What is a bone scintigram?
A bone scintigram is a test that is sensitive to your bone’s reaction to particular diseases. For example, a bone scintigram can identify metastatic foci in bones weeks or months before the same foci would be detected on an x-ray. Therefore, a normal bone scintigram practically rules out bone disease.
How it is performed
First, an injection of technitium 99m (99mTc) will be administered. Then, depending upon the clinical question of your doctor, images of the body region of interest will be obtained. After three hours, when the radiotracer has been distributed throughout the bones, scintigrams of the body will be obtained. Usually this takes 30-60 minutes and you are lying down when these images are taken, but sometimes, the images may also be obtained with you in the sitting position. .It is important to drink a lot of liquid and continually empty your bladder from the
Interdependence of the radiotracer with other medicines
For those patients who are taking particular medications, they do not need to be stopped for the bone scintigram.
Preparation
In general, no preparation is necessary for a bone scintigram, though we recommend that you drink a lot of liquids before and during the exam. If, due to your illness, you think that you may have severe pain during the test, you will need to take medication so that you can lie still for the duration of the scintigram. Any movement will affect the quality of the images obtained. Therefore, please bring along your own pain medication and take it an hour before you will be instructed to lie down for the scintigram.
Risks (unwanted side effects)
Adverse reactions to technitium 99m are extremely rare (0.003% -0.033%, or about one thousandth times less common than a reaction to x-ray contrast agent.) Some patients develop a skin rash 4 to 6 hours after receiving the radiotracer. This will disappear if treated with antihistamines.
The radiotracer injection does not affect your ability to drive a vehicle.
The radiation exposure with a scintigram is very low.
If you are pregnant, it is typical to wait until your pregnancy is over to have the bone scintigram. If you are breastfeeding, we recommend that you temporarily suspend the feedings. This is really for your peace of mind since numerous studies have found no significant amount of radiotracer in breast milk.
Clinical Advantages
As previously mentioned, the main advantage of a bone scintigram is to detect spread of cancer to the bones weeks to months before it would be visible on radiographs. Other indications for a whole body bone scintigram include suspected infection, primary bone tumour, sport’s injury, osteonecrosis or Sudeck's atrophy.
False-negative studies occur in 3% of exams. These are due to specific diseases.
What is a lung scintigram?
A lung scintigram measures the distribution of blood flow and air to the lungs. It is the best noninvasive test for diagnose pulmonary embolus.
How it is performed
An injection of albumin-technetium 99m (99mTc)-labelled particles (circa30 µm in diameter) is given. These particles are distributed throughout the lung, based upon the volume of blood flow to the lungs. The scintigram estimates the volume of blood flow through the lungs. In addition, you will have to inhale a radioactive gas oder aerosol, so that a comparison between blood flow (i.e., perfusion) and aeration (i.e., ventilation) can be made. The entire test lasts circa 30 to 45 minutes.
Interdependence of the radiotracer with other medicines
In general, medications have no effect on lung scintigraphy. Patients with Asthma should bring along their bronchodilatators.
Preparation
No preparation is necessary for this exam. You will need to have a recent chest x-ray for . interpretation of the lung scintigram.
Risks (unwanted side effects)
Adverse reactions are extremely rare Even so, allergic reactions to human albumin have been reported.
The test does not affect your ability to drive a vehicle.
The radiation exposure with a lung scintigram is very low, even though the lung scintigram uses the radioisotopes with the highest radiation dose.
For mothers who are breast feeding, since these radioactive compounds have been found in breast milk, we recommend that you suspend breastfeeding for 12 hours after the exam.
Clinical Advantages
A normal lung scintigram rules out pulmonary emboli, i.e., blood clots in the lungs. If we find multiple segmental defects in the blood to the lung with normal aeration in these regions, this perfusion mismatch is very likely due to pulmonary emboli. The exam is most sensitive at the time when the suspicion of pulmonary emboli is raised. It will be done as soon as possible from this time point. Because ventilation-perfusion mismatches can occur in patients with chronic bronchitis, also, this sometimes makes the exam interpretation difficult.
What is a cardiac scintigram?
A myocardial scintigram combines ergometry (usually walking on a treadmill) or pharmacologically-induced stress test. It is the most sensitive noninvasive test for detection and localization of reduced blood flow to the heart muscles, i.e., ischemia. This test plays a role in judging the risk of an infarct in patients with suspected or known coronary artery disease, and also in estimating the ability of the heart muscles to recover should an infarct occur.
