Scheduling Nuclear Medicine Procedures That Use SPECT Tracers
| Type of scan (referrals must be reviewed by nuclear medicine consultant) | Scans that can be booked and performed as requested (unless patient is at risk of infection) | Scans that require liaison with clinical team for canceling or rescheduling (inform patient) | Scans that must be postponed or rescheduled (inform patient and clinical team) |
| Skeletal | Bone scans in cancer patients | Scans for severe pain pre- and postprocedural orthopedic indications (if there is a question of infection, offer 18F-FDG PET/CT as alternate) | Scans for pre- and postprocedural orthopedic indications; metabolic bone disease; inflammatory arthropathy |
| Endocrine | 99mTc04 thyroid scans in patients not on antithyroid medications or if question of ectopic or neonatal hypothyroidism | 99mTc04 thyroid scans in patients on antithyroid medications; 99mTc-MIBI parathyroid scans for preoperative localization | |
| Cardiovascular (avoid exercise nuclear stress testing because of risk of droplet exposure; consider using pharmacologic stress agents; consider 1-d protocols (e.g., stress–rest) | Myocardial perfusion scans in cases of recent acute coronary syndrome (moderate- to high-risk patients) for urgent coronary revascularization; scans in patients with new or increasing chest pain; scans for preoperative assessment (moderate- to high-risk patients); MUGA scans in oncology patients (before initiation of or subsequent chemotherapy) | Myocardial perfusion scans in patients awaiting liver transplant surgery; scans in patients with stable angina requiring follow-up evaluation; cardiac amyloid DPD scans | 123I-MIBG heart scans; myocardial perfusion scans in patients awaiting renal transplant surgery; cardiac amyloid DPD scans for follow-up evaluation |
| Brain | DaTscan (123I-FP-CIT) scans | ||
| Respiratory (discuss decision to proceed with ventilation–perfusion scan with referrer before booking) | Lung perfusion scans in pregnant patients; lung shunt scans for 90Y-SIRT | Ventilation–perfusion scans in patients with pulmonary hypertension or chronic PE on treatment | Ventilation–perfusion scans if question of resolution of PE in patients receiving thromboprophylaxis |
| Gastrointestinal | Gastrointestinal-bleed Meckel scans | Gastric-emptying esophageal transit scintigraphy; gastroesophageal reflux scintigraphy; SeHCAT small-bowel or colonic transit scans | |
| Hepatobiliary | HIDA scans in patients with biliary leak | HIDA scans if question of acute cholecystitis | Liver or spleen scans; HIDA scans in patients with, for example, cystic duct syndrome or sphincter-of-Oddi dysfunction; liver SPECT in patients with hemangioma; 99mTc-denatured RBC scans |
| Genitourinary | 99mTc-DMSA scans in patients with radiotherapy to abdomen or prior renal surgery; 99mTc-MAG3 scans in patients with urinary leak or transplant rejection; testicular scans in patients with torsion | MAG3 scans if question of obstruction; DMSA scans for donor assessment | 99mTc-MAG3 scans for routine follow-up; 99mTc-DMSA scan for follow-up; captopril renogram scans |
| Infection or inflammation | Scans if question of sepsis in COVID-19–negative patients (suggest FDG PET/CT); scans if question of infection of prosthesis | ||
| Lymphatic system | Sentinel lymph node injections and scans | Lymphoscintigram scans if question of lymphedema | |
| Oncology | 111In-pentetreotide and 99mTcEDDA/HYNIC-Tyr3-Octreotide scans before PRRT | Octreotide/Tektrotyd scans in patients with NET; 123I-MIBG scans in patients with pheochromocytoma or paraganglioma | |
| Miscellaneous | GFR studies in oncology patients before initiation of or subsequent chemotherapy | Dacryoscintigraphy scans; salivary gland scintigraphy; DXA scans |
Referrals must be reviewed by nuclear medicine consultants or in multidisciplinary setting. These are examples based on consensus only, and responsibility lies with each institution or hospital to ensure its written policy adheres to that outlined by national public health guidance in its respective country and hospital.
99mTc04 = 99mTc-pertechnetate; MIBI = methoxyisobutylisonitrile; MIBG = metaiodobenzylguanidine; DPD = 3,3-diphosphono-1,2-propanodicarboxylic acid; [123I]β-CIT = [123I]2β-carboxymethoxy-3β-(4-iodo-phenyl)tropane; [123I]FP-CIT = [123I]N-ω-fluoropropyl-2β-carbome-thoxy-3β-(4-iodophenyl)nortropane; MUGA = multigated acquisition; SIRT = selective internal radiation therapy; PE = pulmonary embolism; HIDA = hepatobiliary iminodiacetic acid; SeHCAT = selenium homocholic acid taurine; GFR = glomerular filtration rate; MAG3 = mercaptoacetyltriglycine; DMSA = dimercaptosuccinic acid; PRRT = peptide receptor radionuclide therapy; NET= neuroendocrine tumor; DXA = dual-energy X-ray absorptiometry; RBC = red blood cells.