lasix

COMPARISON: []  

RADIOPHARMACEUTICAL: []mCi Tc-MAG3 IV via [site]. [No] extravasation at injection site.

ANCILLARY PHARMACEUTICAL: [40]mg Lasix IV given at [start of the exam (within 1 minutes of radiotracer injection)].

TECHNIQUE: Dynamic posterior imaging over bilateral kidneys was performed for [30]min with Lasix given at the beginning of the study.  Static post-void imaging was also performed.

FINDINGS:

FLOW: There is [prompt/symmetric] flow to [bilateral kidneys].

SPLIT FUNCTION: Differential function at 2min is []% on the left and []% on the right.

RENOGRAM AND COLLECTING SYSTEM CLEARANCE: [Symmetric renal size and normal orientation].  [There is no hydronephrosis or hydroureter].  [There is prompt rise to peak and washout of bilateral renal activity].  Time to peak activity is approximately []min on the left and []min on the right (normal 3-5min). Post-Lasix time to half (T1/2) is []min on the left and    []min on the right (normal less than 10 minutes).

POST VOID: [No] significant persistent collecting system activity is noted on post void imaging.  [Progressive clearance of collecting system activity within upright posture and voiding]. [No significant] post-void residual bladder volume.

IMPRESSION: Normal bilateral renal flow and function without obstruction.

NM Renal captopril

COMPARISON: []  

RADIOPHARMACEUTICAL:  []mCi Tc-MAG3 IV on [date] for post-captopril renal scan and    []mCi Tc-MAG3 IV on [date] for baseline renal scan.

TECHNIQUE: Hypertensive medications were held for at least [48]hrs prior to study. On day one, post-ACE inhibitor renal scan was performed with [25mg Captopril PO given 1hr] prior to radiotracer injection.  Patient's blood pressure was monitored throughout the exam with [no adverse reaction].  Dynamic imaging was performed for [30-40]min in posterior projection. On day two, baseline renal scan was performed without ACE inhibitor using same imaging parameters. No Lasix was given.

FINDINGS:

Baseline scan: Differential function is []% left and []% right kidney. Cortical time to peak is    []min left and []min right kidney. 20 min/max activity remaining is []% left and []% right kidney.  Renogram curve is grade [] left and grade [] right kidney.

Post-Captopril scan: Differential function is []% left and []% right kidney. Cortical time to peak is []min left and []min right kidney. 20 min/max activity remaining is []% left and []% right kidney.  Renogram curve is grade [] left and grade [] right kidney.

Misc: Symmetric renal size and normal orientation. No hydronephrosis. Time to half max (T1/2) of collecting system activity is []min on the left and []min on the right. This is unchanged on pre- or post-Captopril scan. Post void images demonstrate []. No significant extravasation is noted at the injection site.

IMPRESSION: Low probability for RAS.

NM thyroid uptake

COMPARISON: Ultrasound thyroid []

RADIOPHARMACEUTICAL: []uCi I-123 P.O.

TECHNIQUE: I-123 uptake and scan performed at 24hrs after radiotracer ingestion.

FINDINGS: Homogenous thyroid gland uptake without focal hot or cold nodule. 24hr radioactive iodine uptake is []% (normal 10-30%). No thyroid enlargement on physical exam.

IMPRESSION: In setting of hyperthyroidism, imaging is suggestive of [Graves disease] with [elevated] 24hr uptake of []%. 

NM VQ XENON

COMPARISON: chest Xray []  

RADIOPHARMACEUTICALS: []mCi Xe-133 gas inhaled and []mCi Tc-MAA IV

TECHNIQUE: Planar ventilation scan was performed in posterior projection after Xe-133 gas inhalation (wash-in, equilibrium, and wash-out phases) followed by perfusion scan with Tc-MAA IV in multiple projections. 

FINDINGS:  Normal ventilation with appropriate wash-out and no significant air-trapping. No mismatched segmental perfusion defect. No focal opacity on recent chest Xray.

IMPRESSION: Low probability for acute PE.

NM VQ AEROSOL

COMPARISON: chest Xray []  

RADIOPHARMACEUTICALS:  []mCi Tc-DTPA aerosol nebulizer and []mCi Tc-MAA IV

TECHNIQUE: Planar ventilation scan was performed in multiple projections after Tc-DTPA aerosol nebulizer administration followed by perfusion scan with Tc-MAA IV in similar projections. [Due to patient's body habitus, limited ventilation-perfusion imaging was performed in anterior and LAO/RAO projections only, with patient in hospital gurney.]

FINDINGS:  Normal ventilation scan without defects or central deposition of radiotracer. No mismatched segmental perfusion defect. No focal opacity on recent chest Xray.

[Mildly] heterogeneous ventilation with [multiple/occasional] matched ventilation-perfusion defects [(with ventilation worse than perfusion)]. No significant mismatched perfusion defect.

IMPRESSION: Low probability for acute PE.

NM VQ shunt

COMPARISON: No previous study available for comparison.

RADIOPHARMACEUTICAL:   []mCi Tc-MAA IV

TECHNIQUE: Lung perfusion imaging was performed for R to L shunt determination. Whole body was imaged from vertex of skull through mid-thighs. Counts were determined using ROI over region of interest on both anterior and posterior projections with geometric mean calculation.

FINDINGS:

Whole body (WB) counts= [] 

Lung counts= []  

Systemic counts= WB counts - Lung counts= []  

Right to left shunt= (Systemic counts / WB counts) x 100%= []% (normal is <5%)

No significant segmental perfusion defects.

IMPRESSION: No significant R to L shunt.

NM VQ split lung

COMPARISON: CXR

RADIOPHARMACEUTICALS:  [] mCi Tc-MAA IV

TECHNIQUE: Quantitative lung perfusion study with split lung analysis. Ventilation was not performed.

FINDINGS: Focal perfusion defect corresponding to known lung mass.

Quantitative perfusion analysis shows total split lung perfusion of []% left lung and  []% right lung. 

Percent perfusion for left upper lung zone is  []%, left mid lung zone is  []%, left lower lung zone is  []%.  Percent perfusion for right upper lung zone is []%, right mid lung zone is []%, right lower lung zone is [] %. 

IMPRESSION: Split lung perfusion as above. [R/L] lung contributes []% to the total lung perfusion (with [] lung zone contributing  []%).