How the test is performed
A variety of radiopharmaceuticals and study protocols may be used. Commonly technetium 99m (99mTc) is used to label the agents (e.g., MIBI oder tetrofosmin) to be injected for stress testing begins or after the administration of the vasodilator Regadenoson which temporarily widens the arteries taking blood to the heart muscles. Soon after, the „stress“ scintigram images are obtained.
After another 60 minutes, images will be taken with you at rest or will be scheduled for another day. Generally, the head of the scintigraphy camera successfully rotates around your body, obtaining images of the heart from different angles. This lasts about 20 minutes.
The entire exam lasts about 3 hours, including the waiting time between the stress and rest scintigrams. However, you do not have to wait in the Nuclear Medicine department between these two sets of images.
Interdependence of the radiotracer with other medicines
Because beta-Blockers interfere with the ergometry part of the exam, if you are taking a beta-blocker, depending upon the half-life of your medication, you must stop taking it starting 3 days before the day of your scheduled scintigram.
Medications that have caffeine or xanthine, such as aminophylline, theophylline, theospirex, spiropentane, as well as coffee, tea, chocolate or Cola drinks will interfere with Regadenoson, if you will be given a pharmacological vasodilator for the exam.
Preparation
You shall have to fast for the exam.
Risks (unwanted side effects)
No serious adverse reactions have been reported to occur after Technetium-99m administration. The main risks are related to the treadmill exercise or pharmacologically-induced vasodilation and include cardiac arrhythmia, heart infarct (occurring in 1-10 out of 100,000 exams), and/or exercise-induced ischemia which is one of the indications for the test. The radiotracer injection does not affect your ability to drive a vehicle.
The radiation exposure is in the mid-range of that for nuclear medicine exams.
Myocardial perfusion agents may appear in breast milk. Therefore, if you are breastfeeding, we recommend that you temporarily suspend the feedings. Should you have further questions, please speak with one of our personnel.
Clinical Advantages
Noninvasive diagnosis of ischemia in patients with chest pain.
Detection of residual stress-ischemia after a myocardial infarct, i.e., heart attack.
Determine the viability of myocardial muscle.
Follow-up exam after angioplasty or bypass surgery. untersuchungen nach Angioplastie oder Bypass Operation
Noninvasive search for re-stenosis in patients who have had dilation or surgery for known coronary artery disease.
What is a renal scintigram?
There are several different methods and also radiopharmaceuticals available for nuclear medicine evaluation of the kidneys. The method and agent are tailored to answer the clinical question,
A renal scan checks the blood flow to, Gewebsfunktion, and excretion of each kidney, It’s the best test to detect renal scars, especially in children, to judge regional and unilateral renal function. Depending upon the clinical question, the kidney function can be studied after giving conventional medications. Blood pressure drop after giving ACE inhibitors, such as Captopril, can also be observed on Captopril nephrograms. This allows assessment of the effectiveness of the renal arteries to changes in blood pressure. Additionally a diuresis nephrogram can be done after giving bladder –activating medications such as Lasix. This can show if there is any bladder dysfunction.
How it is performed
The bladder must be emptied before the test begins so that you can drink lots of liquids, circa 3/4 liter of water. Then you will be given an injection via the vein of a radiotracer chosen to answer the clinical question of your doctor. Scintigrams will be taken immediately after and also a few hours after the injection.
If you are scheduled for a Captopril nephrogram, to check your blood pressure, you will be given the injection of Captopril one hour before the test starts. Other patients will be injected with a diuretic at the end of their study to check bladder responsiveness.
In general, the images take 15 minutes to acquire and are obtained with you lying down. If necessary, scintigrams will be obtained over 15 minutes with you in the sitting position. (You will sit on a stool with your back to the gamma camera.) Whether lying or sitting, it is imperative that you do not move during the 15 minutes while the images are being acquired.
Interdependence of the radiotracer with other medicines
With the exception of ACE (Angiotensin Converting Enzyme)inhibitors, no other medications affect kidney scintigraphy. If you are taking ACE.inhibitors, you must stop taking your medication 5 days before your schedule kidney scintigraphy exam.
Preparation
In general, you do not have to fast for this exam, unless you have high blood pressure. Also, for patients with renal failure, after emptying their bladder, they will be asked to orally hydrate themselves with mineral water, circa 10 ml/kg, starting 45 minutes before the exam. No other preparation is necessary.
