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CUDURADA FAAFA

Hepatobiliary Scan

                                                      Photo by: Shanti.com

 

• Name of the procedure

• Indications

• Contraindications

• Patient Prep

• Radiopharmaceuticals

• Adjunct pharmaceuticals

• Acquisition parameters

• Computer processing parameters

• Images that will be turned to the physician

• Normal results

• Abnormal result

 

 

1. Name of the Procedure:  Hepatobiliary Scan with and without GBEF. 

2. Indications: Assessment of how hepatobiliary system functions,  Evaluation of suspected acute cholecystitis, Evaluation of common bile duct obstruction, Evaluation of suspected chronic biliary tract disorder, and Evaluation of congenital abnormalities of the biliary tree.

3. Contraindications: Retained burium, Serum bilirubin level above 20 mg/dl may cause a nondiagnostic examination due to poor hepatocellular function. patient has just eaten a meal. Do not give Kinevac if gallbladder and bowel activity are not seen within 45-60 min.

4. Patient Preparation: In order to visualize the gallbladder, the patient must have fasted for about 4 hrs prior to injection of the radiopharmaceutical. If the patient has fasted for longer than 24 hrs, the gallbladder may not fill with the tracer. In this case the patient may be pretreated with sincalide.  

5. Radiopharmaceuticals: Tc-99m Choletec is used. Administered dose will be 5-10 mCi given through an IV (Intravenous injection). Inject the dose 4 hrs prior to patient has fasted. Injection to imaging time is 5 min.

6. Adjunct Pharmaceutical:  none.

7. Acquisition Parameters: Hepatobiliary study, Collimator will be low-energy, all-purpose, parallel hole. Images are obtained with 60 min dynamic and 30 min post injection of Kinevac ( 0.02 mcg/kg in 10ml of normal saline administered intravenously over 3-10 min) . Matrix is 64x64; Injection to imaging time is 5 min. positioning will be supine. Photopeak selection is 140keV with 20% window. Anterior view is acquired (1 frame /min) for the first 60 min, the last 30 min (post injection of Kinevac), and the delayed images as needed.  RLAT and RAO views can also be obtained. You can not give Kinevac until the gallbladder and the bowel activity are seen. When the gallbladder is not seen within 40-60 min and cholecystitis is suspected, 3-4 hrs delayed images should be obtained, or morphine may be employed intravenously ( 0.04mg/kg in 10 ml saline over 3-5 min). Delayed images, 18-24hrs may be necessary in some cases (severely ill patients). If the patient is being studied for a biliary leak, 2-4 hr delayed images will be acquired, and decubitus views are employed.  

8. Computer Processing: First, Hepatobiliary processing: Click general display and select the patient’s name; click select all, and then click “all”; click select predefined, and choose dynamic hepato; select the first picture, and then choose select all from the edit list; when all pictures are seen, choose deselect from the edit list; type amount, the kind of radiopharmaceutical, and the root of administration at the bottom of the first picture; then print. The second part. Which is Gallbladder processing, click processing tool on the top of the computer screen; select gallbladder EF; select the patient’s name choosing gallbladder EF; select the first picture; click OK; then select the last picture; click OK; then click DONE; draw region of interest (the gallbladder); click OK; When a graph is seen move the arrow to the highest point, and click OK; print the images.

9. Normal Result:  The size, shape, and function of the gallbladder are normal. The ducts leading from the liver and gallbladder to the small intestine (duodenum) are not blocked or narrowed. Gallbladder visualization within 45 min. GBEF > 35%

10. Abnormal Result:  The tracer may not be removed normally from the bloodstream by the liver, indicating possible liver disease. The radioactive tracer may not reach the gallbladder, indicating inflammation or blockage of the duct by a gallstone. The tracer may not reach the beginning of the small intestine (duodenum), indicating blockage of a bile duct by a stone, a tumor, or inflammation of the pancreas. In addition, the gallbladder may not contract normally. GBEF <35%

Picture is from: www.vh.org

 

 

 

 

 

 

 

 

 

This procedure manual was prepared by:

A/Razaq H. Nuurre

Nuclear Medicine

Ohio, USA