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Parathyroid

PROCEDURE: PARATHYROID IMAGING
SECTION: ENDOCRINOLOGY 3.5
ORIGINAL DATE: 12–29–99
DATE REVISED: 9–22–16
REVIEWED: Annual

Indications: Detect and localize parathyroid adenomas

Contraindications: none

Exam time length

  • Initially: 45 minutes 
  • Delayed 3 hour imaging: 75 minutes

Patient Preparation: None

Radiopharmaceutical & Dose

  • Tc‑99m‑sestamibi. 
  • Dose:
    • Adult: 25 mCi (925 MBq)
    • Pediatric: 0.3 mCi/kg (Dosing Range 1-25 mCi)

Administration Technique
Technique of administration: Standard intravenous injection. 
Using a intermittent I.V. to ensure non-infiltrated dosing. Lymphatic drainage of infiltrated dose may lead to visualization of lymph nodes under arm.

STATIC ACQUISITION PARAMETERS

Time interval between tracer injection and imaging: None

Collimator: LEHR

Patient position: Supine with head and neck extended and immobilized

Energy: 140 kev

Matrix: 128

Time /View

  • 600 sec for all zoomed; 
  • 300sec non-zoom;
  • 30sec Co-57 marker

Images taken

  • Early Zoom-neck 
  • Early non-zoom – neck and chest 
  • Early non-zoom marker – marker on SS notch
  • Early 15 min 
  • Ant 3hr Zoom-neck 
  • Ant 3hr non-zoom-neck and chest 
  • Delay SPECT/CT – see SPECT acquisition instructions

Screen caps to make: All stats. Add marker image to neck and chest image

Send to FUJI: Stats screen cap

Send to Dr. PET: Screen caps

*** NOTE: Show completed exam to radiologist prior to patient leaving. ***

SPECT ACQUISITION & PROCESSING PARAMETERS

Time interval between tracer injection and imaging: SPECT/CT imaging at 3hrs post dose

Camera/Collimator: LEHR

Patient position: Supine – head first

Energy: 140 kev

Matrix: 128

Pixel size: 4.4mm

Number of projections: 60

CW or CCW: CW or CCW

Orbit type: Contour

Start Angle: 0 or as camera starts after CT

End Angle: 360 or as camera ends after CT and SPECT

Time per view: 20 sec

Gating (Y/N): NA

Gating frames: NA

R to R window: NA

Uniformity and COR: NA

Prefilter Type: Hanning

Filter cutoff/power: 0.9,0

Motion correction: NA

Attenuation correction Y/N: Y – with CT atten correction

Normal database used Y/N: N

Reconstruction filter: Hanning 0.9,10

Screen caps to make: None

Send to FUJI: SPECT/CT – NM axail, Fused axial,axial CT and MIP

Send to Dr. PET: Entire study

Data Acquisition- Parathyroid SPECT/CT

When performing a SPECT acquisition where the pallet is NOT supported by the rollers in the gantry, the system applies a “table sag” correction to the data. In this scenario, we can use the body part “head or neck”. If the pallet is advanced far enough during the acquisition set-up where it is supported by the rollers, then use “other” for body part.

To change, as needed, per above:

    • Under SPECT/CT acquisition Tomo Key Parameters, click “More Parameters”. 
    • Click on “Tomo Admin Parameters”, 
    • Under “Image Orientation: Change ‘Body Part” needed by clicking on the drop down.

Data Processing - Parathryoid SPECT/CT

See General SOP - XELERIS SPECT/CT PROCESSING

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