Risks (unwanted side effects)
The radiation exposure is low, clearly lower than that for intravenous urography. Renal Scintigraphy is one oft he most commonly used nuclear medicine exams in children.
Clinical Advantages
The renal scintigram is the most sensitive test for acute pyelonephritis in the pediatric population. Quantitative measurements allow you to know the relative function of each individual kidney. The renal scintigram can also help distinguish between functional versus mechanical outflow obstruction. Furthermore, renovascular hypertension can also be diagnosed.
In the thyroid gland outpatient clinic of the Nuclear Medicine department our specialized staff offer you the best possible care.
Our department treats the entire gamut of throid gland diseases, including an morphologic problems of the thyroid gland, e.g., thyromegaly or thyroid nodules, as well as functional thyroid gland problems, e.g., thyroid hormone metabolism.
Common benign thyroid diseases include autoimmune thyroiditis, i.e, Graves’ disease or Hashimoto’s thyroiditis, as well as thyromegaly or an autonomous thyroid nodule.
Malignant thyroid gland disease, including thyroid gland carcinoma, though relatively rare, are treated in our department.
Thanks to the collaboration of the laboratory, ultrasound and scintigraphy divisions, we are able to diagnose and treat all diseases of the thyroid gland.
At each visit to our outpatient clinic, we consult our Internal Medicine colleagues since thyroid gland conditions may require medication and regular follow-up or iodine radiotherapy or surgery. We also foster a good working relationship with the Radiotherapy Department and the University Clinic for Surgery at the General Hospital in Vienna.
Exam Preparation
Please bring previous images—including scintigrams and ultrasounds, as well as their reports, and lab test results so that our doctors can take these into consideration in determining your diagnosis and/or clinical course.
Also please bring a list of your current and past thyroid medications. Lastly, let us know if you have received iodine contrast material for any exam in the last 6-8 weeks, e.g., angiography or contrast-enhanced CT, or if you have been taking iodine-containing medications (such as Amiodarone or disinfection agents) and/or dietary supplements.
If this will be your first thyroid exam, we ask you to fast. For all follow-up thyroid exams, please check the report to see if you will need to fast before coming to your exam appointment.
You should stop taking any thyroid medication, e.g., Thyrex, Euthyrox, L-Thyroxin, Combithyrex, Novothyral, before your thyroid scintigram. As well, if you are having a fine-needle puncture of the thyroid gland, please do not take your anticoagulants. All other medications may be taken.
What to expect during the exam
Please fill out the medical history form given to you while you wait for the doctor to call you. An in-depth interview with one of our doctors, regarding your symptoms, previous treatment and other illnesses, will take place before your scintigraphy
Usually a thyroid ultrasound will be done to assess the morphologic changes of your thyroid gland.
Also, blood will usually be taken from you to check your thyroid hormone levels, at least.
If there is a suspicion of thyroid function disorder or morphologic changes of the gland, then a thyroid scan will be performed by injecting the radioactive compound 99mTc-Pertechnetate. After a waiting period, images of the thyroid gland will be obtained with a high-speed gamma camera which will show the distribution of the radiotracer in the gland and thyroid nodule(s), if present.
If necessary, a fine needle aspiration will be performed, using ultrasound guidance, to take cells from the thyroid nodule. Looking under a microscope, the lab technologist will be able to tell if these cells are benign or malignant.
After the thyroid gland puncture, you will have to wait 20 minutes to be sure that there is no bleeding from the needle site.
Thyroid Gland Report
Normally, the report and any laboratory results will be sent by mail.
The report will state your diagnosis, recommended therapy, and the recommended date of your follow-up exam.
If anything is unclear, please discuss this with your family doctor. At your follow-up exam appointment, you may also ask us to clarify anything that is confusing.
Should your report recommend that your follow-up treatment be done in another location, please ask us to send the appropriate doctor/site your thyroid scan report.
- Diagnosis and Therapy of Thyroid Gland Diseases
- Clinical Examination
- Specific Laboratory Tests (Calcium stimulation test, TRH-Test, Iodine excretion in bladder, etc.)
- Thyroid Scan Ultrasound
- Thyroid Scan Scintigraphy
- Fine Needle Aspiration
- Special Diagnostic Scintigraphy
Outpatient Clinic with Surgeons
Together with Univ.-Prof. Dr. B. Niederle, University Clinic for Surgery, Clinical Division of General Surgery, Working Group Endocrinology Surgery