PROCEDURE: G.I. BLEED
SECTION: GASTROINTESTINAL 4.1
ORIGINAL DATE: 12-29-99
DATE REVISED: 9-22-16
Refer to Policy Nuclear Medicine/Administration 1.45 "RBC and WBC administration procedure"
- Localization of gastrointestinal bleeding sites.
- Localization of non‑gastrointestinal bleeding sites.
Contraindications: No barium studies 2 days prior to exam.
Exam time length:
- Variable depending on whether and when the site of bleeding is identified.
- The study may be terminated as soon as the site is identified.
- Imaging can be performed for up to 24 hours with a single injection of radiopharmaceutical. Usually the patient will not tolerate lying under the camera for more than 3 hours at a time. However, imaging may be stopped and restarted.
Patient Preparation: No barium studies 2 days prior to exam.
Radiopharmaceutical & Dose
- Radiopharmaceutical: Tc‑99m‑red blood cells.
- Red blood cell labeling method (in vitro method): Use RBC labeling kit (Anazao Health) or Ultratag kit (Mallinckrodt)
- Adult: 35 mCi.
- Pediatric: 0.2 mCi/kg (Dosing Range 1-26 mCi)
Administration Technique: Standard intravenous injection
STATIC ACQUISITION PARAMETERS
Time interval between tracer injection and imaging: Scanning begins at time of injection.
Collimator: Large field of view. Low energy, high resolution, parallel hole.
Patient position: Supine. Imaging field: Usually abdomen and pelvis; may exclude uppermost abdomen. (Occasionally position over a different part of the body depending on suspected site of bleed.)
Energy: 20% window centered at 140 keV.
Matrix: 128 x 128
- Initial flow: anterior, 5 seconds per frame for 60 seconds.
- Acquire serial 60 second images for 60 minutes.
Images taken: Anterior flow. Images in other projections may be acquired if needed, e.g. R LAT or L LAT.
Screen caps to make: Flow – 1hr at 5 minutes/image (16 on 1), Planar Statics (16 on 1).
Send to FUJI: Screen caps, raw data
Send to Dr. PET: None
- Imaging may be resumed without an additional radiopharmaceutical injection for up to 24 hours.
- Recommended per Dr. Manske, delayed random views at 6 hours if not after 10:00 pm often are helpful and are strongly suggested. Radiologist needs to write an order for re-imaging any time patient re-bleeds.
- Radiologist should call report to patient’s physician.