Ga-67 for infection

Ga-67 for infection

Indications:
  • Localization of infection such as osteomyeltitis
  • FUO (fever of unknown origin)
  • chronic inflammations (abscesses)
  • Sarcoidosis
  • TB (tuberculosis)
  • Pericardial inflammation
  • Evaluation of pulmonary disorders.
  • Myocardial inflammation
  • Detection and follow-up of retroperitoneal fibrosis
  • severe leukopenia
  • idiopathic pulmonary fibrosis
  • pulmonary drug reactions
  • pneumocystis carinii
  • malignant external otitis

Contraindications:
  • Cannot have contrast studies such as x-ray, CT, MRI with gadolinium.
  • Patients having another nuclear medicine study during the time period needed for the gallium scan.

Questions asked in Patient History:
  1. Do you have a history or family history of cancer? Yes? No?
    1. If so, when type and when?
  2. Have you had any infections?
  3. Do you have any pain?
    1. If so, how long and where is the pain?
  4. Are you a diabetic?
  5. Have you had any recent trauma?
  6. Have you had any surgery?
  7. Do you have a fever?
  8. Do you have any bowel disease?
  9. What medications are you on or have recently been on?
  10. Have you had any chemotherapy or radiation therapy?
  11. Have you had any previous or planned related scans, x-ray procedures, x-rays, MRI, CT, PET, antibiotic therapy, biopsies or nuclear medicine studies?
  12. Are you pregnant or nursing? (For female patients).
Radiopharmaceutical information:
  • Radionuclide: Ga-67
  • Radiopharmaceutical: Ga-67 citrate
  • Adult dosing: 3-6 mCi (111-222 MBq) for planar imaging
  • Pediatric dosing:
  • Method of administration: intravenous straight stick, Hep-Lock, or reseal catheter with saline flush, a butterfly and three-way stopcock with flush (depends on the amount of radiopharmaceutical).
  • Method of Localization: vascular permeability, binding to lactoferrin
  • Physical Half-life: 78 hours

Patient Preparation:
  • Instruct patient to return for images at designated hours from injection depending on the purpose of the dianosis. (Example: 6, 24, 48, 72, 96 or 120 hours)
  • Sometimes patients are advised to take laxatives and enemas to facilitate a rapid bowel clearance.

Side Effects:

Will the patient feel any different during or after the procedure?

Equipment Used:
Type of Camera or Probe: Large field of view gamma camera
Collimator used: Medium to high energy, parallel hole

Acquisition Setup:
Photopeak(s): 93, 185, 300 keV
Window(s): 20%

Dynamic: View(s)
Matrix:
Time/Frame:
Number of Frames:

Statics: View(s)
Matrix:
Total Counts or Duration: 1000000 counts/image

Whole body: View(s)
Matrix:
Scan Speed: 10cm/min
Start/stop points:

SPECT:
circular or non circular orbit
Total Rotation: 360
Starting point:
Matrix:
Time/Azmuiths: 20-25 sec/stop
Number of Azmuiths: 64 stops

Processing:


Filter:
Cut-off:
Frequency:


Procedure:
Describe the procedure from verifying the requisition to completing the scan. Include any patient instructions pre- or post- injection/scan, delays between injection and imaging, and any side effects.

  1. Patient preparation with laxatives and enemas has been recommended to facilitate more rapid bowel clearance.
  2. Inject patient with 6-8 mCi Ga-67 citrate intravenously.
  3. Patient will return for 24, 48, 72, and/or 96 hour delayed images.
  4. 24 hour images (optional): site of suspected infection if early intervention considered; abdominal images may be helpful for interpreting activity seen at 48 hours.
  5. 48 hour images: whole body imaging, including head and extremities, unless the site of suspected infection is limited to one site, e.g., hip prosthesis
  6. Delayed 72 to 96 hour images of abdomen as indicated to differentiate intra-abdominal infection from normal bowel clearance; laxatives or enemas as needed
  7. SPECT of the abdomen, pelvis, or chest as indicated.


Normal Uptake and common varients:
Insert an image of a normal scan. Describe the normal uptake, and any normal varients visualized.

This image shows four different patients with uptake varying in normal distribution.
external image F1.medium.gif

All four images were obtained 72 hours after injection. Patient A shows mild orbital activity with faint bowel uptake. Patient B demonstrates breast uptake that is prominent but still normal. Patient C is showing intense uptake of the midline from the mediastinum into the upper abdomen, a finding that represents a normally healing surgical incision. On a gallium image obtained in a child, patient D, bone marrow uptake is prominent with relatively less soft-tissue activity. The gastric uptake (arrows) is another normal variant, in the left upper quadrant.

Abnormal Uptake and causes:
Insert an image of an abnormal scan. Describe the abnormal uptake, and the cause of the abnormal uptake.
galium_abnormal.png
This is an abnormal image, which shows increased uptake of the radiopharmaceutical in the area of the eyes and nasal cavity. This abnormal uptake was due to an infection- polychondritis.
Artifacts:
Insert an image with an artifact, and explain what the artifact is.

external image ga001ga162.gif
The artifact in this image is lung uptake due to previous chemotherapy.

References:
http://gamma.wustl.edu/ga001te162.html
http://radiographics.rsna.com/content/20/6/1649/F1.expansion.html