TABLE 1.

¹²³I-MIBG Cardiac Scintigraphy Provider Summary and Protocol

Indication	Contraindication and precaution	Patient preparation and education	Radiopharmaceutical, dose, and administration
Evaluation of cardiac sympathetic innervation	Known hypersensitivity to iobenguane or iobenguane sulfate	When medically feasible, withhold drugs known to interfere with uptake of ¹²³I-MIBG	¹²³I-MIBG
For diagnosis and prognosis of diseases such as congestive heart failure, myocardial infarction, diabetes mellitus, neurodegenerative disorders, cardiac transplant, differentiating various neurodegenerative diseases such as PD from MSA, dementia of Lewy body from Alzheimer disease	Risk of serious reactions in infants due to benzyl alcohol preservative: neonates and infants can experience serious and fatal adverse reactions, including “gasping syndrome” with benzyl alcohol–preserved drugs such as current commercially available ¹²³I-MIBG in the United States (AdreView)	Nursing mothers should pump and discard breast milk for 6 d after ¹²³I-MIBG administration to minimize the risk to nursing infants	Activity: Adults ≥16 y or children <16 y and ≥70 kg is 10 mCi (370 MBq) Children <16 y and <70 kg is 0.14 mCi/kg (5.2 MBq/kg) Minimum recommended activity is 1 mCi (37 MBq)
No appropriate use criteria have been developed to date for cardiac ¹²³I-MIBG scans	Severe renal impairment can cause increased radiation exposure due AdreView clearance by glomerular filtration and nondialyzable property	Patients should stop eating food containing vanillin and catecholaminelike compounds (e.g., chocolate and blue cheese) for approximately 1 wk prior	Technique of administration: Standard slow intravenous injection over 1–2 min
	Pregnancy: radioactive iodine can cross the placenta and permanently impair fetal thyroid function, causing fetal harm; do not administer to pregnant women	Pretreatment with potassium iodine given orally at least 1 h before injection of the radiopharmaceutical: Adult dose: 130 mg of potassium iodide (2 drops or 0.13 mL of saturated solution of potassium iodide) in 1 ounce = 30 mL of distilled water Pediatric Dose: ○ 1–36 mo: 42.5 mg of potassium iodate ○ 3–12 y: 85 mg of potassium iodate ○ Above 12 y old: 170 mg of potassium iodate ○ Alternative is potassium perchlorate (400 mg for adults, body weight-adjusted for children)
	Lactation: ¹²³I is present in breast milk, and there is no information on its effect on breastfed infants
	Pediatric use: safety and effectiveness have not been established in newborns <1 mo old or in any pediatric patients with congestive heart failure