Clinical Indications:

• Metastatic Disease
• Primary Malignant Bone Tumours - Chondrosarcoma, Osteogenic Sarcoma, Ewing’s Sarcoma
• Benign Primary Tumours - Osteoid Osteoma, Bone islands, Bone cysts, Enchondroma, Fibrous Dysplasia
• Osteomyelitis
• Septic Arthritis
• Diabetic Osteoarthropathy
• Prosthetic Joints - Loosening, Infection, Fracture/Dislocation, Heterotropic bone formation
• Fractures - Traumatic, Stress, Insufficiency
• Paget’s Disease
• Avascular Necrosis
• Legg-Calve Perthes Disease
• Reflex Sympathetic Dystrophy
• Heterotropic Ossification
• Arthritides - Degenerative Joint Disease, Rheumatoid Arthritis, Pseudoarthritis.

A Bone scan is a two part test involving an intravenous radioactive injection (Technetium99m HDP) followed by images of the blood flow and blood pool to the area of interest. The HDP takes 2-3 hours to be absorbed by the bones, so a delay is required in order to visualise the bone structures.
We are able to “fuse” CT data onto our SPECT images in order to localise anatomical structures more precisely.

Preparation: Nil.
Injection: 15 minutes (including initial images)
Scan: (2-3 hours later) 45 minutes.

An example of Bone SPECT fused with CT data.

Clinical Indications:

• Longstanding Constipation
• Assessing segmental colon transit times

A Colonic transit study is a 5 day study, in which the patient is given a small amount of radioactivity to drink on Monday morning followed by an image 6 hours later of the abdomen. The radiotracer is then imaged every morning until Friday so we are able to assess the transit times through the ascending, descending and the rectal colon individually.

Preparation:
Discontinue any laxatives or bowel mobility agents 3 days before the study commences.
Monday morning: 2 minute drink. Return 6 hours later for 10 minute scan.
Tuesday - Friday: 10 minute image each morning.

Clinical Indications:

• Assessment of Renal Scarring
• Urinary Tract Infection
• Pyelonephritis
• Renal infarct
• Horseshoe kidney
• Ectopic kidney

Technetium99m DMSA is the radiotracer that is injected intravenously into the patient in order to visualise the renal cortex of the kidneys. This injection will take 3 hours to be bound to the kidneys before any imaging can commence.

Preparation:
Well hydrated throughout the day. Keep Voiding.

Injection: 10 minutes

Scan: (performed 3 hours post injection) 45 minutes.

Clinical Indications:

• Assessment of GFR
• Differential renal function
• Acute renal failure
• Chronic renal failure
• Acute & chronic rejection
• Screening of patients with suspected renal hypertension
• Obstruction
• Hydronephrosis

The exam itself involves an injection of either DTPA or MAG3 followed by immediate images of the kidneys as the injection enters the body. In doing this, we are able to provide information on the renal blood flow, GFR, tubular function and urinary excretion.

Preparation:
1 litre of water 1 hour prior to appointment time. If assessing for RAS, then all ACE inhibitors are to be ceased for at least 3 days.

Scan: 1 hour or 2 hours if looking for RAS (with Captopril).

Clinical Indications:

• SOBOE
• Abnormal ECG
• Chest Pain

The exercise stress test is performed with both the Physician and a Cardiac Nurse, who will attach a 12 lead ECG to the patient and will monitor the BP and HR response throughout the procedure.

Preparation:
Some medications need to be ceased :
Caffeine needs to be ceased for 24 hours prior to the test.

Fasting for 4 hours before the test is also required.

Patients should wear comfortable clothing and running shoes for exercising.

Test Duration: 3.5 hours.

Clinical Indications:

• Osteomyelitis (a bone scan may be required before the gallium scan)
• Pyrexia of Unknown Origin
• Staging and post-therapy in Hodgkin’s disease, Non-Hodgkin’s lymphoma

This exam requires and injection of Gallium67 followed by images anywhere from 1 to 7 days later, depending on the clinical indications. Osteomyelitis requires images at 48 hours after the injection. POU and Lymphoma are imaged at 48 hours and then may need further imaging depending on the results.

Preparation: Nil.

Time Frame:

Injection: 5 minutes
Scan: 1 hour

Clinical Indications:

• Gastroparesis
• Gastrinoma
• Dumping Syndrome
• Delayed gastric emptying

Patients requiring this study will be given an egg which will be labelled to some Technetium99m , in between 2 slices of toast. This enables us to follow the food through the stomach in order to determine how quickly the food is able to be passed through the stomach. We image the patient initially for 30 minutes, and then perform images at set intervals over the next 3 hours in order to physiologically determine the rate of emptying.

Preparation: No eating, smoking, or exercising on the day prior to the exam.

All gastric mobility agents to be ceased the day prior to exam.

