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Microsoft word - renal scan-renogram.doc

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

Source: http://nirc.biz/protocols/NucMed/Renal%20Scan-Renogram%202012-09-20.pdf

Q2370_canaural_ear_dro.1_8.tp

Dechra Veterinary Products Limited (A business unit of Dechra Pharmaceuticals PLC) Sansaw Business Park Hadnall, Shrewsbury Shropshire SY4 4AS Tel: 01939 211200 CANAURAL ® EAR DROPS, SUSPENSION FOR Contraindications, warnings, etc DOGS AND CATS Do not use concomitantly with products known to Presentation Do not use in animals with known hypersensitivityto the active substances or

Microsoft word - santana final.rtf

Medical abortion: A safe and effective alternative to surgical methods WRITER’S COMMENT: When I was first assigned to do a review paper I had no idea what I was going to write about. There were so many topics I was interested in that trying to decide on just one that was specific enough for the paper was tough. I was reading some old scientific news articles to see if anything appealed to

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