Genitourinary System

Assess renal function and urodynamics

Dehydration

Diuretics

Well hydrated-orally or intravenously

Patient to void their bladder before imaging

Start IV

Dose: 10-20mCi

Method of Administration: Intravenously

-Excreted by tubular secretion -Rapid Plasma Clearance -Measures Effective Renal Plasma Flow (ERPF)

Dose: 10-20mCi

Method of Administration: Intravenously

-Glomerular filtration agent
-Measures Glomerular Filtration Rate

-Single or dual head gamma camera
-Full field view for adults
-Zoom field of view for pediatrics
-Low energy all purpose (LEAP) collimator

Patient Position: SUPINE with kidneys and bladder in field of view.
Dose is used to measure that xiphoid process, pelvis/bladder and sides of body are with in field of view

Procedure

FLOW: Bolus Injection, 3 sec/frame for 1 min

Function: Dynamic acquisition- 1 minute per frame for 30 minutes.

Post Void: Posterior Static acquisition- 2 minutes

Processing

Region of interests (ROIs) are drawn around each kidney. Also, background regions are drawn (be careful to draw within body not outside the body), and also an aorta ROI is drawn around the aorta.

Renogram (time activity curve)

Diagnose or exclude urinary tract obstruction

Dehydration

Diuretics

Well hydrated

Patient to void their bladder before imaging

Serum creatine obtained

Start IV

Dose: 10-15mCi

Method of Administration: Intravenously

-Excreted by tubular secretion -Rapid Plasma Clearance -Measures Effective Renal Plasma Flow (ERPF)

Dose: 10-15mCi

Method of Administration: Intravenously

-Glomerular filtration agent
-Measures Glomerular Filtration Rate

Adult Dose: 40mg IV injection

Pediatrics: 1mg/kg max dose of 40mg

Given 20-30 minutes post radiopharmaceutical

-Single or dual head gamma camera
-Full field view for adults
-Zoom field of view for pediatrics
-Low energy all purpose (LEAP) collimator

Patient Position: SUPINE with kidneys and bladder in field of view.
Dose is used to measure that xiphoid process, pelvis/bladder and sides of body are with in field of view

Procedure

FLOW: Bolus Injection, 3 sec/frame for 1 min

Function: Dynamic acquisition- 1 minute per frame for 30 minutes.

Diuretic: 40mg of Furosemide, injected slowly in IV at 20-30 minutes

Continue Dynamic acquisition for 20-30 minutes post furosemide injection

Post Void: Posterior Static acquisition- 2 minutes

Processing

Region of interests (ROIs) are drawn around each kidney. Also, background regions are drawn (be careful to draw within body not outside the body), and also an aorta ROI is drawn around the aorta.

Renogram (time activity curve)

Determination of renal vascular retention

Dehydration

diuretics, ACE inhibitors

Well hydrated

Patient to void before imaging

NPO 4 to 6 hours prior to study

Discontinue diuretics, ACE inhibitors, A2 receptors blockers- 4 DAYS PRIOR TO STUDY

Dose: 10-15mCi

Method of Administration: Intravenously

-Excreted by tubular secretion -Rapid Plasma Clearance -Measures Effective Renal Plasma Flow (ERPF)

Dose: 10-15mCi

Method of Administration: Intravenously

-Glomerular filtration agent
-Measures Glomerular Filtration Rate

CAPTOPRIL

25-50mg pill given orally

1 hour prior to radiopharmaceutical injection

Blood Pressure to be taken ever 15 minutes for 1 hour

ENALAPRILAT

40ug/kg in 10mL saline given over 3-5 minutes

10-15 minutes prior to radiopharmaceutical

-Single or dual head gamma camera
-Full field view for adults
-Zoom field of view for pediatrics
-Low energy all purpose (LEAP) collimator

Patient Position: SUPINE with kidneys and bladder in field of view.
Dose is used to measure that xiphoid process, pelvis/bladder and sides of body are with in field of view

Procedure

25-50mg of Captopril given 1 hour before Tc99m or 40ug/kg of Enalaprilat given 10-15 minutes prior to Tc99m

Blood Pressure taken every 15 minutes for 1 hour when given Captopril

FLOW: Bolus Injection, 3 sec/frame for 1 min

Function: Dynamic acquisition- 1 minute per frame for 30 minutes.

Post Void: Posterior Static acquisition- 2 minutes

Final blood pressure taken (must be 70% of baseline blood pressure)

A baseline renal scan needs to be performed before or after ACE scan to compare.

Detection of pyelonephritis
Differentiation of renal mass from normal variant

Pregnancy
Patient movement

-Well hydrated
-Void prior to imaging
-IV

Dose: 5mCi (adults) 50uCi/kg (children)

Method of Administration: Intravenously

-Taken up in renal cortex

Dose: 10-15mCi

Method of Administration: Intravenously

Secreted by glomerular filtration and tubular secretion

-Single or dual head gamma camera
-Full field view for adults
-Zoom field of view for pediatrics
-Low energy all purpose (LEAP) collimator
-OPTIONAL: Pinhole Collimator

Patient Position: SUPINE with kidneys in field of view

Procedure

Static Images: Posterior, RAO, LAO, RPO, LPO
-500K total counts per image
-Pinhole- 100K or 5 minutes

-Patient needs to void before imaging
-Patient to be imaged 2-4 hours after injection

Evaluation and detection of vesicoureteral reflux (VUR)

Pregnancy

-Cover imaging table with absorbent paper
-Patient to void before imaging
-Written consent for catherization
-Keep track of amount of saline from start to finish

Dose: 0.5-1.0mCi

Method of Administration: Catheter

Tracer is injected into the tubing connected to the catheter

-Single or dual head gamma camera
-Full field view for adults
-Zoom field of view for pediatrics
-Low energy all purpose (LEAP) collimator

Patient Position: SUPINE with camera posterior
or sitting with back and pelvis against camera

Procedure

-Hand 500mL bag of normal saline at least 25cm above table

Use Max Filling Formula to determine how much to fill the bladder: (age+2)x30= volume of bladder in mL

Filling Phase: Dynamic at 5 seconds for 1 minutes

Full Bladder Phase: 120 second immediate static of posterior and right/left posterior obliques

120 second immediate posterior void static image

-Patient to void before procedure
-Inject tracer mixed with saline into the tubing of the catheter
-Fill bladder to max fill limit
-Monitor P-scope carefully to view reflux, if reflux is visualized make note of amount of saline used at that time
-Image full bladder
-Deflate folley balloon and proceed to take post void images
-Record the amount of urine output
-Determine residual bladder volume

voided (ml)x Residual counts/minutes over Max counts/min-Residual counts/minutes