Gallbladder Scan

Indications:
Evaluate:
Abdominal Pain or Discomfort (Especially After Eating and Accompanied by Nausea and Fever)
Cholecystitis
Gallbladder Inflamation
Gallbladder Functioin
Leakage from Surgical Site
Cyst
Hepatobiliary Function
Bile Leak

Detection of:
Gallbladder Perforation
Enterogastric Reflux
Bilary Atresia

Contraindications:
Pregnancy
Food Intake within 4 hours prior to exam
No CCK if diagnosed with Gall Stones
No Morphine Sulfate if Patient has Allergy
Known Common Bile Duct or Intestinal Obstruction regarding use of IV

Radiopharmaceutical information:
  • Radionuclide: Tc-99m
  • Photopeak: 140KeV
  • Radiopharmaceutical: Mebrofenin(Hepatolite) or Disofenin(Choletec)
  • Adult Dosing:
Normal Bilirubin(<2mg/dl): 5mCi
Bilirubin 2-10mg/dl: 7.5mCi

  • Pediatric dosing: 200micro Ci/Kg no less than 1mCi
  • Method of administration: IV
  • Method of Localization: Active Transport (same path as Bilirubin)
  • Physical Half-life: 6 Hours

Patient Preparation:
ID Patient and Confirm Order for Study
Take History and look for Jaundice or signs of alcohol abuse
Explain Procedure: Especally that it will be 1-4hrs and that they may have to return for 24-hour delays
Make sure they are not pregnant/breastfeeding (if breast feeding dispose of milk for 24hr)
NPO for 2-4 hours before scan
No Opiates 6 hours prior to scan

Equipment Used:
Large FOV gamma camera
Collimator used: LEGP or LEHR

Acquisition Setup:

Dynamic: Anterior
Matrix: 128x128
Time/Frame: 60 seconds/frame
Number of Frames:60-90 frames

Statics: Right Lateral and/or Left Anterior Oblique
Matrix:128x128
Total Counts or Duration:500k-1million Counts or 90-180Seconds


Whole body: Right lateral, RAO, LAO
Matrix:128x128
Scan Speed:4-6 min
Starts/Stops: 2 inches above zyphoid process/pelvis

SPECT:
180 or 90 degree configuration
Total Rotation: 180 or 360
Starting point:0 Degrees
Matrix: 128x128
Time/Azmuiths: 10 seconds
Number of Azmuiths: 30

Procedure:
Introduce yourself to the patient, confirm ID and what study they need
  • If the have been NPO for more than 24 hr you need to give them Sincalide 4 hrs prior to study, then continue
Inject with Radiopharmaceutical
Start with blood flow (1sec/frame for 60 sec)
Follow with 60min dynamic
If gallbladder is not seen inject morphine and wait 4 hours then image again
  • If allergic to morphine delay 4 hours and image again
Follow with RAO, LAO or Right Lateral for clarification if needed

Normal Uptake and Common Variants:

external image hida-scan.jpg

Liver is visualized 5-15seconds post injection
Hepatic Duct, Common Bile Duct and Gallbladder are all seen 5-20minutes post injection...but it could be up to 1hour
Cardiac Blood Pool is gone after 5-10 minutes
Intestinal activity visualized at 10-60 minutes
Liver activity appears less as gallbladder becomes more visualized over time
About 19% of people will not have Small Bowl Visualize until after 1 Hour
For Post-gallbladder Surgery there should not be pooling around liver or in abdomen


Abnormal Uptake and causes:
Acute cholecystitis: persistent gallbladder non-visualization by 3-4 hr of passive
imaging or by 30 min post morphine administration

Chronic cholecystitis: In chronic cholecystitis the gallbladder will usually be seen within
30 min of morphine administration or on 3 - 4 hr delayed images

Reduced gallbladder ejection fraction: Occurs in calcanus and acalculous biliary diseases

Biliary leak: A bile leak is present when tracer is found in a location other
than the liver, gallbladder, bile ducts, bowel or urine
Biliary atresia: Failure of tracer to enter the gut is consistent with biliary atresia

Post-cholecystectomy sphincter of Oddi dysfunction: Sphincter of Oddi
dysfunction may have the appearance of partial common bile duct obstruction
with prominent retention of radiotracer in the common bile duct

Duodenogastric bile reflux: During a hepatobiliary scan, activity may reflux
from the duodenum into the stomach

Common bile duct obstruction: Delayed biliary-to-bowel transit beyond 60
min raises the suspicion for partial common bile duct
Artifacts:
Picture1.png
Picture1.png
Acute Cholecystitis
Questions asked in Patient History:
Are you pregnant or breast feeding?
Does you or your family have a history of cancer?
When was the last time you ate?
Do you have a history of Gallbladder or Liver Disease
Have you had a fever?
Have you had nauea or vomited?
Where is your pain?
When does your pain occur....how long after eating?
What medications are you on....when was the last time you took them?
Have you had any surgery to gallbladder, liver, stomach or intestines?
Have you had any abnormal Blood results?
Have you had any recient CT, MRI, Nuclear Medicine or US scans?
Are you allergic to any medication...especially morphine?





References:

http://www.georgiahealth.edu/alliedhealth/brt/radscape/case-cck-study.html
Nuclear Medicine Technology: Procedures and Quick Reference 2nd Addition By Pete Shackett
gallbladder-help.com *For Normal Image*

http://interactive.snm.org/docs/pg_ch11_0703.pdf

Nuclear Medicine the Requisites