RENAL SCAN, RENOGRAM (WITH LASIX AND/OR WITH CAPTOPRIL)
THEORY: The RENAL SCAN, RENOGRAM (WITH LASIX AND/OR WITH CAPTOPRIL) is used to determine renal function and/or obstruction in diverse renal diseases.99m Tc Mertiatide is excreted by the kidneys much like Hippuran, the old Nuclear Medicine gold standard to determine renal function. CLINICAL INDICATIONS:
1) Diminished renal function 2) Flank pain 3) Renal artery stenosis 4) Renal or Ureteral obstruction 5) Frequent UTI 6) Enlarged kidney (unilateral)
1) LASIX 0.3-0.5 mg/kg of body weight 2) CAPTOPRIL 25mg
1) Siemen’s E-CAM 2) Standard venipuncture equipment
1) Perform usual Daily QC (camera, well counter, dose calibrator, survey meter). 2) Check E-CAM 99mTc peak. 3) Prepare pillow(s) and table for patient arrival
1) On scheduling the patient is interviewed about possible pregnancy and/or nursing of
2) The patient is told to be well hydrated prior to arrival 3) No iodinated contrast 24 hrs prior to the scan 4) Stoppage of blood pressure medicine for 24-48 hours prior to scan
PRINCIPLE: 99m Tc Mertiatide is excreted by the kidneys much like Hippuran. Because 10 mCi 99m Tc is used, a flow study is obtained to check for prompt arrival in the kidneys. 99m Tc Mertiatide is cleared by the renal tubules and as such, it makes a good agent for determining renal function. If
there is a renal/ureteral obstruction, LASIX can be administered to the patient during the scan by a R.N. If the patient has high blood pressure Captopril may be given to the patient 45min prior to the scan by a R.N. (if the patient’s blood pressure is > 140/90) to lower the blood pressure for the scan. PROCEDURE: RENAL SCAN, RENOGRAM:
1) Prior to going to the Nuclear Medicine Truck the patient is asked about his/her fluid
intake to ensure that the patient is well hydrated and is encouraged to empty his/her bladder as much as possible.
2) Upon arrival in the Nuclear Medicine Truck the patient is interviewed to assure that
the patient is not pregnant or nursing and has not had any Iodinated contrast for the previous 24 hours.
3) The RENAL SCAN, RENOGRAM is explained to the patient. 4) The patient’s name, MR number, DOB, and the type of scan are entered into the
5) The patient’s name on the computer monitor is highlighted and the ICON for the type
of scan is clicked on. The PREPARE SCAN icon is clicked on.
6) Measure the amount of activity in the syringe of 99m Tc Mertiatide in the DOSE
7) Place the radioactive syringe in a Tungsten syringe shield. 8) Position the patient in the supine position on the imaging pallet with the camera
beneath the patient. (If the patient has had a Renal transplant, position the patient in the supine position on the imaging pallet with the camera over the patient.)
9) Position the patient so that both kidneys (if 2 are present) will be near the top of the
field of view of the camera. (Recheck the positioning.)
10) Check the patient positioning monitor to be sure the START icon is green. 11) Using aseptic technique, the patient is given a bolus injection of usually 10 mCi 99m
12) View the patient positioning monitor. Press the START button as the tracer starts
13) The scan will take 30 minutes. 14) At the end of the scan, save the scan by completing the procedure. 15) At the end of the scan, allow the patient to rise from the scanning pallet and escort the
patient to Radiology for them to release the patient or send the patient on to the next procedure.
16) The patient’s name on the computer monitor is highlighted and the ICON for the
RENAL PROCESSING procedure is clicked on.
17) Review the RENAL FLOW images and record the dose of radiotracer, time and
means of injection and technologist’s initials on the scan.
18) Review the RENOGRAM images. 19) Go to the RENAL PROCESSING program. Review the ROIs. 20) The ROI box over the aorta will have to be moved. Create a small box ROI over the
21) Review and redraw as needed the ROIs over the kidneys and backgrounds. 22) Create SAVE SCREENS for the FLOW, RENOGRAM and PROCESSED GRAPHS.
23) Complete the scan and SEND the 3 SAVE SCREENS into the hospital’s PACs
1) When scheduling the patient, the patient’s weight was asked of the referring
physician’s office. Divide the weight in pounds by 2.2 to find the patient’s weight in kilograms. Multiply the patient’s weight in kilograms by 0.4mg to find the amount of LASIX to be used. Round this number to the nearest 5mg (i.e. 20mg, 25mg, 30mg, 35mg, etc.).
2) Have a physician write a prescription for this amount of LASIX. 3) Prior to going to the Nuclear Medicine Truck the patient is asked about his/her fluid
intake to ensure that the patient is well hydrated (a well hydrated patient is mandatory for this scan) and is encouraged to empty his/her bladder as much as possible (the patient will be on the scanning pallet for 1 hour, so an empty bladder is necessary for patient comfort).
