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Information for GPs

Making a Nuclear Medicine Referral

Each Nuclear Medicine referral form must be filled in correctly and must fulfil all of our requirements before we can accept it.

Each referral is reviewed and then authorised by a member of our team in accordance with ARSAC (Administration of Radioactive Substances Advisory Committee) protocols and following IRMER (Ionising Radiations (Medical Exposure) Regulations) guidelines.

Therefore, please ensure all referrals contain:

  • The patient’s full name, address and date of birth

  • The doctor’s ‘wet’ signature and a clearly legible name and date

  • The doctor’s contact details

  • The name of the patient’s consultant if available

  • The test which is being requested

  • Clinical history of why the test has been  requested

  • The required outcome of the test, ie. question to be answered by the test

  • Any additional information such as mobility, infection status and urgency

All referrals should be sent to:

Nuclear Medicine Department

Glenfield Hospital

Groby Road Leicester

LE3 9QP

 

We aim to see all patients within three weeks of receiving the request. Tests will be reported on by a consultant radiologist or other suitably qualified member of our team. Results should be available within two weeks of the test being performed.

Tests Available at University Hospitals Leicester

Tumour Imaging

  • 67Ga gallium citrate - to investigate the extent of sarcoidosis, fibrosing alveolitis and lymphoma

  • 123I MIBG - performed on patients with known/suspected neuroendocrine tumours to find out extent of disease. Also used to predict patient’s response to 131I MIBG therapy

  • 111In pentetreotide Octreoscan * - performed on patients with neuroendocrine tumours with somatostatin receptors to find the primary/extent of the disease. Can also predict patient’s response to peptide receptor radionuclide therapy

  • 99mTcO4- hepatic haemangioma

Infection / Inflammation Imaging

  • 111In White cell scan - uses in vitro labelled leucocytes to look for sites of infection or inflammation in patients with renal impairment or suspected kidney involvement

  • 99mTc exametazime White cell scan - uses in vitro labelled leucocytes to look for sites of infection or inflammation. Commonly used for investigating inflammatory bowel disease and pyrexia of unknown origin

  • 99mTc sulesomab Leukoscan - to look for sites of infection or inflammation in patients with osteomyelitis

Other

  • 99mTcO4- lacrimal drainage - is used to evaluate tear duct drainage

  • 99mTc nanocolloid lymphoscintigraphy - to investigate the lymphatic drainage in arms or legs to diagnose lymphoedema

  • 51Cr red cell mass - uses labelled red cells to investigate polycythemia

  • 51Cr red cell survival with or without surface counts - uses labelled red cells to investigate red cell survival

Skeletal Imaging

  • 99mTc HDP SPECT bone scan - obtains 3D images of the site of interest. Commonly used for temporomandibular joint hyperplasia. Can also be used for vertebral fracture and avascular hip joints

  • 99mTc HDP planar bone - will show any areas of osteoblastic bone activity. Most commonly used for determining areas of fracture or metastatic activity. Can also be used to locate primary bone tumours, osteomyelitis, Paget’s disease, investigate arthritis, etc

  • 99mTc HDP 3-phase bone - shows blood flow and uptake to provide information on the vascularity of a lesion. Useful in differentiating between loosening and infection for prosthetic joints

Urinary System Imaging

  • 99mTc DMSA - enables relative function to be estimated, identification of cortical scarring, and functioning ectopic renal tissue to be identified

  • 99mTc DTPA renography with or without frusemide - is most frequently used to assess renal function and excretion in suspected upper urinary tract obstruction. Can be followed by a cystogram to assess reflux of urine from the bladder to the kidneys. Captopril can be used and aids in the diagnosis of renal artery stenosis

  • 99mTc MAG3 renography with or without frusemide - is most frequently used to assess renal function and excretion in suspected upper urinary tract obstruction. Can be followed by a cystogram to assess reflux of urine from the bladder to the kidneys. Captopril can be used and aids in the diagnosis of renal artery stenosis

  • 51Cr EDTA GFR - used to assess glomerular filtration rate. Most commonly used in chemotherapy patients and potential live donors to assess kidney function

Lung Imaging

  • 99mTc MAA lung perfusion - used to identify areas of lung tissue with reduced blood flow. Performed to look for pulmonary emboli or before lung volume reduction surgery

  • 99mTc human albumin microspheres - lung perfusion

  • 99mTc DTPA lung ventilation - records the distribution of an inhaled radioactive aerosol within the lungs (usually done in conjunction with a lung perfusion scan)

  • 99mTc colloid paediatric aspiration

Endocrine Imaging

  • 123I iodine thyroid imaging - commonly used to assess nodular disease, enlargement of the thyroid gland and the cause of thyrotoxicosis

  • 99mTcO4-  thyroid imaging - commonly used to assess nodular disease, enlargement of the thyroid gland and the cause of thyrotoxicosis

  • 99mTc sestaMIBI parathyroid imaging - used to look for parathyroid adenoma and to investigate hyperparathyroidism

Cardiac Imaging

  • 99mTc tetrofosmin/sestaMIBI SPECT cardiac - 2 day protocol to provide information on myocardial viability, inducible perfusion abnormalities and global and regional myocardial function

  • 99mTcO4- MUGA scan - uses in vivo stannous labelled erythrocytes to assess left ventricular ejection fraction (LVEF) and wall motion

Brain Imaging

  • 123I ioflupane DatScan * - used to differentiate between Parkinsonian syndromes and other types of tremor

  • 99mTc exametazime SPECT brain scan - used to demonstrate regional perfusion abnormalities. Usually used for investigating dementia and memory disorders, or epilepsy

Haematological Imaging

  • 111In platelet scan - uses in vitro labelled platelets for localising residual spleen tissue, to look for sites for endothelial damage or atherosclerotic plaques, or investigate platelet survival

  • 99mTcO4spleen - uses in vitro labelled denatured erthrocytes for imaging the spleen

  • 99mTc IDA with fatty meal - to investigate functional biliary system using a stimulus to measure gall bladder contraction or biliary reflux

  • 99mTc IDA - for differentiating neonatal hepatitis and paediatric biliary atresia. Also for looking at bile reflux, jaundice, neonatal hepatitis and acute cholecystitis

Gastrointestinal Imaging

  • 111In colonic transit - uses a resin bead capsule to investigate colonic transit

  • 111In indium chloride (solid) and 99mTc DTPA (liquid) gastric emptying - to investigate delayed or rapid gastric emptying in cases of unexplained vomiting or regurgitation, bloating, fullness, nausea, pain or drowsiness

  • 99mTc O4- meckels - to look for meckels diverticulum (ectopic gastric mucosa in the gastrointestinal tract) in patients under 40 years old with unexplained abdominal pain or GI bleeding

  • 99mTc colloid oesophageal transit - for patients who have difficulty swallowing, and assessment of transit in Achalasia before and after surgery

  • 99mTcO4- GI Bleed - uses in vivo stannous labelled erythrocytes to investigate gastrointestinal bleeding. The patient must be actively bleeding at a rate of at least 2ml/min for it to be detected

  • 99mTc O4 - salivary glands

  • 99mTc colloid paediatric swallow and reflux scan

  • 75Se SeHCAT - for investigating unexplained diarrhoea and bile salt malabsorption

*Some of the radiopharmaceuticals listed are expensive and funding may need to be agreed before the procedure can be arranged.