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Thyroid (Both I-123 & I-131)

PROCEDURE: THYROID IMAGING (Both I-123 and I-131)
SECTION: ENDOCRINOLOGY 3.1
ORIGINAL DATE: 4 - 3 - 00
DATE REVISED: 10 - 19 - 16
REVIEWED: Annual

Indications:

  • Evaluation of palpable nodules. 
  • Evaluation of abnormal gland to palpation, but without definite nodules. 
  • Evaluation of patients who had irradiation of the head and neck in childhood with or without palpable nodules. 
  • Evaluation for ectopic thyroid tissue, e.g. Struma Ovarii (image over pelvis) and lingual thyroid (image upper neck and jaw).

Contraindications:

The provider will interview patient regarding the following contraindicated meds. The patient must be off the following for at least:

  1. Thyroxine (T‑4): 6 wks 
  2. Triiodothyronine (T‑3): 2 wks 
  3. Propylthiouracil (PTU): 3 days 
  4. Tapazole (Methimazole): 3 days 
  5. Iodinated contrast: 4 wks

Other substances that might interfere with accurate uptake:

  • Kelp (4 wks)
  • herbal preparations
  • certain vitamins/minerals (4 wks)
  • Lugol’s solution and SSKI (4 wks)
  • some cough medicines (4 wks)
  • perchlorate (4 wks)
  • pertechnetate (1 wk). 

Reference: Dr Caplan 11/2008 +7/2013

Exam time length: 60 minutes

Patient Preparation: See contraindications above.

Radiopharmaceutical & Dose:

  • 123 I dose: Adult: 200 – 400 microCi (2-100 microCi Caps) 
  • Substernal thyroid I 123: 300 microCi (3 -100 microCi Caps) 
  • Pediatric: 100-200 microCi (1-100 microCi Cap)
  • 131 I dose: 100 – 150 microCi

Staff perform bioassay within 3 days after administration of any of the following:

  • any dose of liquid I-131; or 
  • dose >100mCi I-131 in capsules; or 
  • total dose administered by same tech in one 24hr period >100 mCi I-131 in capsules

Administration Technique: Oral


STATIC ACQUISITION PARAMETERS: Infinia

Time interval between tracer injection & imaging: Provider will specify 4 hour or 24 hour exam

Collimator

  • 123 I __LEAP 
  • 131 I___Hi energy

Patient position: Supine, head first

Energy

  • 123 I __159 KeV 
  • 131 I___364 KeV

Matrix: 128 x 128 for both energies

Time /View

  • Ant, 1.5 zoom, 5 min 
  • Ant w/ marker, 1.5 zoom, 30 sec 
  • Ant, 3.0 zoom, 10 min 
  • RAO/LAO, 3.0 zoom, 10 min, use L mode, pan X 26, pan Y -13

Images taken

  • Ant 
  • Ant with marker on SSN, may also mark any palpable nodules, 
  • Mark chin & SSN on post thyroidectomy scan, Transmission image may be taken if needed to define activity seen, 
  • Ant with zoom 
  • RAO/LAO with zoom 
  • If needed do chest view for sublingual thyroid (1.5 zoom, 10 minutes)

Screen caps to make: Add together Ant & marker image(s), display result along with all other images taken, Measure both lobes with electronic ruler and move off to side, 6 on 1, label all views and landmarks. Chest image may be included for sublingual thyroid.

Send to FUJI: Screencaps: type the %uptake on our thydoid uptake/scan screen captures

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