4) Upon arrival in the Nuclear Medicine Truck, the patient is interviewed to assure that
the patient is not pregnant or nursing and has not had any Iodinated contrast for the previous 24 hours.
5) The RENOGRAM WITH LASIX is explained to the patient. 6) The patient’s name, MR number, DOB and the type of scan are entered into the
7) The patient’s name on the computer monitor is highlighted and the ICON for the 60
minute RENOGRAM WITH LASIX is clicked on. The PREPARE SCAN icon is clicked on.
8) Measure the amount of activity in the syringe of 99m Tc Mertiatide in the DOSE
9) Place the radioactive syringe in a Tungsten syringe shield. 10) Position the patient in the supine position on the imaging pallet with the camera
11) Position the patient so that both kidneys (if 2 are present) will be near the top of the
field of view of the camera. (Recheck the positioning.)
12) Check the patient positioning monitor to be sure the START icon is green. 13) Using aseptic technique, start an I.V. Port and inject the patient with a bolus injection
14) View the patient positioning monitor. Press the START button as the tracer starts
down the aorta. The scan will take 60 minutes.
15) At the 30 minute mark (28-32 minutes) have the R.N. administer the previously
16) At the end of the scan, save the scan by completing the procedure. 17) At the end of the scan, allow the patient to rise from the scanning pallet and escort the
patient to Radiology for them to release the patient or send the patient on to the next procedure.
18) The patient’s name on the computer monitor is highlighted and the ICON for the
RENAL PROCESSING procedure is clicked on.
19) Review the RENAL FLOW images and record the dose of radiotracer, time and
means of injection and technologist’s initial son the scan.
20) Review the RENOGRAM images. 21) Go to the RENAL PROCESSING program. Review the ROIs. 22) The ROI box over the aorta will have to be moved. Create a small box ROI over the
23) Review and redraw as needed the ROIs over the kidneys and backgrounds. 24) On the graph page, record the amount of LASIX administered by the R.N., the frame
during the scan it was given, and the R.N.’s initials.
25) Create SAVE SCREENS for the FLOW, RENOGRAM, and PROCESSED
26) Complete the scan and SEND the 3 SAVE SCREENS into the hospital’s PACs
1) Upon arrival to the hospital, the patient is interviewed to assure that the patient is not
pregnant or nursing, that the patient is well hydrated, and that the patient has not had IODINATED contrast in the past 24 hours.
2) The RENOGRAM WITH CAPTOPRIL is explained to the patient. 3) An R.N. will take the patient’s blood pressure to assure that the systolic and/or
diastolic pressure is elevated (over 140/90). If neither pressure is elevated, the CAPTOPRIL RENOGRAM cannot be done, but the referring physician may change the order to a RENAL SCAN, RENOGRAM.
4) If at least one of the pressures is elevated, the Nurse will start an I.V., administer
25mg CAPTOPRIL, have the patient drink several glasses of water over the next 45min and take blood pressures at 15 minute intervals.
5) At 45 minutes after the CAPTOPRIL was given, the patient is taken to the Nuclear
Medicine Truck and is positioned in the supine position on the scanning pallet.
6) The patient’s name, MR number DOB and the type of scan are entered into the
7) Highlight the patient’s name on the computer monitor and click on the ICON for the
30 minute RENOGRAM WITH CAPTOPRIL. The PREPARE SCAN icon is clicked on.
8) Measure the amount of activity in the syringe of 99m Tc Mertiatide in the DOSE
9) Place the radioactive syringe in a Tungsten syringe shield. 10) Position the patient in the supine position on the imaging pallet with the camera
11) Position the patient so that both kidneys (if 2 are present) will be near the top of the
field of view of the camera (recheck the positioning).
12) Check the patient positioning monitor to be sure the START icon is green. 13) Using aseptic technique, start an I.V. Port and inject the patient with a bolus injection
14) View the patient positioning monitor. Press the START button as the tracer starts
down the aorta. The scan will take 30 minutes.
15) At the end of the scan, save the scan by completing the procedure.
16) At the end of the scan, allow the patient to rise from the scanning pallet and escort the
patient to Radiology for them to release the patient or send the patient on to the next procedure.
17) Highlight the patient’s name on the computer monitor and the ICON for the RENAL
18) Review the RENAL FLOW images and record the dose of radiotracer, time and
means of injection and technologist’s initials on the scan.
19) Review the RENOGRAM images. 20) Go to the RENAL PROCESSING program. Review the ROIs. 21) The ROI box over the aorta will have to be moved. Create a small box ROI over the
22) Review and redraw as needed the ROIs over the kidneys and background areas. 23) On the graph page, record the patient’s blood pressures, amount of CAPTOPRIL
administered by the R.N. and the R.N.’s initials.
24) Create SAVE SCREENS for the FLOW, RENOGRAM, and PROCESSED
25) Complete the scan and SEND the 3 SAVE SCREENS into the hospital’s PACs
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