Parathyroid Scan
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The document provides an overview of the parathyroid glands' location, size, and role in hyperparathyroidism management through nuclear medicine. It outlines procedures for non-invasive identification of hyperfunctioning parathyroid tissues, including patient preparations and techniques for scintigraphy. Additionally, it emphasizes the importance of imaging protocols and includes precautions for pregnant and nursing patients.
![Washout Procedure
Static ANT/POST 20 mins after injection of Tetrofosmin
SPECT
If needed
Pinhole
Static Tetrofosmin 60 mins after inject
Pinhole
If needed
SPECT
Static Tetrofosmin delayed 2 hours after inject
SPECT
If needed
Pinhole
[Delayed 3 hours after inject if necessary]
Static
Pinhole
If needed
SPECT](https://image.slidesharecdn.com/parathyroidscan-140929214754-phpapp01/85/Parathyroid-Scan-12-320.jpg)
![Subtraction Procedure
Static ANT/POST 20 mins after injection of Tc99m
SPECT
If needed
Pinhole
Pinhole Tetrofosmin 60 mins after inject
Static
If needed
SPECT
Static Tetrofosmin delayed 2 hours after inject
SPECT
If needed
Pinhole
[Delayed 3 hours after inject if necessary]
Pinhole
Static
SPECT
If needed](https://image.slidesharecdn.com/parathyroidscan-140929214754-phpapp01/85/Parathyroid-Scan-13-320.jpg)
Parathyroid Scan
- 1. TECHNOLOGIST NUCLEAR MEDICINE DEPARTMENT SABAH WOMEN AND CHILDREN HOSPITAL
- 2. Where Are The Parathyroid Glands? Typically there are four parathyroid glands located alongside and sometimes within the thyroid gland. There are usually two parathyroid glands near the left lobe of the thyroid and two near the right lobe. They are small, oval-shaped glands each approximately 6 x 4 x 2 mm and weighing approximately 30–50 mg., (about the size of a pea).
- 3. Parathyroid Study.. Nuclear medicine has an active role in the management of patients with hyperparathyroidism by identifying the sites of excess parathyroid hormone production, that is, the localization of a probable adenoma in a patient with hyperparathyroidism. Parathyroid adenomas are found in diverse localizations alongside, behind, and within the thyroid as well as in areas somewhat distant from the thyroid such as high or low in the neck or mediastinum. For this reason, there is a significant need for a method to accurately and non invasively identify the location of excess parathyroid hormone production. It is important to include the entire chest in the imaging field in all parathyroid imaging protocols for evaluation of potential ectopic sites.
- 4. Indication Localization of hyperfunctioning parathyroid tissue (adenoma/ hyperplasia) in primary hyperparathyroidism is useful before surgery to help the surgeon localize the lesion, thus shortening the time of the procedure. Localization of hyperfunctioning parathyroid tissue in patients with persistent or recurrent disease
- 5. Contraindication Pregnant women
- 6. Precaution Discontinuation of breast feeding for nursing mothers for 24 hours after imaging.
- 7. Patient Preparation Patient might be advised by Medical Officer to discontinue usage of iodide-containing medications that can cause iodine saturation. Radiological studies with iodine-containing contrast media should be avoided 4 weeks prior to the parathyroid scintigraphy. Treatment with Carbimazole or Propylthiouracil should be with held 3 days prior to the scan. Thyroid replacement hormone should be discontinued for 2 weeks prior to scan. Whereas for secondary hyperthyroidism, active Vitamin D should be withheld for at least 1 week, native Vitamin D for 4 weeks and calcimimetics for 2 weeks prior to the scan (need to be discussed with Nuclear Medicine Specialist/Nephrologist)
- 8. Radiopharmaceutical 99mTechnetium-sestamibi adult: 18-22 mCi 99mTechnetium-tetrofosmin adult: 18-22 mCi 99mTechnetium-pertechnetate adult: 2-10 mCi Child: As per body weight (Refer to Gilday’s Chart) Technique of administration: Intravenous Injection
- 9. Protocol Washout Dual phase parathyroid scintigraphy exploits the different washout timing that some radiotracers show in thyroid and parathyroid tissues: to find parathyroid hyperfunctioning tissue, washout timing of radiotracer from the parathyroid must be slower than from thyroid tissue. Subtraction 99mTc-sestamibi is myocardial perfusion tracer and is taken up not only by the hyperfunctioning parathyroid glands but also by thyroid tissue. Hence, the necessity of comparison with a second tracer, which is taken up by the thyroid gland only, such as 99mTechnetium-pertechnetate. The distributions of the 2 tracers can be visually compared and, afterwards, the thyroid scan can be digitally subtracted from the parathyroid scan to remove the thyroid activity and enhance the visualization of parathyroid tissue.
- 10. Instrument PHILIPS Dual-head Gamma Camera Low Energy High Resolution (LEHR) collimator High Energy Low Resolution (Pinhole) collimator
- 11. Procedure Make sure the Gamma Kamera room is ready. Call Patient in the post-injection room. Explain patient about the procedure. Position the patient on the table in the supine position with a pillow positioned under the shoulders which allow the head to drop back and extends the neck. Secure the head so that it does not move from side to side. Make sure the patient is comfortable and cover the patient with blanket before starting the procedure to ensure patient is warm. Tell the patient not to move while performing the scan.
- 12. Washout Procedure Static ANT/POST 20 mins after injection of Tetrofosmin SPECT If needed Pinhole Static Tetrofosmin 60 mins after inject Pinhole If needed SPECT Static Tetrofosmin delayed 2 hours after inject SPECT If needed Pinhole [Delayed 3 hours after inject if necessary] Static Pinhole If needed SPECT
- 13. Subtraction Procedure Static ANT/POST 20 mins after injection of Tc99m SPECT If needed Pinhole Pinhole Tetrofosmin 60 mins after inject Static If needed SPECT Static Tetrofosmin delayed 2 hours after inject SPECT If needed Pinhole [Delayed 3 hours after inject if necessary] Pinhole Static SPECT If needed
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- 17. Cont.. After the completion of the scan, inform the Medical Officer in charge to review the scan images. Be ready to repeat scan or perform additional scan if ordered by the Medical Officer in charge. Assist the patient to get up and ask the patient to have rest while waiting in the post-injection room. Remind patient to take plenty of water and to keep at least 1-2 meter away from children and pregnant ladies for at least 6 hours from the time of the radiopharmaceutical injection. Inform and pass the “Penilaian Selepas Skan Radionuklid” form to the Nurse in charge at the counter or injection room regarding the patient release. Proceed to image processing by referring to the Standard Operating Procedure of Parathyroid Scan Processing.
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- 21. Preferences International Atomic Energy Agency: Nuclear Medicine Resources Manual, 2006 SNM Practice Guideline for Parathyroid Scintigraphy 4.0 2009 EANM Parathyroid Guidelines Distance Assisted Training Programme for Nuclear Medicine Technologists: Parathyroid Imaging, Version 3.1 Nuclear Medicine Technology and Techniques by Donald R. Bernier, Paul E. Chstistian, James K. Langan
- 22. Thank You