Scan: 3 hours

Clinical Indications:

• Assess LVEF
• Pre Chemotherapy Assessment of LVEF
• Post Chemotherapy Assessment of LVEF

Patients will have some blood taken so we can label it with the radioisotope, once labelled the blood will then be re-injected into the patient and images acquired of the heart beating the blood through the body. This provides an assessment method of the Left Ventricular Ejection Fraction which can be used for post chemotherapy response.

Preparation: Nil.

Scan: 1 hour

Clinical Indications:

• Suspected Gastro-Intestinal bleeding

Patients will have some blood taken so we can label it with the radioisotope, once labelled the blood will then be re-injected into the patient and dynamic images will be acquired followed by serial images throughout the day. Occasionally a 24 hour image may need to be taken.

Preparation: Fasting for 4 hours.

Scan: Anywhere from 1 hour to 24 hours, depending on scan findings.

Clinical Indications:

• Acute Cholecystitis
• Chronic Cholecystitis
• Abnormal biliary leakage
• Biliary atresia

Patients will be injected with Technetium99m Hepatolite (HIDA) and images will be taken of the liver and gallbladder for about 60 minutes. After this time, we will determine if the patient requires a CCK infusion or a morphine injection. The CCK infusion simulates the patient eating a fatty meal, so if the gallbladder is visualised, we should expect it to empty after the CCK infusion. However, if the gallbladder is not seen after 60 minutes and infusion of morphine may be given to contract the sphincter of Oddi, which increases biliary pressure, in order to help visualise the gallbladder.

Preparation: Fasting for 4 hours prior to test.

Scan: 2 hours.

Clinical Indications:

• Pulmonary Embolism
• Assessment prior to lung reduction surgery
• This test can be performed on patients who are not suitable for CTPA due to an iodine allergy

The V/Q scan is the recommended test for exclusion of PE in women of child-bearing age, as the radiation exposure to the breasts is much lower than a CTPA.
For this study, patients are required to inhale some radioactive gas in order for us to visualise the ventilation to the lungs. This ventilation image is then acquired prior to an injection into the vein in order to visualise the Perfusion to the lungs. Once the Perfusion image is finished, we are able to compare the two images and look for any mismatches in the perfusion image.

Preparation: Nil.

Scan: 1 hour.

Clinical Indications:

• Diagnosis and management of CAD
• Determine myocardial ischaemia or infarction
• Evaluation of stent patency
• Evaluation of CABG post surgery

This study will examine the blood perfusion to the myocardium at ‘rest’ and then at ‘stress’, following an exercise stress test. We routinely perform Gated SPECT acquisitions for both the rest and stress images to determine the left ventricular EF and wall motion. Additionally we perform both supine and prone images in order to more accurately resolve cardiac abnormalities due to patient artefact. The stress test can be medically induced using persantin or dobutamine if patients are unable to exercise.

Preparation: Cease caffeine for 24 hours.
Fast for 4 hours prior to appointment time.
Some medications may need to be ceased (beta blockers and calcium antagonists) though the test can be performed whilst taking these. Please contact Lakeview Imaging for more details.
Ph: (07) 5493 1649

Test Duration: 3.5 hours.

Clinical Indications:

• Identify adenomas in patient with elevated PTH and Calcium levels
• Localisation of adenoma prior to surgery
• Hyperparathyroidism
• Ectopic Parathyroid tissuey

A parathyroid study consists of an intravenous injection of Sestamibi (MIBI) which will initially localise in both the thyroid and parathyroid glands. Over a period of time the MIBI will washout of the thyroid gland and leave the parathyroid tissue visible. We take planar and SPECT images at both the initial and 3 hour stages to determine any parathyroid tissue.

Preparation: Nil.

Scan:
Initial Image: 45 minutes
Delay Image: 45 minutes.

Clinical Indications:

• Hyperthyroidism - determine cause
• Nodules - Assess activity
• This scan has no role in the evaluation of hypothyroidism without the presence of nodules

A thyroid scan involves an intravenous injection of Technetium Pertechnetate which enables us to determine the function of the thyroid gland with or without the presence of nodules. It also determines the presence and site of the thyroid tissue such as in thyroid bed of a completely excised gland or in other locations (ie sublingual).

Preparation: No CT contrast media 3 months prior

Some medications may need to be ceased, contact Lakeview Imaging for details..

Scan: 45 minutes.

Clinical Indications:

• Chrohn’s Disease
• Osteomyelitis
• PUO (Gallium preferable)
• Abscess

A WBC study involves removing some of the patients blood and labelling it with Technetium99m, which will take 1 hour. This labelled blood is then reinjected into the patient and will be imaged 3 hours later once the labelled WBC’s have migrated to the area of interest.

Preparation: Nil.

Scan: Take blood—5 min

Reinject blood after 1 hour—5 min

3 hour scan: 45 minutes.

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Suite 1 / 30 Main Drive, Warana 4575 Ph: (07) 5493 1649 Fax: (07) 5493 1659 Contact Us: Email: admin@lakeviewimaging.com.au